Is copper hepatotoxic in primary biliary cirrhosis?

In primary biliary cirrhosis (PBC) liver copper retention occurs as a complication of cholestasis. By analogy with Wilson's disease, it has been suggested that copper retention is hepatotoxic in PBC, and this has been the rationale for the use of D-penicillamine in this disease. The hypothesis that copper is hepatotoxic in PBC has not been tested and in this study we have evaluated the role of liver copper retention in the pathogenesis of PBC. Sixty-four patients with PBC have been studied. Fifty-four had increased liver copper concentrations. Liver cell synthetic function was well preserved. All the patients had normal prothrombin times, and only two had subnormal serum albumin concentrations. There was no correlation between liver copper concentrations and the degree of liver cell damage assessed biochemically (aspartate transaminase), and histologically. Electron microscopy was performed on liver biopsies from five patients with markedly increased liver copper concentrations. The liver cell ultrastructure was compatible with cholestasis. Liver cells contained electron dense lysosomes, which were shown to contain copper and sulphur by x-ray probe microanalysis. The characteristic organelle changes associated with copper toxicity in Wilson's disease were not observed. The biochemical, histological, and histochemical differences between PBC complicated by liver copper retention, and Wilson's disease, indicates that there are differences in the handling of copper in these disease. In this study we could find no evidence to suggest that copper plays an important role in the pathogenesis of liver dysfunction in PBC.

Short incubation non-A, non-B hepatitis transmitted by factor VIII concentrates in patients with congenital coagulation disorders.

Ten cases are reported of short incubation (one to four weeks) non-A, non-B hepatitis occurring after infusion of various preparations of factor VIII concentrates into patients with coagulation disorders. Five patients were symptomatic and, in all, serum transaminase levels were increased for at least six months. These cases of chronic hepatitis exhibited none of the features of autoimmune chronic hepatitis: autoantibodies were negative and serum immunoglobulins were normal. Hepatic histology confirmed acute hepatitis in two cases biopsied early in the illness, and chronic active hepatitis (three) of chronic persistent hepatitis (two) in five cases studied later. Lobular inflammation was a prominent feature in all cases. Other features not commonly associated with type A or B hepatitis included fatty change and damaged bile ducts.

Studies on the rat liver following iron overload.

Sprague-Dawley rats were given Jectofer injections to obtain iron overload in rat liver Kupffer and parenchymal cells. The release of iron was studied on the light and electron microscopical level by bleeding of the iron loaded animals and comparing the results with non bled controls. During the mobilization of iron. Kupffer cells showed a rapid and almost complete disappearance of electron dense iron containing particles (IP) while there was only limited decline of IPs in the parenchymal cells. Iron was demonstrated with X-ray microanalysis at the ultrastructural level, and presence of acid phosphatase was revealed using a histochemical method based on precipitation of lead phosphate at sites of enzyme activity in combination with X-ray microanalysis. It was demonstrated that all IP-containing cytoplasmic bodies also showed presence of acid phosphatase implying that all of them represented lysosomes. The mechanism of release of iron from Kupffer and parenchymal cells was discussed with special emphasis on the role of the lysosomes and the relationship between their contents and other cellular structures.

Oxyphilic granular hepatocytes. Mitochondrion-rich liver cells in hepatic disease.

In the course of examining liver biopsy specimens, certain larger than normal liver cells whose cytoplasm is finely granular and strikingly acidophilic have been seen. These cells are called "oxyphilic granular hepatocytes" (oxyphils) because of their similarities to the "oncocytes" of the salivary glands and other endocrine organs. Oxyphilic liver cells can be readily differentiated from acidophilic bodies and groundglass hepatocytes by light and electron microscpy, the latter showing them to be extraordinarily rich in mitochondria. A retrospective study of 214 consecutive liver biopsies was undertaken to determine the prevalence of oxyphilic cells in a variety of liver diseases. Oxyphils were identified in 15% of the biopsy specimens, and were most strongly associated with chronic active hepatitis and cirrhosis in hepatitis B surface antigen (HBsAg)-positive patients. Subsequent reevaluation of 77 biopsy specimens from HBsAg-positive patients showed oxyphils in 28.6%. Their pathogenesis and significance in chronic liver disease are unknown.

Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology.

Twenty-nine patients with primary sclerosing cholangitis were reviewed. Males predominated (2:1). Seventy-six per cent presented with cholestasis and cholangitis, 17% with cirrhosis and portal hypertension, and 7% were asymptomatic, presenting with a raised serum alkaline phosphatase. The serum immunoglobulin IgM concentration was raised in 45% of the patients, but no patient had serum mitochondrial antibody present. Seventy-two per cent had ulcerative proctocolitis. There was no relationship between either duration or severity of ulcerative proctocolitis and the development of primary sclerosing cholangitis. Four patients were not benefited by colectomy. None of the patients ahd Crohn's disease. The prognosis was variable. Corticosteriods and azathioprine were ineffective. Eleven patients (38%) had died with a mean survival time of seven years from diagnosis. Three patients with ulcerative proctocolitis developed bile duct carcinoma. The cholangiograms and liver biopsies were reported without reference to clinical information together with 41 patients with other biliary diseases. Cholangiography was diagnostic in 18/22 (82%). Hepatic histology was diagnostic in 8/22 (36%). Ten showed features of large bile duct disease and three were misdiagnosed as primary biliary cirrhosis. Reduced numbers of bile ducts, ductular proliferation, portal inflammation, and substantial copper deposition, in combination with piecemeal necrosis, are commonly seen in primary sclerosing cholangitis and indicate the need for cholangiography.

Hepatitis B surface antigen and alpha-fetoprotein secreting human primary liver cell cancer in athymic mice.

A human primary liver cancer cell line which retains the property of synthesizing hepatitis B surface antigen has been successfully transplanted into nude (athymic) mice. The morphology of the heterotransplanted tumor is similar to that of a well-differentiated human primary liver cell cancer. It produces hepatitis B surface antigen, but there is no evidence of hepatitis B virion production: Hepatitis B core antigen is not detected in the PLC tissue, and serum is negative for hepatitis B e antigen. The nude mouse exhibits a resistance to the transplantation of the human primary liver cancer cells which can be modified by sublethal total body irradiation, suggesting involvement of an immunologic rejection mechanism. The heterotransplanted primary liver cell cancer also produces alpha-fetoprotein, as did the original tumor in vivo, although this marker was not detected during in vitro cell culture. The serum level of alpha-fetoprotein rises exponentially, enabling quantitative evaluation of tumor growth. The human primary liver cell cancer in nude mice provides an in vivo model for determination of tumor response to chemotherapeutic agents.

Tissue immune complexes demonstrated in the liver of patients with chronic aggressive hepatitis using FITC-labelled human Clq.

Immune complexes in liver specimens from 10 patients with chronic liver diseases [2 with chronic persistent hepatitis (CPH), 3 with chronic aggressive hepatitis (CAH) of moderate activity, 3 with CAH of severe activity, and 2 with liver cirrhosis] were examined by a technique of direct immunofluorescence using FITC-labelled human purified Clq (FITC-Clq). FITC-Clq bound to the nuclei of all cells in liver tissue. After DNase treatment, positive nuclei were absent, but positive staining with FITC-Clq remained in amorphous deposits and hepatic cell membranes in the areas of piecemeal necrosis of four CAH patients. Since FITC-Clq could not be demonstrated in the liver tissue of CPH and liver cirrhosis which contained no piecemeal necrosis, positive fluorescence in the liver of CAH patients was thought to indicate immune complexes bound to FITC-Clq. The fact that these positive substances, however, were few in number, may be the result of physiological mechanisms of immune clearance which rapidly eliminate immune complexes from the body.

Urinary bile acid excretion in correlation to liver histopathology in cystic fibrosis.

Urinary bile acid excretion and liver morphology were compared in 25 patients with cystic fibrosis (CF). None showed clinical signs of liver disease. Most of the patients had normal liver function tests. Bile acids were determined in 24-h samples by a modification of the method of Almé. All patients had increased urinary excretion of trihydroxy bile acids, mainly cholic, 3 beta, 7 beta, 12 alpha- and 3 alpha, 7 beta, 12 alpha-trihydroxy-5 beta-cholanoic acids. Lithocholic acid excretion was lower in CF than in normal children. The urinary excretion of 3 beta-hydroxy-5-cholenoic acid was not increased in CF. In three patients with cirrhosis the urinary excretion of chenodeoxycholic acid was increased. The ratio of cholic to 3 beta-hydroxy-5-cholenoic acids was increased in all but three patients, and the ratio of chenodeoxycholic to 3 beta-hydroxy-5-cholenoic acids was increased in those with cirrhosis. These ratios differed more between cirrhotic and non-cirrhotic CF patients in this series than the ratio of cholic to chenodeoxycholic acids.

Studies on the rat liver following iron overload. Electron probe x-ray microanalysis of acid phosphatase and iron.

Previous electron-microscopic studies on the liver have shown that following excessive administration of iron to experimental animals, small particles believed to represent ferritin and/or hemosiderin (electron-dense iron-containing particles [IPs]) accumulate in membrane-bound bodies--many with a lysosome-like structure--in liver parenchymal and Kupffer cells. Further identification of the IP-containing bodies has been facilitated by the application of histochemical techniques for the demonstration of acid phosphatase. The results have shown that reaction product was deposited over organelles similar in appearance to the IP-containing ones, indicating that they were lysosomes. However, the granular nature of the reaction product makes it difficult or impossible to decide whether IPs are present simultaneously with reaction product in the organelle. In order to clarify this qualitative aspect, x-ray microanalysis has been utilized to identify iron and lead (reaction product) in the various structures thought to represent lysosomes. The results indicate that all IP-containing bodies also show the presence of reaction product, and thus can be regarded as lysosomes. However, in the parenchymal cells there may exist a small population of iron-deficient lysosomes (only lead could be shown). The latter may correspond to "primary lysosomes."

Giant cell tumor of bone. Variations in patterns of appearance of different cell types.

Eleven benign giant cell tumors of bone were studied in the electron microscope, and the fine structural localization of acid phosphatase was elucidated. Three distinct cell types are always present in these tumors: stromal cells type 1; stromal cells type 2; and multinucleated giant cells. Small mononuclear cells may also occur, but are not likely to be actively participating in the neoplastic process. The range of variability in the fine structure of the different cell types constituting this tumor has been established. Variations in appearances include: a) presence of nuclear pseudoinclusions in stromal cells type 1 and multinucleated giant cells; b) aberrations in the structure of the rough surfaced endoplasmic reticulum in the same cell types; c) occurrence of ruffled borders, ectoplasmic layers and cytoplasmic labyrinths containing acid phosphatase in the giant cells. Some giant cells show evidence of marked phagocytic activity and contain large and numerous residual bodies carrying acid phosphatase. The significance of the interrelations between the different cell types are discussed and the possible role of stromal cells type 2 in immunological mechanisms directed against the tumor cells are mentioned.

Malignant giant cell tumor of bone. Fine structure and localization of acid phosphatase.

The fine structure of the different cell types constituting a primary malignant giant cell tumor of bone has been studied and the localization of acid phosphatase in relation to the subcellular organelles been demonstrated. Three distinct cell types with characteristic ultrastructural features were observed: giant cells, fibroblast-like cells, and cells with abundant lipid inclusions and mitochondria. Certain differences were noted between these three cell types and their counterparts in benign giant cell tumors of bone (described in a separate report). The enzyme histochemical and morphological data suggested that the giant cells in the malignant tumor might possess a more active and expansive lysosomal apparatus than corresponding cells in the benign variant.

Giant cell tumor of bone. Fine structural localization of alkaline phosphatase.

The fine structural localization of nonspecific alkaline phosphatase was elucidated in two giant cell tumors of bone using lead as capturing ion and beta-glycerophosphate as substrate in the incubation solution. Lead phosphate precipitate--indicating presence of alkaline phosphatase--was demonstrated on the plasma membranes, and the membranes bordering vesicles and vacuoles of presumed endocytotic nature, in giant cells and type 1 stromal cells (fibroblast-like cells). The findings support the view that stromal cells type I and giant cells are histogenetically related.

Studies on the fine structure of osteoblastoma with notes on the localization of nonspecific acid and alkaline phosphatase.

Electron microscopy of two osteoblastomas revealed the existence of three distinct types of cells in this tumor: osteoblast like, macrophage like, and multinucleated giant cells. In addition to the lysosomes, most Golgi cisternae and vesicles in the osteoblast like cells showed evidence of acid phosphatase activity. Deposits of lead phosphate indicating the site of this enzyme in the macrophage like cells were confined to the large and abundant lysosomes. Wide spread deposition of final product was noted in the cytoplasm of the multinucleated giant cells, both in conventional lysosomes, Golgi regions and special organelles probably corresponding to GERL. With regard to nonspecific alkaline phosphatase, final product indicating the location of enzyme activity was confined to the plasma membranes and associated vesicular and vacuolar structures in the osteoblast like cells. The findings suggest that the giant cells in osteoblastomas participate in lytic bone destructive and resorptive processes while osteoblast like cells appear to be osteoid and bone forming carriers of the neoplastic properties of the tumor.

Contribution to the knowledge of the fine structure of chondrosarcoma of bone. With a note on the localization of alkaline phosphatase and "ATPase".

Seven well differentiated chondrosarcomas of bone have been analyzed by electron microscopy, and the fine structural localization of adenosine triphosphatase and nonspecific alkaline phosphatase has been elucidated. On the basis of the fine structural appearance, two distinct cell types were shown to constitute the tumor tissue: chondrocyte-like cells and large "mitochondria-rich cells". Large, multinucleated cells in the tumor did not seem to correspond to osteoclasts but rather were likely to represent true neoplastic cells. Some chondrocyte-like cells appeared to be binucleated by virtue of deep, groove-like nuclear indentations. Adenosine triphosphatase and alkaline phosphatase were associated with the plasma membrane of both chondrocyte-like and mitochondria-rich cells suggesting that they might be of common origin. Normal chondroblasts and chondrocytes lack histochemically demonstrable adenosine triphosphatase on their plasma membrane. Presence of this enzyme in the tumor cells may indicate that they are histogenetically related to immature non-chondroid matrix forming cells (known to carry the enzymes).

Studies on the rat liver following iron overload. 1. Fine structural appearance.

Iron overload of the rat liver following parenteral administration of Jectofer (an iron sorbitol citric acid complex) was studied in the electron microscope. Abundant ferritin-like granules were present in parenchymal and Kupffer cells, partly free in the cell sap and partly concentrated in 3 types of membrane-bound organelles, with characteristic appearances. In the parenchymal cells these organelles consisted of lysosome-like structures, apparent autophagic vacuoles, and vacuoles lacking features linking them to specific cytoplasmic elements. Organelle-bound ferritinlike granules in the Kupffer cells were demonstrated in lysosomelike structures, in phagocytic vacuoles, and in tubular and vacuolar elements referred to as "type 1" and "type 2" bodies. No ferritin-like granules were observed in other cell types than parenchymal and Kupffer cells.

Giant cell tumor of bone: fine structural localization of acid phosphatase.

The fine structural localization of acid phosphatase in the different cells in a benign giant cell tumor of bone has been studied. Stromal cells type 1 and 2 (fibroblast-like and macrophage-like, respectively) showed the presence of lead phosphate precipitate following incubation in a Gomori-type lead salt medium only in conventional lysosomes. In the multinucleated giant cells, the final product was deposited over lysosome-like organelles, and also over Golgi cisternae, vesicles, and vacuoles. Furthermore, evidence for presence of acid phosphatase was obtained in smooth-surfaced tubular, sausage-, horse-shoe-, and ring-shaped structures and over digestive vacuoles of autophagic or heterophagic origin. Finally, in these cells, many of the tubular and vacuolar elements located subjacent to areas of the plasma membrane with microvillous specializations (abortive brush borders?) were shown to carry acid phosphatase.

A comparison of the effects of three widely used glutaraldehyde fixatives on cellular volume and structure. A TEM, SEM, Volumetric and Cytochemical Study.

The effects of three widely used glutaraldehyde-based fixatives on cellular volume and structure have been studied utilizing TEM, SEM, time-lapse micrography during the fixation procedure, volumetry and demonstration of the lysosomal enzyme acid phosphatase. The cells used were in vitro cultivated human glia and glioma cells and suspensions of isolated rat liver parenchymal cells. The fixatives compared were the following: 2 per cent glutaraldehyde (GA) in 0.1 M Na-cacodylate-HCL buffer (cac) with 0.1 M sucrose (pH 7.2); total osmolality (T) 510 mOsmol; vehicle osmolality (V) 300 mOsm, 2 per cent GA in 0.1 M cac (pH 7.2; T = 410 mOsmol; V = 200 mOsmol) and 1.5 per cent GA in 0.067 M cac with 0.033 M sucrose (pH 7.2; T = 320 mOsmol; V = 170 mOsmol). It was found that the fixative with a vehicle osmolality of 300 mOsmol gave results which were interpreted as ideal while the two fixatives were hypotonic vehicles resulted in changes which were easily demonstrated during volumetry, time-lapse micrography, SEM and cytochemistry. However, the differences observed in the TEM were less obvious and difficult to interpret, the major alternations being changes in the configuration of the ER in the liver cells. In conclusion, our findings show that even small variations in the composition of a glutaraldehyde fixative can result in structural changes which do not correspond to the functional morphology of a living cell. Such changes make correct interpretation of micrographs difficult.