Hypercoagulation and thrombophilia in liver disease.

A complex balance exists between endogenous procoagulants and the anticoagulant system in liver disease patients. Hypercoagulable events occur in cirrhosis patients despite the well-known bleeding diathesis of liver disease. These events may be clinically evident, such as in portal vein thrombosis or pulmonary embolism, but these conditions may also be a silent contributor to certain disease states, such as portopulmonary hypertension or parenchymal extinction with liver atrophy as well as thrombosis of extracorporeal circuits in dialysis or liver assist devices. Moreover, liver disease-related hypercoagulability may contribute to vascular disease in the increasingly common condition of non-alcoholic fatty liver disease. Despite the incidence of these problems, there are few widely accessible and practical laboratory tests to evaluate the risk of a hypercoagulable event in cirrhosis patients. Furthermore, there is little research on the use of commonly accepted anticoagulants in patients with liver disease. This article is a result of an international symposium on coagulation disorders in liver disease and addresses several areas of specific interest in hypercoagulation in liver disease. Critical areas lacking clinical information are highlighted and future areas of research interest are defined with an aim to foster clinical research in this field.

Hepatitis C virus genotype testing in paraffin wax embedded liver biopsies for specimen identification.

Despite advances in medical technology, careful specimen identification is still a fundamental principle of laboratory testing. If pathological samples are mixed up, especially in the case of extremely small biopsy samples, large amounts of time and energy may be wasted in correctly identifying the specimens. Recently, two liver biopsy specimens were mixed up in this department, and a new pathological technology was used to resolve the issue. Liver biopsy was performed on two patients with hepatitis C virus (HCV) infection. During sample transfer or tissue processing, the biopsy specimens were mixed up. Because the ABO blood group of the two patients was identical (type AB), the specimens were subsequently identified by analysing the HCV genotypes. RNA extracted from the paraffin wax embedded liver specimens was examined by a polymerase chain reaction based HCV genotype assay. This enabled the correct identification of the specimens, and each patient received the appropriate treatment on the basis of the accurate diagnosis.

Levels of tau phosphorylation at different sites in Alzheimer disease brain.

The microtubule-associated protein tau is abnormally hyperphosphorylated in Alzheimer's disease (AD) brain. To date, 21 phosphorylated sites of tau have been identified. In the present study the levels of phosphorylation at Ser199/Ser202, Thr231/Ser235, Ser262/Ser356 and Ser396/Ser404 of tau in AD brain homogenate and its 100,000 x g supernatant were determined using radioimmuno-dot-blot assay. In homogenate, Ser199/Ser202 and Ser262/Ser356 were phosphorylated to similar level and were more phosphorylated than Thr231 or Ser396/Ser404. In supernatant, there was no significant difference in phosphorylated tau level among the investigated sites except for Thr231/Ser235 which was least phosphorylated. These results suggest that Ser199/Ser202 and Ser262/Ser356 are major sites of phosphorylation of tau in AD brain.

Development of an animal model for neuroleptic malignant syndrome: heat-exposed rabbits with haloperidol and atropine administration exhibit increased muscle activity, hyperthermia, and high serum creatine phosphokinase level.

The neuroleptic malignant syndrome (NMS) is a life-threatening complication of neuroleptic treatment. To elucidate the pathogenesis of NMS, an animal model has been developed. Experimental rabbits treated with haloperidol (1 mg/kg) by intramuscular injection, were studied for the diagnostic symptoms of increased muscle rigidity, elevated body temperature, and high serum creatine phosphokinase (CPK) level. Administration of haloperiodol (1 mg/kg) and atropine (0.4 mg/kg), and exposure to high ambient temperature (35 degrees C) induced a significant increase in electromyographic activity with muscle rigidity similar to that observed in patients with NMS. Such rabbits also showed elevated body temperature and serum CPK value. In addition to the similarity of the signs and symptoms, all parameters measured (muscle rigidity, body temperature, and serum CPK level) were normalized by dantrolene treatment. The effectiveness of dantrolene in the experimental animal partially confirms the validity of this animal model for NMS. This experimental animal model for NMS may be useful to elucidate the pathogenesis of NMS.

Expression of platelet-derived growth factor and its receptor in livers of patients with chronic liver disease.

To find if platelet-derived growth factor contributes to liver fibrosis in chronic liver disease, we studied the expression of the B-chain of this cytokine and its beta-receptor in livers of patients with chronic hepatitis or cirrhosis. Seventeen patients were included in this study. Five specimens of liver tissue obtained during autopsy from subjects without liver disease were used as controls. The location of the peptides was identified by an immunohistochemical technique with monoclonal antibodies. Expression of mRNA for the B-chain was assessed by in situ hybridization. Cells stained for the B-chain and expressing its mRNA were identified as macrophages. In control tissues, only a few cells were stained. In the patients' specimens, most stained cells were in portal areas and their number increased with histologic liver damage. In intralobular areas, the stained cells were seen in regions of focal necrosis. Portal mesenchymal and perisinusoidal cells expressed beta-receptor. These cells were dense in periportal areas, where many myofibroblast-like cells were seen. These findings suggest that the B-chain of platelet-derived growth factor is released mainly by macrophages involved in inflammatory reactions. This cytokine probably acts on myofibroblast-like mesenchymal cells, and may be implicated in liver fibrosis in chronic liver disease.

Mixed germ-cell tumor of the brain. Pathologic study of six autopsy cases.

Intracranial mixed germ-cell tumors are rare. We describe the findings from six autopsies of patients with these tumors. The patients were all young at presentation (mean age, 16 years), and five of the six were male. Headache, vomiting, polyuria and diplopia were common symptoms. Radiographic evaluation demonstrated a mass on the midline of the brain. The patients were treated mainly with radiation, but survival (mean, 3.7 years) was not as long as predicted. At autopsy, the tumors occupied most of the ventricular spaces, and ranged from being well-circumscribed to invasive. All tumors contained both germinoma components and nongerminomatous germ-cell tumor components. Because the distribution of these components was not homogenous, at least two sections were necessary for the diagnosis. Immunoreactivity for placental alkaline phosphatase was found in all tumors. Immunostaining for human chorional gonadotropin, alpha-fetoprotein and carcinoembryonic antigen was usually associated with abnormally high serum levels of these tumors markers in life. A number of the cells in both kinds of tumor components expressed proliferating cell nuclear antigen, probably reflecting the intense malignant potential.

The effects of repetitive mild brain injury on cytoskeletal protein and behavior.

The purpose of this study was to examine the hypothesis if repetition of mild mechanical brain injury induces the pathological process related to Alzheimer's disease. After defining the magnitude of the subthreshold brain injury which does not induce brain tissue damage by a single hit, the subthreshold mild impact (1.0 atm) was repeated 7 times every 24 h. One week after the last impact, abnormal accumulation of microtubule-associated protein 2 (MAP2) and phosphorylated neurofilament 200 kD (p-NFH) was observed in neuronal perikarya and dendrites. One month after percussion, the number of MAP2-and p-NFH-positive neuronal perikarya was increased and observed in remote areas including the contralateral cortex and the hippocampus. Tau-1 immunoreactivity was increased in deep cortical neurons of the ipsilateral side after dephosphorylation, indicating the accumulation of phosphorylated tau in neuronal perikarya. The abnormal accumulation of cytoskeletal proteins in neuronal perikarya may be due to impaired axonal transport caused by mechanical brain injury. The behavioral study revealed that after repetitive mild percussion, rats show less efficient habituation to a new environment. It is suggested that the repetition of subthreshold mechanical brain injury may trigger cytoskeletal alteration related to neuronal degeneration.

An experimental study on hepatotoxicity of sclerosant ethanolamine oleate flowed into portal vein.

Although endoscopic injection sclerotherapy has been a main treatment option for gastroesophageal varices, intraportal inflow of the sclerosant, ethanolamine oleate, induce liver damage. The aim of this study was to clarify the liver damage due to intraportal inflow of ethanolamine oleate. Ethanolamine oleate suspension was injected into livers of male Wistar rats via the portal (ileocolic) vein. Degrees of liver damage were evaluated by serum levels of transaminases and by histological examination. Intraportal injection of ethanolamine oleate led to extensive liver necrosis, which was marked 1 day after the injection and recovered by 7 days after injection. Liver necrosis became severe as the dose of the injected sclerosant increased. Histologically, neither portal thrombosis nor embolism was evident. Carbon powder particles of India ink, which were injected together with ethanolamine oleate, reached and deposited in sinusoids of the necrotic portions of the liver. These findings suggested that the liver damage had not developed simply as a result of impairment of portal blood flow. Ethanolamine oleate may itself have direct hepatotoxic effects.

[Exercise-induced pathophysiological changes in asthmatic children. VIII. The changes of specific gravity of peripheral eosinophils and serum cortisol levels].

In order to investigate the mechanism of exercise-induced asthma (EIA) from the aspect of eosinophil function, we determined the changes in the peripheral eosinophil count and the specific gravity of the eosinophils in EIA patients, and also as a parameter of endocrine function, we determined the serum cortisol level. All parameters were analyzed in respect to time before and after inducement of exercise. The subjects selected for this study were 14 asthmatic children, an EIA positive group consisting of 8 subjects and 6 subjects in an EIA negative group. Eosinophil counts with a specific gravity less than 1.0825 gm/ml were recorded in respect to the time sequence of 15, 30, and 60 minutes after inducement of exercise. The eosinophil counts recorded were significantly higher in the EIA positive group in comparison to the EIA negative group. With progression of time after inducement of exercise, the number of eosinophils observed with a specific gravity of less than 1.0825 gm/ml tended to increase in the EIA positive group when compared to the results recorded before inducement of exercise. In respect to the course of time, 15 minutes after inducement of exercise, the serum cortisol level tended to decrease. At the point of 7 hours after inducement of exercise, the serum cortisol levels in the EIA positive group were significantly lower than the EIA negative group. These findings suggest that eosinophils and the endocrine system play an important role in EIA.

The stimuli releasing histamine from murine bone marrow-derived mast cells. 1. The presence of P2-purinoceptors.

We have examined the histamine-releasing effects of 4 different stimuli on murine bone marrow-derived mast cells (BMMC). We obtained 10(9) BMMC from one femur of a CBA/J mouse when it was cultured in the presence of conditioned medium from WEHI-3 cells for 4 weeks. When these cells were sensitized with monoclonal anti-DNP IgE antibodies, DNP35HSA antigen, ionomycin, thrombin and ATP induced 70%, 70%, 40% and 60% histamine release from BMMC, respectively. Thrombin induced rapid degranulation, whereas the kinetics of histamine release by other stimuli reached a plateau after 5 min. ADP, AMP and GTP as well as ATP but not adenosine caused histamine release from BMMC, suggesting the presence of P2-purinoceptors on these cells.

Neopterin is associated with plaque inflammation and destabilisation in human coronary atherosclerotic lesions.

BACKGROUND: Previous studies have shown that recent activation of the inflammatory response in coronary atherosclerotic lesions contributes to rapid progressive plaque destabilisation. Neopterin, a by-product of the guanosine triphosphate pathway, is produced by activated macrophages and serves as an activation marker for monocytes/macrophages. OBJECTIVE: To elucidate the role of neopterin in coronary plaque destabilisation by immunohistochemical study of the presence of neopterin in coronary atherectomy specimens obtained from patients with stable angina pectoris (SAP) and unstable angina pectoris (UAP). PATIENTS AND METHODS: All patients underwent atherectomy of the primary atherosclerotic lesions responsible for SAP (n = 25) and UAP (n = 25). Frozen samples were studied with antibodies against smooth muscle cells, macrophages, T cells, neutrophils and neopterin. RESULTS: In 22/25 patients with UAP, abundant neopterin-positive macrophages were found at the sites of coronary culprit lesions. However, in 25 lesions from patients with SAP, only 11 lesions showed neopterin positivity. Quantitatively, the neopterin-positive macrophage score was significantly higher (p<0.001) in patients with UAP than in patients with SAP. Moreover, the neopterin-positive macrophage score showed a significant positive correlation with the number of neutrophils or T cells, respectively (neutrophils, r = 0.55, p<0.001; T cells, r = 0.70, p<0.001). CONCLUSIONS: Neopterin can be considered as one of the significant factors in the process of plaque inflammation and destabilisation in human coronary atherosclerotic lesions. Its exact role in the process needs to be investigated further.

Mast cells in diffuse large B-cell lymphoma; their role in fibrosis.

AIMS: Mast cells (MCs) are associated with fibrosis in various diseases. MCs comprise two phenotypes: the MC(TC) phenotype contains tryptase and chymase, whereas the MC(T) phenotype contains tryptase. Interleukin (IL)-4 promotes the development of MC(TC) from the MC(T) phenotype. The aim of this study was to determine the relationship between MC phenotypes and fibrosis in diffuse large B-cell lymphoma (DLBCL). METHODS AND RESULTS: We examined the distribution and density of MCs in 50 DLBCL and 20 reactive lymph nodes, and evaluated MC phenotypes and IL-4-expressing cells. To detect MCs, immunohistochemistry for tryptase and chymase was performed. The 50 DLBCLs were histologically divided into three groups: no fibrosis (32 cases), reticular type (eight cases) showing reticular fibrosis, and bundle type (10 cases) showing collagenous bundles. The density of tryptase-positive MCs was higher than that of chymase-positive MCs. The densities of tryptase-positive and chymase-positive MCs in fibrotic areas were significantly higher than those in the cellular areas in the reticular and bundle groups. Double immunostaining revealed that MCs in DLBCL comprised MC(T) and MC(TC) phenotypes. Chymase-positive MCs and T lymphocytes expressed IL-4. Although there were few chymase-positive MCs in reactive lymph nodes, the density of tryptase-positive MCs was not different from that in the 'no fibrosis' group. CONCLUSIONS: Tryptase-positive and chymase-positive MCs are associated with fibrosis in DLBCL.

Oxidized phosphatidylcholine in alveolar macrophages in idiopathic interstitial pneumonias.

It has been suggested that oxidative stress plays a pathogenic role in idiopathic interstitial pneumonias. Macrophage- or neutrophil-derived oxidants seem to be important sources of oxidative stress in this group of inflammatory disorders. Recent experimental studies have revealed that oxidative injury during inflammation or apoptosis can change phosphatidylcholine of cell membrane into its oxidized form, which serves as a ligand for macrophage scavenger receptor CD36. Recently, we developed a monoclonal antibody against oxidized phosphatidylcholine. Using this novel antibody, we performed an immunohistochemical investigation to clarify the localization of oxidized phosphatidylcholine in lung tissues of idiopathic interstitial pneumonias and a relationship between oxidized phosphatidylcholine localization and CD36 expression. Lung specimens obtained from patients with desquamative (n = 8) or usual interstitial pneumonia (n = 15) were studied. Thirteen normal lung tissues were also examined as controls. Antibodies against oxidized phosphatidylcholine, CD36, epithelial cells, macrophages, and neutrophils were used as primary antibodies. The positive cell number was counted by computer-aided morphometry. While there were no oxidized phosphatidylcholine-positive cells in normal lungs, lungs of desquamative or usual interstitial pneumonia contained large numbers of oxidized phosphatidylcholine-positive cells in the alveolar spaces. Double-staining analysis revealed that most oxidized phosphatidylcholine-positive cells were macrophages. The oxidized phosphatidylcholine-positive cells were increased in association with the increase in the densities of macrophages (Rs = 0.87, p < 0.0001) and neutrophils (Rs = 0.89, p < 0.0001). Accumulated macrophages also showed distinct CD36 expression. These findings suggest that oxidative stress and the related product, oxidized phosphatidylcholine, play an important role in the pathophysiology of idiopathic interstitial pneumonias.

Carrageenan-induced pulmonary emphysema of rabbit.

A transbronchial injection of 0.75% carrageenan in physiologic saline induced pneumonia followed by emphysema in the insulted lobe. In the stages of pneumonia, scattered infiltration of polymorphonuclear leukocytes was seen throughout the affected lobe within a few days of treatment; later this was replaced by the accumulation of carrageenan-laden macrophages, which lasted for one to two months. Enlargement of alveoli and alveolar ducts appeared 2 weeks to 2 months after the treatment, and pulmonary emphysema was observed at 4 months. The lobes that were not treated with carrageenan were normal in appearance during both the pneumonia and the emphysema. Morphometric analysis of the lung at 4 months showed decrease of the alveoli and/or alveolar ducts and enlargement of their luminal spaces, also suggesting the development of emphysema. In contrast to various kinds of elastases that are known to produce emphysematous changes in animals, the elastolytic activity of carrageenan solution did not show any such effects, although in the homogenate of the lobes given carrageenan, a moderate but significant increase in the proteinase activities of alveolar macrophages are said to occur (Bowers et al. 1985). It was suggested that carrageenan-induced emphysema is a chronic disorder associated with both carrageenan toxicity and accumulated carrageenan-laden macrophages in the insulted lobes.

White matter changes in the gerbil brain under chronic cerebral hypoperfusion.

BACKGROUND AND PURPOSE: An animal model of chronic cerebral hypoperfusion was developed with coiled clips applied to both carotid arteries of adult Mongolian gerbils for between 1 week and 2 months. In the brain of this animal model, rarefaction of white matter with dilatation of the ventricles was frequently observed. To better understand the mechanism of white matter alteration under cerebral hypoperfusion, the chronological sequence of molecular changes in the cerebral white matter of the animal model was determined. METHODS: Specially designed coiled clips were placed around both carotid arteries of Mongolian gerbils to create stenosis without occlusion. Changes in levels of myelin basic protein (MBP) as a marker of myelin, neurofilament H (NFH) as a marker of axonal proteins, and glial fibrillary acidic protein (GFAP) in astroglia after 2 months of cerebral hypoperfusion were analyzed with Western blotting and enzyme-linked immunosorbent assay. RESULTS: Western blotting of the white matter after 2 months of hypoperfusion showed that the levels of MBP and NFH decreased, whereas that of GFAP increased. The time course of MBP and NFH changes determined with enzyme-linked immunosorbent assay revealed that the change of MBP preceded that of NFH. CONCLUSIONS: In the present study it was shown that the damage to myelin precedes that to the axon in the white matter in a chronic cerebral hypoperfusion animal model, suggesting that the change in myelin is the primary pathological event in the cerebral white matter under chronic hypoperfusion. The present study may help in understanding the mechanisms of white matter pathology in leukoaraiosis.