Preservation of functioning human thyroid "organoids" in the scid mouse. IV. In vivo selection of an intrathyroidal T cell receptor repertoire.

To study the in vivo influence of thyroid cells on the T cell receptor repertoire in human autoimmune thyroid disease, we mixed lymphocyte-free thyrocytes (approximately 1.2 x 10[6]) from patients with Graves' disease with autologous peripheral blood mononuclear cells (PBMC; approximately 1.5 x 10[6]) and transplanted this mixture sc into scid mice while suspended in a basement membrane gel (approximately 0.4 ml). Controls included mice that received either thyrocytes only or PBMC only. The resulting artificial mixed cell thyroid organoids were explanted after 5 weeks, and their T cell receptor repertoire was examined. Of a total of 63 organoids constructed, 60 were recovered (95.2%). Total RNA was extracted and then analyzed by reverse transcription-PCR primarily for human T cell receptor (hTcR) Vbeta gene expression using 21 hTcR Vbeta amplimers. A restricted pattern of hTcR Vbeta gene expression was found, with 6 Vbeta genes (Vbeta5, 6, 7, 8, 13.1, and 18) predominantly expressed [P < 0.05, by ANOVA on ranks and Student-Newman-Keul's (SNK) test]. PBMC and control organoids showed no preferential selection of particular hTcR V gene-expressing T cells. This reductionist, mixed cell, thyroid model reflected earlier observations in human and murine autoimmune thyroid diseases in which a bias in hTcR V gene family expression had been observed. The model permitted in vivo T cell selection and/or enrichment of potentially disease relevant human T cells.

Successful production of intrathyroidal human T cell hybridomas: evidence for intact helper T cell function in Graves' disease.

We have developed a series of human intrathyroidal T-T cell hybridomas and evaluated their phenotypic characteristics and lymphokine secretions in order to further understand the role of the T cell in Graves' disease. Mitogen-stimulated T cell blasts were generated from intrathyroidal lymphocyte preparations and fused with a hypoxanthine-, aminopterin-, and thymidine-sensitive variant of the Molt 4 human leukemia T cell line. The resulting intrathyroidal T-T cell hybridomas and T-T cell hybridomas obtained from normal peripheral blood mitogen-stimulated T cell blasts were expanded and tested for their biological function. None of the generated T cell hybridomas exhibited antigen-specific IL-2 secretion when stimulated with autologous thyrocytes, although 60% of the hybridomas expressed CD3 antigen and the T cell receptor alpha/beta heterodimer. However, 9 intrathyroidal and 11 peripheral blood T cell hybridomas secreted a factor(s) that significantly enhanced immunoglobulin G secretion in vitro (P less than 0.005, by Student-Newman-Keuls test; mean +/- SEM, 338 +/- 60% increase). In summary, we have successfully used a technique that allows the construction of T-T cell hybridomas derived from intrathyroidal T cell cultures. The data demonstrated that a predominance of helper factor-secreting T cells were available for fusion within the Graves' thyroid gland. Such observations are further evidence for intact T cell help within the thyroid gland of patients with Graves' disease.

Intrathyroidal T cell clones from patients with autoimmune thyroid disease.

We cloned activated T cells from thyroid tissue of patients with autoimmune thyroid disease. After separation on 40% Percoll gradients, T cells were cultured for 2-7 days with T cell growth factor (interleukin 2; 20 U/mL) and cloned by limiting dilution (0.3 cells/well) in the presence of irradiated autologous peripheral blood mononuclear cells (PMC; 10,000/well) as feeder cells. Fifty-seven clones were successfully expanded and tested for reactivity, cytotoxicity, helper/suppressor function, and phenotype. In the reactivity assays clones were tested for responses to autologous and allogeneic PMC, thyroid cells, human thyroglobulin (hTg), and microsomal antigen. Two distinct patterns of functional T cell clones emerged from these characterization studies. Seventy-five percent of T cell clones recovered from Graves' disease thyroid tissue (n = 21) were of helper-induced (CD4+/4B4+) phenotype, and most were effective immunoglobulin helper clones. Fifty percent of Graves' T cell clones responded to autologous PMC, and 33% had a proliferative response to autologous thyroid cells. No cytotoxic clones were derived from Graves' thyroid tissue. By contrast, intrathyroidal T cell clones from patients with autoimmune thyroiditis (n = 36) were 59% suppressor/cytotoxic (CD8+) phenotype, 17% suppressed immunoglobulin secretion, and 55% were cytotoxic to allogeneic blast cells. Fifty-five percent of clones also responded to autologous PMC, and one clone was nonspecifically autocytotoxic. In the thyroid antigen proliferation assays 11% of thyroiditis clones reacted to human thyroglobulin, but none responded to microsomal antigen. Two clones were cytotoxic to autologous but not allogeneic thyroid cells. These data demonstrate that the majority of intrathyroidal T cells in autoimmune thyroid disease are autoreactive. However, small numbers of thyroid-specific T cell clones are present within the thyroid of such patients; they are principally helper-inducer T cells in Graves' disease thyroid and cytotoxic T cells in autoimmune thyroiditis.

Preservation of functioning human thyroid organoids in the scid mouse: 1. System characterization.

We have characterized a system for preserving reconstituted human thyroid follicles in vivo by transplanting human thyrocytes into mice with severe combined immunodeficiency (scid mice). Human thyroid organoids were constructed from thyroid monolayer cells derived from both normal and abnormal thyroid tissue, and embedded within a basement membrane preparation which was then transferred sc to scid mice. As early as 4 weeks, and as late as 3 months post transplantation, histological examination of human thyroid organoids demonstrated widespread neofollicle formation and colloid accumulation which stained positive for human thyroglobulin (hTg). Although there were no changes in murine serum T4 levels; the transplanted thyroid epithelial cells secreted hTg into the scid mouse circulation (with an average level of 29 micrograms/L). In addition, hTg release was stimulated in vivo by ip administration of recombinant human TSH (0.1-1.0 IU/mouse) achieving greater than 20-fold increases in scid mouse serum hTg levels. In situ immunohistochemistry showed that thyroid organoids derived from patients with Graves' disease retained scattered lymphocytes in peripolesis with the thyroid epithelial cells; those lymphocytes were identified as human T cells of the memory (CD45RO +), rather than naive, type. These data demonstrate that functioning human thyroid organoids establish in scid mice and remain responsive to TSH stimulation. The system offers a unique opportunity to examine human thyroid-lymphocyte interaction within the confines of a predictable animal model.

Intrathyroidal accumulation of T cell phenotypes in autoimmune thyroid disease.

In this study we have correlated peripheral T cell subset phenotypes with intrathyroidal lymphocyte accumulation in patients with autoimmune thyroid disease (Graves' and Hashimoto's disease). Our study utilized euthyroid family members for one of our control groups (n = 48) thus significantly limiting familial, but not disease-specific, influences on these T cell phenotypes. Our principal new observations were found only in patients with Graves' disease. As previously reported, there was a decrease in CD8+ (suppressor/cytotoxic) T cells in the peripheral blood of patients with untreated hyperthyroid Graves' disease (n = 27) (mean +/- SEM, 19 +/- 1.1% in patients compared with 25 +/- 1.2% in controls, p = 0.03), a finding not observed in treated, euthyroid Graves' disease patients or their relatives. However, the relative number of CD8+ T cells, assessed by CD4:CD8 ratios, was increased in the intrathyroidal T cell populations (n = 10), when compared to normal and patient peripheral blood. There were no consistent changes in total CD4+ (helper) T cells in the peripheral blood of patients with treated and untreated Graves' disease but a reduction in CD4+2H4+ (suppressor-inducer) T cells was seen in patients undergoing surgery for Graves' disease (13 +/- 6.9% compared with 39 +/- 3.4%). Again, however, this T cell subset was increased within the target organ of the same patients (41 +/- 5.9%). These data point to either a selective accumulation, or a specific "homing", of certain T cell subsets within the thyroid gland of patients with Graves' disease where T cell differentiation may be strongly influenced by antithyroid drug treatment and the local immune environment.

Low-flow cardiopulmonary bypass: importance of blood pressure in maintaining cerebral blood flow.

BACKGROUND: During cardiopulmonary bypass (CPB), global hypoperfusion of the brain has been shown to result in ischemic insult and subsequent neurologic injury. METHODS: We measured cerebral blood flow during independent manipulations of arterial blood pressure and pump flow rate to determine which of these hemodynamic parameters regulates cerebral perfusion during CPB. Seven adolescent baboons were placed on CPB and cooled to 28 degrees C. Pump flow rate and arterial blood pressure were altered in varied sequence to each of four conditions: (1) full flow (2.23 +/- 0.06 L.min-1.m-2, mean +/- standard deviation) at high pressure (61 +/- 2 mm Hg), (2) full flow (2.23 +/- 0.06 L.min-1.m-2) at low pressure (24 +/- 3 mm Hg), (3) low flow (0.75 L.min-1.m-2) at high pressure (62 +/- 2 mm Hg), and (4) low flow (0.75 L.min-1.m-2) at low pressure (23 +/- 3 mm Hg). During each of these hemodynamic conditions cerebral blood flow was measured by washout of intracarotid xenon 133. RESULTS: Cerebral blood flow was greater at high blood pressure than at low pressure during CPB both at low flow (34 +/- 8.3 versus 14.1 +/- 3.7 mL.min-1.100 g-1) and full flow (27.6 +/- 9.9 versus 16.8 +/- 3.7 mL.min-1.100 g-1) (p < 0.01). At comparable mean arterial blood pressure, alteration of pump flow rate produced no significant change in cerebral blood flow. CONCLUSIONS: These results indicate that during low-flow CPB, mean arterial pressure should be maintained within the brain's autoregulatory range to maximize cerebral blood flow.

Cerebral blood flow is determined by arterial pressure and not cardiopulmonary bypass flow rate.

BACKGROUND: During cardiopulmonary bypass, global hypoperfusion of the brain has been shown to result in ischemic insult and subsequent neurologic injury. Furthermore, outcome after focal cerebral ischemia depends on collateral circulation, which is determined by the parameters of global perfusion. We therefore measured cerebral blood flow during independent manipulations of arterial blood pressure and pump flow rate to determine which of these hemodynamic parameters regulates cerebral perfusion during cardiopulmonary bypass. METHODS: Seven anesthesized baboons were placed on cardiopulmonary bypass and cooled to 28 degrees C. Pump flow rate and arterial blood pressure were altered in varied sequence to each of four conditions: (1) full flow (2.23 +/- 0.06 L.min-1.m-2, mean +/- standard deviation) at high pressure (61 +/- 2 mm Hg), (2) full flow (2.23 +/- 0.06 L.min-1.m-2) at low pressure (24 +/- 3 mm Hg), (3) low flow (0.75 L.min-1.m-2) at high pressure (62 +/- 2 mm Hg), and (4) low flow (0.75 L.min-1.m-2 at low pressure (23 +/- 3 mm Hg). During each of these hemodynamic conditions cerebral blood flow was measured by washout of intracarotid xenon. RESULTS: Cerebral blood flow was greater at high blood pressure than at low pressure during cardiopulmonary bypass both at low flow (34 +/- 8.3 versus 14.1 +/- 3.7 mL.min-1 x 100 g-1) and full flow (27.6 +/- 9.9 versus 16.8 +/- 3.7 mL.min-1 x 100 g-1) (p < 0.01). At comparable mean arterial blood pressures alteration of pump flow rate produced no changes in cerebral blood flow. CONCLUSIONS: These results indicate that cerebral blood flow during moderately hypothermic cardiopulmonary bypass is regulated by arterial blood pressure and not pump flow rate.

Stromal keratitis complicating anterior membrane dystrophy.

Recurrent erosion of the cornea has been well documented in patients with nontraumatic anterior membrane dystrophies of various types. We examined five patients who, in addition to an erosion, developed stromal keratitis. Three of these patients were subjected to a complete microbiologic workup, but the lesions were all sterile. The lesions healed with conservative treatment of patching and, in some cases, a soft contact lens. Stromal keratitis should be recognized as a complication of the non-traumatic recurrent erosion syndrome, which in turn is frequently associated with anterior membrane dystrophy. The finding of such anterior membrane changes in either eye will lead to the correct diagnosis and treatment of the affected eye.

The effect of allograft rejection after penetrating keratoplasty on central endothelial cell density.

We identified all patients who had undergone penetrating keratoplasty for keratoconus and were being observed longitudinally (N = 174). During the follow-up period, 57 of 174 patients (33%) showed evidence of an allograft rejection episode, which occurred at an average of eight months after the operation. We analyzed specular photographs of the corneal endothelium, taken before and after the first allograft rejection episode. A significant decrease in endothelial cell density was observed (11.8%, P less than .0001). As a control, we analyzed all available specular photographs from patients with keratoconus who showed no evidence of allograft rejection after penetrating keratoplasty. The observed endothelial cell density decrease (11.8%) in patients with keratoconus undergoing allograft rejection exceeded that found in the control subjects (6.8%) during a comparable time period (P = .06). Severe allograft rejection episodes resulted in a decrease in endothelial cell density that exceeded expected loss significantly (14.8% compared with 6.9%, P = .01), whereas mild allograft rejection episodes were not associated with a loss in endothelial cell density exceeding that expected (1.8% compared with 6.5%, P = .34).

Isolated cerebral hypothermia by single carotid artery perfusion of extracorporeally cooled blood in baboons.

OBJECTIVE: Hypothermia has been demonstrated to protect the brain from ischemic or traumatic injury. Previous efforts to induce cerebral hypothermia have relied on techniques requiring total body cooling that have resulted in serious cardiovascular derangements. A technique to selectively cool the brain, without systemic hypothermia, may have applications for the treatment of neurological disease. METHODS: After induction of general anesthesia in 12 baboons, the right common carotid artery and ipsilateral femoral artery were each occlusively cannulated and joined to a centrifugal pump. In a closed-circuit system, blood was continually withdrawn from the femoral artery, cooled by water bath, and infused through the common carotid artery with its external branches occluded. Pump flow was varied so that right carotid pressure approximated systemic blood pressure. In six animals, perfusate was cooled to decrease right cerebral temperature to < 19 degrees C for 30 minutes. In six animals, right cerebral temperature was decreased to < 25 degrees C for 3 hours. In those six animals, 133Xe was injected into the right carotid artery before, during, and after hypothermia. Peak radioactivity and washout curves were recorded from bilateral cranial detectors. Systemic warming was accomplished by convective air and warm water blankets. Esophageal, rectal, and bilateral cerebral temperatures were continuously recorded. RESULTS: In animals cooled to < 19 degrees C, right cerebral temperature decreased from 34 degrees C to 18.5 +/- 1.1 degrees C (mean +/- standard deviation), P < 0.01, in 26 +/- 13 minutes. Simultaneously, left cerebral temperature decreased to 20.7 +/- 1.6 degrees C. During 30 minutes of stable cerebral hypothermia, esophageal temperature decreased from 35.1 +/- 2.3 degrees C to 34.2 +/- 2.2 degrees C, P < 0.05. In animals cooled to < 25 degrees C, right cerebral temperature decreased from 34 degrees C to 24.5 +/- 0.6 degrees C in 12.0 +/- 6.0 minutes, P < 0.01. Simultaneously, left cerebral temperature decreased to 26.3 +/- 4.8 degrees C. After 3 hours of stable cerebral hypothermia, esophageal temperature was 34.4 +/- 0.5 degrees C, P < 0.05. Right hemispheric cerebral blood flow decreased during hypothermia (26 +/- 16 ml/min/100 g) compared to values before and after hypothermia (63 +/- 29 and 51 +/- 34 ml/min/100 g, respectively; P < 0.05). Furthermore, hypothermic perfusion resulted in a proportionally increased radioactivity peak detected in the left cerebral hemisphere after right carotid artery injection of 133Xe (0.8 +/- 0.2:1, left:right) compared to normothermia before and after hypothermia (0.3 +/- 2 and 0.3 +/- 1, respectively; P < 0.05). Normal heart rhythm, systemic arterial blood pressure, and arterial blood gas values were preserved during hypothermia in all animals. CONCLUSION: Bilateral cerebral deep or moderate hypothermia can be induced by selective perfusion of a single internal carotid artery, with minimal systemic cooling and without cardiovascular instability. This global brain hypothermia results from profoundly altered collateral cerebral circulation during artificial hypothermic perfusion. This technique may have clinical applications for neurosurgery, stroke, or traumatic brain injury.

Thyroid organoid formation in simulated microgravity: influence of keratinocyte growth factor.

The generation of artificial human thyroid tissues in suspension (low-shear environment, present in simulated microgravity [MG] and generated by a rotary cell culture system [RCCS]), was enhanced by increasing medium kinematic viscosity with a (3% v/v) suspension of extracellular matrix (basement membrane extract [BME]) in serum-free medium to generate artificial human thyroid organoids. Recombinant human keratinocyte growth factor (KGF, 7 ng/mL) facilitated human thyrocyte aggregation and three-dimensional (3-D) differentiation. There was an MG-associated decrease in extractable DNA that was reversed after addition of keratinocyte growth factor (KGF). In simulated MG, the increase in extractable DNA after KGF addition was up to 170% over non-KGF control cultures. In contrast, monolayer cultures in unit gravity showed a maximum DNA increase of 39% after KGF addition. Morphologically, differentiated thyroid neofollicles displayed polarization and were located in close proximity after 2 weeks of culture. Immunogold labeling with antibody to human thyroglobulin (Tg) revealed staining of follicular lumina and secretory vesicles, and a time-dependent increase in human Tg was detected in the culture media. Culture under simulated MG thus allowed direct visualization of KGF-facilitated thyrocyte/extracellular matrix interaction. Such artificial human thyroid organoids-generated in MG and in the presence of KGF-structurally resembled natural thyroid tissue. The above findings may have implications for autoimmune thyroid disease where KGF (if, for example, secreted locally by intraepithelial gammadelta T cells among other cells) may contribute to thyroid cell growth.

Liquid hybridization analysis of TSH receptor mRNA in normal and abnormal human thyroid tissues.

Radiolabeled human TSH receptor (hTSHR) cRNA probes encoding nucleotides 37-2298 and 37-209, with unlabeled sense RNA control segments, were used in a liquid hybridization assay and found to be highly specific and sensitive enabling detection of 0.5 fmol of hTSHR mRNA. Using normal human thyroid monolayer cell cultures we calculated that the average number of TSHR mRNA transcripts was 95 +/- 5 per cell under in vitro basal conditions. We found no significant difference between the hTSHR mRNA concentrations of intact normal human thyroid tissue (n = 4) and specimens from patients with multinodular goiter (n = 5) and Graves' disease thyroid tissues (n = 5) (23.0, 25.2, and 27.6 fmol of hTSHR and mRNA/mg total cellular RNA, respectively). However, there was a relative deficiency of hTSHR mRNA in some samples of thyroid papillary carcinoma tissue (n = 5) (12 fmol of hTSHR mRNA/mg total RNA, p < 0.05). The hTSHR 37-2298 probe was fully protected in normal and abnormal thyroid tissues, consistent with the absence of large deletions or insertions in the hTSHR mRNA transcripts but additional bands were present, consistent with the production of splicing variants.

Penetrating keratoplasty for corneal scarring due to herpes zoster ophthalmicus.

We retrospectively studied the postoperative results in nine patients with corneal scarring due to herpes zoster ophthalmicus who underwent penetrating keratoplasty. This was a highly selected group that satisfied all of the following criteria: (a) absence of active disease of the ocular surface and eyelids, (b) intraocular pressure under control, and (c) absence of active keratouveitis. Penetrating keratoplasty after herpes zoster ophthalmicus may do well in patients with long preoperative quiescent periods in whom these restrictive preoperative criteria are observed.

A controlled trial of esmolol for the induction of deliberate hypotension.

Twenty-five patients scheduled for lumbar fusion or cerebrovascular surgery were enrolled in an open label treatment controlled study comparing blood pressure and heart rate responses during deliberate hypotension with either esmolol or nitroprusside during steady-state N2O/isoflurane anesthesia. The first 5 patients were empirically assigned to the esmolol group; the remaining 20 patients were randomized to receive either esmolol or nitroprusside. The target of 15% reduction in mean arterial pressure (MAP) from baseline determined during anesthesia was attained with esmolol 195 +/- 10 micrograms/kg/min (mean +/- SEM) for the group (n = 15) or nitroprusside 1.9 +/- 0.3 micrograms/kg/min for the nitroprusside group (n = 10). Nitroprusside use was associated with a 15.9 +/- 5.3% increase in heart rate compared to a 12.1 +/- 2.2% decrease in the esmolol group (p = 0.0001 between groups). Upon termination of the hypotensive infusions, nitroprusside patients had a MAP increase of 13.9 +/- 5.5% above baseline (p less than 0.05 compared to prehypotension) while the 7.4 +/- 3.5% increase in the esmolol group was not statistically significant. Although 30% of nitroprusside patients overshot their baseline MAP by more than 25%, no esmolol patients had this degree of rebound. One esmolol patient had a brief period of atrial premature contractions. No patient in either group suffered any adverse reaction to hypotension. It is concluded that in moderate doses esmolol is a safe and effective hypotensive agent during isoflurane anesthesia, with no reflex tachycardia and no significant potential for rebound hypertension. A MAP reduction of 30% from preanesthesia baseline was readily obtained with this combination.