Complete section of the left vagus nerve does not preclude the efficacy of vagus nerve stimulation: illustrative case

BACKGROUND

Vagus nerve stimulation (VNS) represents a valid therapeutic option for patients with medically intractable seizures who are not candidates for epilepsy surgery. Even when complete section of the nerve occurs, stimulation applied cranially to the involved nerve segment does not preclude the efficacy of VNS. Complete vagus nerve section with neuroma causing definitive left vocal cord palsy has never been previously reported in the literature.

OBSERVATIONS

Eight years after VNS implant, the patient experienced worsening of seizures; the interrogation of the generator revealed high impedance requiring surgical revision. On surgical exploration, complete left vagus nerve section and a neuroma were found. Vocal cord atrophy was found at immediate postoperative laryngeal inspection as a confirmation of a longstanding lesion. Both of these events might have been caused by direct nerve injury during VNS surgery, and they presented in a delayed fashion.

LESSONS

VNS surgery may be complicated by direct damage to the left vagus nerve, resulting in permanent neurological deficits. A complete section of the nerve also enables an efficacious stimulation if applied cranially to the involved segment. Laryngeal examination should be routinely performed before each VNS surgery to rule out preexisting vocal cord dysfunction.

The use of opioids in children receiving intrathecal baclofen therapy

PURPOSE

We hypothesized that children on chronic intrathecal baclofen therapy (ITB) may require less analgesics for postoperative pain control and are at higher risk of developing opioid-induced respiratory depression postoperatively. The aims of this study are to review children on chronic intrathecal baclofen therapy receiving opioids after major surgery and to determine the incidence complications in this population.

METHOD

We conducted a retrospective cohort study comparing 13 children on ITB, who underwent posterior spinal fusion surgery, to 17 children with spina bifida that received the same surgery.

RESULTS

On postoperative day 0 (POD 0), four children (40%) had respiratory depression in the baclofen group compared to none in the control group. Desaturation was significantly more frequent in children in the ITB group compared to those of the control group on POD 0; oversedation was recorded in 8 (80%) children in the baclofen group vs. 3 (17.6%) in the control group. Desaturation, respiratory depression, and oversedation were significantly more frequent on POD 0 in children in the baclofen group compared with children in the control group.

CONCLUSIONS

The findings of the current study suggest that children on chronic intrathecal baclofen therapy require lesser amounts of opioids for postoperative pain control and are at a greater risk of developing postoperative respiratory depression and excessive sedation compared to patients without baclofen therapy.

[Mission woman: a survey on the perception of the "Service of Welcome and Listening" offered in the Emergency Department at the San Camillo Hospital in Rome by women victims of violence]

INTRODUCTION

The project Mission Woman was set up to describe how the service offered by the Emergency Department of the Hospital San Camillo-Forlanini in Rome was perceived by women victims ( or supposed to be) of violence. The objective of this investigation is to frame clients' perception about the service offered by staff in terms of sensitivity, recognition and management of the issue. The access to the Emergency Room is the first contact of the client with a helping relationship which goes beyond the simple provision of medical care.

METHODS

A questionnaire devised for the purpose was filled in by women who have asked for help to the Service "Door Woman" . The Service "Door Woman", set up in 2009, aimed to welcome and listen women victims of violence with the collaboration of different operators in the emergency department: nurses, doctors, psychologists and social workers. The project developed within the Hospital S. Camillo-Forlanini is managed by both professionals of the Emergency Department together with the Charity "Be Free". The service is open 24/7, all year, the clients could be women or children and could receive assistance or medical, nursing, psychosocial and legal counselling. The triage nurses are those who through their expertise could first identify the victims of violence and to introduce them in the path.

CONCLUSION

Despite the level of injuries, who access to the Emergency Room for single or repeated events of violence, may have decided to claim in court and not hide seeking.. The research aims to understand what are the theoretical and practical deficiencies of staff in the management of a issue which is not only medical but also social and legal, as well as structural and organizational weaknesses of the service.

Imaging of neuropathies about the hip

Neuropathies about the hip may be cause of chronic pain and disability. In most cases, these conditions derive from mechanical or dynamic compression of a segment of a nerve within a narrow osteofibrous tunnel, an opening in a fibrous structure, or a passageway close to a ligament or a muscle. Although the evaluation of nerve disorders primarily relies on neurological examination and electrophysiology, diagnostic imaging is currently used as a complement to help define the site and aetiology of nerve compression and exclude other disease possibly underlying the patient' symptoms. Diagnosis of entrapment neuropathies about the hip with US and MR imaging requires an in-depth knowledge of the normal imaging anatomy and awareness of the anatomic and pathologic factors that may predispose or cause a nerve injury. Accordingly, the aim of this article is to provide a comprehensive review of hip neuropathies with an emphasis on the relevant anatomy, aetiology, clinical presentation, and their imaging appearance. The lateral femoral cutaneous neuropathy (meiralgia paresthetica), femoral neuropathy, sciatic neuropathy, obturator neuropathy, superior and inferior gluteal neuropathies and pudendal neuropathy will be discussed.

The frequency of regulatory CD3+CD8+CD28- CD25+ T lymphocytes in human peripheral blood increases with age

Aging is commonly associated with immune deficiency and dysregulation. The aging of the immune system involves a progressive reduction in naïve T cell output associated with thymic involution and peripheral expansion of oligoclonal memory T cells. We have investigated frequency, phenotype, and function of CD3+CD8+CD28(-)CD25+ T cells in healthy volunteers over a wide age range. We demonstrate that the frequency of CD3+CD8+CD28(-)CD25+ T cells in healthy volunteers increases with age. Peripheral CD3+CD8+CD28(-)CD25+ T cells share phenotypic and functional features with CD3+CD4+CD25+ regulatory T cells (Tregs): In particular, they strongly express CTLA-4 and forkhead box P3. We observed that in vitro, functional titration assays of CD3+CD8+CD28(-)CD25+ T cells show equivalent regulatory function in young and elderly donors, with suppression of proliferation and cytokine production in response to polyclonal T cell stimulation. Finally, CD3+CD8+CD28(-)CD25+ T cells seem to specifically express the CD122 receptor. Altogether, these observations demonstrate an increase in peripheral blood CD8+ Tregs associated with aging.

Schwann cell-derived factors support serotoninergic neuron survival and promote neurite outgrowth

During embryogenesis and the postnatal period, neurons and glia interact in the development and differentiation of specific populations of nerve cells. Both in the peripheral (PNS) and in the central nervous system (CNS), glial cells have been shown in various experimental conditions to constitute a favorable substrate for neural adhesion, neural polarity, shape and axonal extension, while numerous soluble molecules secreted by neurons influence the survival and differentiation of the glial cells themselves. The aim of the present work was to investigate the influence of postnatal Schwann cells (SC) on embryonic serotoninergic (5-HT) neurons of the raphe, in order to study the possible influence of the peripheral glia on the CNS neurons. Cultures of SC from sciatic nerve of postnatal rats and neurons from rat embryonic rhombencephalon were successfully established and cells were immunocytochemically characterized. The number of 5-HT neurons, and the number and length of their branches were quantified in the cultures of 5-HT neurons, in cultures added with Nerve Growth Factor (NGF) and Insulin-like Growth Factor I (IGF-I), in co-cultures with SC and in cultures added with conditioned medium obtained from SC cultures. The results indicated that SC have the capacity to promote the survival and growth of 5-HT neurons in culture, and that this activity is mediated by soluble factors. Although the precise nature and mechanism of action of the growth factor or factors produced by SC in the presence of 5-HT neurons was not identified, our results add more data on the possible activity of the peripheral glia in promoting and enhancing the survival and outgrowth of the CNS neurons.

Unconventional medicine teaching at the Universities of the European Union

CONTEXT

The recent rapid increase in demand for and use of unconventional medicine requires an adequate medical education. In the United States, 64% of medical schools offer undergraduate courses. No information is available about similar courses at European universities.

OBJECTIVES

To document the incidence of educational courses on unconventional medicine offered by the European universities and their topic content.

DESIGN

Mail survey, which consisted of two questionnaires and was conducted in 1999 (January-June). The first questionnaire was sent to the universities' Rectorats, the second one to the faculties or lecturers indicated by the replies to the first questionnaire.

PARTICIPANTS

The Universities listed by the Confederation of European Union Rectors' Conference.

MAIN OUTCOME MEASURES

Courses offered at European Universities, both at medical faculties and at other faculties.

RESULTS

Five hundred and fifty (550) universities were contacted. Replies were received from 326 (59%); 141 have a faculty of medicine and 107 (76%) of them replied. We also received answers from 29 faculties of health sciences. In addition we received 190 (50%) answers from 380 other miscellaneous universities. Courses on unconventional medicine were offered by 43 (40%) medical schools, 21 (72%) health sciences faculties, and by 15 (8%) other faculties. Topics covered encompassed a wide range of techniques (33), from homeopathy to shamanism.

CONCLUSIONS

Unconventional medicine courses are widely represented at European universities. They cover a wide range of therapies. Many of them are used clinically. Research work is underway at several faculties.

Reduction of cisplatin nephrotoxicity by procainamide: does the formation of a cisplatin-procainamide complex play a role?

Procainamide protects mice bearing P388 leukemic cells against the toxicity of cisplatin without diminishing antitumor activity. The mechanism of action of procainamide protection was investigated both in vitro and in vivo. HPLC studies showed that procainamide forms a complex with cisplatin in vitro that has a UV spectrum similar to that of DPR, a triamine platinum complex that contains procaine as ligand. We report here the effect of the reaction product of cisplatin and procainamide on both cisplatin-induced DNA interstrand cross-links (ISCLs) and on the total DNA platination of isolated DNA. Total DNA platination in vitro of isolated DNA was increased by 113% (P <.01) and 17% (P <.05) after incubation times of 1.75 and 6 h, respectively, compared with products from the reaction of cisplatin with water. Furthermore, the reaction product of cisplatin and procainamide was bound to DNA to a significantly greater extent than was cisplatin itself. ISCLs were decreased by 41% when this drug combination was incubated with DNA for 1.75 h, but no changes were observed after incubation for 6 h. We also examined the influence of the time interval between administration of cisplatin and procainamide on normal kidney injury, the renal distribution and urinary excretion of platinum, and the formation of cisplatin-DNA adducts in renal tissue of Sprague-Dawley rats after i.p. administration of 7.5 mg/kg cisplatin either with or without procainamide. The plasma concentrations of urea and creatinine and kidney histology demonstrated that procainamide provided effective protection in vivo in the rat when administered either simultaneously or at 0.5 and 1 h before or after cisplatin. The protection was accompanied by both higher renal levels of platinum and cisplatin-DNA adducts and by an increase in the formation of ISCLs. Moreover, a dose-dependent reduction of urinary excretion and concentration of platinum was also observed. We propose that procainamide, after accumulation in the kidney, may coordinate with cisplatin to form a less toxic DPR-like complex that renders rats less susceptible to cisplatin-induced toxicity.

Forebrain white matter in spontaneously hypertensive rats: a quantitative image analysis study

The volume and the morphology of brain white matter as well as the number and the size of glial fibrillary acidic protein (GFAP)-immunoreactive astrocytes were investigated in 6-month-old spontaneously hypertensive rats (SHR) and age-matched normotensive Wistar-Kyoto (WKY) rats. The volume of frontal and occipital cortex and of hippocampus was decreased in SHR in comparison with normotensive rats, whereas the volume of neostriatum was unchanged. A remarkable decrease of the volume of internal capsule and striosomes, a moderate reduction of that of corpus callosum and no changes of the volume of external capsule and of white matter of hippocampus were also observed in SHR. In SHR the number of astrocytes was higher in the frontal and occipital cortex and in the white matter of the CA1 and CA3 subfields of the hippocampus, but not in the corpus callosum or in the grey matter of the CA1 and CA3 subfields. Staining for myelin did not reveal alterations in single fibre sheath morphology. These findings indicate the occurrence of changes of forebrain white matter in SHR, consisting in the reduction of it without qualitative modifications of myelinated fibres. The development of gliosis apparently not related with changes of volume of white matter was also found.

Iron-ethanol synergism and pathological liver transformation

The synergistic effects of iron overload and ethanol on the liver of mice were studied over a period of 46 weeks. The determination of several parameters (iron, calcium, magnesium, alpha-hydroxyproline, lipid peroxidation, hepatomegalic and splenomegalic indexes) showed that ferrous and ferric lactates provoke an increase of calcium in the liver, higher than that of ethanol in the control animals. The relationship between liver calcium homeostasis modification and the increase of collagen and lipid peroxidation is discussed. Histological examinations showed differences in the tissular characteristics especially when iron and ethanol were given together. These findings suggest the liver calcium homeostasis changes found as a synergistic effect in the early stages of chronic iron overload may be of importance as a trigger of events leading to the pathway of fibrosis-->cirrhosis-->hepatocarcinoma reported in pathologies such as nutritional siderosis and hemochromatosis.

Rat tibial osteoblasts III: propagation in vitro is accompanied by enhancement of osteoblast phenotype

Postproliferative confluent cultures of primary rat tibial osteoblasts (ROB), cultured in medium supplemented with ascorbic acid and beta-glycerophosphate (AS-bGP, differentiation medium) express, in sequence, specific bone markers which identify a succession of maturation stages, and eventually form mineralized noduli. We report an investigation on the effect of extensive proliferation in vitro in unsupplemented medium on the osteogenic potential of mass cultures of ROB. The growth rates of the populations, derived from two independent primary cultures, was constant throughout 110 cumulative population doublings (CPD) in culture. Propagated cells maintained features similar to osteoblasts in primary cultures with respect to serum and anchorage dependence for growth and to the chemokinetic effect on endothelial cells exerted by their conditioned media (CM). Propagated populations, set at confluence in differentiation medium, were tested for the expression of early [alkaline phosphatase (AP)] and late [osteocalcin (OC); bone sialoprotein (BSP); 45Ca incorporation and mineralization] osteogenic markers. We observed an increase, parallel to the increase in CPD, in both the level of maximal expression of AP (enzyme/microgram cellular DNA) and in the frequency of nodules, reaching five- to sixfold (at 78 CPD) and eightfold (at 60 CPD), respectively, the levels of primary cultures. AP expression (enzyme and mRNA) persisted during mineralization and 45Ca incorporation. The time required by propagated cultures for the formation of nodules decreased with increase of CPD, and was reduced to less than one third at 87 CDP. Nodules became mineralized over a similar lapse of time as in primary cultures and were positive by histochemistry for BSP and OC. We also obtained osteogenic clones from two independent cultures after 72 CPD. 90% of these showed an osteoblast phenotype, expressing AP and forming nodules positive for OC and BSP, which mineralized. Timing of formation and frequency of nodules/plated cells in clones was similar to that found in propagated cultures of equivalent CPD. In summary, propagated ROB populations and derived clones showed enhanced osteoblast phenotype, possibly due to an increase in osteogenic cells and enrichment of proliferating mature osteoblasts, consequent to extended propagation in culture.

Secretion and binding of HMG1 protein to the external surface of the membrane are required for murine erythroleukemia cell differentiation

We show here that murine erythroleukemia (MEL) cells, following induction with hexamethylene bisacetamide, accumulate high mobility group (HMG)1 protein onto the external surface of the cell in a membrane-associated form detectable by immunostaining with a specific anti-HMG1 protein antibody. This association is maximal at a time corresponding to cell commitment. At longer times, immunostainable cells are progressively reduced and become almost completely undetectable along with the appearance of hemoglobin molecules. Binding to MEL cells does not affect the native molecular structure of HMG1 protein. The type of functional correlation between HMG1 protein and MEL cell differentiation is suggested by the observation that if an anti-HMG1 protein antibody is added at the same time of the inducer almost complete inhibition of cell differentiation is observed, whereas if the antibody is added within the time period in which cells undergo through irreversible commitment, inhibition progressively disappears. A correlation between MEL cell commitment and the biological effect of HMG1 protein can thus be consistently suggested.

Effect of the antiarrhythmic drug procainamide on the toxicity and antitumor activity of cis-diamminedichloroplatinum(II)

The class I antiarrhythmic drug procainamide (Pd) was tested on BDF1 mice for its chemoprotective activity against cis-diamminedichloroplatinum(II) (DDP) toxicity. Pd at the dose of 50 mg/kg protected mice against otherwise lethal doses of DDP (survivors at Day 14 after 25 mg/kg DDP or 25 mg/kg DDP-Pd treatment: 0% vs 100%) and greatly reduced the weight loss induced by DDP. Moreover, the increased plasma urea nitrogen levels caused by a single ip administration of DDP in water (8 or 16 mg/kg) as well as the tubular degenerative changes detected by light microscopy were prevented by Pd. Pd had no effect on the sensitivity of P388 leukemic cells to DDP in vitro, but the administration of DDP (16 mg/kg) and Pd (50 mg/kg) to BDF1 mice bearing P388 leukemic cells produced a significant increase in survivals compared to mice receiving ip DDP alone diluted in 0.9% NaCl solution. The increased efficacy of this combination therapy in P388 leukemic mice compared to a single DDP treatment at the same dose was observed both when the drugs were administered ip simultaneously (p = 0.042) and when DDP and Pd were given ip and iv, respectively (p = 0.018). Since procaine, which differs from Pd merely in the replacement of the amide by the ester linkage, has also been reported to significantly enhance DDP efficacy (M. Esposito et al., 1990, J. Natl. Cancer Inst. 82, 677-684.), a comparison of their effects in tumored mice exposed to DDP has been made. Although both drug combinations were superior to that of DDP alone, in terms of both survival time and numbers of cures, Pd treatment seems to offer better protection against DDP-induced lethality than did procaine.

Cultured tibial rat osteoblasts: in vitro production and topography of osteonectin, biglycan and decorin

Rat osteoblasts in culture undergo differentiative changes culminating in the formation of mineralized foci. We here report on the pattern of temporal expression and compartmentalization of osteonectin and of the two small proteoglycans, byglican and decorin. They were constitutively synthesized during in vitro differentiation of rat osteoblasts. The 3 proteins were detected in the conditioned medium and associated with the cell-matrix compartment. Within this compartment they showed prevalent cytoplasmic location and differential distribution on unmineralized noduli was detected for osteonectin and byglican, while decorin was detected throughout the nodules. Along with known functions in the matrix, a possible role in the cytoplasm may have to be sought for these bone cells components.

Para-aminobenzoic acid suppression of cis-diamminedichloroplatinum(II) nephrotoxicity

Concurrent administration of para-aminobenzoic acid (PABA) reduced the toxicity of cis-diamminedichloroplatinum(II) (DDP) in a dose-related manner in rats. When administered i.p. simultaneously with 7.5 mg/kg DDP, PABA (100 mg/kg) significantly reduced plasma urea nitrogen (PUN) and plasma creatinine levels as well as DDP-induced weight loss. Increasing doses of PABA (25, 50 and 100 mg/kg) correlated with progressively better parameters of renal activity and body wt and with lower levels of platinum in plasma and tissues in rats killed 5 days after drug administration. The formation of cisplatin-DNA adducts, the total platinum levels in kidney and testes and the DDP-induced tumor response were investigated in the presence and absence of PABA exposure in mice bearing P388 leukemic cells. Renal and testicular DNA-adducts in mice treated i.p. with 16 mg/kg DDP in normal saline were higher than those observed in mice receiving the same protocol and added PABA. Analysis of tissue platinum content demonstrated significantly lower platinum levels both in kidneys (P < 0.05) and testes (P < 0.01) of mice receiving DDP and PABA in normal saline compared to those receiving only DDP in normal saline. PABA did not affect the in vivo and in vitro antitumor activity of DDP against P388 leukemia, and there was no significant PABA-induced modification in the concentration of platinum both in the tumor cells and in DNA samples isolated from P388 leukemic cells of DDP-treated mice. We conclude that PABA may be a promising compound for reducing DDP-toxic side effects, including nephrotoxicity, without compromising its antitumor activity.

Expression of common acute lymphoblastic leukemia antigen (CD 10) by myelinated fibers of the peripheral nervous system

The common acute lymphoblastic leukemia antigen (CALLA), CD10, is a 100-kDa surface glycoprotein endowed with neutral endopeptidase activity, shared by a number of hemopoietic and non-hemopoietic cells. In this report, immunohistochemical and Western blot techniques, using different anti-CD10 monoclonal antibodies, were utilized to demonstrate that CD10 is also expressed by myelin sheaths of the human peripheral nervous system (PNS), but not of the central nervous system. CD10-positive immunoreactivity appeared to be localized in the outer and inner borders of myelinated fibers, in nodes of Ranvier and in the Schmidt-Lantermann clefts, thus showing a distribution pattern very similar to that of myelin-associated glycoprotein (MAG). The above findings suggest that CD10 antigen, through its enzymatic activity, may have a functional role in the assembly and maintenance of PNS myelin. In addition, it is not known whether CD10, similarly to MAG, may be a target antigen in some PNS immune-mediated disorders.

Synthesis and antitumor activity of a new cis-diammineplatinum (II) complex containing procaine hydrochloride

This paper refers to some of the chemical and biological properties of a new platinum (II) complex where the aromatic amino group of procaine is involved in the coordination with platinum and whose structure was defined by UV, IR, 1H-NMR, and elemental analysis. This new cationic platinum-triamine complex (DPR) displays excellent solubility (> 50 mg/ml) and stability in water. DPR has significant in vitro cytotoxicity against murine P388 leukemic cell line, human K562 erythroleukemic cell line and human Jurkat T cell line. The in vitro cytotoxic effects of DPR on P388 and Jurkat leukemic cells were comparable to those of cis-diamminedichloroplatinum (II) (DDP), while its activity on K562 cells was significantly better than that of DDP [IC50 = 1.07 +/- 0.36 (SD) microM vs 2.62 +/- 0.23 (SD) microM, P < 0.01]. The in vitro Pt accumulation rate for P388 cells was twice as rapid after DPR than after DDP exposure, while no difference in cellular platinum efflux was observed. The antitumor activity of DPR was tested in vivo against P388 leukemic cells in BDF1 mice and gave a % ILS value (75%) similar to that of the maximum tolerated dose (MTD) of DDP (8 mg/Kg). A comparative study of plasma urea nitrogen (PUN) levels and kidney morphological analysis in tumor-bearing mice receiving the LD50 dose of both drugs (39.3 mg/Kg and 16.5 mg/Kg for DPR and DDP, respectively), showed DPR to be less nephrotoxic than DDP. These results indicate that this new cationic platinum-triamine complex containing primary amine ligand is surprisingly active both in vitro and in vivo. In summary, the good characteristics of DPR in terms of high solubility, encouraging anticancer activity and absence of nephrotoxic effects make DPR a promising new platinum anticancer agent for preclinical development.

GFAP expression of human Schwann cells in tissue culture

We have studied the expression of the intermediate filament (IF) proteins, vimentin and glial fibrillary acidic protein (GFAP), in cultured human Schwann cells (SC) from patients with different neuropathies and normal control cases. SC cultures from sural nerve biopsies of 8 subjects with axonal neuropathies, 8 with demyelinating neuropathies and 3 normal controls were included in this study and processed with double immunofluorescence technique, using anti-vimentin and anti-GFAP antibodies, during the 2nd, 4th and 6th week of culture. Five cultures incubated with anti-GFAP antibodies were also processed for immunoelectron microscopy. Specificity tests of the used antibodies were performed. We have found that: (1) cultured human SC constantly express vimentin; (2) SC from normal controls are GFAP-negative in the first period of culture; (3) SC from pathologic nerves can contain GFAP-immunoreactive IF and the percentage of GFAP-positive SC is higher in axonal than in demyelinating neuropathies; (4) during the permanence in culture human SC from both normal and pathologic cases acquire the ability to synthesize GFAP. The obtained data suggest that the removal from axonal contact and the resulting loss of myelinating function induce a cytoskeletal cellular response in human SC characterized by the cytoplasmic accumulation of GFAP-immunoreactive IF.

Schwann cell GFAP expression increases in axonal neuropathies

We studied the Schwann cell (SC) GFAP immunoreactivity in normal human peripheral nerves and in neuropathies of different origin. Immunofluorescence and immunocytochemistry were carried out on serial frozen sections of 58 peripheral nerve biopsies using monoclonal antibodies (mabs) antivimentin and anti GFAP, and antiserum anti S-100 and anti GFAP. To test the specificity of the mabs and antiserum used, proper competition controls on tissue sections of 2 selected cases, tissue cultures studies of human fibroblasts and immunoblotting of homogenates of human fibroblasts, 3 normal and 5 pathologic nerves were carried out. In order to evaluate a possible correlation between SC GFAP positivity and neuropathologic findings a quantitative study was performed, evaluating the SC GFAP reactivity in all the 58 cases, and relating the SC GFAP positivity to the index of nerve pathology (IP) in 9 selected cases, and to the percentage of teased fibers showing axonal degeneration or demyelination and remyelination in 25 representative cases. We demonstrate that in normal human sural nerves and in demyelinating neuropathies only a few scattered SC are recognized by the mabs or antiserum anti GFAP. On the contrary in axonal neuropathies the majority of SC gain the property to express intermediate filaments which show common antigenic properties with GFAP.

Improved therapeutic index of cisplatin by procaine hydrochloride

The local anesthetic procaine hydrochloride (P.HCl) had little effect on the sensitivity of P388 leukemic cells to cisplatin (DDP) in vitro, but the simultaneous administration of DDP and P.HCl (40 mg/kg) to BDF1 mice produced 50% lethal dose (LD50) and 90% lethal dose (LD90) values approximately two times higher than those observed with DDP alone. DDP-P.HCl diluted in water and administered intraperitoneally (IP) on day 1 and on days 1 and 5 to BDF1 mice bearing P388 leukemic cells produced 33% and 50% cure rates, respectively, at the maximum tolerated dose (16 mg/kg for the single administration and 10 mg/kg given on days 1 and 5). In contrast, under the same conditions, the cure rates obtained with DDP alone (10 mg/kg for the single administration and 8 mg/kg given on days 1 and 5) were 17% and 9%, respectively. Protection from DDP nephrotoxicity seems to be the explanation for the higher doses of DDP that mice can tolerate when DDP is given simultaneously with P.HCl. In fact, the increased blood urea nitrogen (BUN) levels observed 4-7 days following a single IP administration of DDP (8 or 16 mg/kg), as well as the tubular degenerative changes detected by light microscopy, were not observed when the same doses of DDP were given simultaneously with P.HCl. Since DDP nephrotoxicity is known to be reduced when the drug is diluted in 0.9% NaCl solution, we compared the combinations DDP-P.HCl in water, and DDP and DDP-P.HCl in 0.9% NaCl solution. The antitumor activity of DDP diluted in water and administered with P.HCl was similar to that observed in mice treated with DDP alone diluted in 0.9% NaCl solution. However, further improvement of the therapeutic index was achieved after the administration of DDP-P.HCl diluted in 0.9% NaCl solution; this regimen produced a cure rate of 67% (12 of 18 animals). The clinical relevance of these findings is strengthened by the observation that similar results were obtained when P.HCl was given by the intravenous route.

[Inhibition of the adhesiveness and proliferation of gingival fibroblasts induced by short-chain fatty acids produced by anaerobic bacteria]

Short-chain fatty acids produced by anaerobic bacteria inhibit attachment and proliferation of gingival fibroblasts. Butyric acid, at concentration normally present in periodontal pockets, produced the highest degree of activity.

Class II antigen expression on human cultured Schwann cells from patients with Charcot-Marie-Tooth disease

T lymphocytes control the extent of the immune reaction by recognizing the antigen in connection with class II histocompatibility surface molecules, coded by genes located on the HLA-D locus. The expression of HLA-DR antigens is confined to a few antigen presenting cells, like lymphocytes and macrophages, which can therefore induce the initial phase of the immune reaction. We report that also Schwann cells (SC) from patients with Charcot-Marie-Tooth disease (CMT), an hereditary disorder of the peripheral nervous system, are able to express HLA-DR antigens. Human SC cultures were carried out from sural nerve biopsies of CMT and normal control cases. Cultures were tested on day 7, 14, 21 and 28, with double immunofluorescence technique using rabbit antiserum anti-S-100 and mouse anti-HLA-DR monoclonal antibody. SC from CMT were HLA-DR positive since the first few days, continuing to express class II antigens for all the duration of the culture. The presence of class II antigens on cultured SC from CMT disease suggests that immune-mediated mechanisms may be relevant in the pathogenesis of this degenerative disorder of the peripheral nervous system.

[The culturing of human Schwann cells: a new contribution to the study of polyneuropathy]

We have established 44 Schwann cell cultures from human peripheral nerves that underwent biopsy for diagnostic purposes using a new "sandwich" connective tissue and cut into 1 mm cubic explants which were placed between two glass coverslips coated with D-poly-L-lysine, in HAM-F10 medium, 15% FCS, 600 mg/dl glucose and antibiotics. In the first 3 weeks this new sandwich technique yields a fairly great and homogeneous amount of Schwann cell growth, with only a few fibroblasts and virtually no macrophages and provides a suitable substrate on which immuno cytochemical studies could be performed.

[Hereditary sensory motor neuropathy: degenerative disease or a disease with an immune-mediated pathogenesis?]

The clinical data proving that some hereditary motor-sensory neuropathies (HMSN type 1) are steroid sensitive may indicate inflammatory or immunomediated mechanisms as cofactors contributing to the clinical course of these disorders. The finding of HLA-DR positivity of Schwann cells in HMSN type I along with the presence in some cases of inflammatory infiltrates in nerve sections provides further evidence for this hypothesis.

HLA-DR Schwann cell reactivity in peripheral neuropathies of different origins

HLA-DR antigens have been found on Schwann cells in peripheral neuropathies of different origins but not in normal control cases. Class II antigen reactivity was more intense in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and hereditary motor and sensory neuropathy type 1 (HMSN), but was also observed in toxic or metabolic neuropathies. The expression of HLA-DR antigen on Schwann cells does not appear to be related to the inflammatory or autoimmune origin of the disease.

Coculture of human keratinocytes and melanocytes: differentiated melanocytes are physiologically organized in the basal layer of the cultured epithelium

Human epidermal keratinocytes differentiate in vitro into a stratified epithelium suitable for grafting on burned patients. In this paper, we show that differentiated melanocytes are present in the cultured epithelium. In particular, we have found that i) melanocytes proliferate in the same culture conditions that allow keratinocyte growth, ii) during the culture the ratio between keratinocytes and melanocytes tends to remain constant, iii) melanocytes organize into the basal layer of the cultured epithelium independently of the presence of dermis, develop dendritic arborizations with melanosome-containing processes and transfer melanosomes into keratinocyte cytoplasm.

In vitro production of different interferon types by cloned human NK cells

Human peripheral blood null cells were conjugated in vitro with K-562 cells and expanded into continuous cell lines using IL-2 containing medium (CM) and periodical restimulation with phytohaemagglutinin (PHA). Most of these lines were made up of granular blasts expressing high natural killer (NK) activity. When analysed for different surface markers, the large majority of the blasts were E rosette+, T3+, Tac+, DR+, Leu7+ with a variable proportion of cells expressing T8 and M1 antigens (range: 20-80%). In contrast, T4 antigen was expressed by the majority of cells of the control cell lines originated in the absence of K-562 cells. Twenty-nine clones were obtained from one of the above lines using the limiting dilution technique and subsequently maintained in CM for 4 months or more. The majority of these clones maintained their cytotoxic potential and were able to produce different interferon (IFN) types (IFN-alpha, IFN-gamma or both) when growing in CM. In addition in a number of selected clones, simultaneous stimulation with PHA and K-562 cells was able to induce or support the production of both IFN types.

Granule formation in large granular lymphocytes (LGL). Ultrastructural and cytochemical studies on cells from patients with abnormally expanded lgl populations

The peripheral blood mononuclear cells from five patients with abnormally expanded populations of large granular lymphocytes (LGL) of possible malignant origin have been studied by electron microscopy. These cells had fewer granules than normal circulating LGL but displayed a variety of organelles possibly involved in the process of granule formation. This process apparently originated from the fusion of vesicles that had a characteristic cup-shape (and appeared to be derived from the Golgi apparatus) with smaller vesicles, mostly of the coated type. This fusion resulted in the formation of multivesicular bodies (MVB) whose limiting membrane was constituted by that of the cup-shaped vesicle. MVB gradually matured into electron-dense granules. A number of cup-shaped vesicles were found positive for the cytochemical localization of thiamine pyrophosphatase (TPP) activity that is a specific marker of the trans aspect of the Golgi apparatus, a finding which confirmed that they were Golgi-derived. The smaller, mostly coated, vesicles were positive for acid phosphatase (AP) and evidence was obtained indicating that they subserved the function of transporting acid hydrolases from the rough endoplasmic reticulum to the cup-shaped vesicles or to the MVB. The plasma membrane did not appear to contribute to MVB or granule formation since endocytic vacuoles induced by reacting the cell surface with the appropriate monoclonal antibodies (followed by peroxidase labelled anti-immunoglobulin) were never seen while fusing with granules or MVB. Rather, these vesicles formed secondary lysosomes after having encountered smooth or, more rarely, coated vesicles. Granulogenesis in LGL, therefore, resembles the process of granule formation observed in secretory cells. The active process of granulogenesis detected in the patient cells and a number of other findings indicate that they were LGL at early stages of maturation. The surface phenotype consistently found in these cells (OKT3+, Leu 1+, OKT8+, Leu 2a+, OKT11+, Leu 5+ and OKM1) is different from that of the majority of the normal LGL and may correspond to that of immature LGL.

Complement receptor distinguishes between two subsets of large granular lymphocytes with different natural killer activity and cytochemical and ultrastructural features

Human peripheral blood large granular lymphocytes (LGL)--that is, cells with intracytoplasmic azurophilic (electron-dense) granules, with a positivity for the cytochemical localization of certain acid hydrolases, and with avid surface receptors for the Fc portion of IgG--have been purified on Percoll density gradients. Approximately 30% of these cells expressed receptors for the third complement component (C3R). They were separated into C3R-positive and C3R-negative cells. C3R+ cells had a significantly greater natural killer (NK) activity against K562 target cells than C3R+ cells. This difference was unrelated to the presence in the C3R+ cells of a contaminant cell type incapable of NK activity, since cytochemical and ultrastructural analysis revealed that C3R+ and C3R- fractions contained comparable LGL numbers. Agarose cytotoxicity assays at the single-cell level demonstrated that C3R+ LGL contained a large number of cells that bound to but did not lyse the target. The remaining fully cytotoxic C3R+ LGL had, however, the same killing and recycling properties as the cells from the C3R fraction. Electron microscopy and cytochemical studies showed that C3R+ cells had fewer electron-dense granules than C3R cells and stained more faintly for the localization of alpha-naphtyl acetate esterase. In contrast to C3R cells, C3R+ LGL displayed morphological features suggesting that an active process of granule formation was taking place. Taken together, the data indicate that C3R+ cells represent a discrete subset or a maturational stage of LGL.

Differentiation of chronic lymphocytic leukemia cells: correlation between the synthesis and secretion of immunoglobulins and the ultrastructure of the malignant cells

The capacity of synthesizing and secreting Ig molecules was studied in 11 patients with B-cell chronic lymphocytic leukemia (B-CLL) whose cells expressed surface IgM, in 3 patients with surface IgG-bearing cells, and in 2 IgM prolymphocytic leukemias (IgM-PLL). Three types of mu chains were detected by SDS-polyacrylamide gel electrophoresis analysis of the endogenously labeled molecules isolated by specific immunoprecipitation. Two of them were isolated from the cell lysates and were identified as the membrane mu chain and the precursor of the secreted molecules, respectively. The latter also possibly contained precursors of the membrane molecules. The third type of molecule was detected only in the culture medium and was identified as secretory mu chain. Not all of the malignant clones possessed the three types of mu chains. Only 7/13 of the IgM-bearing malignant cell clones were capable of secretion, whereas the remaining synthesized the secretory mu chains but degraded them intracellularly. Two types of molecules (membrane and secreted) were found in the IgG-bearing CLL cells from three patients. In all of them, secretion was detected. Ultrastructural analysis demonstrated that cells from the secreting clones had the features of more mature lymphocytes than the cells from nonsecreting clones. These features were represented by a developed Golgi apparatus, various types of vesicles (smooth and coated), and strands of the rough endoplasmic reticulum. A certain heterogeneity of the degree of maturation of the cells was observed within these clones. The data are consistent with the hypothesis that CLL clones are heterogeneous and can be distinguished through the different degrees of maturation of their cell components.

Ultrastructural characteristics of human T cell clones with various cytolytic activities

Fifteen T cell clones with different (specific, antibody-dependent or natural killer-like) cytolytic activity were derived from mixed lymphocyte culture activated T cells and analyzed for their morphological characteristics and, in some instances, for their surface markers. All of the five cytolytic clones analyzed by electron microscopy possessed numerous electron-dense granules and in some instances multivesicular bodies, with or without an electron-dense matrix, that are the putative precursors of the granules. In addition, light microscopy examination of semithin sections of other ten cytolytic clones showed that the large majority of the cells in each clone had numerous toluidine blue-stained cytoplasmic granules. It is of note that nine clones without detectable cytolytic activity analyzed by electron microscopy did not possess granules and presented the features of large agranular blasts. Ten cytolytic clones were analyzed for different surface markers including rosette formation with sheep erythrocytes (E rosettes), receptors for the Fc portion of IgG or IgM ((Fc gamma R and Fc mu R) and a group of antigens recognized by monoclonal antibodies including Ia, 4F2, OKT8 or OKT4. All the clones were E-rosette+, Ia+ and 4F2+. Expression of Fc gamma R was restricted to the clones active in antibody-dependent cell-mediated cytotoxicity. Expression of OKT8 and OKT4 antigens was variable; in particular, five clones were OKT8+/OKT4-, whereas the other five expressed the OKT8-/OKT4+ phenotype. It is noteworthy that the ultrastructural features of cytolytic T cell clones are similar to those of large granular lymphocytes, known to be the only lymphoid cells in normal peripheral blood which possess cytolytic activity. Thus, it is possible that the presence of electron-dense granules may represent a morphological marker for all human cytolytic lymphocytes.

Expression of a receptor for sheep erythrocytes by B lymphocytes from a chronic lymphocytic leukemia patient

A patient with a B-cell chronic lymphocytic leukemia, whose lymphocytes also formed rosettes with sheep red cells, is described. The B-cell nature of the malignant lymphocytes was determined by surface marker analysis, and cytochemical and ultrastructural studies. The lymphocyte membrane immunoglobulin (IgG1K) did not have anti-sheep red cell activity and was not responsible for the binding of sheep erythrocytes to the leukemic cells as shown by (i) the failure to inhibit rosette formation with anti-immunoglobulin reagents and (ii) the different sensitivity to proteolysis of the membrane immunoglobulin and the sheep erythrocyte receptor. The malignant lymphocytes expressed a receptor for sheep erythrocytes similar to that of normal T cells since they stained with monoclonal antibodies directed against the sheep red cell receptors. Furthermore these antibodies blocked rosette formation. Endogenous labeling experiments demonstrated that the patient's cells produced IgG both of the membrane and of the secretory type. The latter molecular form was also actively secreted. Ultrastructural studies demonstrated that the malignant clone comprised cells at different maturational stages and with different secretory properties. These findings were confirmed by the analysis of intracytoplasmic acid hydrolases, which are normally expressed at late maturational stages. These data are consistent with the hypothesis that a process of maturation was occurring within the malignant clone.

Acid hydrolases as markers of maturation in B-cell chronic lymphocytic leukemia

Malignant lymphocytes from 30 B-cell chronic lymphocytic leukemia (B-CLL) patients were studied for the cytochemical localization of two acid hydrolases, alpha-naphthyl acetate esterase (ANAE) and acid phosphatase (AT). The large majority of the cells stained for both ANAE and AP in 7 cases, for AP only in 18 cases, and were negative for both the enzymes in 5 cases. Ultrastructural analysis revealed that the cells that displayed more mature morphological features, such as well developed smooth and rough membrane compartments, were those positive for acid hydrolases. That ANAE and AP are expressed by B cells at late stage of maturation was confirmed by the finding that some lymphocytes and all of the plasmacytoid lymphocytes and plasma cells from Walderström's macroglobulinemia, from mixed cryoglobulinemia, and from multiple myeloma patients stained strongly for both ANAE and AP. Using the expression of acid hydrolases and certain ultrastructural features as markers of cell differentiation, it was possible to demonstrate a process of maturation within the single B-CLL clones with accumulation of the cells at stages that differed in the various cases.

Receptors for the third complement component on a proportion of large granular lymphocytes from human peripheral blood

Large granular lymphocytes (LGL) are nonadherent cells with cytoplasmic azurophilic granules, avid receptors for the Fc portion of IgG, and a paranuclear localization of alpha-naphthyl acid esterase or acid phosphatase. LGL constitute the bulk of TG cells (cells with receptors for sheep erythrocytes and for IgG molecules) and null cells (non-T, non-B cells). In the present study we demonstrate that 20-33% of the circulating human LGL express receptors for the third complement component (C3R). When TG cell or null cell fractions from normal individuals or non-T cells from a patient with infantile agammaglobulinaemia (which contained almost exclusively LGL) were rosetted with erythrocytes coated with antibody and complement, a variable number of C3R-bearing cells were detected. Such cells were isolated and analysed further; the great majority of them displayed the cytochemical and ultrastructural features of LGL.

Large granular lymphocytes in human peripheral blood: ultrastructural and cytochemical characterization of the granules

Large granular lymphocytes (LGL) are defined as nonadherent mononuclear cells with cytoplasmic azurophilic granules, avid receptors for the Fc portion of IgG, and cytotoxic functions (NK or ADCC activities). In the present study, the granules of LGL isolated from human peripheral blood have been analyzed by enzyme cytochemistry and electron microscopy. It had been found that: (1) in the single cells, granules at different stages of maturation could be detected: in addition, packaging of the granules took place in the proximity of the Golgi apparatus, which is similar to that seen in secretory cell types. (2) Acid phosphatase (AP) was observed within the granules and the vesicles located in the Golgi area: the Golgi apparatus identified through its thiamine pyrophosphatase-positivity was consistently negative for AP. (3) Alpha naphthyl-acetate esterase (ANAE) activity was localized in the granules as well as on the membrane of LGL and monocytes. (4) The ANAE activity of LGL was of the monocytic and not of the lymphocytic type, as shown by NaF inhibition. (5) The LGL granules, although identifiable as primary lysosomes, were not involved in the process of phagocytosis, since LGL failed consistently to ingest latex particles or opsonized red cells.

Immunofluorescent and ultrastructural analysis of plasma cell degeneration in the chicken Harder's gland

In this study we describe some aspects of plasma cell degeneration in the chicken Harder's gland. The immunofluorescent patterns of cytoplasmic immunoglobulin (cIg) localization have been studied in relation to the ultrastructure of maturing and degenerating B cells. It appears that Russell body formation through the accumulation of Ig within the cisternae of the rough endoplasmic (RER) does not represent the only mechanism for the formation of cytoplasmic vacuoles. Mitochondrial swelling and disruption or dilation of Golgi cisternae, often preceding alterations of the RER, may be the origin of some vacuoles. It also appears that, in the Harder's gland, degeneration may occur not only in mature plasma cells but also in maturing B cells at a stage when only clusters of polyribosomes are found in the cytoplasm and no RER is yet developed. These observations are relevant to some immunofluorescence and ultrastructural patterns observed in human B-cell pathology.

Ultrastructural localization of alpha-naphthyl acid esterase in human TM lymphocytes

The localization of alpha-naphthyl acid esterase (ANAE) activity in T lymphocytes with receptors for IgM (T(M) cells) have been studied at the electron microscope. The electron-opaque product of the cytochemical reaction was detected around, but never inside, single (or groups of) vesicles, which suggested a possible membrane localization of the enzyme activity. These same vesicles were found to contain acid phosphatase by both light- and electron-microscopic examination and were bound by unit membranes; this data indicates that they likely represent primary lysosomes. The presence of such lysosomes in a restricted paranuclear area is a distinctive feature of T(M) cells.