Vascular lesions: possible pathogenetic basis of the generalized Shwartzman reaction.

Evidence of vascular injury was found in rabbits after a single small dose of endotoxin from Escherichia coli. Eighty percent of the treated animals developed circulating endothelial cells, leukopenia, and thrombocytopenia, and 50 percent had aortic endothelial lesions as determined by electron microscopy. Prior anticoagulation with heparin did not prevent this response. No control animals showed these abnormalities.

Selective arterial medial injury fails to produce intimal hyperplasia in experimental animals.

The hypothesis was tested, in rats and rabbits, that selective medial injury may lead to arterial intimal hyperplasia. Lesions were produced by passage of a micro-suture through the arterial wall without penetration to the lumen, or controls in which the suture did penetrate. Vessels were examined histologically at intervals up to 2 weeks after suturing. Only vessels with penetrating sutures developed intimal hyperplasia, suggesting that medial injury alone is insufficient for the production of arteriosclerosis.

Delayed consequences of endothelial removal from rabbit aortae.

One year after de-endothelialization of rabbit aorta by a balloon catheter, the damaged areas show arteriosclerotic thickening. In the study described here, aortae from six rabbits were examined 2 years after the single injury. Three had advanced atherosclerotic lesions. All the animals had been fed standard rabbit chow, and the five tested did not have hypercholesterolemia when they were sacrificed. Apparently vascular injury alone is sufficient basis for development of atherosclerotic disease in the rabbit.

Monitoring heparin therapy--a role for the chromogenic assay.

Heparin therapy was evaluated by simultaneous determinations of the activated partial thromboplastin time (APTT), and plasma heparin levels by chromogenic assay. These tests showed good correlation (r = 0.73) in patients on heparin alone. However, in the presence of concurrent warfarin administration, r fell to 0.37, reflecting an additional warfarin effect upon the APTT. Furthermore, the studies confirmed the increased heparin requirement in patients with pulmonary embolization.

Long-term effects of deendothelialization of rabbit aorta: in vitro synthesis of DNA, protein, and lipid.

To study the long-term local effects of a single balloon catheter deendothelialization of the aorta in the rabbit, the incorporation of [3H]leucine and [3H]thymidine into protein and DNA, respectively, and [14C]acetate and [14C]mevalonate into sterols was measured in incubations of intima-media sections prepared from vessels taken 1 year following the procedure. The uptake of [3H]thymidine by the tissue was essentially the same as in the nonballooned controls, but the incorporation of [3H]leucine and [14C]acetate into tissue residue (proteins and glycoproteins) was approximately nine times and four times control values, respectively. At the same time, sections from the ballooned animals incorporated over six times the amount of radioactive acetate into nonsaponifiable lipids and cholesterol than did controls. In animals ballooned 3 months before sacrifice, when about half of the aortic luminal surface was covered with endothelium, intima-media tissue from both covered and uncovered areas showed increased uptake of labeled precursors into protein, nonsaponifiables, and cholesterol but there was no significant difference in incorporation between reendothelialized and nonendothelialized areas. The persistence of increased metabolic activity in the vessel following the loss of endothelium could be a contributing factor in the atherogenic process.

The influence of the pituitary on arterial intimal proliferation in the rat.

The formation of arteriosclerotic fibromusculoelastic intimal thickening following arterial de-endothelialization is well documented. Recent findings, both in vitro and in vivo, suggest that platelets are a major participant in the pathogenesis of this lesion by releasing a mitogen to medial smooth muscle cells (SMC). This mitogen results in SMC migration to and proliferation within the intima. A similar mitogen has been described as originating in brain and pituitary tissue. We now report that, in hypophysectomized rats with normal platelet counts, intimal hyperplasia is markedly delayed; pair-fed intact controls normally develop lesions. It therefore appears that the pituitary gland plays a significant role in the experimental arteriosclerotic response.

Platelet interaction with human umbilical cord vascular basement membrane.

The basement membrane of the human umbilical vein was studied by electron microscopy with respect to its ultrastructure, susceptibility to digestion by collagenase or trypsin, and reactivity with human platelets. Electron microscopic examination of this vessel showed a continuous reticulated basement membrane which morphologically resembled those of mammalian capillaries and rabbit heart valves. The vascular endothelium was removed by freezing and thawing, thus uncovering the underlying connective tissue. The vessels were sliced into rings which were incubated with collagenase or trypsin. The basement lamella appeared to be susceptible to digestion by either enzyme. Platelet interaction with exposed vascular basement mambrane was studied by rotating frozen-thawed everted and noneverted rings in anticoagulated whole human blood. In heparinized or citrated blood, large aggregates of degranulated platelets adhered to collagenous controls; in contrast, the test rings with exposed basement membrane were partially covered with a monolayer of platelets which appeared to retain discoid or spherical shape and granules. In EDTA-anticoagulated blood, the collagen control rings accumulated a platelet monolayer, whereas little or no adhesion occurred on the basement membrane surface. In this system the basement membrane of the human umbilical vein appears to be a poor platelet reactive surface as compared to collagen.

Intimal injury and regrowth in the rabbit aorta; medial smooth muscle cells as a source of neointima.

The present study was undertaken to determine the mechanism of neointima formation in rabbit arteries subjected to extensive endothelial desquamation. Endothelial cells were selectively removed from the abdominal aorta by passing an inflated balloon catheter through the vessel. The healing response was then studied serially for up to a week, when neointima formation had provided a virtually complete cover. In en face preparations, the early neointimal cells appeared in random locations; they did not develop in apposition to residual, healthy endothelium. The possibility of blood cell colonization was explored by inserting killed aortic homografts. Since these homografts showed neointima formation only close to the site of junction with the normal aorta and as a direct extension of healthy endothelium, the likelihood of significant blood cell colonization was deemed small. Histologic and electron microscopic sections provided evidence that the early neointimal cells in the healing aorta were derived from medial smooth muscle cells. Healing of the injured arterial intima was accompanied by thickening instead of prompt restoration to normal, and the thickened intima resembled an arteriosclerotic plaque. The present study thus supports the concept that arteriosclerosis is a disease involving proliferation of medial smooth muscle cells.

Side-chain oxidation of lipoprotein-bound [24,25-3H]cholesterol in the rat: comparison of HDL and LDL and implications for bile acid synthesis.

The purpose of the study was to test the hypothesis that high density lipoprotein (HDL) cholesterol would be more easily oxidized in vivo than low density lipoprotein (LDL) cholesterol. Homologous plasma was incubated with [24,25-3H]cholesterol and fractionated by ultracentrifugation to obtain HDL and LDL each labeled with [3H] free sterol. HDL and LDL labeled with [24,25-3H]cholesteryl esters were prepared by ultracentrifugation of plasma from donor rats injected 24 hr previously with [24,25-3H]cholesterol in propylene glycol. These four labeled lipoproteins were administered to recipient rats. It was found that more tritium oxide (3H2O) was produced after the HDL doses than after the corresponding LDL doses, from 2--3-fold more when lipoprotein free cholesterol was labeled and from 2--6-fold more when lipoprotein cholesteryl esters were labeled. More 3H2O was produced from free cholesterol-labeled lipoproteins than from cholesteryl ester-labeled lipoproteins. Since oxidation of cholesterol is a measure of bile acid formation, it is concluded that under the conditions of the study HDL-cholesterol is a better precursor of bile acids than LDL-cholesterol.

In vitro synthesis of DNA, protein, and lipids by the de-endothelialized rabbit aorta.

The uptake of [3H] leucine, [3H] thymidine, [14C] acetate, and [14C] mevalonic acid by aortic intima media from normal rabbits and from rabbits subjected to a single balloon de-endothelialization as measured 6 days, 2 months, and 4 months after treatment to determine how long the injury-induced stimulation of incorporation of these precursors into tissue components persisted beyond 6 days, the time of maximum proliferative response of the smooth muscle cells. We found that [3H] thymidine incorporation (indicative of DNA synthesis and the potential for cell proliferation) was about three times greater in the de-endothelialized tissue than in the control tissue 6 days after vessel injury, but that by 2 months it was normal. Labeled leucine incorporation into the de-endothelialized tissue (a measure of protein synthesis) was eight times higher than normal at the time of maximum proliferative response to injury (6 days), and showed no decrease under identical incubation conditions in ballooned tissue obtained 2 months after de-endothelialization; it continued high at 4 months. Both [14C] acetate and [14C] mevalonate uptake into lipids by the aortic tissue were enhanced by the injury; this increased incorporation was still evident at 4 months. Thus, de-endothelialization of the aorta triggers a vessel wall response characterized by augmented protein synthesis and lipogenesis, which persists at least 4 months after injury and at least 2 months after DNA synthesis has normalized.

Pseudothrombocytopenia masking true thrombocytopenia.

Pseudothrombocytopenia owing to platelet clumping is usually associated with blood specimens anticoagulated with EDTA. It may also be seen if specimens possessing IgM cold agglutinins are processed at room temperature. A patient with a temperature-independent, EDTA-independent agglutinin is reported whose pseudothrombocytopenia was masking true thrombocytopenia. A technique for blood collection when evaluating similar cases is described.

Platelet cytoskeleton: immunofluorescence studies on ADP and collagen-activated platelets.

Immunofluorescence studies reveal that platelet changes induced by adenosine diphosphate and collagen do not include the reorganization of the cytoskeleton in such a way as to expose actin, alpha-actinin, or vinculin. However, when such platelets were made permeable by saponin, these cytoskeletal proteins were present. In studies with collagen, fluorescence was observed along the fibers at areas of platelet adhesion and where no platelets were seen by phase microscopy. No fluorescence was observed with collagen treated with platelet-poor plasma. Scanning electron microscopy of collagen samples treated with platelet-rich plasma revealed a fibrillar meshwork with single platelets, platelet aggregates, and nodular structures that were smaller in size than individual platelets. These nodular structures may represent remnants of platelets still attached to the collagen after platelet detachment has occurred. These tenacious collagen-platelet membrane-binding sites have associated with them cytoplasmic alpha-actinin and vinculin, proteins that have been proposed by others to anchor actin filaments to the plasma membrane.