Using an Aluminum Hydroxide-Chitosan Matrix Increased the Vaccine Potential and Immune Response of Mice against Multi-Drug-Resistant Acinetobacter baumannii.

Acinetobacter baumannii is a Gram-negative, immobile, aerobic nosocomial opportunistic coccobacillus that causes pneumonia, septicemia, and urinary tract infections in immunosuppressed patients. There are no commercially available alternative antimicrobials, and multi-drug resistance is an urgent concern that requires emergency measures and new therapeutic strategies. This study evaluated a multi-drug-resistant A. baumannii whole-cell vaccine, inactivated and adsorbed on an aluminum hydroxide-chitosan (mAhC) matrix, in an A. baumannii sepsis model in immunosuppressed mice by cyclophosphamide (CY). CY-treated mice were divided into immunized, non-immunized, and adjuvant-inoculated groups. Three vaccine doses were given at 0D, 14D, and 28D, followed by a lethal dose of 4.0 × 108 CFU/mL of A. baumannii. Immunized CY-treated mice underwent a significant humoral response, with the highest IgG levels and a higher survival rate (85%); this differed from the non-immunized CY-treated mice, none of whom survived (p < 0.001), and from the adjuvant group, with 45% survival (p < 0.05). Histological data revealed the evident expansion of white spleen pulp from immunized CY-treated mice, whereas, in non-immunized and adjuvanted CY-treated mice, there was more significant organ tissue damage. Our results confirmed the proof-of-concept of the immune response and vaccine protection in a sepsis model in CY-treated mice, contributing to the advancement of new alternatives for protection against A. baumannii infections.

Inactivated alpha toxin from Clostridium novyi type B in nano-emulsion protect partially protects Swiss mice from lethal alpha toxin challenge.

Nano-emulsions are promising carriers for antigen delivery. Here, we evaluated the efficacy of a water-oil nano-emulsion containing concentrated, inactivated Clostridium novyi (C. novyi) type B supernatant culture (nano-iCnB) in protecting Swiss mice against a lethal dose of alpha toxin concentrated extract. Proteins were confirmed in the nano-iCnB and their stabilities were determined according physical parameters such as Zeta Potential (ZP). Biochemical, hematological parameters and morphological appearance of liver, spleen and thigh muscle alterations were examined to determine the safety of the compound. Partial protection against lethal doses was achieved in immunized mice despite low IgG titers. These data suggest that our nano-emulsion is a simple and efficient method of promoting antigen delivery for toxin-related diseases.

Cardiac calcium evaluation in hemodialysis patients with multisection spiral computed tomography.

AIM: The aim of this study is cardiac calcium content evaluation in hemodialysis patients by a new technique, based on ultrafast multisection CT (MTC). METHODS: The study was carried out on 30 HD patients, 14 F and 16 M, average age 57.7 +/- 13.9 years, average HD age 57.3 +/- 47.4 months. The intact PTH levels were 625.4 +/- 571 pg/mL. Serum calcium, phosphate and CaxP product were 9.75 +/- 0.84 mg/mL, 6.21 +/- 1.01 mg/dL and 60.2 +/- 10.7 mg2/dL2, respectively. RESULTS: The values obtained with the MTC technique were reported in terms of Agatson scores. Score values frankly in the pathologic range (>100) were found in 24 patients (80%). Correlation analysis has shown positive and significant correlation coefficients of the score with patients' age (p = 0.003), serum calcium (p = 0.012), CaxP (p = 0.015), iPTH (p = 0.049), and borderline, to HD age (p = 0. 06). CONCLUSION: Risk factors for cardiac calcification are mainly age, degree of hyperparathyroidism, increased CaxP and serum calcium levels. A control of calcium phosphate parameters in hemodialysis patients seems to be mandatory to avoid increased severity of coronary artery disease.

Living donor transplant: wider selection criteria.

The availability of cadaveric donor organs is insufficient for actual needs. The organ demand increases by 20% per year. Living donor transplant (LDT) may be a valid therapeutical alternative provided one uses proper criteria. LDT provides many advantages, like improved patient and organ survival, short waiting time, and the possibility to carefully plan the procedure. Potential risks include perioperative mortality and renal dysfunction in the kidney donor. At present, kidney LDTs in Italy represent 8% of the total, with an organ survival rate of 97% after 1 year (vs 93% for cadaveric transplants) and donors mortality rate of almost null. Most LDTs are performed from kinsmen. Presently, law no. 458, 26 June 1967, is in force in Italy for kidney LDT and law no. 453, 16 December 1999, for liver LDT. The foundations of LDT are, of course, the recipient's condition, the donor's motivation, and the altruism of the donation. It is desirable that in the future an increasing number of LDT be performed, supported by a careful, widespread health education regarding organ donation from living subjects and by the possibility to obtain insurance for the donor, which has been considered but never provided by actual laws.

[Selective adsorption of homocysteine using HFR-on line technique]. / Estrazione di omocisteina in corso di HFR on-line.

Homocysteine (Hcy) is grossly elevated in hemodialysis (HD) patients. Treatment with folic acid and/or vitamin B12 fails to normalize Hcy levels in the majority of patients. Treatment with various dialyzers with different flux characteristics has produced contrasting results. Hemodiafiltration reinfusion (HFR) on-line (double chamber hemodiafiltration (HDF) with regenerated ultrafiltrate reinfusion) is a novel method combining the processes of diffusion, convection and absorbance. The ultrafiltrate is regenerated through a charcoal-resin device. Our aim was to observe the effect of the HFR on-line technique on removing Hcy. We investigated the effect of this treatment on Hcy levels in 10 patients with a mean Hcy level of 57.6 micromol/L (range 24.1-119.7). We measured Hcy, folate and vitamin B12 pre- and post-dialysis and in the ultrafiltrate pre- and post-cartridge at 10, 120 and 240 min. Mean Hcy levels were 57.6 and 35.3 micromol/L (range 9.9-80.3) (p=0.005) pre- and post-dialysis, respectively, while folate and vitamin B12 were unchanged. Pre- and post-cartridge Hcy levels were 11.6 vs 2.5 (p=0.005), 9.3 vs 3.9 (p=0.005), 7.7 vs 4.6 micromol/L (p=0.012) at three time points considered, while folate and vitamin B12 were essentially undetectable. These preliminary data, which need confirmation in a long-term study, seem to indicate that HFR on-line reduces Hcy levels, not only through a possible reduction in uremic toxins, but also through the actual removal of Hcy by absorbance on the charcoal-resin cartridge.

Bidialysis: a new technique.

An increase in solute removal, a shorter dialysis session, the patient's well being and the reduction of global costs are the principal aims of the new hemodialysis methods. The simultaneous use of two hemodialyzers in hemodialysis has been experimented by other researchers. Our technique involves the use of two cuprophan hemodialyzers in sequence (double filter system: DFS), each one connected separately to fresh dialysate. Fifteen symptomatic large patients were treated with DFS and the results were compared to conventional hemodialysis (CHD). After the first hemodialyzer, modification of pH and electrolytes occurred in the plasma composition. In the second hemodialyzer, urea depuration occurred without further significant changes in hydroelectrolytic or acid-basic plasma patterns. The Kt/V increased from 1.10 to 1.29 (18%). The authors conclude that in DFS there was an advantage in urea clearance, osmolarity stability and reduction of side effects.

Annexin V binding perturbs the cardiolipin fluidity gradient in isolated mitochondria. Can it affect mitochondrial function?

The phosholipid bilayer fluidity of isolated mitochondria and phospholipid vesicles after calcium-dependent binding of annexin V was studied using EPR spectroscopy. The membranes were probed at different depths by alternatively using cardiolipin, phosphatidylcholine, or phosphatidylethanolamine spin labeled at position C-5 or C-12 or C-16 of the beta acyl chain. Computer-aided spectral titration facilitated observing and quantitating the EPR spectrum from phospholipid spin labels affected by annexin binding, and spectral mobility was calibrated by comparison with standard spectra scanned at various temperatures. In most cases it was found that binding of the protein to the membranes makes the inner bilayer more rigid up to acyl position C-12 than afterward, in agreement with the previously observed effect in SUVs [Megli, F. M., Selvaggi, M., Liemann, S., Quagliariello, E., and Huber, R. (1998) Biochemistry 37, 10540-10546]. Moreover, in isolated mitochondrial membranes, cardiolipin apparently is more readily affected than the other main phospholipids, while in vesicles made from mitochondrial phospholipids, the different species are affected in essentially the same way. This behavior is consistent with the existence of distinct cardiolipin pools in mitochondria, and with the already advanced hypothesis that these domains are the binding site for annexin V to the isolated organelles [Megli, F. M., Selvaggi, M., De Lisi, A., and Quagliariello, E. (1995) Biochim. Biophys. Acta 1236, 273-278]. Keeping in mind the funcional importance of cardiolipin in the mitochondrial membrane, the question is raised as to whether the observed influence of annexin V binding to this phospholipid and its consequent local fluidity alteration might affect the mitochondrial functionality, at least in vitro.

Hemodialysis with two sequential hemodialyzers.

BACKGROUND/AIMS: The principal aims of the new hemodialysis methods are: a short-time dialysis session, the increase of solute removal, the patient's well-being and, when possible, the reduction of global costs. Other researchers have experimented the simultaneous use of two hemodialyzers in hemodialysis. We tested a new technique which involves the use of two Cuprophan hemodialyzers in sequence (double filter system: DFS), each one connected separately to fresh dialysate. METHODS: We treated 15 large patients with DFS and compared the results with conventional hemodialysis (CHD). RESULTS: Our results showed a significant difference between CHD and DFS in the depuration values. After the first hemodialyzer, modification of pH and electrolytes occurred in the plasma composition. In the second hemodialyzer, urea depuration occurred without further significant changes in hydroelectrolytic and acid-basic plasma patterns. The Kt/V increased from 1.10 to 1.29 (18%). CONCLUSION: Our technique is conceived for the following goal: to increase the diffusion of solution without increasing costs and side effects.