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Phagocytes such as neutrophils, monocytes, and macrophages are the major cells of innate immunity. They produce high amounts of reactive oxygen species (ROS) to kill phagocytized pathogens. The enzyme responsible for ROS production is called the phagocyte nicotinamide adenine dinucleotide phosphate-oxidase (NADPH oxidase) NOX2. NOX2 is a multicomponent enzyme system built by the assembly of cytosolic proteins (p47phox, p67phox, p40phox, and rac1/2) and transmembrane proteins (p22phox and gp91phox which form cytochrome b 558 ). NOX2-derived ROS are essential for innate immunity, however, excessive ROS production induces tissue injury. Thus NADPH oxidase activation must be tightly regulated. This article describes the regulation of this enzyme complex.

Reactive oxygen species (ROS) produced by the phagocyte NADPH oxidase (NOX2) are required for microbial clearance; however, when produced in excess they exacerbate inflammatory response and injure surrounding tissues. NOX2 is a multicomponent enzyme composed of membrane-associated cytochrome b588 and cytosolic components p47

Les polynucleaires neutrophiles humains (PN) sont une des premieres barrieres de defense contre l’introduction d’un agent pathogene dans l’organisme. Ils sont un des pivots de l’immunite innee. Un des mecanismes majeurs conduisant a l’elimination de l’agent pathogene phagocyte est la production d’anions superoxyde, source d’autres formes reactives de l’oxygene (FRO). Cependant, la production par les PN de FRO de facon excessive ou dans un lieu inapproprie est susceptible de participer a l’induction de lesions tissulaires dans certaines maladies inflammatoires aigues ou chroniques. Ceci souligne la necessite d’une regulation fine et precise de cette production. Les FRO sont produites par un systeme multimoleculaire complexe, la NADPH oxydase dont l’activation et la regulation de cette activation dependent de differents stimuli, de mediateurs de l’inflammation, de l’expression de leurs recepteurs par les PN, des signaux transductionnels qui regulent l’assemblage des differents composants et la formation d’une enzyme fonctionnellement active. Parmi les acteurs de cette regulation certaines cytokines presentes au niveau du foyer inflammatoire jouent un role majeur par differents mecanismes. Il peut s’agir d’un mecanisme de “priming” ou amorcage qui correspond au fait qu’un pretraitement par un agoniste augmente la reponse a un deuxieme stimulus applique ulterieurement ; c’est notamment le cas du TNF, du GM-CSF et de l’IL-8. Les mecanismes en sont encore discutes. La resolution de l’inflammation necessite une desactivation du systeme oxydasique. Les phenomenes de desensibilisation par les cytokines peuvent participer a ce phenomene. Une meilleure comprehension de ces phenomenes regulateurs est un prealable au developpement de nouveaux agents pharmacologiques notamment dans les maladies inflammatoires.

Summary. Background: In sepsis, extracellular ATP, secreted by activated platelets and leukocytes, may contribute to the crosstalk between hemostasis and inflammation. Previously, we showed that, in addition to their role in platelet activation, ATP-gated P2X1 ion channels are involved in promoting neutrophil chemotaxis. Objectives: To elucidate the contribution of P2X1 ion channels to sepsis and the associated disturbance of hemostasis. Methods: We used P2X1−/− mice in a model of lipopolysaccharide (LPS)-induced sepsis. Hemostasis and inflammation parameters were analyzed together with outcome. Mechanisms were further studied ex vivo with mouse and human blood or isolated neutrophils and monocytes. Results: P2X1−/− mice were more susceptible to LPS-induced shock than wild-type mice, despite normal cytokine production. Plasma levels of thrombin–antithrombin complexes were higher, thrombocytopenia was worsened, and whole blood coagulation time was markedly reduced, pointing to aggravated hemostasis disturbance in the absence of P2X1. However, whole blood platelet aggregation occurred normally, and P2X1−/− macrophages displayed normal levels of total tissue factor activity. We found that P2X1−/− neutrophils produced higher amounts of reactive oxygen species. Increased amounts of myeloperoxidase were released in the blood of LPS-treated P2X1−/− mice, and circulating neutrophils and monocytes expressed higher levels of CD11b. Neutrophil accumulation in the lungs was also significantly augmented, as was lipid peroxidation in the liver. Desensitization of P2X1 ion channels led to increased activation of human neutrophils and enhanced formation of platelet–leukocyte aggregates. Conclusions: P2X1 ion channels play a protective role in endotoxemia by negatively regulating systemic neutrophil activation, thereby limiting the oxidative response, coagulation, and organ damage.

The respiratory burst oxidase catalyzes the production of O2.- from oxygen and NADPH. It is dormant in resting cells but becomes active when the cells are stimulated. Activation is accompanied by the phosphorylation of multiple serines in the cytosolic oxidase component p47phox, which moves from cytosol to the membrane during oxidase activation. Using immunopurified p47phox isolated from 32Pi-loaded neutrophils activated with phorbol myristate acetate, we showed that all the 32P was in the C-terminal CNBr fragment of the protein, and that in that fragment, Ser-303, Ser-304, Ser-320, Ser-328, Ser-345, and Ser-348 and at least one of the three serines, Ser-359, Ser-370, and Ser-379, were phosphorylated, while Ser-282, Ser-287, Ser-381, and Ser-388 were not. Of the phosphorylated serines, Ser-303, Ser-304, Ser-320, and Ser-328 are located in protein kinase C substrate sequences. Ser-345 and Ser-348, however, are located in sequences recognized by mitogen-activated protein (MAP) kinase (-PXSP-). This finding suggests that MAP kinase or a related proline-directed kinase may participate in the regulation of O2.- production by activated neutrophils. The tryptic peptide map of p47phox phosphopeptides from neutrophils activated by N-formyl-methionyl-leucyl-phenylalanine closely resembled that of p47phox phosphopeptides from phorbol-activated cells, suggesting that the same serines were phosphorylated in response to each agent.

Cefdinir, a new oral 2-amino-5-thiazolyl cephalosporin, inhibited the luminol-amplified chemiluminescence (LACL) response of human neutrophils stimulated by PMA but not opsonized zymosan, in a concentration-dependent but not time-dependent manner. The LACL response to opsonized zymosan in cytochalasin B-treated neutrophils was, however, inhibited by cefdinir. Various cephalosporins, regardless of the presence of a 2-amino-5-thiazolyl moiety, did not significantly alter the neutrophil LACL response triggered by PMA and zymosan. The LACL response induced by the calcium ionophore A23187 and FMLP was also impaired by cefdinir, and this impairment was increased in cytochalasin B-treated neutrophils. Superoxide anion generation by neutrophils, measured in terms of lucigenin-amplified chemiluminescence and cytochrome c reduction, was not altered. Spontaneous and FMLP-induced neutrophil degranulation, assessed by lysozyme and beta-glucuronidase release, were not modified by cefdinir. Furthermore, cefdinir inhibited LACL generation in cell-free systems consisting of H2O2, NaI, and either horseradish peroxidase or a myeloperoxidase-containing neutrophil extract. Orthodianisidine oxidation in these two acellular systems was inhibited by cefdinir. Cefdinir did not alter neutrophil bacterial killing at concentrations that inhibited myeloperoxidase-containing neutrophil extract-dependent reactions induced by soluble stimuli. Taken together, these data strongly suggest that cefdinir directly inhibits the activity of myeloperoxidase-containing neutrophil extract released into the extracellular medium during neutrophil stimulation by soluble mediators, but has no effect on that released into the phagolysosome during phagocytosis. This unusual property of a member of the beta-lactam family could be of interest in modulating the exaggerated inflammatory process often associated with infectious diseases.

The respiratory burst oxidase is responsible for O2- production in stimulated neutrophils and B lymphocytes. Components of this oxidase include cytochrome b558, a membrane-bound flavohemoprotein; the cytosolic polypeptides p47phox and p67phox; and one or more small G proteins including Rac1, Rac2, and/or Rap1A. We found that when normal neutrophils were activated, small percentages of each of the cytosolic proteins p47phox, p67phox, and Rac2 were transferred to the membrane cytoskeleton. However, Rac2 was not transferred to the membrane during activation of p47phox-deficient neutrophils. In normal cells, some p47phox also became associated with the non-cytoskeletal portion of the plasma membrane, but p67phox, Rac2, and O(2-)-forming activity were restricted to the cytoskeleton. Neutrophil activation also causes the phosphorylation of multiple serines in p47phox. The most heavily phosphorylated forms of p47phox were found solely in the membrane cytoskeleton. These results suggest that 1) the membrane cytoskeleton participates in respiratory burst oxidase activation, 2) the fully phosphorylated p47phox is located in the active oxidase, which resides in the membrane cytoskeleton, and 3) Rac2 acts like a dedicated component of the respiratory burst oxidase.

The antimalarial drug quinine has been shown to impair human polymorphonuclear leukocyte (PMN) functions. To gain insight into the mechanism of this phenomenon, we investigated quinine uptake by PMN with a fluorometric assay based on the fluorescence properties of this drug. After 30 min of incubation at 37 degrees C in the presence of 1 and 10 micrograms of quinine per ml, PMN-associated quinine reached 90 +/- 6 and 780 +/- 150 ng/2.5 x 10(6) PMN, respectively, giving a cellular-to-extracellular concentration ratio of 140 to 150. A steady state was reached within 5 min. Uptake was partially dependent on temperature, cell viability, and extracellular pH. Fractionation studies showed that 30 to 40% of the PMN-associated quinine was located in the particulate fraction. The efflux of PMN-associated quinine was rapid and complete when the incubation mixture was replaced by drug-free medium. These data suggest that several mechanisms are involved in the uptake of quinine by PMN, including a viability- and energy-independent process possibly related to reversible association of quinine to cell structures (particularly the membrane). Other mechanisms could involve trapping by protonation and/or active PMN transport systems. Thus, most of the quinine taken up by resting PMN is found in the soluble fraction of disrupted cells. This may partly explain the depressive properties of quinine.

We have previously observed that the antimalarial drug amodiaquine impairs the human polymorphonuclear neutrophil (PMN) oxidative burst in vitro. However, the drug acted at a concentration of 100 micrograms/ml, far higher than that which is achievable therapeutically. Since amodiaquine is extensively metabolized into monodesethyl amodiaquine, we investigated whether the metabolite modified PMN functions at lower concentrations than amodiaquine does. Monodesethyl amodiaquine strongly depressed PMN chemotaxis and phagocytosis at concentrations as low as 10 micrograms/ml. This inhibition was reversed by washing out the drug. The PMN oxidative burst was markedly depressed by monodesethyl amodiaquine, whatever the assay technique (luminol-amplified chemiluminescence, lucigenin-amplified chemiluminescence, myeloperoxidase activity) or stimulus used (opsonized zymosan, phorbol myristate acetate, formylmethionyl leucyl phenylalanine). There were extreme interindividual variations in sensitivity to the depressive effect of monodesethyl amodiaquine when the PMN oxidative burst was assayed in terms of luminol-amplified chemiluminescence or lucigenin-amplified chemiluminescence. PMN samples were divided into two groups on the basis of the MIC of the drug: 60% of the samples were "highly sensitive," being strongly inhibited at concentrations as low as 0.1 micrograms/ml (obtained during therapy), whereas the "moderately sensitive" samples were inhibited at concentrations of 10 micrograms/ml and above. The difference between the two groups was highly significant. This PMN sensitivity to the inhibitory effect of the drug was not related to intrinsic oxidative metabolism. Our data indicate that monodesethyl amodiaquine, the main metabolite of amodiaquine, has a far stronger inhibitory effect on various PMN functions in vitro than the parent drug, warranting relevant in vivo studies.

Cystic fibrosis (CF), is the most common life-shortening autosomal recessive disorder in Caucasians. It is caused by mutations in a single gene on the long arm of chromosome 7 that encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein. CF is characterized by abnormal Na+ and Cl- ion transport in several tissues, including the lungs, pancreas, gastrointestinal tract, liver, sweat glands, and male reproductive system. Progressive pulmonary disease is the dominant clinical feature of CF and accounts for morbidity and mortality. The inflammation characterized by an overabundance of activated neutrophils and macrophages on the respiratory epithelial surface is associated to a high production of reactive oxygen species (ROS) which contribute to the pathogenesis of cystic fibrosis. ROS could have different origins but the role of the NADPH oxidase system is essential. The "NADPH oxidases" (NOX/DUOX) family is an enzymatic complex formed by cytosolic and membrane subunits. Until now several homologues of the phagocytic NADPH oxidase have been identified in different tissues and it has been shown that the lungs preferentially expressed DUOX1-2. Thus, DUOX1-2 could be implicated in the anti-infectious defense system. The role of DUOX enzymes as a source of ROS in cystic fibrosis is examined as they could contribute to a better understanding of molecular mechanisms in CF. Moreover they could be a potential target for a new therapeutic approach.

Josamycin and erythromycin have been compared for their in-vitro interaction with bactericidal killing by human neutrophils. The mechanism of this interaction was studied in two ways. First, the target organisms (Staphylococcus aureus and Pseudomonas aeruginosa) were incubated for 60 min with josamycin, erythromycin or control buffer prior to use in a human polymorphonuclear neutrophil (PMN) killing assay. Second the macrolides were added directly to acellular killing systems mimicking those acting inside the phagolysosome; oxygen-independent systems were obtained from a crude granule extract of PMN and oxygen-dependent systems consisted either of a mixture of xanthine plus xanthine oxidase or of a solution of H2O2. Whereas josamycin-pretreated P. aeruginosa were twice as sensitive to killing by PMN than were control cells, this was not the case for S. aureus. Both oxidant generating systems were more effective in destroying S. aureus in the presence of josamycin (3 and 30 mg/l). Erythromycin showed a similar synergy but only with the xanthine plus xanthine oxidase system. This synergy was observed with neither of the O2-independent systems for S. aureus, nor with any acellular system for P. aeruginosa. These data suggest that at least two kinds of mechanism may explain the bactericidal synergy observed between macrolides and PMN. The first (for macrolide-resistant species such as P. aeruginosa) could be due to alterations in the bacteria by the antibiotics, while the second (for macrolide-sensitive species such as S. aureus) could be based upon an as yet unexplained transformation of the molecules by reactive oxygen species into more "toxic" forms. These differences between josamycin and erythromycin could arise from differences in their chemical structure.

Human polymorphonuclear neutrophils play a key role in host defenses against invading microorganisms. In response to a variety of stimuli, neutrophils release large quantities of superoxide anion (O2.-) in a phenomenon known as the respiratory burst. O2.- is the precursor of potent oxidants, which are essential for bacterial killing and also potentiate inflammatory reactions. Regulation of this production is therefore critical to kill pathogens without inducing tissue injury. Neutrophil production of O2.- is dependent on the respiratory burst oxidase, or NADPH oxidase, a multicomponent enzyme system that catalyzes NADPH-dependent reduction of oxygen to O2.-. NADPH oxidase is activated and regulated by various neutrophil stimuli at infectious or inflammatory sites. Proinflammatory cytokines such as GM-CSF, TNF and IL-8 modulate NADPH oxidase activity through a priming phenomenon. These cytokines induce a very weak oxidative response by PMN but strongly enhance neutrophil release of reactive oxygen species on exposure to a secondary applied stimulus such as bacterial N-formyl peptides. Priming phenomena are involved in normal innate immune defense and in some inflammatory diseases. The mechanisms underlying the priming process are poorly understood, although some studies have suggested that priming with various agonists is regulated at the receptor and post-receptor levels. Resolution of inflammation involves desensitization phenomena and cytokines are involved in this process by various mechanisms. A better understanding of phenomena involved in the regulation of NADPH oxidase could help to develop novel therapeutic agents for inflammatory diseases involving abnormal neutrophil superoxide production.

The most frequent form of chronic granulomatous disease (CGD) is caused by inactivation of the CYBB gene, which encodes the gp91-phox subunit of phagocyte NADPH oxidase. This defect prevents phagocytes from producing reactive oxygen species and thus from eradicating bacterial and fungal infections. We investigated 16 unrelated male patients with suspected X-linked CGD and gp91-phox deficiency. A mutation was found in the CYBB gene of all 16 patients, and 11 of these mutations were novel. Eleven patients (69%) had a point mutation (84GA in two unrelated patients, and 177CG, 217CT, 388CT, 676CT, 691CT, 868CT, 919AC, 1384GT and T1514G in one case each, yielding W28X, C59W, R73X, R130X, R226X, Q231X, R290X, T307P, E462X, L505R gp-91phox). One patient had an in-frame deletion removing two amino acids (R54 and A55). Finally, insertions or duplications were found in four patients (from +1 to +31 bases). Overall, 12 (75%) of the mutations led to the production of a truncated protein. No clear correlation was found between clinical manifestations and genomic/biochemical alterations. Thirteen mothers could be tested, and all were carriers. Hum Mutat 18:163, 2001.

Background Superoxide production by polymorphonuclear neutrophil (PMN) participates in the rheumatoid joint lesions and mainly depends on NADPH oxidase activation. Tumour necrosis factor (TNF), interleukin-8 (IL-8) and granulocyte/macrophage colony stimulating factor (GM-CSF) have a priming effect on NADPH oxidase, depending on the phosphorylation of p47phox, a major cytosolic component of NADPH oxidase. Objectives We sought to determine if the status (primed/activated) of NADPH oxidase of articular PMN was correlated with rheumatic disease activity and TNF, IL-8 and GM-CSF synovial concentrations. Methods Knee joint fluid aspiration was performed in 17 patients, 11 with RA and 6 with spondyloarthropathy (SpA). Usual clinical and biological data were recorded for each patient, allowing a DAS28 scoring. NADPH oxidase activity was analysed with cytochrome c reduction technique. Phosphorylation of p47phox was evaluated with isoelectrofocusing and immunoblotting using a specific antibody. Cytokines concentrations were measured with ELISA kits. Results NADPH oxidase activity was increased in the majority of RA knee joints, and to a lesser extent in the SpA group. In the RA group, the NADPH oxidase activity was correlated positively with DAS28, with the PMN count in the synovial fluid, with the degree of p47phox phosphorylation, and with the synovial concentrations of TNF and IL-8. Concentrations of GM-CSF remained very low or undetectable in all patients. In the RA group only, the DAS28, the PMN count and the phosphorylation of p47phox were correlated with synovial concentrations of TNF and IL-8. Conclusion NADPH oxidase activation, through an increased phosphorylation of p47phox, seems to be implicated in joint inflammation during RA. This phenomenon could be related to high level of TNF and IL-8.

NADPH oxidase is an O-generating enzyme found in phagocytes such as neutrophils. It is composed of a membrane-bound cytochrome b, the cytosolic proteins p67phox, p47phox, p40phox, and the G-protein p21rac. The system is dormant in resting cells but acquires catalytic activity on exposure to appropriate stimuli. Cytochrome b, p67phox, p47phox, and rac2 associate with the cytoskeleton and membrane skeleton of activated neutrophils. It is not known whether p40phox associates with the cytoskeleton. The purpose of this study was to analyze the subcellular distribution of p40phox. When resting neutrophils were lysed in Triton X-100 or octyl glucoside buffer and separated into detergent-soluble and detergent-insoluble fractions, p40phox and p67phox were mainly associated with the detergent-insoluble fraction (defined as the cytoskeleton), whereas p47phox was mainly found in the soluble fraction. Neutrophil activation by phorbol myristate acetate (PMA) induced p47phox translocation to the cytoskeleton but did not affect the distribution of p40phox or p67phox. Using immunofluorescence confocal microscopy, we found that p40phox colocalized with filamentous actin. In neutrophils from a p67phox-deficient patient with detectable p40phox, p40phox associated with the cytoskeleton only after activation by PMA. A complex containing the three proteins was isolated from the cytoskeleton of activated neutrophils. When activated membranes were treated with Triton X-100 buffer, p40phox, p47phox, and p67phox were found in the membrane skeleton enriched in NADPH-oxidase activity; some p40phox and p47phox was found in the soluble membrane fraction, but no p67phox was detected. These findings show that p40phox, like p67phox and p47phox, binds to the cytoskeleton and membrane skeleton. In addition, p40phox can dissociate from p67phox in activated membranes. J. Leukoc. Biol. 66: 1014–1020; 1999.

The respiratory burst oxidase is responsible for superoxide (O2) production by phagocytes and B lymphocytes. This multicomponent enzyme is dormant in resting cells but is activated on exposure of the cells to an appropriate stimulus. Upon activation, several serine residues on the cytosolic oxidase subunit p47phox become phosphorylated. Using two-dimensional tryptic phosphopeptide mapping, we studied the phosphorylation of p47phox in 32Pi-loaded Epstein-Barr virus-transformed B lymphoblasts expressing wild type p47phox or any of several P47phox Ser -Ala mutants. We were able to identify the labeled peptides from wild type p47phox as those contain- ing Ser303/304 Ser315, Ser320, Ser328 and/or Ser359/370, and Ser345/348 ; no 32P-labeled Ser310-containing peptide was found. When purified p47phox, was phosphorylated in vitro by various protein kinases, varying phosphopeptide patterns were observed. Protein kinase C phosphorylated all the peptides except the one containing Ser345/348; protein kinase A phosphorylated the peptide containing Ser320 and one or both of the peptides containing Ser328 and Ser359/370; while mitogen-activated protein kinase phophorylated only the peptide containing Ser345/348. These findings suggest that these three kinases play distinct roles in the activation of the respiratory burst oxidase, each of them catalyzing the phosphorylation of a different group of serines in p47phox.

The respiratory burst oxidase of phagocytes and B lymphocytes catalyzes the reduction of oxygen to O2- at the expense of NADPH. Dormant in resting cells, the oxidase is activated by exposing the cells to appropriate stimuli. During activation, p47phox, a cytosolic oxidase subunit, becomes extensively phosphorylated on a number of serines located between S303 and S379. To determine whether this phosphorylation is necessary for oxidase activation, we examined phorbol-elicited oxidase activity in EBV-transformed B lymphoblasts deficient in p47phox after transfection with plasmids expressing various S-->A mutants of p47phox. The mutant containing S-->A mutations involving all serines between S303 and S379 [S(303-379)A] was not phosphorylated, did not translocate to plasma membrane during activation and was almost devoid of function. As to individual serines, S379 was of special interest because (a) p47 phox S379 was phosphorylated in phorbol-activated lymphoblasts expressing wild-type p47phox, and (b) p47phox S379A failed to translocate to the membrane, and was as functionless as p47phox S(303-379)A; other single S-->A mutations had little effect on oxidase activity. These findings suggest that the phosphorylation of S379 may be important for oxidase activation in whole cells.

The respiratory burst oxidase catalyzes the production of O2.- from oxygen and NADPH. It is dormant in resting cells but becomes active when the cells are stimulated. Activation is accompanied by the phosphorylation of multiple serines in the cytosolic oxidase component p47phox, which moves from cytosol to the membrane during oxidase activation. Using immunopurified p47phox isolated from 32Pi-loaded neutrophils activated with phorbol myristate acetate, we showed that all the 32P was in the C-terminal CNBr fragment of the protein, and that in that fragment, Ser-303, Ser-304, Ser-320, Ser-328, Ser-345, and Ser-348 and at least one of the three serines, Ser-359, Ser-370, and Ser-379, were phosphorylated, while Ser-282, Ser-287, Ser-381, and Ser-388 were not. Of the phosphorylated serines, Ser-303, Ser-304, Ser-320, and Ser-328 are located in protein kinase C substrate sequences. Ser-345 and Ser-348, however, are located in sequences recognized by mitogen-activated protein (MAP) kinase (-PXSP-). This finding suggests that MAP kinase or a related proline-directed kinase may participate in the regulation of O2.- production by activated neutrophils. The tryptic peptide map of p47phox phosphopeptides from neutrophils activated by N-formyl-methionyl-leucyl-phenylalanine closely resembled that of p47phox phosphopeptides from phorbol-activated cells, suggesting that the same serines were phosphorylated in response to each agent.

Stimulation of human neutrophils induces phosphorylation of several cellular proteins. Human neutrophils possess calcium-dependent protein kinase C (PKC) α and β isoforms and calcium-independent n isoforms. Little is known, however, of the physiological substrates of each isoform. In this study, we characterized the substrates of calcium-dependent and -independent PKC isoforms and the substrate of PKC activated by arachidonic acid. Furthermore, we found that the PKC inhibitor H-7 failed to inhibit phosphorylation of endogenous substrates of calcium-independent PKC activity. These results may help to understand the role of PKC in neutrophil activation and shed light on the different responses elicited by H-7 in intact cells.

Polymorphonuclear neutrophils (PMN) play a prominent role in the host response to infectious diseases. One major bactericidal mechanism used by these cells is the production of reactive oxygen species during what is referred to as the oxidative burst. However, excessive oxidant generation can also be involved in cell and tissue damage associated with severe inflammatory reactions. Macrolide antibiotics are able to penetrate and concentrate within phagocytes and have been successfully used to treat infections due to facultative intracellular pathogens. However, intracellular accumulation of macrolides with possible alkalinization of cellular compartments may interfere with normal cell function. In-vitro and ex-vivo data suggest that macrolides affect various phagocytic functions. This paper presents an overview of the published data concerning the modulation of neutrophil function by macrolides. Preliminary data concerning the in-vitro modulation of the neutrophil oxidative burst by dirithromycin and its metabolite, erythromycylamine, are also discussed.

The study of interactions between antibiotics and the host defense system dates virtually from the discovery of these therapeutic agents. However, it is only in recent years that the emerging concept of immunomodulation by antibacterial drugs has received worldwide interest with a view to the development of new strategies for the treatment of infectious diseases. Since phagocytes play a pivotal role in the immediate defenses against invading pathogens, it is thus of major importance to analyze the effects of antimicrobial agents on the functions of these cells [1]. A key step in phagocyte-mediated destruction of pathogens, referred to as the oxidative burst [2], lies in the ability of phagocytes to generate reactive oxygen species.

Subinhibitory concentrations of most parenteral cephalosporins have been reported to alter bacterial infectivity and, in particular, to increase the susceptibility of altered bacteria to the killing effects of polymorphonuclear neutrophils (PMN). Few data on this issue are available for oral cephalosporins. This study investigated the effects of sub-MIC concentrations of the new oral cephalosporin cefixime on two bacterial targets, i.e., S. aureus 209P (MIC 20 mg/l) and E. coli K12 (MIC 0.15 mg/l). After overnight incubation (18 hours) with 10 or 5 mg/l cefixime, susceptibility of S. aureus to the killing effects of PMNs was increased two-fold as compared with control organisms and susceptibility to the O2-independent PMN bactericidal system (PMN extract) was also increased. In contrast, the susceptibility of E. coli to PMN and to cell-free bactericidal systems was identical for cefixime-exposed strains (0.1 and 0.05 mg/l) and for unexposed controls. However, cefixime-exposed E. coli were filamentous, suggesting that bactericidal efficacy in terms of the bacterial mass eliminated was enhanced in exposed strains. These data show that low levels of cefixime are capable of producing major alterations in susceptible and resistant bacteria and of increasing their susceptibility to PMN. These effects may be relevant in vivo, in particular when low concentrations of antibiotics persist over long periods in infected sites.

Polymorphonuclear neutrophils play a crucial role in host defences against infectious diseases. New trends in anti-infectious therapy require knowledge of the possible interactions between the drugs and the natural defence system. This overview summarizes some of the in vitro data on the effects of anti-infectious agents on neutrophils. The relevance for the clinical situation is discussed.

Cefodizime, a 2-amino-thiazolyl cephalosporin, is reported to display in-vitro, ex-vivo and in-vivo immunomodulatory properties; in particular, it enhances the survival of mice infected with cefodizime-resistant pathogens. We have used an in-vitro model to assess the indirect effect of this drug (compared with other cephalosporins) on the neutrophil (PMN) oxidative response. Pseudomonas aeruginosa was employed as the bacterial target for cefodizime and cefotaxime (MICs greater than 128 mg/l), cefsulodin (MIC 16 mg/l) and ceftazidime (MIC 32 mg/l). After overnight growth in the presence of subinhibitory concentrations of each drug (10 mg/l), the altered filamentous P. aeruginosa induced a stronger oxidative response of PMN than untreated control bacteria. For all cephalosporins this was related to alterations of bacterial structure leading to increased deposits of antibodies and/or complement. Furthermore, increased non-opsonin dependent stimulation of the PMN oxidative burst was obtained; the strongest response was observed with cefodizime-treated P. aeruginosa in the case of low responder PMN, which displayed a deficient response after stimulation by control bacteria. The possibility that cefodizime could enhance this PMN function in opsonin-deficient patients requires further investigation.

We have compared the in-vitro interactions of quinine and cinchonine, two alkaloids from cinchona bark, with human neutrophil functions. Although these molecules are structurally similar, they induced a quantitatively different depressive effect on neutrophil chemotaxis and oxidative response. Quinine produced the strongest effect at concentrations as low as 10 mg/l, which may be achievable in serum during therapeutic use of this compound. The depression induced by cinchonine was noticeable only at 100 mg/l. Chemotaxis was decreased by about 25% (formyl-methionyl-leucyl-phenylalanine) or 39% (serum) for quinine (100 mg/l) only if a constant concentration of the drug was maintained during the assay while cinchonine had no effect on this PMN function. The greatest impairment was observed for the PMN oxidative burst: this was dose-dependent whatever the stimulus used (phorbol-myristate-acetate or opsonized zymosan). After 30 min incubation in the presence of the drugs, the zymosan-induced chemiluminescence response was decreased by 96% and by 67% with quinine, 100 and 10 mg/l, respectively, and by 62% with cinchonine 100 mg/l. The myeloperoxidase-mediated iodination of PMN was reduced by 100% and 46% with quinine, 100 and 10 mg/l, respectively, whereas cinchonine decreased this function by about 95% at 100 mg/l and 14% at 10 mg/l. Superoxide anion generation was impaired by 94% (quinine 100 mg/l) or 45% (cinchonine 100 mg/l). The relevance to the clinical situation and the possible mechanisms of such effects are discussed.

We have previously reported that josamycin (JM) displayed a bactericidal synergy with human neutrophils (PMN) in vitro without altering significantly various cell functions (Labro et al., Path. Biol., 1989, 37, 329-334). Since JM may concentrate into phagocytes, and partly at least into lysosomes, it was of interest to analyze if the presence of this molecule could enhance the bactericidal activity of some acellular systems mimicking those acting inside the phagolysosome, using Staphylococcus aureus as the bacterial target. Erythromycin (EM) was assessed comparatively. While none of the macrolides increased the lethal effect of a crude PMN extract (02-independent system), an enhancement of the bacterial killing by an oxidant stress was observed in the presence of the 2 molecules. However, the effect of JM was strongest that the one induced by EM: S. aureus survival after exposure to xanthine + xanthine oxidase was 38 +/- 17.2% and it was reduced to 11 +/- 5.0 and 23 +/- 15.6 with JM (30 and 3 mg/l) and 22 +/- 13.1 and 23 +/- 9.7 with EM (30 and 3 mg/l). On the other hand, S. aureus survival after exposure to H2 O2 was reduced only by JM (16 +/- 9.4 and 32 +/- 6.9% versus 43 +/- 11.2% for controls). Pretreatment of S. aureus for 60 min by JM or EM did not alter the sensitivity of the bacteria either to PMN or to acellular systems. These data suggest that JM (and at a lesser degree EM) could be transformed by reactive oxygen species generated inside the phagolysosome to become more toxic for the bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)