Extracorporeal membrane oxygenation for nonneonatal acute respiratory failure

HYPOTHESIS

Extracorporeal membrane oxygenation (ECMO) is effective in nonneonatal acute respiratory failure under certain circumstances.

DESIGN

Retrospective medical record review.

SETTING

The intensive care unit of a tertiary care hospital.

PATIENTS

Thirty-four nonneonatal patients (mean age, 22 years; range, 8 days to 56 years), with ratios of the PaO2 to the fraction of inspired oxygen persistently below 70, who were treated with ECMO after maximal ventilator therapy had failed (mean time of ventilator therapy, 6.9 days; range, 1-41 days). The mean ECMO duration was 304 hours (range, 56-934 hours). Patients were grouped into 7 categories based on their diagnosis: sepsis or sepsis syndrome (n = 3), bacterial or fungal pneumonia (n = 10), viral pneumonia (n = 5), trauma or burn (n = 2), inhalation injury without burn (n = 1), immunocompromised state (due to transplantation or chemotherapy) (n = 8), and acute respiratory failure of unknown origin (n = 5).

MAIN OUTCOME MEASURE

Survival to hospital discharge following ECMO therapy.

RESULTS

Overall survival was 53% (18 patients). All 6 patients (100%) with viral pneumonias or isolated inhalation injuries survived. Of 13 patients with bacterial pneumonia, sepsis, or sepsis syndrome not complicated by multiorgan failure, 10 (77%) survived. In contrast, all but 1 of the immunocompromised patients died. Survival in patients who were intubated for less than 9 days before ECMO was 64%, whereas survival fell precipitously to 22% for patients who experienced mechanical ventilation for 9 or more days before the implementation of ECMO. Finally, the proportion of patients who died while receiving ECMO therapy was greater when the ECMO duration exceeded 300 hours (62% vs. 38%; P<.05).

CONCLUSIONS

Nonneonatal survival with ECMO therapy is strongly dependent on the diagnosis. Pre-ECMO intubation for less than 9 days had little effect on survival. Survival rates decreased when the length of time of receiving ECMO exceeded 300 hours.

Prenatal vitamin E treatment improves lung growth in fetal rats with congenital diaphragmatic hernia

PURPOSE

Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia. To discover factors that would accelerate fetal lung growth, the authors developed models of hypoplasia, found that antioxidants improved lung growth in vitro, and then proceeded to in vivo studies.

METHODS

Timed-pregnant rats were fed nitrofen (100 mg) on gestational day 9.5 (term, 22), and fetal lungs were harvested at day 13.5 and placed in organ culture in serum-free media with (n = 10) or without (n = 9) additional vitamin E (0.134 IU/mL). Camera lucida tracings were made daily on live, unstained lungs for 4 days, scanned, digitized, and analyzed for multiple growth parameters. Similar nitrofen-exposed rats were fed an optimized total dose of 150 IU vitamin E (n = 19) or olive oil (n = 13) from days 16.5 to 20.5, and fetal lungs were harvested at day 21.5, weighed and fixed for histology, or homogenized and biochemically analyzed.

RESULTS

Vitamin E accelerated hypoplastic fetal lung growth in vitro as measured by area, perimeter, lung bud count, perimeter over square root area, and fractal dimension. In vivo vitamin E significantly increased lung weights, total DNA, and protein contents.

CONCLUSIONS

Vitamin E accelerates hypoplastic fetal rat lung growth and complexity in vitro, and prenatal vitamin E treatment in vivo improves pulmonary hypoplasia in fetal rats with CDH.

Association of apolipoprotein A phenotypes and oxidized low-density lipoprotein immune complexes in children

BACKGROUND

Small apolipoprotein A (apo [A]) phenotypes and oxidized low-density lipoprotein immune complexes (oxLDL-ICs) are known to be associated with the development of atherosclerosis in adults. Presence of these factors in children and their relationships with other known cardiovascular risk factors have not been well documented.

OBJECTIVE

To examine the relationship of oxLDL-ICs with apo(A) phenotypes and other known cardiovascular risk factors in children.

DESIGN

A survey of asymptomatic 9- to 11-year-old children, randomly selected from a cohort of children stratified based on family history of premature coronary artery disease.

SETTING

A preventive medicine research institute.

PARTICIPANTS

Thirty-five children with or without a family history of premature coronary artery disease who are participating in a longitudinal cardiovascular health study.

MAIN OUTCOME MEASURES

The influence of apo(A) phenotypes on plasma levels of oxLDL-ICs after controlling for lipid/lipoprotein levels, percentage of body fat, and physical fitness.

RESULTS

Oxidized low-density lipoprotein immune complexes were significantly correlated with the levels of total cholesterol (r = 0.56, P< or =.05), low-density lipoprotein cholesterol (r = 0.64, P< or =.01), and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (r = 0.54, P<.05). Oxidized low-density lipoprotein immune complexes were also correlated with total cholesterol high-density lipoprotein cholesterol (r = 0.49, P< or =.06) and percentage of body fat (r = 0.48, P< or =.06). However, they achieved only a borderline level of statistical significance after adjustment for multiple comparisons. Multiple regression analysis demonstrated that small apo(A) phenotypes, levels of low-density lipoprotein cholesterol, and family history of premature coronary artery disease explained 54% of the variation of oxLDL-ICs using a parsimonious model (P = .001).

CONCLUSIONS

Significant correlations exist between oxLDL-ICs and known cardiovascular risk factors in children. The association of oxLDL-ICs with the genetically controlled small apo(A) phenotype suggests that the genetic predisposition to immune complex formation may be an important determinant of future coronary artery disease.

Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome

OBJECTIVE

To define the incidence, prophylaxis, and treatment of intra-abdominal hypertension (IAH) and its relevance to gut mucosal pH (pHi), multiorgan dysfunction syndrome, and the abdominal compartment syndrome (ACS).

METHODS

Seventy patients in the SICU at a Level I trauma center (1992-1996) with life threatening penetrating abdominal trauma had intra-abdominal pressure estimated by bladder pressure. pHi was measured by gastric tonometry every 4 to 6 hours. IAH (intra-abdominal pressure> 25 cm of H2O) was treated by bedside or operating room laparotomy.

RESULTS

Injury severity was comparable between patients who had mesh closure as prophylaxis for IAH (n = 45) and those who had fascial suture (n = 25). IAH was seen in 10 (22.2%) in the mesh group versus 13 (52%) in the fascial suture group (p = 0.012) for an overall incidence of 32.9%. Forty-two patients had pHi monitoring, and 11 of them had IAH. Of the 11 patients, eight patients (72.7%) had acidotic pHi (7.10 +/- 0.2) with IAH without exhibiting the classic signs of ACS. The pHi improved after abdominal decompression in six and none developed ACS. Only two patients with IAH and low pHi went on to develop ACS, despite abdominal decompression. Multiorgan dysfunction syndrome points and death were less in patients without IAH than those with IAH and in patients who had mesh closure.

CONCLUSIONS

IAH is frequent after major abdominal trauma. It may cause gut mucosal acidosis at lower bladder pressures, long before the onset of clinical ACS. Uncorrected, it may lead to splanchnic hypoperfusion, ACS, distant organ failure, and death. Prophylactic mesh closure of the abdomen may facilitate the prevention and bedside treatment of IAH and reduce these complications.

Crystallization of an intact GST-estrogen receptor hormone binding domain fusion protein

Crystals of an intact GST-estrogen receptor hormone binding domain fusion protein have been grown from solutions of MPD. The crystals grew as clusters of thin plates and needles of maximum dimensions 100 x 20 x 1 micrometer but were unsuitable for X-ray diffraction analysis. However, examination by electron microscopy shows an ordered lattice in which the protein molecules are clearly visible. Image analysis of electron micrographs of the protein crystals revealed electron stain-excluding density which showed a two-domain trimeric structure in projection, with each molecule of dimensions 12.0 x 5.0 nm diameter. The use of GST-fusion proteins in crystallisation are discussed.

Aziridinyl steroid-induced lesions in DNA and apoptosis in promyelocytic leukemia cells

Variety of synthetic steroids are reported to be mutagenic as well as carcinogenic. The mutagenic and carcinogenic nature of these compounds have been related to their potential of being reactive to genetic material and production of reactive oxygen species. Here we have analyzed the action of aziridinyl steroid on calf thymus DNA and human promyelocytic leukemia cell line HL-60 under in vitro conditions. Calf thymus DNA when treated with various doses of aziridinyl steroid induced a high degree of stand separation and sensitivity/susceptibility to S1 nuclease hydrolysis. The treatment also induced an increasing number of strand breaks per molecule of DNA as determined by alkaline unwinding assay. Relatively higher doses of steroid, however, displayed a reduced susceptibility to S1 nuclease hydrolysis and did not increase the number of strand breaks in DNA. Moreover, the high dose treatments result increased melting temperature and an enhanced rate of reanealing after thermal denaturation, indicating that interstrand crosslinks are induced at higher doses of steroid treatment. Moreover, steroid treatment caused cell death in human promyelocytic leukemia cell line HL-60 and induced DNA degradation, characteristic of apoptosis. The test steroid has the ability to produce reactive oxygen intermediates (ROI) as determined by chemical methods. Incorporation of oxygen radical scavengers into the system blocked the damaging effect of steroid in calf thymus DNA and HL-60 cells. These observations strongly suggest that aziridinyl steroid, a pharmaceutical, damages mammalian DNA and induces apoptosis by the production of ROI in the test system.

Prevalence of Helicobacter pylori in asymptomatic population--a pilot serological study in Bangladesh

Epidemiological reports reveal that H. pylori is distributed among all population in the world. The present cross-sectional study was undertaken to see the H. pylori seroprevalence rates among the asymptomatic adults, as yet reportedly no such data available in Bangladesh. Serum samples were collected from 181 consecutive subjects who attended at the health check-up centre of Bangladesh Institute of Diabeties, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, during the period of August to November 1995 for medical check up. The mean age of these subjects was 30.33 years (range 20-44 yrs). Incidentally all were male and belonged to average socioeconomic class. H. pylori specific IgG antibody level was assayed by an enzyme immunoassay kit ElAgen (Clone system). Among the 181 subjects, 166 (92%) had H. pylori specific antibodies and 15 (8%) were seronegative. No significant difference (p < 0.90) in seroprevalence rates was observed among different age groups. However, the results of higher seroprevalence rates of H. pylori infection in these asymptomatic adult population of Bangladesh are consistent with that of Africa and India.

Shelf-life of pre-cooked rice oral rehydration salt packets

The shelf-life of pre-cooked rice oral rehydration salts (ORS) at the household level was studied in urban Dhaka. To prepare the packets, cooked rice was dried and ground to fine powder and the salt ingredients were mixed according to the World Health Organization formulation. For each half liter packet, 10 g glucose was replaced by 25 g of instant cooked rice powder. The packets were kept in different environments for three months among 30 households of varying socioeconomic status. At monthly intervals, two packets from each family were collected for laboratory tests. Physical characteristics of ORS such as color and dispersibility remained the same throughout the three month study period. However, in the third month flavor changed slightly. The electrolyte concentration of the prepared solution remained the same at the end of the first, second and third months. However, progressive but minimal increase in moisture content of the packets was noted over the allotted time period. This increase in moisture was less when the mixture was packed in double thin layer polythene bags as opposed to the single layer bags. In conclusion, the shelf-life of pre-cooked rice ORS remains stable at least up to three months when stored at the household level. Therefore, pre-cooked rice ORS can be kept at households for future use in the event of diarrheal episodes.

Noninvasive assessment of gastric acid secretion in man. Application of electrical impedance tomography (EIT)

Electrical impedance tomography (EIT) is a tubeless technique that generates tomographic images of gastric resistivity. We investigated the application of EIT to measure gastric acid secretion. Nineteen normal subjects underwent a standard intubation test. Basal acid output (BAO) and stimulated acid output (SAO) (millimoles per hour) were measured before and after pentagastrin, respectively. On a different day, EIT was performed before (basal) and after pentagastrin (stimulated). The changes in impedance over time were measured and the area under the curve (AUC) was calculated. Both the tests were repeated in 13 subjects after omeprazole treatment. As in the intubation test, there was the expected increase in AUC value after pentagastrin (basal vs stimulated; 1.2 +/- 2.8 vs 731 +/- 297, P < 0.0001). A significant fall in acid output and AUC following omeprazole pretreatment was observed (without vs with omeprazole; 20.5 +/- 5.7 vs 0.03 +/- 0.06, P < 0.0001 for intubation test and 731 +/- 297 vs 44 +/- 172, P < 0.0001 for EIT). There was a significant correlation between SAO and the delta AUC with (r = 0.65 P < 0.001) or without (r = 0.95, P < 0.001) omeprazole and in all the experiments (r = 0.87, P < 0.001). This study demonstrates the predictable change of gastric impedance and may be useful as a noninvasive test for measuring gastric acid secretion.

Determinants of endothelium-dependent femoral artery vasodilation in youth

OBJECTIVE

Decreased endothelium-dependent arterial dilation to reactive hyperemia has been shown in adults to be associated with various manifestations of cardiovascular diseases and cardiovascular risk factors. In a sample of children, we examined the relationships between flow-mediated femoral artery dilation and anthropometric, demographic, cardiovascular, and serum lipid variables that have been associated with cardiovascular diseases.

METHOD

Thirty-three asymptomatic, healthy 11 to 14 years olds were randomly selected from participants in a longitudinal cardiovascular health study. There were 17 boys and 16 girls; 21 whites and 12 blacks. Sixteen had documented family history of premature myocardial infarction (ie, < or = 55 years of age) in first-degree relatives and 17 did not. Measurements included fasting lipids, anthropometrics, blood pressure and heart rate at rest and during supine exercise, postural change, and forehead cold stimulation. Femoral artery dilation to reactive hyperemia was measured via high resolution ultrasound.

RESULTS

Bivariate analyses indicated flow-mediated dilation was negatively correlated with systolic pressure increases to postural change, forehead cold stimulation and dynamic exercise, greater average skinfold thickness, and body fat via dual x-ray absorptiometry and positively correlated with cardiovascular fitness (all ps < .05). Stepwise multiple regression revealed that cardiovascular fitness and systolic pressure reactivity to exercise significantly predicted flow-mediated dilation accounting for 31% of the variance (p < .01).

CONCLUSIONS

Decreased flow-mediated dilation is associated with decreased cardiovascular fitness, increased systolic pressure reactivity to various stressors, and increased indices of body fatness in asymptomatic youth. Further research is warranted to better understand early relationships between this noninvasive measure of endothelial function and cardiovascular risk factors in youth.

Analysis of external optical feedback characteristics of asymmetric, quarter-wave-shifted, distributed-feedback semiconductor lasers

External optical feedback sensitivity is analyzed for a quarter-wave-shifted, index-coupled, distributed-feedback semiconductor laser with asymmetries in reflectivity of facets and in the position of a lambda/4 phase shift. Proper asymmetric structures can withstand higher levels of external optical feedback compared with symmetric structures. However, the mode discrimination and yield are reduced for asymmetric lasers because of statistical variation of the corrugation phases at the reflecting facets.

Weight-independent cardiovascular fitness and coronary risk factors

BACKGROUND

It is unclear whether cardiovascular fitness influences risk factors for coronary artery disease and non-insulin-dependent diabetes mellitus independently of level of body fat because fitness is often measured in tasks that involve moving body weight (eg, running) and because body weight and level of body fat are correlated.

OBJECTIVE

To measure fitness during a task in which body weight was controlled experimentally (ie, supine cycling).

DESIGN

Cross-sectional.

PARTICIPANTS

Seventy-four children, 7 to 13 years of age, recruited through school flyers and newspaper advertisements, varying in level of body fat from 7% to 61%. There were 31 boys and 43 girls; 35 were white and 39 were black.

MAIN INDEPENDENT VARIABLES

Cardiovascular fitness was expressed as submaximal heart rate while cycling at a power output of 49 W, and level of body fat was measured with dual x-ray absorptiometry.

MAIN OUTCOME MEASURES

Blood pressure and levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, insulin, glucose, and glycohemoglobin.

RESULTS

Controlling for age and sex, level of body fat was significantly (P < .01) related to unfavorable levels of systolic blood pressure (r = 0.32), triglycerides (r = 0.42), high-density lipoprotein cholesterol (r = -0.31), insulin (r = 0.50), and total cholesterol to high-density lipoprotein cholesterol ratio (r = 0.37); submaximal heart rate was not significantly correlated with any of the other variables.

CONCLUSIONS

When cardiovascular fitness was measured in a weight-independent task, it was not significantly related to level of body fat or the major coronary artery disease and non-insulin-dependent diabetes mellitus risk factors. In addition, we confirmed previous findings that higher levels of body fat are associated with a very unfavorable risk profile.

Glutamine is superior to glucose in stimulating water and electrolyte absorption across rabbit ileum

L-Glutamine is the primary metabolic fuel of the intestinal mucosa. This in vivo study compares the effect of L-glutamine 50 mM with that of D-glucose 50 mM on water and electrolyte absorption in jejunal and ileal loops of healthy rabbits. Using polyethylene glycol (PEG) as a nonabsorbable marker and an incubation at 37 degrees C, we found that absorption of water (P = 0.000), sodium (P = 0.002), potassium (P = 0.001), and chloride (P = 0.003) from the glutamine electrolyte solution was greater than from the glucose electrolyte solution in the ileum. A similar trend was shown in the jejunum. We conclude that L-glutamine may be a useful component to be tested in oral rehydration solutions for treating diarrheal dehydration.

Expression of N-cadherin by human squamous carcinoma cells induces a scattered fibroblastic phenotype with disrupted cell-cell adhesion

E-cadherin is a transmembrane glycoprotein that mediates calcium-dependent, homotypic cell-cell adhesion and plays an important role in maintaining the normal phenotype of epithelial cells. Disruption of E-cadherin activity in epithelial cells correlates with formation of metastatic tumors. Decreased adhesive function may be implemented in a number of ways including: (a) decreased expression of E-cadherin; (b) mutations in the gene encoding E-cadherin; or (c) mutations in the genes that encode the catenins, proteins that link the cadherins to the cytoskeleton and are essential for cadherin mediated cell-cell adhesion. In this study, we explored the possibility that inappropriate expression of a nonepithelial cadherin by an epithelial cell might also result in disruption of cell-cell adhesion. We showed that a squamous cell carcinoma-derived cell line expressed N-cadherin and displayed a scattered fibroblastic phenotype along with decreased expression of E- and P-cadherin. Transfection of this cell line with antisense N-cadherin resulted in reversion to a normal-appearing squamous epithelial cell with increased E- and P-cadherin expression. In addition, transfection of a normal-appearing squamous epithelial cell line with N-cadherin resulted in downregulation of both E- and P-cadherin and a scattered fibroblastic phenotype. In all cases, the levels of expression of N-cadherin and E-cadherin were inversely related to one another. In addition, we showed that some squamous cell carcinomas expressed N-cadherin in situ and those tumors expressing N-cadherin were invasive. These studies led us to propose a novel mechanism for tumorigenesis in squamous epithelial cells; i.e., inadvertent expression of a nonepithelial cadherin.

Duodenal perforation caused by nasogastric intubation

We present a case of duodenal perforation following nasogastric intubation. This complication has not been previously reported in adults.

Intestinal transport of water, sodium & glucose from an electrolyte solution with & without bicarbonate

In this study we have evaluated the role of bicarbonate on water and sodium transport in normal and secreting ilea of rabbits as controversy exists regarding the inclusion of bicarbonate in oral rehydration solution (ORS). In anaesthetized rabbits 10 cm closed ileal loops were constructed and filled with 5 ml of an electrolyte solution with and without bicarbonate, which contained polyethylene glycol (PEG; mol wt 4,000) as a non-absorbable marker. The fluid was withdrawn after an hour and analyzed for PEG, sodium and glucose. Similar studies were carried out in loops one hour after exposure to 1 microgram/ml of purified cholera toxin. Body temperature was maintained at 37 degrees C during the experiment by using a lamp. The mean +/- SE of water and sodium absorption, with bicarbonate versus without bicarbonate, was -1.4 +/- 0.1 vs -1.1 +/- 0.3 ml/h/10 cm, and -340.8 +/- 23.0 vs -308.4 +/- 35.6 mM/h/10 cm, respectively from secreting rabbit ilea. A similar effect was observed in normal ilea. It is concluded that bicarbonate containing electrolyte solution has no additional promoting effect on water and sodium absorption in normal or secreting ilea of rabbits.

Acute cholecystitis resulting from hemobilia after tru-cut biopsy: a case report and brief review of the literature

Acute cholecystitis following hemobilia is very rare, with only five cases reported in the literature. A case report of a 22-year-old woman who underwent a liver biopsy for staging of Hodgkin's lymphoma and developed cholecystitis due to hemobilia is presented. The incidence of hemobilia has increased with the advent of more invasive hepatobiliary procedures, but the mortality has been decreasing due to better recognition and therapy. Acute cholecystitis associated with hemobilia is very rare, but will be seen with increasing frequency; and a high index of suspicion needs to be maintained to ensure timely diagnosis and treatment.

A prospective randomized study of end points of resuscitation after major trauma: global oxygen transport indices versus organ-specific gastric mucosal pH

BACKGROUND

Gastric tonometry, as a method of organ-specific monitoring of the status of the splanchnic circulation, has demonstrated prognostic and therapeutic implications in critically ill patients. The experience with this method in patients with trauma has been limited.

STUDY DESIGN

Fifty-seven patients were prospectively randomized into two groups: group 1, n = 30, normalization and maintenance of gastric mucosal pH (pHi) at or above 7.3 and group 2, n = 27, maintenance of oxygen delivery index of 600 or an oxygen consumption index of greater than 150. The groups had statistically similar injury severity scores, lactate levels, and base deficits.

RESULTS

Of the 44 patients with pHi greater than 7.3 at 24 hours, three (6.8 percent) died of multiple organ dysfunction syndrome as compared with seven (53.9 percent) of 13 in whom pHi was not optimized, p = 0.006. Optimization times for oxygen delivery index, oxygen consumption index, lactate levels, and base excess were similar between survivors and nonsurvivors. The time for pHi optimization was significantly longer in nonsurvivors. Multiple organ dysfunction syndrome points were significantly higher in patients who did not have pHi optimized within 24 hours (6.08 compared with 2.5, p = 0.03). Optimization time for pHi was predictive of mortality on multiple regression. Persistently low pHi was frequently associated with systemic or intra-abdominal complications. It was the first finding in all the nonsurvivors at least 48 to 72 hours before death.

CONCLUSIONS

Gastric mucosal pH may be an important marker to assess the adequacy of resuscitation. Monitoring of pHi may provide early warning for systemic complications in the postresuscitation period.

Parasuicide in Pakistan: experience at a university hospital

There have been few reports of parasuicide from Pakistan, where the act is considered to be a criminal offence and the Islamic religion strongly disapproves of it. In order to address the problem, a retrospective case report analysis of all index cases of parasuicide presenting over a period of 3.5 years to a university hospital in Karachi, Pakistan, was undertaken. Our results showed that most of the subjects were young adults, with married women representing the single largest group. Self-poisoning with medication was the most common method, and benzodiazepines the most frequently used drug. Interpersonal conflict with the opposite sex was the most common precipitating cause. In Pakistani culture, marriage appears to be a significant source of stress for women. Reports based on official police records do not reflect the true picture of the problem in Pakistan.

Enhanced fidelity of 3TC-selected mutant HIV-1 reverse transcriptase

Monotherapy with (-)2',3'-dideoxy-3'-thiacytidine (3TC) leads to the appearance of a drug-resistant variant of human immunodeficiency virus-type 1 (HIV-1) with the methionine-184 --> valine (M184V) substitution in the reverse transcriptase (RT). Despite resulting drug resistance, treatment for more than 48 weeks is associated with a lower plasma viral burden than that at baseline. Studies to investigate this apparent contradiction revealed the following. (i) Titers of HIV-neutralizing antibodies remained stable in 3TC-treated individuals in contrast to rapid declines in those treated with azidothymidine (AZT). (ii) Unlike wild-type HIV, growth of M184V HIV in cell culture in the presence of d4T, AZT, Nevirapine, Delavirdine, or Saquinavir did not select for variants displaying drug resistance. (iii) There was an increase in fidelity of nucleotide insertion by the M184V mutant compared with wild-type enzyme.

Morphological study of thymus stromal cells (TEL-2 cell) which play a role in the elimination of double positive immature thymocytes by phagocytosis

BACKGROUND

The process of the selective elimination of immature double positive thymocytes, during culture with TEL-2 cells (an epithelial cell line from the thymus stroma), is initiated by the contact between thymocytes and TEL-2 cells (Nakashima et al. 1990 Eur. J. Immunol., 20: 47-53; Hirata et al. 1991 Anat. Rec., 230: 524-530).

METHODS

Our approach was to follow the process of thymocyte internalization as a sequelae of this interaction with scanning electron microscopy (SEM), transmission electron microscopy (TEM), and electron microscopic cytochemistry for the hydrolytic enzyme acid phosphatase (Ac Pase).

RESULTS

With SEM, numerous thymocytes lay underneath the TEL-2 cells. An enhanced activity of the TEL-2 cell membrane, consisting of several thin thread-like projections either with or without an expanded termination, was involved with contacting the thymocytes. With TEM, close appositions were noted either at adjacent segments of the cellular membrane or between thick plump local protrusions of the plasma membrane. Blunt pseudopodia and deep invaginations on indented portions of the TEL-2 surface engulfed one or more thymocytes. With Ac Pase histochemistry: 1) the incorporation of thymocytes into a phagosome was indicated by the Ac Pase negative thymocytes enclosed in a membrane beneath the protuberance of a TEL-2 cell surface without fusion to the TEL-2 lysosomes; 2) most of these thymocytes were morphologically intact, whereas the rest were already damaged, having changes similar to apoptosis; and 3) a few Ac Pase positive dense bodies of the TEL-2 cell, mostly with the morphology of secondary lysosomes, fused with the thymocyte-enclosing membrane after which the digestion of several thymocytes proceeded.

CONCLUSIONS

With the prominent activity of the plasma membrane involving the initial attachment and subsequent phagocytosis, a murine thymic epithelial cell line TEL-2 plays a demonstrating role in the mechanism of the elimination of double positive thymocytes.