Multiple myeloma with intramedullary masses of M-component

The bone marrow of a patient with light chain myeloma and amyloidosis was substantially infiltrated with basophilic globular particles. The globules, which were confined to the bone marrow, ranged in size from tiny intracytoplasmic inclusions to large (100 mu) extracellular particles. Both the intra- and extracellular globules stained with fluorescent antibody directed against the light chain (kappa) produced by the patient's abnormal clone, and not with other fluorescent antiserums. By electron microscopy, even the largest extracytophasmic globules were bounded at least in part by rough membranes, suggesting that their extreme size was the result of cellular synthesis rather than extracellular coalescence.

The influence of ascorbic acid on platelet structure and function

To determine the effect on platelet behavior of transient exposure of platelets to ascorbic acid, studies of platelet function and ultrastructure were done before exposure to ascorbic acid at pH 6.5, during exposure to pH 6.5, and after restoration of pH to pre-acidification levels. The effect of ascorbic acid (A.A.) was compared to that of HCl and citric acid (C.A.). ADP- and collagen-induced aggregation of normal platelets were significantly impaired by both A.A. and C.A. but were less affected by HCl. The release of 14C-serotonin was significantly reduced by each agent. The ultrastructure of normal platelets brought to pH 6.5 by A.A. was normal. After neutralization, there was marked dilatation of the open channel system and loss of the disc shape. When platelets were brought to pH 6.5 by A.A., then neutralized, the aggregates which formed after stimulation by ADP or collagen were smaller than normal, the platelets were less closely approximated, and degranulation was less complete. The data show that exposure of platelets to ascorbic acid for short intervals impairs their function when measured after restoration of pH to levels compatible with maximal responses. Platelet survival studies using autologous platelets labelled with 51Cr in the presence or absence of ascorbic acid showed that the recovery of normal platelets was unaffected by ascorbic acid, whereas recovery of platelets from patients with idiopathic thrombocytopenic purpura, idiopathic thrombocythemia, and alcohol-related thrombocytopenia was markedly reduced. The injury resulting from the use of ascorbic acid in preparing platelets for studies of platelet survival in patients with disorders affecting platelets may impair the recovery of the cells, resulting in artifactual changes in the survival studies.

Antieosinophil serum and the kinetics of eosinophilia in Schistosomiasis mansoni

Mice were exposed to different intensities of infection with Schistosoma mansoni (10, 50, or 200 cercariae) and the kinetics of peripheral and bone marrow eosinophilia was followed for as long as 20 wk. When the schistosomula (immature worms) were migrating from the lungs to the liver there was a mild, transient eosinophilia, but soon after the onset of egg laying by the schistosomes, a major and prolonged increase in eosinophils occurred. This was terminated in the heavier infections by the death of the animals, but showed a spontaneous decline beginning at 18 wk in the lightly infected mice. The effect of S. mansoni eggs on eosinophilia in the blood, bone marrow, and granulomatous lesions was then examined by injecting schistosome eggs into mice intraperitoneally, subcutaneously, and intravenously. While the host response was dependent on the route by which eggs were administered, primary peripheral and bone marrow responses were seen on intravenous injection, and secondary responses occurred on intravenous and subcutaneous injection. In unsensitized and egg-sensitized mice, eosinophils were first seen around eggs injected into the pulmonary microvasculature at 96 and 24 h respectively. When the granulomas were maximal in size eosinophils made up at least 50% of the lesions. Administration of antieosinophil serum profoundly suppressed eosinophils in the peripheral blood, eliminated mature eosinophils and markedly increased eosinophil precursors in the bone marrow, and ablated eosinophils from the tissue lesions, considerably reducing their area.

The platelet defect in leukemia. Platelet ultrastructure, adenine nucleotide metabolism, and the release reaction

The ultrastructure and adenine nucleotide metabolism of platelets from patients with acute leukemia were studied to elucidate possible mechanisms for the platelet dysfunction observed in this clinical setting. Nonstimulated (resting) platelets from leukemic patients varied greatly in size; exhibited marked variation in the number of alpha granules present per cell; had poorly delineated circumferential bands of microtubules; and often grossly dilated open channel systems or cytoplasmic vacuolization. The intracellular concentrations of ATP and ADP were significantly below normal, and the specific radioactivity of ATP and ADP of nonstimulated platelets in leukemia was equivalent to or exceeded that seen in stimulated normal platelets. Addition of ADP or collagen to platelets from leukemic patients was followed by retarded and incomplete shape change, delayed and incomplete centripetal migration of subcellular organelles, impaired degranulation, and the formation of loose aggregates composed of relatively few platelets. Stimulation of "leukemic" platelets with collagen led to the release of significantly subnormal amounts of ATP and ADP and no significant change in the specific radioactivity of the intracellular nucleotides. In contrast to the results in normal platelets, the conversion of ATP to inosine monophosphate and hypoxanthine in platelets in leukemia failed to increase significantly with collagen stimulation. The results indicate that abnormalities exist in the storage pool of adenine nucleotides and the release mechanism of platelets in acute leukemia. These defects appear to contribute to an impairment in the release reaction in these platelets. Many of the ultrastructural and metabolic defects seen in acute leukemia occur in platelets in preleukemia.

The bone marrow in multiple myeloma: correlation of plasma cell ultrastructure and clinical state

The bone marrow plasma cells of 52 patients with various kinds of monoclonal gammopathies were studied by electron microscopy, and compared to the bone marrow plasma cells of 22 patients with reactive plasmacytosis. Virtually every marrow from patients with myeloma and macroglobulinemia contained plasma cells with disparity between the nuclear maturation and cytoplasmic differentiation. This asynchronous development was not present in plasma cells of reactive marrows nor in plasma cells from patients with megaloblastic anemias. The degree of asynchrony observed in myeloma and macroglobulinemia was proportional to the extent of disease as judged by clinical criteria. For the most part plasma cells of patients with non-myelomatous monoclonal gammopathy failed to exhibit significant asynchrony. These observations are consistent with the view that multiple myeloma is a neoplastic disorder with a definably malignant-appearing cellular proliferation.

Studies on the platelet defect in alcoholism

Platelet ultrastructure, protein composition, and adenine nucleotide metabolism were studied in patients ingesting ethanol to elucidate the mechanism of ethanol-induced changes in platelet function and survival. Serial measurements were made in 2 patients who maintained blood ethanol levels in excess of 300 mg/100 ml for 3 to 4 weeks. No major changes in structure or metabolism were detected in platelets from the patient whose platelet counts remained stable during the ingestion period. By contrast, the development of thrombocytopenia in the other patient was associated with significantly reduced intracellular ADP, increased ATP/ADP ratio, decreased release of ADP, increased specific radioactivity of intracellular ATP and ADP, and increased formation of hypoxanthine. Additionally, platelets from this patient varied markedly in size, contained giant granules, and possessed a poorly defined microtubular system. After stimulation with ADP or collagen, centripetal granule migration was retarded, and the aggregates formed were small and loose. Several large proteins were absent from the supernatant fraction of sonicated platelets from the thrombocytopenic patient. Exposure of normal platelets to ethanol in vitro resulted in no detectable change in platelet ultrastructure. The data indicate that the ethanol-related abnormalities of platelet function are due in part to subnormal amounts of intracellular ADP and a deficit in the storage pool of ADP. Additionally, the results suggest that impairment in the release mechanism to the observed defect in the release reaction.

Hemochromatosis. Pathophysiologic and genetic considerations

The clinical, genetic, and pathologic findings, and the pertinent case histories in two families with idiopathic hemochromatosis are presented. These studies support the view that idiopathic hemochromatosis is a disease inherited in at least two ways. In one of these families, inheritance appeared to occur in an autosomal recessive manner, whereas in the other, autosomal dominant expression seemed evident. Evidence that an inability of the reticuloendothelial cells to handle iron may play a major role in the pathogenesis of hemochromatosis is presented. The early age of onset and poorer prognosis associated with the recessive inheritance suggest that the defect in reticuloendothelial cell function present in such cases is different from or more severe than those associated with dominant inheritance.

Normal peritoneal lymphocytes: A population with increased capacity for endocytosis

The existence of lymphocyte to macrophage transformation among normal peritoneal lymphocytes (NPLs) was considered. We described the conditions under which pinocytosis of the enzyme tracer horseradish peroxidase (HRP) and phagocytosis of latex particles by NPLs occurred and compared these data with results obtained with splenic lymphocytes (SpLs), a better characterized source of lymphocytes. In the presence of relatively large concentrations (200 mug/ml to 1 mg/ml) of HRP, at least three times as many NPLs took up the protein by pinocytosis as did corresponding SpLs. Also, on the average, NPLs took up about twice as much HRP per cell than did SpLs. The uptake was rapid, and pinocytotic vesicles containing HRP were seen as early as 15 minutes after exposure to the tracer in NPLs but not in SpLs. In contrast to peritoneal macrophages, NPLs retained HRP in a variety of cytoplasmic vesicles and vacuoles in relatively undegraded form for at least 24 hours. Finally, if NPLs, which were nonphagocytic when freshly isolated, were cultured for 24 hours, both erythrophagocytosis and phagocytosis of latex spheres were observed. The cells which had taken up the latex were nonadherent to plastic, resembled lymphocytes ultrastructurally and were peroxidase negative. We concluded that under these culture conditions, NPLs had not transformed into morphologic macrophages, but phagocytic lymphocytes.

Fibrinogen Cleveland II. An abnormal fibrinogen with defective release of fibrinopeptide A

An abnormal fibrinogen (fibrinogen Cleveland II) was detected in the plasma of a 23-yr-old white man with a mild bleeding diathesis. The one-stage prothrombin time, thrombin time, and Reptilase time were all prolonged. 16 of 24 tested relatives had the defect, which appeared to be transmitted as an autosomal dominant characteristic. The thrombin time of normal plasma was slightly inhibited by the proband's plasma. The abnormally long thrombin time of fibrinogen Cleveland II was partially corrected by addition of calcium ions. Fibrinogen Cleveland II was indistinguishable from normal fibrinogen by immunoelectrophoresis, DEAE-cellulose column chromatography, or polyacrylamide gel electrophoresis of reduced fibrinogen in sodium dodecyl sulfate. The major defect detected appeared to be impaired release of fibrinopeptide A when fibrinogen Cleveland II was incubated with thrombin. This defect was localized to the NH(2)-terminal disulfide knot portion of the molecule. An abnormality of polymerization of fibrin monomers was also present, but the abnormal fibrin demonstrated relatively normal crosslinking. Despite these defects, fibrinogen Cleveland II achieved a degree of coagulability similar to normal fibrinogen and appeared to incorporate some molecules of fibrin with intact fibrinopeptide A into the clot. The fibrin clot that was formed appeared to be abnormal by electron microscopy. These functional defects and other descriptive characteristics appear to distinguish fibrinogen Cleveland II from other inherited abnormal fibrinogens.

Peroxidase arthritis. 3. Sequential changes in cellular composition of the developing inflammatory infiltrate

Repeated daily injections of horseradish peroxidase into rabbit knee joints lead to a characteristic sequence of cellular events. Early transient infiltration with polymorphonuclear leukocytes was followed by a progressive increase in the number of macrophages. This appeared to represent, at least in part, a consequence of increased emigration of monocytes. Subsequently, increasing numbers of lymphocytes appeared. Many of the lymphocytes had frequent cytoplasmic polyribosomes. By the eighth or ninth day, immunoblasts, plasmablasts and immature plasma cells were observed; cytochemical evidence of local specific antibody synthesis first was demonstrated in such cells at this stage. These results demonstrate the sequential cellular events in an immunologic inflammatory response to local antigen. Questions remain concerning the stimulus for early monocyte emigration and macrophage accumulation, and the site of initial sensitization of lymphocytes; these problems are discussed.

Arthus synovitis with horseradish peroxidase as antigen: sequential participation of platelets and leucocytes

Direct, active Arthus reactions in response to horseradish peroxidase were studied in the synovial membranes of rabbits. In tissues examined 15 to 30 minutes after antigen injection, immune precipitates were prominent in and about the superficial capillaries. Those within the lumen often lacked peroxidase activity, suggesting that they were formed in antibody excess. In contrast, precipitates within the vessel walls and in the interstitial tissues possessed peroxidase activity, probably reflecting the presence of a greater proportion of antigen. Intraluminal precipitates were associated with aggregated platelets, some of which were degranulated. Junctional gaps between endothelial cells were frequent in the involved vessels. At intervals of one to 6 hours after antigen injection, continued deposition of immune precipitates was associated with emigration of polymorphonuclear leucocytes, thrombosis and haemorrhage. In contrast to the events observed at early intervals, these phenomena were most prominent in the deeper subsynovial venules. Early increased vascular permeability associated with immunologically mediated degranulation of platelets appears to facilitate the development of Arthus vasculitis in this system.

Peroxidase arthritis. II. Lymphoid cell-endothelial interactions during a developing immunologic inflammatory response

The interaction of lymphoid cells with vascular endothelium was studied during the development of immunologic synovitis in response to repeated intraarticular injections of a heterologous protein antigen. Lymphoid cells emigrated in venules and small veins, both by penetrating the endothelial cytoplasm and by traversing intercellular junctions. Frequent endothelial mitoses were coincident with lymphoid cell emigration. Endothelial cells in the involved vessels increased in number and bulged prominently into the vascular lumen. Endothelial nuclei contained dispersed chromatin and prominent nucleoli; the cytoplasm contained many vacuoles and abundant polyribosomes and rough-surfaced endoplasmic reticulum. Intercellular junctions were numerous and complex. These phenomena were prominent in rabbits studied after 12 to 16 daily injections; they then receded, despite continued antigenic stimulation. In animals studied after 35 or 37 daily injections, the venules appeared relatively normal, and lymphoid cell emigration was observed infrequently. Growth of new vessels was prominent at this stage. The present data do not establish whether the endothelial changes were the cause or the result of lymphoid cell emigration, although the latter seems more likely. Further studies are needed to elucidate the exact nature of these interactions.

Peroxidase arthritis. I. An immunologically mediated inflammatory response with ultrastructural cytochemical localization of antigen and specific antibody

Synovitis was produced in rabbits by daily intra-articular injections of the heterologous antigen horseradish peroxidase. The resulting "peroxidase arthritis" resembled rheumatoid arthritis histologically. Many of the subsynovial plasma cells, plasmablasts and immunoblasts contained specific antibody to horseradish peroxidase; the remainder appeared to contain immunoglobulins of other specificities. Peroxidase arthritis has unique advantages for the study of the cellular and subcellular events in the pathogenesis of the local immune inflammatory response to heterologous antigen. Antigen and specific antibody can be localized precisely by ultrastructural cytochemical technics. The reaction can be terminated at any stage, permitting observation of the early events in its pathogenesis.

Spectrum and possible mechanism of carrageenan cytotoxicity

Carrageenan, a sulfated polygalactose which suppresses established delayed hypersensitivity in vivo, is shown to be cytotoxic to macrophages but not to lymphocytes in vitro. This cytotoxicity depends on the carrageenan concentration and degree of lysosomal differentiation but is independent of serum. Survival of macrophages in the presence of carrageenan can be enhanced temporarily by corticosteroids. Ultrastructural studies reveal that carrageenan is readily taken up by macrophages and stored in lysosomes, which subsequently swell and rupture, apparently resulting in cell death. The presence of corticosteroids temporarily retards lysosome swelling. It is suggested that carrageenan may exert its cytotoxic effect by causing osmotic rupture of lysosomes. The possible immunologic significance of these findings is discussed.