Differential patterns of osteoblast dysfunction in trabecular bone in patients with established osteoporosis

AIMS

To analyse osteoblast function in 153 cases of established osteoporosis as previous work has indicated that osteoporosis is a heterogeneous condition characterised by different patterns of osteoclast and osteoblast dysfunction.

METHODS

Histomorphometric data from 153 cases with established osteoporosis was used to analyse osteoblast function, using the following parameters: osteoblast number was assessed using the ratio of osteoblast surface to bone surface (ObS:BS); the percentage of active osteoblasts was assessed by using mineralising surface as a proportion of osteoid surface (sLS + dLS/OS); and the efficiency of active osteoblasts was assessed using the ratio of double to total labelled surface (dLS:tLS). The values of each parameter were standardised using age and sex matched control data and a three dimensional matrix was used to identify groups of patients with similar patterns of altered function.

RESULTS

The largest group (60 cases) showed a reduction in all three parameters, while a small group (9 cases) had normal osteoblast function. However, one group showed reduction in osteoblast number only (23 cases), while another group showed a normal number of osteoblasts but both reduced percentage and efficiency of activity (14 cases). The results also suggest that efficiency of activity falls first and that this eventually leads to exit from the active pool.

CONCLUSIONS

These results demonstrate the presence of heterogeneity of osteoblast dysfunction in osteoporosis, indicating that the disease is caused by interference at a variety of target sites along the pathway of osteoblast proliferation, differentiation, and activation. Greater understanding of this pathway and of the variety of alterations in the pathway that can occur in osteoporosis may allow more focused therapy for different patient groups identified on the basis of histomorphometric analysis.

Mature osteoblasts in human non-union fractures express collagen type III

AIMS

High levels of collagen type III are biochemically detectable in biopsies of non-uniting fractures, and in the serum of patients suffering from this condition. The aim of this study was to determine whether the expression of collagen type III was limited to fibrous tissue in non-unions, or whether some was present in bone.

METHODS

Biopsies from normally healing human fractures and non-unions were examined using in situ hybridisation and immunohistochemistry.

RESULTS

The mesenchymal cell population, which includes fibroblast and osteoblast precursors, expressed mRNA for collagen type III. However, mature osteoblasts on the surface of woven bone varied profoundly between normally healing fractures (in which they were negative or occasionally weakly positive) and non-unions (in which they were strongly positive). Areas of woven bone that had osteoblasts positive for collagen type III mRNA also immunostained positively for the protein.

CONCLUSIONS

This study shows that non-union fracture callus osteoblasts on the surfaces of woven bone exhibit an unusual phenotype: they express collagen type III, a molecule characteristic of an earlier stage of osteoblast differentiation, which is not expressed by osteoblasts on woven bone surfaces of bone that develops normally. This finding may be useful in developing an early clinical test for impending non-union.

Nerve ingrowth into diseased intervertebral disc in chronic back pain

BACKGROUND

In the healthy back only the outer third of the annulus fibrosus of the intervertebral disc is innervated. Nerve ingrowth deeper into diseased intervertebral disc has been reported, but how common this feature is and whether it is associated with chronic pain are unknown. We examined nerve growth into the intervertebral disc in the pathogenesis of chronic low back pain.

METHODS

We collected 46 samples of intervertebral discs from 38 patients during spinal fusion for chronic back pain. 30 samples were from pain levels clinically established by discography and 16 samples were from adjacent vertebral levels with no pain. We obtained 34 control samples of intervertebral disc from previously healthy individuals with normal histology within 8 h of recorded death. We used standard immunohistochemical techniques to test for a general nerve marker, a nociceptive neurotransmitter (substance P), and a protein expressed during axonogenesis (growth-associated protein 43 [GAP43]).

FINDINGS

We identified nerve fibres in the outer third of the annulus fibrosus in 48 (60%) of the 80 samples of intervertebral discs. Nerves were restricted to the outer or middle third of the annulus fibrosus in the 34 control samples. Among the patients with chronic low back pain, nerves extended into the inner third of the annulus fibrosus and into the nucleus pulposus in 21 (46%) and ten (22%) samples, respectively. Nerves usually accompanied blood vessels, but in 14 of the samples from back-pain patients, isolated nerve fibres were seen in the discal matrix. Both types of nerve fibres expressed substance P, but only non-vessel-associated fibres expressed GAP43. Deep nerve ingrowth into the inner third of the annulus fibrosus, the nucleus pulposus, or both was seen in four (25%) of 16 biopsy samples from non-pain levels and in 17 (57%) samples from pain levels. Of the 16 paired samples from both pain and non-pain levels, five pain-level samples and one non-pain-level sample showed deep nerve ingrowth.

INTERPRETATION

Our finding of isolated nerve fibres that express substance P deep within diseased intervertebral discs and their association with pain suggests an important role for nerve growth into the intervertebral disc in the pathogenesis of chronic low back pain.

Quantification of vitamin D receptor mRNA in tissue sections demonstrates the relative limitations of in situ-reverse transcriptase-polymerase chain reaction

In situ-reverse transcriptase-polymerase chain reaction (IS-RT-PCR) is a recently described technique that is used to localize low levels of mRNA within cells and tissue sections. One of the major criticisms levelled at this technique is that positive results may be meaningless, as amplification is required to demonstrate the transcripts of interest. The use of IS-RT-PCR to demonstrate mRNA for receptors for 1,25-dihydroxyvitamin D3 (VDR) in sections of human kidney and bone has previously been described. To ascertain whether the levels of VDR mRNA detected following IS-RT-PCR were transcriptionally significant, computerized image analysis was used to determine the mean silver grain density in human kidney and bone cells following conventional in situ hybridization and after various cycles of IS-RT-PCR. Only a few cycles of PCR were needed to produce an optimum signal, but amplification of signal following IS-RT-PCR was found to be relatively inefficient. Following the optimum number of cycles of IS-RT-PCR in kidney sections, there was a less than four-fold increase in signal. Similarly, in bone, the optimum signal detected was only approximately five times greater than that found with conventional in situ hybridization. These results clearly demonstrate that the increase in signal following IS-RT-PCR follows a more linear pattern and is relatively inefficient, compared with the usual exponential increase with conventional solution phase RT-PCR.

Demonstration of estrogen receptor mRNA in bone using in situ reverse-transcriptase polymerase chain reaction

Falling estrogen levels affect the female skeleton profoundly. Following menopause, estrogen lack is a major cause of osteoporosis. The site of estrogen action in human bone, however, is unclear, but responsive cells must express the estrogen receptor (ER). One obstacle to localizing these cells is that mRNA for ER is expressed in low copy number. Hence, conventional molecular techniques are either too insensitive to detect receptor transcripts (in situ hybridization) or necessitate amplification of RNA extracted from tissue [Northern analysis and polymerase chain reaction (PCR)], thus failing to identify the specific target cells within the mixed-cell population of bone. In situ PCR (IS-PCR) is a technique that combines the sensitivity of PCR with the localization of conventional in situ hybridization. The technique has previously been used primarily to detect single-copy genes and viral DNA within cells. More recently, incorporation of a reverse-transcriptase reaction (IS-RT-PCR) has allowed the technique to be used to identify rare mRNAs within tissues. We have therefore applied the technique of IS-RT-PCR to localize ER mRNA first in human breast tumors, a known positive tissue, and then in bone. Using conventional riboprobe in situ hybridization, ER transcripts were not detectable in any bone cells within sections taken from normal bone and several actively remodeling bone tissues, namely, Paget's disease, renal hyperparathyroidism, and healing fracture callus. The technique of IS-RT-PCR, however, allowed amplification of transcripts to a detectable level. Following two cycles of amplification, hybridization signal was observed in osteoblasts and to a lower level in osteoclasts and occasional osteocytes. This positive signal was more obvious after five cycles, particularly in osteoclasts and osteocytes. After ten cycles, although signal was increased in osteoclasts and osteocytes, it appeared to be decreased in osteoblasts, suggesting that overamplification leads to loss of target complex from these cells. We conclude that several cell types in human bone express ER mRNA in vivo.

Demonstration of vitamin D receptor transcripts in actively resorbing osteoclasts in bone sections

The effects of the active metabolite of vitamin D, 1,25 dihydroxyvitamin D3 (1,25D), are mediated via the vitamin D receptor (VDR). 1,25D is known to have profound effects on bone resorption, but proof that the human osteoclast expresses VDR in vivo is absent. Receptors have been demonstrated in osteoblasts, and it has been generally accepted that the effects of 1,25D on formed osteoclasts are mediated via osteoblasts. Using conventional riboprobe in situ hybridization, VDR transcripts were readily detectable in osteoblasts within sections taken from normal bone and several actively remodelling bone tissues, namely, Paget's disease, renal hyperparathyroidism, and healing fracture callus. However, VDR transcripts also appeared to be present at low levels within osteoclasts from two pagetic samples and two hyperparathyroid samples. To examine this latter finding further, we have used the novel technique of in situ-reverse transcriptase-polymerase chain reaction (IS-RT-PCR) for specific amplification and detection of VDR mRNA within sections taken from the same conditions described above, and also from osteoclastoma samples. As expected, VDR transcripts were amplified and detected in osteoblasts and marrow cells, but were also prominently found in osteoclasts at approximately 50% of the level detected in osteoblasts in normal bone and at 60% in the active bone tissues. This suggests that in addition to effects on osteoclast precursors and those mediated via osteoblasts, 1,25D could exert direct effects on the active bone resorbing cells in vivo.

Novel and sensitive detection systems for the vitamin D receptor--in situ-reverse transcriptase-polymerase chain reaction and immunogold cytochemistry

The receptor for the active metabolite of vitamin D, 1,25(OH)(2)D(3), known as the vitamin D receptor (VDR), belongs to the steroid hormone nuclear receptor superfamily. We have developed novel methods for detection of VDR mRNA and protein within a human promyelomonocytic cell line, HL-60. Using the newly developed technique of in situ-reverse transcriptase-polymerase chain reaction (IS-RT-PCR), low levels of VDR mRNA could be amplified and demonstrated unequivocally within these cells, and also within a human kidney proximal tubule cell line, CL-8. Use of a novel immunogold cytochemical technique has allowed clear and sensitive detection of VDR protein expression within the HL-60 cells. Further development of IS-RT-PCR has allowed us to apply this technique to tissue sections. We have shown clear amplification of VDR transcripts within sections of formalin-fixed paraffin-embedded human kidney and liver. These techniques will be useful to localise specifically the VDR within cell types that contain low levels of mRNA and protein, and will permit further investigation of the role played by 1,25(OH)(2)D(3) in cellular regulatory mechanisms.

Association of thrombospondin-1 with osteogenic differentiation of retinal pericytes in vitro

Vascular pericytes can differentiate into osteoblast-like cells in vitro, suggesting that these cells may represent a potential source of osteoprogenitor cells in the adult. Pericyte differentiation is associated with a characteristic pattern of nodule formation and mineralisation. Nodules are formed in post-confluent cultures by the retraction of multilayered areas. Crystals of hydroxyapatite are deposited on the extracellular matrix of these nodules which then becomes mineralised. We now demonstrate that thrombospondin-1 (TSP-1) gene expression is modulated during pericyte differentiation in vitro. That is, the relative levels of TSP-1 (protein and mRNA) increased markedly during nodule formation and then decreased when mineralisation of the nodules had taken place. TSP-1 was localised throughout non-mineralised nodules but it was largely excluded from the inner mass of mineralised nodules. The production of a mineralised matrix by vascular pericytes was promoted by the presence of antibodies to TSP-1 in the culture medium and was inhibited by exogenous TSP-1. These effects did not appear to be mediated through the activation of latent TGF-beta, since neither exogenous TGF-beta nor neutralising antibodies to TGF-beta had any effect on the rate or extent of mineralisation seen in the pericyte cultures. Taken together these results suggest that high levels of TSP-1 inhibit pericyte mineralisation, supporting the view that this protein plays a role in pericyte differentiation and bone formation.

Canine bone marrow cell cultures infected with canine distemper virus: an in vitro model of Paget's disease

We have previously shown that the canine paramyxovirus, canine distemper virus (CDV), is a possible aetiologic agent in Paget's disease of bone and in the canine bone disorder, metaphyseal osteopathy. More recently, we have examined the effects of CDV on the formation of multinucleated, tartrate resistant acid phosphatase positive, calcitonin receptor positive, osteoclast-like cells in cultures of canine bone marrow mononuclear cells, and shown that both in vitro and in vivo infection with CDV produced a dose dependent increase in the number and size of osteoclast-like cells. We have now extended these results to show that CDV infection induces interleukin-6 and c-Fos mRNA in these cells, similar to our recent findings in pagetic bone cells. These results further support the hypothesis that CDV might be involved in the aetiopathogenesis of Paget's disease and metaphyseal osteopathy and suggest that canine marrow culture systems will prove useful as an in vitro model to examine the disease processes in more detail.

Platelet-derived growth factor expression in normally healing human fractures

Platelet-derived growth factor (PDGF) has been shown to have effects on bone and cartilage cells in vitro, but its role in vivo in bone repair is not clear. We studied biopsy material from 16 normally healing fractures at a variety of times after injury, using immunohistochemistry for PDGF and in situ hybridization for PDGF A and B chains. PDGF A-chain gene was found to be expressed by many cell types over a prolonged period during fracture healing. These cells included endothelial and mesenchymal cells in granulation tissue and osteoblasts, chondrocytes, and osteoclasts later during fracture healing. PDGF B-chain gene expression was more restricted, being detected principally in osteoblasts at the stage of bone formation. PDGF was detected using immunohistochemistry in the cell types expressing PDGF A. These findings indicate that PDGF is expressed during normal human fracture repair, and the in vitro data also suggest that PDGF is likely to be an important local regulator in this process.

Histomorphometric classification of postmenopausal osteoporosis: implications for the management of osteoporosis

AIMS

To define and group static and dynamic iliac crest histomorphometric parameters in women with established osteoporosis.

METHODS

Iliac crest biopsy specimens from 146 white women were sectioned undecalcified and examined using image analysis.

RESULTS

Five distinct groups were defined on the basis of histomorphometric changes in cell function: group 1, decreased osteoblastic and osteoclastic activity; group 2, decreased osteoblastic and increased osteoclastic activity; group 3, increased osteoblastic and osteoclastic activity; group 4, no bone surface cell activity; and group 5, apparently normal osteoblastic and osteoclastic activity.

CONCLUSIONS

Five distinct subgroups of patients with postmenopausal osteoporosis can be defined based on changes in bone cell function. Defining cellular dysfunction in this way may be important for tailoring treatment regimens to the needs of individual patients.

Herniated intervertebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration

STUDY DESIGN

Prospective histologic comparison of perineural tissues from patients requiring decompression surgery for herniated intervertebral disc with those from cadaveric controls.

OBJECTIVES

To examine the significance of herniated intervertebral-disc-associated perineural vascular and fibrotic abnormalities with respect to back pain symptom generation.

SUMMARY OF BACKGROUND DATA

Previous cadaveric studies have demonstrated perineural vascular congestion, dilatation, and thrombosis and perineural and intraneural fibrosis occurring in association with herniated intervertebral disc. It was suggested that these neural abnormalities were the result of ischemia, due to venous outflow obstruction, and also represented a possible cause of ongoing back pain symptoms. Criticisms of such a conclusion arose, however, because the possibility could not be excluded that these abnormalities were the result of postmortem artifact.

METHODS

Histologic and immunohistochemical comparison of discal and peridiscal tissues removed from 11 patients with radiographically proven herniated intervertebral disc requiring decompressive surgery and from 6 fresh cadavers without history of back pain in life.

RESULTS

Histology and immunohistochemistry of perineural and extraneural tissues from patients revealed vascular congestion, neovascularization, and endothelial abnormalities including luminal platelet adhesion, in association with reductions in von Willebrand factor levels, together with perivascular and perineural fibrosis. Elevated fibrogenic cytokine concentrations were also detected in patients' tissues. These changes occurred without evidence of inflammation and were absent in cadaveric control tissues.

CONCLUSIONS

The vascular abnormalities detected in patients may represent an important etiopathologic factor predisposing to intraneural and perineural fibrosis, and hence to chronic pain symptoms, after disc herniation. It seems important to preserve the perineural microcirculation following disc herniation.

Expression of type VI collagen mRNAs in human endometrium during the menstrual cycle and first trimester of pregnancy

The pattern of type VI collagen deposition in human endometrium throughout the menstrual cycle and in decidua of the first trimester of pregnancy was studied. Immunohistochemical analysis demonstrated a dense microfibrillar network of collagen VI in the stroma of preimplantation endometrium which was reduced during the peri-implantation period and no longer detected in first trimester decidua. However, type VI collagen was consistently present within blood vessel walls in both endometrium and decidua. Using in situ hybridization, mRNAs encoding alpha 1(VI), alpha 2(VI) and alpha 3(VI) chains within endometrial stromal and vascular cells were identified. All three mRNA species are abundant in the villous mesenchyme of the first trimester placenta. The detection of collagen VI mRNA species in the endometrium throughout the menstrual cycle suggests that the apparent decrease in abundance of extracellular immunoreactive fibrils may be a consequence of translational control, matrix redistribution or turnover. In contrast, in the first trimester of pregnancy, collagen VI protein was mainly absent from the decidual stroma and amounts of mRNA were very low, indicating a significant reduction in production. Loss of stromal type VI collagen contributes to the remodelling of the maternal extracellular matrix of pregnancy.

Age related histomorphometric changes in bone in normal British men and women

AIMS

To define the iliac crest histomorphometry of static variables in 234 individuals aged 16-100 years (91 men, 143 women) and of dynamic variables in 84 individuals aged 19-94 years (33 men, 51 women) from the North West of England.

METHODS

Iliac crest biopsy specimens were sectioned, undecalcified, and examined using image analysis.

RESULTS

The decrease in the quantity of cortical and trabecular bone and the connectivity of trabecular bone was more pronounced in women than men. This was associated with a reduction in bone formation and increased bone resorption which was greater in women at both the tissue and cellular level. Some of these histomorphometric differences first became evident at the natural menopause, and therefore provide clues as to the cause of the high prevalence of osteoporosis in postmenopausal women.

CONCLUSIONS

These results show an age and sex dependent variation both in static and dynamic parameters, which differ, in some respects, from other studies and confirm the need for large regional studies to provide a database of normal morphometric results for a specific population.

Interleukin-6, IL-6 receptor, and IL-6 nuclear factor gene expression in Paget's disease

The cytokine interleukin-6 (IL-6) is considered an important regulator of bone cell function and may play a central role in bone disease states characterized by increased bone remodeling, such as Paget's disease. Indeed, recent in vitro data suggest that IL-6 may be an autocrine/paracrine factor for pagetic osteoclasts. However, its expression and role in vivo are not known. Using in situ hybridization we investigated the spatial localization of expression of IL-6, IL-6 receptor (IL-6R), and the transcription factor (NF-IL-6) in pagetic bone. Our results show that osteoblasts in the normal remodeling bone of osteoarthritis (controls) and in Paget's disease express IL-6, IL-6R, and NF-IL-6 genes with higher levels of IL-6 and IL-6R mRNA in pagetic bone. Osteoclasts in both osteoarthritic and pagetic bone express IL-6R mRNA and NF-IL-6, but only pagetic osteoclasts expressed IL-6, suggesting that in Paget's disease IL-6 can act as an autocrine factor on osteoclasts. These results provide evidence for a major role of the IL-6 regulatory pathway in the phenotype of the pagetic osteoclasts and lead us to suggest a model linking possible paramyxovirus infection and IL-6 regulation in the pagetic osteoclast.

New histological observations in spontaneously developing osteoarthritis in the STR/ORT mouse questioning its acceptability as a model of human osteoarthritis

Naturally developing spontaneous osteoarthritis (OA) is seen in a number of small animals one of which is the STR/ORT mouse, an accepted model of human OA. A histological evaluation of the patello-femoral joints of 37 male STR/ORT mice has shown features that are inconsistent with the disease in human joints. These include the presence of a prominent acute and chronic synovial inflammatory infiltrate. Such findings call into question the proposed aetiology of the arthropathy in this strain of mouse and its acceptability as a model of human primary OA.

The vascular basement membrane in systemic sclerosis skin: heterogeneity of type IV collagen

In systemic sclerosis (SS) changes in the dermal microvasculature include endothelial cell damage, a reduction in the number of vessels, and vascular basement membrane thickening. The basement membrane is a critical component of the vessel, and alterations in its structure may lead to changes in the surrounding tissue. In SS the altered basement membrane is associated with the subsequent development of fibrosis. To investigate the relationship between vascular basement membrane changes in affected skin and disease progression, immunohistochemical analyses were performed using both polyclonal and monoclonal antibodies against type IV collagen, the major basement membrane collagen. Using two monoclonal antibodies directed against different conformational epitopes within the (alpha 1)2 (alpha 2) helical domain, type IV collagen was detected in normal skin, and uninvolved SS skin, but not in later grades of disease. Identical results were obtained using a monoclonal antibody against a sequential determinant on the denatured alpha 1 (IV) chain. The use of a polyclonal antibody, however, showed that type IV collagen was present in all grades of disease, suggesting an alteration in the composition of type IV collagen with disease progression.

Mast cells in the synovium and synovial fluid in osteoarthritis

SF and synovium from normal individuals and patients with OA, RA and traumatic arthritis (TA) were studied for the presence of mast cells (MC). When compared with normals, patients with OA had large numbers of intact and degranulated MC in the synovium and SF of diseased joints. The numbers of MC are comparable with those in RA where they have been implicated in the pathogenesis of joint damage. These data raise the possibility that in OA too MC may participate in the pathological processes in articular and periarticular tissues.

The effect of tissue decalcification on mRNA retention within bone for in-situ hybridization studies

Tissue decalcification is a routine part of the preparation of bone tissue for histological studies. Although in-situ hybridization has been employed to localize mRNA of collagenous and non-collagenous bone related proteins in skeletal tissue, little is known regarding the effects of decalcifying agents on mRNA retention within tissue. In this study in-situ hybridization using an oligonucleotide probe (i.e. a poly d(T) probe) to detect total messenger RNA has been employed to investigate the effects of the decalcifying agents nitric acid, formic acid and EDTA on mRNA retention compared to undeacalcified tissue. The results show that formalin fixation and EDTA decalcification preserve substantial amounts of mRNA within the tissue. In particular, this study illustrates that it is possible to perform in-situ hybridization on formalin fixed decalcified paraffin embedded tissue.

Distribution of type X collagen mRNA in normal and osteoarthritic human cartilage

The function of collagen X, a unique homotrimer synthesised by hypertrophic chondrocytes, is not known but its localisation and transient expression at sites of calcification suggest that it is likely to be associated with events in the early stages of endochondral bone formation. Osteoarthritis (OA) is a disorder characterised by new bone formation but the role of type X collagen in its pathogenesis is unclear. A 700-bp restriction fragment encoding most of the C-terminal non-collagenous domain and part of the 3'-untranslated region of the human collagen X gene has been used for in situ hybridisation studies on human OA joints removed from hip and knee replacement operations and the results compared with immunohistochemical localisation of type X collagen gene product. Collagen X gene expression was detected in chrondrocytes present in OA tissue in areas where there appeared to be a re-initiation of the endochondral bone formation process including osteophytes and areas of subchondral bone sclerosis.

Investigation of a quantitative post-hybridization signal amplification system for mRNA-oligodeoxyribonucleotide in situ hybridization

This study was undertaken to assess a post-hybridization amplification system for increasing the sensitivity of in-situ hybridization with oligodeoxyribonucleotide (oligonucleotide) probes. The technique employs a multilayer streptavidin-biotinylated link protein amplification technique, similar to that used in the ABV histochemical amplification system, to attach increasing numbers of radiolabelled streptavidin molecules to a biotinylated ologonucleotide probe. In tissue sections the amplification technique increases the signal-to-noise ratio dramatically, increasing the sensitivity of in situ hybridization and reducing the autoradiographic exposure time. On an artificial medium the amplification technique has been shown to increase the hybridization signal 100-fold when compared with a directly radiolabelled oligonucleotide probe. The technique could be used to compare relative amounts of target molecule, there being a linear relationship between the detectable signal and the log of the concentration of the target molecule.

Demonstration of variation in chondrocyte activity in different zones of articular cartilage: an assessment of the value of in-situ hybridization

Several methods have been described for investigating chondrocyte metabolism in vitro. In this study, in-situ hybridization (ISH) using an oligonucleotide probe (i.e. a poly-d(T) probe) to detect total messenger RNA (mRNA) in cartilage explants has been compared with radiosulphate and radioleucine uptake studies in an attempt to assess the value of ISH in investigating chondrocyte metabolism. The relative results of the three parameters indicate qualitative similarities in cells in the intermediate, deep and calcified zones but differences in the superficial zone. The relative levels of mRNA and leucine and sulphate uptake in the midzone areas could be construed as indicating that the bulk of cellular activity was directed towards the synthesis of proteoglycans. A similar relation between the three parameters, but at a lower level, was seen in chondrocytes in the calcified zone demonstrating that these cells are viable and biosynthetic. Both quantitative and qualitative differences between the three methods were observed in the superficial chondrocytes regarding the amount of mRNA compared to sulphate and leucine uptake. The results suggest that ISH can detect differences in the amount of mRNA present in chondrocytes in differing zones of cartilage and, like the radioleucine and radiosulphate studies, particularly emphasizes their functional heterogeneity.

Intervertebral foramen venous obstruction. A cause of periradicular fibrosis?

Disc herniation into the intervertebral foramen (IVF) or osteophytic outgrowths from the margins of the apophyseal joints that project into the IVF may compress the neural structures, but in this cadaveric study of 160 lumbar foramens (age range, 35-91 years), the authors have found that they were much more commonly associated with compression and distortion of the large venous plexus within the IVF. In the absence of direct nerve compression (seen in only eight specimens), the most severe neural changes were associated with compression, congestion, and resultant dilatation of foraminal veins. Pathologic changes within and around the nerve root complex included peri- and intraneural fibrosis, edema of nerve roots, and focal demyelination. Inflammatory cells were notably absent. Vascular changes within the thickened fibrous sheath about damaged nerves, namely, basement membrane thickening, suggestive of endothelial cell injury also were observed. The association between vascular compression, tissue fibrosis, and endothelial injury distant from the compression may be causal--probably due to ischemia as a result of reduced venous outflow. Such observations have led the authors to propose that venous obstruction may be an important pathogenic mechanism in the development of perineural and intraneural fibrosis.

Retained surgical swab debris in post-laminectomy arachnoiditis and peridural fibrosis

We examined soft tissue biopsies from 26 patients with symptomatic nerve root fibrosis and arachnoiditis after a previous laminectomy. Dense fibrous connective tissue was found about the nerve roots and in 14 cases (55%) fibrillar foreign material was seen within it. This material had the histochemical characteristics of cotton fibres from swabs and neurosurgical patties. In two other cases nerve root fibrosis was associated with residual radiopaque lipid thought to derive from earlier myelography. Our findings suggest that risks may be associated with the introduction of foreign material into the vertebral canal, and that microscopic fragments of surgical swabs and patties may have a role in the pathogenesis of postoperative periradicular fibrosis.