High versus low ultrafiltration rates during experimental peritoneal dialysis in rats: Acute effects on plasma volume and systemic haemodynamics

Introduction: Intradialytic hypotension is a common complication of haemodialysis, but uncommon in peritoneal dialysis (PD). This may be due to lower ultrafiltration rates in PD compared to haemodialysis, allowing for sufficient refilling of the blood plasma compartment from the interstitial volume, but the underlying mechanisms are unknown. Here we assessed plasma volume and hemodynamic alterations during experimental PD with high versus low ultrafiltration rates. Methods: Experiments were conducted in two groups of healthy Sprague-Dawley rats: one group with a high ultrafiltration rate ( N = 7) induced by 8.5% glucose and a low UF group ( N = 6; 1.5% glucose), with an initial assessment of the extracellular fluid volume, followed by 30 min PD with plasma volume measurements at baseline, 5, 10, 15 and 30 min. Mean arterial pressure, central venous pressure and heart rate were continuously monitored during the experiment. Results: No significant changes over time in plasma volume, mean arterial pressure or central venous pressure were detected during the course of the experiments, despite an ultrafiltration (UF) rate of 56 mL/h/kg in the high UF group. In the high UF group, a decrease in extracellular fluid volume of −7 mL (−10.7% (95% confidence interval: −13.8% to −7.6%)) was observed, in line with the average UF volume of 8.0 mL (standard deviation: 0.5 mL). Conclusion: Despite high UF rates, we found that plasma volumes were remarkably preserved in the present experiments, indicating effective refilling of the plasma compartment from interstitial tissues. Further studies should clarify which mechanisms preserve the plasma volume during high UF rates in PD.

Protease Domain Exosites Regulate Plasma Recovery and Extravascular Distribution of Factor IX(a) Variants in Hemophilic Mice

Introduction: Among the coagulation protease, factor IX (FIX) is unique in that a substantial pool of extravascular factor exists that contributes to in vivo hemostasis. Extravascular distribution of FIX contributes to poor plasma recovery of infused FIX in hemophilia B (HB). The effect of mutations in the heparin (K126A/K132A) and antithrombin (R150A) binding exosites of FIX and FIXa on the distribution of these variants between the plasma and extravascular binding sites was examined in HB and hemophilia A (HA) mice, respectively. Methods: Recombinant human FIX wild type (18 U/kg) or equimolar FIX K126A/K132A was administered to HB mice (n=8) via tail vein injection with sacrifice 5 min post-injection following retro-orbital blood collection. Equimolar doses of human FIXa wild type (WT), K126A/K132A and R150A were similarly injected into HA mice (n=4-8), with blood collection and sacrifice 5 min post-injection. Plasma was isolated by centrifugation, organs (liver, spleen, kidneys, heart, lung, and brain) harvested, rinsed with PBS, weighed, with a portion made into tissue lysates and remainder frozen. FIX(a) content of tissue lysates was determined by a species-specific human FIX(a) ELISA with variant-specific standard curves. Tissue concentration was determined by total FIX(a) present in lysate (ng) divided by respective tissue weight (mg). Organ distribution was determined by extrapolating FIX(a) tissue concentration to total organ weight. The FIX(a) present in a specific organ was divided by the administered FIX(a) dose to determine the % organ distribution. Results: PK studies in HB mice demonstrated that FIX WT and R150A demonstrated a similar pattern and time course of elimination. In contrast, FIX K126A/K132A demonstrated ~2.4 fold higher plasma recovery relative to FIX WT. Based on plasma concentrations at 5 min post-injection (plasma volume 40 ml/kg), ~12.9% of FIX WT and 30.5% of FIX K126A/K132A was localized to the plasma compartment. Tissue lysates from the liver, spleen, kidney and brain demonstrated that liver had the highest FIX content by far, with ~41% of the FIX WT dose at 5 min post-injection. Other tissues demonstrated markedly less FIX WT content, including kidney (1%), spleen (0.1%) and brain (undetectable). FIX tissue concentration was significantly higher in the liver (0.69 ng/mg tissue) compared to other tissues, followed by kidney (0.07 ng/mg), spleen (0.02 ng/mg) and brain (undetectable). Comparison of FIX K126A/K132A tissue content to WT demonstrated reduced liver localization (25% dose) with concomitant reduction in tissue concentration (0.45 ng/mg). In contrast, FIX K126A/K132A increased localization to the kidney (1.7%) and spleen (0.37%) relative to WT. In protease PK studies, FIXa K126A/K132A and R150A both enhanced plasma recovery (2.2-2.5 fold) in HA mice compared to FIXa WT. Based on plasma concentrations at 5 min post-injection, ~16.1% of FIXa WT and 41.1% of FIXa K126A/K132A dose localized in the plasma compartment. Similar to zymogen, tissue lysates demonstrated that liver had the highest FIXa WT content (28%). Other tissues contained markedly less FIXa, including kidney (2.4%), spleen (0.2%), heart (0.5%) and brain (undetectable). Similarly, FIXa tissue concentration was 4-fold higher in the liver (0.47 ng/mg) compared to other tissues, followed by kidney (0.12 ng/mg), spleen and heart (0.06 ng/mg) and brain (undetectable). Localization of FIXa K126A/K132A to the liver was reduced by nearly half compared to FIXa WT (16%) with reduction in liver tissue concentration (0.29 ng/mg). FIXa K126A/K132A had increased localization to the kidney (3.3%) relative to WT. In contrast, FIXa R150A (not shown) had similar liver distribution (31.9% dose) and tissue concentration (0.53 ng/mg) to FIXa WT, despite increased localization to the plasma (36.2%). Conclusions: Liver is the predominant organ for extravascular FIX binding and the heparin binding exosite contributes to this localization, similar to the collagen IV binding site in the Gla domain. Heparan sulfate and collagen IV co-localize in the basement membrane suggesting synergistic roles. FIXa also localizes to extravascular sites via the heparin-binding exosite, although that binding may be modestly limited by endogenous FIX in the HA mouse. Disruption of the antithrombin binding exosite re-distributes FIXa to the plasma compartment by an independent mechanism, as liver content is unchanged. Disclosures Sheehan: Bayer: Consultancy, Research Funding; Roche: Consultancy, Research Funding; BioMarin: Consultancy, Research Funding.

A Cross-Talk between the Erythrocyte L-Arginine/ADMA/Nitric Oxide Metabolic Pathway and the Endothelial Function in Subjects with Type 2 Diabetes Mellitus

(1) Background: Type-2-diabetes-mellitus (DM) is one the most important cardiovascular-risk-factors. Among many molecules regulating vascular tone, nitric oxide appears to be the most pivotal. Although micro- and macrovascular-abnormalities are extensively studied, the alterations in the nitric-oxide-metabolic-pathway require further investigations. Additionally, the role of erythrocytes in the vascular tone regulation has not been extensively explored. The aim of this study was to evaluate the endothelial-function and the nitric-oxide-metabolic-pathway in erythrocytes and plasma of diabetic individuals. (2) Methods: A total of 80 subjects were enrolled in this cross-sectional study, including 35 patients with DM and 45 healthy individuals. The endothelial-function was evaluated in response to different stimuli. (3) Results: In the DM group, decreased Arginine and citrulline concentrations in the plasma compartment with reduced Arginine/ADMA and ADMA/DMA-ratios were observed. Preserved nitric-oxide-metabolism in erythrocytes with reduced citrulline level and significantly higher NO-bioavailability were noted. Significant endothelial dysfunction in DM individuals was proved in response to the heat-stimulus. (4) Conclusions: DM patients at an early stage of disease show significant differences in the nitric-oxide-metabolic-pathway, which are more pronounced in the plasma compartment. Erythrocytes constitute a buffer with a higher nitric-oxide-bioavailability, less affected by the DM-related deviations. Patients at an early-stage of DM reveal endothelial-dysfunction, which could be diagnosed earlier using the laser-Doppler-flowmetry.

P0917N-ACETYL CYSTEINE FAILS TO IMPACT ON PLASMA ANTIOXIDANT CAPACITY IN BOTH A PLACEBO CONTROLLED CROSSOVER STUDY AND A PARALLEL GROUP TRIAL OF PATIENTS WITH CKD STAGE III: IMPLICATIONS FOR ITS USE AS A PROPHYLACTIC FOR CONTRAST INDUCED NEPHROPATHY

This project has been funded by the EU’s INTERREG VA programme, managed by the special EU Programmes Body (SEUPB) Background and Aims N-acetyl-L-cysteine (NAC) has been proposed as a prophylactic for the prevention of contrast induced nephropathy (CIN), a serious, adverse complication following administration of contrast media in patients with diabetes and chronic kidney disease (CKD). However, clinical trial results have failed to demonstrate consistently the beneficial qualities of NAC in this setting. The suggested mechanism by which NAC has been proposed to be effective is via antioxidant activity, but NAC itself appears not to be a powerful antioxidant; intracellular conversion of NAC to glutathione (GSH) is essential for antioxidant effects. We tested the hypothesis that oral or intravenous NAC fails to increase antioxidant activity in the plasma of healthy volunteers or CKD stage III patients undergoing elective coronary angiography. Method 16 healthy volunteers (8 receiving contrast media) and 8 patients with chronic renal failure were recruited to 3 separate groups as a part of a crossover design study. 66 patients with CKD stage III undergoing elective coronary angiography were recruited to a parallel group randomized controlled trial. Each volunteer or patient was randomised to receive NAC (i.v.; 50 mg/kg/hr infusion for 2 h, followed by 20 mg/kg/hr infusion for a further 5 h), or NAC (oral; 1200 mg twice daily, commencing the day before the study visit) or placebo. Participants attended the Clinical Research Facility on three occasions for the crossover groups, but only once in the parallel group trial. Patients were infused with para-aminohippurate (PAH) and inulin to enable measurement of renal function parameters. Plasma and paired buffy coat samples were collected at several time points for 2 hours before contrast infusion and for 6 hours after. Samples were used to measure various clinical parameters, along with intracellular and plasma thiol concentrations and the plasma antioxidant capacity (oxygen radical antioxidant capacity; ORAC). Results Plasma NAC concentrations peaked at 222 µM (healthy volunteers), 354 µM (CKD patients), 271 µM (healthy volunteers receiving contrast) and 348 µM (CKD patients undergoing elective coronary angiography) following infusion of NAC. The corresponding peak concentrations were ∼2 µM following oral NAC across all groups. No comparable increase in the plasma compartment ORAC antioxidant capacity was measured in any of the treatment groups. Equally, contrast infusion itself did not significantly reduce antioxidant capacity in plasma, even in the placebo group. Buffy coat measures showed that there was a significant increase of intracellular GSH in some patients. Also, no clear additional benefit was witnessed by increasing plasma NAC ∼100-fold through infusion of NAC over oral administration. Conclusion NAC fails to influence ORAC antioxidant capacity in the plasma compartment of CKD stage III patients receiving contrast media. Our results question the importance of oxidative stress in contrast-induced nephropathy. Furthermore, the findings fail to demonstrate a direct antioxidant impact of NAC in the plasma compartment and question the antioxidant hypothesis related to contrast-induced nephropathy and NAC.

Plasma Protein Signatures of a Murine Venous Thrombosis Model and Slc44a2 Knockout Mice Using Quantitative-Targeted Proteomics

The plasma compartment of the blood holds important information on the risk to develop cardiovascular diseases such as venous thrombosis (VT). Mass spectrometry-based targeted proteomics with internal standards quantifies proteins in multiplex allowing generation of signatures associated with a disease or a condition. Here, to demonstrate the method, we investigate the plasma protein signatures in mice following the onset of VT, which was induced by RNA interference targeting the natural anticoagulants antithrombin and protein C. We then study mice lacking Slc44a2, which was recently characterized as a VT-susceptibility gene in human genome-wide association studies. We use a recently developed panel of 375 multiplexed mouse protein assays measured by mass spectrometry. A strong plasma protein siganture was observed when VT was induced. Discriminators included acute phase response proteins, and proteins related to erythrocyte function. In mice lacking Slc44a2, protein signature was primarily overruled by the difference between sexes and not by the absent gene. Upon separate analyses for males and females, we were able to establish a signature for Slc44a2 deficiency, in which glycosylation-dependent cell adhesion molecule-1 and thrombospondin-1 were shared by both sexes. The minimal impact of Slc44a2 deficiency on the measured plasma proteins suggests that the main effect of Slc44a2 on VT does not lay ultimately in the plasma compartment. This suggests further investigation into the role of this VT-susceptibility gene should perhaps also question the possible involvement in cellular mechanisms.

Impact of Suboptimal APOBEC3G Neutralization on the Emergence of HIV Drug Resistance in Humanized Mice

ABSTRACT HIV diversification facilitates immune escape and complicates antiretroviral therapy. In this study, we take advantage of a humanized-mouse model to probe the contribution of APOBEC3 mutagenesis to viral evolution. Humanized mice were infected with isogenic HIV molecular clones (HIV-WT, HIV-45G, and HIV-ΔSLQ) that differ in their abilities to counteract APOBEC3G (A3G). Infected mice remained naive or were treated with the reverse transcriptase (RT) inhibitor lamivudine (3TC). Viremia, emergence of drug-resistant variants, and quasispecies diversification in the plasma compartment were determined throughout infection. While both HIV-WT and HIV-45G achieved robust infection, over time, HIV-45G replication was significantly reduced compared to that of HIV-WT in the absence of 3TC treatment. In contrast, treatment responses differed significantly between HIV-45G- and HIV-WT-infected mice. Antiretroviral treatment failed in 91% of HIV-45G-infected mice, while only 36% of HIV-WT-infected mice displayed a similar negative outcome. Emergence of 3TC-resistant variants and nucleotide diversity were determined by analyzing 155,462 single HIV reverse transcriptase gene (RT) and 6,985 vif sequences from 33 mice. Prior to treatment, variants with genotypic 3TC resistance (RT-M184I/V) were detected at low levels in over a third of all the animals. Upon treatment, the composition of the plasma quasispecies rapidly changed, leading to a majority of circulating viral variants encoding RT-184I. Interestingly, increased viral diversity prior to treatment initiation correlated with higher plasma viremia in HIV-45G-infected animals, but not in HIV-WT-infected animals. Taken together, HIV variants with suboptimal anti-A3G activity were attenuated in the absence of selection but displayed a fitness advantage in the presence of antiretroviral treatment. IMPORTANCE Both viral (e.g., RT) and host (e.g., A3G) factors can contribute to HIV sequence diversity. This study shows that suboptimal anti-A3G activity shapes viral fitness and drives viral evolution in the plasma compartment in humanized mice.

Impact of suboptimal APOBEC3G neutralization on the emergence of HIV drug resistance in humanized mice

ABSTRACTHIV diversification facilitates immune escape and complicates antiretroviral therapy. In this study, we take advantage of a humanized mouse model to probe the contribution of APOBEC3 mutagenesis to viral evolution. Humanized mice were infected with isogenic HIV molecular clones (HIV-WT, HIV-45G, HIV-ΔSLQ) that differ only in their ability to counteract APOBEC3G (A3G). Infected mice remained naïve or were treated with the RT inhibitor lamivudine (3TC). Viremia, emergence of drug resistant variants and quasispecies diversification in the plasma compartment were determined throughout infection. While both HIV-WT and HIV-45G achieved robust infection, over time HIV-45G replication was significantly reduced compared to HIV-WT in the absence of 3TC treatment. In contrast, treatment response differed significantly between HIV-45G and HIV-WT infected mice. Antiretroviral treatment failed in 91% of HIV-45G infected mice while only 36% of HIV-WT infected mice displayed a similar negative outcome. Emergence of 3TC resistant variants and nucleotide diversity were determined by analyzing 155,462 single HIV reverse transcriptase (RT) and 6,985 vif sequences from 33 mice. Prior to treatment, variants with genotypic 3TC resistance (RT-M184I/V) were detected at low levels in over a third of all animals. Upon treatment, the composition of the plasma quasispecies rapidly changed leading to a majority of circulating viral variants encoding RT-184I. Interestingly, increased viral diversity prior to treatment initiation correlated with higher plasma viremia in HIV-45G but not in HIV-WT infected animals. Taken together, HIV variants with suboptimal anti-A3G activity were attenuated in the absence of selection but display a fitness advantage in the presence of antiretroviral treatment.IMPORTANCEBoth viral (e.g., reverse transcriptase, RT) and host factors (e.g., APOBEC3G (A3G)) can contribute to HIV sequence diversity. This study shows that suboptimal anti-A3G activity shapes viral fitness and drives viral evolution in the plasma compartment of humanized mice.

Pulmonary Pharmacokinetics of Colistin following Administration of Dry Powder Aerosols in Rats

ABSTRACT Colistin has been administered via nebulization for the treatment of respiratory tract infections. Recently, dry powder inhalation (DPI) has attracted increasing attention. The current study aimed to investigate the pharmacokinetics (PK) of colistin in epithelial lining fluid (ELF) and plasma following DPI and intravenous (i.v.) administration in healthy Sprague-Dawley rats. Rats were given colistin as DPI intratracheally (0.66 and 1.32 mg base/kg of body weight) or i.v. injection (0.66 mg base/kg). Histopathological examination of lung tissue was performed at 24 h. Colistin concentrations in both ELF and plasma were quantified, and a population PK model was developed and compared to a previously published PK model of nebulized colistin in rats. A two-compartment structural model was developed to describe the PK of colistin in both ELF and plasma following pulmonary or i.v. administration. The model-estimated clearance from the central plasma compartment was 0.271 liter/h/kg (standard error [SE] = 2.51%). The transfer of colistin from the ELF compartment to the plasma compartment was best described by a first-order rate constant (clearance of colistin from the ELF compartment to the plasma compartment = 4.03 × 10−4 liter/h/kg, SE = 15%). DPI appeared to have a higher rate of absorption (time to the maximum concentration in plasma after administration of colistin by DPI, ≤10 min) than nebulization (time to the maximum concentration in plasma after administration of colistin by nebulization, 20 to 30 min), but the systemic bioavailabilities by the two routes of administration were similar (∼46.5%, SE = 8.43%). Histopathological examination revealed no significant differences in inflammation in lung tissues between the two treatments. Our findings suggest that colistin DPI is a promising alternative to nebulization considering the similar PK and safety profiles of the two forms of administration. The PK and histopathological information obtained is critical for the development of optimal aerosolized colistin regimens with activity against lung infections caused by Gram-negative bacteria.

Abstract 626: The ABCA1 Agonist Peptides CS-6253 and ATI-5261 Replicate ApoA-I Function and Generate nHDL Particles that Are Remodeled and Maturated Within the Plasma Compartment, Resulting in Efficient Cholesterol SR-BI Delivery to Hepatic Cells

Novel apolipoprotein (apo) mimetic peptides are potent mediators of ABCA1-mediated cholesterol efflux, mimicking native apoA-I. We investigated CS-6253 (CS) and ATI-5261 (ATI) in their ability to promote lipid transfer between nascent (n)HDL particles and plasma lipoproteins and examined cholesterol influx from remodelled HDL-like particles to hepatic cells through the SR-BI receptor. nHDL-like lipoproteins nHDL-CS and nHDL-ATI were generated by incubating CS or ATI in the presence of BHK cells expressing ABCA1 labelled with 3 [H]cholesterol and 3 [H] choline; native apoA-I was used as control. These nHDL particles were incubated with plasma at 37°C. Both CS and ATI increased LCAT activity significantly, although were approximately 50% less efficient than nHDL-apoA-I (fractional esterification rate (FER) =22.32±0.86%/h; vs nHDL-CS and nHDL-ATI; FER=11.40±0.045%/h; p<0.05). The majority of 3 [H]cholesterol from nHDL mimetics was esterified by LCAT, resulting in an increase in α1-migrating HDL-like particles in plasma (as shown by 2D-PAGGE). The ability of nHDL mimetics to transfer 3 [H]-phosphatidyl choline to plasma apoB-containing lipoproteins is (76±20%) in HDL-apoA-I, (38±0.5%) in nHDL-ATI and (54±13%) in nHDL-CS. These data show that nHDL mimetics are actively remodelled in the presence of plasma lipoproteins. We then investigated cholesterol delivery from HDL-CS and HDL-ATI mimetic to hepatic tissue via SR-BI using Fu5AH cells, having HDL-apoA-I as control. Kinetic parameters for SR-BI-mediated cholesterol influx are as follows: HDL-CS ( K m = 0.30±0.05 ug/ml; p<0.05) efficient as HDL apoA-I at promoting cholesterol uptake into Fu5AH cells ( K m = 0.37±0.13 ug/ml), while HDL-ATI was least efficient ( K m = 1.03±0.20 ug/ml). The inhibition of SR-BI selective uptake with BLT-1 affected the uptake of cholesterol from apoB precipitated plasma containing either HDL-CS, HDL-ATI or apoA-I. Here we present an in-vitro model of nHDL-CS and nHDL-ATI that actively undergo remodelling and maturation in plasma and replicate the function of apoA-I. These mature HDL mimetics generated from ABCA1 agonist peptides deliver cholesterol efficiently to hepatocytes specifically through the SR-BI receptor.