The connective tissue is a tissue that fills the interstices (spaces) between more specialized elements and serves to hold them together and support them. It is characterized by few cells and large amounts of extracellular matrix (extracellular materials) that separate cells from one another.

The extracellular matrix has three major components: protein fibres, ground substance and fluid.

The protein fibres that form the connective are collagen fibres, reticular fibres and elastic fibres.

Collagen fibres are made of collagen (the most abundant protein in the body). They are tough and flexible but resist stretching. They are often called white fibres because fresh collagen fibres have a glistening white appearance as seen in tendons. Tendons, ligaments and the dermis are made mainly of collagen. They are also found in the matrix of cartilages and bones.

Reticular fibres are very fine, short collagen fibres coated with glycoproteins. They branch to form a sponge-like supporting network for organs like the spleen and lymph nodes. They are also abundant at points where connective tissue attaches to other tissues, like in the basement membrane of epithelial tissues.

Elastic fibres are made of elastin. They look like coiled metal springs which are capable of recoiling to their original shape after being stretched. They are often called yellow fibres because fresh elastic fibres are yellowish.

The ground substance is the featureless background against which cells and collagen fibres are seen. It usually has a gelatinous to rubbery consistency caused by protein-carbohydrate complexes like glycosaminoglycans, proteoglycans and adhesive glycoproteins.

Connective tissue cells are named according to their functions. Blast cells produce the matrix e.g. osteoblast form the bone matrix. Cyte cells maintain the matrix e.g. osteocytes maintain the bone matrix. Clast cells break down the matrix for remodeling e.g. osteoclast break down bone matrix.

The nature of the extracellular matrix determines the functional characteristics of the connective tissue. It is therefore used as a means of classification of connective tissue into fibrous connective tissue, cartilage, bone and blood.

FIBROUS CONNECTIVE TISSUE

Fibrous connective tissues (figure 1) are the most diverse type of connective tissue. They are also called fibroconnective tissue or connective tissue proper. They have very conspicuous fibres hence the name fibrous connective tissues.

The cells of fibrous connective tissues are fibroblasts, macrophages, leucocytes, plasma cells, mast cells and adipocytes.

Fibroblasts are large, flat cells that often taper at the ends and have slender processes. They produce the matrix of the tissue. After which they become inactive and are called fibrocytes.

Adipocytes (fat cells) are large round cells filled mainly with a droplet of triglyceride. The nucleus and cytoplasm occupy only a thin layer beneath the plasma membrane. Adipocytes appear in small clusters in some fibrous connective tissues. However when they dominate a tissue, the tissue is called adipose tissue.

Macrophages are large, irregular-shaped phagocytic cells arising from monocytes or from the stem cells that produce monocytes. They move about in the connective tissue and ingest and destroy bacteria, other foreign particles and dead or dying cells of the body. They also activate the immune system upon sensing foreign substances.

Mast cells are non-motile cells found especially alongside blood vessels. They detect foreign organisms and in response, release chemicals that promote inflammation.

Leukocytes (white blood cells) travel briefly in the bloodstream and then enter the connective tissue where they spend most of their time. Most of them are neutrophils and eosinophils which wander about in search of bacteria. Lymphocytes act against bacteria, toxins and other foreign agents.

Plasma cells are rarely seen except in the walls of the intestine and in inflamed tissue. Certain lymphocytes turn into plasma cells when they detect foreign agents. Plasma cells synthesize antibodies.

Collagen fibres, reticular fibres and elastic fibres are found in fibrous connective tissues. Based on the relative abundance of these fibres, fibrous connective tissue is divided into loose connective tissue and dense connective tissue (figure 2).

LOOSE CONNECTIVE TISSUE

In this kind of tissue much of the space is occupied by the ground substance. The types of loose connective tissues are areolar tissue, reticular tissue and adipose tissue.

AREOLAR TISSUE

Areolar tissue (figure 3) exhibits a loose arrangement of fibres, abundant blood vessels and a lot of ground substance.It contains all six cell types mentioned earlier.Its fibres run in random directions and are mostly collagenous. Elastic and reticular fibres are also present.

Areolar tissue is the most abundant connective tissue in the body. It is found underlying nearly all epithelia, surrounding blood vessels, nerves, oesophagus and trachea, fascia between muscles, visceral layers of pericardium and pleura.

Areolar tissue loosely binds epithelia to deeper tissues.It allows the passage of nerves and blood vessels to other tissues.It provides an arena of immune defense.The blood vessels of areolar connective tissue provide the epithelium with nutrition, waste removal and a ready supply of infection-fighting leukocytes.

RETICULAR TISSUE

Reticular tissue (figure 4) is characterized by a loose network of reticular fibres and fibroblasts, filled with numerous lymphocytes and other blood cells.It forms the structural framework of organs and tissues like the lymph nodes, spleen, thymus and bone marrow.

ADIPOSE TISSUE (FAT TISSUE)

Adipose tissue (figure 5) is characterized by large closely packed cells, with very little matrix. Adipocytes are the dominant cell type in adipose tissue.Adipose tissue is richly vascularized.It is the subcutaneous fat beneath skin, breast, heart surface, mesenteries and surrounding organs such as kidneys and eyes.

Adipose is primarily for energy storage. It however also provides thermal insulation, heat production, protective cushion for some organs, fills space and shapes the body (breasts and hips).

DENSE CONNECTIVE TISSUE

In dense connective tissues, fibres are closely packed and occupy more space than the cells and ground substance. The two types of dense connective tissue are the dense regular and dense irregular connective tissues.

DENSE REGULAR CONNECTIVE TISSUE

This tissue contains closely packed, parallel, often wavy bundles of collagen fibres, with scanty ground substance (figure 6). The only cells in this tissue are fibroblasts which are squeezed between the bundles of collagen fibres. It is found especially in tendons and ligaments. It also forms the fascia. Dense regular connective tissue has few blood vessels, so injured tendons and ligaments are slow to heal.

DENSE IRREGULAR CONNECTIVE TISSUE

This tissue contains thick bundles of collagen fibres that run in random directions (figure 7). There is relatively little room for cells and ground substance. The arrangement of collagen enables the tissue to resist stress in different directions. Dense irregular connective tissue constitutes most of the dermis and forms a protective capsule around organs like the kidneys, testes and spleen. It also forms a tough fibrous sheath around bones, nerves and cartilages.

Connective tissues are made up of a matrix consisting of living cells and a nonliving substance, called the ground substance. The ground substance is made of an organic substance (usually a protein) and an inorganic substance (usually a mineral or water). The principal cell of connective tissues is the fibroblast. This cell makes the fibers found in nearly all of the connective tissues. Fibroblasts are motile, able to carry out mitosis, and can synthesize whichever connective tissue is needed. Macrophages, lymphocytes, and, occasionally, leukocytes can be found in some of the tissues. Some tissues have specialized cells that are not found in the others. The matrix in connective tissues gives the tissue its density. When a connective tissue has a high concentration of cells or fibers, it has proportionally a less dense matrix.

The organic portion or protein fibers found in connective tissues are either collagen, elastic, or reticular fibers. Collagen fibers provide strength to the tissue, preventing it from being torn or separated from the surrounding tissues. Elastic fibers are made of the protein elastin; this fiber can stretch to one and one half of its length and return to its original size and shape. Elastic fibers provide flexibility to the tissues. Reticular fibers are the third type of protein fiber found in connective tissues. This fiber consists of thin strands of collagen that form a network of fibers to support the tissue and other organs to which it is connected. The various types of connective tissues, the types of cells and fibers they are made of, and sample locations of the tissues is summarized in Table 33.3.

Connective Tissues

Table 33.3

Loose/Areolar Connective Tissue

Loose connective tissue, also called areolar connective tissue, has a sampling of all of the components of a connective tissue. As illustrated in Figure 33.12, loose connective tissue has some fibroblasts; macrophages are present as well. Collagen fibers are relatively wide and stain a light pink, while elastic fibers are thin and stain dark blue to black. The space between the formed elements of the tissue is filled with the matrix. The material in the connective tissue gives it a loose consistency similar to a cotton ball that has been pulled apart. Loose connective tissue is found around every blood vessel and helps to keep the vessel in place. The tissue is also found around and between most body organs. In summary, areolar tissue is tough, yet flexible, and comprises membranes.

Figure 33.12 Loose connective tissue is composed of loosely woven collagen and elastic fibers. The fibers and other components of the connective tissue matrix are secreted by fibroblasts.

Fibrous Connective Tissue

Fibrous connective tissues contain large amounts of collagen fibers and few cells or matrix material. The fibers can be arranged irregularly or regularly with the strands lined up in parallel. Irregularly arranged fibrous connective tissues are found in areas of the body where stress occurs from all directions, such as the dermis of the skin. Regular fibrous connective tissue, shown in Figure 33.13, is found in tendons (which connect muscles to bones) and ligaments (which connect bones to bones).

Figure 33.13 Fibrous connective tissue from the tendon has strands of collagen fibers lined up in parallel.

Cartilage

Cartilage is a connective tissue with a large amount of the matrix and variable amounts of fibers. The cells, called chondrocytes, make the matrix and fibers of the tissue. Chondrocytes are found in spaces within the tissue called lacunae.

A cartilage with few collagen and elastic fibers is hyaline cartilage, illustrated in Figure 33.14. The lacunae are randomly scattered throughout the tissue and the matrix takes on a milky or scrubbed appearance with routine histological stains. Sharks have cartilaginous skeletons, as does nearly the entire human skeleton during a specific pre-birth developmental stage. A remnant of this cartilage persists in the outer portion of the human nose. Hyaline cartilage is also found at the ends of long bones, reducing friction and cushioning the articulations of these bones.

Figure 33.14 Hyaline cartilage consists of a matrix with cells called chondrocytes embedded in it. The chondrocytes exist in cavities in the matrix called lacunae.

Bone

Bone, or osseous tissue, is a connective tissue that has a large amount of two different types of matrix material. The organic matrix is similar to the matrix material found in other connective tissues, including some amount of collagen and elastic fibers. This gives strength and flexibility to the tissue. The inorganic matrix consists of mineral salts—mostly calcium salts—that give the tissue hardness. Without adequate organic material in the matrix, the tissue breaks; without adequate inorganic material in the matrix, the tissue bends.

There are three types of cells in bone: osteoblasts, osteocytes, and osteoclasts. Osteoblasts are active in making bone for growth and remodeling. Osteoblasts deposit bone material into the matrix and, after the matrix surrounds them, they continue to live, but in a reduced metabolic state as osteocytes. Osteocytes are found in lacunae of the bone. Osteoclasts are active in breaking down bone for bone remodeling, and they provide access to calcium stored in tissues. Osteoclasts are usually found on the surface of the tissue.

Bone can be divided into two types: compact and spongy. Compact bone is found in the shaft (or diaphysis) of a long bone and the surface of the flat bones, while spongy bone is found in the end (or epiphysis) of a long bone. Compact bone is organized into subunits called osteons, as illustrated in Figure 33.15. A blood vessel and a nerve are found in the center of the structure within the Haversian canal, with radiating circles of lacunae around it known as lamellae. The wavy lines seen between the lacunae are microchannels called canaliculi; they connect the lacunae to aid diffusion between the cells. Spongy bone is made of tiny plates called trabeculae; these plates serve as struts to give the spongy bone strength. Over time, these plates can break causing the bone to become less resilient. Bone tissue forms the internal skeleton of vertebrate animals, providing structure to the animal and points of attachment for tendons.

Figure 33.15 (a) Compact bone is a dense matrix on the outer surface of bone. Spongy bone, inside the compact bone, is porous with web-like trabeculae. (b) Compact bone is organized into rings called osteons. Blood vessels, nerves, and lymphatic vessels are found in the central Haversian canal. Rings of lamellae surround the Haversian canal. Between the lamellae are cavities called lacunae. Canaliculi are microchannels connecting the lacunae together. (c) Osteoblasts surround the exterior of the bone. Osteoclasts bore tunnels into the bone and osteocytes are found in the lacunae.

Although you may not typically think of the skin as an organ, it is in fact made of tissues that work together as a single structure to perform unique and critical functions. The skin and its accessory structures make up the integumentary system, which provides the body with overall protection. The skin is made of multiple layers of cells and tissues, which are held to underlying structures by connective tissue (Figure 5.2). The deeper layer of skin is well vascularized (has numerous blood vessels). It also has numerous sensory, and autonomic and sympathetic nerve fibers ensuring communication to and from the brain.

Figure 5.2 Layers of Skin The skin is composed of two main layers: the epidermis, made of closely packed epithelial cells, and the dermis, made of dense, irregular connective tissue that houses blood vessels, hair follicles, sweat glands, and other structures. Beneath the dermis lies the hypodermis, which is composed mainly of loose connective and fatty tissues.

The Epidermis

The epidermis is composed of keratinized, stratified squamous epithelium. It is made of four or five layers of epithelial cells, depending on its location in the body. It does not have any blood vessels within it (i.e., it is avascular). Skin that has four layers of cells is referred to as “thin skin.” From deep to superficial, these layers are the stratum basale, stratum spinosum, stratum granulosum, and stratum corneum. Most of the skin can be classified as thin skin. “Thick skin” is found only on the palms of the hands and the soles of the feet. It has a fifth layer, called the stratum lucidum, located between the stratum corneum and the stratum granulosum (Figure 5.3).

Figure 5.3 Thin Skin versus Thick Skin These slides show cross-sections of the epidermis and dermis of (a) thin and (b) thick skin. Note the significant difference in the thickness of the epithelial layer of the thick skin. From top, LM × 40, LM × 40. (Micrographs provided by the Regents of University of Michigan Medical School © 2012)

The cells in all of the layers except the stratum basale are called keratinocytes. A keratinocyte is a cell that manufactures and stores the protein keratin. Keratin is an intracellular fibrous protein that gives hair, nails, and skin their hardness and water-resistant properties. The keratinocytes in the stratum corneum are dead and regularly slough away, being replaced by cells from the deeper layers (Figure 5.4).

Figure 5.4 Epidermis The epidermis is epithelium composed of multiple layers of cells. The basal layer consists of cuboidal cells, whereas the outer layers are squamous, keratinized cells, so the whole epithelium is often described as being keratinized stratified squamous epithelium. LM × 40. (Micrograph provided by the Regents of University of Michigan Medical School © 2012)

Stratum Basale

The stratum basale (also called the stratum germinativum) is the deepest epidermal layer and attaches the epidermis to the basal lamina, below which lie the layers of the dermis. The cells in the stratum basale bond to the dermis via intertwining collagen fibers, referred to as the basement membrane. A finger-like projection, or fold, known as the dermal papilla (plural = dermal papillae) is found in the superficial portion of the dermis. Dermal papillae increase the strength of the connection between the epidermis and dermis; the greater the folding, the stronger the connections made (Figure 5.5).

Figure 5.5 Layers of the Epidermis The epidermis of thick skin has five layers: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.

The stratum basale is a single layer of cells primarily made of basal cells. A basal cell is a cuboidal-shaped stem cell that is a precursor of the keratinocytes of the epidermis. All of the keratinocytes are produced from this single layer of cells, which are constantly going through mitosis to produce new cells. As new cells are formed, the existing cells are pushed superficially away from the stratum basale. Two other cell types are found dispersed among the basal cells in the stratum basale. The first is a Merkel cell, which functions as a receptor and is responsible for stimulating sensory nerves that the brain perceives as touch. These cells are especially abundant on the surfaces of the hands and feet. The second is a melanocyte, a cell that produces the pigment melanin. Melanin gives hair and skin its color, and also helps protect the living cells of the epidermis from ultraviolet (UV) radiation damage.

In a growing fetus, fingerprints form where the cells of the stratum basale meet the papillae of the underlying dermal layer (papillary layer), resulting in the formation of the ridges on your fingers that you recognize as fingerprints. Fingerprints are unique to each individual and are used for forensic analyses because the patterns do not change with the growth and aging processes.

Stratum Spinosum

As the name suggests, the stratum spinosum is spiny in appearance due to the protruding cell processes that join the cells via a structure called a desmosome. The desmosomes interlock with each other and strengthen the bond between the cells. It is interesting to note that the “spiny” nature of this layer is an artifact of the staining process. Unstained epidermis samples do not exhibit this characteristic appearance. The stratum spinosum is composed of eight to 10 layers of keratinocytes, formed as a result of cell division in the stratum basale (Figure 5.6). Interspersed among the keratinocytes of this layer is a type of dendritic cell called the Langerhans cell, which functions as a macrophage by engulfing bacteria, foreign particles, and damaged cells that occur in this layer.

Figure 5.6 Cells of the Epidermis The cells in the different layers of the epidermis originate from basal cells located in the stratum basale, yet the cells of each layer are distinctively different. EM × 2700. (Micrograph provided by the Regents of University of Michigan Medical School © 2012)

The keratinocytes in the stratum spinosum begin the synthesis of keratin and release a water-repelling glycolipid that helps prevent water loss from the body, making the skin relatively waterproof. As new keratinocytes are produced atop the stratum basale, the keratinocytes of the stratum spinosum are pushed into the stratum granulosum.

Stratum Granulosum

The stratum granulosum has a grainy appearance due to further changes to the keratinocytes as they are pushed from the stratum spinosum. The cells (three to five layers deep) become flatter, their cell membranes thicken, and they generate large amounts of the proteins keratin, which is fibrous, and keratohyalin, which accumulates as lamellar granules within the cells (see Figure 5.5). These two proteins make up the bulk of the keratinocyte mass in the stratum granulosum and give the layer its grainy appearance. The nuclei and other cell organelles disintegrate as the cells die, leaving behind the keratin, keratohyalin, and cell membranes that will form the stratum lucidum, the stratum corneum, and the accessory structures of hair and nails.

Stratum Lucidum

The stratum lucidum is a smooth, seemingly translucent layer of the epidermis located just above the stratum granulosum and below the stratum corneum. This thin layer of cells is found only in the thick skin of the palms, soles, and digits. The keratinocytes that compose the stratum lucidum are dead and flattened (see Figure 5.5). These cells are densely packed with eleiden, a clear protein rich in lipids, derived from keratohyalin, which gives these cells their transparent (i.e., lucid) appearance and provides a barrier to water.

Stratum Corneum

The stratum corneum is the most superficial layer of the epidermis and is the layer exposed to the outside environment (see Figure 5.5). The increased keratinization (also called cornification) of the cells in this layer gives it its name. There are usually 15 to 30 layers of cells in the stratum corneum. This dry, dead layer helps prevent the penetration of microbes and the dehydration of underlying tissues, and provides a mechanical protection against abrasion for the more delicate, underlying layers. Cells in this layer are shed periodically and are replaced by cells pushed up from the stratum granulosum (or stratum lucidum in the case of the palms and soles of feet). The entire layer is replaced during a period of about 4 weeks. Cosmetic procedures, such as microdermabrasion, help remove some of the dry, upper layer and aim to keep the skin looking “fresh” and healthy.

Dermis

The dermis might be considered the “core” of the integumentary system (derma- = “skin”), as distinct from the epidermis (epi- = “upon” or “over”) and hypodermis (hypo- = “below”). It contains blood and lymph vessels, nerves, and other structures, such as hair follicles and sweat glands. The dermis is made of two layers of connective tissue that compose an interconnected mesh of elastin and collagenous fibers, produced by fibroblasts (Figure 5.7).

Figure 5.7 Layers of the Dermis This stained slide shows the two components of the dermis—the papillary layer and the reticular layer. Both are made of connective tissue with fibers of collagen extending from one to the other, making the border between the two somewhat indistinct. The dermal papillae extending into the epidermis belong to the papillary layer, whereas the dense collagen fiber bundles below belong to the reticular layer. LM × 10. (credit: modification of work by “kilbad”/Wikimedia Commons)

Papillary Layer

The papillary layer is made of loose, areolar connective tissue, which means the collagen and elastin fibers of this layer form a loose mesh. This superficial layer of the dermis projects into the stratum basale of the epidermis to form finger-like dermal papillae (see Figure 5.7). Within the papillary layer are fibroblasts, a small number of fat cells (adipocytes), and an abundance of small blood vessels. In addition, the papillary layer contains phagocytes, defensive cells that help fight bacteria or other infections that have breached the skin. This layer also contains lymphatic capillaries, nerve fibers, and touch receptors called the Meissner corpuscles.

Reticular Layer

Underlying the papillary layer is the much thicker reticular layer, composed of dense, irregular connective tissue. This layer is well vascularized and has a rich sensory and sympathetic nerve supply. The reticular layer appears reticulated (net-like) due to a tight meshwork of fibers. Elastin fibers provide some elasticity to the skin, enabling movement. Collagen fibers provide structure and tensile strength, with strands of collagen extending into both the papillary layer and the hypodermis. In addition, collagen binds water to keep the skin hydrated. Collagen injections and Retin-A creams help restore skin turgor by either introducing collagen externally or stimulating blood flow and repair of the dermis, respectively.

Hypodermis

The hypodermis (also called the subcutaneous layer or superficial fascia) is a layer directly below the dermis and serves to connect the skin to the underlying fascia (fibrous tissue) of the bones and muscles. It is not strictly a part of the skin, although the border between the hypodermis and dermis can be difficult to distinguish. The hypodermis consists of well-vascularized, loose, areolar connective tissue and adipose tissue, which functions as a mode of fat storage and provides insulation and cushioning for the integument.

Pigmentation

The color of skin is influenced by a number of pigments, including melanin, carotene, and hemoglobin. Recall that melanin is produced by cells called melanocytes, which are found scattered throughout the stratum basale of the epidermis. The melanin is transferred into the keratinocytes via a cellular vesicle called a melanosome (Figure 5.8).

Figure 5.8 Skin Pigmentation The relative coloration of the skin depends of the amount of melanin produced by melanocytes in the stratum basale and taken up by keratinocytes.

Melanin occurs in two primary forms. Eumelanin exists as black and brown, whereas pheomelanin provides a red color. Dark-skinned individuals produce more melanin than those with pale skin. Exposure to the UV rays of the sun or a tanning salon causes melanin to be manufactured and built up in keratinocytes, as sun exposure stimulates keratinocytes to secrete chemicals that stimulate melanocytes. The accumulation of melanin in keratinocytes results in the darkening of the skin, or a tan. This increased melanin accumulation protects the DNA of epidermal cells from UV ray damage and the breakdown of folic acid, a nutrient necessary for our health and well-being. In contrast, too much melanin can interfere with the production of vitamin D, an important nutrient involved in calcium absorption. Thus, the amount of melanin present in our skin is dependent on a balance between available sunlight and folic acid destruction, and protection from UV radiation and vitamin D production.

It requires about 10 days after initial sun exposure for melanin synthesis to peak, which is why pale-skinned individuals tend to suffer sunburns of the epidermis initially. Dark-skinned individuals can also get sunburns, but are more protected than are pale-skinned individuals. Melanosomes are temporary structures that are eventually destroyed by fusion with lysosomes; this fact, along with melanin-filled keratinocytes in the stratum corneum sloughing off, makes tanning impermanent.

Too much sun exposure can eventually lead to wrinkling due to the destruction of the cellular structure of the skin, and in severe cases, can cause sufficient DNA damage to result in skin cancer. When there is an irregular accumulation of melanocytes in the skin, freckles appear. Moles are larger masses of melanocytes, and although most are benign, they should be monitored for changes that might indicate the presence of cancer (Figure 5.9).

Figure 5.9 Moles Moles range from benign accumulations of melanocytes to melanomas. These structures populate the landscape of our skin. (credit: the National Cancer Institute)

Most cuts or wounds, with the exception of ones that only scratch the surface (the epidermis), lead to scar formation. A scar is collagen-rich skin formed after the process of wound healing that differs from normal skin. Scarring occurs in cases in which there is repair of skin damage, but the skin fails to regenerate the original skin structure. Fibroblasts generate scar tissue in the form of collagen, and the bulk of repair is due to the basket-weave pattern generated by collagen fibers and does not result in regeneration of the typical cellular structure of skin. Instead, the tissue is fibrous in nature and does not allow for the regeneration of accessory structures, such as hair follicles, sweat glands, or sebaceous glands.

Sometimes, there is an overproduction of scar tissue, because the process of collagen formation does not stop when the wound is healed; this results in the formation of a raised or hypertrophic scar called a keloid. In contrast, scars that result from acne and chickenpox have a sunken appearance and are called atrophic scars.

Scarring of skin after wound healing is a natural process and does not need to be treated further. Application of mineral oil and lotions may reduce the formation of scar tissue. However, modern cosmetic procedures, such as dermabrasion, laser treatments, and filler injections have been invented as remedies for severe scarring. All of these procedures try to reorganize the structure of the epidermis and underlying collagen tissue to make it look more natural.