Assessment of the effect of candidate anti-inflammatory treatments on the interaction between meningococci and inflammatory cellsin vitro in a whole blood model

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Abstract
A wide range of immunomodulating agents are now available which may be of benefit in reducing inflammatory cell activation in meningococcal sepsis. In order to facilitate selection of candidate anti-inflammatory agents for clinical trials, we have used an in vitro whole blood model to evaluate the effects on meningococcal induced neutrophil and monocyte activation, of dexamethasone, prostacyclin, pentoxifylline and a human IgM anti-lipid A monoclonal antibody (HA-1A). Known concentrations of heat and penicillin killed meningococci were added to whole blood and the time course of cellular activation was determined. Using elastase-α 1-antitrypsin (elastase-α 1-AT) and TNFα production as markers of neutrophil and monocyte activation respectively, plasma levels of elastase-α 1-AT and TNFα were found to increase in a dose-dependant manner. Elastase-α 1-AT was detected early, with most release occurring between 15–30 min whereas TNFα was detected later, between 120–180 min. Dexamethasone, prostacyclin and pentoxifylline caused a dose dependant inhibition of TNFα release but had no effect on elastase release. HA-1A had no effect on either TNFα or elastase release. This model may be useful in determining the sequence of inflammatory cell activation and in selecting candidate anti-inflammatory agents for evaluation in clinical trials.