Patterns of regeneration in vessels of human diseased muscle and skin. An ultrastructural study

The role of anti-endothelial cell antibody-mediated microvascular injury in the evolution of pulmonary fibrosis in the setting of collagen vascular disease

We encountered 16 patients with connective tissue disease in whom pulmonary fibrosis developed. Routine light microscopic, ultrastructural, and direct immunofluorescent analyses were conducted, and circulating antibodies, including those of endothelial cell derivation, were assessed using indirect immuno-fluorescence and Western blot assays. Underlying diseases were dermatomyositis, scleroderma, mixed connective tissue disease, sclerodermatomyositis, Sjögren syndrome, rheumatoid arthritis, and anti-Ro-associated systemic lupus erythematosus. Antibodies to one or more Ro, RNP, Jo 1, OJ, and/or nucleolar antigens were seen in all cases and antiphospholipid antibodies in half. All biopsies revealed microvascular injury in concert with intraparenchymal fibrosis; in some cases, there were corroborative ultrastructural findings of microvascular injury. Patterns of fibroplasia represented nonspecific interstitial pneumonitis and usual interstitial pneumonitis. We noted IgG, IgA, and/or complement in the septal microvasculature. In 6 cases with available serum samples, indirect immunofluorescent endothelial cell antibody studies were positive and Western Blot studies showed reactivity of serum samples to numerous endothelial cell lysate-derived proteins. Pulmonary fibrosis, a recognized complication of systemic connective tissue disease, develops in connective tissue disease syndromes with pathogenetically established immune-based microvascular injury at other sites. A similar mechanism of antibody-mediated endothelial cell injury may be the basis of the tissue injury and fibrosing reparative response.

Perifascicular atrophic fibers in childhood dermatomyositis with particular reference to mitochondrial changes

Ten of 17 muscle biopsy specimens from 15 patients with childhood dermatomyositis (DM) showed distinct perifascicular atrophy. The atrophic fibers showed the following characteristics: (1) decreased cytochrome c oxidase (CCO) activity, (2) rare positive reaction with acridine orange (AO) staining, (3) type 2C reaction in 7.9% (0.4-17.5%) of the fibers, (4) an increased number of activated satellite cells, (5) mitochondria which were increased in number but decreased in size, (6) a significantly decreased CCO activity in isolated mitochondria (51.6 +/- 30.3 nmol/min per mg mitochondrial protein) as compared with that in the controls (103.6 +/- 41.5). The major pathogenetic mechanism in muscles in childhood DM is thought to be ischemia due to involvement of the microvasculature. The presence of type 2C fibers and increased numbers of activated satellite cells reflect a focal repair process taking place concomitantly in the damaged myofibers. Mitochondrial enzyme defect, especially CCO deficiency is present not only in genetic disorders with mitochondrial involvement but in other neuromuscular disorders including inflammatory myopathies.

Inflammatory myopathy: a review of etiologic and pathogenetic factors

Human idiopathic inflammatory myopathy is an acquired disorder with an annual incidence of two to five cases per million. A genetic influence on host susceptibility may also play a role. With the marked heterogeneity of the disease one of the major challenges is to identify subsets that might share a more uniform pathogenesis and manifest a less diverse profile of clinical findings, histopathological abnormalities, and natural history. Dermatomyositis can be distinguished by clinical appearance and pathological changes, but the recognition of additional disease subsets remains very inexact. Current evidence suggests that dermatomyositis occurs as a result of a vasculopathy, but immune mechanisms involved in other categories of idiopathic inflammatory myopathy may also involve cell-mediated immunity and possibly multiple mechanisms. Even though viral-induced muscle inflammation occurs in humans, there is no convincing evidence for a viral cause of idiopathic inflammatory myopathy. Experimental allergic myositis may be produced by the injection of animals with skeletal muscle homogenates and complete Freund's adjuvant, but the myositogenic factor is unknown and the parallels between experimental allergic myositis and human idiopathic inflammatory myopathy are limited.