Endotoxin is an important pathogenic trigger for sepsis. The polymyxin B-immobilized endotoxin removal hemoperfusion cartridge, Toraymyxin (hereafter PMX), has been shown to remove endotoxin in preclinical and open-label clinical studies. In a multicenter, open-label, pilot, randomized, controlled study conducted in the intensive care unit in six academic medical centers in Europe, 36 postsurgical patients with severe sepsis or septic shock secondary to intra-abdominal infection were randomized to PMX treatment of 2 h (n = 17) or standard therapy (n = 19). PMX was well tolerated and showed no significant side effects. There were no statistically significant differences in the change in endotoxin levels from baseline to 6 to 8 h after treatment or to 24 h after treatment between the two groups. There was also no significant difference in the change in interleukin (IL)-6 levels from baseline to 6 to 8 h after treatment or to 24 h after treatment between the two groups. Patients treated with PMX demonstrated significant increases in cardiac index (CI; P = 0.012 and 0.032 at days 1 and 2, respectively), left ventricular stroke work index (LVSWI, P = 0.015 at day 2), and oxygen delivery index (DO2I, P = 0.007 at day 2) compared with the controls. The need for continuous renal replacement therapy (CRRT) after study entry was reduced in the PMX group (P = 0.043). There was no significant difference between the groups in organ dysfunction as assessed by the Sequential Organ Failure Assessment (SOFA) scores from day 0 (baseline) to day 6. Treatment using the PMX cartridge is safe and may improve cardiac and renal dysfunction due to sepsis or septic shock. Further studies are needed to prove this effectiveness.

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Several recent studies have identified eosinophils as a cellular source of various cytokines, indicating that eosinophils play not only an effector role, but also a regulatory role within the allergic inflammatory cell network. In this study, we demonstrate that eosinophils can generate and secrete monocyte chemoattractant protein-1 (MCP-1), a prototype of C-C chemokines. Eosinophils generated immunoreactive MCP-1 in response to such diverse stimuli as C5a, formyl-methionyl-leucyl-phenylalanine (FMLP) and ionomycin, but MCP-1 production was not induced by interleukin (IL)-1 or tumor necrosis factor-alpha. C5a- and FMLP-induced eosinophil MCP-1 production was absolutely dependent on pretreatment with cytochalasin B. Eosinophils elaborated significantly more MCP-1 than neutrophils. Immunoreactive MCP-1 was detected at 6 h of incubation with C5a or FMLP. Expression of MCP-1 mRNA reached a maximum within the first 3 h after stimulation and then declined rapidly to a very low and stable level by 18 h. Pretreatment with IL-5 markedly amplified C5a-induced MCP-1 production, and the enhancement occurred at the pretranslational level. Eosinophil-active chemokines such as eotaxin failed to induce MCP-1 generation, even when eosinophils were primed by IL-5. Since MCP-1 exerts a potent histamine-releasing effect on human basophils, our results indicate that eosinophils may regulate basophil mediator release with possible consequent contribution to the pathogenesis of allergic inflammation via a paracrine mechanism.

Phage display technique is a powerful tool with which to identify novel binding sequences for antibody and receptor targets. Few studies, however, have used this technology to select affinity peptides for ligand molecules. Here, we screened a peptide phage library for binding to toxic shock syndrome toxin 1 (TSST-1) to examine whether peptide ligands for TSST-1 which mimic the structure of major histocompatibility complex (MHC) class II receptors could be identified. After three cycles of biopanning, four potent sequences reactive with TSST-1 were isolated (designated phages 2, 3, 8, and 11). Selected phage were found to react specifically with TSST-1 but not with other staphylococcal exotoxins. A synthetic peptide (pep3) corresponding to the most frequently identified sequence (phage3) was shown to inhibit binding of all four isolated phage to TSST-1, suggesting that they bind to a common site on TSST-1. Furthermore, pep3 was shown to compete with MHC class II molecules for binding to TSST-1 in a concentration-dependent manner. Comparison of their sequences with MHC class II molecules revealed that phage8 shared sequence homology with two regions of the beta chain of MHC class II molecules: amino acids 57-62, containing a residue (Tyr-60) involved in TSST-1 binding as suggested by X-ray crystallographic data of TSST-1-MHC class II complex; and amino acids 188-193, a region not previously known as a contact domain. These results suggest that the selected sequences recognized the MHC class II binding site on TSST-1. Thus, affinity selection for peptides binding to ligand molecules (e.g., TSST-1) rather than their cognate receptors (e.g., MHC class II) from a random phage display library represents a useful approach to understanding receptor-ligand interactions.

Immune reactivities of blood donor sera with the peptides of various lengths (24, 30, 40 and 50 mer) and those with genotypic sequence variations in the N-terminal portion of the core protein of hepatitis C virus (HCV) were compared by enzyme-linked immunosorbent assays. It was found that a 40-mer oligopeptide (amino acids 2-41) was recognized more frequently than other peptides even in serum samples that did not react with the C22-3 (core) by the recombinant immunoblot assay (RIBA-II). On the other hand, a 30-mer peptide (amino acids 1-30) had good correlation with viremia as confirmed by the polymerase chain reaction (PCR). In addition, four individuals showed the obvious differences in the immune responses to 30-mer oligopeptides representing the 4 genotypic variations. As a result, some samples that were PCR-positive but nonreactive by a commercial assay were found to react with short synthetic peptides in the N-terminal portion of the core protein.