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The concentration of fibronectin in rheumatoid synovial fluid was found to be 2-3 times higher than in the corresponding plasma. Normal plasma revealed a homogeneous precipitate by cross- immunoelectrophoresis using antifibronectin, while rheumatoid plasma and rheumatoid synovial fluid exhibited a heterogeneous precipitate. The heterogeneous precipitate in rheumatoid plasma was found to be a complex between fibronectin and fibrinogen as evidenced by cross-immunoelectrophoresis. Synovial fluid fibronectin demonstrated a lower molecular weight by gelfiltration on Sepharose CL6B than did normal plasma fibronectin. We suggest that the presence of degraded fibronectin in rheumatoid synovial fluid may be the result of either the degradation of fibrin-fibronectin complexes or the destruction of matrix fibronectin from the synovial tissue.

The influence of testicular hyaluronidase treatment on the immunohistochemical localization of fibronectin in different tissues (human articular cartilage, large intestine, synovial membrane and experimental granulation tissue) as well on frozen as on formaldehyde fixed, paraffin embedded tissue, has been studied using the indirect immunoperoxidase technique. Pretreatment with hyaluronidase is essential in demonstrating fibronectin in frozen sections of human articular cartilage. In the other tissues examined treatment with hyaluronidase was not essential, but gave a more optimal staining quality. The effect of hyaluronidase treatment was to some extent dependent on the duration of treatment. In formaldehyde fixed, paraffin processed tissue the improvement with hyaluronidase treatment was only seen when the hyaluronidase followed pepsin digestion of the deparaffinized tissue sections.

The sequential changes in the presence of fibronectin in the synovial membrane during the development of antigen-induced arthritis in rabbits were studied using an indirect immunoperoxidase technique on the tissue specimens fixed in formaldehyde, embedded in paraffin and pre-treated with pepsin and testicular hyaluronidase. The relation to the distribution of fibronectin and connective tissue fibres, demonstrated as either argyrophilic or red by van Gieson method, was studied. Initial after the induction of the arthritis the synoviocytes became increased in size and number. The subsynoviocytial tissue was invaded by granulocytes and the number of vessels was increased. Fibronectin in increased amount was seen around the lining cells. After 2-4 weeks a markedly reduced amount of granulocytes were seen together with an increase in the number of macrophages. At this stage, fibronectin was also found together with argyrophilic fibres in the subsynoviocytial connective tissue. After 8-13 weeks the synovial membrane was found hypertrophic and folded. The lining layer was unchanged, but in the subsynoviocytial tissue lymphocytes and plasma cells were more focally arranged. At that time fine fibres, stained by the van Gieson method, were present together with fibronectin and argyrophilic fibres in the subsynoviocytial tissue. The morphological change and the distribution of fibronectin in experimentally induced arthritis correlated temporally to the morphological change and the presence of fibronectin found in experimentally induced granulation tissue.

Fibronectin and fibrinogen are unique proteins, since they both are present in a soluble form in plasma and in an insoluble form in connective tissue. The insoluble fibronectin is always present in connective tissue, while the presence of fibrin is temporary. The two proteins may be associated under various conditions. Fibronectin is incorporated into polymerizing fibrin, e.g. in the tissue repair process and during thrombus formation. Fibronectin is also associated with other biological structures, such as collagen of all types, sulphated proteoglycans, blood platelets and the cell walls of Staphylococcus aureus. These properties result in a depletion of plasma fibronectin in certain clinical situations, such as disseminated intravascular coagulation (DIC), traumatic shock and severe burns. The decreased plasma fibronectin concentration might result in an increased fibrin polymer concentration in the circulation, thus accentuating the microvascular thromboses and the coagulation factor consumption in DIC. The practical clinical implication is that a low plasma concentration of fibronectin might define a group of patients with a high risk of developing DIC.

Fresh frozen tissue sections of human articular cartilage was treated without and with human testicular hyaluronidase (2 x 10(6) units/l) for 60 min at 37 degrees C and stained by the indirect immunoperoxidase technique with rabbit antihuman fibronectin. The rabbit antihuman fibronectin was purified by affinity chromatography on human fibronectin-Sepharose. Fibronectin was only found on the acellular surface of the articular cartilage in tissue sections not treated with hyaluronidase. In this surface layer, probably identical to "lamina splendens", the arrangement of fibronectin was as a membrane. No collagen was seen in this area by van Gieson staining. No staining for fibronectin was found in the cartilage matrix or in the chondrocytes. Treatment of the cartilage tissue with hyaluronidase resulted in visualization of high amount of fibronectin in the cartilage matrix, with the highest intensity around the chondrocytes. The staining of the acellular surface layer of the articular cartilage was identical with the results obtained without hyaluronidase treatment. These results indicate that articular cartilage is rich in fibronectin probably in complex with hyaluronic acid, and that the chondrocytes produce fibronectin in situ. It also demonstrates the steric hindrance of hyaluronic acid aggregates in diffusion of the antibody and the value of hyaluronidase treatment of tissue before demonstration of fibronectin.

Clumping of different staphylococci by fibronectin and other purified plasma proteins has been investigated. Purified fibronectin was capable of clumping Staphylococcus aureus strains in concentrations identical with concentrations of fibronectin in human plasma. S. epidermidis and S saprophyticus were not clumped by fibronectin. The binding of fibronectin to S. aureus was not mediated by protein-A, as a strain lacking protein-A clumped in the presence of fibronectin, and the presence of IgG could not inhibit the clumping of S. aureus strains. The fibronectin-binding component on the staphylococcal cell wall seems to be unrelated to the fibrinogen-binding clumping factor.

Plasma fibronectin concentrations and liver morphology were investigated in 45 morbidly obese subjects (median overweight 88%) and in 42 normal weight controls, matched for sex and age. A significantly (P less than 0.01) raised plasma fibronectin concentration (median 464 mg/l, range 276-862 mg/l) was found in the obese subjects when compared with concentrations in the controls (median 348 mg/l, range 164-536 mg/l). Plasma fibronectin concentrations of the obese patients correlated significantly to their degree of overweight (r = 0.33, P less than 0.05) as well as to the degree of fatty change found in their liver biopsies (r = 0.33, P less than 0.05). Significantly (P less than 0.05) elevated plasma fibronectin concentrations even in obese subjects without hepatic fatty change indicate that liver fat accumulation is no prerequisite of the obesity-related elevation of plasma fibronectin. Raised plasma fibronectin concentration in obesity may more readily be explained by an increased fibronectin formation by lipocytes.

By quantitative electroimmunoassay the plasma fibronectin concentration was determined in 42 patients with chronic renal failure and treated with haemodialysis. The plasma fibronectin concentration was significantly reduced, independent of the haemodialysis, compared to a control group. Delayed wound healing seen in patients with chronic renal failure might be a result of the reduced plasma fibronectin.

The peripheral stromal fibronectin (FN) staining patterns of invasive breast carcinomas (IBC) from 77 women were compared to the aggressivity of the tumors, which in each case had been determined through a complete clinical follow-up and autopsy investigation. Polyclonal, monospecific rabbit antibody to human FN was applied on formalin-fixed, paraffin-embedded tissue sections using the peroxidase-antiperoxidase staining technique. An FN-positive staining reaction was defined as a constant, diffuse, or pericellular demarcation of FN-positive fibers surrounding tumor cells at the invasive border. In lack of such a staining pattern, FN-negative staining was recorded. The FN-positive staining reaction was significantly associated with a low metastatic potential and appeared in a multivarians analysis to be an excellent prognostic factor, which surpassed other known parameters, such as clinical stage, histological type or grade, and lymph node status. 27 out of 31 women, who died without evidence of metastatic spread, had FN-positive IBC (87%) in contrast to women with metastatic disease, where only 15 out of 46 had FN-positive tumors (33%). An extensive histopathological examination of the contralateral breast revealed in this latter group a high rate of second primaries (22/46), which might have been responsible for the metastatic spread. If these women with bilateral IBC were excluded, only three metastasizing tumors with a FN-positive staining pattern remained, suggesting that the prognostic value of the FN-staining pattern along the invasive border of IBC might be even higher than anticipated from this study.

Normal synovial membranes and synovial membranes from patients with classic rheumatoid arthritis were investigated for the presence of fibrin and fibronectin by an indirect immunoperoxidase technique. In normal synovial membranes, fibronectin was found around the monolayer of the synovial lining cells. Staining was most intense on the surface and beneath the lining cells, but not detectable in the cytoplasm. Fibronectin was also found in the cytoplasm of the endothelial cells. No staining for fibrin was found in the normal synovial membrane. In synovial membranes from patients with rheumatoid arthritis, large amounts of fibronectin were found around the multilayer of synovial lining cells, in the cytoplasm of the endothelial cells, and in argyrophilic fiber-rich connective tissue. In superficial areas denuded of synovial lining cells, high amounts of fibronectin were found incorporated in fibrin. In some areas with noninjured synovial lining cells, fibrin was also found, but in this case no fibronectin was incorporated. No fibronectin was found in connective tissue in areas with infiltration of inflammatory cells. After treatment of normal and rheumatoid synovial membranes with hyaluronidase, fibronectin was still present around the lining cells but the staining was found to be more distinct. This study relates the presence of fibrin and fibronectin in the rheumatoid synovial membrane to the high amount of these proteins, recently described, in rheumatoid synovial fluid. It also suggests that fibronectin present in the synovial membrane is produced and secreted by the endothelial cells.

The effect of the opsonic activity of human purified fibronectin on phagocytosis of Staphylococcus aureus by human polymorphonuclear leukocytes was investigated. After opsonization with fibronectin there was a significant increase in the rate of phagocytosis of four out of six Staphylococcus aureus strains. Both attachment to and ingestion by leukocytes was affected, as revealed by lysostaphin treatment. Incubation of leukocytes with fibronectin prior to phagocytosis did not enhance the phagocytosis of Staphylococcus aureus. This shows that the observed enhancement of phagocytosis was dependent on the binding of fibronectin to Staphylococcus aureus. The ability of fibronectin to opsonize different strains of Staphylococcus aureus varied with the strain. A variation was also observed in fibronectin-induced phagocytosis by leukocytes from different donors.

The presence and localization of fibronectin in normal and mechanically injured aorta in rabbits was studied using an indirect immunoperoxidase technique on tissue specimens fixed in formaldehyde, embedded in paraffin and pretreated with pepsin. The effect on staining quality of treatment with testicular hyaluronidase prior to immunoperoxidase staining was also examined. In the intima from normal aorta fibronectin was present in the subendothelial basal layer, along the internal and external elastic laminae, around and between the smooth muscle cells of the media and along the collagen and elastic fibres in the adventitia. Sixteen days after a single mechanical dilatation of the descending thoracic aorta all animals developed gross atherosclerotic-like changes. Microscopic examination revealed prominent neo-intimal hyperplasia with subendothelial, cushion-like thickenings but no medial or adventitial alterations. Fibronectin, in increased amounts, was found between and around the endothelial cells and in the subendothelial thickenings between the proliferating smooth muscle cells in relation to the fine, thin elastic and argyrophilic fibres. In the media and adventitia the amount and distribution of fibronectin was indistinguishable from uninjured control aortas. Treatment with testicular hyaluronidase before immunoperoxidase staining resulted in a higher staining resolution in normal and injured aorta. The conspicuous observation in the present study is that fibronectin exclusively accumulates in areas of tissue repair. The origins and functions of fibronectin during tissue injury and repair are discussed.

Plasma, obtained just prior to diagnostic liver biopsy in 71 patients with various liver diseases, was examined by electroimmunoassay using immunoglobulin against human fibronectin and purified plasma fibronectin as standard. The plasma fibronectin concentration was not significantly different from age- and sex-matched healthy controls in patients with chronic persistent or chronic active hepatitis (n = 7), primary biliary cirrhosis (n = 8), alcoholic fatty liver (n = 9), alcoholic hepatitis (n = 10), and alcoholic cirrhosis (n = 16). Patients with acute viral hepatitis (type A (n = 2); type B (n = 7); type non A, non B (n = 1] had significantly (P less than 0.01) raised plasma fibronectin concentrations (median 506 mg/l (range 339-804] compared to controls (median 399 mg/l (range 304-462]. Morbidly obese patients with fatty liver (n = 11) had significantly (P less than 0.001) raised plasma fibronectin concentrations (median 610 mg/l (range 429-862] compared to controls (median 361 mg/l (range 303-419].

The temporal appearance of fibronectin in experimental granulation tissue has been studied using the immunoperoxidase technique on material fixed in formaldehyde, embedded in paraffin and pretreated with pepsin. Furthermore, the relationship between the distribution of fibronectin and connective tissue fibres, demonstrated as either argyrophilic or red by the van Gieson method, has been investigated. Fibronectin was demonstrated as part of the fibrinous network in the sponge before the formation of granulation tissue. In the development of granulation tissue fibronectin was seen in the initial cellular stage codistributed with the newly formed fibres, first the argyrophilic fibres and later with those stained red by the van Gieson method, too. With maturation of the granulation tissue, predominated by these fibres, the amount of fibronectin was gradually reduced. The presence of fibronectin in the sponge already before the formation of granulation tissue suggests that fibronectin in the initial stage of inflammation derives from plasma. The increase in amount of fibronectin corresponding to the cellular (fibroblastic) proliferation and the formation of fibres, both argyrophilic and van Gieson positive, indicates that fibronectin in young granulation tissue is synthesized by fibroblastic cells. The relationship between the morphologically demonstrated argyrophilic fibres and van Gieson positive fibres and the biochemical type III and type I collagens is discussed.

Plasma fibronectin concentrations were measured in 33 patients with major burn injury. Changes in plasma fibronectin concentration were related to the day of burn injury, surgery and to the development of sepsis. Within 24 hours of the burn injury and surgical treatment, a decrease of the plasma fibronectin concentration was observed, which returned to normal values within 72 hours. A decrease in the plasma fibronectin concentration was observed as sepsis developed, while recovery from septicaemia was associated with plasma fibronectin concentration returning to normal values.

The presence and localization of fibrin and fibronectin in rheumatoid nodules were studied using an indirect immunoperoxidase technique on tissue specimens fixed in formaldehyde, embedded in paraffin and pretreated with pepsin and testicular hyaluronidase. Three zones characteristic for rheumatoid nodules was recognized. Central area with necrosis, containing at least in part fibrinogen-antigenic material and fibronectin especially in the peripheral part of the necrotic area. Around the necrosis a layer of mesenchymal cells in a palisade arrangement was found. Especially in the external part of this layer fibronectin was demonstrated around and between the cells, where fibrin was absent. Peripherally, a zone of non-specific granulation tissue containing moderate amount of fibronectin decreasing towards the surround mature connective tissue, was seen. In the border of the cellular layer vessels were found in variable amount. In some of the vessels vasculitis was demonstrated with the presence of inflammatory cell infiltration, fibrin deposition and occasionally thrombosis. The pathogenesis of the inflammatory reaction in rheumatoid nodules is discussed.

Plasma and urine fibronectin concentration was determined by electroimmunoassay and ELISA-method in patients who received renal transplantation. The plasma fibronectin concentration decreased both after the transplantation, in relation to the acute rejection of the graft, and in the relation to immunosuppressive therapy. Urine fibronectin excretion increased in relation to the kidney transplantation and acute rejection of the graft. In association with improved kidney function, the urine fibronectin excretion decreased. It is suggested that it might be of clinical importance to determine the excretion of fibronectin into the urine in patients undergoing kidney transplantation.

The antibody response against Staphylococcus aureus antigens was quantitated in mice immunized with live staphylococci, the fibronectin-binding protein, clumping factor, or saline by means of enzyme-linked immunosorbent assay. Immunization with purified clumping factor induced a significant increase in antibody levels, while the fibronectin-binding protein gave a poor response. All mice immunized with live S. aureus developed a high antibody level. The immunization of mice with live S. aureus or clumping factor resulted in an increased resistance towards staphylococcal intraperitoneal infection.

The plasma concentration of fibronectin was determined in 374 normal subjects, newborn to 85 years of age, by quantitative electroimmunoassay. The plasma fibronectin concentration was higher in males than in females and the concentration increased with age. No day to day or diurnal variation was found. Different stabilizers of blood did not influence the results.

Plasma fibronectin concentrations were measured in 49 patients with chronic myeloproliferative disorders and compared to sex- and age-matched controls. A significantly lower plasma fibronectin concentration was observed in patients with idiopathic myelofibrosis as compared with the control group (p less than 0.01). In addition, plasma fibronectin concentrations in myelofibrosis patients differed significantly, when compared with patients with polycythaemia vera (p less than 0.01), whereas no significant difference was found between myelofibrosis patients and those with a transitional myeloproliferative disorder or chronic myelogenous leukaemia (p greater than 0.05). An inverse relationship was demonstrated between plasma fibronectin and spleen size, the lowest plasma fibronectin levels being found in patients with large spleens. It is supposed that low plasma fibronectin concentrations in splenomegalic patients may be due to enhanced consumption of the opsonin in the expanded splenic mononuclear-macrophage system.

The distribution pattern of fibronectin in 24 invasive human breast carcinomas has been studied using the indirect immunoperoxidase technique. A positive cytoplasmic staining reaction was observed in 16 tumours. Well-differentiated carcinomas showed weak or no staining, whereas all moderately or poorly differentiated carcinomas and one signet ring cell carcinoma contained fibronectin positive tumour cells with moderate or strong staining. The staining intensity was positively correlated to degree of anaplasia with the exception of two moderately differentiated duct carcinomas and the two medullary carcinomas, which were only slightly positive. Non-attached independently growing tumour cells stained more intensely than tumour cells in clusters. Pericellular fibronectin was found in only one carcinoma of medullary type. In normal ducts and glands it was seen at the stromal-epithelial junction corresponding to the basement membrane, around myoepithelial cells and along the luminal border. The results support the findings of several in vitro investigations that breast tumour cells synthesize fibronectin. It also suggests that cytoplasmic fibronectin expression might be an indicator of tissue differentiation in non-solidly growing invasive duct carcinomas of the human mammary gland.

The influence of fixation and tissue preparation on the immunohistochemical localization of human fibronectin in gastrointestinal tract tissue has been examined using indirect immunoperoxidase technique. The most optimal staining result with strong intensity and well defined localization was obtained on frozen sections of unfixed material. Nearly identical results with improved morphology were obtained when staining paraffin sections of tissue fixed in 96% ethanol, 96% + 1% acetic acid and absolute acetone. All other fixatives tested, 10% neutral buffered formalin. Lillie's AAF, Bouin's fixative, Clarke's fixative, 4% formaldehyde, 4% formaldehyde + 0.5% cetylpyridiniumchloride (F-CPC), 4% formaldehyde +0.1% glutaraldehyde gave unsatisfactory results. However, proteolytic digestion with pepsin of paraffin sections prior to staining of buffered formalin and F-CPCfixed material gave results comparable with those obtained on unfixed frozen sections are regards definition of the staining whereas staining intensity was decreased in some degree. No improvement was observed when using proteolytic digestion of tissue fixed in other fixatives.

Two methods for quantitative determination of the high molecular weight glycoprotein, fibronectin, have been developed. Both methods are based on enzyme-linked immunoadsorbent (ELISA) techniques. In the first of the methods an antibody against fibronectin is used to trap the antigen. This double antibody technique can detect a slight decrease in the concentration of fibronectin stored for 5 days compared to the amount of fibronectin in the freshly purified preparation. In the second method, gelatin which is known to bind specifically to fibronectin, is used to catch fibronectin. By this method less than 1% of the fibronectin present in a freshly prepared preparation is measured after storage for 5 days. The results obtained with the two methods applied on a freshly prepared and a stored fibronectin are in agreement with sodium dodecylsulphate polyacrylamide gel electrophoresis followed by immunoblotting before and after gelatin-Sepharose adsorption. These techniques demonstrate that all the freshly prepared fibronectin adsorbs to gelatin-Sepharose, while stored fibronectin, which is broken down to numerous peptides, still reacts with the fibronectin antibody, but does not adsorb to gelatin-Sepharose. The two ELISA techniques were applied on amniotic fluid, cerebrospinal fluid and urine. The results indicated significant degradation of fibronectin in urine, and less degradation of fibronectin in amniotic and spinal fluid.

The distribution pattern of fibronectin in metaplastic carcinomas, stromal sarcomas, malignant cystosarcoma phyllodes tumours and histiocytic type lymphomas of the human female breast has been studied using the indirect immunoperoxidase technique on formalin fixed paraffin embedded tissue. Fibronectin was demonstrated as intensely stained strands between tumour cells forming an irregular network in metaplastic carcinomas and lymphomas. Stromal sarcomas and the malignant stromal component of the phyllodes tumours exhibited, in contrast, a uniform staining throughout tumour cells and stroma which was weaker than in adjacent normal-looking connective tissue. We suggest that the intense staining reaction of metaplastic carcinomas is due to the scirrhous reaction generally associated with invasive human breast carcinomas. The advantage of using fibronectin as a diagnostic tool in the differentiation of carcinoma/lymphoma versus sarcoma is the fact that the antigen is a stromal marker and its staining intensity is not influenced by the morphology or degree of differentiation of non-mesenchymal tumours.

The plasma fibronectin level was determined by immunoelectrophoresis in patients under intensive care. The decrease in plasma fibronectin concentration was most pronounced in patients with sepsis and DIC. Survival of these patients was related to the extent of decrease of the plasma fibronectin concentration. Burn injury and the associated surgical treatment were followed by a decrease in fibronectin concentration which then normalized in 24-48 h after the burn injury. It is concluded that serial determinations of plasma fibronectin are essential for studying the relation of a low plasma fibronectin with the clinical condition.