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This paper presents the case study of six patients suffering from acute bilateral optic neuritis simultaneously manifested in both eyes. The clinical picture and the full laboratory investigation failed to establish a real cause of the disease. Finally the lack of general neurological symptoms and the good prognosis of the disease after a two year follow-up is stressed.
Experimental allergic neuritis (EAN) was induced in normal and irradiated Lewis rats by passively transferring T cells sensitized to SP-26, a peptide fragment of P2 myelin protein. The recipients became sick 4-8 days post transfer and the degree of disability correlated directly with the dose of T cells. Smaller doses caused demyelination of nerve roots and sciatic nerves and larger doses produced more severe demyelination and significant axonal degeneration. Irradiated recipients developed similar clinical EAN and showed macrophage-mediated demyelination despite severe suppression of the host inflammatory response.
Experimental allergic neuritis was induced in Lewis rats by inoculation with autoreactive T cell lines sensitized to residue 57-81 of P2 myelin protein. Control rats received cells derived from immunization to complete Freund's adjuvant alone. Endoneurial fluid pressure (EFP) was measured in both sciatic nerves at 0, 3, 5, 7, 9, and 11 days post-inoculation (PI). The temporal evolution of inflammatory disease was studied by correlating EFP with a morphometric analysis of the nerve microenvironment and with electron microscopic observations. Both edema, as evidenced by increased endoneurial extracellular space, and inflammation paralleled the time course of the EFP increase, reaching peak values at 7 days PI and declining to near-normal values after 11 days. Wallerian degeneration was detectable at 7 days and increased 9 days after inoculation. Axonal damage appeared at the height of the inflammatory process, when edema and increased EFP were maximal. Evidence of demyelination was apparent by 7 days and persisted through 11 days. The onset of edema was associated with changes in venular endothelial cells which tended to lose their normal scaphoid appearance and assumed rhomboid configurations reminiscent of high endothelial venules. At that point, the barrier endothelium was visibly disrupted with the loss of tight junctions and separation of adjacent cells. Specific cell-cell interactions took place between endothelial cells and infiltrating leukocytes as they immigrated into the endoneurial compartment. There was evidence of altered perineurial permeability with fibrin deposition and leukocyte infiltration between the layers of the perineurial sheath.
In experimental allergic neuritis (EAN) severity of clinical disease and pathology correlate with the dose of antigen (Hahn et al., Lab Invest 59:115-125, 1988). To avoid axonal membrane contamination of the antigen, EAN was induced with a synthetic peptide, corresponding to residues 53-78 of bovine P2 myelin protein. Severity of EAN correlated with the dose of peptide in the inoculate. The relationship between demyelination, inflammation and axonal degeneration was studied. Low doses resulted in pure demyelination. Axonal degeneration occurred only with high doses of antigen and in association with very active mononuclear inflammation. The role of macrophages in producing axonal damage is discussed.
A case of myasthenia gravis is described in association with optic neuritis in which brain-stem auditory and somatosensory evoked potentials were normal. CSF contained alkaline oligoclonal IgG bands. Blood lymphocyte subpopulations showed a decreased number of T-suppressor cells.
The optically evoked blink reflex (BR) was recorded in 30 patients (20 females, 10 males) with primary acute optic neuritis (ON) unassociated with other CNS disorders. The reflex was studied in the acute stage between the 1st and 6th day after onset, during the 1st month following the acute stage once a week, and then 2 and 6 months later. In patients in whom a relapse occurred, the programme was restarted from the beginning. Control values were taken from prior investigations in 50 healthy subjects. In the acute stage differences in the amplitudes were present in 26 patients, but the latencies remained within normal limits. Six patients (20%) developed multiple sclerosis during the 5-year follow-up until December 1985. In these cases the optic BR showed increased latencies and decreased amplitudes. In patients without manifestation of multiple sclerosis the BR remained normal. In 7 patients cranial magnetic resonance imaging (MRI) was done. All patients with some abnormalities in the visual BR also had an abnormal MRI. The pattern-shift visual evoked potentials were abnormal in the acute stage of ON in 90%, and CSF abnormalities were found in 56.6%. In 4 patients (13%) the visual BR could not be evoked at all.
MRI was performed on seven patients with acute optic neuritis, using two sequences which suppress the signal from orbital fat: frequency-selective fat-saturation and inversion recovery with a short inversion time. Lesions were seen on both sequences in all the symptomatic optic nerves studied.
Electrophysiological, clinical and histological techniques were used to monitor the time course of events related to experimental allergic neuritis (EAN) in 48 Lewis rats. The primary lesion was found to be paranodal demyelination without cellular infiltration. Endoneural phagocytes derive from hematogenous ED1+ED2- monocytes and possibly from resident ED1-ED2+ monocytic cells, not from Schwann cells and fibroblasts. We demonstrate a population of monocytic Ia-bearing, ED1-ED2+ spindle-shaped cells residing in normal peripheral nerve and provide evidence for their transformation into macrophages in the course of EAN.
The selective toxicity of silica dust for macrophages has been used to assess the role of these cells in experimental allergic neuritis (EAN). Inbred Lewis rats were inoculated with bovine dorsal roots in Freund's complete adjuvant (day 0). In two experiments, animals received 200 mg of silica dust in 1 cm3 of saline intraperitoneally (IP) at days 8 and 16. In another two experiments, animals received IP silica at days 3, 7, and 11. Control animals received 1 cm3 saline IP at corresponding times. Regular clinical assessment showed that in animals treated on days 8 and 16 there was a significant delay in the time taken to reach their maximum degree of illness. This delay was not seen in the animals treated on days 3, 7, and 11. Neither of the injection regimes reduced the final maximum severity of the disease. In three experiments recovery of the treated and control animals occurred concurrently, hence the duration of the disease was reduced in the animals treated at days 8 and 16. However, in one group of animals given silica at days 3, 7 and 11, there was a delay in the time taken to recover from the most severe phase of the disease but thereafter the treated animals improved more quickly to reach their best grade at the same time as the controls. If the silica blockade of macrophages is to be effective in delaying the onset of EAN, the timing of injections is critical.
After experimental allergic neuritis (EAN) was induced in 16 male Lewis rats with bovine peripheral myelin and adjuvants, peripheral nerves were examined morphologically at intervals of 12-21 days post inoculation (dpi). Signs of motor involvement were present in ten rats and were first elicited 12 dpi. They ranged from tail droop to complete lower limb paralysis. Autonomic nervous system (ANS) involvement was studied by contrasting morphological findings in the cervical sympathetic nerves (CSN), which are poorly myelinated and vagal nerves (VN) which contain numerous myelinated fibers in the endoneurium. Edema, perivenular infiltrates, and demyelination appeared in the VN of seven of nine neurologically affected rats, while the CSN showed edema and infiltrates in only one rat. ELISA assays were negative for anti-galactocerebroside antibody, and electron microscopy failed to show abnormalities of Schwann cells.
Passive transfer of experimental allergic neuritis (EAN) lymph node cells (LNC) by intraneural injection did not produce significant demyelination. EAN-LNC stimulated with myelin in vitro produced mild demyelination while those incubated with Concanavalin A had no effect. The lack of demyelination by unstimulated EAN-LNC is in contrast to the marked demyelination produced by intraneural injection of EAN serum. The mononuclear cell infiltration and demyelination of classical EAN seem to require both cellular and humoral immune responses.
The integrity of the blood-nerve barrier (BNB) was studied during the development of experimental allergic neuritis (EAN). Lewis rats immunized with bovine nerve or myelin plus complete Freund's adjuvant developed histological lesions of EAN in nerve roots by 10-12 days and in sciatic nerves by 12-14 days. Evans blue-albumin (EBA) and horseradish peroxidase (HRP) were injected i.v. 1 h prior to killing on days 6-18. Perivascular and diffuse endoneurial leakage of the tracers was seen in nerve roots by 10-12 days post immunization (p.i.) and in sciatic nerves by 12-14 days. This coincided with the appearance of endoneurial infiltration with inflammatory cells and endoneurial proteinaceous edema at a time when Schwann cell and myelin changes were still minimal. Therefore, an alteration in BNB permeability occurs early in EAN, coincident with inflammatory cell infiltration. This could be an expression of delayed hypersensitivity, yet it would also facilitate the entry of anti-myelin antibodies into the endoneurium where they could initiate demyelination.
Patterns of demyelination were studied in sciatic nerves, spinal roots and ganglia of chickens afflicted with either Marek's disease (MD) or experimental allergic neuritis (EAN). MD was induced in susceptible chicks after hatching by inoculation of the JM strain of MD Herpes virus. Tissues from these chickens were examined 7-83 days after infection. EAN was studied 10-21 days after sensitization of 4 week old chickens to emulsions containing human peripheral nerve with complete Freund's adjuvant. In both conditions lesions were encountered which consisted of perivenular infiltrates of mononuclear cells that penetrated the basal lamina of the neurolemmal sheath, displaced Schwann cells, lysed and stripped myelin lamellae without damage to axons. Other lesions in MD were characterized by lymphomatous infiltrates that contained necrotic cells and disintegrating axons. The similarity of the demyelinating process in MD to that seen in EAN suggests that MD virus infection activates lymphocytes sensitized to peripheral nerve myelin. The findings are discussed with reference to acute idiopathic polyneuritis (Guillain-Barré syndrome) in patients with preceding or concurrent Herpes virus infections including those known to cause lymphoproliferative disorders.
Experimental allergic neuritis (EAN) was induced in Lewis rats aged 4 months by the inoculation of whole bovine dorsal root with Freund's complete adjuvant. Prolonged follow-up demonstrated that a relapsing course is a regular feature of the disorder in animals at this age. Although the initial disease episode was the most severe, clinical recovery from subsequent relapses was less satisfactory, this probably being related to persistent morphological abnormalities in the peripheral nervous system. Antecedent thymectomy, splenectomy, or the two combined, had little effect on the clinical course of the disorder, apart from reducing the duration of relapses. This was only statistically significant following combined thymectomy/splenectomy. Histological abnormalities, however, tended to be less severe in the operated as compared with normal control or sham-operated animals with EAN. The animals must have attained an immunocompetent state at the time of thymectomy and/or splenectomy. The capacity to develop EAN presumably resides in the draining lymph nodes and the occurrence of relapses is due to the continuing presence of antigen at the injection sites.
It has recently been suggested that severed axons fail to regenerate in the mammalian central nervous system as a result of an autoimmune reaction to myelin basic protein released into the circulation at the time of injury. Since the autoantigenic components of peripheral myelin are rapidly phagocytosed after axonal transection, it is claimed that a comparable immune response does not occur following injury to peripheral nerves, so the regenerative process is not hindered. If this contention is correct, it should be possible to inhibit the regeneration of peripheral axons by inoculating animals with suitable neuritogenic homogenates of peripheral nervous tissue. It has been shown that axonal regneration proceeds at the same rate in rats with experimental allergic neuritis as in healthy controls inoculated only with Freund's adjuvant. It is unlikely, therefore, that myelin basic proteins can stimulate the production of antibodies capable of inhibiting regenerative axonal growth.
Experimental allergic neuritis (EAN) was induced in guinea pigs and rats and treated with Cyclosporin-A (Cy-A). When Cy-A was given prophylactically for 1 month from the time of induction of the disease, it prevented the development of EAN during the course of its administration. When Cy-A was given therapeutically after the onset of neurological signs, it effectively prevented further deterioration. This effect was more marked after 3 weeks' treatment than after only 1 week's treatment. In both regimens, when dosing with Cy-A ceased there was a latent period before clinical signs of EAN developed. This latent period is similar to that seen in the development of EAN in normal control animals and is probably due to the continued presence of antigen at the injection sites. After primary treatment of EAN with Cy-A, animals that relapsed did not respond to further treatment with Cy-A. Histological examination revealed that the nature of the EAN lesions in both groups of animals given Cy-A were not as severe as those seen in control animals. Despite these observations, there was no statistically significant difference between the maximum clinical grades reached by animals in any one group. These experiments suggest that T-cells are important in the development of EAN and that Cy-A interferes with this process by suppressing T-helper cells. They also show that it is possible to influence favourably the course of immune mediated neurological disease.
Cultures of mouse cerebellum were exposed to sera from rabbits with experimental allergic neuritis induced by whole peripheral nerve immunization (WN-EAN) and to rabbit anti-galactocerebroside (GC) antisera, and were studied by electron microscopy. Both antisera produced almost identical demyelinative patterns. These consisted of large intramyelinic splittings, "smudged" changes of myelin, degeneration of oligodendrocytes, and phagocytosis of myelin by astrocytes, changes similar to those described after application of whole spinal cord-induced experimental allergic encephalomyelitis (WM-EAE) sera. In addition, patterns which have been considered more characteristic of in vivo demyelinative lesions have been found, susch as vesicular disruption of myelin lamellae and peeling off and phagocytosis of myelin by phagocytic mononuclear cells with electron dense cytoplasm. The morphologic similarities between demyelinative patterns in central nervous system (CNS) cultures induced by anti-GC antiserum and WN-EAN serum and WM-EAE serum, and the fact that elevated antibody titers to GC are found in sera from rabbits with WN-EAN and WM-EAE (Saida, et al., 1977), support the concept that anti-GC antibody is the major factor in the production of CNS demyelination in vitro by sera from rabbits with WN-EAN and WN-EAE.
The injection of bovine dorsal root antigen in complete Freund's adjuvant can be used to produce experimental allergic neuritis (EAN) in rats. In this study attempts were made to prevent the development of the disease by prior injections of antigen. It was found that eight intradermal (i.d.) injections of antigen in either incomplete Freund's adjuvant or in saline failed to suppress EAN. A single intraperitoneal (i.p.) injection of antigen in saline produced only minimal protection against the disease. However, it was found that rats which had been given a primary course of EAN were subsequently completely unresponsive to a second injection of antigen.