Fibroblast androgen receptors in patients with genitourinary anomalies

The etiology of certain disorders of sexual differentiation is unclear. The authors have examined the hypothesis that hypospadias and other disorders compatible with a defect in androgen action, such as cryptorchidism, micropenis, chordee/penile torsion, and ectopic testis, might be explained by androgen receptor abnormalities. Therefore, 25 subjects were studied who were selected only because they had one of these developmental defects, together with a predominantly male phenotype, and no readily ascertainable explanation for the defect. Four of these subjects had mixed gonadal dysgenesis with multiple genito-urinary anomalies. They were included for comparative purposes, since there is no evidence for androgen resistance in this disorder. Patients with testicular regression syndrome (gross testosterone deficiency), impaired testosterone biosynthesis (relative testosterone deficiency), 5 alpha-reductase deficiency (altered T/DHT ratio), and a family history or endocrine profile suggestive of androgen resistance, were all excluded from evaluation. Androgen receptor content (R0) and binding affinity (Kd) were measured in 26 genital or pubic skin fibroblast strains cultured from 25 affected patients using a dispersed, whole cell assay at 22 C. There was no difference in the mean androgen receptor content (approximately 10,000 sites/cell) or binding affinity (approximately 1 nM) between the patients' fibroblasts and those from 26 fibroblast strains established from 26 normal males. Moreover, there were no differences in the nuclear uptake of [3H]dihydro-testosterone into dispersed, intact fibroblasts incubated at 37 C when 11 patient and seven normal male fibroblast strains were compared.(ABSTRACT TRUNCATED AT 250 WORDS)

The fate of the grafted quail Mullerian duct in the chick embryonic coelom

Recent morphological analyses of Mullerian duct regression suggested that some ductal cells might survive, in contrast to the previous view that regression was an example of "programmed cell death." The present study was designed to demonstrate survival of Mullerian duct cells after regression, and to map migration into local or distant tissues. Seven or eight-day-old chick embryos received intraabdominal grafts of Mullerian ducts from seven- or eight-day-old quails, creating chick-quail chimeras. Three or four days later the abdomen was serially sectioned and examined histologically using a modified Feulgen stain. Sixty-six of the 230 grafted embryos survived (29%). After sectioning, grafts were found in 34 of the 58 embryos in the body wall, peritoneum or mesenephros, with several adherent to the hosts' Mullerian ducts. Twenty female embryos contained grafts, all of which were developing normally. Fourteen male embryos contained grafts in various stages of regression. Regression was more advanced in mesonephric or body wall grafts while free intraperitoneal grafts showed the least regression. Migration of quail cells was striking when seen in grafts placed in the mesonephros or adherent to the host Mullerian duct. In these, regressing quail cells migrated into and became incorporated in adjacent chick mesenephros. Migration patterns were seen also in non-regressing cells in female hosts, where quail cells "homed" to the host chick Mullerian duct structures.

Cryotherapy of subglottic hemangioma

The natural history of the hemangioma is spontaneous regression; therefore, most lesions require no treatment. The large occlusive subglottic hemangioma which presents before the age of 6 months, however, may be life-threatening. Two infants with subglottic hemangiomas with complete upper airway obstruction were treated successfully with cryotherapy, after tracheostomy. In each case the cryoprobe was placed transbronchoscopically on the subglottic hemangioma at -80 degrees C. for 30 to 45 seconds, the freezing interval varying with the age of the patient. One infant is asymptomatic and has had the tracheostomy tube removed. The other infant, after successful cryosurgical treatment, died from an unrelated illness. The histopathology of the larynx 3 1/2 months after cryotherapy of the hemangioma showed tracheal reepithelialization, active regeneration of cartilage with maintenance of luminal diameter, minimal submucosal fibrosis, and minimal residual hemangioma. Cryotherapy for subglottic hemangiomas offers many advantages including hemostasis, controlled local surgical injury, subsequent rapid healing of tissues with minimal fibrosis, and preservation of lumen without stricture. Previous forms of therapy which have been supplanted include radiotherapy, injection of sclerosing substances, systemic steroids, and surgical excision. Carbon dioxide laser is an effective therapeutic modality that we reserve for selected smaller hemangiomatis lesions of the subglottic area.

Immunocytochemical localization of Mullerian inhibiting substance in the rough endoplasmic reticulum and Golgi apparatus in Sertoli cells of the neonatal calf testis using a monoclonal antibody

Mullerian Inhibiting Substance (MIS) has been localized in the Sertoli cells of the neonatal calf testis using preembedding immunoperoxidase techniques and a monoclonal antibody which almost completely blocks the biological activity of MIS. Both the peroxidase-labeled antibody method using a peroxidase-conjugated F(ab')2 fragment of IgG as a second antibody and the unlabeled antibody peroxidase-antiperoxidase (PAP) method using Fab fragments of the PAP complex were employed. With both methods, MIS was demonstrated within the cisternae of the rough endoplasmic reticulum (RER) and the Golgi apparatus. In the Golgi, MIS was concentrated in the transmost cisternae especially at their peripheral expansions. This study indicates that MIS is synthesized in the RER and transported to the Golgi apparatus, presumably for glycosidation, before secretion from Golgi derived vacuoles.

Cyclic adenosine 3',5'-monophosphate modulation of mullerian duct regression

(Bu)2cAMP inhibits the action of testicular Mullerian inhibiting substance (MIS) in vitro, but it is unknown whether the intracellular nucleotide diminishes production of MIS by the testis or interferes with its action at the Mullerian duct. When added to the 14 1/2-day old rat embryo Mullerian duct in organ culture, (Bu)2cAMP (0.1 or 1.0 mM) inhibited regression caused by biologically active exogenous MIS fractions, as well as that produced by the fetal testis (1.0 mM). Dibutyryl cyclic guanosine 3',5'-monophosphate was ineffective against exogenous MIS fractions or the fetal testis. The phosphodiesterase inhibitor, methyl-isobutyl-xanthine, had the same inhibitory effect on the MIS-fraction (0.1 or 1.0 mM), as well as against MIS secreted from the fetal testis (1.0 mM). Theophylline at 1.0 mM inhibited the action of the MIS fraction. The presence of (Bu)2cAMP in the medium was required for at least the first 24 h of the 72-h incubation to significantly inhibit MIS action. These results indicate that intracellular cAMP inhibits the action of MIS at the Mullerian duct itself by a potentially reversible change in the cells. We speculate that cAMP may act by altering the state of differentiation in the cells, perhaps by mediating phosphorylation of intracellular (and extracellular) proteins.

Androgen stimulation of nucleotide pyrophosphatase during mullerian duct regression

Mullerian inhibiting substance (MIS) causes regression of the embryonic Mullerian duct. In the fetal rat urogenital ridge, extracellular nucleotide pyrophosphatase (NPPase) can be detected by histochemical staining on the regressing male Mullerian duct, with no corresponding enzyme localization on developing female Mullerian ducts. In vivo results in male embryos can be confirmed in vitro by incubating 14.5-day-gestation female urogenital ridges with MIS and testosterone for 72 h before enzyme localization. Since the addition of testosterone to MIS is obligatory to detect NPPase activity in vitro, and certain steroids enhance Mullerian duct regression, additional steroids were tested in vitro alone or in combination with MIS for their abilities to stimulate NPPase. NPPase induction occurred only with the combinations of MIS and testosterone or MIS and medroxyprogesterone acetate. Neither MIS alone nor any steroid used alone stimulated NPPase activity. The effect of exogenous NPPase added alone to the developing urogenital ridge was also assessed. Incubation of the female urogenital ridge for 72 h with exogenous NPPase caused marked hyperplasia of the Mullerian duct epithelial cells and early mesenchymal cell condensation, without the basement membrane breakdown normally seen in regression. Since NPPase activity is present in the Mullerian duct only during regression, these findings suggest that MIS and fetal androgens are synergistically modulating the activity of this enzyme. Its role in the Mullerian duct, as suggested by its cytological effects, may be to stimulate cellular responses before migration during regression.

Complete laryngotracheoesophageal cleft: management and repair

A newborn baby with a complete or type III laryngotracheoesophageal cleft from larynx to carina was managed with a bifurcated endobronchial tube prior to complete reconstruction in one stage. To prevent pressure on the posterior suture line, a tracheostomy tube was constructed from a REA tube originally designed to use for cleft palate repairs. Fundoplication prevented gastroesophageal reflux and allowed enteral feedings. The child is now monitored at home on a prolonged pharyngeal retraining program with intermittent plugging of his tracheostomy tube. This report describes the management and repair of the first long-term survivor with this severe defect.

Changing patterns of fibronectin, laminin, type IV collagen, and a basement membrane proteoglycan during rat Mullerian duct regression

Antibodies to type IV collagen, laminin, heparan sulfate proteoglycan, and fibronectin were used to study the regression of the rat Mullerian duct. All four of these matrix constituents are located at the perimeter of the Mullerian duct within the ductal basement membrane. As the Mullerian duct regresses, the staining of all of these basement membrane constituents becomes irregular and discontinuous. Fibronectin, which is also present in the interstitium, becomes undetectable in the mesenchyme which condenses around the regressing Mullerian duct. These data indicate that degradation of the extracellular matrix around the male Mullerian duct is a central event in the regression of this structure.

Improved histology for the chick-quail chimera

A simple modification of nuclear staining after acid hydrolysis has been made which provides easy identification of quail nuclear markings in a chick-quail chimera. This method also improves the histologic detail normally seen with hematoxylin and eosin when compared to the more commonly used Feulgen reaction. Embryonic tissues can be fixed in Zenker's or Helly's solution and the sections obtained are hydrolyzed in acid (3.5 N HCl at 37 C for 40-50 min). After acid hydrolysis the sections are stained with hematoxylin and eosin rather than Schiff reagent and fast green. The interphase nuclei of chick cells show homogeneous or mottled purplish blue staining, while quail nuclei contain a dark blue spot. This staining corresponds to the reddish purple staining of the quail's heterochromatin seen adjacent to the nucleolus in the standard Feulgen stain. This new technique facilitates identification of quail cell types in the chick host and provides superior histology of the chick tissues by demonstrating cytoplasmic detail.

Phosphorylation events during Müllerian duct regression

Regression of the fetal rat Müllerian duct in vitro was stimulated by sodium fluoride in the absence of Müllerian inhibiting substance. The action of Müllerian inhibiting substance was inhibited by sodium vanadate, adenosine 5'-triphosphate, and several related nucleotides in the presence of manganese ions. Epidermal growth factor specifically inhibited the substance, but only with manganese ions present. Insulin, platelet-derived growth factor, and nerve growth factor had no effect. These results suggest that dephosphorylation of membrane proteins mediates the action of Müllerian inhibiting substance.

Müllerian inhibiting substance inhibition of a human endometrial carcinoma cell line xenografted in nude mice

Müllerian inhibiting substance (MIS) is a fetal testicular product which causes regression of the müllerian duct in the male mammalian embryo. This material has been partially purified from a neonatal bovine source and in cruder fractions has shown antitumor effects when tested against the HOC-21 ovarian carcinoma line in monolayer cytotoxicity, in soft agar colony inhibition assay, and in nude mouse xenografts. The glycoprotein used for the present studies was more highly purified by sequential ion exchange, carbohydrate affinity, and dye affinity chromatography. After a 1-hr exposure with 1.0 X 10(6) tumor cells prior to heterotransplantation, this more purified preparation with MIS biological activity as determined by organ culture assay of embryonic urogenital ridges delayed the appearance of palpable tumor nodules. That this response may be specific for tumors derived from the coelomic epithelium of the embryo is further supported by the absence of any antitumor effect when this substance was tested against the SW-48 colon carcinoma line. It is of interest that the antitumor activity followed the biological activity as the preparation was further purified to 30,000-fold.

Production of Monoclonal Antibodies for Affinity Purification of Bovine Mullerian Inhibiting Substance Activity

Two monoclonal antibodies (IG8 and IG10) specific for Mullerian inhibiting substance (MIS) were obtained from the fusion between myeloma cell line SP2/0 and spleen cells from an A/J mouse immunized with partially purified MIS. The resulting hybridomas were screened by a solid-phase RIA and two lines were selected and cloned. Both MAbs IG8 and IG10 subsequently demonstrated specificity for MIS by their ability to inhibit biologically active MIS by precipitation with a second antibody, directly block MIS activity in the organ culture assay, and adsorb and elute active MIS when coupled to a solid support. SDS-polyacrylamide gel electrophoresis of affinity purified MIS demonstrated a major band at 140 kD in unreduced gels and two bands with approximate molecular weights of 70 and 74 KD following reduction. Protein bands were localized either directly by silver staining or on immunoblots developed with radiolabeled anti-MIS MA.

The role of nucleotide pyrophosphatase in Mullerian duct regression

Mullerian inhibiting substance (MIS), a glycoprotein from the fetal testis causing regression of the embryonic Mullerian duct, can be inhibited in vitro in the presence of Mn2+ by a wide range of nucleotides including GTP, NAD, ATP, AMP, and several nonhydrolyzable synthetic ATP analogs. Extracellular nucleotide pyrophosphatase (NPPase), an enzyme able to hydrolyze the wide variety of the nucleotides and analogs found to inhibit Mullerian duct regression, was studied by histochemical staining (H. Sierakowska and D. Shugar (1963). Biochem. Biophys. Res. Commun. 11, 70-74) to determine if NPPase localized in or around the Mullerian duct during regression. Frozen sections of urogenital ridges from 14 1/2- to 17 1/2-day rat fetuses (n = 77) were incubated with a-naphthyl thymidine-5'-phosphate (naphthyl TMP) and Fast Red TR. Nucleotide pyrophosphatase hydrolyzes naphthyl TMP, releasing naphthol, which then reacts with Fast Red to produce color at the enzyme site. Nucleotide hydrolysis was detected around regressing male (n = 16) Mullerian duct cells at 16 1/2 days of gestation, but no hydrolysis was detected around female (n = 17) Mullerian duct cells at any stage. Controls (n = 24) incubated without substrate did not stain. Addition of exogenous ATP (n = 20) to the histochemical incubation medium inhibited nucleotide hydrolysis on male Mullerian ducts, suggesting that this staining is specific for pyrophosphatase activity. Results in vivo were confirmed in vitro by incubating 14 1/2 day female rat urogenital ridges with MIS for 72 hr prior to histochemical staining. The addition of testosterone to MIS was obligatory to detect staining in vitro (n = 10). The localized NPPase activity around the regressing Mullerian duct suggests that NPPase may appear as a consequence of duct regression and may act to control the degree of membrane phosphorylation by degrading excess trinucleotides.

Is Mullerian-inhibiting substance a circulating hormone in the chick-quail chimera?

Mullerian-inhibiting substance (MIS) is a glycoprotein from the fetal testis which causes regression of the embryonic Mullerian duct. It was thought to be a locally acting agent, because in the true hermaphrodite, a Fallopian tube remains on the side contralateral to that bearing a testis, but is absent on the side adjacent to the testis. To test whether Mullerian duct regression could occur at a distant site, the chick-quail chimera was used. Chick embryos were maintained in shell-less culture from 3-14 days of incubation. At 7-9 days of incubation, a chick/quail chimera was created by grafting a quail Mullerian duct into the eye of the chick. Three or four days later, the eye was enucleated and histologically examined using the Feulgen reaction or a modification of this technique. Under these conditions, the quail cell nuclei could be readily identified, allowing absolute identification of the cells around the graft. Twenty-three female chick hosts received grafts; of the 17 grafts recovered, 16 were developing normally. In 16 male chicks receiving grafts, 10 Mullerian ducts were recovered, with 9 of these showing clear signs of regression, such as basement membrane dissolution, condensation of mesenchyme, diminution of epithelial tube size, and thinning of mesenchymal cuff. These results suggest that MIS reached the quail duct in the eye and was functionally active. This model suggests that MIS may be a true endocrine testicular secretion.

Roux-en-Y on-line intussusception to avoid ascending cholangitis in biliary atresia

A child with biliary atresia experienced severe ascending cholangitis when the exteriorized loop of a portahepatoenterostomy was internalized. Backwash of bowel contents was reduced and further cholangitis was prevented by creation of an on-line intussuscepted Roux-en-Y jejunal loop to provide a nonrefluxing conduit from the porta hepatis. The loop could then be internalized and antibiotic therapy could be discontinued. The success of this procedure in this case encourages us to use this method in similar cases of biliary atresia. It may be of use in all Roux-en-Y loops, such as those used to drain the transplanted liver of patients with biliary atresia and those created to drain the distal part of the transplanted pancreas.

Mullerian inhibiting substance fractionation by dye affinity chromatography

Mullerian inhibiting substance (MIS), a large glycoprotein secreted by the fetal and neonatal testis, is responsible for regression of the Mullerian ducts in the male embryo. This fetal growth regulator has been purified more than 2000-fold from crude testicular incubation medium following fractionation on a triazinyl dye affinity support. A high yield of 60% recovered activity was achieved in the absence of exogenous carrier protein by stabilizing MIS with 2-mercaptoethanol, EDTA, and Nonidet-P40 and eliminating losses in the handling and concentration of MIS fractions. Although affinity elution with nucleotides has proved successful in other systems, MIS could not be eluted with ATP, GTP, or AMP, with or without divalent metal ions. Nucleotide elution, however, does remove contaminating proteins prior to MIS recovery with high ionic strength. The 2000-fold-purified MIS fraction, although not homogeneous, shows a reduction-sensitive band after SDS-gel electrophoresis that has been proposed to be the MIS dimer.

Complications of pediatric percutaneous renal procedures: incidence and observations

Successful definitive (complete) percutaneous renal procedures in the pediatric age group were performed in 97 per cent of antegrade pyelograms, in 94 per cent of ureteral perfusions (Whitaker test), in 98 per cent of nephrostomies, and 100 per cent of both retroperitoneal fluid drainages and renal aspiration biopsies. Significant complications, or those necessitating specific treatment or prolonged hospitalization, were 1.1 per cent. 0.7 per cent, 15.2 per cent, 0 per cent, and 0 per cent, respectively, for the above procedures. Not surprisingly, certain operators are more adept than others at successfully performing procedures and at avoiding some but not all complications (see Tables 2 and 3). Proper training, experience, and adherence to basic principles are important. However, there were no deaths, no kidneys lost, and no transfusions or operations required as a result of any complication from the pediatric percutaneous renal procedures; correction of any existing blood coagulation disorder is necessary prior to their performance to avoid potentially fatal hemorrhage.

Specific estradiol binding in embryonic Mullerian ducts: a potential modulator of regression in the male and female chick

The total content of putative estradiol-specific cytosolic type I and nuclear type I and II estradiol-specific binders was measured in 8- and 9-day-old male and female chick embryo Mullerian ducts. Cytosolic and nuclear type I estradiol-specific binding levels were similar in males and females, and no significant differences were noted among right vs. left and 8-day-old vs. 9-day-old embryo Mullerian ducts. The levels of nuclear type I estradiol binder were consistently higher than the cytosolic type I binder, but this difference was not significant. Nuclear type II estradiol-specific binding, however, was significantly higher in the left Mullerian ducts of both male and female embryos. The significance of these findings in relation to the regression of Mullerian ducts in male and female chick embryos is discussed.

Estrogen inhibition of Mullerian inhibiting substance in the chick embryo

Diethylstilbestrol (DES) feminizes the embryonic chick testes and causes retention of the Mullerian duct, an observation made by Etienne Wolff in 1939. The present study was designed to determine if the feminized testis could produce Mullerian Inhibiting Substance (MIS). DES in various doses was injected into the air sac or yolk of 5-day chick embryos, with removal of the gonads at 13-16 days of incubation. That the DES-treated testis was feminized was documented by the development of a left "ovarian" cortex, yet this gonad continued to produce MIS as estimated by a graded organ-culture assay. The male chick Mullerian ducts, exposed to both endogenous MIS and exogenous estrogen (DES), however, were preserved, indicating that the Mullerian duct retention seen in DES-treated embryos was not caused by suppression of MIS secretion. These data support the hypothesis that MIS and estrogens interact at the target-organ (i.e., Mullerian duct), resulting in Mullerian duct retention. The implications of this hypothesis for mammalian sexual development especially in regard to the effect of DES-treatment on male fetuses, and the possible role of MIS and estrogens in testicular descent are considered.

Steroid enhancement of Mullerian duct regression

The biologic activity of the glycoprotein, Mullerian Inhibiting Substance (MIS), was enhanced by added testosterone, medroxyprogesterone acetate, and progesterone, although these steroids did not cause Mullerian duct regression when added alone. Statistically significant augmentation by testosterone and medroxyprogesterone was observed at concentrations of 10(-7) and 10(-8) M. Progesterone enhanced MIS activity at a concentration of 10(-6) M. By contrast, dihydrotestosterone, estradiol, and corticosterone at concentrations of 10(-9) to 10(-5) M produced no significant effect on MIS activity. Since MIS does not bind directly to the steroids studied, we suspect that the enhancement effect occurs at the receptor level, probably at the mesenchyme as observed in other developmental systems.

Advances in management of laryngeal and subglottic stenosis

The introduction of cryotherapy and the refinement of surgical techniques has promoted progress in the care of infants and children with previously unresponsive intraluminal lesions of the larynx and subglottic area. Three cases illustrate the pluralistic approach that often must be brought to and individualized for these difficult cases before a measure of success can be assured. One case, stenotic since intubation required when the child was less than 1 k, was treated with fulguration, cryotherapy, and prolonged stenting. The severe stenosis from the tracheotomy site to the vocal cords eventually required open repair with anterior and posterior cricoid splits and a hyoid pedicled bone graft, followed by prolonged stenting. A method of internal stenting through the cords with percutaneous fixation was effective for long-term (3-6 mo) therapy. Another patient with severe stenosis was managed with multiple cryotherapy procedures followed by prolonged internal stenting. A third patient with subglottic stenosis secondary to an inhalation burn, was treated with cryotherapy without stenting. This presentation discusses the techniques of internal stenting with percutaneous fixation, cryotherapy, and open repair with combined anterior and posterior cricoid split, considering the indications and idiosyncracies of each technique.

Dysgenesis of testicular and streak gonads in the syndrome of mixed gonadal dysgenesis: perspective derived from a clinicopathologic analysis of twenty-one cases

The clinical and pathologic aspects of 21 cases of mixed gonadal dysgenesis (MGD) were studied. The gonads in 15 patients consisted of a macroscopic testis and a streak gonad; six patients had variants, including two with bilateral testes and four with bilateral streak gonads or tumors. Functionally, the gonads were incompetent. Testes 1) failed to completely inhibit müllerian development, 2) failed to support full differentiation of mesonephric duct structures, 3) failed to adequately masculinize development of the external genitalia, or 4) often failed to mediate their own descent, resulting in asymmetry of the internal and external genitalia. None of the streak gonads mediated normal female adolescent development or fertility. Microscopic examination revealed that every gonad, regardless of its gross appearance, was morphologically abnormal. Although gonads with seminiferous tubules usually developed to a moderately advanced state, macroscopically resembling testes, the hilar zone remained architecturally disorganized; the cortex invariably lacked more than a rudimentary tunica albuginea or exhibited partial ovarian differentiation, sometimes even with a rare primordial follicle. Over time, the seminiferous tubules atrophied and hyalinized. Gonads that grossly resembled streak gonads were observed microscopically to be composed of a stroma resembling that of normal ovarian cortex. In patients more than several years of age, the entire complement of germ cells in streak gonads disappeared. It is suggested that patients with MGD be raised as females. Early removal of gonads will prevent the development of gonadoblastoma and dysgerminoma. If the uterus is retained and the patient is subsequently given exogenous estrogen, care should be taken to detect early any signs of the development of endometrial carcinoma or its precursor, to which these patients may be prone.

Mullerian inhibiting substance inhibits colony growth of a human ovarian carcinoma cell line

Mullerian inhibiting substance (MIS), a fetal testicular product which causes regression of the Mullerian duct in the male mammalian embryo, is being evaluated as an inhibitor of genital tract tumors. The present study demonstrates in a clonogenic soft agar that biologically active MIS inhibits the growth of a human ovarian carcinoma cell line (HOC-21) in a dose-dependent manner when compared to phosphate-buffered saline medium controls, heat-inactivated MIS, or biochemical fractions which lack biological activity (P less than 0.05).

Monoclonal antibody to Mullerian inhibiting substance

Mullerian Inhibiting Substance (MIS) is a testicular product that causes the regression of the Mullerian duct in the developing male embryo. Antibody specific for MIS would facilitate the purification and study of this "hormone," but because of its impure status, traditional polyclonal antisera specific for MIS would be untenable. The requisite specificity, however, might be obtained by the technique of somatic fusion, regardless of the purity of the immunizing antigen. This paper describes the production of 2 monoclonal antibodies specific for MIS by the technique of somatic cell fusion. Spleen cells from mice immunized with an impure preparation of MIS were fused with myeloma cell line NS1. Culture media from the resulting hybridoma cell lines were screened for anti-MIS antibody by a sensitive RIA. Specificity for MIS was demonstrated by the adsorption of biologically active MIS on an affinity column prepared from monoclonal anti-MIS antibody. MIS activity as assessed by an organ culture assay was subsequently recovered from the affinity column in the fraction eluted with MH4SCN. Using the RIA, monoclonal anti-MIS antibody was also shown to compete favorably with a variety of potentially cross-reactive proteins.

Monoclonal antibody to Mullerian inhibiting substance

Mullerian Inhibiting Substance (MIS) is a testicular product that causes the regression of the Mullerian duct in the developing male embryo. Antibody specific for MIS would facilitate the purification and study of this "hormone," but because of its impure status, traditional polyclonal antisera specific for MIS would be untenable. The requisite specificity, however, might be obtained by the technique of somatic fusion, regardless of the purity of the immunizing antigen. This paper describes the production of 2 monoclonal antibodies specific for MIS by the technique of somatic cell fusion. Spleen cells from mice immunized with an impure preparation of MIS were fused with myeloma cell line NS1. Culture media from the resulting hybridoma cell lines were screened for anti-MIS antibody by a sensitive RIA. Specificity for MIS was demonstrated by the adsorption of biologically active MIS on an affinity column prepared from monoclonal anti-MIS antibody. MIS activity as assessed by an organ culture assay was subsequently recovered from the affinity column in the fraction eluted with MH4SCN. Using the RIA, monoclonal anti-MIS antibody was also shown to compete favorably with a variety of potentially cross-reactive proteins.

The ontogeny of Mullerian inhibiting substance in the gonads of the chicken

Mullerian inhibiting substance (MIS) was studied in the testis, ovary, and ovotestis of the domestic fowl, from early embryonic development to adulthood by a graded organ-culture method using the urogenital ridge of a 14.5 day fetal rat. The chick testis had high levels of MIS from 8 days of embryonic development (4-5+) until sexual maturity, when activity declined (2+) but persisted throughout adulthood. The right gonad (ovotestis) of the hen showed moderate levels of MIS activity from 8 to 12 days of embryonic life (1-3+) before its normal involution by the time of hatching (21 days). The left gonad (ovary) of the hen also produced MIS at levels similar to that seen in the testis. Activity was high during embryonic development (4+) and after hatching, and persisted in the adult hen at diminished levels (2+). MIS production by the female gonads explains regression of the right Mullerian duct, but the mechanisms that allow preservation of the left duct remain unexplained. Evidence suggests that ovarian estrogens may interact with MIS at the receptor level to protect the left Mullerian duct. MIS persists in the sexually mature gonads of both the hen and cockeral, long after the Mullerian duct has regressed, suggesting a wider role for this substance in reproductive physiology.

Mullerian inhibiting substance inhibits growth of a human ovarian cancer in nude mice

Mullerian inhibiting substance (MIS) was investigated for its ability to inhibit growth of a human ovarian cancer in nude mice. Biologically active preparations from newborn calf testes, obtained after sequential ion exchange chromatography, delayed or prevented growth of a human ovarian cancer (HOC-21) when 2 X 10(6) cells were preincubated with them prior to subcutaneous injection of the tumor cells into Balb/C homozygous nude mice. Preincubation of a human colon carcinoma cells (SW-48) with similar preparations of MIS failed to inhibit growth of the tumor cells in nude mice. Human serous carcinomas are thought to arise from the ovarian surface epithelium, a derivative of the coelomic epithelium of the urogenital ridge, which invaginates to form the mullerian duct early in embryonic life. The neoplastic cells of serous tumors simulate morphologically the lining cells of the fallopian tube, which are derivatives of mullerian duct epithelium. This study provides physiologic confirmation of the mullerian nature of this type of tumor and suggests that MIS may ultimately prove to be effective in its therapy.

Correction of congenital abnormalities of the vagina and perineum

Techniques used for vaginoplasty in patients with congenital anomalies are described. They include simple cutback, inlay of a perineal flap, perineal pullthrough, abdominal-perineal pullthrough, and the use of a free skin graft. When the clitoris is enlarged, clitoroplasty should be performed instead of clitoridectomy. The technique should vary according to the size of the phallus. Labia minora can be constructed from excess skin of the clitoris. Labioscrotal tissue can be advanced posteriorly to provide a more normal appearing vulva. These various reconstructive procedures can be performed either simultaneously or in stages depending on the complexity of the case and the age of the patient.

The inferior epigastric vein as an alternate site for central venous hyperalimentation

The inferior epigastric vein is a good access site when central venous nutrition cannot be delivered through the usual routes. The babies can remain mobile without angulating the catheter and, by tunneling above the diaper line, contamination can be avoided.

Enhanced purification of Mullerian inhibiting substance by lectin affinity chromatography

Mullerian inhibiting substance (MIS), a secreted testicular product responsible for regression of the Mullerian ducts in the male mammalian embryo, was purified 7000 fold, exploiting the glycoprotein nature of this important fetal regressor to achieve enhanced purification. The present procedure employs media incubation of newborn calf testis, passage through DEAE Bio-Gel A and CM Bio-Gel A and sequential lectin affinity chromatography on wheat germ lectin (WGL)-Sepharose 6MB and concanavalin A (Con A)-Sepharose 4B. Strongly bioactive MIS was released from both lectin columns in the bound glycoprotein fraction only after elution with lectin-specific sugar. Carbohydrate analysis of the highly purified glycoprotein fraction eluted from Con A indicated the presence of both N-acetyl glucosamine and mannose, as would be expected from its sequential lectin affinity, as well as of galactose, galactosamine and N-acetyl neuraminic acid. Electrophoresis of this fraction on polyacrylamide-SDS gels showed an identical band pattern after staining with either Coomassie blue or periodic acid-Schiff reagent, further indicating that MIS is a glycoprotein.

Pelvic kidney in infants and children: experience with 16 cases

Sixteen cases of pelvic kidney were treated in the past 12 yr. Some are associated with other major malformations including ureteropelvic junction obstruction, vesicoureteral reflux, ectopic ureter, vaginal atresia, and vertebral anomalies. The pivotal role of the resorbing mesonephros and its duct in Mullerian duct development and in renal development and ascent are considered.

Gastroesophageal reflux and hiatus hernia in children: experience with 70 cases

Seventy cases of gastroesophageal reflux with or without hiatus hernia were operated upon since 1959. The technique described herein was used in the majority of cases with satisfactory results.

Involution of the female Mullerian duct of the fetal rat in the organ-culture assay for the detection of Mullerian Inhibiting Substance

The study of Mullerian Inhibiting Substance (MIS) has been made possible because of the organ-culture bioassay devised by Picon ('69) for detecting MIS in vitro. We have studied the degeneration of the female Mullerian duct of the rat fetus, the target tissue of the assay, with electron microscopy. We have observed that the involution of the female Mullerian duct in the organ-culture assay follows a pattern of degeneration similar to the normal involution of the male Mullerian duct under the influence of MIS from the fetal testis (Price et al., '77). This involution involves alterations in the duct epithelium subsequent to a response of the mesenchyme surrounding the duct. The degeneration of a specific organ system under the direct influence of a specific factor, Mullerian Inhibiting Substance, represents an example of "programmed cell death."

Müllerian duct regression in the embryo correlated with cytotoxic activity against human ovarian cancer

A significant cytotoxicity index was obtained when human ovarian cancer cells in a microcytotoxicity assay were exposed during the S (DNA-synthesizing) phase of the cell cycle to purified fractions of testis exhibiting high Müllerian inhibiting substance bioactivity. The same effect was not observed when these fractions were tested against human glioblastoma or fibroblast lines. Most human ovarian cancers are said to resemble Müllerian tissues histologically. Müllerian inhibiting substance may thus deserve further study as a potential chemotherapeutic agent.

Manometry and histochemistry in the diagnosis of Hirschsprung's disease

Acetylcholine esterase histochemistry and rectal manometry have been used sequentially to evaluate constipated children and to make the diagnosis of Hirschsprung's disease. When applied together, these modalities give a reliable diagnosis of Hirschsprung's disease, restricting the use of deep rectal biopsy to those patients in whom symptoms are most suggestive of Hirschsprung's disease. Acetylcholine esterase histochemistry may be more reliable than rectal manometry in the newborn and premature periods. It is hoped that the combined use of these techniques may make deep rectal biopsy obsolete except in patients with hypoganglionosis.

Mixed gonadal dysgenesis, pathogensis, and management

Fourteen patients with Mixed Gonadal Dysgenesis who presented as infants or children are discussed. Gonadal asymmetry, and/or sex chromosomal mosaicism, as well as retained Mullerian Ducts characterize the anomaly. The dysgenetic testis may occur as the result of a cascade of development mishaps stemming from abnormalities of H-Y antigen expression or function that lead to abnormal differentiation of the indifferent urogenital ridge and, in turn, to aberrant production of Mullerian inhibiting Substance and testosterone. The latter two cause retention of Mullerian ducts and incomplete masculinization of the external genitalia. Absence of a second X chromosome may lead to the formation of a streak ovary, in which the dysgenetic testis may invoke formation of hilar and medullary cords. Neoplastic transformation, so characteristic of this group of patients, may result from unprotected germ cells and abnormally high and prolonged gonadotropin stimulation. Gonadoblastoma and seminoma-dysgerminomas are the tumors found in the gonads with the risk exceeding 50% as the third decade is approached. Laterality of the gonads in this anomaly remains an enigma. The gonads should be removed at birth if possible and the external genitalia repaired soon thereafter. These patients should be raised as females. The risk of neoplastic transformations must be considered at all stages of management.

Salivary gland heterotopia in the lower part of the neck

Heterotopic salivary gland tissue in branchial cleft cysts in the upper part of the neck reputedly differentiates from the epithelial lining of the cyst. We describe a patient with salivary gland tissue found in the lower part of the neck. How salivary gland tissue finds its way to the lower neck is obscure. It is conceivable that the tissue originated from a precervical sinus or cervical vesicle, a distinct embryologic structure that forms in the lower part of the neck between the second branchial arch and the upper thoracic wall, but that normally disappears by the time of birth. The epithelial lining of the cervical vesicle is thought to be associated with the early development of the glossopharyngeal and vagus nerves. Salivary gland tissue may differentiate from the epithelial lining of cervical vesicles and nurture the growing nerves by nerve growth factor elaboration.

Cholinergic nerve development of fetal lung in vitro

The development of the cholinergic or parasympathetic nervous system was studied in embryonic lung dissociated from the central nervous system and placed in organ culture. In vitro development was similar to that seen in vivo. This study demonstrated that migration of neuroblasts from the central nervous system to the trachea takes place before day 12. Neuroblasts differentiate to small immature ganglia and then to larger more mature ganglia that give off nerve fibers to the submucosa and the epithelium. This isolated lung preparation was used to study neurostimulators. Thyroxine (T4) was found to accelerate nerve fiber growth and differentiation of ganglia in vitro. The neuroepithelial body, an epithelial cell with acetylcholine-esterase-positive granules, also differentiated in vitro. This cell may fill the morphologic criteria of an intrapulmonary chemoreceptor.

True hermaphroditism: a clinical description and a proposed function for the long arm of the Y chromosome

True hermaphroditism is a very rare form of ambiguous genitalia characterized by the presence of both ovarian and testicular tissue in the same individual. Sixty percent of these patients have a 46,XX karyotype; however, most have H-Y antigen detectable. Since H-Y antigen is thought to be the gene product of the short arm of the Y, then the short arm must be present somewhere in the karyotype. Products of the short arm loci are thought to initiate testicular differentiation and male determination. The long arm of the Y has not been detected in true hermaphrodites. Testicular histology in true hermaphrodites is characterized by spermatogenic arrest, causing us to speculate that the long arm of the Y might be essential for germ cell maturation beyond the spermatogonia state.

Increased secretion of Müllerian inhibiting substance after immunological blockade of endogenous luteinizing hormone releasing hormone in the rat

In order to evaluate the role of leuteinizing hormone releasing hormone (LHRH) and gonadotropins in the control of secretion of Müllerian inhibiting substance, groups of pregnant rats were injected intraperitoneally with high potency antiserum from a rabbit immunized with LHRH. Pregnant females were injected at 13 and 20 days of gestation with LHRH antiserum or an equal volume of normal rabbit serum as a control. The testes and penis were reduced in weight and size in 6-day-old pups of the experimental group indicating the luteinizing hormone (LH) was blocked and that LHRH antiserum was active. Testicular fragments of 17-day fetuses and 6-day-old pups showed an increase relative to controls in Müllerian inhibiting substance activity in a graded organ culture bioassay system. These studies suggest that secretion of Müllerian inhibiting substances is curtailed by one or both gonadotropins.