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Biomedical subjects

N Scolding

Publications and source records attributed to N Scolding.

At least 19 recordsLinked to original sources
PubMed2004

Is cerebrospinal fluid spectrophotometry useful in CT scan-negative suspected subarachnoid haemorrage?

Missed cerebral aneurysms in CT-negative patients can have serious implications. We set out to determine the usefulness of cerebrospinal fluid (CSF) spectrophotometry and the individual significance of CSF oxyhaemoglobin, bilirubin and methaemoglobin in 463 CT scan-negative patients with suspected subarachnoid haemorrhage (SAH) and normal neurological examination. CSF spectrophotometry resulted in the diagnosis of an intracranial aneurysm in 2% (9/463) of patients with CT-negative suspected SAH. No aneurysms were found in patients in whom spectrophotometry was negative for haem pigments. Less than 1% of patients with oxyhaemoglobin alone had aneurysms diagnosed, whilst 21% of patients with bilirubin had an aneurysm. CSF spectrophotometry is an important investigation in patients with CT-negative suspected SAH, particularly where clinical suspicion is strong. Patients positive for bilirubin are likely to provide a high yield of aneurysmal bleed and should undergo angiography. Patients with oxyhaemoglobin alone in whom SAH is strongly suspected may benefit from angiography. Based on a small number of patients, we recommend that patients with methaemoglobin should also be investigated. Patients with negative spectrophotometry are unlikely to benefit from further investigation.

Bilirubin↗
PubMed2002

Intravenous immunoglobulin in neurological disease: a specialist review.

Treatment of neurological disorders with intravenous immunoglobulin (IVIg) is an increasing feature of our practice for an expanding range of indications. For some there is evidence of benefit from randomised controlled trials, whereas for others evidence is anecdotal. The relative rarity of some of the disorders means that good randomised control trials will be difficult to deliver. Meanwhile, the treatment is costly and pressure to "do something" in often distressing disorders considerable. This review follows a 1 day meeting of the authors in November 2000 and examines current evidence for the use of IVIg in neurological conditions and comments on mechanisms of action, delivery, safety and tolerability, and health economic issues. Evidence of efficacy has been classified into levels for healthcare interventions (tables 1 and 2).

Drug Costs↗
PubMed2001

Glial cells as targets for cytotoxic immune mediators.

Oligodendrocytes and Schwann cells are the glia principally responsible for the synthesis and maintenance of myelin. Damage may occur to these cells in a number of conditions, but perhaps the most studied are the idiopathic inflammatory demyelinating diseases, multiple sclerosis in the CNS, and Guillain-Barré syndrome and its variants in the peripheral nervous system (PNS). This article explores the effects on these cells of cytotoxic immunological and inflammatory mediators: similarities are revealed, of which perhaps the most important is the sensitivity of both Schwann cells and oligodendrocytes to many such agents. This area of research is, however, characterised and complicated by numerous and often very substantial inter-observer discrepancies. Marked variability in cell culture techniques, and in assays of cell damage and death, provide artifactual explanations for some of this variability; true inter-species differences also contribute. Not the least important conclusion centres on the limited capacity of in vitro studies to reveal disease mechanisms: cell culture findings merely illustrate possibilities which must then be tested ex vivo using human tissue samples affected by the relevant disease.

Animals↗
PubMed1999

Therapeutic strategies in multiple sclerosis. II. Long-term repair.

Spontaneous myelin repair in multiple sclerosis (MS) provides a striking example of the brain's inherent capacity for sustained and stable regenerative tissue repair--but also clearly emphasizes the limitations of this capacity; remyelination ultimately fails widely in many patients, and disability and handicap accumulate. The observation of endogenous partial myelin repair has raised the possibility that therapeutic interventions designed to supplement or promote remyelination might have a useful and significant impact both in the short term, in restoring conduction, and in the long term, in safeguarding axons. Therapeutic remyelination interventions must involve manipulations to either the molecular or the cellular environment within lesions; both depend crucially on a detailed understanding of the biology of the repair process and of those glia implicated in spontaneous repair, or capable of contributing to exogenous repair. Here we explore the biology of myelin repair in MS, examining the glia responsible for successful remyelination, oligodendrocytes and Schwann cells, their 'target' cells, neurons and the roles of astrocytes. Options for therapeutic remyelinating strategies are reviewed, including glial cell transplantation and treatment with growth factors or other soluble molecules. Clinical aspects of remyelination therapies are considered--which patients, which lesions, which stage of the disease, and how to monitor an intervention--and the remaining obstacles and hazards to these approaches are discussed.

Astrocytes↗
PubMed1998

Regional potential for oligodendrocyte generation in the rodent embryonic spinal cord following exposure to EGF and FGF-2.

The origin of oligodendrocytes in the developing rodent spinal cord has not been fully established, with some evidence that oligodendrocyte progenitors arise exclusively from the ventral neuroepithelium, other studies suggesting that both halves of the spinal cord have oligodendrogenic potential. One way of exploring this issue is to study more primitive oligodendrocyte precursors. Although specific markers are not available, their presence may be inferred using mitogens such as EGF and FGF-2, which stimulate the proliferation of immature neuroepithelial cells, and subsequently studying their differentiation into lineage restricted cells. We used this approach to assess whether the dorsal embryonic rodent spinal cord has the intrinsic potential for oligodendrocyte formation at E14. We confirm that significant numbers of oligodendrocytes and their immediate (A2B5+) precursors are present only in the ventral spinal cord of the E14 rodent, but following exposure to EGF and FGF-2, significant numbers of oligodendrocytes and A2B5+ precursor cells also develop from isolated E14 dorsal derived cells without interaction from the ventral spinal cord. In addition, bromodeoxyuridine studies demonstrate that isolated dorsal derived cells proliferate and express A2B5 following exposure to EGF and FGF-2. The observation that from E14, the dorsal cord already has latent oligodendrogenic potential provides an alternative mechanism for oligodendrocyte formation to ventro-dorsal migration of oligodendrocyte precursors.

Animals↗
PubMed1998

Oligodendrocyte progenitors are present in the normal adult human CNS and in the lesions of multiple sclerosis.

In multiple sclerosis, partial remyelination is conspicuous in many lesions, but widespread and lasting myelin repair ultimately fails as disability and handicap accumulate. Thus far, the precise identity of the cell responsible for limited spontaneous myelin repair has remained obscure. In the rodent, the proliferative oligodendrocyte progenitor is the most efficient remyelinating cell; this has now been identified in cultures prepared from normal human brain, but has proved difficult to demonstrate in situ. We adapted techniques using antibodies against the human platelet-derived growth factor-alpha receptor to identify oligodendrocyte progenitors in human tissue sections. Small numbers of oligodendrocyte progenitors were found in normal adult human white matter. Progenitors were also demonstrable in acute and chronic lesions from patients dying with multiple sclerosis, but with no evidence of any marked reactive increase in cell numbers. Understanding the biology of the remyelinating cell, and in particular the reason for its apparent failure to repopulate demyelinated lesions, is important for the development of remyelination treatments.

Adult↗
PubMed1997

Glial lineages and myelination in the central nervous system.

Oligodendrocytes, derived from stem cell precursors which arise in subventricular zones of the developing central nervous system, have as their specialist role the synthesis and maintenance of myelin. Astrocytes contribute to the cellular architecture of the central nervous system and act as a source of growth factors and cytokines; microglia are bone-marrow derived macrophages which function as primary immunocompetent cells in the central nervous system. Myelination depends on the establishment of stable relationships between each differentiated oligodendrocyte and short segments of several neighbouring axons. There is growing evidence, especially from studies of glial cell implantation, that oligodendrocyte precursors persist in the adult nervous system and provide a limited capacity for the restoration of structure and function in myelinated pathways damaged by injury or disease.

Adult↗
PubMed1997

Strategies for repair and remyelination in demyelinating diseases.

A variety of therapeutic approaches aimed towards promoting myelin repair in multiple sclerosis and in other demyelinating diseases are now on the brink of clinical implementation. In this article, the extensive experimental studies of the past 2 decades, and in particular the considerable progress made over the last 12 months, will be briefly reviewed. A number of hurdles remain, together with practical and ethical problems which may be more difficult to solve; nevertheless, increasing excitement is apparent in this novel therapeutic field, and the rapid progress emerging from these laboratory based studies justifies a cautious optimism towards the successful translation of remyelination strategies from experimental neurobiology to clinical neurology.

Demyelinating Diseases↗
PubMed1996

CAMPATH-IH in multiple sclerosis.

In a pilot study, seven patients with multiple sclerosis were treated with CAMPATH-IH which targets the CD52 antigen present on lymphocytes and monocytes. There was a substantial reduction in disease activity as measured by gadoliunium-enhancing lesions on MRI. Encouraged by this result a further seven patients have been treated with CAMPATH-IH; four also received anti-CD4 antibody. Lymphopaenia developed rapidly and was sustained for at least one year. In 12 patients, the first infusion of antibody was characterised by significant exacerbation or re-awakening of pre-existing symptoms lasting several hours. These clinical effects of antibody treatment correlated with increased levels of circulating cytokines. Peak levels of tumour necrosis factor alpha (TNF alpha) and interferon gamma (IFN gamma) occurred at 2 h whereas the rise in interleukin-6 (IL-6) was significantly delayed and peaked at 4 h after starting antibody treatment. The neurological symptoms could not be attributed directly to pyrexia and were not provoked (in one patient) by an artificial rise in temperature. In the remaining two patients, a single pre-treatment with intravenous methylprednisolone (500 mg) prevented both the transient increase in neurological symptoms and the cytokine release. Our results suggest that soluble immune mediators contribute to symptom production in multiple sclerosis by directly or indirectly blocking conduction through partially demyelinated pathways.

Adrenal Cortex Hormones↗
PubMed1996

Failure to achieve remyelination of demyelinated rat axons following transplantation of glial cells obtained from the adult human brain.

The ability of transplanted glial cells to myelinate axons in experimental animals offers the prospect that it may be possible to achieve remyelination in human demyelinating disease by the implantation of oligodendrocyte lineage cells. Autologous normal white matter could represent a potential source of cells whose use would avoid tissue rejection and overcome ethical and practical constraints associated with the use of fetal tissue. To determine the remyelinating potential of cells isolated from adult human CNS, a cell preparation prepared from adult human white matter which contained 56% oligodendrocytes, 3% preoligodendrocytes and 1% precursor cells was transplanted into non-repairing demyelinating lesions in immunosuppressed rats created by the injection of ethidium bromide into x-irradiated spinal cord white matter. The extent of remyelination was examined 3 and 5 weeks after transplantation. Although the transplanted oligodendrocytes survived in the area of demyelination, associated with demyelinated axons and produced myelin membranes, no myelin sheaths were produced and there was no evidence of cell migration or division. The failure of human oligodendrocytes to form myelin sheaths may reflect the poor remyelinating potential of post mitotic oligodendrocytes, and the failure of the small number of co-transplanted bipotential oligodendrocyte progenitor cells to differentiate and myelinate axons may be a consequence of lack of appropriate environmental factors within the rat lesion required for expansion and differentiation of these cells.

Adult↗