An improved technique for hyaluronan histochemistry using microwave irradiation

Thirty years of translational research in Mobility Medicine: Collection of abstracts of the 2020 Padua Muscle Days

More than half a century of skeletal muscle research is continuing at Padua University (Italy) under the auspices of the Interdepartmental Research Centre of Myology (CIR-Myo), the European Journal of Translational Myology (EJTM) and recently also with the support of the A&CM-C Foundation for Translational Myology, Padova, Italy. The Volume 30(1), 2020 of the EJTM opens with the collection of abstracts for the conference "2020 Padua Muscle Days: Mobility Medicine 30 years of Translational Research". This is an international conference that will be held between March 18-21, 2020 in Euganei Hills and Padova in Italy. The abstracts are excellent examples of translational research and of the multidimensional approaches that are needed to classify and manage (in both the acute and chronic phases) diseases of Mobility that span from neurologic, metabolic and traumatic syndromes to the biological process of aging. One of the typical aim of Physical Medicine and Rehabilitation is indeed to reduce pain and increase mobility enough to enable impaired persons to walk freely, garden, and drive again. The excellent contents of this Collection of Abstracts reflect the high scientific caliber of researchers and clinicians who are eager to present their results at the PaduaMuscleDays. A series of EJTM Communications will also add to this preliminary evidence.

Is low molecular weight hyaluronan an early indicator of disease in avian systemic sclerosis?

AIM OF THE STUDY

To further elucidate the pathogenesis of systemic sclerosis (SSc) an experimental avian model was used. The University of California at Davis line 200 (UCD-200) chickens spontaneously develop a SSc-like disease that has most features of human SSc with vascular effects, inflammation, autoimmunity, and fibrosis. The first signs of disease in UCD-200 chickens are swelling and ischemic lesions of the comb and the presence of a tissue containing high amounts of glycosaminoglycan hyaluronan (HA). The aim of this study was to evaluate inflammatory and fibrotic processes of the disease with regard to the molecular weight of HA.

MATERIAL AND METHODS

Comb biopsies from UCD-200 and healthy White Leghorn (WL) chickens, as controls, at different ages were studied with the histochemical localization of HA, hyaluronidase-1 (Hyal-1), cluster of differentiation 3, immunoglobulin Y, and collagen I and III. The molecular weight distribution of HA was estimated with gas-phase electrophoretic analysis.

RESULTS

At 2 days of age, HA was visualized in UCD-200 chickens at the dermal part of the comb with no simultaneous staining of Hyal-1. In adult UCD-200 chickens, the comb skin was almost totally devoid of HA compared to WL chickens of the same age. An increase of low molecular weight (LMW) HA was detected in comb tissue from UCD-200 at the age of 1 day, 1 week, 2 weeks, and 4 weeks, in contrast to adult animals.

CONCLUSIONS

An early inflammatory process involving LMW HA was confirmed as a possible profibrotic process. This indicates that HA might be an important participant in the early inflammatory events of SSc in UCD-200 chickens and that the disappearance of HA in skin predisposes to fibrosis.

Identification of the two KIT isoforms and their expression status in canine hemangiosarcomas

BACKGROUND

KIT is a tyrosine kinase growth factor receptor. High expression of KIT has been found in several tumors including canine hemangiosarcoma (HSA). This study investigated the correlation of KIT expression and c-kit sequence mutations in canine HSAs and benign hemangiomas (HAs).

RESULTS

Immunohistochemistry (IHC) staining confirmed KIT expression in 94.4 % (34/36) of HSAs that was significantly higher than 0 % in HAs (0/16). Sequencing the entire c-kit coding region of HSAs and normal canine cerebellums (NCCs) revealed GNSK-deletion in exon 9. As for exon 9 genotyping by TA-cloning strategy, GNSK-deletion c-kit accounted for 48.6 % (68/140) colonies amplified from12 KIT-positive HSAs, a significantly higher frequency than 14.1 % (9/64) of colonies amplified from six NCCs.

CONCLUSIONS

Due to the distinct expression pattern revealed by IHC, KIT might be used to distinguish benign or malignant vascular endothelial tumors. Moreover, the high incidence of GNSK-deletion c-kit in canine HSAs implicates KIT isoforms as possibly participating in the tumorigenesis of canine HSAs.

The structure of the basement membrane zone differs between keloids, hypertrophic scars and normal skin: a possible background to an impaired function

Scar tissues were collected from patients with keloids, hypertrophic scars and mature scars. Normal skin was obtained from healthy individuals. Clinical attributes were used to select which tissue to obtain but the distribution of the specific hyaluronan (HA) staining was then used for the definite classification of the various scar types. Light microscopic and ultrastructural analyses were performed with an HA-binding probe, antibodies for collagen I and III and staining for mast cells. Ultrastructural studies of keloids revealed an altered collagen structure in the dermal layers, with an abundance of collagen fibres of similar diameter in both the reticular dermis (RD) and the papillary dermis (PD) compared to normal skin. Furthermore, the keloids displayed epidermal changes, which involved the basement membrane (BM), with fewer hemidesmosomes and an altered shape of desmosomes in the entire enlarged spinous layer. The frequency of mast cells found in keloids was lower than in other scar tissues and normal skin. These alterations in epidermis could influence the hydrodynamic and cell regulatory properties of the wounded skin with impaired function and insufficient regulative capacity to hinder the ever-growing collagen tissue that is characteristic for keloids.

Effect of radiotherapy on expression of hyaluronan and EGFR and presence of mast cells in squamous cell carcinoma of the head and neck

Head and neck squamous cell carcinoma is a common form of cancer, and despite improvements in treatment during the last decades, survival rates have not significantly increased. There is therefore a need to better understand how these tumours and the adjacent tissues react to radiotherapy, the most common type of treatment for this group of tumours. In order to improve this understanding, the expression of hyaluronan (HA) and epidermal growth factor receptor (EGFR) and the presence of mast cells were mapped before and after radiotherapy using immunohistochemistry. The results showed HA and EGFR to have similar expression patterns in tumour tissue and histologically normal squamous epithelium prior to radiotherapy. Following radiotherapy, EGFR increased in histologically normal epithelium. An increased number of mast cells were also observed as a result of radiotherapy. No expression of EGFR was observed in the connective tissue either prior to or following radiotherapy.

Progression of bone marrow fibrosis in patients with essential thrombocythemia and polycythemia vera during anagrelide treatment

Anagrelide is a second-line option for reduction of thrombocythemia in patients with chronic myeloproliferative disorders (CMPDs). A multicenter, open, phase II study of anagrelide treatment in 60 patients during 2 yr was performed by the Swedish Myeloproliferative Disorder Study Group. Adequate bone marrow biopsies were obtained from 53 of the CMPD patients [36 essential thrombocythemia (ET), 16 polycythemia vera (PV), 1 chronic idiopathic myelofibrosis (CIMF)] before treatment and compared with biopsies from 30 healthy volunteers and 34 patients with acute myeloid leukemia (AML). Higher reticulin and hyaluronan (HYA) scores were found before anagrelide therapy in the CMPD patients than in the normal controls (p < 0.001 and p < 0.001, respectively) and AML patients (p < 0.001 and p = 0.011, respectively). At the end of the study 30 CMPD patients were still on anagrelide treatment and in 19 of these patients, all diagnosed as ET (n = 16) or PV (n = 3), pretreatment bone marrow biopsies were compared with follow-up samples. After 2 yr of anagrelide therapy the reticulin and HYA scores were significantly higher than before treatment (p = 0.02 and p = 0.002, respectively). The cellularity was significantly higher (p = 0.014), although the number of megakaryocytes did not change significantly. The increase of reticulin and HYA in the bone marrow after 2 yr of treatment with anagrelide indicated progression of fibrosis. Although anagrelide is a valuable drug for reduction of platelet levels, it seems unable to stop progression of bone marrow fibrosis and hypercellularity in ET and PV.

Hyaluronan and its receptor CD44 in the heart of newborn and adult rats

The extracellular matrix is a dynamic space and a prerequisite for the function of cardiomyocytes. We have previously reported on the distribution of the glycosaminoglycan hyaluronan (HYA) and its cellular receptor CD44 in the vascular system. In newborn rats, HYA and its receptor were colocalized, but in the adult animals, no such colocalization was observed. Furthermore, the distribution of both HYA and CD44 differed between newborn and adult animals. In this study, the distribution of HYA and its receptor CD44 is explored in the heart. Hearts from newborn and adult rats were stained for visualization of HYA and CD44 using histochemistry and immunohistochemistry. HYA stained the interstitium of the myocardium heterogeneously. Strong staining was seen in the heart valves of both newborn and adult animals. CD44 staining was sparse in hearts from both newborn and adult animals. There are no major changes in the distribution of HYA in the myocardium during the postnatal development in contrast to the blood vessels. Thus, the structure of the interstitium does not change after birth when the heart starts to grow mainly through cardiomyocyte hypertrophy rather than hyperplasia. The abundance of HYA in the heart valves is probably related to their unique physiological properties to withstand repetitive mechanical stress.

Expression of the CD44 Receptor in the Blood Vessel System: An Experimental Study in Rat

The CD44 receptor is a transmembrane glycoprotein expressed on a variety of cells like endothelial, epithelial and smooth muscle cells. This molecule has many important functions, e.g. in cell-cell and cell-matrix interactions and signal transduction. The main ligand for CD44 is hyaluronan (HYA). HYA is a glycosaminoglycan with structural and cell biological properties. The localization of HYA in the vessel wall of arteries and veins in the healthy adult and newborn rat has been described earlier. In this study the occurrence of the CD44 receptor was investigated in the same vessels and compared to the localization of HYA. Both CD44 and its ligand showed an increased expression in the vessel wall of newborn rats compared to that of adult rats. Although HYA is abundant in the adventitia of adult rats, virtually no expression of CD44 was observed. Our results indicate that the CD44 receptor expression is increased during the stage of maturation of the vessel tree whereas the CD44 receptor is less needed by HYA in the healthy vessel wall.

The stromal reaction in basal cell carcinomas. A prerequisite for tumour progression and treatment strategy

Specimens of basal cell carcinomas collected from 28 patients were classified into three groups: superficial, nodular, and infiltrative, according to their microarchitecture. The specimens were then subjected to histological characterization by means of a biotinylated hyaluronan-binding probe (HABP). By using Ki-67 and PCNA the proliferative activity of the BCC tumours was evaluated with immunohistological techniques. In superficial BCC the tumour islands displayed moderate hyaluronan (HA) staining. Feeble proliferation, denoted by modest mitotic activity and weak Ki-67 and PCNA immunoreactivity, occurred within the tumour islands. The surrounding connective tissue resembled normal skin, and no differentiated tumour stroma was observed. In nodular BCC, the HA staining of the tumour strands was weak to moderate, denoting increased proliferative activity. The differentiated surrounding tumour stroma stained strongly for HA. Tumour islands of infiltrative BCC stained weakly to moderately to HA and evidenced intense proliferation. The intensely HA-stained tumour stroma ended abruptly and the adjacent areas were almost devoid of HA. This study showed that the proliferative activity of BCC cells is associated with increased expression of HA in the tumour stroma. Modification of tumour-associated connective tissue indicates a close relationship between the tumour cells and the adjacent matrix. In particular, in infiltrative BCC, such alterations include degeneration and possible modification and remodelling of the surrounding extracellular matrix. These processes involving areas of probable importance for tumour progression, should be considered when deciding the extent of intended surgical resection.

Importance of hyaluronan biosynthesis and degradation in cell differentiation and tumor formation

Hyaluronan is an important connective tissue glycosaminoglycan. Elevated hyaluronan biosynthesis is a common feature during tissue remodeling under both physiological and pathological conditions. Through its interactions with hyaladherins, hyaluronan affects several cellular functions such as cell migration and differentiation. The activities of hyaluronan-synthesizing and -degrading enzymes have been shown to be regulated in response to growth factors. During tumor progression hyaluronan stimulates tumor cell growth and invasiveness. Thus, elucidation of the molecular mechanisms which regulate the activities of hyaluronan-synthesizing and -degrading enzymes during tumor progression is highly desired.

Myringotomy delays the tympanic membrane recovery in acute otitis media: a study in the rat model

BACKGROUND/HYPOTHESIS

Acute otitis media is a major cause of visits to pediatric health care providers. Myringotomy in uncomplicated acute otitis media is debatable today. The study addressed this problem through the otomicroscopic and histopathological observations of the events occurring in the tympanic membrane during the first week after myringotomy.

STUDY DESIGN

Randomized study in an experimental animal model.

METHODS

Under anesthesia, the left middle ear of 36 Sprague-Dawley rats was inoculated with Streptococcus pneumoniae type 3. Forty-eight hours later, at day 0, four animals were immediately killed and the remaining animals were randomly assigned into a myringotomy group (n = 16, myringotomy on the left ear) and a non-myringotomy group (n = 16, otomicroscopy without myringotomy). Otomicroscopy and killings were performed in series of four animals from each group at days 1, 2, 4, and 7 after myringotomy. Tympanic membranes were collected after fixation and processed for light and electron microscopy.

RESULTS

All inoculated ears showed a manifest acute otitis media at day 0. An intense infiltration by inflammatory cells and edema distorted severely the tympanic membrane structure. These findings decreased the following days. However, inflammation as evaluated by the thickness and the cytoarchitecture of the tympanic membrane layers, recovered significantly faster in the membranes in the non-myringotomy group. At day 7, all tympanic membranes in the myringotomy group were closed by a hypertrophic keratinizing epithelium and a remodeling connective tissue layer, whereas the animals in the non-myringotomy group had a residual edema in the lamina propria.

CONCLUSIONS

The present infectious model induced an intense inflammatory reaction within the entire structure of the tympanic membrane. Myringotomy provoked a delayed recovery from the inflammatory process within the tympanic membrane. Therefore, if applicable to human conditions, the use of myringotomy in the management of acute otitis media should be restricted to selected cases of acute otitis media.

Histochemical studies of the extracellular matrix of human articular cartilage--a review

OBJECTIVE

This paper reviews the histochemistry of the extracellular matrix of human articular cartilage. No systematic review of histochemical knowledge and techniques in the study of articular cartilage has been published previously.

METHODS AND RESULTS

Literature was searched in the Winspirs Medline database from 1960 to 2000. Only techniques applicable for bright field or polarization microscopy were considered. Unless otherwise noted, all applies to hyaline cartilage. The most widely used fixatives are adequate for routine staining of proteins, but proteoglycan fixation is problematic, and no one fixative can be recommended. Proteoglycan can be stained reliably but it is problematic that, at low substrate concentrations, these methods are not stoichiometric. Collagen can be stained efficiently, although attempts to differentiate collagen types have not been successful.

CONCLUSIONS

Detailed studies of fixation and staining procedures should be carried out and standards for cartilage sampling, handling and evaluation agreed upon if results from different laboratories are to be compared.

Localisation and distribution of hyaluronan in normal bone marrow matrix: a novel method to evaluate impending fibrosis?

Bone marrow trephine biopsies from 30 healthy volunteers, 10 men and 20 women aged 18-60 yr were obtained for identification and localisation of hyaluronan (HYA). Fixation, decalcification and embedding were performed by two different methods, with identical results in both. For comparison bone marrow trephine biopsies from three patients with different haematological diseases and known fibrosis were studied. All bone marrow specimens were also stained for reticulin grading. HYA was found in the bone marrow specimens from healthy individuals in a pattern that was concordant with the reticulin staining, the common way of visualising bone marrow fibrosis. In bone marrow from the patients with known fibrosis the HYA and reticulin staining were both more intense and abundant. Interestingly, HYA was also found intracellularly in eosinophilic cells in normal bone marrow. HYA is a polysaccharide unique both in structural and biological properties, and in excess it may predict bone marrow fibrosis.

Antenatal betamethasone administration decreases the lung hyaluronan concentration in preterm rabbit pups

Maternal treatment with corticosteroids before preterm delivery is effective in reducing the incidence of respiratory distress syndrome and neonatal mortality. We hypothesized that corticosteroids might lower the lung hyaluronan concentration. Twenty-five rabbit dams (term = 31 d) with timed pregnancies were injected s.c. with 0.75 mg of betamethasone or saline (controls) 1 d before delivery. In addition, two dams delivered at 25 d of gestation were injected with 0.75 mg of betamethasone on two consecutive days before delivery. A total of 238 live pups were delivered by preterm cesarean section at 25, 27, 28, or 29 d of gestation and killed immediately. Their lung hyaluronan concentrations were measured with a radiometric assay, and wet/dry lung weight ratios were determined. Lungs of rabbit pups exposed antenatally to betamethasone and delivered at 25 or 27 d of gestation, but not at 28 or 29 d, displayed significantly (p = 0.001 and p = 0.008, respectively) lower hyaluronan concentrations than control pups, accompanied by less intense subepithelial staining for hyaluronan in alveolar walls. There was no significant difference in wet/dry lung weight ratio between pups exposed to one dose of betamethasone and controls. Antenatal corticosteroid exposure lowers the lung hyaluronan concentration in preterm rabbit pups delivered at 25 or 27 d of gestation, but not in those delivered at 28 or 29 d.

Proteoglycans and hyaluronan in human fetal membranes

OBJECTIVE

The aim of this study was to describe the distributions of major extracellular matrix components, such as proteoglycans, collagen and hyaluronan, in the fetal membranes at term.

STUDY DESIGN

Fetal membranes were obtained from elective cesarean deliveries at term. Guanidinium extracts were analyzed for proteoglycans with alcian blue precipitation, sodium dodecyl sulfate- polyacrylamide gel electrophoresis, and Western blotting and for hyaluronan with a radioimmunoassay. Collagen was measured by estimating hydroxyproline content. Tissue sections were immunostained for decorin and biglycan and stained for hyaluronan with a biotin-labeled hyaluronan-binding protein.

RESULTS

The fetal membranes contained predominantly smaller proteoglycans, such as biglycan and decorin. The amnion consisted of typical fibrous connective tissue with a high concentration of collagen. The amnion was dominated by decorin located in close connection with the collagen fibrils. The chorion was composed of a fibroblastic part containing collagen and decorin and a trophoblastic part mainly containing biglycan. In addition, large amounts of hyaluronan were found, especially in the amnion and in the decidual cell layers.

CONCLUSION

The distributions of proteoglycans, collagen, and hyaluronan in human fetal membranes may explain the biomechanical properties of this tissue. We suggest that changes in the relative proportions of these extracellular molecules are crucial for the proposed maturation process in the fetal membranes during the last weeks of pregnancy.

Reduced hyaluronan in keloid tissue and cultured keloid fibroblasts

Extracellular matrix hyaluronan is prominent during wound healing, appearing at elevated levels early in the repair process. It is prevalent throughout the course of fetal wound healing, which is scar-free, but decreases late in adult wound repair, that is often marked by scarring. To determine whether aberrant hyaluronan metabolism is associated with the excessive scarring that characterizes keloids, cultured fibroblasts derived from keloids and from the dermis of normal human skin and scar were compared. Levels of hyaluronan in 48 h conditioned media of keloid-derived cultures were significantly lower than in cultures of normal skin and scar fibroblasts. Profiles of hyaluronan polymer size were comparable in these two cell types, suggesting that excessive hyaluronan degradation was not involved. Hydrocortisone decreased hyaluronan levels approximately 70% in the conditioned media of both keloid and normal fibroblasts. Diminished hyaluronan accumulation in keloid-derived cells compared with normal fibroblasts was also observed in an in vitro wound healing model. Histolocalization of hyaluronan in keloids, normal skin, and scar samples confirmed the biochemical observations that the dermis of keloids, which comprises most of the scar tissue, contained markedly diminished levels of hyaluronan. Alterations in hyaluronan in the epidermis overlying keloids, however, were also observed. A modest increase in hyaluronan staining intensity was observed in the epidermis of keloids, as well as changes in the patterns of distribution within the epidermis, compared with that in normal skin and scar. Increased hyaluronan was present in the granular and spinous layers of the keloid epidermis Abnormalities are present apparently in both the overlying epidermis as well as in the dermis of keloids. Aberrations in signaling between keloid stroma and keloid epidermis may underlie abnormalities that contribute to the excessive fibrosis characteristic of these lesions.

Lung hyaluronan and water content in preterm and term rabbit pups exposed to oxygen or air

Rabbit pups were delivered by cesarean section 1 or 2 d before term, or vaginally around term, and then reared in room air or exposed to intermittent or continuous hyperoxia (> 85%) for up to 9 d. Pups were killed at different ages, and lung hyaluronan (HA; microgram/g of dry lung weight) and lung water content, measured as wet/dry lung weight, were determined. Compared with the day of birth, the lung HA concentration did not change significantly on succeeding days in pups kept in air delivered 2 d (-2 d) or 1 d (-1 d) before term, whereas the water content decreased significantly. Continuous exposure to hyperoxia resulted in a significantly raised lung HA concentration 6 d postterm in both -2 d and -1 d pups, and intermittent exposure to hyperoxia resulted in a significantly raised HA concentration 6 d postterm in -1 d pups, compared with the groups exposed to room air. These increases were accompanied by significantly elevated wet/dry lung weight ratios. Microscopic examination revealed significantly increased HA staining scores in alveoli, arterioles, and bronchioli in both hyperoxia-exposed groups of -2 d pups 6 d postterm, and nonsignificantly higher scores in -1 d and vaginally delivered pups of comparable age, compared with the scores at birth. The results indicate that oxygen exposure neonatally may result in an increase in lung HA accompanied by an increase in lung water content. The increase in lung HA concentration in our study may be an effect of oxygen free radicals or of oxygen-induced stimulation of inflammatory mediators.

Calibration and standardization of microwave ovens for fixation of brain and peripheral nerve tissue

Rapid and reproducible fixation of brain and peripheral nerve tissue for light and electron microscopy studies can be done in a microwave oven. In this review we report a standardized nomenclature for diverse fixation techniques that use microwave heating: (1) microwave stabilization, (2) fast and ultrafast primary microwave-chemical fixation, (3) microwave irradiation followed by chemical fixation, (4) primary chemical fixation followed by microwave irradiation, and (5) microwave fixation used in various combinations with freeze fixation. All of these methods are well suited to fix brain tissue for light microscopy. Fast primary microwave-chemical fixation is best for immunoelectron microscopy studies. We also review how the physical characteristics of the microwave frequency and the dimensions of microwave oven cavities can compromise microwave fixation results. A microwave oven can be calibrated for fixation when the following parameters are standardized: irradiation time; water load volume, initial temperature, and placement within the oven; fixative composition, volume, and initial temperature; and specimen container shape and placement within the oven. Using two recently developed calibration tools, the neon bulb array and the agar-saline-Giemsa tissue phantom, we report a simple calibration protocol that identifies regions within a microwave oven for uniform microwave fixation.

Identification and characterization of the cell-associated binding protein for urinary trypsin inhibitor

Urinary trypsin inhibitor (UTI) inhibits not only tumor cell invasion but also production of experimental and spontaneous metastasis. Cell-binding experiments indicated that human choriocarcinoma SMT-cc1 cells have specific binding sites for UTI on their cell surface. [Kobayashi et al., J. Biol. Chem. 269, 1994, 20,642-20,647]. UTI binding protein (UTIBP) was purified to homogeneity by a combination of UTI-coupled affinity beads, preparative polyacrylamide gel electrophoresis and reverse phase HPLC. This protein is very similar to a truncated form of human cartilage link protein (LP). LP was identified structurally by its apparent molecular mass with and without deglycosylation treatment: Immunologically by the reactivity with anti-UTIBP antibody, and functionally by its ability to bind the NH2-terminal domain of UTI. UTI and UTIBP are distributed uniformly in the cytoplasm and/or over the cell surface of tumor cells and fibroblasts. The level of staining for hyaluronic acid, UTIBP and UTI is much lower in sections digested with hyaluronidase. These results suggest that the cell membrane-derived UTI-associated binding protein is the LP of proteoglycan-hyaluronic acid aggregates, which interacts with hyaluronic acid. Cell-associated LP may play a role in modulating protease activity to the environment close to tumor and fibroblast cell surface.

Dextranomeres in hyaluronan (DiHA): a promising substance in treating vocal cord insufficiency

The morphology of the rabbit vocal cord was studied after injecting a mixture of dextranomere microspheres in sodium hyaluronan solution (DiHA), two substances that are nonimmunogenic and biocompatible. DiHA is already in clinical use as a space filler in pediatric urology (Deflux R). Specimens from injected vocal cords were investigated by light microscopy at different time intervals up to 6 months after injection. On macroscopic examination a bulge was seen in the injected vocal cord, and on microscopic examination new fibrous connective tissue developed. Throughout the study a weak inflammatory reaction was observed, but no foreign body reaction. Hyaluronan disappeared from the injected site within 1 week, but the dextranomeres remained and were recovered intact up to 6 months after injection. The dextranomeres recruited fibroblasts that generated new collagen, resulting in endogenous soft tissue augmentation. It is conceivable that DiHA may become a useful injection material for treatment of vocal cord insufficiency.

Patterns of hyaluronan staining are modified by fixation techniques

The apparent intensity of hyaluronan (HA) staining in tissue sections can vary as a function of fixation techniques. We examined the histochemical distribution of HA in normal human skin using an HA-specific binding peptide derived from bovine nasal cartilage. The HA, particularly in the dermis, was best preserved in sections fixed in 10% acid-formalin with 70% ethanol. In contrast, sections fixed in the routine 10% neutral-buffered formalin had a much weaker intensity of HA staining. Furthermore, acid-formalin/ethanol-fixed sections retained much of their apparent HA after incubation with saline, in contrast to the neutral formalin-fixed sections, in which most of the stainable HA was lost. Such marked differences in staining intensity were not observed in slides stained with Alcian blue, a procedure presumed to stain HA as well as other glycosaminoglycans. Staining using the HA binding peptide was entirely absent when sections were first preincubated in hyaluronidase, whereas similar Alcian blue-stained sections retained most of their staining intensity. Caution should be exercised in evaluating the distribution of HA in tissues using the HA binding peptide, particularly when different fixation techniques among several laboratories are being compared. In addition, the ability to evaluate the HA content of tissues using Alcian blue staining should be reconsidered. The sulfated glycosaminolglycans of the "ground substance" appear to be the predominant substrates for Alcian blue.

Presence of glycosaminoglycans in the endolymphatic sac

Earlier morphological investigations have revealed that the endolymph, which is present in the endolymphatic sac (ES) seems to differ from that found elsewhere in the labyrinth, in that it contains a stainable substance. Histochemical investigations indicate that this substance is rich in glycosaminoglycans (GAGs). It has been speculated that the stainable substance might play a role in regulation of fluid and ions and also, possibly, the pressure within the endolymphatic sac compartment. Endolymphatic sac specimens obtained from adult guinea pigs, rats, mice and in vitro cultured fetal inner ears were incubated with monoclonal antibodies against epitopes, and after enzymatic digestion revealed five different GAGs: hyaluronan, chondroitin-4-sulphate+dermatan sulphate, chondroitin-6-sulphate and keratan sulphate. In order to verify the specificity of these antibodies, otocysts from fetal mice were incubated in the same way. These cartilaginous specimens are known to contain GAGs in abundance and served as positive controls. The results indicate that the hyaluronan visualized by the monoclonal antibody is present to a large extent in the lumen of the ES and in the epithelial cells. Keratan sulphate and chondroitin-4-sulphate+dermatan sulphate are present within the epithelial lining, in the subepithelial tissue, and to some minor extent in the lumen, while chondroitin-6-sulphate does not show any specific staining.

Extracellular matrix components reflect the dynamics of a healing tympanic membrane perforation--a histochemical study

Extracellular matrix components have hitherto been sparsely studied in tissue repair processes. In this study, the distribution of hyaluronan (HYA), fibronectin, and five chondroitin sulfate glycosaminoglycans (GAGs) was analysed in healing tympanic membrane (TM) perforations of rats, at different time points, using a HYA-binding protein probe and six monoclonal antibodies (MAbs). Hyaluronan appeared, the first day, around migrating squamous epithelial and inflammatory cells in the perforation borders and close to dilated vessels at the malleus handle. Accumulated HYA persisted in the thickened perforation rim until closure of the perforation, then it slowly disappeared from the healed TM area. Fibronectin immunoreactivity occurred around proliferating cells in the perforation edge and around collagen bundles in the connective tissue. The MAbs for chondroitin sulfate GAGs rendered specific, constant immunostaining patterns throughout the healing process. Unsulfated chondroitin, chondroitin-4-sulfate and chondroitin-6-sulfate were present in small amounts in the connective tissue surrounding collagen fibres and fibroblasts. The staining for native chondroitin and dermatan sulfate was most pronounced in the epithelial layers, in particular the squamous epithelium and its keratin layer, whereas the loose connective tissue was left unstained. After closure of the TM perforations, the immunoreactivity for unsulfated chondroitin, native chondroitin and dermatan sulfate increased in the scar tissue. It is concluded that HYA is abundant in early stages of healing of TM perforations, whereas fibronectin, unsulfated chondroitin, chondroitin-4 and 6-sulfate are constantly present in small amounts during the healing process. Unsulfated chondroitin, native chondroitin and dermatan sulfate increase in the healed TM area.

An animal model for external otitis

External otitis was produced in 12 Sprague-Dawley rats by mechanical stimulation through a plastic micropipette inserted into the right external auditory canal (EAC). The EAC was later evaluated regarding the color of the skin, swelling and the presence of fluid. Within 1 day all rats developed an external otitis that was characterized by a red, swollen ear canal containing an opalescent fluid. The tympanic membrane and middle ear cavity appeared to be normal. No healed EACs were seen within the initial 10 days of follow-up and 4 of 6 rats still exhibited external otitis at day 21. Light microscopy of biopsy specimens revealed pronounced edema of the dermis of the ear canal. Mast cells were more numerous in the early phase of the otitis present, although very few inflammatory cells were found in tissues despite the marked inflammatory reaction produced. Findings show that this animal model for external otitis can be used to investigate pathogenesis as well as to test various treatment strategies.

Localization of hyaluronan in human liver sinusoids: a histochemical study using hyaluronan-binding protein

Circulating hyaluronan is mostly derived from lymph, fibroblast and Ito cells in the liver, and more than 90% of hyaluronan is degraded in hepatic sinusoidal endothelial cells. Thus, elevated serum hyaluronan is regarded as an indication of hepatic fibrosis with activated Ito cells and dysfunctional sinusoidal endothelial cells. We studied the distribution of hyaluronan in human liver sinusoids to determine the influences on elevated hyaluronan levels in sera. Histochemical examination was made using hyaluronan-binding protein (HABP) and serial sections of liver tissue for staining of alpha-smooth muscle actin (ASMA) (an indicator of activated Ito cells) and of ulex europaeus agglutinin I lectin (UEA-1) (closely related to hepatic sinusoidal capillarization). Positive staining, indicating the presence of hyaluronan, was noted in fibrous regions around the portal tracts, areas of focal necrosis in the liver parenchyma, and walls of the sinusoids in chronic hepatitis. In this group, hyaluronan-positive areas corresponded to positive ASMA staining and faint staining of UEA-1. On the contrary, in liver cirrhosis, UEA-1-positive areas were essentially identical to hyaluronan-positive areas and to ASMA-negative areas in sinusoidal walls. Hyaluronan and ASMA could be detected in the same areas of sinusoidal walls in chronic hepatitis, but not in liver cirrhosis. Hyaluronan appears to be mainly related to the staining of activated Ito cells in chronic hepatitis. Therefore, we concluded that in chronic hepatitis, the production of hyaluronan was accelerated in Ito cells; however, degradation of hyaluronan by sinusoidal endothelial cells continued. On the contrary, in liver cirrhosis, hyaluronan production decreased in Ito cells, and a marked transformation of sinusoidal endothelial cells with hepatic sinusoidal capillarization indicated loss of the ability to degrade hyaluronan. These different mechanisms in chronic hepatitis and liver cirrhosis may operate in the sinusoidal walls and may cause the elevation of hyaluronan in sera.

Hyaluronan localization in the rabbit larynx

BACKGROUND

The larynx is a complex organ composed of different connective tissue elements. So far, the extracellular matrix of the larynx has not been thoroughly described. Hyaluronan is a matrix polysaccharide with physicochemical effects and biological cell functions in soft connective tissues.

METHODS

The histochemical distribution of hyaluronan (hyaluronic acid, hyaluronate) was studied in tissue sections from various levels of the rabbit larynx by means of a hyaluronan-binding protein and avidin biotin peroxidase staining. Microwave-aided fixation was used to retain the extracellular location of hyaluronan.

RESULTS

Hyaluronan accumulated chiefly in the subepithelial lamina propria and in the connective tissue enclosing striated muscle fibres of the thyroarytenoid muscle and vocalis muscle. This localization contrasted sharply with the weak staining for hyaluronan in muscles external to the thyroid cartilage. Intensive staining for hyaluronan was found in perivascular and periglandular connective tissue, as in the vacuoles of the hyaline cartilage of the thyroid, cricoid and arytenoid cartilages, and to a lesser extent in the lacunae of the chondrocytes and in the perichondrium of the elastic cartilage of the epiglottis.

CONCLUSIONS

Hyaluronan was heterogenously distributed in the rabbit larynx. It was abundant in intrinsic laryngeal muscles performing small, precise, and rapid movements and in the subepithelium at the glottic level, where it may facilitate mucosal movements. The abundant hyaluronan in the subglottic region may be involved in the control of vascular leakage and edema formation.

Hyaluronan in human cerebrospinal fluid

We studied the concentration of hyaluronan in cerebrospinal fluid (CSF) in various diseases and attempted to define its reference interval. A radioassay utilizing cartilage proteins with affinity for hyaluronan was used in determining the concentration of 200 lumbar and 27 ventricular CSF specimens and 11 brain cyst fluids. Molecular weight distributions were determined by gel chromatography and localization in brain tissue by histochemistry. The hyaluronan level of lumbar CSF showed an increase with age; comparatively healthy children had (mean +/- SD) 50 +/- 41 micrograms/L (n = 40) and adults 166 +/- 77 micrograms/L (n = 9); i.e. significantly different values. The highest level was recorded in a patient with meningitis (> 8000 micrograms/L). More than 4000 micrograms/ L was noted in a patient with tumour metastasis in the cerebellum. Significantly elevated levels were especially found with spinal stenosis, head injury and cerebral infarction, but also in inflammatory medical disorders, hydrocephalus and encephalitis. We found no significant increase in multiple sclerosis and some other neurological diseases. Ventricular CSF of adults contained significantly less hyaluronan (53 +/- 73 micrograms/L; n = 16) than lumbar CSF. Hyaluronan in cyst fluids varied from 31 to 25,000 micrograms/L. Weight average molecular weight of hyaluronan in CSF was 2.9-3.0 x 10(5) and in brain tumour cyst fluid 2.4 x 10(6). In search for the origin of hyaluronan in CSF it was found that its concentration in the choroid plexus and leptomeninges was low, but that hyaluronan was accumulated in the superficial layer of the cerebral cortex. Continued screening for hyaluronan in CSF may be valuable in cases of inflammatory diseases, tumours and obstruction to CSF flow.

Structural characterization of persistent tympanic membrane perforations in man

In the present structural study the authors investigated the border of permanent tympanic membrane (TM) perforations in patients selected for myringoplasty. Furthermore, a panel of monoclonal antibody markers that recognize different epitopes within glycosaminoglycans as well as antibodies to epidermal growth factor and fibronectin were applied to the sections. In half of the specimens the epithelial junction ended at the inside of the perforation border, whereas in the other half it was located at the perforation border itself. In the junctional area the keratinocytes were covered by a thick keratin layer which protruded as a spur centripetally in order to bridge the perforation. Epidermal cells formed papillae and contained remnants of keratinocyte nuclei that showed similarities to those of the skin in inflammatory conditions. The connective tissue layer was fibrous and showed areas containing sclerotic plaques. The inner epithelium of the TM had abundant ciliae, thus supporting the concept that cells of the mucosal lining of the TM are able to differentiate in inflammatory conditions into ciliated cells and secretory cells. The immunoreactivity of hyaluronan and other glycosaminoglycans, the immunoreactivity of epidermal growth factor, and immunoreactivity of fibronectin, all of which are known to occur in healing wounds, were only scantily demonstrated; this could be one reason for the arrested healing and a reason why the natural drive to complete a mature closure is abandoned.

Ultrastructural association of hyaluronan with rat unmyelinated nerve fibres

A potential association between hyaluronan and unmyelinated nerve fibres in the PNS (rat skin and iris) and CNS (rat retinal inner plexiform and nerve fibre layers) was investigated at the ultrastructural level using two different hyaluronan-binding probes (link protein-gold and aggrecan-gold). Neuronal and glial cell plasma membranes, as well as the periaxonal space in between, were specifically labelled, suggesting that hyaluronan is secreted by these cells and utilized locally. Intracelluarly, weak labelling of mitochondrial profiles was observed.

Localization and quantity of hyaluronan in urogenital organs of male and female rats

The histochemical distribution of hyaluronan was analysed in various urogenital organs of male and female (non-pregnant and pregnant) rats by use of a hyaluronan-binding protein and avidin biotin/peroxidase staining. Microwave-aided fixation was used to preserve the extracellular location of hyaluronan. The concentrations of hyaluronan in the different tissues were measured with a highly sensitive radio-assay. Hyaluronan accumulated predominantly in the connective tissue around smooth muscle fibres and in the subepithelial lamina propria. Abundant hyaluronan also occurred in perivascular and perineural connective tissue. In the female urogenital organs, hyaluronan content was high in the vagina and urinary bladder, and highest in the vagina during pregnancy. In the uterus, the surface epithelium of the endometrium stained intensely. In the ovary, the zona pellucida of the oocyte and the theca interna cell layer of the follicles and the follicular fluid of mature follicles exhibited prominent staining. The corpus luteum was devoid of hyaluronan, whereas enlarged corpora lutea of pregnancy exhibited weak, patchy staining. In male urogenital organs, staining for hyaluronan was absent from the testis and epididymis, whereas the erectile connective tissue of the penis stained intensely. The hyaluronan concentrations were high in penile tissue and urinary bladder, while testis, epididymis and the ductus deferens contained only little hyaluronan.

Application of microwave fixation techniques in pathology to neuroscience studies: a review

The introduction of microwave energy into the scientist's repertoire of fixation modalities offers for the first time in relatively large specimens the potential for 'instantaneous' preservation of cellular structure for light and electron microscopy with minimal alteration of cellular biochemistry and antigenicity. Because of the rapid evolution of this new technology, we provide a classification system of newly generated microwave methods as applied to specimen preservation for microscopic analysis. With emphasis on neuronal tissue, we review qualitative and quantitative microscopy data of specimens fixed by two microwave methods in common use: (1) microwave stabilization and (2) fast and ultrafast, primary microwave-chemical fixation. In addition, we provide a table of neuropeptides or proteins in neuronal tissues that are preserved by various microwave fixation methods for histochemistry, immunohistochemistry, and immuno-electron microscopy studies. Commercial microwave ovens have limitations which can result in irreproducible fixation results. Therefore, we present a calibration protocol that is used to identify the best locations for fixation within large cavity (i.e., household) microwave ovens. We also provide a standardization protocol to improve the reproducibility of microwave fixation in calibrated, large-cavity microwave ovens.

The distribution of hyaluronan in human skin and mature, hypertrophic and keloid scars

A hyaluronan-binding protein (HABP) was used to locate the distribution of HA in normal skin and in various types of scar tissue: mature scar tissue, hypertrophic scar tissue and keloids. The study was intended to establish whether or not a deviant HA distribution could explain the different clinical features of these scar tissues. The distribution of HA was found to differ between the various scar tissues. In normal skin an intense HA-staining was observed in the papillary dermis. In mature scar tissue the distribution of HA resembled that of normal uninjured tissue, but the layer of HA was thinner. In hypertrophic scar tissue, HA occurred mainly as a narrow strip in the papillary dermis. Keloid tissue showed the least HA-staining of the papillary layer and resembled that of the bulging reticular dermis. In contrast, the thickened granular and spinous layer of the keloid epidermis exhibited an intense HA-staining. We suggest that the altered distribution and amount of HA in these different scar tissues may contribute to their different clinical characteristics. This histochemical technique for the demonstration of HA in scar tissue could be of use in clinical work to decide on therapeutic strategies.

Improved ultrastructural preservation of rat ciliary body after high pressure freezing and freeze substitution: a perspective view based upon comparison with tissue processed according to a conventional protocol or by osmium tetroxide/microwave fixation

Conventional fixation of the delicate, highly folded rat ciliary body and its iridial extension, as well as of vitreal structures, is associated with the induction of a number of artifacts, thus limiting the reliability of morphological interpretations. Improved ultrastructural preservation may be achieved by microwave heating in combination with osmium tetroxide fixation. This protocol, although simple and cheap, yields results, particularly with respect to the extracellular matrix compartment between inner and outer ciliary epithelial cells, which are not greatly inferior to those obtained by implementing the sophisticated high pressure freezing and freeze substitution technique. The latter affords good to very good ultrastructural preservation of epithelium and stromal components, such as blood vessels, neural elements, smooth muscle cells, fibrocytes, and free cells, up to a depth of 50-100 microns from the tissue surface. Its superiority over osmium tetroxide/microwave fixation is revealed in the cytoplasmic, intraorganellar, and vitreal matrix compartments, which incur no obvious losses.

Localization of hyaluronan in the human endolymphatic sac. A study using the affinity hyaluronan binding protein

This study was undertaken with the aim of localizing hyaluronan (hyaluronic acid, HYA) in tissue sections of the human endolymphatic sac by use of a hyaluronan-binding affinity protein and the avidin-biotin/peroxidase staining procedure. Five human endolymphatic sacs were removed during surgery for acoustic neuroma. After microwave-aided fixation and decalcification, paraffin-embedded sections were prepared by routine histological methods. HYA was detected in some of the intraluminal substance as well as in parts of the epithelial lining, mainly in the rugose portions of the endolymphatic sac. HYA was observed intracellularly in epithelial cells. It was also found in the subepithelial tissue near the epithelia and close to the bony aqueduct. The distribution of HYA was uneven at all locations. The finding of HYA within the human endolymphatic sac may imply that this substance has important functions in the control of inner ear fluid homeostasis.

Microwave histoprocessing of bone marrow trephine biopsies

In recent years, the microwave oven has been increasingly used in the pathology laboratory for processing of tissue for diagnostic purposes with a remarkable reduction in processing time and also reports of excellent morphology and immunohistochemistry. We evaluated some of these processes on post mortem bone marrow trephine biopsies and describe a novel way of processing these biopsies in the microwave oven.

Age-dependent changes of hyaluronan in human skin

Hyaluronan is a major component of the extracellular matrix of skin. The large volume of water of hydration associated with hyaluronan may be a mechanism for maintaining the normal hydration of skin. As such, decreasing levels of hyaluronan deposition might underlie the changes associated with the aging process. To test this hypothesis, hyaluronan levels were determined in extracts of skin obtained at autopsy from individuals of different ages. However, no significant differences in hyaluronan concentrations were found. The distribution of hyaluronan polymer sizes in various extracts did not change as a function of age as measured by size exclusion chromatography. However, major differences in hyaluronan extractability did occur as a function of age. Sequential extraction was performed utilizing 1) 0.1% Triton X-100, 2) 4 M guanidine-HCl, and 3) papain digestion, to release species of hyaluronan progressively more tightly associated with tissue. With advancing age, hyaluronan polymers became progressively more tissue associated. The proportion of hyaluronan released after papain digestion increased from 7% of the total in fetal to 23% of the total in senescent skin. Finally, histolocalization of hyaluronan was examined in full-thickness sections of human skin of different ages. Major differences in compartmentalization were found. We conclude that neither the concentration nor polymer size of hyaluronan changes as a function of age. However, enhanced association with tissue occurs, presumably through hyaluronan-binding proteins and alterations in the histolocalization of hyaluronan. Such observations may underlie some of the changes in human skin that occur with aging.

Cytochemical localization of hyaluronan in rat and human skin mast cell granules

Rat and human skin were processed either by osmium tetroxide/microwave fixation followed by embedding in epoxy resin or by glutaraldehyde/microwave fixation and low-temperature embedding in Lowicryl K4M. Hyaluronan-binding proteins and link proteins (LP) were isolated from bovine nasal cartilage, coupled to 15-20-nm gold particles and employed as markers in a one-step post-embedding procedure for identifying hyaluronan (hyaluronic acid) at the ultrastructural level. Mast cell granules of both species were labeled. The specificity of the hyaluronan-binding probes was demonstrated by treatment of sections with testicular hyaluronidase, Streptomyces hyaluronidase, and chondroitinase ABC, and pre-incubation of probes with hyaluronan oligosaccharides. The results suggest that mast cell granules are a rich source of hyaluronan; this finding may account for the striking concurrence of hyaluronan accumulation with a mastocytotic condition in many tissues undergoing pathologic changes.

Ultrastructural localization of hyaluronan in myelin sheaths of the rat central and rat and human peripheral nervous systems using hyaluronan-binding protein-gold and link protein-gold

Neural tissue of central (rat spinal cord) and peripheral origin (rat sciatic nerve, nerve fascicles of rat skin and iris and of human conjunctiva) was processed by osmium tetroxide/microwave fixation and embedded in epoxy resin. Hyaluronan-binding proteins and link proteins coupled to 15-20-nm gold particles were used as markers in a one-step post-embedding procedure for identifying hyaluronan (hyaluronic acid) at the ultrastructural level. All myelin sheaths in both rat and human material were found to be intensely labelled. The specificity of the hyaluronan-binding probes was demonstrated by the total loss of labelling following treatment of sections with hyaluronidase or by preincubating either the probes with hyaluronan oligosaccharides or the sections with unlabelled hyaluronan-binding protein. The identified hyaluronan appears to be located extracellularly, but is precise role here remains to be elucidated.

Localization of hyaluronan in various muscular tissues. A morphological study in the rat

The histochemical distribution of hyaluronan (hyaluronic acid, HYA) was analysed in various types of muscles in the rat by use of a hyaluronan-binding protein (HABP) and the avidin-biotin/peroxidase complex staining procedure. Microwave-aided fixation was used to retain the extracellular location of the glycosaminoglycan. In skeletal muscles, HYA was detected in the connective tissue sheath surrounding the muscles (epimysium), in the septa subdividing the muscle fibre bundles (perimysium) and in the connective tissue surrounding each muscle fibre (endomysium). HYA was heterogeneously distributed in all striated muscles. In skeletal muscles with small fibre dimensions (e.g., the lateral rectus muscle of the eye and the middle ear muscles), HYA was predominantly accumulated around the individual muscle fibres. Perivascular and perineural connective tissue formations were distinctly HYA-positive. In cardiac muscles, HYA was randomly distributed around the branching and interconnecting muscle fibres. In comparison, smooth muscle tissue was devoid of HYA.