Leukocytoclasis: ultrastructural in situ nick end labeling study in anaphylactoid purpura

In order to characterize leukocytoclasis of polymorphonuclear neutrophils (PMNs), the method of in situ nick end labeling for DNA breakdown was applied on tissue samples from 36 patients with anaphylactoid purpura at ultrastructural, as well as light microscopic, level. Light microscopic immuno-peroxidase technique showed positively labeled PMNs infiltrating in the dermis of 24 cases in which leukocytoclastic vasculitis was fully developed, suggesting that breakdown of DNA strands is triggered in the PMNs. Electron microscopic immuno-gold technique employed in six patients with the fully developed stage of inflammation identified the DNA breaks in the nuclei of PMNs. Ultrastructure of these cells, however, showed that only a minor population ( approximately 1/60) of PMNs showed the condensed and marginated nuclei, being compatible with typical apoptotic change. However, the majority of immuno-gold-labeled cells showed relatively intact nuclei without margination of condensed heterochromatin and with disintegrated cytoplasmic organelles and plasma membrane, suggesting that apoptotic cell removal mechanism may be incomplete. The immuno-gold-positive nuclear debris scattering in the tissue is most likely the remnants of unsatisfactory disposal by apoptosis of potentially injurious PMNs, resulting in the vascular and perivascular damage in leukocytoclastic vasculitis in anaphylactoid purpura.