Ultrastructural cytochemical studies on the cell coat of macrophages and the localization of fibronectin in granuloma formation

Experimental granulomatous lesions induced by subcutaneous injection of glucan or carrageenan into the footpad of rats were analysed using ruthenium red staining and immunoperoxidase staining for fibronectin at the ultra-structural level in order to clarify the characteristics of the cell coat of aggregated macrophages. In both types of lesion, the macrophages were aggregated loosely or closely with interdigitated pseudopods, while those with large vacuoles containing carrageenan fibrils were markedly swollen and did not show any mutual attachment or interdigitation of pseudopods. The surface coat of the aggregated cells in both groups lacked the outer filamentous layer usually present in those in the free state and was thickened focally just above the site where subplasmalemmal microfilaments were condensed. Fibronectin was demonstrated among the inflammatory cells and the irritants at the early stage and at the site of the focally thickened cell coat at the late stage. However, these findings were not observed in the macrophages with large vacuoles containing carrageenan. These results support the contention that fibronectin participates in the phagocytosis of irritants by macrophages and that, in granulomatous lesions, fibronectin appears focally just above the site of condensed subplasmalemmal microfilaments, this transmembrane association (fibronexus) playing some role in the attachment of macrophages.

Cavitary lung nodules associated with combination chemotherapy containing bleomycin

We describe a patient in whom multiple cavitary lung nodules developed without infectious symptoms after treatment with bleomycin, cisplatin and vinblastine combination chemotherapy for metastatic testis cancer. Open lung biopsy demonstrated extensive granuloma formation without evidence of malignancy or infection. This report extends the spectrum of bleomycin pulmonary toxicity to include cavitary pulmonary nodules associated with granuloma formation.

Transient suppression of the zymosan-induced chemiluminescence produced by bone marrow cells during a subcutaneous nonspecific inflammation in the mouse

The oxidative metabolism of remote phagocytes has been studied during the course of an acute nonspecific inflammation in the mouse. The bone marrow cells (BMC) from mice bearing a polyacrylamide-microbead-induced granuloma (Biogels P4 and P100) show a transient striking decrease of their chemiluminescence (CL) response to opsonized zymosan. This decreased oxidative response occurs between the third and 72nd hr, with a minimum observed at the 24th hr. Bone marrow granulocytes are assessed to represent the main chemiluminescent BMC compartment, using complement-mediated cytotoxicity assays with a monoclonal antimouse granulocyte antibody. Biogel P4-treated mice, but not Biogel P100-treated ones, show at the 24th hr a significantly decreased percentage of segmented bone marrow granulocytes (-45%, P less than .001). The accurate mechanisms involved in this transient suppression of stimulus-induced CL produced by BMC remain to be elucidated.

Involvement of glucocorticoid in insulin-induced angiogenesis of adjuvant pouch granuloma in diabetic mice

The effects of insulin and glucocorticoid on granuloma formation and angiogenesis were studied using an adjuvant pouch in mice and a carrageenin pouch in rats. Carrageenin-induced granuloma formation was suppressed in the diabetic state induced by alloxan in rats. The suppression was restored by adrenalectomy. Corticosterone counteracted the restoration, whereas epinephrine did not, suggesting that the effects of adrenalectomy are due to the lack of adrenocortical hormones rather than epinephrine. The blood corticosterone levels in alloxan mice increased, following the increase of glucose level, to more than 20 micrograms/dl after 4 weeks. The increase of corticosterone levels disappeared after adrenalectomy. In the mouse adjuvant pouch, corticosterone dose-dependently decreased granuloma formation and angiogenesis. The values of these two parameters obtained with a dose of 20 micrograms/pouch corticosterone agreed with those of the serum levels in diabetic mice. Insulin dose-dependently reversed the suppressed angiogenesis of 20 micrograms corticosterone-treated mice and the dose-response curve approximated the curve of alloxan-treated mice. The effects of diabetes were concluded to involve insulin deficiency as well as glucocorticoid enhancement and the counteraction between the two may control granuloma formation and angiogenesis.

Distribution of cefodizime to exudate in the croton oil-induced rat granuloma pouch and its therapeutic effects on experimental infections in the pouch

Cefodizime was compared with cefotaxime (CTX) in regard to its distribution to an inflammatory site (exudate in croton oil-induced granuloma pouch) of rats and its therapeutic effects on experimental infections in such pouches after intravenous injection. Cefodizime levels in rat serum and pouch exudate were higher than those of CTX, and the former compound disappeared from the serum and pouch exudate far more slowly than the latter. In the tests for therapeutic effects, cefodizime showed almost the same degree of inhibitory activity as CTX against growth in pouch exudate of Escherichia coli Ec-7, Proteus mirabilis Pm-428, and Serratia marcescens Sm-390 for which the minimum inhibitory concentrations (MICs) of cefodizime were equal to or greater than the CTX values, and such activity of cefodizime lasted for a longer period than that of CTX. These results suggest that the above pharmacokinetic features of cefodizime compensate for its MICs against organisms displaying lower values for CTX.

Isolation of mycolic acid-containing glycolipids in Nocardia rubra and their granuloma forming activity in mice

Three classes of glycolipids (TMM (trehalose monomycolate), TDM (trehalose dimycolate) and GM (glucose mycolate] containing mycolic acids as hydrophobic components were isolated from a strain of Nocardia rubra (Rhodococcus rubrum) and their structures have been partially characterized using infrared spectrometry, gas-liquid chromatography and gas chromatography-mass spectrometry. Acid or alkaline hydrolysis of isolated glycolipids revealed that trehalose was the sole water soluble component in TMM and TDM, while glucose was the hydrophilic component in GM. On the other hand, saturated, monoenoic and dienoic mycolic acids with carbon atoms ranging from C36 to C50 contained constituents of fatty acid moiety at C44. From the analytical results, TMM, TDM and GM were tentatively identified as trehalose monomycolate, trehalose dimycolate and glucose monomycolate, respectively. The mycolic acid composition differed significantly by the glycolipid classes: the highest amount of saturated mycolic acids were detected in TMM and GM, while a significant amount of dienoic mycolic acids have been found in TDM and the cell wall bound lipid fraction (BL). All these three classes of glycolipids containing mycolic acids showed strong granuloma forming activity in lungs and spleen of ICR mice 1 week after intravenous injection of 100 to 500 micrograms glycolipid in W/O/W micelles containing Freund's incomplete adjuvant. These results indicated that glycolipids containing shorter carbon chain mycolic acids ranging C40-50, corresponding to less acyl numbers or monosaccharides such as glucose, can also produce foreign body-type granuloma in mice without protein antigens.

A model of pulmonary granulomata induced by beryllium sulfate in the rat

In humans beryllium is known to cause pulmonary granulomata which are histologically indistinguishable from sarcoidosis. There is some evidence in man that beryllium-induced pulmonary granulomata are immunologically mediated. We set out to develop an animal model to study the immunopathogenesis of beryllium-induced granulomatous lung disease. Beryllium sulfate (BeSO4) was injected intratracheally (i.t.) into F344 rats previously immunized to BeSO4. This results in well-formed, sarcoid-like lung granulomata at 6 weeks post BeSO4. There was a conspicuous presence at 4 weeks post BeSO4 of numerous, perivascularly located Langhans' giant cells which preceded the development of well-formed granulomas at 6 weeks. Rats were sacrificed at 4, 6, 8 and 12 weeks after i.t. BeSO4. At the time of sacrifice bronchoalveolar lavage (BAL) was performed; B and T (W3/25+ helper 0X8+ suppressor/cytotoxic) lymphocyte populations were quantitated and compared to lymphocyte populations obtained from lung tissue. Both B and T cells were significantly elevated in lung tissue post BeSO4. At 4 weeks when granulomata were just developing, a W3/25+ to 0X8+ ratio of 20:1 in lavage and 2:1 in lung tissue was seen. At 6 weeks when granulomata were well-formed there was a predominance of W3/25+ cells in lavage but not in lung tissue. At 8 and 12 weeks, when the granulomata were regressing, lavage fluid still contained a W3/25+ predominance in contrast to lung tissue which contained a predominance of 0X8+ cells.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute granulomatous interstitial nephritis with iritis. Possible induction by non-steroidal antiphlogistics]

A 49-year old woman developed non-oliguric acute renal failure accompanied by bilateral acute anterior uveitis, following a three weeks' period of lethargy, anorexia and temporary fever. Kidney biopsy revealed acute interstitial nephritis with interstitial infiltrations of lymphocytes and monocytes, as well as multiple perivascular epithelioid granulomas. A substantial improvement of renal function was achieved under treatment with systemic corticosteroids. The uveitis resolved completely under additional topical treatment. During a follow-up period of 9 months, there has been no relapse of nephritis or uveitis. The disease of this patient resembles the so-called TINU syndrome of unknown aetiology. Remarkable features of the present case are the histological diagnosis of granulomatous acute interstitial nephritis in the absence of systemic granulomatous disease, as well as a possible association with the administration of non-steroidal antiinflammatory drugs.

[Paraffin granuloma of the lower lid]

A young man developed a solid tumor of the lower eyelid, which histological studies showed to be a paraffinoma. Two years before the first manifestation a dacryocystitis had been treated by probing and injection of antibiotic ointment into the lacrimal drainage system. Since paraffin is a constituent of most ointments, the possibility of a granulomatous reaction should be considered if the ointment containing paraffin is introduced into the subcutaneous tissue.

Sarcoidlike lung granulomatosis induced by aluminum dusts

Interstitial lung disease developed in a 32-yr-old chemist after working 8 yr in a dusty atmosphere containing aluminum powders. Bronchoalveolar lavage disclosed a helper T-lymphocyte alveolitis, and transbronchial lung biopsies showed sarcoidlike epithelioid granulomas. These granulomas contained dust identified by mineralogic analyses as consisting mainly of aluminum particles. Nasal and liver biopsies and a Kveim test did not reveal extrapulmonary granulomatous infiltration. An extensive immunologic work-up showed none of the abnormalities classically seen in sarcoidosis, but peripheral blood lymphocytes exhibited blastic transformation in the presence of soluble aluminum compounds. About 1 yr after cessation of exposure, a chest radiograph and lung function tests remained essentially unchanged, but signs of alveolitis disappeared. This observation suggests that aluminum may cause granulomatous lung disease accompanied by a helper T-lymphocyte alveolitis, similar to that of berylliosis and sarcoidosis. Further observations would be necessary to show if this constitutes an early stage of aluminum-induced fibrosis (aluminum lung).

The effect of doxycycline on polyvinylpyrrolidone-induced granuloma formation in the rat liver

The tetracyclines specifically inhibit mitochondrial protein synthesis when present at the same low concentrations as used for their antibacterial action. Inhibition of mitochondrial protein synthesis leads to decrease in the oxidative energy-generating capacity of cells. Therefore, the presence of tetracyclines may result in proliferation arrest. In the present study we show that continuous intravenous administration of polyvinylpyrrolidone (PVP) induces the formation of granulomas in the normal rat liver; the rats usually die within 2 weeks of continuous PVP treatment. Athymic (nude) rats appear to be more resistent to the deleterious effects of PVP as they survive the treatment for at least 5 weeks. Although the livers of the PVP-treated nude rats are heavily infiltrated with phagocytic cells, they seldom show granulomas. Reconstitution of nude rats with syngenic thymocytes leads, on the other hand, to extensive granuloma formation. Normal rats treated continuously with PVP plus doxycycline, however, all survive, their livers showing only a few very small granulomas and the normal low number of phagocytic cells. We conclude that the formation of granulomas induced by PVP is a process which is mediated by T-lymphocytes. Because doxycycline prevents this kind of granuloma formation it seems likely that doxycycline not only impairs the proliferation and differentiation of T-lymphocytes but also of monocytes and macrophages.

Long-term evolution of BCG- and CFA-induced granulomas in rat lungs. Correlation of histologic features with cells in bronchoalveolar lavage samples

Granulomatous inflammation was induced in the lungs of rats for assessment of the suitability of this animal species for long-term study of granuloma development and resolution and for comparison of the histologic changes with the cellular profile in bronchoalveolar lavage (BAL) samples. It was found that after a single intravenous injection of bacillus Calmette-Guérin (BCG) organisms suspended in saline-0.01% Triton, complete Freund's adjuvant (CFA), or BCG suspended in CFA (BCG + CFA), distinct pathologic patterns developed in the lungs during the acute stages. BCG alone caused numerous small epithelioid granulomas associated with interstitial infiltration; CFA alone caused large discrete granulomas with minimal interstitial changes, and BCG + CFA caused large granulomas associated with diffuse interstitial infiltration. Following CFA or BCG + CFA the maximum number and size of granulomas were reached approximately 4 weeks after injection. By 8 weeks collagen was seen in the larger granulomas in sections stained with hematoxylin and eosin from animals given CFA or BCG + CFA. Maximum collagen deposition was seen at 16 weeks. From that point onward the degree of collagen deposition decreased, so that by approximately 42 weeks collagen was no longer seen. At 52 weeks residual granulomatous lesions consisted of a few foci of foamy macrophages surrounded by several layers of lymphocytes or epithelioid cells surrounded by dense layers of lymphocytes. Bronchoalveolar lavage samples revealed that at all time periods the number of leukocytes was increased and that the increase was due primarily to an influx of macrophages and lymphocytes. The increase in number of lymphocytes was so striking that at the peak of granulomatous changes following injection of BCG + CFA up to 50% of the total cells were found to be lymphocytes. The total number of leukocytes in BAL samples and the absolute number of lymphocytes closely paralleled the intensity of histologic changes seen in microscopic sections. It is concluded that the intravenous injection of BCG, CFA, or BCG + CFA in rats causes distinct and profound granulomatous patterns that are associated with increased cellularity in BAL samples. The findings suggest that the rat may be an excellent model for study of the mechanisms of granuloma development and resolution.

Collagen biosynthesis and degradation during deposit and resorptive phases of carrageenin granuloma

Collagen metabolism was studied in both, the developing and resorptive phases of carrageenin granuloma. The rate of collagen biosynthesis relative to the rate of total protein synthesis is almost twice as high during the deposit phase compared with the resorptive phase of the same process. Total collagenolytic activity appears to be approximately the same in both, deposit and resorption stages of the granuloma. Notwithstanding, the enzyme is fully active during resorption; whereas half of this activity is in a latent form during deposit. Collagenolytic activity increased remarkably when assayed at 30 mM CaCl2 as compared to 10 or 50 mM.

Granulomatous interstitial nephritis associated with allopurinol therapy

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[Thorotrastoma--late damage following thorotrast arteriography]

We report two cases of cervical thorotrastoma. Thorotrast is no longer used as a radiographic contrast agent, so that the rare thorotrastoma is often forgotten in the differential diagnosis of hypopharyngeal tumours. Surgical treatment of a thorotrastoma is not recommenced.