B-cell superantigens may play a role in B-cell development and selection in the young rabbit appendix

In order to develop protective antibodies against a wide range of potentially infectious pathogens, the young rabbit must diversify a limited initial repertoire by somatic mechanisms (the high copy number primary repertoire). The majority of rabbit B cells produce heavy chain variable regions by rearranging the VHa allotype-encoding VH1 gene. Thus in normal rabbits the majority of serum immunoglobulins bear VHa allotype (due to VH1 FR1 and FR3 sequences). The young rabbit appendix is a site of diversification of rearranged VH genes by gene-conversion-like and somatic hypermutation mechanisms. The newly generated B cells probably undergo selection processes that involve foreign and self-antigens and superantigens. We find preferential expansion and survival of B cells in normal and VH-mutant ali/ali rabbits based on their heavy chain FR1 and FR3 sequences (VHa allotype). This selection may involve "superantigen"-like interactions with endogenous as well as exogenous ligands.

Rabbit appendix: a site of development and selection of the B cell repertoire

As early as 1963, it was proposed that the rabbit appendix was a homologue of the chicken bursa of Fabricius (ARCHER et al. 1963). The finding that the young rabbit appendix was thymus independent contributed to the concept of central primary lymphoid tissue. Today we know that appendix is a site that generates the high copy number primary repertoire through diversification of rearranged VH genes by gene conversion-like and somatic hypermutation mechanisms. Thus the appendix of young rabbits functions as a mammalian bursal equivalent. In the appendix, newly generated B cells also undergo selection processes involving self and foreign antigens and superantigens. Preferential expansion and survival of B cells in normal and mutant ali rabbits based on FR1 and FR3 expression may involve "superantigen"-like interactions with endogenous and exogenous ligands. One endogenous ligand appears to be CD5. Additional ligands may be produced by gut flora. Further studies in the rabbit model are needed to determine the fates of emigrants from primary GALT, their sites of postulated self-renewal in the periphery, and the nature of secondary diversification in secondary germinal centers where populations of B lymphocyte memory cells may develop. These data may also be helpful in understanding how the repertoire of human B cells is formed and how this repertoire might be manipulated for clinical benefit.

VH mutant rabbits lacking the VH1a2 gene develop a2+ B cells in the appendix by gene conversion-like alteration of a rearranged VH4 gene

We investigated the molecular basis for the appearance of V(H)a2 allotype-bearing B cells in mutant Alicia rabbits. The mutation arose in an a2 rabbit; mutants exhibit altered expression of V(H) genes because of a small deletion encompassing V(H)1a2, the 3'-most gene in the V(H) locus. The V(H)1 gene is the major source of V(H)a allotype because this gene is preferentially rearranged in normal rabbits. In young homozygous ali/ali animals, the levels of a2 molecules found in the serum increase with age. In adult ali/ali rabbits, 20 to 50% of serum Igs and B cells bear a2 allotypic determinants. Previous studies suggested that positive selection results in expansion of a2 allotype-bearing B cells in the appendix of young mutant ali/ali rabbits. We separated appendix cells from a 6-wk-old Alicia rabbit by FACS based on the expression of surface IgM and a2 allotype. The VDJ portion of the expressed Ig mRNA was amplified from the IgM+ a2+ and IgM+ a2- populations by reverse transcriptase-PCR. The cDNAs from both populations were cloned and sequenced. Analysis of these sequences suggested that, in a2+ B cells, the first D proximal functional gene in Alicia rabbits, V(H)4a2, rearranged and was altered further by a gene conversion-like mechanism. Upstream V(H) genes were identified as potential gene sequence donors; V(H)9 was found to be the most frequently used gene donor. Among the a2- B cells, y33 was the most frequently rearranged gene.

Human intestinal M cells exhibit enterocyte-like intermediate filaments

BACKGROUND

The derivation and ultrastructural composition of M cells covering the lymphoid follicles of Peyer's patches is still unknown. Results from different animal models have shown that there are species specific differences in the composition of intermediate filaments between M cells and neighbouring enterocytes. Little is known, however, about intermediate filaments of human M cells.

AIMS

To compare components of the cytoskeleton of human M cells with those of adjacent absorptive enterocytes.

METHODS

The expression and localisation of different cytokeratins, vimentin, and desmin in M cells was determined on follicle associated epithelia of human appendix using immunohistochemistry and immunogold electron microscopy.

RESULTS

Cytokeratins specific for human intestinal epithelial cells such as cytokeratins 8, 18, 19, and 20 were expressed in both absorptive enterocytes and M cells with no differences in intensity and cellular distribution between both cell types. Vimentin and desmin, tissue specific markers of either mesenchymal or myogenic cells, as well as other cytokeratins were not detectable in enterocytes or M cells.

CONCLUSION

This is the first study on the structure of intermediate filaments in human intestinal M cells. Our results show that in contrast to several animal models, human M cells apparently do not differ from adjacent enterocytes in the composition of their intermediate filament cytoskeleton. The presence of enterocyte like cytokeratins and the absence of other cytokeratins as well as of vimentin and desmin supports the hypothesis of an epithelial origin of human intestinal M cells and suggests that M cells may derive from differentiated enterocytes.

Eosinophils in acute appendicitis: possible significance

120 consecutive appendicectomies and 20 appendices from medicolegal autopsies were studied. The cases were grouped as. A: Acute appendicitis. B: Acute presentation, not diagnostic of acute appendicitis C: Elective appendicectomies D: Normal appendices from autopsies. Eosinophils and mast cells were counted in the muscularis, in Giemsa stained sections. The mean eosinophil and mast cell counts per mm2 were--A. 215.9; 26.5. B. 66.0; 32.1. C. 6.7; 25.8. D. 4.2; 19.6 respectively. Eosinophil count is significantly higher in A compared to others (p < 0.0001) and there was no range overlap with C and D. B is a heterogenous group with 37.5% having eosinophil counts in the range seen in A. Cases with mural eosinophil showed histological evidence of mast cell degranulation. Eosinophil infiltration of the muscularis is an early event universally seen in acute appendicitis. It is possible that the disease is triggered by Type I Hypersensitivity, and that infection is a later consequence.

In situ end labelling: effect of proteolytic enzyme pretreatment and hydrochloric acid

AIM

To determine the effect of dilute hydrochloric acid on the in situ end labelling (ISEL) reaction, with and without a variety of different proteolytic enzymes.

METHODS

Sections of tissue fixed in buffered formalin were pretreated with trypsin, protease XIV (at two different concentrations), or protease XXIV (for two different incubation times), with and without subsequent 1 M hydrochloric acid treatment. The results were compared with those obtained using hydrochloric acid alone, with proteinase K, and pepsin pretreatment, and with no pretreatment.

RESULTS

When hydrochloric acid was added to the sections in addition to trypsin, protease XIV, and protease XXIV, there was a significant increase in ISEL reactivity in both apoptotic nuclei and morphologically normal nuclei. Hydrochloric acid alone had no significant effect.

CONCLUSIONS

Hydrochloric acid has a distinctive effect on the ISEL reaction that is dependent on prior proteolytic digestion.

RAG1 and RAG2 in developing rabbit appendix subpopulations

The appendix of young rabbits is a site of primary heavy chain variable region-gene diversification and B cell selection. Appendix cells from 6- to 9-wk-old rabbits were stained and sorted for surface CD43 and IgM. We found that the CD43+IgM- and double-negative CD43-IgM- cells contained RAG1 transcripts and RAG2 protein. The presence of RAG gene products in appendix raised the possibility that pro-/pre-B cells were present in young rabbit appendix. Although an early suggestion that RAG2 plays a role in variable region-gene diversification by gene conversion in chicken bursa was not supported by studies of RAG2 protein in this tissue, we produced anti-rabbit RAG2 Abs to determine whether RAG2 protein was present in rabbit appendix, where cells that recently underwent gene conversion are found. We detected RAG2 protein in the four subpopulations of rabbit appendix lymphocytes, distinguished by surface CD43 and IgM markers. The appearance of RAG gene products during different stages of B cell maturation may reflect the function of the young rabbit appendix as a site of both B cell development and diversification.

Histochemical study of expression of lectin-reactive carbohydrate epitopes and glycoligand-binding sites in normal human appendix vermiformis, colonic mucosa, acute appendicitis and colonic adenoma

In a glycohistochemical analysis of human appendix vermiformis we report the assessment of lectin binding in cells of the Gut Associated Lymphoid Tissue of normal samples and in acute appendicitis using a panel of plant, invertebrate and mammalian lectins with specificity for alpha-L-Fuc (UEA-I), alpha-D-Gluc and alpha-D-Man (Con A), alpha-D-GalNAc (DBA), GalNAc (SBA, HPA), beta-Gal (RCA-I, 14 kDa = galectin-1) and alpha-, beta-Gal (VAA). Moreover, we initiate the study of expression of carbohydrate-binding sites in this tissue and in colonic mucosa, employing several types of carrier-immobilized carbohydrate ligands as suitable probes for this purpose. Within the three populations of macrophages intra-/subepithelial macrophages of the dome region, the lamina propria of the intercryptal region and the follicle-associated epithelium were apparently reactive with most of the lectins and also with mannose and fucose residues of the tested neoglycoproteins. Distinguishing features of germinal center macrophages in relation to intra-/subepithelial phagocytes were the lack of binding of UEA-I and DBA. In comparison to all other types of phagocytes, macrophages of the T-region displayed a rather restricted binding capacity only to Con A and RCA-I. Labeling of macrophages with SBA, HPA and VAA in this location was only rarely found. With respect to dendritic cells no consistently positive reaction was seen for follicular cells, whereas interdigitating cells of the T-region bound Con A, HPA and RCA-I, and, less frequently, SBA. Lymphocytes in all anatomical subsites of the Gut Associated Lymphoid Tissue, centrocytes, centroblasts and plasma cells had binding sites for Con A and RCA-I in common. Notably, a small number of lymphocytes mostly in the T-region but also in B-cell-rich areas expressed intranuclear binding sites for fucose and mannose residues. Intraepithelial lymphocytes and lymphatic cells of the T-region differed from lymphocytes in other regions by a more frequent expression of VAA-binding sites. The epithelium of appendix vermiformis and colonic mucosa not only presents lectin binding sites, but also has the capacity to bind carbohydrate structures, as shown by labeled glycoligand-exposing neoglycoproteins. In normal mucosa the extent of binding appeared to be associated with maturation of cells, the surface epithelium showing the most intense staining reaction. This pattern is not detectable in colonic adenoma which reveal increased intensity, when compared to normal mucosa. In contrast to development of hyperplasia, acute inflammation in appendicitis caused no detectable changes of neoglycoprotein binding. Taking our previous assessment on lectin binding in appendicitis into account, we conclude that glycosylation of goblet cell mucus, but not the capacity to bind certain sugar epitopes responds to inflammatory processes, whereas tumorigenesis of colonic adenoma can also affect the binding of neoglycoproteins.

CD5 is a potential selecting ligand for B cell surface immunoglobulin framework region sequences

In rabbits nearly all B lymphocytes express the glycoprotein CD5, in contrast to mice and humans, where only a small proportion of B cells express this molecule (Raman, C., and K.L. Knight. 1992. J. Immunol. 149:3858-3864). CD5+ B cells appear to develop early in ontogeny and be maintained throughout life by self-renewal. The function of CD5 on B cells is still unknown. We showed earlier that "positive" selection occurs during B lymphocyte development in the rabbit appendix. This selection favors B cell expressing surface immunoglobulins with VHa2 structures in the first and third framework regions (Pospisil, R., G.O. Young-Cooper, and R.G. Mage. 1995. Proc. Natl. Acad. Sci. USA. 92:6961-6965). Here we report that F(ab')2 fragments, especially those bearing VHa2 framework region determinants, specifically interact with the B cell-surface glycoprotein CD5. This interaction can be inhibited by anti-CD5 antibodies. Furthermore, immobilized F(ab')2 fragments selectively bind CD5 molecules in appendix cell lysates. Interactions of VH framework region structures with CD5 may affect maintenance and selective expansion of particular B cells and thus contribute to autostimulatory growth of autoimmune or transformed cells.

Preferential expansion and survival of B lymphocytes based on VH framework 1 and framework 3 expression: "positive" selection in appendix of normal and VH-mutant rabbits

B cells with a rearranged heavy-chain variable region VHa allotype-encoding VH1 gene segment predominate throughout the life of normal rabbits and appear to be the source of the majority of serum immunoglobulins, which thus bear VHa allotypes. The functional role(s) of these VH framework region (FR) allotypic structures has not been defined. We show here that B cells expressing surface immunoglobulin with VHa2 allotypic specificities are preferentially expanded and positively selected in the appendix of young rabbits. By flow cytometry, a higher proportion of a2+ B cells were progressing through the cell cycle (S/G2/M) compared to a2- B cells, most of which were in the G1/G0 phase of the cell cycle. The majority of appendix B cells in dark zones of germinal centers of normal 6-week-old rabbits were proliferating and very little apoptosis were observed. In contrast, in 6-week-old VH-mutant ali/ali rabbits, little cell proliferation and extensive apoptosis were observed. Nonetheless even in the absence of VH1, B cells with a2-like surface immunoglobulin had developed and expanded in the appendix of 11-week-old mutants. The numbers and tissue localization of B cells undergoing apoptosis then appeared similar to those found in 6-week-old normal appendix. Thus, B cells with immunoglobulin receptors lacking the VHa2 allotypic structures were less likely to undergo clonal expansion and maturation. These data suggest that "positive" selection of B lymphocytes through FR1 and FR3 VHa allotypic structures occurs during their development in the appendix.

Rabbit IgH sequences in appendix germinal centers: VH diversification by gene conversion-like and hypermutation mechanisms

Although the rabbit IgH locus contains approximately 100 VH genes, the majority of B cells rearrange VH1. To produce a primary repertoire containing a sufficient number of protective antibodies, rearranged VH1-DH-JH sequences may diversify within rabbit B cells in an organ that functions like a chicken bursa, sheep ileal Peyer's patch, or both. It was suggested many years ago that the rabbit appendix could be a bursal equivalent. To reexamine this possibility, we analyzed rearranged heavy chain variable region sequences in B cells from light and dark zones of appendix germinal centers from 6-week-old rabbits. Our findings indicate that antibody diversification occurs by gene conversion-like and somatic hypermutation mechanisms in appendix germinal centers of young rabbits.

Assessment of gut intraepithelial lymphocytes during late gestation and the neonatal period

Intraepithelial lymphocyte counts (IEL % enterocytes) were carried out in histological samples of jejunal, ileal and appendiceal mucosa of 39 neonates, aged from birth to 28 days. Correlations between IEL counts and developmental factors, namely gestational age, birth weight and intrauterine growth, as well as neonatal infections or feeding state were performed. No significant differences were observed among neonates grouped according to birth weight, intrauterine growth or neonatal infections. The pattern of feeding, however was associated with significantly higher IEL counts (p < 0.02) in the ileum in oral/enterally fed neonates than in the unfed or parenterally fed. Full-term neonates also had higher counts in the ileum (p < 0.02). In this group, oral/enterally fed neonates had the higher values. Thus, besides in utero development, the pattern of feeding might be considered as an important modulating factor on IEL postnatal expansion.

[The distribution of mucosal endocrinocytes in the normal human appendix and in inflammation]

The method of light microscopy was used for studying the histotopography of endocrinocytes of the vermiform process mucosa of man. The direction of their distribution was found in distal, medial and proximal parts of the vermiform process mucosa. The greatest amount of endocrinocytes in normal conditions per 1 mm2 of the mucous membrane was found in the proximal part and it was getting less towards the distal one. In inflammation there occurs an increase of the amount of endocrinocytes (in acute ordinary appendicitis, it is 1.5 times higher, in the phlegmonous form--2 times). With the development of deep destructive processes in the mucous membrane the content of endocrinocytes is sharply decreased.

Identification of M cells and their distribution in rabbit intestinal Peyer's patches and appendix

The distribution of intestinal membranous (M) cells has been studied within the follicle-associated epithelium of rabbit Peyer's patches and appendix. Vimentin expression has been assessed as a primary criterion to identify rabbit M cells in tissue sections and in whole tissue preparations. This criterion has been compared to the use of the absence of alkaline phosphatase which, due to its heterogeneous distribution within the enterocyte population, is less reliable than vimentin expression as a marker for rabbit M cells. The pattern of vimentin immunostaining revealed that the majority of M cells are located in the periphery of the follicle-associated epithelium, the dome apex being largely free of M cells. This distribution was confirmed by scanning electron microscopy. Vimentin is also expressed by follicle-associated epithelial cells in the vicinity of crypts which lack the typical lymphocyte-containing pocket of M cells. Cytoplasmic peanut agglutinin binding coincides with vimentin-expression throughout the follicle-associated epithelium but is absent from vimentin-negative enterocytes. The co-localisation of these two phenotypic markers in both M cells and epithelial cells adjacent to crypts, which lack the typical morphology of fully developed rabbit M cells, suggests that they correspond to immature M cells which by their location appear to derive directly from undifferentiated crypt stem cells and not from mature columnar enterocytes.

[Structural basis of appendiceal function in rabbits]

Enzymo-, immuno- and lactin-histochemical methods were used to study the structure of the rabbit appendix wall. The value of some structural components in the function of this part of the intestine is discussed. Some findings were documented electronmicroscopically. In addition to its resorptive function, the rabbit appendix is equipped with a potent defense mechanism against adverse environmental effects of the appendix content. Individual structures of this defensive barrier are closely characterized with regard to cellular equipment and possibilities of its morphological identification.

Age, site and distribution of subepithelial neurosecretory cells in the appendix

The appearance of subepithelial neurosecretory cells (SNC) was investigated by studying completely sampled appendices of 50 children, adolescents and adults. The cells were demonstrated using lead hematoxylin, a selective stain for neurosecretory cells. Additional routinely sampled specimens were also studied for comparison. In children up to the age of 9 yrs only occasional SNC were found. After this age, however, SNC were present in most appendices and in greater numbers. The majority of SNC were located in the distal portion of the appendix, with only small numbers of these cells being present in the proximal segment. Occasional SNC-like cells were identified in the appendiceal submucosa in all regions of the appendix at all ages. This lends support to the hypothesis that a correlation exists between the presence of increased numbers of SNC, patient age and the site distribution of both acute appendicitis and appendiceal carcinoid tumors.

Role of interleukin-6 in human and mouse mucosal IgA plasma cell responses

In summary, we have shown that human appendix and murine PP B cells, freshly isolated from normal tissue, respond IL-6 with significant increases in IgA SFC. Further, sIgA+ B cells from appendix express more IL-6R than is seen with B cells isolated from PBMC and spleen. When IgA subclass responses were measured, rhIL-6 induced both IgA1 and IgA2 SFC responses; however, 60-70% of the total response was represented by the IgA2 subclass. Our studies suggest that the human appendix as well as murine PP are enriched sources for sIgA+ B cells which are responsive to cytokines such as IL-6 for induction of IgA plasma cell responses.

Occluding junctions in the epithelia of the gut-associated lymphoid tissue (GALT) of the rabbit ileum and caecum

The zonulae occludentes of the dome epithelia and adjacent non-dome epithelia in four locations of the gut-associated lymphoid tissue (GALT) in the rabbit ileum and caecum (Peyer's patches, sacculus rotundus, caecal lymphoid patches, appendix) were studied in freeze-fracture replicas. In all locations the zonulae occludentes of the dome epithelium are composed of more junctional strands than in the corresponding non-dome epithelium. In the dome epithelia of Peyer's and caecal lymphoid patches the zonulae occludentes show considerable structural variation; the number of superimposed strands is approximately 10 (range 5-18). In the dome epithelia of sacculus rotundus and appendix, in addition to zonulae occludentes, extended networks of junctional strands (fasciae occludentes) are present particularly between M-cells and enterocytes. The zonulae occludentes consist of approximately 8 to 9 (range 5-15) superimposed strands; the fasciae occludentes extend up to a depth of 20 microns on the lateral membranes. The presence of the fasciae occludentes correlates with the appearance of regularly shaped clusters of lymphocytes, which are most developed in the dome epithelia of sacculus rotundus and appendix. These results suggest (1) that in contrast to the dome epithelia of Peyer's and caecal lymphoid patches those of sacculus rotundus and appendix are compartmentalized, and (2) that the mobility of lymphocytes and diffusion of antigens in the dome epithelia of sacculus rotundus and appendix is restricted.

The topographical and age distributions of neuroendocrine cells in the normal human appendix

In order to clarify the histogenesis of appendiceal carcinoid tumours, epithelial (ENC) and subepithelial (SNC) neuroendocrine cells were counted at four sites in 50 normal appendices stained by standard argyrophil and argentaffin techniques. In general, ENC were present in similar number at all sites within the appendix, whereas SNC were more numerous at the tip than at the base. The number of ENC was similar throughout life, apart from an increase in one neonate and some elderly patients, whereas SNC were maximal in young adults. Thus, the topographical and age distributions of SNC, but not those of ENC, parallels the topographical and age incidence of appendiceal carcinoid tumours, suggesting that most appendiceal carcinoid tumours arise from SNC rather than ENC.

Immunolocalization of integrin receptors in normal lymphoid tissues

The integrin superfamily of cell adhesion receptors consists of heterodimeric glycoproteins composed of unique alpha and beta subunits. These receptors mediate cell-substrate and cell-cell adhesive properties for a variety of cell types. This investigation has focused on the histologic distribution of the beta 1 subfamily of integrins within lymphoid tissues including tonsil, lymph node, spleen, thymus, and appendix. The dendritic cells of both follicular center and thymic origin express the alpha 1, alpha 2, alpha 3, alpha 5, and alpha 6, as well as the beta 1 integrin subunits. Most lymphoid cells in normal tissues do not express the alpha 1, alpha 2, alpha 3, alpha 5, and alpha 6 subunits, or the alpha v beta 3 integrin. The beta 1 subunit is expressed by all lymphocytes but with variable intensity. Increased levels of the alpha 5 and beta 1 subunits are observed in the follicular light zone, suggesting a role for these integrins in B-cell activation. Although the alpha 4 subunit is expressed by all lymphoid cells, an increased expression of alpha 4 and decreased expression of beta 1 by the mantle zone B-cell compartment is noted in comparison with the decreased expression of alpha 4 and increased expression of beta 1 by follicular center B-cells. These studies suggest that alpha 4 may be paired with a beta subunit other than beta 1 on the mantle zone lymphoid population. Thus, integrin expression by cells of lymphoid tissues varies with location and function and differs significantly from integrin expression observed on circulating and cultured peripheral blood lymphocytes.

Tissue localization and CD8 accessory molecule expression of T gamma delta cells in humans

In this study, we used TCR isotype-specific antibodies to examine the frequency, phenotype, and histologic localization pattern of T gamma delta cells in humans. The TCR delta 1+ cells comprised an average of 15% of the splenic CD3+ cells and 7% of circulating T cells. The T gamma delta cells in these human tissues, like their avian counterparts, were often not "double-negative" for the CD4 and CD8 accessory molecules. Approximately 50% of the splenic delta+ cells expressed CD8, and 30% of the delta+ cells in blood were CD8+. T cells of both gamma delta and alpha beta TCR isotypes were exceedingly rare in the skin. The T gamma delta cells exhibited preferential homing to the sinusoidal areas (red pulp) of the spleen and into the epithelial layer of the intestine in humans, as had been previously noted in chickens. Although 80% of the T gamma delta cells in the human intestinal mucosa were localized in the epithelial layer, these cells represented only 5 to 10% of all the CD3+ T cells in this microenvironment. We conclude that T gamma delta cells represent a sizeable subpopulation of the T cells in human peripheral tissues. The phylogenetic conservation of the CD8 expression by peripheral T gamma delta cells and of their preferential homing pattern suggests a special role in bodily defense for this T cell subpopulation.

Absence of secretory component expression by epithelial cells overlying rabbit gut-associated lymphoid tissue

The expression of secretory component by epithelial cells overlying intestinal lymphoid aggregates was examined immunocytochemically in rabbits. Intensely labeled epithelial cells were distributed along surfaces of villi surrounding follicles in jejunal and ileal Peyer's patches and along interdomal epithelium in sacculus rotundus and appendix. Secretory component labeling extended from within crypts and appendiceal crevices to the tips of villi and interdomal regions. In contrast, no immunologically detectable secretory component sites were observed in follicle-associated epithelial cells. In crypts and crevices supplying follicles, epithelial cells facing the lamina propria of villi and interdomal epithelium expressed secretory component, but cells flanking the follicle domes lacked secretory component immunostaining, with a clear demarcation between positive and negative zones at the base of the stem cell regions. These findings demonstrate a unique difference in the expression of the receptor for immunoglobulin A antibody between follicle-associated and non-follicle-associated epithelium.

Occurrence of multinucleated giant cells in the appendix of clinically healthy rabbits

The spontaneous formation of multinucleated giant cells was observed in the appendix of clinically healthy adult rabbits that were free of infection with intestinal viruses, pathogenic bacteria, fungi and parasites. Giant cells occurred singly and in aggregates. They were of the foreign body and of the Langhans' type, but intermediate forms were also noticed. Ultrastructurally, the hallmark of these appendiceal polykaryons were large phagolysomal fields harbouring amorphous debris and remains of cytoplasmic organelles and bacteria. The bacteria in the appendiceal tissues were neither of a special type nor acid-fast. The aetiology and significance of appendiceal giant cells remains to be clarified.