Impaired T cell functions during amphibian metamorphosis: IL-2 receptor expression and endogenous ligand production.

T cell functions are impaired during defined developmental stages of amphibian metamorphosis (Marx et al., 1987). Here we show, using a fluorescent anti-human IL-2 receptor antibody and flow cytometry, that during these stages, the splenocytes of Xenopus laevis, the South African clawed toad, have a progressively diminished capacity to express IL-2 receptors (IL-2R), after in vitro lectin stimulation. Preincubation with human rIL-2 specifically blocks binding of the anti-IL-2R antibody. Separation of an endogenous ligand bound to the IL-2R leads to a substantial increase in available epitope recognized by the anti-IL-2R antibody when pre- and postmetamorphic splenocytes are employed, but not when splenocytes of the prometamorphic stages are treated similarly. Thus, the cells from the prometamorphic stages are not producing significant quantities of the ligand. Finally, we demonstrate that human rIL-2 is not by itself mitogenic in the toad, but it can act as a co-stimulator of antigen-induced mitogenesis. Thus, an absence of an endogenous ligand (autologous IL-2?), coupled with a reduced capacity to express IL-2 receptors may be responsible for impaired T cell clonal expansion in metamorphosing Xenopus. Inhibition of T cell functions during this period is vital, since adult cells forming within the larval body bear surface proteins not found on larval cells (Flajnik et al., 1986).

Apoptosis and the cell cycle in Xenopus laevis: PHA and PMA exposure of splenocytes.

T cell receptor (TCR) ligation and protein kinase C (PKC) activation stimulate proliferation and modulate apoptosis in both mammalian and amphibian lymphocytes. The potential relationship between apoptosis and the cell cycle in mature Xenopus laevis splenic lymphocytes is addressed by monitoring apoptosis and DNA synthesis over time, using incorporation of propidium iodide (PI) and flow cytometry. Aliquots of the same populations of cells are followed after exposure in vitro to phytohemagglutinin (PHA) or phorbol 12-myristate 13-acetate (PMA). Significant increases in apoptosis preceed those in DNA synthesis by 12 to 16 h following exposure to both reagents. Since apoptosis preceeds DNA synthesis, these dying cells clearly do not need to enter the S phase of the cell cycle before becoming apoptotic, in contrast to mammalian T cells. Another striking difference is that the reagent with weaker mitogenic properties in this species, PHA, is significantly a more potent apoptogen, than the strong mitogen, PMA. The two phenomena then appear to be inversely related in Xenopus cells. Data on DNA synthesis suggest independence of the two phenomena, as DNA synthesis is stimulated in direct proportion to the strength of each reagent as a mitogen. Mature mammalian T-cells undergo apoptosis only when previously activated. The Xenopus lymphocytes examined were not deliberately activated by exposure to antigen or lectin. PMA, a cancer promoter in mammals, usually 'rescues' mammalian cells from apoptosis, but stimulates apoptotic increases in Xenopus cells. Thus, mature Xenopus lymphocytes may be more readily stimulated to die by cancer inducing agents than mammalian lymphocytes. This could make them less susceptible to transformation into immortalized cancer cells. This characteristic may considerably contribute to the observed resistance to spontaneous and chemically-induced neoplasia in wild type, non-isogeneic or non-inbred Xenopus.

The time course, localization and quantitation of T- and B-cell mitogen-driven apoptosis in vivo.

Apoptosis has very recently been visualized in situ in a mammalian thymus and spleen. We report here the first in situ visualization, localization and quantitation of the time course of mitogen-altered basal levels of apoptosis within the thymus and spleen of a vertebrate. Adult Xenopus leavis, South African clawed toads, were injected intraperitoneally with either the T-cell mitogen, Concanavalin (Con) A, or the B-cell mitogen, lipopolysaccharide (LPS). Controls, reflecting the basal level of apoptosis of both organs, were injected with isotonic phosphate-buffered saline for amphibians (APBS). ConA and LPS failed to enhance the nearly 2% apoptotic rate in the thymic cortex, which is made up largely of immature lymphocytes, but it did double the base level of 2% apoptosis in the mature lymphocytes of the medulla, particularly along the corticomedullary boundary. In the lymphoid splenic white pulp, the 2% basal level was exceeded slightly after ConA treatment, while the 6% basal lymphoid apoptotic rate in the red pulp was enhanced 7-fold in 12 h. LPS induced lymphocytic apoptosis in the partly erythropoietic red pulp of the spleen after 12 h but did not effect the white pulp. Extensive macrophage engulfment of apoptotic cells was apparent in both the thymus and the spleen.

Interleukin-2-induced mortality during the metamorphosis of Xenopus laevis.

In anuran metamorphosis, histoincompatible adult cells arise within an immunocompetent larval body. However, the larvae are unresponsive to these altered-self cells. The basis for this tolerance is an issue of considerable interest. While a loss of tolerance in mammalian pregnancy may initiate localized abortion, since the entire metamorphic amphibian is involved, there is the potential for total body self-destruction. Metamorphosing Xenopus laevis, the South African clawed toad, produce an internal corticosterone environment that induces T-cell anergy. This impairment may save the animal from immune self-destruction. Here we examine the capacity of recombinant gene produced human interleukin 2 (IL-2) to substitute for, or restore the level of autologous IL-2, as a further test of whether the altered-self tolerance found during metamorphosis may rely on corticosteroid-induced anergy. We find that the capacity of rIL-2 to break this tolerance and stimulate mortality is low, unless it is accompanied by antigenic co-stimulation. A study of sections of experimental and control animals revealed lymphocyte and mast cell increases within the kidney, particularly in the region of the coelomoduct, perhaps reflecting autoimmune reactivity responsible for the mortality.

Expression of a Fas-like proapoptotic molecule on the lymphocytes of Xenopus laevis.

Ligation of the externally expressed Fas (APO1/CD95) molecule will initiate programmed cell death (apoptosis), in many mammalian developing and adult cells. Fas-induced apoptosis has not been demonstrated with the cells of any non-mammalian vertebrate. We immunostained suspensions of splenocytes from adult Xenopus laevis, the South African clawed toad, with a polyclonal rabbit anti-human Fas antibody raised against the amino acid residues 321-335 of human Fas. The binding was specific, as it was dramatically reduced by preincubation of the antibody with the Fas peptide used to make it, but not with a Fas-ligand (FasL) peptide. The binding was enhanced after in vitro exposure of the splenocytes to phytahemagglutinin (PHA), a T cell mitogen and apoptogen in this species. Sections of developing Xenopus larval tissue were also immunostained with the polyclonal rabbit anti-human Fas antibody. Consistent binding of thymocytes and splenocytes was not observed until early metamorphosis in these immunological sites. A monoclonal mouse anti-human Fas antibody, previously used to stimulate apoptosis in mammalian cells, induced significant levels of apoptosis in adult Xenopus splenocytes and additionally, bound specifically to a splenocyte extract, as assayed by ELISA. Thus, a molecule on Xenopus splenocytes shares both structural and functional homologies with human Fas, indicating the evolutionary conservation within vertebrates of this means of initiating apoptosis.

In situ lymphocyte apoptosis in larval Xenopus laevis, the South African clawed toad.

During Anuran metamorphosis larval structures regress, adult structures form anew and impaired T cell immune functions are noted, as are alterations in endogenous glucocorticoid titers. In situ histological data, after staining for DNA fragmentation, reveal patterns of lymphocyte suicide in the thymus and spleen of non-antigenically challenged, laboratory bred, developing larvae, that do not correlate with either impaired immune functions or plasma glucocorticoid titers. Apoptotic levels in the thymus are high in premetamorphic stages, low during prometamorphosis and high again, after metamorphic climax, reflecting a periodic removal of thymocytes. Lymphocytic apoptosis in the spleen is low during premetamorphosis, rises in prometamorphic stages, principally within the red pulp, reaching a peak at climax, before declining as metamorphosis is completed.

Apoptosis in thymus of adult Xenopus laevis.

Thymocyte apoptosis in adult Xenopus laevis is demonstrated on agarose gels and is quantified by propidium iodide incorporation using flow cytometry. Basal apoptotic levels are increased after in vitro exposure to a glucocorticoid, dexamethasone (DEX), and to the lectin, phytohemagglutinin (PHA). To determine the role that newly introduced antigenic determinants may play in this regard, a repertoire of altered-self antigens was created by exposing thymuses in vitro to trinitrobenzene sulfonic acid (TNBS) thereby derivatizing self-cells and proteins via 2,4,6-trinitrophenyl-acetic acid conjugation. An increase in apoptosis in TNBS-treated thymuses is observed. Thus, the thymocytes of adult Xenopus laevis are susceptible to apoptosis when induced by a glucocorticoid, a lectin, and by altered self, antigen activation.

The development of peripheral TNP-tolerance and suppressor function in Xenopus laevis, the South African clawed toad.

In adult Xenopus laevis, inducer- and effector-suppressor functions are located in the spleen. These peripheral suppressor functions must be established at this location near the end of metamorphosis, since both functions are in the thymus in premetamorphic and in developmentally-blocked metamorphosing larvae. This study examined whether TNP-conjugated self-antigens resulting from exposure to trinitrobenzene sulfonic acid (TNBS), will stimulate TNP-tolerance in premetamorphic, metamorphic, and in developmentally-blocked metamorphosing larvae. Premetamorphic and developmentally-blocked larvae produce little TNP-tolerance or peripheral suppressor function. However, when TNBS exposure includes the late stages of the metamorphic period, both TNP-tolerance and splenic anti-hapten suppressor function are demonstrable. Removal of suppressor function with cyclophosphamide prevents expression of tolerance, thus, they are functionally related. Suppressor function and tolerance both differentiate during the late metamorphic stages when new adult antigens are being expressed and incorporated into a library of self.

Phosphatidylserine expression on apoptotic lymphocytes of Xenopus laevis, the South African clawed toad, as a signal for macrophage recognition.

Inflammation is avoided in apoptosis by early removal of dying cells by macrophages (MOs). In mammalian cells, an early aspect of apoptosis is the translocation of phosphatidylserine (PS) from the inner leaflet of the cell membrane to the surface. PS recognition can serve as a signal for triggering removal of dying cells. PS expression on splenocytes and thymocytes of Xenopus laevis was quantified using FITC-Annexin and flow cytometry following exposure in vitro to several known apoptogens for this species. All apoptogens used induced PS expression. Dose dependency and the kinetics of PS expression following exposure to the calcium ionophore, A23187, were also examined. Peritoneal exudate cells (PEC's) were cultured with A23187-treated thymocytes to test MO capacity for recognition of PS. MO binding to apoptotic thymocytes was reduced following exposure of PEC's to a water soluble analogue of PS, phospho-L-serine. The presence of a phagocytic PS-dependent recognition system in amphibia is supportive of the evolutionary conservation of this function in mammals that is crucial in limiting inflammation induced by dying cells.

Apoptosis in the thymus of developing Xenopus laevis.

Metamorphosis in Xenopus laevis is a time when thyroxine and glucocorticoid levels rise, dramatic morphological and physiological changes take place, and tolerance is established to newly expressed adult antigens. In vitro exposure of thymocytes tested at different metamorphic stages, to the T-cell lectin, phytohemagglutinin (PHA), stimulates increased apoptosis, but incubation with the synthetic glucocorticoid, dexamethasone (DEX), fails in this regard. Altered-self antigenicity, following trinitrobenzene sulfonic acid (TNBS) treatment, increases apoptosis only in the late stages of metamorphosis. Developmentally blocked metamorphosing larvae demonstrate low thymic apoptotic rates that are also unaffected by in vitro exposure to DEX or by in vivo exposure to thyroxine, but are increased by PHA and in some individuals by TNBS. When released from blockade, their thymic apoptotic rates rise as progress through metamorphosis is renewed. Larval thymic apoptosis is glucocorticocoid- and thyroxine insensitive, but is lectin and altered-self antigen activated, particularly during postclimax stages.

Neoplasms of the large bowel following ureterosigmoidostomy.

A poorly differentiated adenocarcinoma of the rectum developed in a 43-year-old man 37 years after ureterosigmoidostomy for epispadias with urinary incontinence. The review of literature indicates that patients who have undergone ureterosigmoidostomy have an increased risk for the development of large bowel neoplasia. The median time interval between the procedure and the diagnosis of the neoplasm is 21 years, and the median age at diagnosis is 33 years. The majority of the lesions are malignant and seem to occur at the site of ureteric anastamosis. The suggested etiologic mechanisms and the clinical aspects of colonic neoplasia following ureterosigmoidostomy are discussed.

Pigmentary degeneration of the retina in the Hallervorden-Spatz syndrome.

Dizygotic twins developed a progressive neurologic disorder at age 6 months. When examined at age 7 1/2 years each had spastic quadriparesis and dystonia. Neither had ever spoken a complete sentence. The fundi showed bone spicule formation, a conspicuous choroidal circulation, and a striking accumulation of yellowish-white globular masses of varying sizes and shapes. Because our patients developed both the pigmentary degeneration and clinical signs of Hallervorden-Spatz syndrome at a much younger age than patients without retinopathy, we believe this case demonstrated a distinct nosologic entity.

Slit-lamp examination of the bedridden patient.

Slit-lamp examination of bedridden patients is facilitated by using a stretcher with the patient lying prone and holding the head erect.

Pigmentary macular degeneration with multifocal necrotizing encephalopathy.

A previously healthy 10-year-old girl suffered sudden, binocular visual deterioration. During the next few years her neurologic and visual condition progressively worsened and she developed hypertension, seizures, ataxia, and lactic acidemia, leading to death at the age of 16 years. Bilateral optic disk pallor was followed by the loss of the foveal reflex and pigmentary maculopathy, manifested as disorganization of the retinal layers, loss of ganglion cells, degeneration of the photoreceptors and nuclei, and irregular infiltration of the retina by pigment epithelial cells. The optic nerves and tracts showed central axonal loss. Bilateral, multifocal symmetric areas of cerebral atrophy and necrosis of the neuropil and neurons in the cerebral cortex, basal ganglia, and thalamus were observed; neurons persisted in the dorsal medulla, despite neuropil degeneration.

Diagnosis and surgical management of "H-type" tracheoesophageal fistula in infants and children.

By means of the new rod lens telescopic endoscopes, the diagnosis of H- or N-type tracheoesophageal fistula in infants and children can now be made definitively without the difficulties and complications previously described, and the numerous methods recommended in the literature, all of which have their inconsistensies, failures, errors, and dangers. Using these advanced endoscopes the fistula is demonstrated by bronchoscopy, a small Fogarty catheter is threaded through the opening in the trachea under direct view of the telescope and passed through the fistula into the esophagus. The balloon is inflated and the bronchoscope removed, leaving the catheter in place. A proper incision is then made in the neck or chest, depending on the location of the lesion, and the fistulous tract is quickly located by palpation of the balloon and catheter. Then with minimal and accurate dissection, correction is carried out.