Plasmapheresis in chronic demyelinating polyneuropathy.
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Humans↗
Biomedical subjects
K V Toyka
Publications and source records attributed to K V Toyka.
Production of nitrite by neonatal rat microglial cells/brain macrophages.
Microglial cells/brain macrophages from neonatal rats were examined for their capacity to generate nitrite, a product of the NO pathway. Upon incubation with bacterial lipopolysaccharide (LPS) or rat interferon-gamma (IFN-gamma), cells from the microglia-enriched fraction released measurable amounts of nitrite into the supernatant within 24-48 hr. The production of nitrite was dependent on the cell number and the dose of IFN-gamma and LPS. It could be inhibited by NG-monomethylarginine. We conclude that activated microglial cells can secrete nitrite. Stimulation of the NO pathway in microglial cells may be relevant to the pathogenesis of inflammatory and autoimmune demyelinating diseases of the brain.
Animals↗
Reversible conduction block in human ischemic neuropathy after ergotamine abuse.
Conduction block [a significant reduction in compound muscle action potential (CMAP) amplitude after proximal compared to distal stimulation] is often found in demyelinating neuropathies, including inflammatory neuropathies and degenerative neuropathies, such as "liability to pressure neuropathy." There is experimental evidence that a transient conduction block can occur in rats after ischemic lesions of peripheral nerves are induced either by ligation of arterial vessels supplying nerve trunks, or by injection of arachidonic acid into peripheral arterial vessels. Conduction block has also recently been described in cases with necrotizing vasculitis. To date, however, no example of a reversible conduction block has been reported in human ischemic neuropathy.
Adult↗
Inflammatory mediators in demyelinating disorders of the CNS and PNS.
Work in both experimental models and human disorders of the central and peripheral nervous system has delineated multiple effector mechanisms that operate to produce inflammatory demyelination. The role of various soluble inflammatory mediators generated and released by both blood-borne and resident cells in this process will be reviewed. Cytokines such as interleukin (IL)-1, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha are pivotal in orchestrating immune and inflammatory cell-cell interactions and represent potentially noxious molecules to the myelin sheath, Schwann cells, and/or oligodendrocytes. Arachidonic acid metabolites, synthesized by and liberated from astrocytes, microglial cells and macrophages, are intimately involved in the inflammatory process by enhancing vascular permeability, providing chemotactic signals and modulating inflammatory cell activities. Reactive oxygen species can damage myelin by lipid peroxidation and may be cytotoxic to myelin-producing cells. They are released from macrophages and microglial cells in response to inflammatory cytokines. Activation of complement yields a number of inflammatory mediators and results in the assembly of the membrane attack complex that inserts into the myelin sheath-creating pores. Activated complement may contribute both to functional disturbance of neural impulse propagation, and to full-blown demyelination. Proteases, abundantly present at inflammatory foci, can degrade myelin. Vasoactive amines may play an important role in breaching of the blood-brain/blood-nerve barrier. The importance of nitric oxide metabolites in inflammatory demyelination merits investigation. A better understanding of the multiple effector mechanisms operating in inflammatory demyelination may help to devise more efficacious antigen non-specific therapy.
Animals↗
Serum interleukin-2 concentrations in Guillain-Barré syndrome and chronic idiopathic demyelinating polyradiculoneuropathy: comparison with other neurological diseases of presumed immunopathogenesis.
Serum concentrations of the cytokine interleukin-2 (IL-2) were quantitated by enzyme-linked immunosorbent assay in 42 patients with Guillain-Barré syndrome, 15 patients with chronic idiopathic demyelinating polyradiculoneuropathy, 37 patients with other neuropathies, 54 patients with other noninflammatory, nondemyelinating neurological disorders, and 26 healthy control subjects. We found markedly increased serum levels of IL-2 in patients with Guillain-Barré syndrome and to a much lesser extent, in patients with chronic idiopathic demyelinating polyradiculoneuropathy. Increased serum concentrations of IL-2 in patients with Guillain-Barré syndrome returned to normal in parallel with recovery from the disease. These findings suggest ongoing T-cell proliferation in patients with Guillain-Barré syndrome and some patients with chronic idiopathic demyelinating polyradiculoneuropathy. IL-2 levels were also raised in patients with active multiple sclerosis, myasthenia gravis, and herpes simplex encephalitis, and some patients with polymyositis, invoking T cells in the pathogenesis of these diseases.
Autoimmune Diseases↗
Presence of the terminal complement complex (C5b-9) precedes myelin degradation in immune-mediated demyelination of the rat peripheral nervous system.
In this study, the terminal complement complex C5b-9 (TCC) was localized by immunocytochemistry at different clinical stages of experimental autoimmune neuritis. Deposits of TCC were found on the surface of Schwann cells and their myelin sheaths, and to some extent in the extracellular space at predilective sites of impending demyelination before onset of clinical signs and for a short period thereafter. Additionally, TCC was deposited on the surface of W3/13 positive leukocytes. No TCC immunoreactivity was seen in the distal stump of transected sciatic nerves 1 to 15 days after axotomy. The early and transient deposition of TCC on Schwann cells and myelin sheaths in experimental autoimmune neuritis before overt demyelination suggests that complement activation plays a pathogenic role in the initiation of immune-mediated myelin damage. The lack of TCC immunoreactivity after nerve transection excludes a nonspecific activation process. The signals involved in local TCC formation in demyelinating peripheral nervous system disorders have yet to be explored.
Animals↗
Rat astrocytes express interferon-gamma immunoreactivity in normal optic nerve and after nerve transection.
Astrocytes are pivotal components of immune reactions in the CNS. We further support this notion by the localization of the lymphokine interferon-gamma (IFN-gamma), which plays an important role during immune responses, to astrocytes in rat optic nerve (ON). Astrocytes identified by glial fibrillary acidic protein immunoreactivity were IFN-gamma positive in normal and transected ON while oligodendrocytes did not express IFN-gamma immunoreactivity. These findings indicate that astrocytes can generate important signals which orchestrate immunoinflammatory responses in the brain.
Animals↗
The role of interferon-gamma in the pathogenesis of experimental autoimmune disease of the peripheral nervous system.
The role of interferon-gamma in the pathogenesis of experimental autoimmune disease of the peripheral nervous system was investigated. Administration of rat recombinant interferon-gamma markedly augmented both myelin-induced and T-cell line-mediated experimental autoimmune neuritis. Conversely, in vivo application of a monoclonal antibody to interferon-gamma suppressed the disease. Clinical and electrophysiological findings were corroborated by semiquantitative morphometric analysis. Mechanisms responsible for the enhancing effects of interferon-gamma include upregulation of major histocompatibility complex class II antigen expression in the nerve lesion, increased cellular influx of T cells and macrophages, and heightened macrophage activity with enhanced release of toxic oxygen species. These observations establish a pivotal role of the cytokine interferon-gamma in the pathogenesis of experimental autoimmune disease of the peripheral nervous system.
Animals↗
T-cell and macrophage activation in experimental autoimmune neuritis and Guillain-Barré syndrome.
Evidence implicating cellular immune responses in the pathogenesis of experimental autoimmune neuritis (EAN) and Guillain-Barré syndrome (GBS) is reviewed. In EAN the decisive role of T-lymphocytes in the initiation of immune-mediated nerve damage has been firmly established by adoptive transfer experiments. Macrophages but not Schwann cells express major histocompatibility complex class II gene products in situ and hence may function as antigen presenters. Macrophages are crucial in the amplification and effector phase and damage the myelin sheath by phagocytic attack and release of inflammatory mediators such as toxic oxygen radicals, arachidonic acid metabolites, complement, or hydrolases. Macrophage activation in EAN is achieved by interferon-gamma. Attempts to detect specific sensitization of T-lymphocytes to nerve antigens in patients with GBS have so far been unsuccessful. However, circulating activated T cells can be found in patients with GBS, as evidenced by augmented expression of HLA-DR antigen, the transferrin receptor, and the interleukin-2 receptor on the surface of peripheral blood T cells, and by increased serum concentrations of interleukin-2 and the soluble interleukin-2 receptor. In addition, we present data indicating macrophage activation in GBS.
Humans↗
Macrophages but not Schwann cells express Ia antigen in experimental autoimmune neuritis.
This study was designed to identify which cells express major histocompatibility complex class II (Ia) antigen in experimental autoimmune neuritis and may therefore be antigen presenters. Serial 1-micron-thick cryosections of ventral roots of animals with experimental autoimmune neuritis were labeled with Ox6 antibody against rat Ia, the ED1 antibody to identify monocytes/macrophages and an antiserum against S100, a marker for Schwann cells. Ia-positive cells were predominantly present before overt clinical signs and demyelination (day 12). At later stages when many axons were demyelinated, their number was markedly reduced. Few Ia-positive cells that had extending long processes, which over some distance were in immediate contact with several myelin sheaths, were scattered in normal-appearing nerve roots at these later time points. Most of the Ia-positive cells could be identified as ED1-positive lean monocytes/macrophages, but in contrast most phagocytic macrophages in advanced stages of myelin degradation no longer expressed Ia. Ia-positive structures were invariably negative for S100 at early and late stages of experimental autoimmune neuritis, indicating that Schwann cells did not express identifiable Ia antigen. These findings contrast with reports of expression of major histocompatibility complex class II antigens by Schwann cells in human neuropathies. Furthermore they do not support the notion that aberrant Ia expression by Schwann cells plays a major pathogenic role in experimental autoimmune disease of the peripheral nervous system.
Animals↗
T cell activation in Guillain-Barré syndrome and in MS: elevated serum levels of soluble IL-2 receptors.
Guillain-Barré syndrome (GBS), chronic idiopathic demyelinating polyradiculoneuropathy (CIDP), and multiple sclerosis (MS) are disorders with presumed immunopathogenesis. To obtain evidence for T cell activation, we determined serum concentrations of soluble interleukin-2 receptors (sIL-2 R) in 50 patients with GBS, 24 with CIDP, and 54 with MS. Both in GBS and clinically active MS sIL-2 R levels were markedly increased compared with those in patients with other neurologic diseases. Four of 24 CIDP patients had abnormally increased sIL-2 R concentrations. sIL-2 R concentrations decreased with clinical improvement in serial samples taken from GBS patients, but were not otherwise correlated with disease severity. These data establish that T cells are activated in GBS and some patients with CIDP, and corroborate earlier evidence that activated T cells are circulating in the blood of MS patients.
Chronic Disease↗
[Paraneoplastic syndromes of the nervous system].
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Autoimmune Diseases↗
[New aspects of the pathogenesis and therapy of Guillain-Barré syndrome and chronic polyneuritis].
The Guillain-Barré syndrome and chronic idiopathic polyradiculoneuropathy (CIDP) are examples of immune-mediated neuropathies. In the Guillain-Barré syndrome, antibodies directed to neutral glycolipids of peripheral nerve myelin have been detected that activate the complement system. There is evidence for the presence of circulating activated T lymphocytes. Humoral factors have been implicated in the pathogenesis of CIDP. The animal model experimental autoimmune neuritis lends itself to the elucidation of pathogenic immune mechanisms. The principal treatment is plasmapheresis. Further approaches to the therapy of the Guillain-Barré syndrome and CIDP are discussed.
Animals↗
Role of therapeutic plasmapheresis in chronic inflammatory demyelinating polyneuropathy.
Therapeutic plasmapheresis is an effective therapy in the management of CIDP. A varying percentage of patients, approximately 30 to 60%, may benefit from the treatment. The optimal frequency and volume of PE need to be clarified, but, taking into account the heterogeneity of the disease, a too rigid approach should be avoided. According to our experience, neither morphological findings on sural nerve biopsy, nor conduction slowing, conduction block, or the amount of spontaneous activity on needle electromyography in a weak muscle correlated clearly with the later outcome of PE. Possibly our patient number is too small to provide any statistically significant predictor of outcome. In our opinion it is essential to combine plasmapheresis with effective immunosuppression to avoid a rebound with overshooting synthesis of putative pathogenic antibodies or factors. Finally, IA with T-PVA columns has proven effective in single, case-controlled patients with CIDP. It may be a promising supplement to PE avoiding the need and risks of protein replacement.
Autoimmune Diseases↗
Recombinant interleukin-1 beta stimulates eicosanoid production in rat primary culture astrocytes.
Astrocytes may play a prominent role in the initiation of immunoinflammatory responses in the central nervous system. They can be induced to synthesize eicosanoids but how immunologically relevant molecules modulate this process is not known. We examined the influence of recombinant interleukin-1 (rIL-1), an immunomodulating monokine on the release of arachidonic acid metabolites. IL-1 (1-30 U) induced a dose-related elaboration predominantly of the cyclo-oxygenation products prostaglandin E and thromboxane B2. Preincubation of rIL-1 with a specific antibody abrogated and heat-inactivation destroyed this activity. Both mepacrine and the isoquinolinesulfonamide H7 blocked the stimulatory effect dose-dependently, indicating involvement of protein kinase C in this novel biologic activity of IL-1. In central nervous system inflammation, IL-1-evoked release from astrocytes of arachidonic acid-derived metabolites may influence the severity of phlogistic responses and modulate local immune reactivity.
Animals↗
Suppression of P2-T cell line-mediated experimental autoimmune neuritis by interleukin-2 receptor targeted monoclonal antibody ART 18.
The monoclonal antibody ART 18 directed to the rat interleukin-2 receptor (IL-2 R) was administered to Lewis rats immediately prior to and/or on consecutive days after adoptive transfer of autoreactive P2-T line lymphocytes. The effects of ART 18 and sham treatment on the development of adoptive transfer--experimental autoimmune neuritis (AT-EAN) were assessed by clinical inspection, serial electrophysiological monitoring, and semiquantitative histomorphological analysis. Early injection of ART 18 suppressed AT-EAN while treatment after appearance of clinical signs did not. Since the IL-2 R is expressed exclusively on proliferating T cells activated by antigen, the in vivo application of an IL-2 R-targeted monoclonal antibody allows for more selective immunosuppression of experimental autoimmune disease of the peripheral nervous system than has previously been achieved.
Animals↗
The blood-nerve barrier in Wallerian degeneration: a sequential long-term study.
The blood-nerve barrier (BNB) for serum proteins was studied after a crush lesion of the murine sciatic nerve or after transsection with persistent Wallerian degeneration. Using single intraperitoneal injections of biotinylated human albumin, transferrin, IgG, and complement components as tracers, the integrity of the BNB during degeneration and regeneration was determined over time. In Wallerian degeneration induced by crush the BNB became increasingly leaky, with a maximum in the distal stump 8 days after crush (i.e., during early regeneration). When regeneration potentials could first be elicited from the small foot muscles and when thinly myelinated nerve fibers were present, the BNB gradually regained its barrier function and was nearly intact on day 30 after crush. After transsection breakdown of the BNB persisted beyond 30 days. The BNB leakage may foster repair by allowing exchange of trophic factors of large molecular size during nerve regeneration.
Animals↗