Infusion-related hypersensitivity reactions during natalizumab treatment.
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Biomedical subjects
Publications and source records attributed to A Wajgt.
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Recently there has been achieved a substantial progress in research concerning pathogenesis of subacute spongiform viral encephalopathies. For this group of disorders, there has been found a common unconventional virus - proteinaceous infectious particle (PrP). There has been recognised a molecular mass, biochemical composition and physicochemical properties of this infectious form. Mutations of scrapie amyloid precursor gene discovered in Gerstmann-Sträussler-Scheinker syndrome (GSS) and familial cases of Creutzfeldt-Jakob disease (CJD) have been revealed. Nowadays examinations in the field of relationships between prion protein and mutations of scrapie precursor gene are continued.
The purpose of this study was to evaluate the effect of various therapeutic regimens on: 1) intrathecal IgG synthesis on the basis of IgG Index value, 2) oligoclonal IgG spectrum visualized by SDS-PAGE of unconcentrated CSF, 3) CSF antibody specific activity against MBP estimated by solid phase RIA and expressed in cpm/micrograms IgG, and 4) immune complex (CIC) level in the CSF estimated by C1q binding solid phase RIA. CSF antibody against Gal-C and ganglioside was also estimated. Patients with clinically definite MS were selected according to 4 therapeutic regimens: group 1, subjected to Mega-dose prednisone therapy (4000 mg over 54 days), group 2, subjected to moderate dose prednisone therapy, group 3 subjected to Mega-dose Solu-Medrol therapy (7500 mg over 10 days), and group 4, subjected to intravenous Cyclophosphamide therapy (4000 mg over 10 days). This last group was characterized by chronic progressive course of disease. Intrathecal IgG production was significantly reduced in all 4 groups as a result of therapy. More pronounced reduction was obtained in Mega-dose prednisone (p below 0.001) and CY (p below 0.001) treated group. Therapeutic regimens did not influence the IgG oligoclonal pattern. The moderate dose prednisone therapy and Mega-dose Solu-Medrol therapy on CSF IgG anti-MBP antibody specific activity were less effective than the Mega-dose prednisone medication. CY therapy did not influence anti-MBP antibody specific activity in MS group characterized by chronic progressive course of disease. The influence of therapeutic regimens on elevated CIC level in the CSF was insignificant. In our study CSF the anti-galactocerebroside antibody appeared to be of IgM class.
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In our clinical trial we have compared the effect of high doses of prednisone, ACTH alone or ACTH and cyclophosphamide on plasma and CSF albumin and IgG levels. We have found that the treatment with high doses of prednisone is more effective in the suppression of CNS IgG synthesis than ACTH, or cyclophosphamide. However the significance of this immunological phenomenon in the pathogenesis of MS is a very complex problem, since we have not observed any correlation between the depression of the intrathecal IgG synthesis and clinical results of MS treatment.
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The content of myelin associated glycoprotein (MAG) was studied in the rabbit optic nerves undergoing Wallerian degeneration after ophthalmectomy . MAG was estimated according to the method described by Matthieu and Quarles (1973). The results of the studies demonstrated only negligible changes in the content of MAG in the course of central Wallerian degeneration. These experiments do not support the assumption that the periaxionally localized MAG of the central myelin is as a rule seriously involved in subcellular mechanisms functioning in early stages of central demyelinating processes.
Cerebrospinal fluid (CSF) from 18 multiple sclerosis (MS) patients, 13 subacute sclerosing panencephalitis (SSPE) patients, 22 other neurological disease (OND) patients, and 7 neurotic patients as controls were tested in an 125I-labeled anti-human F(ab')2 binding assay for the presence of antibodies to normal human brain cells from tissue culture, human fibroblasts, plasma membranes of MS and normal human brain, myelin basic protein (MBP) and bovine oligodendrocytes. Antibodies to MBP and to oligodendrocytes were found in the CSF of MS, SSPE and OND patients. Absorption of CSF with bovine CNS myelin significantly diminished binding activity to oligodendrocytes. Antibodies in the CSF against MBP and oligodendrocytes, on which some myelin determinants are expressed, seem to be a common feature of diseases in which demyelination is a component.
Cerebrospinal fluid (CSF) from 40 multiple sclerosis (MS) patients was tested by solid-phase radioimmunoassay (RIA) for ability to bind 2 common structural components of myelin and oligodendroglia, i.e., to bind myelin basic protein (MBP) and myelin-associated glycoprotein (MAG). To prevent the effect of differences in CSF IgG concentration on binding activity, the CSF samples were tested at equal IgG concentration 1 mg/ml. The mean binding activity to MBP and MAG was significantly higher than in control neurotics, respectively P less than or equal to 0.05 and P less than or equal to 0.001. In 33% of MS cases, CSF antibody against both antigens was found. Indirect data were obtained that autoantibodies whose antigens are associated with myelin-oligodendrocyte unit are produced locally within the central nervous system (CNS). Anti-MAG and anti-MBP CSF antibody activity was significantly higher, P less than or equal to 0.01 for both antibody specificity, in MS cases characterized by high IgG Index, greater than or equal to 0.70 = means + SD in the neurotic group, versus MS cases characterized by normal IgG Index (less than or equal to 0.70). Correlation coefficient between antibody activity and IgG Index values was 0.785 for anti-MBP antibody, and 0.400 for anti-MAG antibody. The importance of intrathecally produced antibody to MBP and MAG lies in the fact that it indicates an active humoral autoimmune process against a myelin-oligodendrocyte unit in which more than one autoantigen is involved.
In agreement with the close correlation between intrathecal IgG production and anti-MBP (myelin basic protein) and anti-MAG (myelin-associated glycoprotein) antibody activity in the CSF of active MS cases, and parallel to the reduction of intrathecal IgG synthesis resulting from corticosteroids medication, we have found a significant reduction of anti-MBP and anti-MAG antibody activity expressed per 0.5 micrograms of CSF IgG in the same group of 40 MS patients subjected to high-dose prednisone therapy. Every patient received 3980 mg of prednisone over 54 days. In native CSF of 30% (21/70) of active MS cases, circulating immune complexes (CIC) were detected by C1q binding solid-phase RIA. There was no correlation between CIC level in the CSF or MS patients and 1. IgG index which was used as an indicator of intrathecal IgG synthesis, or 2. CSF anti-MBP specific antibody activity, or 3. CSF anti-MAG specific antibody activity. High-dose prednisone therapy resulted in a highly significant reduction of the CSF CIC level. CIC were also found in the CSF of patients affected with various chronic diseases of the CNS.
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A method has been evolved for assessing the functional state of the blood-brain barrier based on determinations of albumin level and calculation from it of the so called albumin index in the cerebrospinal fluid. The results obtained by this method were compared with the value of total protein determination in the assessment of the functional state of the blood-brain barrier with regard to serum proteins. The analysis of these results showed that determinations of the albumin level and albumin index is an objective method in the assessment of the blood-brain barrier. Both methods gave similar results. Determination of the total protein level in the cerebrospinal fluid is of only limited value for the assessment of the functional state of blood-brain barrier in multiple sclerosis.
Peripheral blood lymphocytes of twenty-two multiple sclerosis (MS) patients and thirty-five healthy controls were examined for the presence of surface markers characteristic for B lymphocytes (surface immunoglobulin, receptor for C3 (EAC), reporter for Fc (EA) and the spontaneous rosette-forming capacity characteristic of T cells. The results obtained indicate that the number of B and T cells in MS is similar to controls, as evaluated by the presence of surface immunoglobulin and E rosette-forming capacity. However, a statistically significant reduction in the percentage of lymphocytes bearing C3 receptors has been found in MS patients. It might have resulted from a reduction in the lymphocyte population bearing C3 receptor but no surface immunoglobulin. The EA rosette test revealed the greatest difference between the groups. The difference indicated a reduction in the density of the receptor for 7S Fc on lymphocytes from MS patients. The results obtained are consistent with the hypothesis of an immune deficit in multiple sclerosis.
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