Ultrastructural and functional changes in pancreatic acinar cells during autolysis

Development and validation of a quantitative electron microscopy score to assess acute cellular stress in the human exocrine pancreas

The pancreas is particularly sensitive to acute cellular stress, but this has been difficult to evaluate using light microscopy. Pancreatic ischaemia associated with deceased organ donation negatively impacts whole‐organ and isolated‐islet transplantation outcomes. Post‐mortem changes have also hampered accurate interpretation of ante‐mortem pancreatic pathology. A rigorous histological scoring system accurately quantifying ischaemia is required to experimentally evaluate innovations in organ preservation and to increase rigour in clinical/research evaluation of underlying pancreatic pathology. We developed and validated an unbiased electron microscopy (EM) score of acute pancreatic exocrine cellular stress in deceased organ donor cohorts (development [n = 28] and validation [n = 16]). Standardised assessment led to clearly described numerical scores (0–3) for nuclear, mitochondrial and endoplasmic reticulum (ER) morphology and intracellular vacuolisation; with a maximum (worst) aggregate total score of 12. In the Validation cohort, a trend towards higher scores was observed for tail versus head regions (nucleus score following donation after brainstem death [DBD]: head 0.67 ± 0.19; tail 0.86 ± 0.11; p = 0.027) and donation after circulatory death (DCD) versus DBD (mitochondrial score: DCD (head + tail) 2.59 ± 0.16; DBD (head + tail) 2.38 ± 0.21; p = 0.004). Significant mitochondrial changes were seen ubiquitously even with short cold ischaemia, whereas nuclear and vacuolisation changes remained mild even after prolonged ischaemia. ER score correlated with cold ischaemia time (CIT) following DBD (pancreatic tail region: r = 0.796; p = 0.018). No relationships between CIT and EM scores were observed following DCD. In conclusion, we have developed and validated a novel EM score providing standardised quantitative assessment of subcellular ultrastructural morphology in pancreatic acinar cells. This provides a robust novel tool for gold standard measurement of acute cellular stress in studies evaluating surrogate measures of peri‐transplant ischaemia, organ preservation technologies and in samples obtained for detailed pathological examination of underlying pancreatic pathology.

Delivery of pancreatic digestive enzymes into the gastrointestinal tract by pancreatic exocrine tissue transplant

Exocrine pancreatic insufficiency, caused by disease-induced loss of pancreatic exocrine cells, may be treated through regenerative stem cell technologies that facilitate the production of pancreatic exocrine cells from induced pluripotent stem cells (iPSCs). However, delivering the digestive enzymes produced in the transplanted cells to the gastrointestinal tract remains a challenge. To generate an allogenic transplantation rat model, minced pancreas was transplanted into the gastric submucosal space with ablation of muscularis mucosa. In the allogenic transplantation, transplanted pancreatic cells were engrafted. Elevated amylase was detected in gastric juice, while transplanted cells disappeared through auto-digestion when the muscularis mucosa was not eliminated. Human iPSCs were differentiated into pancreatic exocrine cells by stage-specific treatment with growth factors and chemical compounds, and the differentiated pancreatic cells were implanted into the gastric submucosal space of nude rats. The transplanted cells were engrafted, and amylase was detected in the gastric juice in some cases. These findings suggest that transplantation of pancreatic exocrine cells into the gastric submucosal space with muscularis mucosa elimination will contribute to a regenerative approach for pancreatic exocrine insufficiency.

The Adult Pancreas in Trauma and Disease

The spectrum of traumatic and natural disease that can affect the adult pancreas is multiple and varied. Some entities are more commonly encountered in routine forensic pathology practice and the forensic pathologist needs to be very familiar with their pathological features and development from a pathophysiological perspective. However, many of the conditions are extremely rare and may never be encountered in the professional lifetimes of an individual pathologist. Still, forensic pathologists need to be aware of them in case they are one day faced with these entities as possible diagnoses to be established at postmortem examination. This can be the result of clinical concerns raised in life, potential natural disease explanations for unexpected biochemical results, and sudden, unexpected or otherwise unexplained deaths where criminal concern about the exogenous administration of a substance must be considered. Acad Forensic Pathol. 2018 8(2): 192-218.

Time- and temperature-dependent autolysis of urinary bladder epithelium during ex vivo preservation

Morphological and functional preservation of urinary bladder epithelium-urothelium after extirpation from an organism enables physiological studies of that tissue and provides the basis for successful organ transplantations. The aim of this study was to determine the optimal temperature for maintaining urothelium in ex vivo conditions. Mouse urinary bladders were kept at the three temperatures usually used for maintaining tissue during transportation: at the temperature of melting ice (1°C), at room temperature (22-24°C), and at the body temperature of most mammals (37°C). Autolytic structural changes were followed with electron microscopy, while destruction of cytoskeleton and intercellular junctions was observed by immunolabeling. The first ultrastructural changes, swelling of mitochondria and necrosis of individual cells, became evident 30 min after extirpation if the tissue was kept at 1°C. After 60 and 120 min in ex vivo conditions, the most severe changes with increasing plasma membrane ruptures were detected at 1°C, while at room temperature only mild changes were detected. At 37°C, the extent of ultrastructural changes was between those of the other two experimental temperatures. Autolytic destruction of cytoskeleton and intercellular junctions was not observed before 2 h after extirpation. After 4 h, severe degradation of cytokeratin 20 and microtubules were found at 1°C and 37°C, while being almost undisturbed at room temperature. On the other hand, the reduction of desmoplakin and ZO-1 labeling was more evident at 37°C than at 1°C and room temperature. These findings provide evidence that room temperature is most appropriate for short ex vivo preservation of urothelial tissue.

Postmortem acinar autolysis in rat sublingual gland: a morphometric study

Objective

To analyze and to quantify morphological acinar postmortem changes in rat sublingual glands (SLG).

Material and Methods

Fifty rats were divided into two groups of 25 animals each. Group I was used for morphological and morphometric evaluations and group II for the determination of gland density and processed gland volume. Acinar autolytic changes were studied at 0 (control group), 3, 6, 12 and 24 h postmortem periods. The morphometric analysis of the volume density (Vv) and total volume (V_T) of intact (ia) and autolyzed (aa) acini was performed under light microscopy using a Zeiss II integration grid with 100 symmetrically distributed points.

Results

Morphologically, temporal progressive nuclear alterations and gradual loss of the structural architecture of acinar cells were found. Regarding quantitative results, both the Vvaa and the Vvia showed statistically significant differences among all postmortem periods (p<0.05). Vvaa increased from 0.42% at 0 h to 75.84% at 24 h postmortem and Vvia decreased from 71.16% to 0% over the same period. For V_Taa and V_Tia, no statistically significant differences occurred between 12-24 h and 0-3 h (p>0.05), respectively. Vtaa increased from 0.18 mm³ at 0 h to 38.17 mm³ at 12 h, while Vtia showed a decrease from 33.47 mm³ to 0 mm³ between 3-24 h postmortem. Data concerning V_Taa were adjusted by twovariable linear regression, obtaining the equation: y=-3.54 + 3.38x (r²=0.90). The V_Taa growth rate calculated by this equation was 3.38 mm³/h between 0-12 h.

Conclusion

Acinar autolysis on rat SLG demonstrated the most significant signs during the first 6 h postmortem and was widely spread through the gland at 12 h.

Ultrastructural changes during in situ early postmortem autolysis in kidney, pancreas, liver, heart and skeletal muscle of rats

Many morphological studies of the postmortem interval were carried out under conditions in which the tissue was incubated in vitro after extirpation. However, the extirpation affects cell viability. We examined the ultrastructural changes in the kidney, pancreas, liver, heart and skeletal muscle of male Wistar rats occurring postmortem in situ. In each organ, cell edema (cell swelling), appearance of amorphous dense deposits in the mitochondria, loss of glycogen granules, dilation of the endoplasmic reticulum, clumping and margination of nuclear chromatin, and/or condensation of nuclear chromatin were observed, but the duration of the period of ultrastructural change was organ specific. Most of the ultrastructural changes occurred earlier in kidney. In hepatocytes, the morphological degeneration occurred later than in the renal tubule epithelium and earlier than that in the myocardium. Of the five organs we examined, skeletal muscle showed the greatest delay in postmortem change. In the distal tubule epithelium and pancreatic acinar cells, two forms of nuclear change were seen: one resembled necrotic change and the other resembled apoptotic change. The effect of lysosomes and hydrolytic enzymes was not as great as previous findings.

Growth of rotaviruses in primary pancreatic cells

Rotavirus infection in children at risk of developing type 1 diabetes has been temporally associated with development of pancreatic islet autoantibodies. In this study, nonobese diabetic mice were shown to be susceptible to rhesus rotavirus infection and pancreatic islets from nonobese diabetic mice, nonobese diabetes-resistant mice, fetal pigs, and macaque monkeys supported various degrees of rotavirus growth. Human rotaviruses replicated in monkey islets only. This islet susceptibility shows that rotavirus infection of the pancreas in vivo might be possible.

Preservation time dependent morphological changes in cold stored human donor pancreas

Pancreatic transplantation is being used to treat insulin-dependent diabetes. An intact structure of the graft is a prerequisite for preserved function and we therefore monitored the light microscopic and ultrastructural changes in 30 human donor pancreases stored in the cold in University of Wisconsin preservation solution. Twenty-three pancreases were stored for less than 24 h and 7 for more than 30 h. All glands stored longer than 30 h displayed cytoplasmic vacuolisation in a variable proportion of acinar cells. In addition, the glands stored over 40 h showed focal acinar necrosis. Endocrine tissue was only slightly affected, while duct cells showed no changes. It is concluded that cold preserved pancreases stored for less than 24 h are best for transplantation purposes and that acinar cells are more sensitive to ischaemic damage than endocrine and duct cells.

Ultrastructure of human acute pancreatitis

Few studies have been published on the ultrastructural changes which accompany human acute pancreatitis, and these have concentrated primarily on parenchyma. The present study concentrates on extraparenchymal changes, compares acute pancreatitis occurring alone with that on a background of chronic pancreatitis, and tests for similarity with observations made previously in an experimental model. Pancreatic tissue came from 16 patients undergoing surgery for pancreatic disease and five subjects without pancreatic disease. Regressive changes in parenchymal cells were consistent with ischemia, and with previously described studies. Polymorphonuclear leukocytes infiltrated into stroma and parenchyma. Platelets accumulated intra- and extravascularly. Fibrin deposits were common in the connective tissue, and could be observed in intercellular spaces at the base of acini, mingled with degenerating acinar cells and secretion product. Microthrombi occurred in blood vessels. These alterations were consistent with those in experimental acute pancreatitis. Similar changes were observed whether or not acute pancreatitis occurred on a background of chronic pancreatitis. The vascular component is important in acute pancreatitis, and altered epithelial barriers allow interaction between blood-borne material and pancreatic exocrine secretions.

Quantitative analysis of mitochondrial flocculent densities in rat hepatocytes during normothermic and hypothermic ischemia in vitro

The development of flocculent densities in mitochondria as a sign of irreversible cell injury in rat hepatocytes has been studied by quantitative electron microscopy during in vitro ischemia under both normothermic (37 degrees C) and hypothermic (4 degrees C) conditions. At 37 degrees C flocculent densities first appear after 1 h ischemia; at this stage they are small in diameter (170 nm) and occur in only 8% of mitochondria. After 1.5 hour ischemia, flocculent densities increase in diameter (207 nm) and are seen in 37% of mitochondria. Death of the majority of hepatocytes seems to occur between 1.5 and 2 h ischemia since at this stage the percentage of mitochondria containing flocculent densities reaches a maximum (48%). However, flocculent densities continue to increase in size (to 337 nm diam.) up to between 2 and 4 h ischemia (the prenecrotic phase). In contrast, at 4 degrees C signs of ischemic damage to hepatocytes are considerably delayed. Flocculent densities of comparable size and frequency to those observed after 1 h ischemia at 37 degrees C are not seen till as late as 4 days at 4 degrees C. At the latter temperature, only after 7 days ischemia a substantial rise (to about 25%) in the proportion of mitochondria containing flocculent densities occurs. A further slow increase in size and in the percentage of mitochondria containing densities occurs up to 14 days ischemia at 4 degrees C. It is concluded that the development of flocculent densities may be used only as a parameter of irreversible damage in cells with a sufficient number of mitochondria, such as hepatocytes, under normothermic conditions. With ischemia at 4 degrees C, possibly due to a different protein denaturation pattern, the development of flocculent densities is of much less value as an indication of irreversible cell damage and cannot, therefore, be considered as a reliable sign of cellular damage in organs stored at 4 degrees C for transplantation purposes.

What's new in in vitro studies of exocrine pancreatic cell injury?

Exocrine pancreas in vitro models are useful for the study of pancreatic differentiation, secretion mechanisms, cell injury, and lysosomal processing of secretory product. Syrian hamster pancreas in explant organ culture undergoes a series of morphologic changes which parallel in vitro acinar cell injury, differentiation, and phenotypic alteration. Within 48 hours, the cultured acinar cells show morphologic evidence of sublethal cell injury. Autophagy and crinophagy are particularly striking. The autophagic processes can be inhibited by the addition of the protein synthesis inhibitor cycloheximide or by culture at lowered temperatures (20 degrees C). Acinar cells lethally damaged show pyknotic nuclei, high amplitude swelling, and necrosis. Approximately 25% of each explant is viable after 72 hr in culture and the viability remains constant at 25-35% for up to 60 days of culture. The morphological changes of the explants are consistent with many of the features of pancreatitis and carcinoma of the exocrine pancreas. There is an increase in the ductal elements and a decrease in acini over time in culture. This may be due to: (a) an increased replication of ductal epithelial cells concomitant with necrosis of acinar epithelial cells and/or (b) phenotypic alteration of acinar cells to ductal cells. Acinar cell necrosis and phenotypic alterations may in part be due to the activation of lysosomal degradation pathways. Processes which inhibit lysosomal activation proved protective against these alterations, while processes which promote zymogen activation were deleterious.

Experimental pancreatitis in the rat. Light and electron microscopical observations on early pancreatic lesions induced by intraductal injection of trypsin, phospholipase A2, lysolecithin and non-ionic detergent

Trypsin, phospholipase A2, lysolecithin or non-ionic detergent polyoxyethylene p-t-octyl phenol solutions were injected into the rat biliopancreatic duct. Histological and ultrastructural changes in the gland were studied 15 min and 3 h after the injections. The rough surfaced endoplasmic reticulum disintegrated in two ways: (1) the endoplasmic reticulum in the cell periphery was vesiculated but ribosomes were well preserved at 15 min, and (2) large, round membranous structures appeared in apical cytoplasm at 3 h. Zymogen granules disintegrated in the second type, which possibly represents autodigestion. Both types of injury lead ultimately to structureless necrosis. Lesions induced by phospholipase A2 and lysolecithin were identical. Trypsin-induced damage developed slowly and the two phases of endoplasmic reticulum disintegration were not sharply separable. Lesions caused by polyoxyethylene p-t-octyl phenol were variable at 15 min, but at 3 h the type 2 injury described above was observed. It was concluded that although the initial damage in pancreatic acinar cells may vary, necrotic changes are similar despite the injected material at the later time interval. During acute pancreatitis, the acinar cell necrosis is most probably due to the action of lysolecithin produced by the activation of phospholipase A2.

Pancreatic acinar ultrastructure in human acute pancreatitis

Ultrastructural alterations in pancreatic acini from six patients operated for acute necrotizing pancreatitis are described. One of the patients suffered from biliary tract disease, the rest had excessive alcohol intake as the presumed aetiology. Areas of the pancreatic parenchyma showing oedematous inflammation in light microscopy were studied in the electron microscope. Findings in acinar cells included changes in zymogen granules and an increased autophagocytosis in addition to unspecific organelle alterations. Zymogen granules showed increase in size and number, loss or variation of electron-density and peripheral dissolution. Increased autophagic activity was indicated by several autophagic vacuoles and residual bodies. Acinar lumina were dilated showing effacement of microvilli and invaginations in the luminal plasma membrane of the acinar cells. In acinar lumina and in the interstitium fibrillar material was observed, with an increasing frequency in those areas showing severe cellular disintegration. These findings suggest: 1) an increased activity of zymogen granules, 2) an increased autophagocytosis, and 3) penetration of acinar luminal contents into the interstitium.

Autolytic changes in the rat adenohypophysis. A histologic, immunocytologic and electron microscopic study

Thirty-nine adult female Long Evans rats were decapitated and the heads stored at room temperature. The pituitaries were removed at intervals from 30 minutes to seven days, fixed, embedded and studied by histology, immunocytology and electron microscopy. Histologically, changes were noticeable after two hours postmortem. Immunoperoxidase staining showed postivity for growth hormone, prolactin, FSH, LH and TSH up to seven days after sacrifice, appearing even stronger in the advanced stages of autolysis. Fine structural alterations were evident at 30 minutes and more conspicuous later. Changes included dilation, partial degranulation and whorl formation of RER, swelling of Golgi complexes and mitochondria, chromatin clumping, lysis, rhexis and pyknosis of nuclei, cytosegresome formation and disruption of cell membranes. Secretory granules remained well preserved throughout, although some exhibited fusion or reduced electron density. Dilation of capillaries with accumulation of erythrocytes, platelets and fibrin fibers were prominent findings. The severity of changes varied considerably from cell to cell indicating that the rate of autolysis is not the same among different cell types and is possibly affected by the actual functional state of the cell. It appears that increased membrane permeability and disruption of plasmalemma represent important steps in the autolytic process.