Arterial Lesions and Arteriosclerosis

333 Pages·1974·18.16 MB·English

by  H. Jellinek (auth.)

ARTERIAL LESIONS
AND
ARTERIOSCLEROSIS
ARTERIAL LESIONS
AND
ARTERIOSCLEROSIS
Edited
by
H. JELLINEK
Professor of Pathology
Director of the 2nd Department of Pathology
Semmelwels University Medical School, Budapest
PLENUM PRESS . LONDON AND NEW YORK
Translated
by
TIona Koch
Translation edited
by
Andreas A. Abraham
The Lankenau Hospital
Division of Research and Pathology
Philadelphia, U.S.A.
© Akademiai Kiad6, Budapest 1974
Softcover reprint of the hardcover 1 st edition 1974
All Rights Reserved
Joint Edition published by
Akademiai Kiad6, Budapest, Hungary
and
PLENUM PUBLISHING CORPORATION
227 West 17th Street, New York N. Y. lOOll, U.S.A.
United Kingdom edition published by PLENUM PRESS, LONDON
a division of
PLENUM PUBLISHING COMPANY LIMITED
4a Lower John Street, London WIR 3PD, England
(Telephone No. 01-439 2364)
ISBN-13: 978-1-4615-8713-2 e-ISBN-13: 978-1-4615-8711-8
001: 10.1007/978-1-4615-8711-8
Library of Congress Catalog Card Number 74-4249
Contributors
A. BALINT
I. HUTTNER
H. JELLINEK
ANNA KADAR
T. KERENYI
EVA KONYAR
Z.NAGY
KLARA SZEMENYEI
B. VERESS
All the contributors are members of the staff of the
2nd Department of Pathology
Semmelweis University Medical School, Budapest, Hungary
CONTENTS
PREFACE ............................................................. 13
INTRODUCTION ....................................................... 15
Ohapter 1
THE FINE STRUCTURE OF THE MAMMAUAN ARTERIAL WALL 17
by A. B8.Iint
The structural effect of vascular preservation . . . . . . . . . . . . . . . . . . . . . . . . . • . . . 17
Components of the normal arterial wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Generalstructure .................................................. 17
Tunica intima ................................................... 17
Aorta ........................................................ 18
Coronary arteries .............................................. 19
Large and medium size arteries .....................•........... 20
Small arteries . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . 20
Capillaries .............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Tunica media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Elastic arteries .................................•.............. 21
Muscular-type vessels......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21
Hybrid vessels '" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Tunica adventitia ................................................ 21
Vasa vasorum ................................................. 22
Lymph vessels " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 22
Cytology ..............•.•......................................... 23
Endothelium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Smooth muscle cell .............................................. 24
Fibroblast .................................................... " 25
Ohapter 2
AORTIC RESPONSE TO VARIOUS EFFECTS............................ 26
Introduction ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . 26
Development and structure of regenerative IP . . . . . . . . . . . .. . . . . . . . . . . . .. 27
Course of aortic regeneration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
by B. Veress, Anna Kadar
Analysis of the cellular components of IP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
by B. Veress, Anna Kadar
Ultrastructure of the lining cells of IP . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 29
7
Origin of endothelial cells ofIP . . . . . . . . . . . . . .. . . . . . . .. ............. 30
Structure of cell components of the proliferate . . . . . . . .• ............. 31
Origin of smooth muscle cells. . . . .. ... .. .. ...•.•...••.. .. .. . ... . . . . 32
The intercellular substance of IP . . . . . . . . . . . . • • . . . . . . . • . . . . . . • . . . . . . . 33
by ADD& Kadar, B. Veress
Elastic fibre genesis in embryonic vessels.. . . . .. . . ... .. . . . .. . .. . . .. .. .. 37
by ADD& Kadar, B. Veress
Examinations by digestion with elastase ........................... 39
Function of smooth muscle cells and their role in fibrillogenesis ...•....... 42
by ADD& Kadar, B. Veress
Structure of inactivity (involutional) proliferation of the intima . . . . . . . . . . . .. 43
by B. Veress, ADD&' Kadar
Intimal proliferation in transplanted grafts (neo-intima) ., . . . . . . . . . . . . . . . . . 45
by B. Veress, Anna Kadar
Development and structure of the neo-intima . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Origin of cell components of neo-intima . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 46
Degenerative changes in transplantationalIP .. . . . . . . . . . . . . • . . . . . . . . . . .. 47
Changes of large vessels in experimental hypertension .. . . . . . . • . . . . . . . . . . . . 48
by B. Veress, I. Hiitmer
Survey of the literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • • . . . . . . . . . . . . . 48
Morphology of large vessel changes in experimental malignant hypertension 49
Characteristics of hypertensive reparative IP .......................... 52
Chapter 3
DEVELOPMENT AND ULTRASTRUCTURE OF ARTERIOSCLEROTIC
LESIONS .................................................................. 54
by B. Veress
Introduction .................................. . . . . • . . . . . . . . . . . . . . . . . . 54
Ultrastructure of arteriosclerotic lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Structure of the pre-atheroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Endothelial cell row . . . . . . . . . . . .. . .. . . . . . . . . . . . .. . . . . .. . . . . . . .. . . . 57
Subendothelium ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 58
The arteriosclerotic pla.que ........................................... 60
Structure of the atheroma ............................ : . . . . . . . . . . . . . 60
Structure and origin of the foam cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Source of lipids localizing in the atheroma . . . . . . . . . . . . . . . . . . . . . . . . . 62
Structure of the fibrous plaque . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Comparison of aortic responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Chapter 4
STUDIES OF LARGE MUSCULAR VESSELS 65
by Klara Szemenyei
Chapter 5
MORPHOLOGICAL CHANGES OF SMALL MUSCULAR-TYPE VESSELS AND
ARTERIOLES UNDER THE INFLUENCE OF VARIOUS INJURIES........ 68
by T. Kerenyi, I. Hiittner
Lesions of muscular-type small vessels in acute experimental hypertension 68
8
Acute hypertensive lesions of small vessels as a model of vascular damage . .. 68
Acute hypertensive lesion of the intima . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Development, forms and components of the vascular fibrinoid ......... 70
Acute hypertensive damage of smooth muscle cells of the media . . . . . . . . 71
Chapter 6
EXPERIMENTAL OBSERVATIONS 73
Investigations by light microscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Mechanism of development of the subendothelial fibrinoid. . . . . . . . . . . . . . . . . 74
Electron-microscopic structure and fibrin formations of the
subendothelial fibrinoid ........................................... 74
Electron-microscopic study of the media fibrinoid and of necrotic
muscle cell changes .............................................. 76
Localization of acute hypertensive damage in small vessels . . . . . . . . . . . . . . 77
Histochemistry of acute vascular lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Histochemical examinations for protein, carbohydrate and lipid . . . . . . . . . . 77
Enzyme histochemical studies....................................... 78
Acid muscopolysaccharide (AMP) synthesis in experimental
hypertension of muscular-type small arteries ......................... 80
by Eva Konyar
Morphological changes of small vessels after painting with acid . . . . . . . . . . . . . 82
by Klara Szemenyei, I. Hutter
Noradrenalin-induced lesions of muscular-type small vessels... . . . . . . . . . .. 84
by T. Kerenyi
Small vessel changes on hypersensitization. . . . . . . . . . . . . . . . . . . . . . . . . . . ..• 86
by Eva Konyar
Chapter 7
CHRONIC LESIONS OF SMALL VESSELS (VASCULAR WALL TRANSFORMA-
TION FOLLOWING ACUTE LESIONS OF SMALL VESSELS) ................ 91
Chronic small vessel changes after hypertension . . . . . . . . . . . . . . . . . . . . . . . . .. 91
by T. Kerenyi, I. Huttner
Chronic proliferative reactions of vessels damaged by a single trauma or
by an acute hypertensive crisis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 92
Small vessel hyalinization after an acute hypertensive crisis or other
singular damage ................................................. 94
Proliferative vascular lesions in chronic benign hypertension . . . . . . . . . . . . . . . 95
Hyaline vascular changes in chronic benign hypertension . . . . . . . . . . . . . . . . . . 98
Hypoxic vascular changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Chronic transformation of vascular lesions induced by painting with acid,
noradrenalin administration or sensitization with horse serum ......... 100
Chapter 8
INFLUENCE OF DRUG THERAPY ON SMALL VESSEL CHANGES IN
EXPERIMENTAL HYPERTENSION, PROBLEMS OF HEALING AND RE-
VERSmIUTY ............................................................... 103
by Eva Konyar
Ohapter 9
CONCLUSIONS FROM AVAILABLE EXPERIMENTAL DATA ON THE ROLE
OF VASCULAR STRUCTURE IN THE MORPHOWGY OF VASCULAR
LESIONS .................................................................. 107
Ohapter 10
PROBLEMS OF TRANSPORT ACROSS THE VESSEL WALL ...•••........ 110
byZ.Nagy
Introduction ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 110
Methods of tracing the transmural passage of material. Colloidal tracers . . . .. III
Factors responsible for intramural transport ....................•........• 114
Factors controlling permeability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 114-
Transcellular permeability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 114
Enzymatic phenomena accompanying endothelial permeability . . . . . . .. 115
Intercellular (gap-junction) transport............................... 116
Extracellular amorphous substances. External coat, basement membrane 117
External coat.................................................. 117
Basement membrane ........................................... 117
Ground substance ....................................•........ 118
Components controlling transmural flow .......................•....... 118
Ground substance ............................................... 118
Transport-controlling function of elastic elements . . . . . . . . . . . . . . . . . . . . .. 120
Smooth muscle cells . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . .. 120
Factors responsible for drainage of plasma substances .•... , ............ 121
Increase of permeability in association with lymph stasis .........••..... 121
Intramural diffusion of various plasma substances .....•...........•..•... 123
Serum proteins, lipids, lipoprotein and ions .................. , ........ 123
Effects of abnormal accumulation of vasoactive amines and hormones
and of hypoxia and pH-changes on permeability ............•....... 126
Pressure and flow factors .............................................. 128
Effect of hypertension on transport across the vessel wall . . . . . . . . . . . . . . . . .. 128
by I. Hiittner
Hypertensive disturbances of transmural flow in small arteries . . . . . . . . . . .. 128
Post-hypertensive permeability disturbance of aorta . . . . . . . . . . . . . . . . . . . .. 130
Tracer studies ................................................... 131
Peroxidase experiments ........................................ 131
Ferritin experiments............................................ 131
Colloidal carbon experiments ................................... 132
Arteriosclerosis and mural transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 134
Role of permeability in atherogenesis . . .. .. . .. . . . . .. .. . .. . . .. . .. . . . . . .. 134
Role of lymph circulation in experimental arteriosclerosis of the rat . . . . . .. 136
Ohapterll
STUDIES ON HUMAN VASCULAR DISEASES WITH REGARD TO
OBSERVATIONS IN MODEL EXPERIMENTS. . • . . . . . . . . . . . . . . . . . . . . • • . • .. 138
Evaluation of acute small vessel lesions . . . . . . • . . . . . . . . . . . . . . . . . . . . . • • • . .. 138
10
Chronic lesions of small vessels ......................................... 140
Correlation of human large vessel lesions with similar changes
in experimental animals............................................. 142
Appendix
DESCRIPTION OF SURGICAL METHODS AND FIXING AND STAINING
TECHNIQUES FREQUENTLY REFERRED TO IN TmS BOOK. . . . . . . . . . .. 149
PUBLICATIONS BY THE EDITOR AND ms TEAM. . . . . . . . . . . . . . . . . . . . .. 155
GENERAL BIBLIOGRAPHY ............................................ 160
PLATES .............................................................. 201
11
PREFACE
This monograph summarizes the results of a fifteen-year vascular pathology
research project sponsored by the Hungarian Academy of Sciences. The workers
who have participated in this project are indebted to the Academy for financing
extensive investigations and visits to institutes abroad, the aims of which were
to solve certain problems by international cooperation. The results presented
here have been achieved by the collective effort of research teams, each studying
a particular problem, but working together to the same end. Mutual discussion
of findings and a regular exchange of information between the research groups
have contributed to the progress of the investigations. Regular pUblication of
details and mutual criticism ensured that the findings were uniformly interpreted.
It is hoped that the fundamental aim of our long-term project, i.e. the selection
of the right approach to the complex problem of vascular pathology, has been
achieved.
The new approach results from the recognition that since arteriosclerosis
finally leads to various kinds of vascular injury, attention should be focussed
on the events preceding the development of the lesions rather than on the lesions
themselves. This claim has been confirmed by various model experiments in which
vascular injury inflicted under different conditions uniformly led to morphologi
cally verified arteriosclerotic change. The recent increase in the incidence of civi
lization diseases of the vascular system has resulted in a world-wide expansion
of arteriosclerosis research. Any contribution elucidating one or another aspect
of the condition(s) will promote both the clarification of pathogenesis and the
development of preventive measures. We believe that the concept proposed
here might change the course of traditional arteriosclerosis research. There are
already indications that we have been on the right track, judging from literary
reports based on this new experimental approach.
Considerable assistance was given by the contributors to this monograph,
A. Balint, I. Huttner, Anna Kadar, T. Kerenyi, Eva Konya.r, Z. Nagy, Klara Sze
menyei, B. Veress by their having compiled a number of chapters each embodying
their original work. The editor wishes to express his sincere appreciation for their
contribution. Since the topics covered are closely interrelated, each chapter
includes ample reference to the results of those who have dealt with a certain aspect
of the problem and have thus indirectly contributed to one or another part of the
monograph.
Elaboration of minor problems in the field of related sciences is indispensable in
making the work complete. For their contribution in this respect the authors
are indebted to present or former co-workers of the institute, Gy. Goracz,
J. Hintalan, A. K6cze, F. Lajosi, A. T6th and Kla.ra Szentagothai.
13