Histopathologic comparison of a pulmonary autograft and pulmonary homograft in a patient 17 months after a Ross procedure: an autopsy study.

BACKGROUND AND AIM OF THE STUDY: The Ross operation has become very popular during the last decade. However little is known about the cellular behaviour of a normally functioning pulmonary autograft. METHODS: This case report deals with a 14-year-old female who died from a non-valve-related cause 17 months after a Ross-Konno operation using a cryop-reserved viable pulmonary homograft for the right outflow tract. Comparison is made between the homologous and autologous pulmonary valves by macroscopic description, histology and immunohistochemistry. RESULTS: The autograft kept its cellular population-except for the dendritic cells which have disappeared, and developed a jet lesion on the ventricular aspect of one cusp as a likely adaptation to a transvalvular gradient. The homograft was extensively devitalized, its cusps being partially covered with a fibrous sheath of recipient origin; few inflammatory cells, consisting of macrophages and rare T lymphocytes were present. CONCLUSIONS: The most puzzling observation, which needs confirmation, is the selective disappearance of the dendritic cells from the viable autograft. It is disappointing that a viable cryopreserved homograft valve has devitalized in the midterm. This phenomenon seems to result from a clinically silent immune reactions.

Effects of some nonsteroidal anti-inflammatory agents on experimental radiation pneumonitis.

Corticosteroids have previously been found to be protective against the mortality of radiation pneumonitis in mice, even when given well after lethal lung irradiation. We explored the possibility that this effect was due to their well-known anti-inflammatory actions by giving various nonsteroidal inhibitors of arachidonate metabolism to groups of mice that had received 19 Gy to the thorax (bilaterally). Treatments of four cyclooxygenase inhibitors, one lipoxygenase inhibitor, and one leukotriene receptor antagonist, given by various routes in various doses, were commenced 10 weeks after irradiation or sham irradiation and continued throughout the period when death from radiation pneumonitis occurs, 11-26 weeks after irradiation. Each of the treatments had the appropriate effect on arachidonate metabolism in the lungs as assessed by LTB4 and PGE2 levels in lung lavage fluid. The principal end point was mortality. The 5-lipoxygenase inhibitor diethylcarbamazine and the LTD4/LTE4 receptor antagonist LY 171883 markedly reduced mortality in dose-response fashion. The effects of cyclooxygenase inhibitors were divergent; piroxicam and ibuprofen were marginally protective, indomethacin in all doses accelerated mortality, and aspirin reduced mortality in a dose-response fashion. These results suggest that the protective effect of corticosteroids in radiation pneumonitis can be tentatively attributed to their anti-inflammatory actions, and that nonsteroidal anti-inflammatory agents, particularly those that affect lipoxygenase products, may offer equal or better protection than corticosteroids against mortality due to radiation pneumonitis.

Surfactant subtypes of mice: metabolic relationships and conversion in vitro.

Mouse alveolar surfactant can be separated by equilibrium centrifugation on continuous sucrose gradients into three subtypes which we call "ultraheavy", "heavy", and "light" on the basis of their buoyant densities. We examined their metabolic relationship by in vivo labeling studies and by physical manipulation, cycling the surface area in vitro in an attempt to convert one subtype into another. Labeling studies indicated rapid quantitative progression of surfactant through ultraheavy, heavy, and light subtypes in sequence. To mimic the in vivo conversion of subtypes in vitro we "cycled" the surface area of surfactant in plastic tubes. Newly secreted surfactant obtained from incubated lungs, as well as surfactant obtained by alveolar lavage and lamellar bodies, exhibited conversion of material from heavier to lighter subtypes. The conversion between subtypes was quantal and was dependent on cycling, temperature, and time. We conclude that the three subtypes are discrete forms of alveolar surfactant that evolve from one into another. Cycling may provide a means to study the mechanisms of their interconversion in vitro.

Surfactant subtypes in mice: characterization and quantitation.

Surfactant obtained by bronchoalveolar lavage of normal adult mice was separated into subtypes by a one-step centrifugation to equilibrium on continuous sucrose gradients. Mouse surfactant resolved in this way exists in three subtypes with similar phospholipid compositions. A "light" subtype of buoyant density 1.027 +/- 0.012 (SD) g/ml comprises 43 +/- 18% of the total alveolar lavage phospholipid, has little surface activity, and consists exclusively of small unilamellar vesicles. A "heavy" subtype of buoyant density 1.055 +/- 0.016 g/ml comprises 48 +/- 11% of the total, is surface active, and consists of small amounts of tubular myelin among large empty vesicles. A third component, called "ultraheavy," comprises 9 +/- 4% of the total alveolar lavage phospholipid, has a density of 1.072 +/- 0.020 g/ml, is surface active, and consists of large aggregates of tubular myelin associated with lamellar bodylike structures. Labeling studies suggested that the ultraheavy material was labeled first and was of the same density as purified lamellar bodies. These results are consistent with the view that, in mice, surfactant is secreted into the alveolar compartment in an ultraheavy form, which evolves into the heavy and light forms.

Experimental radiation pneumonitis. Corticosteroids increase the replicative activity of alveolar type 2 cells.

Corticosteroid administration during radiation pneumonitis in mice markedly improves the physiologic abnormalities and decreases mortality, an effect that has been attributed to the stimulation of surfactant synthesis and secretion by type 2 alveolar epithelial cells. In the present experiments we explored the effects of corticosteroids on the replicative activity of type 2 cells of lethally irradiated lungs at the height of the radiation reaction. The labeling index of type 2 cells of irradiated mice was increased threefold above that of sham-irradiated controls. Corticosteroids given continuously from 10 weeks after thoracic irradiation further increased the type 2 cell labeling index another threefold above that of irradiated untreated mice. The enhanced reproductive activity of type 2 cells following thoracic irradiation is seen as a protective response that is augmented by corticosteroids, whose effect may be both to improve the physiology of the alveolar surface and to maintain the population of alveolar epithelial cells. The bearing of this result on the controversial role of the type 2 cell as a target in radiation pneumonitis is discussed.

Recycling of surfactant in black and beige mice: pool sizes and kinetics.

Lung disaturated phosphatidylcholine (DSPC) turnover was investigated in normal C57 black and mutant beige mice; the latter have been postulated to have microtubular defects. Turnover experiments were performed on 117 black and 74 beige mice that were assayed for lamellar body-rich fraction (LB) and alveolar lavage fluid (AF) DSPC from 0.5 to 100 h after injection of [3H]glycerol. The data were analyzed by a program that derived the best-fit rate constants for an operator-chosen compartmental model. For black mice, a simple model with bidirectional exchange of DSPC between LB and AF compartments fitted the data almost as well as more complex models. This model yielded a turnover time of 5.9 h, a biological half-life of 16 h, and recycling of AF DSPC into LB of 47%. There was some evidence to suggest that DSPC might be degraded rather than recycled as a unit. For beige mice, the DSPC turnover time was 4.8 h, and its biological half-life was 40 h. The AF DSPC pool was smaller than in black mice, but the LB pool was larger. The bidirectional flux of DSPC between AF and LB was much greater than in black mice, the percent of recycling being 85. These data do not support a microtubular defect in beige mice, but the calculations for beige mice are based on a model of questionable validity.

Protective effect of corticosteroids on radiation pneumonitis in mice.

We explored the protective effect of corticosteroids on the mortality of mice that received thoracic irradiation. Methylprednisolone, 100 mg/kg/week, given from 11 weeks after gamma irradiation of the thorax resulted in an increase in the LD50 (11-26 weeks) from 14.3 +/- 0.3 (mean +/- SE) Gy to 17.6 +/- 0.4 Gy, P less than 0.001, a protection factor of 1.2. Withdrawal of steroids at various times during the period of radiation pneumonitis resulted in accelerated mortality in the next 2-4 weeks, so that the cumulative mortality "caught up" with that of control animals by 4 weeks after steroid withdrawal. However, after the end of the usual period of pneumonitis withdrawal of steroids did not result in accelerated mortality, suggesting that the time when steroids are protective corresponds to the duration of pneumonitis. A smaller dose of steroids, 25 mg/kg/week, was found to be as protective as the larger dose used in the above experiments. The possibility that corticosteroids reduce mortality, even when given many weeks after radiation, may have important practical and theoretical implications.

Replicative activity of lung type 2 cells following lung X irradiation.

We investigated the replicative activity of type 2 cells in the lungs of mice at various times from 3 to 22 weeks after 18 Gy of X rays to the thorax. No significant changes were found until 11 weeks after thoracic X irradiation. Thereafter the replicative index of type 2 cells was significantly elevated, rising four to sixfold above that of control, sham-irradiated mice. During the period when the replicative activity of type 2 cells was elevated, the breathing frequency increased and there was histologic evidence of the presence of radiation pneumonitis. The magnitude of each of these indices of pneumonitis correlated significantly with the type 2 cell replicative index, suggesting that type 2 cell replication is related to pneumonitis in extent as well as in chronology. How these changes relate to the pathogenesis of radiation pneumonitis is unclear.

Staining glycol methacrylate embedded cartilage with triethyl-carbocyanin DBTC ("ethyl-stains all") with special reference to the interlacunar network.

The dye, triethyl-carbocyanin DBTC, was tested for differential staining of cartilage structures. Femoral head articular cartilage from neonatal rats was processed for histology to demonstrate the interlacunar network. Sections of glycol methacrylate (GMA) embedded cartilage were stained at pH 2.8, 5.4, 6.1 and 8.0 to determine the optimal staining conditions. Only at pH 6.1 were all cartilage structures stained and the best contrast achieved. Streptomyces hyaluronidase, chondroitinase ABC, pepsin, trypsin, and pronase digestions were carried out prior to staining at pH 6.1 to evaluate the selectivity of the stain. Undigested chondrocyte nuclear chromatin stained dark purple; staining intensity was reduced slightly by pepsin or trypsin digestion. Undigested chondrocyte cytoplasm stained light blue but stained purple after hyaluronidase digestion. Undigested extracellular matrix stained light violet; staining was almost entirely eliminated by chondroitinase ABC digestion, was unaffected by hyaluronidase, and was either unaffected or increased after proteinase digestion. Staining of a narrow zone of matrix adjacent to the network was prevented by proteinase digestion while the network element appeared as a thin dark line. The network appears to be a trilaminar structure; a core element of hyaluronic acid and protein surrounded by a protein sheath. Triethyl-carbocyanin DBTC staining of cartilage offers slightly more selectivity and contrast than methylene blue, toluidine blue or safranin O. At pH 6.1, DNA, perhaps RNA, and hyaluronic acid stained deep purple; chondroitin sulfate, light violet; protein (collagen), stained very light violet if at all.

Morphological evidence of the shedding of chondrocytes from the articular surface in neonatal rats: relationship to the interlacunar network.

The superficial zone of the femoral head articular cartilage of 5- to 15-day old rats was examined by light and electron microscopy for evidence of shedding into the joint space. Chondrocytes deepest in the superficial zone were round, surrounded by a capsule, and connected to adjacent chondrocytes by the interlacunar network, whereas cells in the middle of the zone appeared similar but with less cytoplasm. At the circular surface, chondrocytes were small, with pyknotic nuclei and poorly defined organelles. These cells occasionally protruded from the articular surface but maintained at least partial connection with the network and their capsule. Depressions in the articular surface were lined with material similar to that of the network and were the only locations found where the network did not terminate at a cell surface. This static evidence suggested at least two hypotheses: 1) Degenerating chondrocytes moved up through the superficial zone to the articular surface and were shed into the joint space. This movement may be facilitated by the network as part of neonatal cartilage development. 2) During joint formation, the surface of the articular cartilage was eroded down to the chondrocytes, which were exposed to the joint fluid, causing cell degeneration, death, and shedding. Evidence of cell shedding was rarely seen after 2 weeks of age. Likewise, the interlacunar network disappeared from the superficial zone during this period. A physiological as well as structural relationship may exist between the chondrocytes and interlacunar network.