C. Garbarsch

Serum YKL-40 is increased in patients with hepatic fibrosis

BACKGROUND/AIMS YKL-40, a mammalian member of the chitinase family, is a lectin that binds heparin and chitin. The function of YKL-40 is unknown, but it may function in tissue remodelling. The aims of this study were to assess the level of circulating YKL-40 in patients with various kinds and degree of chronic liver disease and its possible relation to liver fibrosis. METHODS Serum YKL-40 levels were determined by radioimmunoassay in 129 patients with suspected liver disease and related to histological findings and immunohistochemical staining of YKL-40 in a liver biopsy taken simultaneously with the blood sample. RESULTS The median serum YKL-40 was highest in patients with alcoholic cirrhosis (532 microg/l), in particular in patients with additional alcoholic hepatitis (740 microg/l). Patients with alcoholic cirrhosis, post-hepatitic cirrhosis (425 microg/l) and non-cirrhotic fibrosis (330 microg/l) had significantly higher serum YKL-40 than normal subjects (102 microg/l), patients with fatty liver (195 microg/l) or patients with viral hepatitis without fibrosis (174 microg/l). Serum YKL-40 was significantly (p<0.001) related to the degree of liver fibrosis with the highest levels in patients with moderate (466 microg/l) to severe (676 microg/l) fibrosis. Serum YKL-40 was also increased (p=0.018) in patients with slight fibrosis (270 microg/l) compared to patients without fibrosis. Immunohistochemical analysis demonstrated positive staining for YKL-40 antigen in areas with fibrosis, particularly areas with active fibrogenesis. YKL-40 staining was never found in hepatocytes. CONCLUSIONS Our study indicates that the increased serum YKL-40 in patients with liver disease of various degree and aetiology seems to reflect fibrosis and fibrogenesis.

Plasma YKL-40: A New Potential Marker of Fibrosis in Patients with Alcoholic Cirrhosis?

BACKGROUND YKL-40 (human cartilage glycoprotein-39, or 38-kDa heparin-binding glycoprotein) is a mammalian member of a protein family that includes bacterial chitinases. YKL-40 mRNA is expressed by human liver and may play a role in tissue remodelling. The aims were to assess whether circulating YKL-40 is released or extracted in the hepatosplanchnic system and to localize YKL-40 in liver tissue. METHODS Plasma YKL-40 was determined by radioimmunoassay in 25 patients with liver diseases (alcoholic cirrhosis (n = 20), chronic active hepatitis (n = 2), cirrhosis of unknown aetiology (n = 2), and fatty liver (n = 1) and in 18 subjects with normal liver function during a haemodynamic investigation with catheterization of liver vein and the femoral artery. Immunohistochemical studies of the localization of YKL-40 in cryostal liver biopsy specimens were obtained from eight other patients with alcoholic liver disease. RESULTS Plasma YKL-40 was significantly increased in patients with alcoholic cirrhosis (median, 523 micrograms/l; P < 0.001) compared with controls (106 micrograms/l), and plasma YKL-40 in the hepatic vein was higher (P < 0.01) than that of the artery in both the patients and controls, showing release of YKL-40 from the hepatosplanchnic area. The release rate of YKL-40 from the hepatosplanchnic area was higher in patients with liver disease than in controls (11.0 versus 2.1 micrograms/min, P < 0.05). Furthermore, the highest plasma YKL-40 levels were found in patients with a moderate or severe degree of liver fibrosis, and immunohistochemical studies showed positive staining for YKL-40 antigen in areas of the liver biopsy with fibrosis. CONCLUSIONS The increased plasma YKL-40 in patients with alcoholic cirrhosis may reflect the remodelling of liver fibrosis.

The distribution of YKL-40 in osteoarthritic and normal human articular cartilage

YKL-40, also called human cartilage glycoprotein-39, is a major secretory protein of human chondrocytes in cell culture. YKL-40 mRNA is expressed by cartilage from patients with rheumatoid arthritis, but is not detectable in normal human cartilage. The aim was to investigate the distribution of YKL-40 in osteoarthritic (n=9) and macroscopically normal (n=5) human articular cartilage, collected from 12 pre-selected areas of the femoral head, to discover a potential role for YKL-40 in cartilage remodelling in osteoarthritis. Immunohistochemical analysis showed that YKL-40 staining was found in chondrocytes of osteoarthritic cartilage mainly in the superficial and middle zone of the cartilage rather than the deep zone. There was a tendency for high number of YKL-40 positive chondrocytes in areas of the femoral head with a considerable biomechanical load. The number of chondrocytes with a positive staining for YKL-40 was in general low in normal cartilage. The present findings, together with previous observations, suggests that YKL-40 may be of importance in cartilage remodelling/degradation of osteoarthritic joints.

YKL‐40 in giant cells and macrophages from patients with giant cell arteritis

OBJECTIVE YKL-40, a mammalian member of the family 18 glycosyl hydrolases, is secreted by activated macrophages at a late stage of differentiation. Macrophages are present in inflammation of the arterial wall and are thought to participate in the pathogenesis of giant cell arteritis (GCA). The aim of this study was to evaluate whether macrophages and giant cells of patients with GCA produce YKL-40, and whether serum YKL-40 concentrations are elevated in these patients. METHODS Serum YKL-40 was determined by radioimmunoassay in 19 patients with GCA and 8 patients with polymyalgia rheumatica (PMR) who were followed up prospectively during 1 year of treatment with prednisolone. Immunohistochemical staining for YKL-40 was performed in temporal artery biopsy samples that were obtained before treatment. RESULTS In the arteritic vessels of patients with GCA, positive staining for the YKL-40 antigen was found in CD68+ giant cells and mononuclear cells located in the media. Macrophages located in the adventitia and intima were negative for YKL-40. At the time of diagnosis, patients with GCA had an increased median serum level of YKL-40 (256 microg/liter; P<0.01) compared with healthy age-matched controls (median 118 microg/liter), and the serum level of YKL-40 decreased to normal levels during prednisolone treatment (-38% after 1 month; P<0.001). Most patients with PMR had normal serum YKL-40 levels (median 158 microg/liter) and had no changes in the serum YKL-40 levels during prednisolone treatment. The observed changes in serum YKL-40 did not always parallel the changes in serum C-reactive protein levels and erythrocyte sedimentation rate during the 1-year study period. CONCLUSION YKL-40 is found in CD68+ giant cells and mononuclear cells in the media of arteritic vessels of patients with GCA, and the concentration of serum YKL-40 may reflect the local activity of these cells in the inflamed artery.

Arteriosclerosis and hypoxia

Summary Male albino rabbits were exposed to short daily periods of systemic hypoxia for 2 weeks. Thirteen out of 16 rabbits showed gross arteriosclerotic changes, while no gross changes were found in 14 controls. The microscopic changes were primarily located to the media and consisted of calcified necrotic foci surrounded by amorphous, metachromatic intercellular substance. Metachromatic intercellular substance was also found in the form of “lakes” between the elastic membranes. A similar increase in the metachromatical intercellular substance was seen in the intima. The meta-chromasia indicated accumulation of acid mucopolysaccharides, which in the present study appeared to be primarily chondroitin-4-sulphate and/or chondroitin-6-sulphate and some dermatan sulphate and/or heparitin sulphate. A distinct calcification of the endothelial lining was observed. The changes probably reflect a damage of the aortic wall following systemic hypoxia and secondary non-specific processes of repair in the vascular connective tissue. The alterations have features in common with human arteriosclerosis.

Arteriosclerosis in rabbit aorta induced by noradrenaline: The importance of the duration of the noradrenaline action☆

Abstract Gross and microscopic arteriosclerosis was induced in the aorta of male albino rabbits by daily intravenous infusions of noradrenaline for 2 weeks. In one experiment the rabbits had daily infusions in two periods of 15 min with an interval of 5 min. In another experiment the animals had daily infusions of noradrenaline in six periods of 5 min with an interval of 5 min between the individual periods. The daily injected amount of noradrenaline (1 mg) and the entire daily infusion period (30 min) were the same in both experiments. Similarly the integrated arterial hypertension curves of the two infusion types were identical. Nevertheless the gross and microscopic arteriosclerosis were considerably more extensive and frequent in the aortas of the 2 × 15-min experiment than in the aortas of the 6 × 5-min experiment. Thus a continuous action of high doses of noradrenaline seems to be more harmful to the aortic wall than an intermittent action. The observations support the theory of a hypoxic damage, but does not exclude a dilatation injury produced by the arterial hypertension.

Serum aminoterminal type III procollagen peptide

Serum aminoterminal type III procollagen peptide was measured in rats during the development of granulation tissue induced by subcutaneous implantation of viscose cellulose sponges. Active collagen type III synthesis in granulation tissue during the first three weeks was accompanied by an increase in serum propeptide level. A positive correlation was observed between the increase in serum propeptide level on the one hand and the increase in granulation tissue collagen type III content and the in vitro formation of tissue 3H‐hydroxyproline on the other hand. In some animals the serum propeptide level remained low, despite biochemical signs of collagen synthesis, indicating variations in the release into serum and/or the metabolism of circulating propeptide. The increase in propeptide antigen concentration was mainly due to an elevated content of material with molecular weight equal to or twice that of the propeptide. A minor fraction of the propeptide remained attached to the interstitial collagen fibres in the granulation tissue. The correlation between the serum propeptide level and the biosynthesis of collagen at the site of the focal fibroproliferative process suggests that the serum propeptide level may be a valuable indicator of fibrogenesis and thereby of disease activity in fibrotic conditions.

Macrophages in the Small Intestinal Muscularis Externa of Embryos, Newborn and Adult Germ-Free Mice

Previously, we demonstrated the presence of a constant and regularly distributed macrophage population of ramified cells in the intestinal muscle layers of smaller rodents. The function of these resident macrophages under normal conditions remains unknown. Histochemistry, immunohistochemistry and electron microscopy were applied to the muscularis externa of 15- and 17-day-old embryos, 2-day-old mice, adult germ-free and conventional mice. Since lipopolysaccharides (LPS) activates macrophages and inflammation affects gut motility, LPS-treated mice were also included in the study. Two macrophage antibodies, F4/80 and 2F8 were used to demonstrate the presence of macrophages in the muscle layers. The localization was confirmed by electron microscopy. In contrast to conventional adult mice, the muscle layers in embryos, newborn and germ-free adult mice were devoid of class II MHC antigen reactive cells. The acid phosphatase reaction and antibodies directed towards a lysosomal protein (Lamp-2) were used in order to verify other activation markers. None of these showed specific staining of the muscularis macrophages. Only LPS-treated adult mice showed iNOS-positive cells in whole mounts. We conclude that the characteristic organization and distribution of muscularis macrophages in adult mice are also present in embryos, newborn and germ-free mice and thus develop independently of foreign antigens. Further, these macrophages are truly resident and appear to have differential responses to exogene stimuli.

Arteriosclerosis in rabbit aorta induced by mechanical dilatation: Biochemical and morphological studies☆

Abstract The aortas of male albino rabbits were dilated with a Fogarty arterial embolectomy catheter. Two weeks after a single short-lasting dilatation, the animals developed severe gross arteriosclerosis of a type similar to that induced by catecholamines and exposure to systemic hypoxia. The microscopic alterations of the media were also identical to those induced by catecholamines and systemic hypoxia, whereas intimal thickening was more severe and frequent in the arteriosclerotic lesions induced by the mechanical dilatation. The aortic content of hexosamine, chondroitin-4,6-sulphates and hydroxyproline was increased. The uptake of [ 35 S] sulphate into the sulphated glycosaminoglycans was also increased, reflecting a stimulated synthesis of these substances. Finally there was an increased permability to 125 I labelled human serum albumin in the dilated aortas. The biochemical alterations were interpreted as 2-week-old repair processes of the vascular connective tissue. The similarities in the location and gross appearances of the arteriosclerotic lesions may indicate that dilatation of the aorta also plays a role in the development of arteriosclerosis induced by catecholamines and systemic hypoxia.

Sirius Red and Acid Fuchsin Staining Mechanisms

The purpose of the study was to investigate the staining mechanism of acid fuchsin and Sirius red. Acid (poly-glutamic acid), neutral (poly-hydroxyproline) and basic (poly-arginine, poly-histidine, poly-lysine) poly-amino acids, collagen types I, II and III, and arginine- and lysine-containing histones were used as test substances applied to nitrocellulose membranes as dot blots. Five micrometer sections of granulation tissue on slides were tested in parallel. Some dots and sections were treated with chloramine-T before staining with acid fuchsin and Sirius red and some with 1 M NaOH after staining. The acid and neutral poly-amino acids were not stained, but the basic amino acids polylysine and poly-arginine, poly-amino acids containing these basic amino acids and the histones and the collagens exhibited intense staining. Oxidative deamination by chloramine-T abolished the staining and 1 M NaOH removed the staining except in the case of poly-arginine. Tissue sections treated in the same way showed a considerable decrease in staining after oxidative deamination with chloramine-T; in particular, the staining of the smaller fibers was abolished. The staining was totally removed by destaining with 1 M NaOH. Therefore, acid fuchsin and Sirius red are not selectively bound to collagen; they are also bound to other proteins containing basic amino acids, and staining to a large extent is influenced by electrostatic forces. The staining seems not to be selective for collagen, and one must account for this when quantitative conclusions are drawn from collagen methods using these stains.