A morphological and immunohistological study of the human and rabbit appendix for comparison with the avian bursa

Intra-Tumoral CD8+:CD3+ Lymphocyte Density Ratio in Appendix Cancer Is a Tumor Volume- and Grade-Independent Predictor of Survival

BACKGROUND

The immune contexture of solid tumors plays a critical role in cancer progression and response to immunotherapy. However, immunologic characterization of appendiceal cancer (AC) has lagged behind advancements in other gastrointestinal malignancies. This study aims to define the AC immune microenvironment by quantifying CD3+ and CD8+ lymphocyte densities and assessing their prognostic significance.

METHODS

Archival tissue samples from 95 AC patients were analyzed using immunohistochemistry to assess CD3+ and CD8+ T cell densities and their ratios. Associations between lymphocyte density and clinical, pathologic, and oncologic variables were examined using Spearman's correlation, Kruskal-Wallis tests, and Cox proportional hazards analysis.

RESULTS

Tumor samples exhibited substantial immunologic heterogeneity with significant rightward skew. CD3+ and CD8+ densities were higher in low-grade tumors (p = 0.02 and p = 0.01, respectively) and low-grade histologic subtypes (p = 0.01 and p = 0.006). Lymphocyte density was inversely associated with patient age and was significantly lower in high-grade and non-mucinous tumors. The CD8+:CD3+ ratio emerged as an independent prognostic marker for progression-free survival (HR = 0.39, p = 0.004), whereas absolute CD3+ and CD8+ densities were less predictive.

CONCLUSIONS

This study highlights the diverse immune microenvironment in AC, with immune infiltration patterns correlating with tumor grade and histologic subtype. The CD8+:CD3+ ratio is a potential prognostic biomarker for patient stratification, underscoring its clinical significance. Future studies should expand immune biomarker panels and explore immunomodulatory therapies for lymphocyte-rich AC subsets.

Prior appendectomy and cerebral infarction as potential risk factors for recurrent ischemic colitis: A retrospective observational study

Background and Aim

Ischemic colitis (IC) is a benign disease associated with acute lower gastrointestinal bleeding and frequent recurrence. While several studies have investigated risk factors for IC onset, few have assessed the risk factors for recurrent IC. This study aimed to identify risk factors for recurrent IC.

Methods

Potential risk factors for recurrence were assessed by examining medical records and laboratory findings in this single-center retrospective study. We extracted the following data from the patients' medical records: patient characteristics, clinical signs and symptoms, laboratory findings, method of treatment, length of hospital stay, disease course, and the frequency of IC morbidities. Patients with IC were selected from a total of 439 312 patients over an 11-year period. Patients were divided into recurrent and nonrecurrent IC groups.

Results

In total, 225 patients met the diagnostic criteria for IC during the specified study period; of these, 204 patients (90.7%) and 21 patients (9.3%) were included in the nonrecurrent and recurrent IC groups, respectively. Univariate and multivariate analyses showed a significant association between IC recurrence and both cerebral infarction (P = 0.008, odds ratio [OR] = 6.3) and history of appendectomy (P = 0.0005, OR = 6.2). The median (interquartile range [IQR]) follow-up time for all patients was 1556 (353-2768) days; this was much longer than the median (IQR) time to recurrence of 291 (64-907) days in the recurrent IC group.

Conclusion

The results of this study suggest that prior cerebral infarction and appendicectomy may be risk factors for IC recurrence.

Expression of Homing Receptors in IgM+IgD+CD27+ B Cells and Their Frequencies in Appendectomized and/or Tonsillectomized Individuals

BACKGROUND

In humans, blood circulating IgM⁺IgD⁺CD27⁺ B cells are considered analogous to those described in the marginal zone of the spleen and are involved in important immunological processes. The homing receptors they express, and the organs involved in their development (for example, intestinal organs in rabbits) are only partially known. We recently reported that this population is heterogeneous and composed of at least two subsets: one expressing high levels of IgM - IgM^hi B cells - and another low levels - IgM^lo B cells.

OBJECTIVES

To evaluate the expression of homing receptors on IgD⁺CD27⁺ IgM^hi and IgM^lo B cells and quantify their frequencies in blood of control and appendectomized and/or tonsillectomized volunteers.

MATERIALS AND METHODS

Using spectral flow cytometry, the simultaneous expression of 12 previously reported markers that differentiate IgM^hi B cells and IgM^lo B cells and of α4β7, CCR9, CD22 and CCR10 were evaluated in blood circulating B cells of control and appendectomized and/or tonsillectomized volunteers.

RESULTS

The existence of phenotypically defined IgM^lo and IgM^hi B cell subsets was confirmed. They differentially expressed intestinal homing receptors, and the expression of α4β7 and CCR9 seems to determine new IgM subpopulations. IgM^lo and IgM^hi B cells were detected at lower frequencies in the appendectomized and/or tonsillectomized volunteers relative to controls.

CONCLUSIONS

Human blood circulating IgD⁺CD27⁺ IgM^lo and IgM^hi B cell subsets differentially express homing receptors, and it is necessary to investigate if mucosal organs are important in their development.

Issues for patchy tissues: defining roles for gut-associated lymphoid tissue in neurodevelopment and disease

Individuals diagnosed with neurodevelopmental conditions such as autism spectrum disorder (ASD; autism) often experience tissue inflammation as well as gastrointestinal dysfunction, yet their underlying causes remain poorly characterised. Notably, the largest components of the body's immune system, including gut-associated lymphoid tissue (GALT), lie within the gastrointestinal tract. A major constituent of GALT in humans comprises secretory lymphoid aggregates known as Peyer's patches that sense and combat constant exposure to pathogens and infectious agents. Essential to the functions of Peyer's patches is its communication with the enteric nervous system (ENS), an intrinsic neural network that regulates gastrointestinal function. Crosstalk between these tissues contribute to the microbiota-gut-brain axis that altogether influences mood and behaviour. Increasing evidence further points to a critical role for this signalling axis in neurodevelopmental homeostasis and disease. Notably, while the neuroimmunomodulatory functions for Peyer's patches are increasingly better understood, functions for tissues of analogous function, such as caecal patches, remain less well characterised. Here, we compare the structure, function and development of Peyer's patches, as well as caecal and appendix patches in humans and model organisms including mice to highlight the roles for these essential tissues in health and disease. We propose that perturbations to GALT function may underlie inflammatory disorders and gastrointestinal dysfunction in neurodevelopmental conditions such as autism.

Clinical, surgical, and pathological findings in client-owned rabbits with histologically confirmed appendicitis: 19 cases (2015-2019)

OBJECTIVE

To report clinical, surgical, and pathological findings in client-owned rabbits with histologically confirmed appendicitis.

ANIMALS

19 rabbits.

PROCEDURES

Medical records for client-owned rabbits that had a histologic diagnosis of appendicitis were reviewed.

RESULTS

Median age of the rabbits at presentation was 24.0 months (range, 4 to 84 months). Seventeen cases occurred during the summer and fall seasons. Decreased appetite (17/19 rabbits), abnormal rectal temperature (hyperthermia, 9/16 rabbits; hypothermia, 4/16 rabbits), hypocalcemia (8/11 rabbits), and hypoglycemia (7/15 rabbits) were common signs. Abdominal ultrasonography and CT findings were suggestive of appendicitis in 6 of 8 rabbits and in 1 of 2 rabbits, respectively. Of the 6 rabbits that received medical treatment, 3 died at 48 hours, 1 died at 24 hours after hospitalization, and 1 died at 10 days after presentation; 1 rabbit was alive at 1,030 days after presentation. Of the 8 rabbits that underwent appendectomy, 3 died before discharge from the hospital and 1 died 113 days after surgery; 4 rabbits were alive at 315, 334, 1,433, and 1,473 days after presentation. The remaining 5 rabbits either died or were euthanized before treatment could be instituted. In each of the 19 rabbits, the appendix had evidence of severe inflammation with mucosal ulceration, heterophilic inflammation, and necrotic debris.

CLINICAL RELEVANCE

For rabbits with decreased appetite and an apparently painful abdomen, hyperthermia, hypocalcemia, or hypoglycemia, appendicitis should be considered as a differential diagnosis. Further comparisons of medical and surgical treatments are required to establish treatment recommendations for rabbits with appendicitis.

Case Report: Spontaneous Appendicitis With Suspected Involvement of Klebsiella variicola in Two Pet Rabbits

Although laboratory rabbits are commonly used as models of appendicitis in man, spontaneous appendicitis was only described ante-mortem in one pet rabbit with an acute abdomen. The aim of this article is to describe two spontaneous cases of appendicitis in pet rabbits, to describe therapeutic appendectomy, and to discuss the microbial flora of the inflamed appendix. A 5-month-old intact female and a 16-month-old, neutered male were presented to the veterinary clinic with restlessness, anorexia, and reduced faecal output. The main clinical findings were restlessness, severe discomfort on abdominal palpation, a mid-abdominal palpable tubulous mass and an elevated rectal temperature. Blood analyses showed lymphocytosis, monocytosis, and hyperglycaemia. Radiography was inconclusive. Abdominal ultrasound revealed a presence of a tubular structure with wall thicknesses of 4.2 and 3.7 mm in the two rabbits, respectively. The tubular structure had a rounded, closed end, and a multilayered wall, suggestive of appendicitis. Due to metabolic acidosis and poor prognosis, the first rabbit was euthanized. In the 16-month-old rabbit, appendectomy was performed. Recovery was uneventful, and 4 h after surgery, the rabbit started to become normally active. Postoperative care consisted of fluid therapy, multimodal analgesia, supportive care and prokinetics. Follow-up examinations at 10 days, 1 month, and at 11 months after the surgery did not show any abnormal clinical or laboratory findings. Histopathological examination of appendices from both rabbits showed gangrenous appendicitis. Aerobic cultivation showed the presence of pure culture of Klebsiella variicola sensitive to enrofloxacin, marbofloxacin, tetracycline, cefuroxime, trimethoprim sulphonamide, neomycin, and gentamicin. Restlessness associated with anorexia, abdominal pain, palpable abdominal mass, hyperglycaemia, lymphocytosis, and elevated rectal temperature may be indicative of inflammation within the gastrointestinal tract. Abdominal ultrasound is recommended in rabbits with showing these clinical signs because radiography can be inconclusive. Appendicitis is a life-threatening condition, which should be included into the list of differential diagnoses; for the rabbit, an acute abdomen and gastrointestinal stasis syndrome and must be treated immediately. K. variicola may be associated with appendicitis in rabbits as a causative agent or in association with appendix intraluminal dysmicrobia.

The cecal appendix is correlated with greater maximal longevity in mammals

The cecal appendix had been considered as a useless vestige since Darwin's work, but recent research questioned this idea demonstrating that the cecal appendix appeared among the mammals at least 80 million years ago and has made multiple and independent appearances without any obvious correlation with diet, social life, ecology, or size of the cecum. However, functions and probable selective advantage conferred by this anatomical structure still remain enigmatic. We found, through analyses of data on 258 mammalian species, that cecal appendix presence is correlated with increased maximal observed longevity. This is the first demonstration of a correlation between cecal appendix presence and life history. Interestingly, the classical evolutionary theory of aging that predicts an increased longevity when the extrinsic mortality is reduced has been questioned several times, but recent comparative studies asserted its validity in the taxa, which experience age-dependent and density-dependent mortality, as in mammals. Thus, the cecal appendix may contribute to the increase in longevity through a reduction of extrinsic mortality. A lower risk of fatal infectious diarrhea is one of the most plausible hypotheses that could explain it. However, several hypotheses coexist about the possible functions of the cecal appendix, and our results provide new insights about this much-disputed question. In addition, we show that the cecal appendix arose at least 16 times and was lost only once during the evolutionary history of the considered mammals, an asymmetry that supports the existence of a positive selective of this structure.

Effects of Maternal Abdominal Surgery on Fetal Brain Development in the Rabbit Model

INTRODUCTION

Anesthesia during pregnancy can impair fetal neurodevelopment, but effects of surgery remain unknown. The aim is to investigate effects of abdominal surgery on fetal brain development. Hypothesis is that surgery impairs outcome.

METHODS

Pregnant rabbits were randomized at 28 days of gestation to 2 h of general anesthesia (sevoflurane group, n = 6) or to anesthesia plus laparoscopic appendectomy (surgery group, n = 13). On postnatal day 1, neurobehavior of pups was assessed and brains harvested. Primary outcome was neuron density in the frontal cortex, and secondary outcomes included neurobehavioral assessment and other histological parameters.

RESULTS

Fetal survival was lower in the surgery group: 54 versus 100% litters alive at birth (p = 0.0442). In alive litters, pup survival until harvesting was 50 versus 69% (p = 0.0352). No differences were observed for primary outcome (p = 0.5114) for surviving pups. Neuron densities were significantly lower in the surgery group in the caudate nucleus (p = 0.0180), but not different in other regions. No differences were observed for secondary outcomes. Conclusions did not change after adjustment for mortality.

CONCLUSION

Abdominal surgery in pregnant rabbits at a gestational age corresponding to the end of human second trimester results in limited neurohistological changes but not in neurobehavioral impairments. High intrauterine mortality limits translation to clinical scenario, where fetal mortality is close to zero.

The Impact of Appendectomy in Clostridium difficile Infection and Length of Hospital Stay

Introduction

We aim to investigate Clostridium difficile infection (CDI) recurrence, severity, complications, and length of hospital stay in patients with and without prior history of appendectomy who were admitted to the hospital with CDI.

Method

We analyzed retrospective data for 862 patients, 18 years and older, with C. difficile inpatients diagnosed between January 1, 2017 and December 31, 2018 and sorted into two groups, with or without prior appendicectomy, to look for outcomes such as recurrence, hospital stay, complications, and related death in each group and use statistical analysis for comparison.

Result

There were 862 patients admitted with CDI, of which 122 (14.2%) had a prior history of appendectomy and 740 (85.8%) did not. Patients with an appendectomy prior were older (median age of 75 vs. 69, p = 0.0033) and had a higher proportion of females (68.9% vs. 53.6%, p = 0.0017).

C. difficile recurrence in prior appendicectomy group vs. no appendectomy group was 12.3% and 9.3%, respectively, but no statistical difference was noted (p = 0.28). Also, there was no statistical difference in complications like ileus, colectomy, and mortality related to CDI in both groups. However, patients with appendectomies had significantly shorter hospital stays during C. difficile admission compared to patients without appendectomies (median of six days vs. seven days, p = 0.0014).

Conclusion

Our study shows that there is no statistical difference in the recurrence, severity, and complications of CDI in the presence or absence of the appendix but remarkably noted that people with prior appendicectomy had a shorter hospital stay.

Factors Involved in the Degeneration of Lymphoid Tissue in the Appendix

INTRODUCTION

Studies evaluating the age-related alteration of human appendix have been reported. Although the appendix shows a degeneration of lymphoid tissues with aging, the mechanism of action remains unclear.

MATERIAL AND METHODS

Surgically resected appendix tissues from patients with colon cancer, intestinal malrotation and ulcerative colitis (UC) were utilized for histological and flow cytometric analysis.

RESULTS

Histological analysis showed that aging may induce steatotic changes in the appendix. However, there was no clear association between appendiceal fibrosis and aging. Lymphoid follicles in the appendix may start to develop before 5 days of age, gradually mature, and eventually disappear with aging. Flow cytometric analysis clearly identified a lymphocyte population in the appendix at 5 days, 45 and 75 years of age, and lymphoid follicles were also confirmed histologically. In contrast, lymphoid population was rarely detectable in the appendix at 79 and 80 years of age, and no lymphoid follicles were present histologically. Interestingly, cytograms from a case at 5 days of age suggested the existence of immature immune cells, as forward scatter showed an increase in cell size of the lymphocyte population. Histological analysis in UC patients found submucosal fat in the appendix of a case 66 years of age. Lymphoid follicular formation and mucosal structure were disrupted in cases of 70 and 72 years of age. UC patients may be more susceptible to steatotic change. Cytograms from appendices of UC patients also supported these histological findings. Our study confirms previous results that lymphoid tissues in the appendix degenerate over time, and proposes that inflammatory insult may facilitate the degenerative process in patients with UC.

Comparing the rates of methane production in patients with and without appendectomy: results from a large-scale cohort

There is no clear study identifying the microbiome of the appendix. However, in other diverticular conditions, such as diverticulosis, methanogens appear important. We investigated whether patients who had undergone appendectomies had decreased levels of exhaled methane (CH₄). Consecutive patients who underwent breath testing (BT) from November 2005 to October 2013 were deterministically linked to electronic health records. The numbers of patients with CH₄ ≥ 1 ppm (detectable) and ≥ 3 and ≥ 10 ppm (excess) were compared between patients who did and did not undergo appendectomy using a multivariable model adjusted for age and sex. Of the 4977 included patients (48.0 ± 18.4 years, 30.1% male), 1303 (26.2%) had CH₄ ≥ 10 ppm, and 193 (3.9%) had undergone appendectomy. Appendectomy was associated with decreased odds of CH₄ ≥ 1, ≥ 3, and ≥ 10 ppm (ORs (95% CI) = 0.67 (0.47–0.93), p = 0.02; 0.65 (0.46–0.92), p = 0.01; and 0.66 (0.46–0.93), p = 0.02, respectively). Additionally, the percentage of CH₄ producers increased 4-fold from the first to ninth decade of life. This is the first study to report that appendectomy is associated with decreased exhaled CH₄. The appendix may play an active physiologic role as a reservoir of methanogens.

Ultrasound morphology of cecal appendix in pet rabbits

PURPOSE

Cecal appendix is the terminal part of cecum and is characteristic of rabbit, among domestic animals. The purpose of this work is to evaluate its morphology upon ultrasound.

METHODS

A prospective study was planned for the duration of approximately 1 year. Rabbits presented in the study period for abdominal ultrasound with no clinically evident alterations of the gastrointestinal tract were eligible for inclusion in the study. Abdominal ultrasound was performed under manual restrain with a high frequency linear probe (8-18 MHz).

RESULTS

Cecal appendix was visualized in 40/42 rabbits (95.2%) with median or left paramedian views. The wall appeared multilayered in accordance with normal bowel anatomy, and the luminal content showed in all cases an alimentary pattern. Measurement of appendix wall thickness (AWT) was possible in all 40 rabbits in which the appendix was visualized while measurement of the appendix diameter (AD) was possible in 39 rabbits. Reference intervals for AWT were 1.1-2.1 mm, and for AD were 3.9-8.8 mm. There was a negative correlation between age and AWT (r = - 0.35, P = 0.027) and a moderate positive correlation between AWT and AD (r = 0.71, P < 0.001).

CONCLUSIONS

Cecal appendix is recognizable via ultrasound in the vast majority of rabbits. We describe the normal morphological aspect of the appendix and we provide reference intervals for wall thickness and diameter of the appendix, in order to aid in the diagnosis of disorders of the appendix. The negative correlation between age and AWT indicates lower values of AWT associated with increasing age that could represent the physiological decrease in the immunitary function of the appendix in aged rabbits.

Intestinal macrophages in Peyer's patches, sacculus rotundus and appendix of Angora rabbit

The largest pool of macrophages in the body is harboured by the intestinal mucosa. As the principal phagocytic component of the immune system, macrophages are essential for maintaining mucosal homeostasis as they prevent commensal bacteria from adhering to mucosal epithelial cells. This study provides a RAM11 immunohistochemical and electron microscopic investigation of the existence, localization and distribution of intestinal macrophages in organized gut-associated lymphoid tissue (GALT), including Peyer's patches (PPs), the sacculus rotundus (SR) and the appendix, in the Angora rabbit. Although rabbit intestinal macrophages did not express the tissue macrophage marker macrosialin (CD68), they expressed RAM11. RAM11-positive intestinal macrophages were mostly localized to the subepithelial dome region, interfollicular area and germinal centres (GCs) of the GALT and the lamina propria or submucosa of the ileum and jejunum devoid of PPs and were also observed in the follicle-associated epithelium of PPs, but not in that of the SR and appendix. RAM11-positive macrophages containing engulfed apoptotic bodies were present in the GCs of the lymphoid follicles in the GALT. Electron microscopy further revealed multiple macrophages containing apoptotic bodies within the GCs of the follicles in the GALT. Some macrophage aggregations were observed in the GC and between the GC and the corona region of the follicles in the SR and appendix. Rabbit intestinal macrophages thus undertake both potent phagocytic activity and the efficient scavenging of apoptotic cells. Immunohistochemical data suggest that RAM11 can be reliably used for the determination of intestinal macrophages in the GALT of rabbits.

Characterization of New Zealand White Rabbit Gut-Associated Lymphoid Tissues and Use as Viral Oncology Animal Model

Rabbits have served as a valuable animal model for the pathogenesis of various human diseases, including those related to agents that gain entry through the gastrointestinal tract such as human T cell leukemia virus type 1. However, limited information is available regarding the spatial distribution and phenotypic characterization of major rabbit leukocyte populations in mucosa-associated lymphoid tissues. Herein, we describe the spatial distribution and phenotypic characterization of leukocytes from gut-associated lymphoid tissues (GALT) from 12-week-old New Zealand White rabbits. Our data indicate that rabbits have similar distribution of leukocyte subsets as humans, both in the GALT inductive and effector sites and in mesenteric lymph nodes, spleen, and peripheral blood. GALT inductive sites, including appendix, cecal tonsil, Peyer's patches, and ileocecal plaque, had variable B cell/T cell ratios (ranging from 4.0 to 0.8) with a predominance of CD4 T cells within the T cell population in all four tissues. Intraepithelial and lamina propria compartments contained mostly T cells, with CD4 T cells predominating in the lamina propria compartment and CD8 T cells predominating in the intraepithelial compartment. Mesenteric lymph node, peripheral blood, and splenic samples contained approximately equal percentages of B cells and T cells, with a high proportion of CD4 T cells compared with CD8 T cells. Collectively, our data indicate that New Zealand White rabbits are comparable with humans throughout their GALT and support future studies that use the rabbit model to study human gut-associated disease or infectious agents that gain entry by the oral route.

Development of immune organs and functioning in humans and test animals: Implications for immune intervention studies

A healthy immune status is mostly determined during early life stages and many immune-related diseases may find their origin in utero and the first years of life. Therefore, immune health optimization may be most effective during early life. This review is an inventory of immune organ maturation events in relation to developmental timeframes in minipig, rat, mouse and human. It is concluded that time windows of immune organ development in rodents can be translated to human, but minipig reflects the human timeframes better; however the lack of prenatal maternal-fetal immune interaction in minipig may cause less responsiveness to prenatal intervention. It is too early to conclude which immune parameters are most appropriate, because there are not enough comparative immune parameters. Filling these gaps will increase the predictability of results observed in experimental animals, and guide future intervention studies by assessing relevant parameters in the right corresponding developmental time frames.

Risk of new-onset type II diabetes after appendicectomy

BACKGROUND

Altered immune function after appendicectomy has been associated with autoimmune disease, even though the mechanisms are not clearly elucidated. This study aimed to investigate whether the frequency of new-onset type II diabetes was increased after appendicectomy in a case-control study.

METHODS

This was a retrospective cohort study from the Taiwan Longitudinal Health Insurance Database 2000. The relative risk was compared with that in the general population using population-based data. Each patient was tracked for a 3-year interval to identify those who developed type II diabetes. Cox proportional hazard regression analysis was used to assess the risk of type II diabetes during follow-up.

RESULTS

A total of 31,512 patients were included in the study, of whom 5252 had an appendicectomy (study cohort) and 26,260 were matched for comparison. Some 714 patients (2.3 per cent) developed type II diabetes during the 3-year follow-up, 161 in the study cohort (3.1 per cent) and 553 in the comparison cohort (2.1 per cent). The adjusted hazard ratio (HR) for type II diabetes in the study cohort was 1.45 (95 per cent c.i. 1.22 to 1.74). This increased risk was most pronounced in men (adjusted HR 1.47, 1.16 to 1.88) and in those with a perforated appendix (adjusted HR 2.28, 1.71 to 3.03), and applied only to patients younger than 65 years of age.

CONCLUSION

An increased risk of new-onset type II diabetes within 3 years after appendicectomy was found in patients aged less than 65 years. The risk was highest in men and in those with complicated appendicitis.

A glimpse towards the vestigiality and fate of human vermiform appendix-a histomorphometric study

INTRODUCTION

The vermiform appendix in human is considered to be a vestigial organ by most of the authors. Absence of appendix is already reported in Indian population. Whether the human appendix is performing any function is debatable but when present it can create trouble. So if there is no appendix we can escape the ill-effects of the organ. With this hope the study has been done to see whether the appendix is really going to be rudimentary or absent or not. Marerials and Methods: Length, external diameter, number of lymphoid follicles, maximum diameter of the follicle or submucous coat, thickening of the muscle coat and seromucosal thickening of freshly removed appendix from human cadavers were seen. After fixation in 10% formal saline tissues were stained with haematoxylin-eosin stain and photographs were taken. The results had been tabulated and statistically correlated.

RESULT

The parameters like number of lymphoid follicles, length and diameter all are changed as per the age advancement which is strictly indicating some functional activities of the organ which is against the idea of vestigiality of the appendix.

CONCLUSION

Human appendix cannot be called a vestigial organ unless the functional inactivity is proved. Lymphoid changes which occur after birth to provide the gut immunity is needed to be proved by further studies. There might be incidental absence or rudimentary appendix in human body, but that does not indicate that we would not have any appendix in future.

Increased risk of pulmonary tuberculosis among patients with appendectomy in Taiwan

The aim of this study was to determine whether there is a relationship between appendectomy and pulmonary tuberculosis in Taiwan. We designed a case-control study by analyzing the database from the Taiwan National Health Insurance Program. In total, we found 11,366 individuals (aged 20 years and older) with newly diagnosed pulmonary tuberculosis as the case group and 45,464 individuals without pulmonary tuberculosis as the control group from 1998 to 2011. The case group and the control group were matched on sex, age, and index year of diagnosing pulmonary tuberculosis. Using the multivariable unconditional logistic regression model, we measured the odds ratio (OR) and 95 % confidence interval (CI) for the risk of pulmonary tuberculosis associated with appendectomy and other comorbidities. After controlling for covariables, the multivariable unconditional logistic regression model disclosed that the OR of pulmonary tuberculosis was 1.4 in appendectomized patients (95 % CI = 1.13, 1.75) when compared to individuals without appendectomy. In further analysis, comorbidity with chronic obstructive pulmonary diseases (OR = 4.63, 95 % CI = 3.21, 6.68), pneumoconiosis (OR = 7.80, 95 % CI = 1.43, 42.5), chronic kidney diseases (OR = 5.65, 95 % CI = 1.79, 17.8), or diabetes mellitus (OR = 2.11, 95 % CI = 1.30, 3.44) increased the risk of pulmonary tuberculosis in appendectomized patients. Individuals with appendectomy are at a 1.4-fold increased risk of pulmonary tuberculosis. Comorbidities, including chronic obstructive pulmonary disease, pneumoconiosis, chronic kidney diseases, and diabetes mellitus, enhance the risk of pulmonary tuberculosis.

New insight into the origin of IgG-bearing cells in the bursa of Fabricius

The bursa of Fabricius is a primary lymphoid organ for B-cell development and gut-associated lymphoid tissue. After hatching, IgG-containing cells with reticular branches are found in the medulla of bursal follicles on frozen sections stained with anti-Cγ antibody, and IgM(+)IgG(+) B cells are detected in single-cell suspension of the bursa. IgG-containing cells in the medulla do not biosynthesize IgG and are composed of aggregated maternal IgG and environmental antigens. Then, those cells in the medulla are acknowledged as follicular dendritic cells retaining immune complexes. Also, it is presumed that IgM(+)IgG(+) B cells are generated by the attachment of immune complexes to IgM(+) bursal B cells because IgM(+)IgG(+) B cells are induced by antigen-dependent attachment of maternal IgG. Therefore, it is reasonable to suppose that immune complexes exert further B-cell differentiation in the medulla.

Diversification of the primary antibody repertoire begins during early follicle development in the rabbit appendix

Rabbits generate a diversified primary antibody repertoire by somatically mutating, in gut-associated lymphoid tissue (GALT), an initial repertoire that is limited by preferential rearrangement of the 3'-most IGVH gene segment. To determine when repertoire diversification begins in GALT, we performed in situ hybridization on neonatal rabbit appendix sections with an activation-induced cytidine deaminase (AID) riboprobe, because AID is required for the mutational processes that diversify the primary antibody repertoire. We first detected AID mRNA expression around 1 week of age, in the basal region of developing follicles. By PCR-amplifying V-D-J genes from AID mRNA(+) B cells isolated by laser capture microdissection, we found evidence of somatic hypermutation, and one likely instance of somatic gene conversion. Our results suggest that V-(D)-J gene diversification begins during early postnatal appendix development, in B cells stimulated to enter a proliferative program by signals derived from select intestinal commensals.

Immunohistochemical analysis of granzyme B in non-perforated appendicitis--short communication

The aim of the present study was to determine the expression ofgranzyme B in non-perforated appendicitis. Appendix biopsies were obtained from the patients with clinically diagnosed as acute appendicitis and subjects admitted for elective abdominal surgery. All biopsies from the patients were non-perforated and histologically divided into acute and non-acute appendicitis. Granzyme B expression was assessed immunohistochemically. The results showed that granzyme B expression in both acute and non-acute appendicitis was significantly lower than that in the control appendix tissues (P < 0.05). The expression of this cytotoxic protein in acute and non-acute appendicitis was comparable (P > 0.05). Therefore, the results of the present study suggest that reduced expression of granzyme B in non-perforated appendicitis may reflect low cytotoxic activities which may prevent tissue damage.

Expression and localization of rabbit B-cell activating factor (BAFF) and its specific receptor BR3 in cells and tissues of the rabbit immune system

Rabbits are widely used for vaccine development, and investigations of human infectious and autoimmune diseases such as Systemic Lupus Erythematosus (SLE). For these applications, we cloned, sequenced and expressed rabbit B-cell Activating Factor (BAFF), and localized BAFF in cells and tissues of the rabbit immune system. The rabbit homolog of the human BAFF binding site (miniBR3 peptide) within the BAFF-specific receptor BR3 was synthesized. This 26-residue core domain binds to recombinant rabbit BAFF protein. Flow cytometric analyses using purified recombinant rabbit BAFF combined with real-time PCR findings revealed that BAFF detected on peripheral blood B-cells from normal rabbits is probably complexed to BAFF receptors rather than produced by the B-cells. BAFF was detected in developing appendix of young rabbits by immunohistochemical staining suggesting that BAFF plays a role during the period following birth when rabbit B-cell development and pre-immune antibody repertoire diversification and selection is occurring.

Board-invited review: porcine mucosal immunity of the gastrointestinal tract

The gastrointestinal tract (GIT) constitutes one of the largest immunological organs of the body. The GIT must permit absorption of nutrients while also maintaining the ability to respond appropriately to a diverse milieu of dietary and microbial antigenic components. Because of the diverse population of antigenic components within the GIT, a sophisticated mucosal immune system has evolved that relies on collaboration between the innate and adaptive arms of immunity. The collaborative, mucosal immune effort offers protection from harmful pathogens while also being tolerant of dietary antigens and normal microbial flora. Knowledge with respect to porcine mucosal immunity is important as we strive to understand the interrelationships among GIT physiology, immunology, and the resident microbiota. The aim of this review is to provide a descriptive overview of GIT immunity and components of the mucosal immune system and to highlight differences that exist between the porcine species and other mammals.

Neutral detergent-soluble fiber improves gut barrier function in twenty-five-day-old weaned rabbits1

The effect of neutral detergent-soluble fiber level on gut barrier function and intestinal microbiota was examined in weaned rabbits. A control diet (AH) containing 103 g of neutral detergent-soluble fiber/ kg of DM included alfalfa hay as main source of fiber. Another diet (B-AP) was formulated by replacing half of the alfalfa hay with a mixture of beet and apple pulp resulting in 131 g of soluble fiber/kg of DM. A third diet (OH) was obtained by substituting half of the alfalfa hay with a mix of oat hulls and a soybean protein concentrate and contained 79 g of soluble fiber/kg of DM. Rabbits weaned at 25 d and slaughtered at 35 d were used to determine ileal digestibility, jejunal morphology, sucrase activity, lamina propria lymphocytes, and intestinal microbiota. Suckling 35-d-old rabbits were used to assess mucosa morphology. Mortality (from weaning to 63 d of age) was also determined. Villous height of the jejunal mucosa increased with soluble fiber (P = 0.001). Rabbits fed with the greatest level of soluble fiber (BA-P diet) showed the highest villous height/ crypt depth ratio (8.14; P = 0.001), sucrase specific activity (8,671 mumol of glucose/g of protein; P = 0.019), and the greatest ileal starch digestibility (96.8%; P = 0.002). The opposite effects were observed in rabbits fed decreased levels of soluble fiber (AH and OH diets; 4.70, 5,848 mumol of glucose/g of protein, as average, respectively). The lowest ileal starch digestibility was detected for animals fed OH diet (93.2%). Suckling rabbits of the same age showed a lower villous height/crypt depth ratio (6.70) compared with the B-AP diet group, but this ratio was higher than the AH or OH diet groups. Lower levels of soluble fiber tended (P = 0.074) to increase the cellular immune response (CD8+ lymphocytes). Diet affected IL-2 production (CD25+, P = 0.029; CD5+CD25+, P = 0.057), with no clear relationship between soluble fiber and IL-2. The intestinal microbiota biodiversity was not affected by diets (P >/= 0.38). Rabbits fed the B-AP and AH diets had a reduced cecal frequency of detection compatible with Campylobacter spp. (20.3 vs. 37.8, P = 0.074), and Clostridium perfringens (4.3 vs. 17.6%, P = 0.047), compared with the OH diet group. Moreover, the mortality rates decreased from 14.4 (OH diet) to 5.1% (B-AP diet) with the increased presence of soluble fiber in the diet. In conclusion, increased levels of dietary soluble fiber improve mucosal integrity and functionality.

A murine model of appendicitis and the impact of inflammation on appendiceal lymphocyte constituents

Data indicate that appendicectomy for intra-abdominal inflammation protects against inflammatory bowel disease (IBD). This suggests an important role for the appendix in mucosal immunity. There is no established model of appendicitis. We therefore developed a murine model of appendicitis and examined the effect of inflammation on appendiceal lymphocyte constituents. The caecal patch of specific pathogen-free (SPF)-Balb/c mice was transformed into an obstructed 'appendiceal pouch' by standardized suction and band ligation. Mice were killed and 'pouches' removed for histology and phenotypic analysis of leucocytes by flow cytometry. Serum C-reactive protein (CRP) was determined by enzyme-linked immunosorbent assay. All 'pouches' developed features resembling human appendicitis - mucosal ulceration, transmural inflammation with neutrophils, lymphocytes and occasional eosinophils, and serositis. These changes were most evident between days 7 and 10. There was significant elevation of serum CRP (8.0 +/- 0.3 ng/ml to 40.0 +/- 3.1 ng/ml; P < 0.01), indicating systemic inflammation. Following the initial neutrophil-predominant response, there was an increase in CD4(+) (15.3% +/- 1.2% to 31.0 +/- 2.0%; P < 0.01) and CD8(+) T lymphocytes (3.7% +/- 0.6% to 9.2 +/- 0.8%; P < 0.01). CD25(+) forkhead box P3 (FoxP3)(+) regulatory T lymphocytes were increased by 66% (P < 0.01). Furthermore, significant increases in CD8(+) FoxP3(+) regulatory T lymphocytes were restricted to younger mice (age < 10 weeks, P < 0.003). This is the first description of a murine model of appendicitis. Inflammation resulted in T lymphocyte accumulation associated with an increase in regulatory T lymphocytes, which might explain the age-dependent protective phenomenon. Further exploration will provide insights into the mechanisms of intestinal immune homeostasis and the immunopathogenesis of IBD.

De novo expression of MECA-79 glycoprotein-determinant on developing B lymphocytes in gut-associated lymphoid tissues

Rabbit is one of several species that depend on development of B lymphocytes in gut-associated lymphoid tissues for primary immunoglobulin-repertoire diversification. The rabbit appendix is an important site of early B-lymphocyte development. We previously reported that peripheral lymph node addressin detected by monoclonal antibody (mAb) MECA-79 played a role in recruitment of immature blood-borne B cells into neonatal rabbit appendix. Here, we report expression of an approximately 127 000 MW O-linked sulphated proteoglycan on developing B cells in appendix and Peyer's patches recognized by the mAb MECA-79. Binding of the mAb to B lymphocytes was sensitive to enzyme treatment with O-sialoglycoprotease and expression was partially inhibited by sodium chlorate, a metabolic inhibitor of sulphation. The proportions of MECA-79(+) B lymphocytes gradually increased from < 0.5% at 3 days to > 70% at 6 weeks in appendix and Peyer's patches. The proportions of MECA-79(+) B lymphocytes in spleen and peripheral blood were very low (0.5-2%). However, the MECA-79 determinant was detected on B cells in splenic germinal centres after immunization. In situ labelling of appendix cells showed that the MECA-79 determinant was expressed on fluorescein-labelled B lymphocytes that migrated from appendix into mesenteric lymph nodes. B-cell MECA-79 may be involved in interactions with T cells and/or dendritic cells. Alternatively, because we found that lymphatic endothelium in the thymus-dependent area of appendix, a site for lymphocyte exit, expressed P-selectin (CD62P), interaction of the MECA-79 determinant on B cells with CD62P may have a role in the exit of B lymphocytes from rabbit appendix.

CD5+ B cells are preferentially expanded in rabbit appendix: the role of CD5 in B cell development and selection

Although only a small proportion of mouse and human B cells are CD5(+), most adult rabbit B cells express CD5. However, CD5 was not detectable on the majority of B cells in neonatal appendix 1 and 3days after birth. Cell trafficking studies demonstrated that CD5(+) and CD5(-) CD62L(+) B cells from bone marrow migrated into appendix. There, CD5(+) B cells were preferentially expanded and predominated by approximately 2weeks of age. In mutant ali/ali rabbits, VHa2(+) B cells develop through gene conversion-like alteration of rearranged VH genes upstream of deleted VH1a2. Correlated appearance of individual CD5(+) germinal centers and VHa2(+) B-cells in mutant appendix suggests that CD5 binding positively selects cells with a2(+) framework regions that bind CD5. Following negative and positive selection, cells with diversified rearranged heavy- and light-chain sequences exit appendix, migrate to peripheral tissues and constitute the preimmune repertoire of CD5(+) B cells that encounter foreign antigens.

Regulated expression of peripheral node addressin-positive high endothelial venules controls seeding of B lymphocytes into developing neonatal rabbit appendix

Young rabbit appendix is a homologue of chicken bursa of Fabricius; both are crucial sites for preimmune B-cell repertoire diversification. Here, we report that appendix regulates precursor lymphocyte recruitment for further development by modulating the sites of extravasation. The total area of peripheral node addressin-positive (PNAd(+)) high endothelial venules (HEVs) increased from 1 day to 1 week after birth, remained constant up to 2 weeks and declined to a low and persistent amount by 3 weeks. In normal 1-week and manipulated 5-week appendix where growth of follicles was retarded, PNAd(+) HEVs were present in the basolateral sides of B-cell follicles whereas, in normal 5-wk-appendix these were restricted to T-cell areas. The PNAd was expressed on the lumenal surface of HEVs. The proportions of CD62L(+) B cells in appendix declined from approximately 40% at 3 days to 2-3% at 4 weeks. In lymphocyte transfer experiments, CD62L(+) B cells were preferentially recruited compared with CD62L(-) B cells, anti-PNAd antibody blocked migration of B cells by approximately 50%, and 100 times more B cells were recruited in 1-week compared to 6-week appendix. Thus, a unique spatiotemporal expression pattern of PNAd(+) HEVs is associated with development of B-cell follicles. This regulates migration of blood-borne B-lymphocytes into developing appendix by interacting with CD62L.

Esophageal tonsil: a novel gut-associated lymphoid organ

The esophageal tonsil of the chicken is a novel, significant element of the gut-associated lymphoid tissue (GALT). Its stable location and histological organization fulfills the meaning of the term "tonsil." The six-to-eight-isolated tonsillar units are located at the border of the esophagus and the proventriculus. The number of tonsillar units is identical with that of the esophageal folds. Each tonsillar unit consists of a crypt lined by lymphoepithelium and surrounded by dense lymphoid tissue, which is organized into T- and B-dependent regions, like peripheral lymphoid organs. The excretory ducts of the mucosal glands of the esophagus are frequently involved in the formation of the lymphoepithelium. The esophageal tonsil is anatomically located cranial to the stomach, unlike the other parts of the GALT. Therefore, it is continuously exposed to undigested environmental antigens, allergens, food, and infectious agents. To develop effective oral vaccines, the existence of the esophageal tonsil has to be taken into account.