Some, but not all, glycine substitution mutations in COL7A1 result in intracellular accumulation of collagen VII, loss of anchoring fibrils, and skin blistering.

COL7A1 gene mutations cause dystrophic epidermolysis bullosa, a skin blistering disorder. The phenotypes result from defects of collagen VII, the major component of the anchoring fibrils at the dermo-epidermal junction; however, the molecular mechanisms underlying the phenotypes remain elusive. We investigated naturally occurring COL7A1 mutations and showed that some, but not all, glycine substitutions in collagen VII interfered with biosynthesis of the protein in a dominant-negative manner. Three point mutations in exon 73 caused glycine substitutions G2006D, G2034R, and G2015E in the triple helical domain of collagen VII and interfered with its folding and secretion. Confocal laser scanning studies and semiquantitative immunoblotting determined that dystrophic epidermolysis bullosa keratinocytes retained up to 2.5-fold more procollagen VII within the rough endoplasmic reticulum than controls. Limited proteolytic digestions of mutant procollagen VII produced aberrant fragments and revealed reduced stability of the triple helix. In contrast, the glycine substitution G1519D in another segment of the triple helix affected neither procollagen VII secretion nor anchoring fibril function and remained phenotypically silent. These data demonstrate that collagen VII presents a remarkable exception among collagens in that not all glycine substitutions within the triple helix exert dominant-negative interference and that the biological consequences of the substitutions probably depend on their position within the triple helix.

Expression of functional high affinity immunoglobulin E receptors (Fc epsilon RI) on monocytes of atopic individuals.

Suggestive evidence indicates that immunoglobulin E (IgE)-dependent activation of mononuclear phagocytes plays an important pathogenic role in allergic tissue inflammation. Prevailing opinion holds that low affinity IgE receptors are the relevant IgE-binding structures on monocytes/macrophages and that functional events occurring after cross-linking of membrane-bound IgE on these cells are mediated by these receptors. Here we demonstrate that peripheral blood monocytes can bind monomeric IgE via the high affinity IgE receptor (Fc epsilon RI) and that Fc epsilon RI expression on these cells is upregulated in atopic persons. Further, we demonstrate that, upon monocyte adherence to substrate, bridging of monocyte Fc epsilon RI is followed by cell activation. We propose that direct interaction of multivalent allergen with Fc epsilon RI(+)-bound IgE on mononuclear phagocytes results in cell signaling via Fc epsilon RI and that the biological consequences of this event may critically influence the outcome of allergic reactions.

T-cell receptor diversity in dendritic epidermal T cells in the rat.

The rat epidermis contains a population of dendritic CD3+ cells. For a better characterization of these cells and to investigate their relationship to epidermal lymphocytes of other species, we stained rat epidermal sheets using a variety of monoclonal antibodies against rat leukocyte differentiation antigens in an indirect immunofluorescence procedure. Additionally, we attempted to define their T-cell receptor (TCR) isotype at both the nucleic acid and protein level. Results obtained showed that the majority of the CD3+ dendritic epidermal cells are CD45+, CD2+, TCR alpha beta-, major histocompatibility complex class II-, Thy-1-, asialo GM1-, CD4-, CD5-, and CD8- lymphocytes. We further observed that, in contrast to the mouse system, the rat epidermis additionally harbors a small but distinctive portion of dendritic CD3+ cells that exhibit reactivity with an anti-pan TCR alpha beta monoclonal antibody. Our further finding that rat epidermal cells enriched for CD3+ lymphocytes express full-length C delta mRNA suggests that the vast majority of rat epidermal T cells carry surface-bound TCR gamma delta moieties. On the basis of these findings, one may speculate that the indigenous T-cell population of the epidermis is not necessarily programmed to uniformly express monomorphic TCR gamma delta molecules but, to effectively fulfill its role in host defense, is capable of adaptation to the specific challenges encountered by a given species.

A review on Fc epsilon RI on human epidermal Langerhans cells.

In order to show the surface expression of Fc epsilon RI on human epidermal Langerhans cells (LC), we examined monomeric IgE binding to LC. We demonstrated that the majority of epidermal LC were able to bind monomeric IgE. IgE binding to LC could neither be prevented by preincubation of the tissue with monoclonal antibodies (mAb) against either Fc epsilon RII/CD23 or Fc gamma RII/CD32, nor by the addition of lactose, but could be entirely abrogated by preincubation with the anti-Fc epsilon RI mAb 15-1. These data show that epidermal LC express Fc epsilon RI molecules.

In vivo cytokine expression in normal and perturbed murine skin--analysis by competitive quantitative polymerase chain reaction.

Although cells from both epidermis and dermis have been shown to produce a variety of soluble mediators in vitro, it is not clear whether this reflects the in vivo situation. To study in vivo cytokine expression, whole skin as well as dispase-separated epidermis and dermis from normal adult mice were prepared and snap-frozen immediately. RNA was then extracted and analyzed both by conventional and by competitive quantitative polymerase chain reaction. Molecular analysis showed that murine skin in vivo constitutively expresses several cytokine genes at moderate (e.g., interleukin-1 alpha) or low (e.g., interleukin-6 and granulocyte-macrophage colony-stimulating factor) abundance. A striking, rapid upregulation was observed for some of these cytokines in the process of tissue separation. Of interest, the epidermal and dermal compartments exhibited different induction patterns: interleukin-1 alpha, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor-alpha expression were detected preferentially in the epidermis, whereas upregulation of interleukin-6 was found to be most prominent in the dermis. This pattern of cytokine expression was also reflected in supernatants generated from the respective single-cell suspensions. Thus, this study determines the baseline in vivo cytokine expression in the skin and the occurrence of immediate, compartment-specific alterations on perturbation. These data should contribute to our understanding of both skin homeostasis and the host-defense mechanisms initiated following injury to this organ.

Cytokine pattern of Langerhans cells isolated from murine epidermal cell cultures.

In the present study we demonstrate that supernatants of highly enriched cultured Langerhans cells (cLC) display IL-1, IL-6, granulocyte/macrophage (GM)-CSF, and TNF-alpha, but no IL-2, IL-3, IL-4, and IFN-gamma activities. We further show that IL-6, GM-CSF, and TNF-alpha bioactivities can be specifically blocked in the presence of the respective neutralizing mAb. Concerning the IL-1 bioactivity, the combined use of anti-IL-1 alpha and anti-IL-1 beta mAb was needed to completely inhibit the proliferative response of the indicator cell line D10. One of the difficulties in studying the secretory potential of LC is that even highly enriched cLC are contaminated with keratinocytes (KC), which are known to be a rich source of cytokines. To overcome this problem we compared cytokine bioactivities in supernatants of cell cultures consisting of selected cLC:cKC ratios. These cell mixing experiments revealed that cLC are the major source of the IL-6 bioactivity, whereas IL-1, GM-CSF, and TNF-alpha are predominantly generated by cKC. In order to determine whether the cytokine bioactivities measured in supernatants of epidermal cell cultures are simply caused by an increased release or by de novo synthesis, we performed molecular biologic studies. Polymerase chain reaction analysis of cLC and cKC revealed that IL-1 beta and IL-6 transcripts are virtually limited to cLC, whereas IL-1 alpha, GM-CSF, and TNF-alpha messages are preferentially exhibited by cKC. mRNA coding for IL-2, IL-3, IL-4, and IFN-gamma could neither be amplified from cLC nor from cKC. Furthermore, the quantitative comparison of cytokine transcripts in cLC vs cKC using Northern blot analysis and mRNA detection on the single cell level using in situ hybridization confirmed that cLC generate IL-6, whereas cKC synthesize IL-1 alpha and GM-CSF. Taken together our results demonstrate that cultured murine LC synthesize and secrete IL-1 beta and IL-6, cytokines known to be important accessory molecules in T cell activation.

Fc epsilon RI mediates IgE binding to human epidermal Langerhans cells.

In a recent series of experiments, we observed that epidermal Langerhans cells (LC) of healthy, non-atopic individuals have the capacity of specifically binding monomeric serum or myeloma IgE. IgE-binding to LC could neither be prevented by pre-incubation of the cryostat sections with monoclonal antibodies (MoAb) against either Fc epsilon RII/CD23 or Fc gamma RII/CD32 nor by the addition of excess amounts of lactose, but could be entirely abrogated by pre-incubation with the anti-Fc epsilon RI MoAb 15-1. A direct testing of the anti-Fc epsilon RI MoAb 15-1 and 19-1 on cryostat sections in an indirect immuno-double-labeling technique showed that, in contrast to eight different anti-Fc epsilon RII/CD23 MoAb, these MoAb react with the majority of CD1a-bearing epidermal cells. At an ultrastructural level, 15-1 immunogold-labeling in the epidermis was confined to the surface of cells exhibiting Birbeck granules. In further experiments, we were able to amplify by polymerase chain reaction (PCR) technology transcripts for the alpha, beta, and gamma chains of Fc epsilon RI from LC-enriched epidermal cells and dermal cells, but not from LC-depleted epidermal cells. Transcripts for the mast cell enzyme tryptase were exclusively found in dermal cell-derived RNA preparations, thus excluding a contamination of the LC-enriched epidermal cell preparations by dermal mast cells. Collectively, these data show that epidermal LC, but not other epidermal cells, express Fc epsilon RI molecules.

Fetal skin: a site of dendritic epidermal T cell development.

Thy-1 Ag and CD3-associated TCR-gamma (V gamma 3)/delta (V delta 1) are coexpressed on virtually all dendritic epidermal T cells (DETC) in the adult mouse. In contrast, day 16 fetal mouse skin contains small numbers of CD45+/Thy-1+/CD3- but no CD3+ cells. To see whether the CD45+/Thy-1+/CD3- fetal skin cells can qualify as DETC precursors, we transplanted day 16 fetal skin of C57BL/6 (Thy-1.2) mice onto adult B6Pl-Thy-1a (Thy-1.1) animals. At certain time points after transplantation, grafts were analyzed for the presence of Thy-1 and CD3/TCR Ag. Examination of the grafts, 4 days after transplantation, revealed the presence of few donor-type Thy-1.2+/CD3- and some Thy-1.2+/CD3+ epidermal cells of either round or dendritic configuration. At 10 weeks after transplantation, essentially all CD45+/Thy-1.2+ epidermal cells were anti-TCR V gamma 3 and anti-CD3-reactive, displayed a uniformly dendritic configuration, and, thus, represent DETC. Our assumption that CD45+/Thy-1+/CD3- cells are the only lymphocytes within day 16 fetal skin gained additional support by the observations: 1) that unfractionated as well as anti-CD45 gated single cell suspensions prepared from day 16 fetal skin were consistently devoid of anti-CD3 epsilon and anti-TCR V gamma 3-reactive cells; and 2) that stimulation of these cell suspensions with either Con A plus IL-2 or IL-2 alone regularly resulted in the outgrowth of CD45+/Thy-1+/CD3-/TCR V gamma 3- cells, but never in the appearance of CD45+/Thy-1+/CD3+/TCR V gamma 3+ cells. Our additional finding that Con A plus IL-2- or IL-2-stimulated day 16 fetal skin cells and cell lines derived therefrom contain transcripts of some (CD3 gamma, TCR C beta, TCR C gamma 1, TCR C gamma 4) but not of other (CD3 delta, CD3 epsilon, TCR C alpha, TCR C delta) genes encoding the CD3/TCR complex suggests that Thy-1+/CD3- fetal murine skin cells are of T cell lineage. We therefore propose that the fetal skin microenvironment can provide the stimuli promoting growth and maturation of CD3/TCR V gamma 3/V delta 1-expressing DETC from their CD3- precursors.

Epidermal Langerhans cells from normal human skin bind monomeric IgE via Fc epsilon RI.

Human epidermal Langerhans cells (LC) bearing IgE are found in disease states associated with hyperimmunoglobulinemia E. When studying the mechanism(s) underlying this phenomenon, immunohistology revealed that a majority of epidermal LC from normal skin of healthy individuals can specifically bind monomeric IgE. IgE binding to LC could neither be prevented by preincubation of the tissue with monoclonal antibodies (mAb) against either Fc epsilon RII/CD23 or Fc gamma RII/CD32, nor by the addition of lactose. However, binding could be entirely abrogated by preincubation with the anti-Fc epsilon RI alpha mAb 15-1, which interferes with IgE binding to Fc epsilon RI alpha gamma transfectants. These observations indicated that IgE binding to epidermal LC is mediated by Fc epsilon RI rather than by CD23, CD32, or the D-galactose-specific IgE-binding protein. This assumption gained support from our additional findings that: (a) the majority of LC exhibited distinct surface immunolabeling with the anti-Fc epsilon RI alpha mAbs 15-1 and 19-1, but not with any of eight different anti-Fc epsilon RII/CD23 mAbs; and (b) transcripts for the alpha, beta, and gamma chains of Fc epsilon RI could be amplified by polymerase chain reaction from RNA preparations of LC-enriched, but not of LC-depleted, epidermal cell suspensions. In view of the preeminent role of Fc epsilon RI crosslinking on mast cells and basophils in triggering the synthesis and release of mediators of allergic reactions, the demonstration of this receptor on epidermal LC may have important implications for our understanding of allergic reactions after epicutaneous contact with allergens.

The role of fetal epithelial tissues in the maturation/differentiation of bone marrow-derived precursors into dendritic epidermal T cells (DETC) of the mouse.

Our attempts to clarify the contribution of the thymic vs. the cutaneous microenvironment in the maturation of dendritic epidermal T cell (DETC) precursors into DETC gave diverse results. In one series of experiments, we found that i.v. injection of fetal thymocytes (containing a TCR V gamma 3-expressing subpopulation), but not of adult thymocytes (containing no TCR V gamma 3+ cells) results in the appearance of CD3/TCR V gamma 3+ dendritic epidermal cells (=DETC). In other experiments, we have obtained evidence that transplantation of day 16 fetal skin onto a Thy-1-disparate recipient results in the appearance of donor-type DETC. Our further observation that the transplanted skin contains CD45+/Thy-1+/CD3- lymphocytes, but no mature T cells, therefore implies that fetal skin can provide stimuli promoting the expression of CD3/TCR genes in immature (CD3-) DETC precursors. It remains to be seen whether both or only one of these maturational pathways are (is) followed under physiological conditions.

[Ligament reinforcement with resorbable PDS cord and early functional after-care. Results of follow-up of surgically managed cruciate ligament injuries]. / Bandverstärkung mit resorbierbarer PDS-Kordel und früh-funktionelle Nachbehandlung. Ergebnisse einer Nachuntersuchung operativ versorgter Kreuzbandverletzungen.

After operating on the injured cruciate ligaments, immediate mobilization and protection of the healing ligament are indispensible. However, no approach has yet been shown to safely provide both. Therefore, in 1984 we introduced a new technique: the repaired or reconstructed cruciate ligaments are augmented with a biodegradable material - a doubled-over PDS cord, 1.5 mm in diameter. It allows for immediate and safe mobilization. Because of its appropriate elasticity it does not cause "stress shielding." Postoperatively, the patients are mobilized on a motorized frame for 2 weeks. Subsequently, we have used a limited mobilization cast (LMC). Forty-nine out of 63 patients (78%) have now been reexamined for this follow-up study, using the score from the Hospital for Special Surgery and stress X-rays in the Lachmann, position (30 degrees flexion). The results compare favorably with a prior follow-up study of patients from our hospital without PDS augmentation and without early mobilization. The knees in the present study are more stable and have a better range of motion, particularly when the LMC was used.