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.

Immunizing effect of vaccinia virus expressing the nucleoprotein of rinderpest virus on systemic rinderpest virus infection in rabbits

A recombinant vaccinia virus (RVV) expressing the nucleoprotein (NP) of rinderpest virus (RPV) was examined in rabbits for the involvement of the NP protein in protection from the RPV infection. Despite their production of anti-NP antibody, the RVV-immunized rabbits succumbed to the RPV challenge, although there was a slight delay in the onset of disease after the low-dose challenge. On the other hand, the animals immunized with RVV expressing the hemagglutinin (H) protein of the RPV were completely protected. These results indicate that the NP protein might be not so effective as the H protein for the protection against viremic and systemic infection with RPV.

The primary site of CD4- 8- B220+ alphabeta T cells in lpr mice: the appendix in normal mice

There have been no reports on an abundance of CD4- 8- B220+ alphabeta T cells, seen in autoimmune mice carrying the lpr gene (abnormal Fas gene), in any immune organs of normal mice. We herein report, however, that such alphabeta T cells were abundant at intraepithelial sites of the appendix in normal mice. They lacked the expression of NK1.1 Ags (C57BL/6 mice), but had the morphology of granular lymphocytes and contained forbidden T cell clones in the minor lymphocyte-stimulating antigen (Mls) system (C3H/He mice with Mls-1b2a). In other words, many properties of intraepithelial T cells in the appendix resembled those ascribed to abnormal alphabeta T cells, which expand in the lymph nodes and spleen of lpr mice. In the case of lpr mice, CD4- 8- B220+ alphabeta T cells first expanded in the appendix and then extended to other organs. CD4- 8- B220+ alphabeta T cells seemed to originate in situ from c-kit+ stem cells in the appendix. These results suggest that the appendix is one of the primary sites in which CD4- 8- B220+ alphabeta T cells exist, and that these cells carry many primordial properties as prototype T cells.

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.

Neonatal appendectomy impairs mucosal immunity in rabbits

We compared the effects of neonatal appendectomy in rabbits on total Ig and antigen (Ag)-specific Ig levels in the serum and gut, and on plasma cell numbers in the small intestine in response to intraperitoneal (i.p.) and intraduodenal (i.d.) immunizations with ovalbumin (OVA). Animals were sacrificed after 9 weeks. Antibodies (Abs) in the duodenum were collected and quantified by enzyme-linked immunosorbent assay (ELISA) while plasma cells were quantified by double immunofluorescent staining. Appendectomy markedly reduced total intestinal IgA (P < 0.0006), IgM (P < 0.003), and IgG (P < 0.05) relative to controls, whereas total serum Ig levels were not lowered significantly. Moreover, appendectomy nearly ablated OVA-specific IgA (P < 0.007) in the gut and severely depleted OVA-specific IgG in the gut (P < 0.03) and serum (P < 0.007). The sharp decreases in total IgA and anti-OVA IgA were paralleled by decreases in total IgA+ plasma cells (P < 0.0005) and OVA-reactive IgA+ plasma cells (P < 0.05). These results support a major role of the rabbit appendix in seeding the intestinal lamina propria with plasma cell precursors, especially those producing IgA.

Immunohistochemical and ultrastructural analysis of an extracellular matrix bound antigen preferentially associated with mucosal postcapillary venules

Human lymphoma derived monoclonal antibody (anti "mucosal vessel associated antigen' [MVAA]) binds to high endothelial venules (HEV) in gut-associated lymphoid tissue, but shows only weak reactivity with HEV in peripheral lymphoid tissues. We have used immunohistochemistry and immunoelectron microscopy to define the precise ultrastructural distribution of the molecule, and to determine whether there is any association between this molecule and cellular traffic. We have observed that MVAA is a component of basement membrane which is only expressed by a subset of blood vessels. Although it is restricted to vessels which support lymphocyte traffic within lymphoid tissue, we did not observe any association between the distribution of MVAA and extravasating lymphocytes. MVAA is expressed in the fetal intestine in association with a subset of larger vessels. It is therefore not necessarily induced as a consequence of antigenic challenge. It is likely that MVAA has a structural role related to its restricted microanatomical distribution; possibly the maintenance of integrity of vessel walls which are continuously disrupted by the extravasation of lymphocytes.

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.

Expression of CD15 in normal and metaplastic Paneth cells of the digestive tract

AIMS

To substantiate that incubation with monoclonal antibody CD15 (C3D-1) elicits a distinctive immunoreaction in normal small intestinal Paneth cells, normal and metaplastic Paneth cells along the digestive tract were assessed to determine whether they are also immunoreactive to CD15.

METHODS

Paneth cells in paraffin wax embedded specimens of normal small intestine, appendix and proximal ascending colon, and from cases of chronic gastritis and ulcerative colitis were investigated immunohistochemically for lysozyme and CD15 antigen expression by means of the avidin-biotin peroxidase complex method.

RESULTS

CD15 antibody reacted with a high proportion of both normal and metaplastic Paneth cells. Paneth cell immunoreactivity to CD15, however, was less intense and less extensive than to antilysozyme antibody, though the latter also stained many other cell types and was more commonly associated with nonspecific background staining.

CONCLUSIONS

CD15 seems to be a valuable adjuvant for the study of Paneth cells in the normal and diseased digestive tract. Furthermore, as CD15 has been shown to be involved in activation of phagocytes, its expression in Paneth cells reinforces their proposed role as antimicrobial agents and regulators of the intestinal flora.

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.

Selective recruitment of lymphocyte subsets to the inflamed appendix

Total lymphocyte counts and the distribution of lymphocyte subsets were determined in peripheral venous blood and appendiceal mononuclear cells from 60 patients who underwent appendicectomy for the clinical diagnosis of appendicitis. A significant peripheral lymphopenia was observed in the 46 patients with histologically confirmed acute appendicitis which was accompanied by an increase in the appendiceal lymphocyte concentration. There was an even greater depletion of CD45RO+ (memory) T lymphocytes in peripheral blood and an increase in the inflamed appendix. Reciprocal changes were observed in the CD45RA+ (naive) T lymphocyte subset. These changes were reflected in the local arterial and venous CD45RA and CD45RO T lymphocyte subsets. Proliferation studies showed an expanded functional repertoire of T lymphocytes in the inflamed appendix. Selective recruitment of memory T lymphocytes from the peripheral blood to the inflamed appendix was demonstrated.

Gut intraepithelial lymphocyte counts in neonates, infants and children

Intraepithelial lymphocyte (IEL) counts were histologically assessed in the jejunum, ileum and appendix of 39 neonates (0-28 days), 32 infants (1-9 months) and 13 children (1-9 years). Small intestinal mucosa samples were obtained from 73 autopsies, and from 8 surgical and 3 aspirative biopsies. IEL counts of specimens from the jejunum, ileum and appendix gave similar results in the same patient. The number of IEL counts was significantly lower in neonates for all three segments. The difference between infants and children was more marked in the jejunum than in the ileum, although this was not significant. In the appendix, there was no difference between the different age groups. Our results indicate that postnatal expansion of IEL occurs homogeneously along the gut after the neonatal period.

The appendix functions as a mammalian bursal equivalent in the developing rabbit

In this paper we present genomic DNA sequence and histological evidence that the appendix is a site of diversification of the rabbit's primary antibody repertoire. By 6 weeks after birth, the B cell follicular regions of the rabbit appendix and the distribution of the resident lymphoid cells bear a strong morphological resemblance to similar regions within two primary lymphoid tissues, the chicken bursa and the sheep ileal Peyer's patch. However, similarities between the rabbit appendix, chicken bursa and sheep ileal Peyer's patch end as these animals reach adulthood. The rabbit appendix undergoes morphological and cellular distribution changes as it matures taking on the appearance of a secondary lymphoid tissue, while the sheep ileal Peyer's patch and the chicken bursa both involute. We determined DNA sequences of PCR amplified rearranged variable region genes from germinal center B cells of 6 week old rabbits isolated from several different appendix dark zones and light zones. There was a trend toward a higher degree of diversification from the germ-line VH gene DNA sequence in dark zones than light zones. It is likely that both gene conversion and somatic hypermutation are responsible for the nucleotide changes we observed. Our findings suggest that the rabbit appendix functions as a mammalian bursal equivalent early in development. As the rabbit matures, the appendix appears to evolve into a secondary lymphoid tissue resembling secondary GALT in appearance and possibly in function.

The intestinal immune system and its relation to disease

The essential protective structure against the heavy enteric antigenic burden, the gut mucosa, prevents penetration of noxious agents, but allows a minimal exchange of large molecules and particles between the gut lumen and the 'milieu intérieur' of the body. M cells in the follicle-associated epithelium of the gut, ideal gateways for the presentation of enteric antigens to the cells of the gut-associated lymphoid tissue (GALT), are also weak links in the mucosal barrier, and may provide access for various microorganisms. The afferent limb of the GALT consists of distinct aggregates of lymphoid cells located in Peyer's patches, the vermiform appendix and the solitary lymphatic follicles, and of the mesenteric lymph nodes. The efferent limb subsumes the diffusely scattered mucosal leukocytes, mainly lymphocytes and plasma cells. Intraepithelial and mucosal T lymphocytes are instrumental in launching local immune responses, producing lymphokines, and in the specific lysis of virally infected cells. Antigenic stimulation of the GALT results in local secretion of antibodies, or in suppression of systemic immunologic responses to ingested antigens ('oral tolerance'). Poorly controlled mucosal immune responses result in organ-specific diseases. Extranodal lymphomas that mimic structures of the GALT may arise on a background of inflammatory or immunologic (autoimmune) disorders.

Effects of IL6 on B cells in mucosal immune response and inflammation

Freshly isolated surface IgA+ (sIgA+) B cells from human gut-associated lymphoreticular tissues (GALT), e.g. the appendix, express high levels of IL6 receptor (IL6R) and respond to IL6 with significant increases in the number of IgA-secreting cells. On the other hand, neither sIgM+ nor sIgG+ B cells from appendix express IL6R. When the effect of IL6 on IgA subclass antibody synthesis was examined, the numbers of both IgA1- and IgA2-producing cells were increased upon incubation of GALT B cells with IL6; however, 60-70% of IgA-secreting cells were IgA2 subclass. Aberrant local production of IL6 can contribute to increased B-cell responses that occur in mucosal inflammation such as gingiva of patients with adult periodontitis (AP). When gingival mononuclear cells (GMC) isolated from AP patients were cultured without any stimulus, GMC spontaneously produced biologically active IL6 which induced peripheral blood mononuclear cells (PBMC) from the same patients to become IgG- and IgA-producing cells. Further, mRNA extracted from GMC possessed high message for IL6. When the expression of IL6R was compared between GMC and PBMC isolated from AP patients, IL6R-bearing cells were only seen in the former population. Thus, a high production of IL6, which have the ability to regulate later stages of IL6R+ B-cell development and to induce them to become Ig-secreting plasma cells and to support plasmacytoma growth, are important immunopathological elements for the induction of the increased B-cell response region in inflamed mucosal tissues.

Complement activation in the follicular light zone of human lymphoid tissues

A comparative immunohistochemical study of the distribution pattern of complement components and regulatory proteins within secondary lymphoid follicles was performed by the immunoperoxidase technique. Fifteen lymphoid tissues including appendices. Peyer's patches and tonsils were analysed. Sixty secondary lymphoid follicles with evident polarity, that is, the distinct coexistence of a light zone, dark zone and mantle zone in the same lymphoid follicle, were tested with single antibodies. The light zones were consistently immunostained in a dendritic meshwork pattern with all antibodies. The immunostaining patterns were classified into two major groups based on the immunoreactivity of the dark zone. One immunostaining pattern was characterized by no immunostaining of the dark zone to the majority of the antigens. The second group was characterized by a diffusely weak to moderate dendritic meshwork pattern of the dark zone to some of the immunostainings of C9 (monoclonal), S-protein, and DF-DRC1, and all immunostainings of CR1 (CD35), Ber-Mac-DRC (CD35), CR2 (CD21), and R4/23. All four complement regulatory proteins were localized by immunoelectron microscopy attached to the cell surface of the cells, including follicular dendritic cells, in the light zone. Our data indicate that there is an evident functional difference between the light zone and the dark zone, and that complete activation of the complement system occurs only in the light zone.

[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.

Gut associated lymphoid tissue in the cotton rat (Sigmodon hispidus) and its response to protein restriction

We examined age and nutritional related changes in the distribution and size of gut associated lymphoid tissues in the intestinal tract of cotton rats (Sigmodon hispidus). Peyer's patches in the small intestine are prominent, ranging from four to 13, and increase in size (surface area) with age. The average Peyer's patch in the adult cotton rat measured 23.9 mm2. Lymphoid tissue in the cecum was primarily limited to a large aggregate located in the vermiform appendix, which increased in size with age. Age related changes in the number of visible lymphoid follicles in the large intestine were highly significant, increasing from 24.8 in juveniles to 45.1 in adults. Weights of dissectable Peyer's patch tissue in animals consuming a low protein diet were significantly lower in juveniles and greater in subadults compared to those on high protein diets. Relative weights of Peyer's patch tissue averaged 84 to 95% more in low protein-fed animals than in the group on the high quality protein diet. Our results suggest that peripheral lymphoid tissues in wild cotton rats are more resistant to protein deficiencies than other tissues in the body and could be a useful index for assessing nutritional status.

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.

Human appendix B cells naturally express receptors for and respond to interleukin 6 with selective IgA1 and IgA2 synthesis

Past studies have shown that freshly isolated human B cells from peripheral blood and tonsils do not express IL-6 receptors (IL-6R); however, mitogen or antigen activation of these B cells induces IL-6R and responsiveness to IL-6. In this study, we have shown that a high proportion of B cells enzymatically dissociated from human appendix, a gut-associated lymphoreticular tissue (GALT), expresses the IL-6R, and that recombinant human IL-6 induces significant increases in the number of Ig-producing cells. The recombinant human IL-6-induced increase in Ig-producing cells is restricted to the IgA isotype. Further, IgA2 is the major subclass; however, significant numbers of IgA1 producing cells are also seen. In contrast, human tonsillar and peripheral blood B cells express low levels of IL-6R, and exogenous IL-6 does not increase numbers of Ig-producing cells. When PBMC or tonsillar cells are stimulated with PWM, the former display an equal distribution of IgA1 and IgA2 secreting cells, while tonsillar B cells are mainly of the IgA1 subclass. The distribution of surface Ig-positive (sIg+) B cells in the appendix B cell population is sIgA+ greater than sIgG+ greater than sIgM+, and the sIgA+ B cells express higher levels of IL-6R when compared with sIgG+ or sIgM+ B cells. These studies show that human appendix contains B cell subsets that constitutively express IL-6R, and that a high proportion of these cells are committed to the IgA isotype. Furthermore, higher numbers of IL-6 responsive IgA2 B cells are present in the human appendix as compared to tonsils or PBMC.

Phenotypically distinct subpopulations of T cells in domes and M-cell pockets of rabbit gut-associated lymphoid tissues

Follicle epithelium and domes of gut-associated lymphoid tissue (GALT) contain populations of lymphocytes which first contact antigen taken up from the intestine. In order to study the association of lymphocytes with M cells in follicle epithelium, monoclonal antibodies (mAb) were generated by immunizing BALB/c mice with lymphocytes populating GALT domes from NZW rabbits, and their specificity was assessed by immunohistochemistry and flow cytometry. mAb 3C10 (IgM) and 3B6 (IgG3) recognized subpopulations of intraepithelial lymphocytes associated with M cells. mAb 3C10 also identified macrophage-lymphocyte clusters in domes and tangible body macrophages in germinal centres of GALT but did not react with cells in T-dependent areas (TDA) or B cells in follicles. mAb 3B6 recognized lymphocytes in domes and B cells in follicles but not T cells in TDA of GALT. The distribution of 3B6+ cells overlapped with, but was more restricted than, that of Ia+ cells. Analysis of lymphocytes in follicle epithelium showed that greater than 95% of lymphocytes associated with M cells were Ia+. T cells represented approximately 95% of intraepithelial lymphocytes in the appendix and approximately 65% in Peyer's patches. A majority of intraepithelial lymphocytes was recognized by mAb 3B6, but mAb 3C10 identified only approximately 30%. Because neither 3C10 nor 3B6 recognized lymphocytes in TDA of GALT, these results indicate that most lymphocytes associated with M cells are a distinct phenotype of Ia+ T cells.

[Clinico-immunologic characteristics of appendicitis in children]

Inflammation of the appendix is primarily a local process with the development of localized subcompensation of immunogenesis in simple appendicitis. Decompensation of immunogenesis and a destructive process develop in progressive insufficiency of immune reactions, in immune reactions of considerable intensity the inflammation is arrested spontaneously, but atrophy of lymphoid tissue remains as a consequence. Frequent (48.7%) recurrent inflammation is attended by a more severe clinical course and rapid development of complications, owing to which appendectomy is recommended in simple appendicitis. The authors revealed changes of the general resistance of the organism, which were manifested by activation of leukocyte phagocytic activity and reduction of their content of cation proteins and by increase of the level of circulating immune complexes in the blood.

Antigen delivery to gut associated lymphoid tissue of rabbits

A rabbit model was developed so that antigens, microbes or potential mucosal vaccines could be delivered in multiple doses directly to the luminal surface of the gut associated lymphoid tissue (GALT) located in the cecal appendix. A polyethylene catheter was implanted surgically into the tip of the appendix. It exited the body wall and progressed subcutaneously around the thorax to the dorsocervical region where it was attached to a subcutaneous obturator. The catheters were flushed every day with sterile saline. To assess patency of the system, radiographic contrast media was injected and the animals were radiographed. Rabbits were necropsied at 10, 30 and 60 days and tissues evaluated by histological, immunohistochemical and electron microscopic means. The microbial flora was evaluated also. All tissues examined were free of significant abnormalities. The advantage of this delivery system is its ability to provide multiple doses of immunogenic agents directly to a physiologically normal appendix over an extended period.

[Lavage of the appendix as a possible method of obtaining immunoglobulin levels]

The author presents results of appendiceal lavage made after surgical removal in acute and chronic inflammations. The lavage was performed by the author's own method and in the obtained solution immunoglobulin values were assessed. In the majority of cases in both types of inflammation positive results were obtained.

[Virological research on appendicitis]

Investigations were conducted on groups of subjects hospitalized in surgery services with a clinical diagnosis of acute or chronic appendicitis, to detect the presence of inframicrobial antibodies and antigens, as well as that of the C reactive protein in these patients as compared with a control group. The results of serological tests and of the examination of pieces of appendix are also presented. The obtained data are used as arguments for the theory of an inframicrobial infection part in some acute and chronic forms of appendicitis.

Precocious development of lectin (Ulex europaeus agglutinin I) receptors in dome epithelium of gut-associated lymphoid tissues

Dome epithelium (DE), the tissue covering lymphoid domes of gut-associated lymphoid tissues, was examined in both adult and neonatal rabbit appendix or sacculus rotundus to determine if dome epithelial cells matured earlier than epithelial cells covering adjacent villi. The localization of well-differentiated epithelial cells in rabbit gut-associated lymphoid tissues (GALT) was accomplished histochemically by use of molecular probes: fluorescein isothiocyanate or horseradish peroxidase conjugates of Ulex europaeus agglutinin I (UEA), a lectin specific for terminal L-fucose molecules on certain glycoconjugates. The villus epithelial cells of newborn and 2-, 5-, or 10-day-old rabbits did not bind UEA, but between the twelfth and fifteenth days of postnatal life, UEA receptors were expressed by well-differentiated villus epithelial cells. In contrast to villus epithelium, DE in appendix and sacculus rotundus of neonatal rabbits expressed UEA receptors two days after birth, a feature that distinguished the DE of neonatal GALT for the next two weeks. In adult rabbits, UEA receptors were associated with dome epithelial cells extending from the mouths of glandular crypts to the upper domes; in contrast to the domes, UEA receptors were only present on well-differentiated epithelial cells at the villus tips. Results suggested that in neonatal rabbits most dome epithelial cells developed UEA receptors shortly after birth, reflecting precocious development of DE as compared to villus epithelium. In adult rabbit dome epithelium UEA receptors appeared on dome epithelial cells as they left the glandular crypts, representing accelerated epithelial maturation.

Development of dome epithelium in gut-associated lymphoid tissues: association of IgA with M cells

The dome epithelium (DE), which covers gut-associated lymphoid tissues (GALT) and provides both a protective barrier over lymphoid follicles and a route for antigen uptake from the gut, develops in rabbit appendix (caecum) during the first week of neonatal life. To determine if secretory immunoglobulins from maternal milk interact with this developing tissue, their interrelationships in neonatal rabbit appendix were examined by use of immunocytochemical techniques. The glycoprotein, secretory component, was not produced by neonatal rabbits less than 15 days old, since neither the membranous nor the free, secreted forms of maternal secretory component were associated with villi or DE of neonates. Immunoglobulin A (IgA), but neither IgG nor IgM, were noted on DE by light microscopy, even though IgG was abundant in the villus lamina propria and vascular spaces. The epithelial IgA was distributed, in a patchy pattern, across the upper dome surface of some two-day-old, and all five-and ten-day old nursing animals, but IgA was not on DE of rabbits prevented from nursing. Immuno-electron microscopy of appendix from nursed rabbits revealed IgA directly over the apical surface of M cells, where it formed a continuous, thick coating without binding to adjacent immature absorptive cells; it was also within apical vacuoles of M cell cytoplasm. The distribution of IgA on the DE of rabbit appendices indicated that in differentiating GALT, maternal IgA reacted preferentially with M cells or pre-M cells, leading to speculation concerning a role for IgA in the development of GALT and in establishment of mucosal immune responses in neonates.

Immunocompetence of normal human appendiceal lymphoid cells: in vitro studies

In order to study the activity of immunocompetent lymphocytes in normal human adult mucosal lymphoid tissues in the gut, viable mononuclear cells (MNC) from surgically removed appendices were isolated with a rapid and improved technique, and their immune reactivity determined in vitro. Nearly two-thirds of the isolated cells were B cells, composed of sIgM (30%), sIgA (19%) and sIgG (12%), less than one-third of cells being T cells, composed of OKT4+ helper/inducer T cells (18%) and OKT8+ suppressor/cytotoxic T cells (9%). Isolated B cells were responsive to SAC (Cowan type I Staphylococcus aureus) with marked augmentation of IgG production, but not to lipopolysaccharides (LPS). In the presence or absence of pokeweed mitogen (PWM) and protein A, all isotype-specific Ig production was augmented along with increasing ratios of autologous T cells to B cells, whereas in the presence of anti-HLA-DR antibodies the production of IgA and IgM was reduced to a great extent. Finally, in vitro induction of concanavalin A (Con A)-induced suppressor T (Ts) cells was less than that of helper T (Th) cells. Thus, normal adult appendiceal (Ap) lymphocyte reactivity is predominated by helper T (Th) cells; IgA isotype-specific Ig production appears to be largely regulated by the autoreactive Th subset. This responsiveness to exogenous stimuli may play an important role in the gut mucosal immune responsiveness.

Detection of urothelial Lewis antigens with monoclonal antibodies

The detectability of Lewis a and b antigens (Lea, Leb) was examined in the normal urothelium of 28 human subjects whose red blood cells (RBCs) were also tested for Lea and Leb. Mouse monoclonal antibodies as well as goat and human antisera were used on paraffin-processed and fresh-frozen tissues. Multiple biopsy specimens from the same individual were studied in order to evaluate temporal as well as topographic consistency of the results. In addition, the expression of the Lewis antigens in the appendiceal mucosa was investigated in 9 of these patients. The antibodies against Lea reacted with the urothelium of all patients with either Lea+b- or Lea-b+ RBC phenotype. None of the 5 patients with Lea-b- RBCs had Lea urothelial reactivity. The antibodies against Leb reacted with the urothelium of all patients with Lea+b- or Lea-b+ RBCs and with 2 of the 5 patients with Lea-b- RBCs. The mucin in the goblet cells of the appendiceal mucosa was positive only for the Lewis antigen that was also detectable of the individual's RBCs. These findings indicate that the expression of Lewis antigens in nonsecretory epithelia may not follow the same principles as in the blood and secretions.

Neuromas of the appendix. A light-microscopic, immunohistochemical and electron-microscopic study of 20 cases

The neural origin and even the existence of appendiceal neuromas have been questioned. We have studied 20 examples, 7 discovered during a prospective examination of 26 consecutive routine appendectomy specimens (for an incidence of 27%), 2 selected from random cases, and 11 discovered in a retrospective review of 11 randomly selected cases of appendices diagnosed as "fibrous obliteration." By light-microscopy, appendiceal neuromas appear as a loose proliferation of spindle cells usually in a myxoid background, frequently with entrapped fat and connective tissue and infiltrated by eosinophils. Seventeen were located centrally in the appendix without nodule formation. One was central with nodularity and two were confined to the mucosa. The spindle cells were positive for S-100 protein and neuron-specific enolase in all cases. In 12, serotonin positive cells entrapped in the proliferation were present. In 5 of 11 cases with apparent uninvolved appendix present in the specimen, the number of serotonin cells in the crypts was greater than in normal appendix controls. Two appendiceal neuromas contained somatostatin positive cells. Stains for vasoactive intestinal polypeptide, substance P, neurotensin, bombesin and gastrin were negative. Ultrastructural examination of one case confirmed the presence of a mixture of Schwann cells and cells containing neurosecretory granules. We conclude that appendiceal neuroma is a rather common entity, and that most cases of so-called fibrous obliteration actually represent appendiceal neuroma.

Distribution of immunoglobulin producing cells is different in normal human appendix and colon mucosa

The densities of IgG-, IgA-, IgM- and IgD-producing immunocytes were determined by paired immunofluorescence staining and morphometric analysis in the lamina propria of normal appendix specimens. Normal colon specimens were used as reference material, mostly paired from individual subjects. The density (median of cells/mm2 lamina propria area) of IgA immunocytes tended to be slightly higher in the appendix than in the colon (1259 vs 962) and the same held true for IgM cells (71 vs 55). Conversely, the overall density of IgG immunocytes was much higher in the appendix than in the colon (95 vs 38). A striking feature was the fact that almost 50% of all immunocytes were of the IgG isotype adjacent to lymphoid follicles. It seemed justified to conclude, therefore, that the abundance of such follicles explains the overall enrichment of IgG-producing cells in normal appendix mucosa. These immunocytes most likely represent follicle derived B cells that have reached terminal maturation locally, whereas precursors generated from less mature memory clones probably emigrate and home ubiquitously to distant sites of the gut lamina propria where they develop into IgA-producing immunocytes.

Immunoglobulin- and J chain-producing cells associated with lymphoid follicles in the human appendix, colon and ileum, including Peyer's patches

Immunohistochemistry of B cells associated with normal human Peyer's patches and solitary lymphoid follicles of the ileum, colon and appendix mucosa showed that local accumulation of IgG-producing cells is a common feature of gut-associated lymphoid tissue (GALT). These immunocytes have strikingly down-regulated J-chain expression, indicating that they belong to mature memory clones. They are located mainly in the dome areas, alongside the follicles, and to a lesser extent in the germinal centres, and are accompanied by a much smaller number of J-chain negative IgA- and IgM-producing cells. It is concluded that B cells of mature memory clones are retained in GALT, whereas relatively early counterparts with a high J chain-expressing potential probably emigrate rapidly after stimulation and seed distant secretory sites where they undergo terminal differentiation to produce mainly J chain-containing dimeric IgA.

Expression of HLA-DR antigens on epithelium associated with lymphoid tissue in the human gastrointestinal tract

Mucosa from human stomach, terminal ileum, appendix, and colon was studied for epithelial HLA-DR expression using an immunoperoxidase technique with a monoclonal antibody that detects HLA-DR antigens in paraffin embedded tissues. Expression of HLA-DR by epithelial cells was studied with particular reference to the effect of adjacent lymphoid tissue or surrounding chronic inflammation. In the stomach, epithelial HLA-DR appeared to be induced by chronic inflammation. Where lymphoid nodules were present only that epithelium directly adjacent to the lymphoid tissue expressed HLA-DR. Expression was independent of cell type. Epithelium adjacent to normal lymphoid tissue in the terminal ileum, appendix, and colon also expressed HLA-DR, the relationship between expression and proximity to lymphoid tissue being remarkably precise. Expression of HLA-DR by gastrointestinal epithelium appears to be an effect of adjacent lymphocytes, whether part of an inflammatory response or normal tissue. This must be taken into account when assessing HLA-DR expression by gastrointestinal epithelium.

Gut associated lymphoid tissue: a morphological and immunocytochemical study of the human appendix

Gut associated lymphoid tissue in 15 normal appendices has been characterised in tissue sections using both morphological criteria and immunocytochemical techniques. A panel of monoclonal and polyclonal antibodies was used including antibodies to B-cells, T-cells, macrophages, HLA DR and immunoglobulins. The lymphoid tissue in the appendix was shown to bear a strong resemblance to that in lymph nodes with the exception of the region where the appendix follicles associate with the dome epithelium, which has no lymph node equivalent. This zone of cells between the lymphoid follicles and the dome epithelium termed the 'mixed cell zone' has been shown to contain an abundance of HLA DR-bearing cells, some of which have irregular nuclear morphology and resemble follicle centre cells. These cells were seen to extend into the epithelium of the dome but not the crypts. Using a monoclonal anti-B-cell antibody a population of B-cells was detected in the equivalent areas of mixed cell zone and epithelium and quantitative studies showed that these intraepithelial B-cells comprised approximately 4-5% of the cells in the epithelium. The mixed cell zone was also seen to contain T-cells, S-100 protein-containing macrophages and occasional lysozyme-containing macrophages. Plasma cells were rarely seen in this area.

Double immunocytochemical evidence for a clonal development of specific antibody-containing cells in the rabbit spleen

Rabbits were intravenously primed with the antigens human serum albumin (HSA) and bovine gamma globulin (BGG). The antigens were given simultaneously, or at an interval of 1, 2, or 4 days. After 2 months an intravenous booster injection with both antigens was given simultaneously. The localization pattern of anti-HSA-antibody-containing cells and of anti-BGG-antibody-containing cells in the spleen was determined during both the primary and secondary immune response. Anti-HSA-antibody-containing cells and anti-BGG-antibody-containing cells were not distributed randomly but, rather, were found in defined groups during the induction of an immune response. The most probable explanation for this grouping is that lymphoid cells, once triggered to proliferation by a particular antigen, show a clonal development in the spleen. During their proliferation and successive antibody formation, they migrate only slowly, so that they remain close together. Specific-antibody-containing cells were also detected in the popliteal lymph nodes and in the appendix of the rabbits.

[Development of the mucosa and differentiation of the lymphocytes of the vermiform appendix of the human fetus]

One hundred and twenty-two appendices have been obtained from 12-30-week-old human fetuses and studied histologically (90) and immune-morphologically (32). Lymphoid follicles in the organ appear on the 17th week. Character of the epithelial and the reticular tissue structure in the area of the cupola including the lymphoid follicle have been studied. T- and B-lymphocytes have been stated to be present in the appendix of a 17-week-old fetus. As the fetus is further developing, the number of lymphocytes in the appendix increases: the amount of T-lymphocytes is practically constant, and that of B-lymphocytes increases. Direction of the lymphocytes migration out of the follicle is demonstrated. The lymphoid formations of the appendix are necessary for certain local protective reactions and already in the fetus they begin to participate in the general system of the organism's immunogenesis.

Spontaneous helper factor production by nonadherent rabbit lymphoid cells and its feedback regulation by adherent cells

Normal, unstimulated rabbit lymphoid cells, when depleted of adherent cells, produced soluble helper factor activity that augmented antibody formation by rabbit spleen cells primed against sheep red blood cells (SRBC). Adherent cells inhibited the production of the helper factor by nonadherent cells via a soluble product. Thus unseparated (adherent cell-containing) appendix, lymph node, and spleen cell cultures did not produce the helper factor. On the other hand, the activity of the helper factor required the presence of adherent cells in the assay cultures. Peritoneal exudate cells, predominantly esterase positive, also inhibited the production of the helper factor if they were first exposed to the helper factor-containing culture supernatant. These results imply that a helper factor may participate in the feedback regulation of its own production via an adherent cell population.

Appendectomy and subsequent cancer risk

Although earlier epidemiologic studies reported a positive association between appendectomy and certain cancers, interest was limited due to lack of confidence in the study findings. However, recent morphologic studies on the immune structure of the vermiform appendix in the rabbit and man argue for a reevaluation of the appendectomy--cancer association. This paper reviews briefly the morphologic and epidemiologic literature on the subject to date. The validity of the earlier epidemiologic findings is discussed and avenues for further research assessing the relationship of appendectomy to subsequent cancer risk are proposed.

Histochemical study on human germinal centre, mantle-zone and extra-follicular area lymphoid cell subpopulations. Immunological and cytochemical correlations with lymphomatous cells, peripheral normal and leukemic lymphocytes

Tissue sections of lymph nodes, appendices and tonsils, together with smears of immunologically separated peripheral lymphoid cells from a B-CLL and lymphomatous cells from an immunocytoma were submitted to combined enzyme cytochemical investigations with acid alpha-naphthyl acetate esterase (ANAE), beta-glucuronidase (B-G), acid phosphatase (AcPh), adenosine triphosphatase (ATPase), a,d 5'nucleotidase (5'N). T-cells were Acph+, ATPase- and 5'N-. The vast majority of T- and B-cells displayed ANAE and B-G activities with two distinct staining patterns (T-like and B-like pattern). A high proportion of lymphoid cells in the germinal centre (G.C.) and the vast majority of lymphoid cells in the mantle-zone (M.Z.) were shown to belong to B-cell system because of the expression of ATPase and 5'N in their membranes. Some lymphoid cells positive for ANAE and B-G with a B-like pattern and for AcPh were recognizable in the G.C. In the M.Z. only a few lymphoid cells being ANAE+, with a T-like pattern, and AcPh+ were shown to belong to the T-cell system. In contrast, in this zone a high proportion of small lymphoid cells (64% +/- 10%) showed ANAE activity, mostly with B-like pattern. Therefore, these findings indicate that in the M.Z. a high proportion of B-cells ATPase+ and 5'N+ also display ANAE activity. By comparison of the results obtained from lymphoid tissue sections, B-CLL and immunocytoma cell suspensions and normal circulating lymphocytes we can conclude that B-ANAE-positive cells of the M.Z. do not usually appear in the peripheral blood. They circulate in large numbers only in some pathological conditions (like our reported B-CLL). Therefore, B-ANAE-positive lymphoid cells of the mantle, with a B-like staining pattern, include a wide range of subsets which exclude large lymphoid cells and plasma cells.

[Neurogenic appendicopathy - an immunocytochemical study]

Neurogenic appendicopathy is a frequent (17.8%), non-purulent form of appendicitis. Light microscopy enabled differentiation between an intramucosal variant, a type with central neuroma and neuromuscular proliferations in the submucosa. All nerves within the gut wall were visualized independently of neurotransmitters by immunostaining for neuron-specific enolase. Proliferation of nerve fibres with substance P- and VIP-immunoreactivity was observed in the intramucosal variant and in central neuroma. Moreover, an increase was found in stromal endocrine cells with 5-hydroxy-tryptamine-, somatostatin- and substance P-immunoreactivity. These endocrine stroma cells are considered to be the site of origin of appendix carcinoids. We, therefore, suggest that appendix carcinoids originate in-frequently multicentric-foci of small endocrine cell groups localized within proliferating nerve fibres in the subepithelial stroma, independent of the epithelial layer.

[Enhanced growth of transplanted tumor in appendectomized rats]

The effect of appendectomy on carcinoma RS-1 growth has been studied in young and old Wistar rats and in randombred ones. It has been found that the tumor grew more intensely in the appendectomized animals. This effect was evident in the young animals, both linear and randombred ones. It remained unchanged after administration of the retinoids (all-transmethylretinoate and retinoid C15) but did not develop in the old animals.