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Biomedical subjects

B G Mills

Publications and source records attributed to B G Mills.

At least 19 recordsLinked to original sources

Giant cell tumor arising in Paget's disease of bone. Recurrences after 36 years.

A 96-year-old woman had both Paget's disease and a giant cell tumor of the same bone, the left scapula. Despite five surgical procedures, a full course of radiation therapy, and treatment with salmon calcitonin, human calcitonin, and finally disodium etidronate, the tumor has recurred over a 36-year period. The characteristic viral-like nuclear and cytoplasmic inclusions found in the osteoclasts of Paget's disease were found in the tumor giant cells, in specimens excised over an eight-year period, and in specimens obtained during orthopedic procedures on her other pagetic bone lesions over 12 years.

Aged

Ultrastructural and immunohistochemical evidence of measles virus in active otosclerosis.

Because of the similarity between otosclerosis and Paget's disease of bone, and the mounting evidence of a viral cause in Paget's disease, we have investigated a possible viral cause for otosclerosis. Transmission electron microscopy of stapes footplate fragments with active otosclerosis has revealed structures morphologically identical with measles virus nucleocapsid in osteoblasts and preosteoblasts. Immunofluorescence and immunoperoxidase studies have confirmed the presence of measles nucleocapsid antigen in active lesions. Application of sera from patients with subacute sclerosing panencephalitis, a defective measles virus infection of the central nervous system, resulted in positive immunoreaction in areas of active otosclerosis.

Antigens, Viral

Immunohistochemical evidence of measles virus antigens in active otosclerosis.

Despite intensive investigation, the cause of otosclerosis remains uncertain. Recent studies of Paget's disease of bone have revealed a possible viral origin. Because of similarities between otosclerosis and Paget's disease, we have pursued investigation of a possible viral cause of otosclerosis. Four temporal bone specimens from patients with otosclerosis, processed for immunohistochemistry, demonstrated positive specific reactivity with monoclonal antibodies to measles virus antigens using the indirect immunofluorescent and immunoperoxidase techniques. Reactivity was most intense in active foci. Reactivity in the peroxidase assay was also observed in areas of acting otosclerosis with application of primary antisera from patients with subacute sclerosing panencephalitis, a disorder of the central nervous system in which a defective measles virus has been isolated. Other related paramyxoviruses, including mumps and respiratory syncytial virus, were negative, as were negative controls.

Antibodies, Monoclonal

Osteoclasts in human osteopetrosis contain viral-nucleocapsid-like nuclear inclusions.

We report the discovery of nuclear inclusions in the osteoclasts of three unrelated patients with benign osteopetrosis that resemble the osteoclast inclusions characteristic of Paget's disease of bone. These inclusions are morphologically and dimensionally identical to the nucleocapsids of a virus of the Paramyxoviridae family. Supporting a possible viral association with benign osteopetrosis in the observation of the presence of antigens of respiratory syncytial virus, measles virus, and/or mumps virus in the cells of all five patients whose paraffin-embedded bone specimens were tested. These included two patients whose osteoclasts contained nuclear inclusions. No patients with the malignant form of the disease have been studied. There is as yet no proof that a virus is causally related to human osteopetrosis even though a virus can produce an avian form of the disease.

Adult

Gallium-67 citrate localization in osteoclast nuclei of Paget's disease of bone.

Gallium-67 citrate scintigraphy has been used to indicate the extent of bone involvement in patients with Paget's disease of bone and is an excellent marker in monitoring the effects of specific therapy. Since gallium uptake is dependent on cellular function, autoradiographic techniques can be applied to cells of Paget's lesions to understand better the mechanism of [67Ga]citrate uptake. Bone biopsies were obtained from sites of increased uptake using [67Ga]citrate scintigraphy in two patients with Paget's disease. In both patients electron microscopic autoradiographs demonstrated a high concentration of silver grains over the nuclei of osteoclasts. The cellular mechanism is unknown but may be related to the known inhibitory effect of calcitonin on osteoclast activity. The association of [67Ga]citrate with the nucleus of the osteoclasts is unique and different from tumor cells in which there is a high association of [67Ga]citrate with the lysosome fraction within the cytoplasm.

Autoradiography

Critical evaluation of viral antigen data in Paget's disease of bone.

This study evaluates previous viral antigen data obtained from fixed tissue sections and cells grown in culture from bone affected by Paget's disease. Finding antigens to both respiratory syncytial virus (RSV) and measles virus (MV) in the same osteoclasts of ten patients could not be explained on the basis of any previously known cross-reactivity. Therefore, possible causes for these observations were sought. Monoclonal antibodies to viral proteins of RSV and MV were used to label proteins. Polyclonal antibodies that were monospecific and were produced exclusively in nonhuman species were used to rule out nonspecific reaction with human proteins. Antivimentin antibody was used to test the possibility of cross-reactivity with a cytoskeletal protein, as a second antibody F(ab')2 conjugated to fluorescein was used to rule out nonspecific reactivity with Fc receptors. Electron microscopy was used to evaluate bone cell cultures derived from Paget's bone in comparison with Paget's osteoclasts. Results showed that the pattern of monoclonal viral antibody labeling followed different patterns in different patients. Nonspecific reactivity was ruled out by significant negative and positive controls. Cross-reactivity with vimentin could not account for the positive immunofluorescent results because of an entirely different pattern of fluorescence in the same samples of live and fixed cells after colchemid treatment. It was concluded that specific viral antigens are present in osteoclasts and in cells grown from Paget's bone and that the present data are compatible with the possibility that Paget's disease of bone is a slow virus infection.

Antibodies, Monoclonal

Filamentous structures morphologically similar to viral nucleocapsids in otosclerotic lesions in two patients.

Two of four patients with active stapedial otospongiosis had abnormal filamentous structures in osteoblast-like cells. These structures were rare in these cells and did not occur in any other cells. The structures were 17 nm wide and clustered in a loose skein in dilated cisternae of the rough endoplasmic reticulum. They resembled the nucleocapsids of subacute sclerosing panenecephalitis, a variant of measles virus.

Capsid

A viral antigen-bearing cell line derived from culture of Paget's bone cells.

This study documents the characteristics of a viral antigen-bearing cell line derived from co-culture of the bone from a 71-year-old woman with Paget's disease of bone and HEp-2 cells. The cell line has survived in continuous culture for 3 1/2 years and 185 subcultures. The cells are epithelioid in appearance, produce alkaline and acid phosphatase, increase alkaline phosphatase activity in response to 1,25-(OH)2-D3 and contain receptors for 1,25-(OH)2-D3. Immunofluorescent studies utilizing antisera to respiratory syncytial virus and measles virus reveal antigens of both viruses in the cells. These cells do not produce bone in culture and the adenylate cyclase activity found in their plasma membrane does not increase significantly in response to parathyroid hormone or calcitonin. The cells are not contact inhibited and form spherical colonies in agarose. They are aneuploid and have a modal number of 62-74 as well as HeLa markers. When injected into athymic mice, osteosarcomas are produced. These tumors continue to bear viral antigens. The availability of this cell line should aid in further studies of the viral antigens associated with Paget's disease of bone.

Aged

Evidence for both respiratory syncytial virus and measles virus antigens in the osteoclasts of patients with Paget's disease of bone.

Recent ultrastructural and immunohistochemical evidence supports the hypothesis that Paget's disease of bone is a slow viral infection of the Paramyxoviridae family. Conflicting evidence for the presence of respiratory syncytial virus (RSV), a pneumovirus, or measles, a morbillivirus, has been reported. By the indirect fluorescent antibody assay, four RSV antisera were compared with four measles antisera on serial sections of pagetic bone or replicate coverslips of cells from pagetic bone grown in culture from 30 patients. Results produced positive immunofluorescence for RSV in 28 of 29 patients and positive immunofluorescence for measles in 11 of 22 patients. Of the 20 patients from whom comparable samples could be tested for antigens, 11 were found to harbor both antigens. These studies support the hypothesis that Paget's disease of bone is a slow viral infection of the Paramyxoviridae family more closely related to the pneumoviruses than the morbilliviruses.

Antigens, Viral

Evidence for a viral etiology of Paget's disease of bone.

Ultrastructural studies of the bone cells in patients with Paget's disease of bone have revealed the presence of nuclear and cytoplasmic inclusions that resemble the nucleocapsids of Paramyxoviridae virus. Immunocytologic studies of bone biopsy specimens and cultured bone cells have demonstrated positive responses with antisera against measles virus and/or respiratory syncytial virus. These observations suggest that Paget's disease may be a slow viral infection of bone. The exact nature of the putative viral agent has yet to be established.

Animals

Immunohistological demonstration of respiratory syncytial virus antigens in Paget disease of bone.

Respiratory syncytial virus antisera have been found to produce a positive immunohistologic response in osteoclasts in bone sections or in cells cultured from Paget disease lesions in 12 out of 12 patients tested. These experiments were carefully controlled by several means. Use of experimentally infected cells served as positive controls. Adsorption of antisera on human bone powder and KB cells did not remove the specific immunologic stain, but adsorption of the antisera by the virus did. Negative results were also obtained in osteoclasts of patients with primary or secondary hyperparathyroidism. In addition, negative results in specimens of Paget disease were found with antisera to measles; parainfluenza 1, 2, and 3; influenza A, B and C; rubella; and herpes simplex. These results are consistent with the hypothesis that the nuclear and cytoplasmic inclusions in the osteoclasts of Paget disease are a result of viral activity.

Antigens, Viral

Comparison of the ultrastructure of a malignant tumor of the mandible containing giant cells with Paget's disease of bone.

Distinction between lesions of the jaws containing giant cells can be difficult. This study reports the results of the study of the ultrastructure of 30 patients with Paget's disease in comparison with a patient diagnosed as having malignant giant cell tumor of the mandible. The ultrastructure of the malignant giant cell tumor of the mandible was found to contain nuclear inclusions morphologically identical with the 12-15 nm tubules characteristic of the nuclei of osteoclasts in Paget's disease of bone. No clinical or laboratory signs of Paget's disease was found in this patient. A search of the literature failed to produce reports of identical nuclear inclusions in soft tissue giant cell tumors, osteosarcomas, reparative granulomas containing giant cells or in osteitis fibrosa cystica. Such nuclear inclusions have been reported in benign giant cell tumors of bone, one another in malignant giant cell tumor and cases of polymyositis. These observations raise the question of a possible virus associated with the tumor since there are recent reports of immunological evidence for the presence of a virus in Paget's disease, and viruses have been suspected in polymyositis.

Adult

Cell cultures from bone affected by Paget's disease.

Cells obtained from Paget's bone specimens were maintained in culture for up to 8 1/2 months. The cells had several characteristics of bone cells including the presence of alkaline phosphatase, acid phosphatase, or succinic dehydrogenase as demonstrated histochemically. Electron microscopy revealed nuclear inclusions similar to those found in the osterclasts of Paget's disease in 4 or 11 cultures. Immunohistology utilizing specific antisera demonstrated the presence of respiratory syncytial virus antigen(s) in 7 or 7 patients. Negative results were obtained with antisera to a variety of paramyxoviruses.

Aged

Long-term culture of cells from bone affected by Paget's disease.

Cells obtained from surgical bone specimens of eight patients with Paget's disease of bone were maintained in culture for up to 8 months and seven passages. The doubling time during the period of maximal cell growth ranged from 4 to 12 days. Evidence consistent with the hypothesis that many of the cells were bone cells included the following: (a) histochemical techniques demonstrated staining of some cells for alkaline phosphatase or acid phosphatase and succinic dehydrogenase; (b) parathyroid extract stimulated increased uptake of 3H-thymidine and 3H-uridine; (c) parathyroid extract suppressed and salmon calcitonin stimulated uptake of 3H-proline; and (d) crystalline calcium deposits were found within cells and extracellularly. Ultrastructural analysis revealed that three of the eight cultures contained cells whose nuclei had inclusions which were almost identical to those found in the osteoclast nuclei of all patients with Paget's disease. The maintenance of cells derived from pagetic bone in long-term culture should aid in testing the hypothesis that Paget's disease represents a slow virus infection of bone.

Aged

The etiology of Paget's disease of bone.

The etiology of Paget's disease is not known but recent studies of the ultrastructure of bone cells in pagetic lesions have raised the possibility of a viral etiology. In 41 of 41 patients evaluated in France and Los Angeles characteristic nuclear inclusions were found in osteoclasts only. These structures were similar to nuclear inclusions found in the slow virus infection of the brain, subacute sclerosing panencephalitis. Definitive identification of a virus or viral antigens in pagetic lesions awaits future studies. Other possible etiologies of Paget's disease include an inborn error of connective tissue biosynthesis, a disorder of hormone secretion, a vascular disorder, an autoimmune state, and a neoplastic transformation of bone cells.

Bone Neoplasms

Nuclear inclusions in Paget's disease of bone.

The ultrastructure of bone cells was examined in biopsies from 18 patients with Paget's disease of bone and from 60 patients with a variety of other bone diseases. A characteristic nuclear inclusion was found in the osteoclasts of each patient with Paget's disease. The nuclear inclusion most closely resembles viral nucleocapsids of the measles type.

Biopsy

Florid osseous dysplasia. A clinical-pathologic study of thirty-four cases.

Thirty-four patients with florid osseous dysplasia were studied. The majority were asymptomatic Negro women: Seventeen biopsy-proven simple bone cysts were found in affected quadrants of fourteen patients. Radiographs displayed a spectrum of sclerotic and ground-glass opacities limited to alveolar processes but not to root apices. Biopsy material was studied in all cases, and biochemical analyses of serum and cyst fluid were performed on some patients. Test results and skeletal radiographs indicate that the disease is limited to the jaws. Patients have remained asymptomatic with little alteration of radiographic patterns. Three cysts failed to heal following treatment, others filled with radiographically abnormal tissue. Chronic osteomyelitis may infrequently complicate the disease. These cases appear to represent the most exuberant manifestation of this reactive fibro-osseous jaw disease.

Adult