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Ferluga J, Yasmin H, Bhakta S, Kishore U. Vaccination Strategies Against Mycobacterium tuberculosis: BCG and Beyond. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1313:217-240. [PMID: 34661897 DOI: 10.1007/978-3-030-67452-6_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Tuberculosis (TB) is a highly contagious disease caused by Mycobacterium tuberculosis (Mtb) and is the major cause of morbidity and mortality across the globe. The clinical outcome of TB infection and susceptibility varies among individuals and even among different populations, contributed by host genetic factors such as polymorphism in the human leukocyte antigen (HLA) alleles as well as in cytokine genes, nutritional differences between populations, immunometabolism, and other environmental factors. Till now, BCG is the only vaccine available to prevent TB but the protection rendered by BCG against pulmonary TB is not uniform. To deliver a vaccine which can give consistent protection against TB is a great challenge with rising burden of drug-resistant TB. Thus, expectations are quite high with new generation vaccines that will improve the efficiency of BCG without showing any discordance for all forms of TB, effective for individual of all ages in all parts of the world. In order to enhance or improve the efficacy of BCG, different strategies are being implemented by considering the immunogenicity of various Mtb virulence factors as well as of the recombinant strains, co-administration with adjuvants and use of appropriate vehicle for delivery. This chapter discusses several such pre-clinical attempts to boost BCG with subunit vaccines tested in murine models and also highlights various recombinant TB vaccines undergoing clinical trials. Promising candidates include new generation of live recombinant BCG (rBCG) vaccines, VPM1002, which are deleted in one or two virulence genes. They encode for the mycobacteria-infected macrophage-inhibitor proteins of host macrophage apoptosis and autophagy, key events in killing and eradication of Mtb. These vaccines are rBCG- ΔureC::hly HMR, and rBCG-ΔureC::hly ΔnuoG. The former vaccine has passed phase IIb in clinical trials involving South African infants and adults. Thus, with an aim of elimination of TB by 2050, all these cumulative efforts to develop a better TB vaccine possibly is new hope for positive outcomes.
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Affiliation(s)
- Janez Ferluga
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Hadida Yasmin
- Immunology and Cell Biology Laboratory, Department of Zoology, Cooch Behar Panchanan Barma University, Cooch Behar, West Bengal, India
| | - Sanjib Bhakta
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, London, UK
| | - Uday Kishore
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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Martinet W, Timmermans JP, De Meyer GRY. Methods to assess autophagy in situ--transmission electron microscopy versus immunohistochemistry. Methods Enzymol 2015; 543:89-114. [PMID: 24924129 DOI: 10.1016/b978-0-12-801329-8.00005-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autophagy is a well-conserved lysosomal degradation pathway that plays a major role in both oncogenesis and tumor progression. Transmission electron microscopy (TEM) as well as immunohistochemistry are indispensable tools for the evaluation of autophagy in situ. Here, we describe an optimized protocol for the study of autophagic vacuoles by TEM and elaborate on the immunohistochemical detection of microtubule-associated protein 1 light chain (MAP1LC3, best known as LC3), which is currently considered as one of the most reliable markers of the autophagic process. The advantages, potential pitfalls, and limitations of these methods, as well as their value in the field of autophagy and oncometabolism research are discussed. Overall, we recommend a combined use of different techniques including TEM, immunohistochemistry, and molecular approaches (such as immunoblotting) for the unambiguous detection of autophagy in malignant as well as in normal tissues.
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Affiliation(s)
- Wim Martinet
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium.
| | | | - Guido R Y De Meyer
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
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Schmitz G, Orsó E. Intracellular cholesterol and phospholipid trafficking: comparable mechanisms in macrophages and neuronal cells. Neurochem Res 2001; 26:1045-68. [PMID: 11699932 DOI: 10.1023/a:1012357106398] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During the past ten years considerable evidences have accumulated that in addition to monocytes/macrophages, that are implicated in innate immunity and atherogenesis, neuronal cells also exhibit an extensive cellular metabolism. The present study focuses on the major protein players that establish cellular distribution of cholesterol and phospholipids. Evidences are provided that neuronal cells and monocytes/macrophages are equipped with comparable intracellular lipid trafficking mechanisms. Selected examples are presented that trafficking dysfunctions lead to disease development, such as Tangier disease and Niemann-Pick disease type C, or contribute to the pathogenesis of diseases such as Alzheimer disease and atherosclerosis.
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Affiliation(s)
- G Schmitz
- Institute for Clinical Chemistry and Laboratory Medicine, University of Regensburg, Germany.
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Takahashi T, Ueda S, Takahashi K, Scow RO. pH-dependent multilamellar structures in fetal mouse bone: possible involvement of fatty acids in bone mineralization. THE AMERICAN JOURNAL OF PHYSIOLOGY 1994; 266:C590-600. [PMID: 8166222 DOI: 10.1152/ajpcell.1994.266.3.c590] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
pH-dependent multilamellar structures in fetal mouse bone: possible involvement of fatty acids in bone mineralization. Am. J. Physiol. 266 (Cell Physiol. 35): C590-C600, 1994.--Multilamellar structures (MLS) were found inside and outside osteoblasts in cultured and uncultured fetal mouse parietal bone fixed at pH 7.3 with glutaraldehyde solution containing tannic acid (TA). Electron-lucent areas (up to 1.5 microns in diameter) surrounded by thin lamellar structures were found in place of MLS in bone and bone cell cultures fixed at pH 6.0 in the presence of TA. Large lipid droplets were found, in place of electron-lucent areas and MLS, in specimens fixed at pH 7.4 in the absence of TA and dehydrated with a procedure that did not extract neutral lipid. Freeze-fracture studies showed phosphatidylcholine formed MLS at both pH 8.1 and pH 6.0, whereas oleic acid formed MLS at pH 8.1 and lipid droplets at pH 6.0. Thus fatty acids probably formed the pH-dependent MLS found in bone. The data suggest that osteoblasts synthesize and secrete fatty acids, as droplets, into the extracellular space. The close association of MLS with calcifying osteoid in specimens processed with TA suggests that fatty acids are directly involved in bone mineralization.
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Affiliation(s)
- T Takahashi
- Department of Oral Anatomy, Kanagawa Dental College, Yokosuka, Japan
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Hulsmann WC, Ashruf JF, Bruining HA, Ince C. Imminent ischemia in normal and hypertrophic Langendorff rat hearts; effects of fatty acids and superoxide dismutase monitored by NADH surface fluorescence. BIOCHIMICA ET BIOPHYSICA ACTA 1993; 1181:273-8. [PMID: 8318552 DOI: 10.1016/0925-4439(93)90032-v] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hypertrophic hearts contain areas of hypoperfusion which can be visualized by increased NADH surface fluorescence during in vitro perfusion without oxygen-carrying particles under constant pressure and pacing. By contrast, fluorescence remained low when non-hypertrophic hearts were used instead. When during perfusion of normal hearts the pH of the medium was lowered from 7.5 to 7.0, areas of high fluorescence appeared in a few minutes. The high fluorescent areas under conditions of cardiac hypertrophy or pH 7.0 perfusion could be reduced by addition of superoxide dismutase. It indicates that oxygen free radicals interfere with proper flow regulation in areas of low pH. Fluorescence in hypertrophic hearts also diminished during addition of albumin-bound oleate to the standard, glucose-containing, medium. This is in agreement with our earlier finding of fatty acid protection from acidosis-initiated loss of capillary flow (Biochim. Biophys. Acta, 1033 (1990) 214-218). In contrast to low concentrations of free fatty acids, high concentrations interfere with tissue oxygenation. This has been illustrated by the use of 1 mM octanoate, which after a few min caused the appearance of high fluorescent areas. We conclude that decompensation of flow in hypoperfused areas of heart, as occurs in hypertrophy, may be stimulated by acidosis and oxygen free radicals.
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Affiliation(s)
- W C Hulsmann
- Department of Surgery, Erasmus University, Rotterdam, The Netherlands
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Scow RO, Blanchette-Mackie EJ. Endothelium, the dynamic interface in cardiac lipid transport. Mol Cell Biochem 1992; 116:181-91. [PMID: 1480147 DOI: 10.1007/bf01270586] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vascular endothelium is the dynamic interface in transport of lipid from blood to myocytes in heart and arteries. The luminal surface of endothelium is the site of action of lipoprotein lipase on chylomicrons and VLDL and the site of uptake of fatty acids from albumin. Fatty acids and monoacylglycerols are transported from the lumen in an interfacial continuum of endothelial and myocyte membranes. Lipoprotein lipase is transferred from myocytes to the vascular lumen, and is anchored there, by proteoheparan sulfate in cell membranes. Insulin, needed for synthesis of lipoprotein lipase and esterification of fatty acids, is captured from the blood stream and delivered to myocytes by endothelial insulin receptors. Fatty acids, monoacylglycerols, lipoprotein lipase and insulin are transported along the same route, but by different mechanisms. The route involves the plasma membrane of endothelium and myocytes, the membrane lining transendothelial channels, and intercellular contacts.
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Affiliation(s)
- R O Scow
- Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892
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Scow RO, Blanchette-Mackie EJ. Transport of fatty acids and monoacylglycerols in white and brown adipose tissues. Brain Res Bull 1991; 27:487-91. [PMID: 1959050 DOI: 10.1016/0361-9230(91)90147-c] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Long chain fatty acids (FA) and 2-monoacylglycerols (MG) are produced by lipoprotein lipase (LPL) from plasma triacylglycerols (TG) in capillaries of adipose tissue and transported to adipocytes for TG synthesis. It is widely proposed FA may be transported in cells by FA-binding protein. Mode of transport of MG has received little attention. Our findings in tissues and model membranes indicate that FA (as 1:1 acid-soaps) and MG can be transported in vivo by lateral movement in an interfacial continuum (IFC) of the outer leaflets of plasma and intracellular membranes of capillary endothelium and adipocytes. We postulate that FA and MG enter the IFC in capillaries and flow in the IFC across endothelium and extracellular space to sites in adipocytes where MG are hydrolyzed by MG-lipase (MGL) to FA and glycerol, and FA are esterified in endoplasmic reticulum or transferred to inner mitochondrial membrane for oxidation. FA and MG produced by hormone-sensitive lipase also enter the IFC. These MG flow in the IFC to sites of MGL activity, and the FA flow in the IFC to capillaries for transport to other tissues by albumin, or to mitochondria for heat production.
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Affiliation(s)
- R O Scow
- Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892
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Abstract
A light and electron microscopic study of the skin of domestic chickens, seagulls, and antarctic penguins revealed abundant extracellular dermal lipid and intracellular epidermal lipid. Dermal lipid appeared ultrastructurally as extracellular droplets varying from less than 1 micron to more than 25 microns in diameter. The droplets were often irregularly contoured, sometimes round, and of relatively low electron density. Processes of fibrocytes were often seen in contact with extracellular lipid droplets. Sometimes a portion of such a droplet was missing, and this missing part appeared to have been "digested away" by the cell process. In places where cells or cell processes are in contact with fact droplets, there are sometimes extracellular membranous whorls or fragments which have been associated with the presence of fatty acids. Occasionally (in the comb) free fat particles were seen in intimate contact with extravasated erythrocytes. Fat droplets were seen in the lumen of small dermal blood and lymph vessels. We suggest that the dermal extracellular lipid originates in the adipocyte layer and following hydrolysis the free fatty acids diffuse into the epidermis. Here they become the raw material for forming the abundant neutral lipid contained in many of the epidermal cells of both birds and dolphins. The heretofore unreported presence and apparently normal utilization of abundant extracellular lipid in birds, as well as the presence of relatively large droplets of neutral lipid in dermal vessels, pose questions which require a thorough reappraisal of present concepts of the ways in which fat is distributed and utilized in the body.
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Affiliation(s)
- M W Stromberg
- Department of Anatomy, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana 47907
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Blanchette-Mackie EJ, Dwyer NK, Amende LA. Cytochemical studies of lipid metabolism: immunogold probes for lipoprotein lipase and cholesterol. THE AMERICAN JOURNAL OF ANATOMY 1989; 185:255-63. [PMID: 2476020 DOI: 10.1002/aja.1001850218] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this article, cytochemical methods are presented for the study of lipid metabolism both in normal cells and in mutant cells with genetic disorders characterized by abnormal lipid metabolism. The benefit of using an immunocytochemical approach to the study of lipase in tissues is discussed, and a review is presented of the results on immunolocalization of lipoprotein lipase in cardiac tissue of normal mice. Immunocytochemical techniques are applied to the study of lysosomal proliferation in hepatocytes from liver of mutant mice with a genetic defect responsible for the lack of hepatic lipase and lipoprotein lipase activity in these animals. Localization of lipids in tissues with structural techniques has been an area of great interest to our laboratory for many years. Attention is called to the development of a technique for the visualization of fatty acids as a function of their ionization state and the production of fatty-acid myelin figures in membranes. Results on the use of filipin to detect unesterified cholesterol in membranes are reviewed. Filipin produces fluorescent filipin-cholesterol complexes but also perturbs cell membranes. Application of this cytochemical probe, in combination with immunocytochemistry of lysosomes, produced useful information on defects in low-density lipoprotein-derived cholesterol translocation in mutant human fibroblasts. Initial results on the application of immunological techniques to the study of cholesterol in lipid model systems indicate a novel approach, which may be applicable to specialized cell systems. Recent advances in cryoultramicrotomy and development of immunoprobes present valuable opportunities for the structural assessment of lipids and lipases in cell organelles and cell membranes.
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Affiliation(s)
- E J Blanchette-Mackie
- Laboratory of Cellular and Developmental Biology, National Institutes of Diabetes and Kidney Diseases, Bethesda, Maryland 20892
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Scow RO. Effect of sodium taurodeoxycholate, CaCl2 and albumin on the action of pancreatic lipase on droplets of trioleoylglycerol and the release of lipolytic products into aqueous media. Biochimie 1988; 70:1251-61. [PMID: 3147718 DOI: 10.1016/0300-9084(88)90192-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
1. Effects of various substances on the activity of pancreatic lipase and on the release of lipolytic products into aqueous media were studied with droplets of trioleoylglycerol suspended from a membrane filter at the top of a flow-through chamber. The droplets were perifused for 7 min with a commercial preparation of pancreatic lipase in 0.15 M NaCl solution at pH 6.5 and then perifused for 60 min with lipase-free media, either 0.15 M NaCl at pH 6.5 or basal medium at pH 7.4 (70 mM sodium barbital) containing different additives. 2. About 6% of the trioleoylglycerol in droplets was hydrolyzed during the perifusion with lipase. Another 15% was hydrolyzed in 30 min, but none thereafter, when the droplets were perifused with 0.15 M NaCl alone. The rate of hydrolysis was doubled and prolonged when droplets were perifused with basal medium at pH 7.4. Lipolytic products formed at pH 7.4 were 62% oleic acid, 20% monooleoylglycerol and 18% dioleoylglycerol, yet only 4% of the lipolytic products were released into the perifusate. 3. Sodium taurodeoxycholate (TDC) (17 mM ) added to basal medium increased 18 x the amount of lipolytic products released into the perifusate but increased lipolysis only 13%. The molar ratio of oleic acid to monooleoylglycerol in the perifusate was 5.7 during the first 30 min and 4.0 during the last 30 min. 4. Ca2+ (3.3 mM) added to basal medium increased lipolysis 87% but did not affect the amount (4%) of lipolytic products released into the perifusing medium. 5. TDC and Ca2+ added to basal medium produced the largest increase in lipolysis, with 59% of trioleoylglycerol hydrolyzed in 15 min and 91% in 60 min. The amount of lipolytic products released into the perifusing medium, however, was not increased above that released into medium containing TDC alone. 6. Serum albumin (0.6 mM) and Ca2+ added to basal medium increased 14 x the amount of lipolytic products released into the perifusate without affecting the basal lipolytic rate. Albumin, however, suppressed by 40% the stimulatory effect of Ca2+ on pancreatic lipase activity.
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Affiliation(s)
- R O Scow
- Laboratory of Cellular and Development Biology, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892
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Blanchette-Mackie EJ, Amende LM. Electron microscopic visualization of fatty acids in tissues. JOURNAL OF ELECTRON MICROSCOPY TECHNIQUE 1987; 7:205-21. [PMID: 3504448 DOI: 10.1002/jemt.1060070310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Long-chain fatty acids are amphipathic molecules with important structural and metabolic functions in tissues. Fatty acids are derived from triacylglycerol-rich particles in capillaries (chylomicrons and very-low-density lipoproteins) and from triacylglycerol stored in cells (lipid droplets) by the hydrolytic activity of tissue lipases. The identification and localization of fatty acids in tissues has been considered difficult to obtain by using conventional ultrastructural techniques. However, structural findings from our studies on fatty acid transport in tissue became interpretable due to the use of many overlapping techniques. We present here these ultrastructural techniques developed to study fatty acids in tissues and review data which demonstrate lipase activity and fatty acid production from triacylglycerol in aldehyde-fixed tissue. Accumulations of fatty acid in tissue are present as lamellar structures with periodicity of 40-50 A in sections of resin-embedded tissue and as hydrated myelin figures in freeze fracture replicas of unfixed and fixed tissue. Finally, a new method, using the ionization properties of fatty acids combined with freeze fracture, locates these amphipathic molecules to leaflets of membrane bilayers.
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Affiliation(s)
- E J Blanchette-Mackie
- Endocrinology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892
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Rhodes RH. Ultrastructure of complex carbohydrates of rodent and monkey ependymal glycocalyx and meninges. THE AMERICAN JOURNAL OF ANATOMY 1987; 179:369-84. [PMID: 3661459 DOI: 10.1002/aja.1001790407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The surfaces of the brain offer metabolic and mechanical support to the underlying parenchyma. Mouse, rat, and monkey brains were fixed by immersion in a glutaraldehyde fixative or glutaraldehyde with cetylpyridinium chloride, followed by block staining for complex carbohydrates using alcian blue with OsO4 postfixation, or OsO4 postfixative solution containing ruthenium red, or alcian blue and then ruthenium red-OsO4 treatment. The ependyma in these species had a glycocalyx extending into the ventricular fluid as a finely filamentous network when stained with alcian blue or with alcian blue followed by ruthenium red-OsO4. Mice in the middle age range had stained material in this glycocalyx resembling the hyaluronic acid reported in the ocular vitreous body. Similar material was seen in the arachnoidal space of these mice and in the inner connective tissue matrix of the dura mater. Both the mouse and monkey had a cell-free zone, termed the inner dural matrix zone, between the thick fibrous dura and its innermost cellular layer. This zone contained filamentous and globular alcian blue-stained material. The complex carbohydrates of the mouse ependymal glycocalyx and inner dural matrix zone underwent changes developmentally. Aged rats were injected intraventricularly with latex beads, which, along with extravasated erythrocytes, were seen to adhere to the ependymal glycocalyx. A similar adhesion of erythrocytes was seen in the mouse and monkey ependymal glycocalyx and in the filamentous network of the mouse and monkey inner dural matrix zone. The ependymal glycocalyx, formed in part of complex carbohydrates, is much thicker than previously demonstrated. Some activities related to the ependymal lining of the ventricles, including the movement of cells or particles, the penetration of metabolites or serum-protein fractions (e.g., immunoglobulins), and cell-surface hydration, probably depend in part on complex carbohydrates that provide a sticky, electrically negative, hydrophilic environment. The complex carbohydrates in the inner dural matrix zone might provide mechanical buffering. Complex carbohydrates in the arachnoidal space may help to maintain a loose tissue that needs not only to be hydrated, but also to be open enough to provide cerebrospinal fluid circulation.
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Affiliation(s)
- R H Rhodes
- Department of Pathology, University of Southern California School of Medicine
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Amende LM, Blanchette-Mackie EJ, Scow RO. Demonstration of fatty acid domains in membranes produced by lipolysis in mouse adipose tissue. A freeze-fracture study. Cell Tissue Res 1986; 246:495-508. [PMID: 3791379 DOI: 10.1007/bf00215189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Fatty acids produced by isoproterenol-stimulated lipolysis in mouse adipose tissue incubated at pH 7.4 formed myelin figures when the tissue was processed at pH 9.0. Myelin figures, visualized with freeze-fracture electron microscopy, were found in intracellular channels of adipocytes, extracellular space, intracellular channels of endothelial cells, and capillary lumen. The E-fracture face of plasma membranes of adipocytes and endothelial cells and intracellular membranes of adipocytes contained areas that were free of particles. These areas, which were continuous with particle-studded areas of the E-fracture faces, were irregular in shape, sometimes circular or oblong, other times long and narrow. The surfaces of particle-free areas were flat, concave, convex, and often corrugated, with multiple folds that sometimes abutted on myelin figures. We conclude that the particle-free areas are composed of partially ionized fatty acids located in the external leaflets of plasma and intracellular membranes of adipocytes and endothelium. They were formed by fatty acids that entered leaflets at pH 9.0, probably from lipolyzed lipid droplets in adipocytes, moved in a continuum of membrane leaflets between and within cells, overcrowded the leaflets, and subsequently produced corrugations and lamellar extensions (myelin figures) of leaflets.
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