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Lethal encephalitis and non-lethal multifocal central nervous system demyelination in herpes simplex virus type 2 infections in mice.

Six-week-old Swiss-Webster mice were infected intracerebrally with a low dose of herpes simplex virus type 2 (HSV-2) and were studied by pathological, virological and immunological methods. One third of mice developed severe neurological disease and died during the first 31/2 weeks of infection, while the remaining two thirds survived this acute stage with relatively minor neurological signs. These survivors had multifocal demyelinative white-matter lesions in the CNS, and gray-matter lesions, if present, were few, small and usually minor. By contrast, groups of mice killed during the acute stage had a much greater proportion of gray-matter lesions, and these were frequently larger and more severe. Two subgroups could be identified in the acute stage. Mice with severe gray-matter disease, high virus titres, abundant viral antigen and later virus clearance had more severe neurological signs leading to death. By contrast, those destined to survive had pupillary signs alone, and pathologically had white-matter lesions of primary demyelination with minimal or no evidence of gray-matter involvement, low levels of detectable virus and earlier virus clearance. These results show that HSV-2 can produce non-lethal CNS disease in a high proportion of mice, even if infected by the intracerebral route, and that the lesions, which may be found throughout the CNS, are mainly in the white matter, and are demyelinative in type. Survivors of this infection may be useful in a search for evidence of herpes-virus persistence in the CNS, and for a role of this virus in chronic demyelinating disease.

Animals↗

Central nervous system demyelination and remyelination in the mouse: an ultrastructural study of cuprizone toxicity.

Male weanling mice (Biobreeding Laboratories) exposed to the drug Cuprizone (biscyclohexanone, oxaldihydrazone) in the diet for periods of 6 weeks and longer, consistently showed almost complete demyelination of the superior cerebellar peduncle. The demyelination was primary and followed degeneration of oligodendrocytes and their processes, whereas axons remained intact. After formation of myelinic vacuoles and removal of myelin by macrophages and astrocytes, the axons became invested with astroglial processes. As part of the glial response to demyelination, numerous reactive or immature cells appeared, some of which were identified as being either astrocytic or oligodendrocytic in nature. Some mature oligodendrocytes survived. When allowed to recover on a normal diet, remyelination began within a week, and progressed until all axons were myelinated. The mechanism of remyelination appeared similar to the spiral wrapping mechanism seen in normal development. The myelinating cell in all cases was the mature oligodendrocyte. Sources for these oligodendrocytes include residual surviving oligodendrocytes, differentiation of immature forms, and possibly the perineuronal satellite cell. The sheaths eventually reached a thickness approximately half that of normal development, with a disturbed relationship between myelin thickness and axon diameter. A visual impression of shortened internodal length was obtained. It is concluded that the Cuprizone model is an excellent situation in which to study the cellular mechanisms of demyelination and remyelination.

Animals↗

Recombinant human IL-6 suppresses demyelination in a viral model of multiple sclerosis.

We used a murine model of multiple sclerosis (MS) induced by Theiler's murine encephalomyelitis virus (TMEV) to test the effect of IL-6 on central nervous system (CNS) demyelination. Administration of human rIL-6 (2.5 micrograms/dose), beginning one day before infection and then twice daily for 28 days, dramatically reduced demyelination and inflammation in the spinal cord of susceptible SJL/J mice. Benefit also was observed when rIL-6 was used as a therapeutic agent and begun on day 15 after infection, a time in which there is the first evidence of inflammation and demyelination in the spinal cord. Suppression of myelin damage by treatment with rIL-6 was associated with fewer virus Ag-positive cells in the spinal cord. Infectious CNS virus titers, as measured by plaque assay, were reduced in rIL-6-treated animals on day 15 after infection, but not on day 7, 22, or 29 after infection. Total serum Igs and virus-specific Igs, as detected by indirect ELISA, were increased markedly in rIL-6-treated mice, whereas no effect was observed on TMEV-neutralizing Ab titers. In vivo administration of rIL-6 inhibited a murine CNS-demyelinating disease induced by a virus, suggesting that this IL may have application for the treatment of human MS.

Animals↗

Perivascular demyelination and intramyelinic oedema in reperfusion nerve injury.

Nerve ischaemia plays a major role in the development of pathological alterations in various neuropathies, and the effects of ischaemia are amplified by reperfusion in various tissues. While pathological alterations in acutely ischaemic nerve have been established, nerve pathology resulting from reperfusion injury has never been elucidated. To evaluate what cell type in peripheral nerve is affected by reoxygenation following a hypoxic episode, we developed an animal model of transient severe limb ischaemia. Near-complete ischaemia, confirmed by the measurement of nerve blood flow, was achieved by clamping multiple arteries of supply to rat hindlimb. After 3, 5 or 7 h of limb ischaemia, vascular clips were released to reperfuse blood flow. Pathology in sciatic, tibial and peroneal nerves at the lower thigh level was examined at 7 d after reperfusion. All reperfused nerves developed demyelinated nerve fibres, particularly in perivascular regions. Although 3 h of ischaemia followed by reperfusion caused demyelination, perivascular demyelination was more prominent after a longer period of ischaemia with reperfusion. Two types of nerve oedema were observed; endoneurial oedema especially in perivascular and subperineurial spaces, and intramyelinic oedema. Nerve fibres with intramyelinic oedema were not confined to the perivascular region. Swollen endothelial cells in endoneurial vessels were also invariably observed. Nerve ischaemia per se, without reperfusion, did not induce these pathological changes. Because myelin appears to be particularly susceptible to activated free radicals, oxidative stress, activated neutrophils, and cytokine formation seem to be important underlying mechanisms in the development of perivascular demyelination and intramyelinic oedema in ischaemic/reperfused nerves.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The expression of the endothelial cell antigen CD34 in demyelinating disease.

In this study, the antigenic expression of CD34, a 110 kDa glycoprotein which is expressed on human haemopoietic progenitor cells and vascular endothelium, has been assessed in a variety of neuropathological conditions, including infectious and demyelinating disease. Using immunoperoxidase staining on paraffin sections, the immunohistochemical results show that CD34 antigen is expressed widely on human CNS endothelium in grey and white matter, in the eye including retina, and in the anterior and posterior lobes of the pituitary. In demyelinating disease CD34 antigen expression was not detected in acute lesions, whereas strong expression was observed in old lesions. CD34 endothelial positivity was observed in areas of gliosis, vasogenic oedema, vascular disease and in Alzheimer's and Parkinson's disease pathology. A general pattern emerged, with CD34 antigen reactivity predominantly negative in areas of inflammation with demyelination but positive in adjacent non-inflamed tissue, irrespective of myelin pathology. We conclude that perivascular inflammation is a key factor in the absence of immunoreactivity of CD34 in the CNS in demyelinating disease.

Antigens, CD34↗

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↗

Experimental allergic neuritis (EAN) as a model for the immune-mediated demyelinating neuropathies.

The inflammatory demyelinating neuropathies (GBS and CIDP) are autoimmune disorders; their pathogenesis and the precise immunological target(s) remain unknown. Valuable insights into the immune mechanisms have been gained from the animal models: Lewis rat EAN and chronic EAN of rabbits. Lewis rats immunized with myelin or myelin proteins P2 and P0 in Freund's adjuvant develop transient paralysis. The pathological findings of nerve edema, perivenular lymphocyte infiltrates and macrophage-mediated demyelination are identical to those of GBS. Severity of clinical EAN and of the pathology correlate with the antigen dose used for immunization. In Lewis rat EAN there is firm evidence of a cell-mediated process. The strongest support for T-cell autoimmunity has come from the adoptive transfer of EAN to syngeneic animals with antigen-specific (P2 and P0) autoreactive T-cells. Humoral factors play a role in the demyelination. Both mechanisms may function synergistically, in that activated neuritogenic T-cells breach the blood-nerve-barrier and thus provide circulating anti-myelin antibodies access to the target tissues. Rabbits immunized with a single large multiportal dose of myelin predictably develop EAN with a chronic progressive or relapsing course. The clinical, electrophysiological and pathological features are identical to human CIDP. IgM and IgG anti-Gal C antibody titres parallel the disease course and have demyelinating activity. T-cell responses have not yet been characterized in this model. Both forms of EAN lend themselves to the study of very specific immunotherapies.

Animals↗

Acceleration in the rate of CNS remyelination in lysolecithin-induced demyelination.

One important therapeutic goal during CNS injury from trauma or demyelinating diseases such as multiple sclerosis is to develop methods to promote remyelination. We tested the hypothesis that spontaneous remyelination in the toxic nonimmune model of lysolecithin-induced demyelination can be enhanced by manipulating the inflammatory response. In PBS-treated SJL/J mice, the number of remyelinating axons per square millimeter of lesion area increased significantly 3 and 5 weeks after lysolecithin injection in the spinal cord. However, methylprednisolone or a monoclonal antibody (mAb), SCH94.03, developed for its ability to promote remyelination in the Theiler's virus murine model of demyelination, further increased the number of remyelinating axons per lesion area at 3 weeks by a factor of 2.6 and 1.9, respectively, but did not increase the ratio of myelin sheath thickness to axon diameter or the number of cells incorporating tritiated thymidine in the lesion. After 3 weeks, the number of remyelinating axons in the methylprednisolone or mAb SCH94.03 treatment groups was similar to the spontaneous remyelination in the 5 week PBS control-treated group, indicating that these treatments promoted remyelination by increasing its rate rather than its extent. To address a mechanism for promoting remyelination, through an effect on scavenger function, we assessed morphometrically the number of macrophages in lesions after methylprednisolone and mAb SCH94.03 treatment. Methylprednisolone reduced the number of macrophages, but SCH94.03 did not, although both enhanced remyelination. This study supports the hypothesis that even in toxic nonprimary immune demyelination, manipulating the inflammatory response is a benefit in myelin repair.

Animals↗

Histopathological evaluation of inflammatory & hereditary demyelinating polyneuropathies.

In view of therapeutic implications and problems in clinical diagnosis, this study sought to evaluate and identify histopathological features of acquired inflammatory demyelinating neuropathies and hereditary demyelinating neuropathies. Sural nerve biopsies from 41 patients of demyelinating neuropathies, diagnosed on the basis of accepted clinical criteria, were studied using routine histological staining and special stains for myelin and axons. Chronic inflammatory neuropathies differed from the acute ones in having more endoneurial connective tissue, less of subperineurial oedema and presence of axonal sprouting and occasional onion bulb formation. Acquired neuropathies differed from hereditary neuropathies in having a more localized involvement, endoneurial oedema and variable inflammatory cell infiltration, while in hereditary neuropathies Schwann cell proliferation was diffuse and relatively uniform. The frequency and degree of nerve thickening was more in hereditary neuropathy. Evidence of inflammation was not universal, both in the acute and the chronic inflammatory demyelinating neuropathies. Histopathological examination is essential as the clinical and electrophysiological features alone may not offer definitive diagnosis.

Adult↗

Inflammatory demyelinating neuropathy in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis (CAPD)

OBJECTIVE: To report on 3 patients with inflammatory demyelinating peripheral neuropathy in strong temporal coincidence with the initiation of peritoneal dialysis (PD) therapy. SETTING: Nephrology and Neurology Department of the University Hospital, Munich, Germany. PATIENTS: Three patients with end-stage renal failure presented with the clinical picture of inflammatory demyelinating peripheral neuropathy within 4 to 10 weeks after start of continuous ambulatory peritoneal dialysis (CAPD). They had acute or subacute onset of lower extremity or generalized weakness, diminished reflexes, elevated spinal fluid protein levels, and signs of demyelinating neuropathy on electrophysiological testing. MEASURES: Clinical follow-up, nerve conduction studies, cerebral spinal fluid (CSF). RESULTS: All patients did not improve under intensified PD therapy but took profit from immunomodulatory therapy. One bed-bound patient improved after change to hemodialysis and showed complete remission after renal transplantation. CONCLUSION: Because of strong temporal coincidence, a causal relationship between CAPD and inflammatory demyelinating peripheral neuropathies can be suspected in these 3 patients.

Adult↗

[The role of the spontaneous occurrence of Pulfrich's stereophenomenon in the diagnosis of demyelinating diseases of the central nervous system].

PURPOSE: Checking the usefulness of the spontaneous occurrence of Pulfrich's stereophenomenon in the diagnosis of demyelinating diseases. MATERIAL AND METHODS: Research embraced 22 patients with visual disturbances (including 9 patients with retrobulbar neuritis and others with anterior ischaemic neuropathy, central retinal vein occlusion, intrabulbar optic neuritis and traumatic atrophy of the optic nerve). The research also embraced 27 patients with demyelinating diseases (sclerosis multiplex). RESULTS: Spontaneous occurrence of Pulfrich's stereophenomenon was reported in 9 retrobulbar neuritis patients. It was also reported in 24 demyelinating patients. CONCLUSION: This simple Pulfrich's pendulum test is positive in 92% of demyelinating patients, including all patients with SM and retrobulbar neuritis.

Demyelinating Diseases↗

Inflammatory demyelinating polyradiculitis in a patient with multiple sclerosis.

A case of multiple sclerosis (MS) occurred in which there were recent demyelinated plaques in the CNS, and inflammatory demyelination and remyelination in the peripheral (Schwann cell) portions of the spinal roots. The lesions in the peripheral nervous system (PNS) were characterized by inflammation, primary segmental demyelination, myelin stripping, the occurrence of lipid debris-containing macrophages in the endoneurium, and remyelination. To our knowledge, this is the first description of simultaneous acute inflammatory demyelination in the CNS and PNS in MS.

Acute Disease↗

Vaccinations and risk of central nervous system demyelinating diseases in adults.

BACKGROUND: Several case reports of the onset or exacerbation of multiple sclerosis or other demyelinating conditions shortly after vaccination have suggested that vaccines may increase the risk of demyelinating diseases. OBJECTIVE: To evaluate the association between vaccination and onset of multiple sclerosis or optic neuritis. DESIGN: Case-control study involving cases of multiple sclerosis or optic neuritis among adults 18 to 49 years of age. Data on vaccinations and other risk factors were obtained from computerized and paper medical records and from telephone interviews. SETTING: Three health maintenance organizations. PARTICIPANTS: Four hundred forty case subjects and 950 control subjects matched on health maintenance organization, sex, and date of birth. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Onset of first symptoms of demyelinating disease at any time after vaccination and during specified intervals after vaccination (<1 year, 1-5 years, and >5 years). RESULTS: Cases and controls had similar vaccination histories. The odds ratios (95% confidence intervals), adjusted for potential confounding variables, of the associations between ever having been vaccinated and risk of demyelinating disease (multiple sclerosis and optic neuritis combined) were 0.9 (0.6-1.5) for hepatitis B vaccine; 0.6 (0.4-0.8) for tetanus vaccination; 0.8 (0.6-1.2) for influenza vaccine; 0.8 (0.5-1.5) for measles, mumps, rubella vaccine; 0.9 (0.5-1.4) for measles vaccine; and 0.7 (0.4-1.0) for rubella vaccine. The results were similar when multiple sclerosis and optic neuritis were analyzed separately. There was no increased risk according to timing of vaccination. CONCLUSION: Vaccination against hepatitis B, influenza, tetanus, measles, or rubella is not associated with an increased risk of multiple sclerosis or optic neuritis.

Adolescent↗

Chronic inflammatory demyelinating polyneuropathy in non-Hodgkin's lymphoma.

A 42-year-old man was diagnosed with large cell non-Hodgkin's lymphoma 3 years after autologous bone marrow transplantation for Hodgkin's disease. The day before beginning systemic chemotherapy, the patient began to have symptoms of a sensorimotor neuropathy characterized by proximal and distal weakness, lower-extremity areflexia, elevated cerebrospinal fluid protein level, and evidence of demyelination on nerve conduction studies. Symptoms progressed despite two courses of intrathecal methotrexate, for possible lymphomatous meningitis, as well as systemic chemotherapy. The diagnosis of chronic inflammatory demyelinating polyneuropathy was made. Daily plasma exchange was performed for a total of 10 treatments with immediate improvement and eventual complete recovery in strength, sensation, and gait. A review of the literature confirms that inflammatory demyelinating polyneuropathy is a highly unusual but important cause of peripheral nervous system dysfunction. The potential for complete response to plasma exchange should be recognized in patients with symptoms, signs, and nerve conduction studies suggestive of chronic inflammatory demyelinating polyneuropathy.

Adult↗

Measles encephalomyelitis: lack of evidence of viral invasion of the central nervous system and quantitative study of the nature of demyelination.

Measles encephalomyelitis appears to be an immune-mediated parainfectious disorder, but it is unclear whether viral invasion of brain is an obligate step in its development. Immunocytochemical methods were used to search for virus antigen in formalin-fixed, paraffin-embedded central nervous system (CNS) tissues from 10 patients with measles encephalomyelitis and 12 patients who had died of measles without CNS involvement. All the CNS tissues studied were viral antigen negative. Similarly fixed CNS tissues from all of 6 patients with subacute sclerosing panencephalitis were viral antigen positive and served as controls. The pattern of perivenular demyelination was also determined in 4 cases of measles encephalomyelitis using antibodies to myelin associated glycoprotein and myelin basic protein and a Luxol fast blue stain. Areas of demyelination in serial sections were quantitated, and no morphometrical differences were found among tissues stained with the three stains. The data suggest the lack of virus replication in the CNS during encephalomyelitis or fatal measles without CNS symptoms. The pattern of loss of myelin associated glycoprotein and myelin basic protein in regions of perivenular demyelination resembles that reported in experimental allergic encephalomyelitis. This pattern of demyelination has been proposed to result from a primary attack on the myelin sheath rather than from direct involvement of the oligodendroglial cell.

Adolescent↗

Tissue culture demyelination by normal human serum.

Serum from all of 20 normal individuals induced some degree of demyelination when applied to well-myelinated mouse cerebellum cultures. An intact complement sequence through C5 is required. Demyelinating activity was heat labile at 56 degrees C for 30 minutes but was not destroyed at 50 degrees C for 30 minutes (which inhibits properdin factor B and alternate complement pathway activation, but not the classic complement pathway). Sera from patients with agammaglobulinemia, C4 deficiency, or C6 deficiency all induced demyelination. Our results suggest that tissue culture demyelination results from nonimmunoglobulin activation of the alternate complement pathway and is not limited to sera from patients with neurological disease.

Animals↗

Physiological effects of 4-aminopyridine on demyelinated mammalian motor and sensory fibers.

The selective response of demyelinated sensory fibers to 4-aminopyridine (4-AP) has been proposed as a mechanism underlying the reported paresthesias that complicate the use of this potassium-channel blocking agent in clinical trials for the treatment of multiple sclerosis and neuromuscular disorders. To identify differences in the electrophysiological response of specific fiber types to the application of 4-AP, rat ventral and dorsal spinal roots, demyelinated by intrathecal injections of lysophosphatidylcholine, were examined in vitro before and during potassium-channel blockade. The compound action potentials of demyelinated ventral roots showed a prominent postspike negativity associated with a broadening of single action potentials following application of 4-AP. Under similar conditions, whole root responses of demyelinated dorsal root axons also developed a late negativity, but individual fibers were observed to fire repetitively in response to a single stimulus. The data support the hypothesis that the prominent sensory dysfunctions reported in clinical trials of 4-AP are due to the selective response characteristics of sensory fibers.

4-Aminopyridine↗

Effect of digitalis on central demyelinative conduction block in vivo.

In searching for agents effective in treating multiple sclerosis, we studied the effect of a short-acting digitalis, ouabain, on conduction block in an animal model of central nervous system demyelination. The electrogenic sodium/potassium pump, which digitalis specifically inhibits, is responsible for part of the resting membrane potential and also the activity-related membrane hyperpolarization following high-frequency impulses. The latter causes intermittent conduction block in demyelinated fibers. Therefore, digitalis might be expected to reverse demyelinative conduction blocks by reducing the threshold at the blocking node. Somatosensory evoked potentials were monitored in 11 rats with spinal cord demyelination before and after systemic administration of ouabain (0.1-0.6 mg or 0.21-1.58 mg/kg IP). In all rats, slowed conduction velocity of the compound action potential through the lesion was significantly reversed, and failure to transmit high-frequency impulses was improved upon. The amplitude of the cortical somatosensory evoked potentials also increased significantly. Digitalis is a promising therapeutic agent for trial in patients with multiple sclerosis.

Afferent Pathways↗