Demonstration of fibronectin in normal and acutely inflamed appendix

The presence and localization of fibronectin in normal and acutely inflamed appendices in man was studied using indirect immunoperoxidase technique on sections of formaldehyde fixed and paraffin embedded tissue, following pretreatment with pepsin and testicular hyaluronidase. In the normal appendix fibronectin was demonstrated in the region of the basement membrane of the surface epithelium, in the loose connective tissue, in the perimysium around the individual smooth muscle cells and in the vessel walls. In the acutely inflamed appendices, fibronectin was found in the luminal necrotic area, both intercellularly and in the cytoplasma of some inflammatory cells. In relation to the surface inflammation and in the tissue matrix corresponding to the acute inflammatory reaction fibronection was, compared to the normal appendix, found in increased amount. Furthermore, a comparison between the use of a primary antibody to fibronectin, produced in our collaborating laboratory and two different commercial primary antibodies showed that the staining results concerning the localization of fibronectin were equal for all three antibodies, whereas the commercial antibodies showed a weaker staining intensity and some unspecific staining compared to the antibody produced in our collaborating laboratory.     

Expression of 5-lipoxygenase in specialized epithelial cells of nasopharyngeal-associated lymphoid tissue

Leukotrienes are lipid mediators that are produced primarily by certain types of leukocytes. The synthesis of the leukotriene LTB₄ is initiated by the enzyme 5-lipoxygenase and completed by LTA₄ hydrolase. Epithelial cells constitutively express LTA₄ hydrolase but normally lack 5-lipoxygenase. In this study, we report that the stratified squamous epithelial cells from inflamed or hyperplastic tissues of palatine and pharyngeal tonsils (nasopharyngeal-associated lymphoid tissue) express 5-lipoxygenase protein. The localization of 5-lipoxygenase was indicated by immunohistochemical staining and presence confirmed by immunoblot. Positive staining for 5-lipoxygenase in infiltrating leukocytes in inflamed tissues served as internal positive controls for immunohistochemical staining. Staining for 5-lipoxygenase in appendix tissue was negative for epithelial cells while positive for polymorphonuclear leukocytes, indicating that 5-lipoxygenase expression is not a general feature of epithelial cells in mucosa-associated lymphoid tissue. In tonsils, 5-lipoxygenase staining was pronounced in broad regions but reduced or absent in others, suggesting regional regulation of expression. Epithelial cells of tonsils were also positive for 5-lipoxygenase activating protein and leukotriene A₄ hydrolase, indicating a capacity to produce LTB₄. Taken together, these results suggest that the specialized epithelial cells of the mucosa-associated lymphoid tissue of human tonsils can synthesize LTB₄. This lipid mediator may serve to modulate the function of cells within the lymphoid tissue as well as promote an inflammatory response.     

Atypical localization of myenteric ganglia in the human appendical wall: a comparative study with animal appendix

The presence of well developed appendices in some animals when compared to humans has led to speculation that appendix is a vestigial organ. Increasing number of studies have revealed that the appendix serves as an important organ in humans. The function of animal appendix, and the differences between species remain poorly understood. In this study we examined human myenteric plexus and compared them with animal studies. Appendices were obtained from five young adults in which the appendix was found to be normal after removal. Fixed appendix cryosections were examined by immunofluorescence methods using neuronal marker antibodies to neurofilaments and beta III tubulin. Both antibodies stained myenteric ganglia which were arranged in an apparently irregular pattern in human appendix wall. We observed unexpected localization of myenteric ganglia in the subserosa often accompanied by rarely occurring ganglia in the longitudinal muscle layer. These ganglia were of different sizes and shapes and unequally distributed under a thin layer of serosa. Our findings raise many questions about the possible role of irregular and atypical myenteric ganglia localization in relation to altered motility and subsequent pathogenesis of the appendix in inflammatory disease in humans. On the other hand, studies of the literature have revealed simplicity in the organization of myenteric plexus, e.g., in well-developed rabbit appendix. In addition, appendicitis in animals is restricted to in apes with similarly shaped appendix to humans.     

Rational use of antibiotic therapy after appendicectomy.

A prospective randomised trial was carried out on 263 patients admitted for appendicectomy. In those patients with normal or inflamed appendix only, wound sepsis occurred in five (5%) of the 96 patients receiving metronidazole compared with seven (7%) of the 91 controls. In patients with gangrenous or perforated appendices, however, 15 of the 32 patients (47%) receiving ampicillin and five (16%) of 31 patients receiving metronidazole developed a wound infection (p less than 0.025). Therapeutic courses of metronidazole significantly reduced wound sepsis rate in those with gangrenous or perforated appendices. Together with another antibiotic it should form part of the management of such patients, but antibiotics are unlikely to reduce further the low rate of wound infection in patients with normal or inflamed appendices.     

Ultrastructural localization of human kidney antigens using monoclonal antibodies.

A highly sensitive method of ultrastructural-immunoperoxidase staining was developed for use with monoclonal antibodies which have been raised in this laboratory to a variety of antigens of the human kidney. Because of the susceptibility of the antigens to fixation and processing, a four layer, pre-embedding method of staining was used. Results confirmed and clarified previously reported light microscopy results, indicating that an antigen recognized by the PHM5 antibody was found on the podocyte cell membrane within the glomerulus and was not present within the glomerular basement membrane. The antigen was also present on the extraglomerular endothelial cell membrane. The study also demonstrated the presence of an antigen specific to endothelial cells throughout the renal cortex, and gave further insight into the precise localization of glomerular basement membrane components including fibronectin. The method of staining is now being used together with detailed ultrastructural studies to identify the cells produced from isolated glomeruli in tissue culture.     

Production and characterization of monoclonal antibodies to rabbit lymphocyte subpopulations. I. Tissue immunofluorescence and flow cytometric analysis

Nine monoclonal antibodies to rabbit T cells and B subpopulations have been generated from three separate fusions of spleen cells from mice immunized with fractionated populations of rabbit lymphocytes. These monoclonal antibodies, as well as a previously described rabbit T cell monoclonal antibody, 9AE10, have been analyzed by immunofluorescence staining on frozen tissue sections of rabbit thymus, spleen, and appendix. This screening method permits rapid identification of the lymphocyte subdomains in each tissue which is not possible by other screening methods. Each monoclonal antibody selected has a unique tissue staining pattern. Flow cytometric analysis of these monoclonal antibodies, using indirect immunofluorescence techniques on thymocytes, splenocytes, and PBL, revealed varying percentages of positive cells and individual mean fluorescence intensities indicating different epitope densities for each antigen. These monoclonal antibodies are now being used to characterize normal lymphocyte function and the role of specific lymphocyte subpopulations in experimental disease models in the rabbit.     

Ultrastructural localization of cathepsin B in gingival tissue from chronic periodontitis patients

Summary Loss of tooth support during chronic periodontitis is very likely to involve tissue proteases such as cathepsin B. The distribution of this enzyme was, therefore, examined in ultrathin sections of gingival tissue embedded in acrylic resin and labelled with a sheep polyclonal antibody and gold-conjugated secondary antibody. Macrophages and fibroblasts in both inflamed and non-inflamed areas of tissue showed labelling, and this was strongest in lysosomes, corresponding to the normal intracellular location of cathepsin B. However, additional gold particles were found on the surface of these cells. Monocytes in inflamed areas also had surface labelling, some of which was present on microvilli. Labelled collagen fibres adjacent to all three cell types indicated that cathepsin B had been released into the immediate extracellular environment. Plasma membrane cathepsin B has previously been associated with cancers, but enzyme redistribution and release in the gingiva may have been linked to the inflammatory response, since fibroblasts and macrophages in non-inflamed areas showed less labelling of their surface and adjacent collagen. The collagen labelling added to evidence that cathepsin B can function extracellularly as well as intracellularly in connective tissue degradation. This destructive role for the enzyme is supported by our earlier measurements of increased biochemical activity in chronic periodontitis This revised version was published online in November 2006 with corrections to the Cover Date.     

The expression of Lewisx on carcinoembryonic antigen (CEA)-related glycoproteins of normal and inflamed oesophageal squamous mucosa

Carcinoembryonic antigen (CEA)-related antigens were detected histologically in normal and inflamed oesophageal squamous mucosa using polyclonal anti-CEA antisera and monoclonal antibodies recognizing CEA or NCAs (non-specific cross-reacting antigens). Expression was limited to the surface of more mature squames. Immunoblotting of detergent extracts of oesophageal mucosa separated on polyacrylamide gels using polyclonal anti-CEA antisera showed a number of CEA-related proteins, of 195, 145, and 80 kDa. CEA-specific monoclonal antibodies recognized only the 195-kDa glycoprotein. The lower molecular weight species were recognized by anti-NCA antibody DD9 and a CD66 antibody. The carboyhydrate antigen Lewis^x (Le^x, CD15), previously shown to be a marker of mature squames, was present predominantly on a subpopulation of the 195-kDa antigen and was demonstrable on the higher molecular weight component of a doublet recognized by the CEA antibodies. Expression of Le^x carbohydrate antigens in inflamed oesophageal squamous mucosa was shown to be significantly reduced relative to the expression seen in normal tissue. A suprabasal layer of CEA-positive, Le^x-negative cells became apparent in inflamed tissue showing altered glycosylation of the CEA under these conditions. It is postulated that CEA plays a role in maintaining the integrity of the squamous mucosa.     

Platelet-derived growth factor and inflammatory cytokines have differential effects on the expression of integrins α1β1 and α5β1 by human dermal fibroblasts in vitro

Dermal fibroblasts are essential for the repair of cutaneous wounds. Fibroblasts presumably use cell surface receptors of the integrin family during migration into a wound from the adjacent uninjured tissue and for the subsequent matrix repairs. We have investigated the possible roles of platelet-derived growth factor and inflammatory cytokines in the regulation of integrin expression on wound fibroblasts using a porcine cutaneous wound model and cultured human cells. Tissue specimens collected from 4-day pig wounds were stained with antibodies specific for the α1 and α5 integrin subunits. Staining for α1 was markedly decreased on fibroblasts adjacent to the wound and in the granulation tissue, while staining for α5 was clearly enhanced in both locations. Normal adult human dermal fibroblasts in culture express the integrins α1β1, a collagen receptor, and α5β1, a fibronectin receptor. Quantitative flow cytometry was used to measure cell surface integrin expression after treatment with platelet-derived growth factor (PDGF)-AA, PDGF-AB, or PDGF-BB. Each isoform of PDGF produced a significant decrease in the level of α1 present on the cell surface and an increase in the level of α5. Furthermore, PDGF-BB produced a corresponding decrease in α1 mRNA and an increase in α5 mRNA. In contrast, treatment with three inflammatory cytokines, IL-1β, TNF-α, and IFN-γ, produced clear increases in the levels of α1 and α5 present on the cell surface. Our observations suggest that the differential effects of PDGF and inflammatory cytokines may be part of the mechanism regulating the expression of α1 and α5 integrins by dermal fibroblasts during wound repair. © 1996 Wiley-Liss, Inc.     

Differential expression of the extra domain-containing form of cellular fibronectin in human placentas at different stages of maturation

The distribution of the extra domain-containing form of cellular fibronectin was studied in human placentas at different stages of maturation by using the monoclonal antibody 52DH1 in indirect immunofluorescence. In early chorionic tissue (7 to 10 weeks post menstruationem) cellular fibronectin was codistributed with laminin and type IV collagen in the trophoblastic basement membranes. At weeks 11 to 12 the trophoblastic basement membranes were negative but positivity was typically revealed in distinct aggregates in the stromal tissue. In second-trimester and term placentas the immunoreactivity was confined to the vessel endothelia of villous stroma. Extravillous trophoblast cells seen in placentas at different stages did not show positivity. Double staining with the 52DH1 monoclonal antibody and polyclonal fibronectin antibodies showed that both in the early and term placentas there was much fibrillar positivity only revealed with the polyclonal antibodies. The present results show that cellular fibronectin is a prominent component of early trophoblastic basement membranes and may thus play a special role in the maturation of chorionic villi.     

Prepro-endothelin-1 mRNA and its mature peptide in human appendix

Because the precise immunopathological events occurring in appendicitis are not completely understood, possible local production of endothelin-1 (ET-1) in human appendix was investigated. We used immunohistochemistry and in situ hybridization to detect the presence, distribution, and phenotype of ET-1-positive cells and prepro-ET-1 (pp-ET-1) mRNA-expressing cells. ET-1-positive stromal cells and pp-ET-1 mRNA-expressing cells were detected with different distributions and relative frequencies in normal control appendix, histologically normal appendix, and inflamed appendix. Six of 20 histologically normal appendixes from patients with a clinical diagnosis of acute appendicitis had many ET-1-positive stromal cells and high pp-ET-1 mRNA expression, similar to inflamed appendix. Forty percent of the pp-ET-1 mRNA-expressing cells were neutrophils, and the other positive cells were mast cells and macrophages. We suggest that local production of ET-1 by neutrophils and other inflammatory cells could be a molecular sign of focal inflammation in histologically normal appendixes and that ET-1 could be implicated, with other cytokines, in the pathogenesis of appendicitis by inducing appendiceal ischemia through vasoconstriction.     

The function of multiple extracellular matrix receptors in mediating cell adhesion to extracellular matrix: preparation of monoclonal antibodies to the fibronectin receptor that specifically inhibit cell adhesion to fibronectin and react with platelet glycoproteins Ic-IIa

We have identified monoclonal antibodies that inhibit human cell adhesion to collagen (P1H5), fibronectin (P1F8 or P1D6), and collagen and fibronectin (P1B5) that react with a family of structurally similar glycoproteins referred to as extracellular matrix receptors (ECMRs) II, VI, and I, respectively. Each member of this family contains a unique alpha subunit, recognized by the antibodies, and a common beta subunit, each of approximately 140 kD. We show here that ECMR VI is identical to the fibronectin receptor (FNR), very late antigen (VLA) 5, and platelet glycoproteins Ic-IIa and shall be referred to as FNR. Monoclonal antibodies to FNR inhibit lymphocyte, fibroblast, and platelet adhesion to fibronectin-coated surfaces. ECMRs I, II, and FNR were differentially expressed in platelets, resting or activated lymphocytes, and myeloid, epithelial, endothelial, and fibroblast cell populations, suggesting a functional role for the receptors in vascular emigration and selective tissue localization. Tissue staining of human fetal skin localized ECMRs I and II to the basal epidermis primarily, while monoclonal antibodies to the FNR stained both the dermis and epidermis. Experiments carried out to investigate the functional roles of these receptors in mediating cell adhesion to complex extracellular matrix (ECM) produced by cells in culture revealed that complete inhibition of cell adhesion to ECM required antibodies to both the FNR and ECMR II, the collagen adhesion receptor. These results show that multiple ECMRs function in combination to mediate cell adhesion to complex EMC templates and predicts that variation in ECM composition and ECMR expression may direct cell localization to specific tissue domains.     

Differential expression of the extra domain-containing form of cellular fibronectin in human placentas at different stages of maturation

Summary The distribution of the extra domain-containing form of cellular fibronectin was studied in human placentas at different stages of maturation by using the monoclonal antibody 52DHl in indirect immunofluorescence. In early chorionic tissue (7 to 10 weeks post menstruationem) cellular fibronectin was codistributed with laminin and type IV collagen in the trophoblastic basement membranes. At weeks 11 to 12 the trophoblastic basement membranes were negative but positivity was typically revealed in distinct aggregates in the stromal tissue. In second-trimester and term placentas the immunoreactivity was confined to the vessel endothelia of villous stroma. Extravillous trophoblast cells seen in placentas at different stages did not show positivity. Double staining with the 52DHl monoclonal antibody and polyclonal fibronectin antibodies showed that both in the early and term placentas there was much fibrillar positivity only revealed with the polyclonal antibodies. The present results show that cellular fibronectin is a prominent component of early trophoblastic basement membranes and may thus play a special role in the maturation of chorionic villi.     

Multiple and masked pools of fibronectin in murine fibroblast cell-substratum adhesion sites

Substrate-attached material (SAM) prepared from murine BALB/c 3T3 cells and various derivatives contains adhesion sites which pinch off from the cell surface during EGTA-mediated detachment but which remain bound to the serum-coated tissue culture substratum. SAM contains the related adhesive glycoproteins cold-insoluble globulin (CIG) (from serum in the medium) and fibronectin (synthesized by the cells) as detected by immune staining of electrophoretically separated proteins, using antibodies of defined specificity. Serum and SAM contain cross-linked multimers of serum-derived CIG (not disulfide-mediated) but not of cell-derived fibronectin; therefore, thiol-resistant cross-linking between CIG and fibronectin is not involved in adhesion of these cells. Immunofluorescence microscopy of SAM from sparse cultures reveals fibrillar pools containing cellular fibronectin, although most retraction fibers seen on EGTA-treated cells do not stain, even after treatment with non-ionic detergent. Very little specific staining can be detected in SAM prepared from dense cultures, although gel electrophoretic analysis reveals proportionately as much murine fibronectin as is found in SAM from sparse cultures. Hyaluronidase digestion of SAM has no effect on the immunofluorescent staining, while gentle trypsin digestion completely abolishes staining without removing all biochemically detectable fibronectin. We conclude that some of the fibronectin and CIG in adhesion sites is masked and unavailable for antibody binding and that multiple pools of fibronectin exist in this adhesive material.     

Demonstration of fibronectin in normal and injured aorta by an indirect immunoperoxidase technique

The presence and localization of fibronectin in normal and mechanically injured aorta in rabbits was studied using an indirect immunoperoxidase technique on tissue specimens fixed in formaldehyde, embedded in paraffin and pretreated with pepsin. The effect on staining quality of treatment with testicular hyaluronidase prior to immunoperoxidase staining was also examined. In the intima from normal aorta fibronectin was present in the subendothelial basal layer, along the internal and external elastic laminae, around and between the smooth muscle cells of the media and along the collagen and elastic fibres in the adventitia. Sixteen days after a single mechanical dilatation of the descending thoracic aorta all animals developed gross atherosclerotic-like changes. Microscopic examination revealed prominent neo-intimal hyperplasia with subendothelial, cushion-like thickenings but no medial or adventitial alterations. Fibronectin, in increased amounts, was found between and around the endothelial cells and in the subendothelial thickenings between the proliferating smooth muscle cells in relation to the fine, thin elastic and argyrophilic fibres. In the media and adventitia the amount and distribution of fibronectin was indistinguishable from uninjured control aortas. Treatment with testicular hyaluronidase before immunoperoxidase staining resulted in a higher staining resolution in normal and injured aorta. The conspicuous observation in the present study is that fibronectin exclusively accumulates in areas of tissue repair. The origins and functions of fibronectin during tissue injury and repair are discussed.     

The use of monoclonal antibodies against human chorionic gonadotropin for immunoperoxidase staining of normal placenta, pituitary gland, and pituitary adenomas

A monoclonal mouse antibody to human chorionic gonadotropin (hCG) was used in a modified unlabeled antibody enzyme-bridge staining method to demonstrate the localization of hCG in normal human placenta, pituitary gland, and six pituitary chromophobe adenomas. Mouse ascitic fluid containing monoclonal antibody could be diluted up to 1:500,000 for detection of hCG in the syncytiotrophoblast, whereas no staining was observed in the pituitary or adenomas even with high antibody concentrations (dilutions from 1:500 upward). Nonspecific background staining was negligible. These results demonstrate that monoclonal antibodies are suitable for immunohistochemical localization of antigens in tissues.     

Demonstration of immunoreactive sites on cartilage after in vivo administration of biotinylated anti-type II collagen antibodies

Administration of biotinylated monoclonal antibodies provides the basis of a simple technique for identifying immunoreactive sites in vivo. Biotinylated anti-type II collagen antibodies were injected intraperitoneally into normal DBA/1 mice. The mice were sacrificed after 96 hr and the front paws removed and decalcified to allow tissue sectioning before snap-freezing. Binding of antibodies in vivo was visualized with affinity cytochemical staining using avidin-biotin-peroxidase complexes. Specific binding of antibodies to cartilaginous structures was seen after injection of 20-500 micrograms biotinylated monoclonal or polyclonal anti-type II collagen antibodies, but not after injection of a biotinylated control antibody. This technique should further the detection and localization studies of tissue components involved in the dynamics of physiological and pathological processes.     

The Normal Appendix on CT: Does Size Matter?

Purpose

(1) To evaluate the frequency of visualisation and measurements of the normal appendix. (2) To correlate Body Mass Index (BMI) and gender with visualisation of the normal appendix. (3) To correlate age, gender and body length with appendiceal length.

Materials and Methods

A retrospective review of 186 patients undergoing abdominal CT without suspicion of acute appendicitis was done. Frequency of visualisation and measurements (including maximal outer diameter, wall thickness, length, content, location of base and tip) of normal appendices were recorded.

Results

Prevalence of appendectomy was 34.4%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visualisation of the normal appendix were 76%, 94%, 96%, 67%, and 82% respectively. The mean maximal diameter of the appendix was 8.19 mm±1.6 (SD) (range, 4.2–12.8 mm). The mean length of the appendix was 81.11 mm±28.44 (SD) (range, 7.2–158.8 mm). The mean wall thickness of the appendix was 2.22 mm±0.56 (SD) (range, 1.15–3.85 mm). The most common location of the appendiceal tip was pelvic in 66% appendices. The most common location of the appendiceal base was inferior, medial, and posterior in 37%. The normal appendix contained high-density material in 2.2%. There was a significant correlation between gender and appendiceal length, with men having longer appendices than women.

Conclusion

Most normal appendices are seen at multislice CT using IV contrast. The maximal outer diameter of the normal appendix overlaps with values currently used to diagnose appendicitis on CT.     

Antibodies to phospholipids and liposomes: binding of antibodies to cells

Binding of two monoclonal anti-liposome antibodies to the surface of cultured murine peritoneal macrophages was investigated by indirect immunofluorescence and enzyme-linked immunosorbent assay. Neither antibody bound to cultures of freshly explanted, nonadherent macrophages, but immunoreactivity was observed following cell adherence to tissue culture plastic. Fluorescent microscopic evaluation revealed heterogeneity in staining patterns of the antibodies on adherent cells. Binding both to viable and fixed adherent macrophages was observed even after a 10,000-fold dilution of antibody. Treatment of adherent macrophage cultures with trypsin increased antibody binding. Further treatment of trypsinized-macrophages with alkaline phosphatase or neuraminidase did not affect antibody binding, but phospholipase D and, to a greater extent, phospholipase C resulted in a marked decrease in cellular binding. The data indicate that antibodies produced against liposomes appear to bind to surface phospholipids of macrophages, but binding can be influenced by the physiological state of the macrophage and overlying cell surface proteins.