Familial cases of HTLV-I-associated myelopathy

We studied two familial cases of human T-lymphotropic virus type I (HTLV-I)-associated myelopathy from the Kii Peninsula, an area of endemic adult T-cell leukemia-lymphoma (ATLL) in Japan. Incidence of familial clustering of HTLV-I-associated myelopathy was about 20%. Type C retrovirus was isolated from cultured cerebrospinal fluid and peripheral blood lymphocytes in both cases. Modes of transmission seem to be similar to those described in ATLL, although there are no reports of both HTLV-I-associated myelopathy and ATLL occurring in the same family. We suggest three possibilities: (1) that the virus associated with HTLV-I-associated myelopathy is different from the virus causing ATLL, although they seem to be morphologically and immunologically similar; (2) that HTLV-I-associated myelopathy may be determined by the ATLL-causing virus plus a specific genetic background; and (3) some combination of factors 1 and 2.

"Ectopic" extramammary Paget's disease affecting the lower anterior aspect of the chest

A case of extramammary Paget's disease that affected the lower anterior aspect of the chest of a 54-year-old man is reported. It is extremely rare that the disease arises in areas other than the anogenital region and the axillae.

Expression of heterophile, Paul-Bunnell and Hanganutziu-Deicher antigens on human melanoma cell lines

Expression of heterophile antigens was studied on 6 human melanoma cell lines. Paul-Bunnell and Hanganutziu-Deicher (H-D) antigens, but not Forssman antigen, were demonstrated on these cell lines. H-D antigen was also demonstrated on melanoma cells isolated from primary and metastatic lesions. Evidence was also presented that HLA class I but not class II (DR and DQ) molecules are expressed on these cell lines. H-D antibodies of IgG class were detected in 10 of 23 (42%) melanoma patients suggesting the possibility that H-D antigen might have been expressed in an immunogenic form in the patients.

Sera from patients with multiple sclerosis react with human cell T lymphotropic virus-I gag proteins but not env proteins--Western blotting analysis

To study the possible involvement of human T cell lymphotropic virus type I (HTLV-I)-related agent in Japanese multiple sclerosis (MS), we performed a Western blotting analysis, using purified viral antigens, on sera from 46 patients with MS, nine patients with other neurologic diseases, and 11 healthy controls. Of 46 MS patients, 11 (24%) had antibodies reactive with antigens corresponding to the group-specific antigen (gag) proteins (p15, p19, and p24), although the prevalence was lower than that reported in a recent study using an enzyme-linked immunosorbent assay (ELISA). Despite the lower frequency of immunoreactivity, Western blotting technique had merits of identification of multiple antigens and higher specificity for detection of antibodies than ELISA. Those sero-positive patients consisted of four cases with IgG antibodies reactive mainly to the gag p24 and/or p15, four with IgM antibodies mainly to the gag p24 and/or p19, and three with both IgG and IgM antibodies. These immunostaining patterns of MS sera were clearly distinguishable from those of adult T cell leukemia patients who had antibodies to the envelope (env) proteins and its precursors in addition to the gag proteins. The antibody in MS sera was generally of low titer and reactive at a high serum concentration (1/10 dilution). None of the sera from patients with other neurologic diseases and healthy controls had the viral antibodies. These findings indicate that at least one quarter of Japanese MS patients have antibody responses to a hitherto unidentified agent related to HTLV-I, which possibly plays a part, primarily or secondarily, in the pathogenesis of those patients.

Sera from patients with multiple sclerosis react with human cell T lymphotropic virus-I gag proteins but not env proteins--Western blotting analysis

To study the possible involvement of human T cell lymphotropic virus type I (HTLV-I)-related agent in Japanese multiple sclerosis (MS), we performed a Western blotting analysis, using purified viral antigens, on sera from 46 patients with MS, nine patients with other neurologic diseases, and 11 healthy controls. Of 46 MS patients, 11 (24%) had antibodies reactive with antigens corresponding to the group-specific antigen (gag) proteins (p15, p19, and p24), although the prevalence was lower than that reported in a recent study using an enzyme-linked immunosorbent assay (ELISA). Despite the lower frequency of immunoreactivity, Western blotting technique had merits of identification of multiple antigens and higher specificity for detection of antibodies than ELISA. Those sero-positive patients consisted of four cases with IgG antibodies reactive mainly to the gag p24 and/or p15, four with IgM antibodies mainly to the gag p24 and/or p19, and three with both IgG and IgM antibodies. These immunostaining patterns of MS sera were clearly distinguishable from those of adult T cell leukemia patients who had antibodies to the envelope (env) proteins and its precursors in addition to the gag proteins. The antibody in MS sera was generally of low titer and reactive at a high serum concentration (1/10 dilution). None of the sera from patients with other neurologic diseases and healthy controls had the viral antibodies. These findings indicate that at least one quarter of Japanese MS patients have antibody responses to a hitherto unidentified agent related to HTLV-I, which possibly plays a part, primarily or secondarily, in the pathogenesis of those patients.

Isolation and characterization of multilayered sheath membrane rich in glucocerebroside from shrimp ventral nerve

A membrane fraction rich in glucocerebroside was isolated from homogenates of ventral nerves of pink shrimp (Penaeus duorarum) by sucrose gradient centrifugation. The membrane fraction was observed at 0.15 M sucrose and was rich in lipids (lipid/protein ratio approximately 15:1). Electron microscopy showed that the fraction was derived from myelin-like multilayered glial membrane ensheathing axons, which has morphological similarities to myelin. Most of the lipids in shrimp nerve, including glucocerebroside, sphingomyelin, phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine, and ethanolamine-plasmalogen, as well as cholesterol, appeared to be concentrated in this fraction. The fatty acids of these phospholipids were exclusively saturated or monounsaturated with C14-C26 chain lengths. The aldehyde moiety of plasmalogens contained only saturated C14-C18 carbon chains. Like glucocerebrosides, the sphingoid base of sphingomyelin consisted mainly of C14-C16 sphingenines and sphinganines, but they also contained significant amounts of C19 and C20 sphinganines. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of the proteins in this fraction showed several bands in the 23,000-85,000 Mr range. Radioimmunoassay, however, did not show cross-reactivity with antibodies to myelin basic protein. The functional role of this membrane in relation to mammalian myelin is discussed.

Perforating pilomatricoma

A case of "perforating pilomatricoma" is reported. A cutaneous horn-like tumor, the size of a grain of rice, developed on the left upper arm of a 51-year-old man. Histological examination revealed typical microscopic features of pilomatricoma. In addition, however, an interesting phenomenon was observed: a small portion of the mass had extruded from the upper dermis to the skin surface through the perforated epidermal channel. It might have been possible in this case for all of the tumor mass to be extruded by transepithelial elimination.

Ultrastructural study of central nervous system demyelination in galactocerebroside sensitized rabbits

The rabbit eye model was used to investigate the role of delayed type hypersensitivity and of circulating antigalactocerebroside antibody in primary demyelination. Delayed type hypersensitivity reaction to tuberculin was induced within the retinal myelinated layers by injecting purified protein derivative into the vitreous of rabbits that were previously immunized with complete Freund's adjuvant (CFA) alone, or galactocerebroside (GC) in CFA. The morphological features of the myelinated zones were assessed 5 days after injection. All rabbits showed infiltration of mononuclear cells within the myelinated fiber bundles. Rabbits previously sensitized with CFA alone showed nonspecific destruction of nerve fibers in severe inflammatory lesions, but primary demyelination was rarely found. This suggests that myelin destruction induced by delayed type hypersensitivity reaction to interstitial antigens (purified protein derivative, so-called "bystander demyelination") by itself does not play a major role in inducing primary demyelination. On the other hand, primary demyelination was recognized in the vicinity of infiltrating mononuclear cells in rabbits previously immunized with GC in CFA and had elevated titers of serum anti-GC antibody. The destruction of the blood-brain barrier was suggested by the presence of fibrin exudates in demyelinative lesions where observation revealed selective myelin breakdown such as vesicular disruption and active stripping of myelin. This study indicates that the anti-GC antibody is an important factor in central nervous system demyelination of GC-sensitized rabbits.

Role of nonspecific myelin destruction by delayed type hypersensitivity in primary demyelination

To clarify the role of nonspecific myelin destruction mediated by delayed type hypersensitivity (DTH) in primary demyelination, DTH to tuberculin was induced within the endoneurium by intraneural injection of purified protein derivative (PPD) or sonicated Mycobacterium tuberculosis into the sciatic nerves of Lewis rats and guinea pigs which had previously been sensitized to tuberculin. The morphological features of the nerves proximal to the site of needle insertion were assessed 5 days after injection. By changing the PPD concentration of solution for intraneural injection, various degrees of DTH reaction could be produced in the nerve. Infiltration of mononuclear cells including macrophages was observed around the vessels and in the vicinity of the myelin sheaths. Although nonspecific damage of axons, myelin sheaths and Schwann cells was observed in areas heavily infiltrated with inflammatory cells, primary demyelination was hardly recognized. Another group of Lewis rats previously immunized with galactocerebroside (GC), the major glycolipid hapten of myelin, in Freund's complete adjuvant received intraneural injection of PPD or GC liposomes. Neither cellular nor humoral immunity to GC was detected in these rats. The nerves injected with GC liposomes showed no inflammatory cell infiltration except for a few macrophages containing liposomes and those injected with PPD showed infiltration of mononuclear cells without primary demyelination. Our findings reveal that nonspecific myelin destruction induced by DTH does not play an important role in immune-mediated demyelination.

Orbital apex syndrome caused by rheumatoid nodules

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Experimental clioquinol intoxication in rats: abnormalities in optic nerves and small nerve cells of dorsal root ganglia

Pathological abnormalities in the central (CNS) and peripheral nervous system (PNS) were produced in rats by daily administration of 300-400 mg/kg clioquinol for 7-40 days. The changes comprised axonal degeneration of optic nerve fibers and mitochondrial swellings in small nerve cells of dorsal root ganglia. There were occasional myelin splittings in the spinal nerve roots. No apparent changes were observed in the spinal cord or peripheral nerves. Similar changes were occasionally encountered to a lesser extent in control rats by restricting the diet and water to maintain the body weight comparable to the ranges of experimental animals. It seemed that not only clioquinol intoxication but nutritional deficiency also contributed, in part, to the production of these CNS and PNS abnormalities. The possibility of the presence of peripheral neuropathy in subacute myelooptic neuropathy is discussed.

Proliferation of Schwann cells in demyelinated rat sciatic nerve

Experimental demyelination was induced by intraneural injection of anti-galactocerebroside serum into the sciatic nerves of rats. Schwann cells undergoing mitotic division were observed between days 3 to 9 after the injection and demyelinated segments were still associated with macrophages. Dividing Schwann cells were often present in association with both unmyelinated and myelinated fibers. Whether or not, daughter Schwann cells migrate along the same fiber towards neighboring demyelinated segments remains unclear. When Schwann cells attached to axon membranes of demyelinated segments were studied at later time points, they were present in clusters randomly at various regions of the segments. There was no proximo-distal gradient for the wave of Schwann cell proliferation. Mean Schwann cell internuclear distances were around 40-50 microns at the earliest time of remyelination. Schwann cell redistribution and remyelination progressed regardless of the length of demyelinated segments.

Familial neuropathy with dementia, retinitis pigmentosa, and dysautonomia

We studied a 59-year-old woman with dementia, retinitis pigmentosa, sensorimotor neuropathy, and attacks of vomiting associated with blood pressure lability and loss of consciousness. Abnormalities included CT evidence of cerebral atrophy, low IQ, slow central and peripheral nerve conduction velocities, axonal degeneration in sural nerve biopsy, and elevated levels of catecholamines and slow waves in EEG during attacks. Her sister, two brothers, and daughter also had progressive muscle weakness, visual disturbance, and similar vomiting attacks. The hereditary nervous system disorder does not fit any previously described condition.

Amyotrophic lateral sclerosis: a double-blind crossover trial of thyrotropin-releasing hormone

A double-blind crossover trial was conducted of thyrotropin releasing hormone treatment in six patients with amyotrophic lateral sclerosis. Patients received 4 mg of thyrotropin releasing hormone intramuscularly daily during the two-week treatment period. Although three patients reported subjective improvement, objective evaluation failed to demonstrate therapeutic effectiveness of thyrotropin releasing hormone in this dosage.

Phenotypic changes induced by a novel benzophenone derivative and resultant suppression of cell proliferation in the human thymic acute lymphoblastic leukemia cell line HPB-ALL

A novel benzophenone derivative, 2-(2-benzoyl-4-chlorophenoxy)-N-methylpropionamide (Ch-13), induced phenotypic differentiation linked to the inhibition of cell proliferation in human thymic acute lymphoblastic leukemia cell line HPB-ALL cells. The Ch-13-induced morphological changes consist of a decrease in cell size, nucleolar disappearance, and an alteration in the chromatin distribution, resembling large or atypical lymphocytes. Treatment with Ch-13 brought about a remarkable reduction in OKT6-, OKT4/Leu3a-, and OKT9-positive cells. At the optimal differentiation-inducing dose (5 X 10(-5)M), Ch-13 inhibited the cell proliferation, de novo DNA synthesis, and specific antibody-induced cell surface antigen capping.

Spontaneous partial regression of primary melanoma with death due to metastases

A 42-year-old man had a metastatic melanoma in the brain, but no obvious primary melanoma could be detected. A halo nevus-like depigmented lesion was found on the left side of the patient's back. The histopathologic features of the depigmented lesion were compatible with those of a spontaneously regressed primary lesion of malignant melanoma. Enhanced immune responses to autologous and homologous melanoma cells were not detected when investigated in the late disease stage. Subsequently, the patient died of disseminated melanoma.

Rapid alterations of the axon membrane in antibody-mediated demyelination

Alterations of nodal and paranodal axolemma of the rat sciatic nerve were investigated in antigalactocerebroside serum-induced demyelination. A ferric ion-ferrocyanide (FeFCN) stain that appears to stain the regions with a high sodium channel density in nerve fibers was applied. When acute conduction block was initiated 20 to 180 minutes after the antiserum injection, myelin terminal loops began to be detached from the paranodal axolemma and reaction product of FeFCN stain originally localized at the nodes decreased in density and extended to the paranodal axolemma. By the time that complete conduction block was established, 5 hours after the injection, FeFCN stain was barely detectable around the nodal area. The loss of staining was associated with detachment and vesiculovacuolar degeneration of the paranodal myelin. This rapid deterioration and disappearance of normal cytochemical characteristics of the axolemma in the presence of only modest paranodal demyelination could be a morphological correlate of the loss of excitability of the axon membrane.

P2 protein-induced experimental allergic neuritis. An ultrastructural study

Experimental allergic neuritis (EAN) was induced in 2 groups of inbred Lewis rats by sensitization with P2 protein and peripheral nervous system (PNS) myelin, both purified from bovine intradural roots. Light- and electronmicroscopic study of P2-induced EAN revealed demyelinative lesions in spinal ganglia and root nerves and less frequently in peripheral nerves and root entry zones. Both small and large myelinated fibers were demyelinated, contradictory to the reported selective binding of anti-P2 antibodies to myelin of large fibers. The early lesions were characterised by perivenular lymphocytic infiltration, and subsequent "dissolution" of myelin sheath was associated with invasive of phagocytic cells. The distribution of demyelinative lesions and patterns of demyelination resembled those of PNS myelin-induced EAN except that the disease was milder and dissolution of myelin and intramyelinic edema were more frequently found in P2-induced EAN. The abundance of demyelination in P2-induced EAN strikes contrast to the scarcity of myelin change in experimental allergic encephalomyelitis (EAE) induced by myelin basic protein immunization.

Primary malignant melanoma of the esophagus

The case of a 54-year-old man with primary malignant melanoma of the esophagus is described. The results of morphologic examination are presented, and the histogenesis of the tumor and the classification of melanomas are briefly discussed. Histologic examination suggested that this was a case of primary malignant melanoma of the esophagus arising from melanosis of the esophageal mucosa. Like melanomas from the oral mucosa, vagina, anus, and vulva, the tumor had lentiginous radial components.

Development of a malignant proliferating trichilemmal cyst in a patient with multiple trichilemmal cysts

A case of multiple trichilemmal cysts is presented. After trauma, a large tumor developed on one of the cysts. The histologic features of this tumor were similar to those of proliferating trichilemmal cyst, but some of the tumor cells showed definite nuclear atypicality. The malignant potential of this tumor was confirmed by later development of metastases to the regional lymph nodes.

Teleocidin-induced phenotypic changes in thymic ALL cell line, HPB-ALL

An indole alkaloid, teleocidin, induced phenotypic differentiation in the thymic ALL cell line HPB-ALL. Within 30 min of seeding in the presence of teleocidin, the cells formed a smooth round shape. Upon 5-day exposure to teleocidin, most of the cells became smaller and reminiscent of large or atypical lymphocytes. A thymic antigen stained with monoclonal antibody OKT6 was remarkably reduced while Leu2a-positive cells were increased in the treated cells. Upon teleocidin-induced phenotypic differentiation, the growth rate of cells was inhibited, their ability to incorporate DNA via [3H]-labelled precursors was reduced, their ability to bind sRBC rosettes was increased. These changes were paralleled to that induced by 12-o-tetradecanoyl-phorbol-13-acetate.

Phorbol ester-induced differentiation of human T-lymphoblastic cell line HPB-ALL

12-O-Tetradecanoylphorbol-13-acetate (TPA), a potent tumor promoter, induced phenotypic differentiation in the human thymic acute lymphocytic leukemia cell line, HPB-ALL. Within 30 min of seeding in the presence of TPA, the cells formed a smooth round shape. After a 7-day exposure to TPA, most of the cells became smaller and reminiscent of large or atypical lymphocytes. Electron microscopic analysis evidenced morphological differentiation in TPA-treated HPB-ALL cells. Thymic antigens stained with monoclonal antibody OKT6 were dramatically reduced while Leu2a-positive cells were increased in the TPA-treated HPB-ALL cells. However, OKT3-positive cells did not appear in these TPA-treated cells for up to 7 days. Upon TPA-induced phenotypic differentiation, the growth rate of cells was significantly inhibited, their ability to incorporate DNA and RNA via 3H-labeled precursors was reduced, their ability to bind sheep red blood cell rosettes was significantly increased, and the proportion of terminal deoxynucleotidyl transferase-positive cells was decreased.

A change in the cerebrosides and sulfatides in a demyelinating nervous system. Development of the methodology and study of multiple sclerosis and Wallerian degeneration

This report described a new method for the microanalysis of sphingolipids and its application for the characterization of cerebrosides and sulfatides in multiple sclerosis brain and rat sciatic nerves undergoing Wallerian degeneration. Tissue was extracted with isopropanol/hexane (20:78), and the total lipids obtained were subjected to benzoylation-desulfation. A portion of this was directly analyzed by silica-column high performance liquid chromatography for the determination of nonhydroxycerebroside, hydroxycerebroside, nonhydroxysulfatide, and hydroxysulfatide. Another portion was fractionated by thin-layer chromatography, and the spots corresponding to the sphingolipid derivatives were eluted. The material from each spot was analyzed by reverse phase high performance liquid chromatography for its homolog composition. With this new procedure the concentrations and homolog compositions of cerebrosides and sulfatides were measured in plaque, periplaque, and normal-appearing white matter from brains of multiple sclerosis patients and Wallerian degenerated rat sciatic nerves distal to the nerve transection. One piece of plaque studied contained only 1.86, 2.76, 0.60, and 0.45 nmol of nonhydroxycerebroside, hydroxycerebroside, nonhydroxysulfatide and hydroxysulfatide/mg of protein, respectively. These concentrations are less than 1% of those found in normal white matter. Periplaques were found to contain concentrations of these sphingolipids between those of plaque and normal white matter. The levels of these sphingolipids in degenerative nerves were 10-20% below normal the third day after the nerve was severed and about 70% below normal after 10 days. The rate of decrease lessened from ten days to 55 days. The homolog compositions of these sphingolipids in both multiple sclerosis brain and degenerating nerves were similar to those in the control. The implications of these findings and the advantages of this new analytical method are discussed.

Acute conduction block associated with experimental antiserum-mediated demyelination of peripheral nerve

Intraneural injection of antisera from rabbits with high antigalactocerebroside antibody levels into rat sciatic nerve produced acute nerve conduction block. This was first apparent in some motor axons between 30 and 60 minutes after injection and progressed to completion within 2 to 4 hours. Concurrent morphological evidence of demyelination was present, but structural changes at the time of onset of block were mild and were restricted to the myelin and Schwann cell, particularly at the paranodal areas and Schmidt-Lanterman clefts. It is suggested that paranodal lesions could account for the observed conduction block.

Conduction block in rat myelinated fibres following acute exposure to anti-galactocerebroside serum

1. We have observed conduction in single rat spinal ventral root nerve fibres following acute topical application of anti-galactocerebroside serum.2. Conduction of nerve impulses was initially slowed and subsequently blocked at the site of serum exposure.3. Conduction block occurred within as little as 1 hr in more slowly conducting (20-30 m/sec) myelinated fibres but occurred later in fibres conducting more rapidly.4. Conduction block was preceded by a rise in internodal conduction time from the normal 20 musec to about 200 musec.5. At nodes exposed to serum, conduction block was invariably associated with greatly decreased depolarization; this was contrasted with nodes exposed to local anaesthetic or tetrodotoxin where conduction block occurred despite nodal depolarization well beyond threshold potential.6. Nodal capacitance and resistance were estimated from simultaneous recordings of membrane current and extracellular potential at blocked nodes exposed to local anaesthetic or tetrodotoxin (normal nodes) and at blocked nodes exposed to anti-galactocerebroside serum.7. For normal fibres of internodal length 0.8-1.1 mm, an upper limit estimate for average nodal capacitance was 2.6 +/- 0.3 pF and a lower limit estimate for average nodal resistance was 55 +/- 10 MOmega. There was an order of magnitude increase in the capacitance of nodes at which conduction block occurred following exposure to anti-galactocerebroside serum.8. We conclude that the early conduction block caused by anti-galactocerebroside serum is due to paranodal demyelination and that acute paranodal demyelination is sufficient to cause conduction block.

In vivo demyelinating activity of sera from patients with Guillain-Barré syndrome

The in vivo demyelinating capacity of sera from 27 patients with Guillain-Barré syndrome (GBS) and 47 other individuals was studied by intraneural injection into rat sciatic nerves. The morphological features of the nerves in cross section taken just proximal to the site of needle insertion was assessed 48 hours after injection and the extent of demyelination was quantitated. All 27 GBS serum samples were obtained in the first three weeks of clinical disease. Of these, 11 (41%) produced demyelination. Demyelinative activity of GBS sera correlated only with severity of clinical disease (p less than 0.01). The extent of demyelination after intraneural injection of human sera was less intense on average than that produced by sera from animals with experimental allergic neuritis. Three of 40 (7.5%) sera obtained from normal subjects and patients with other neurological diseases also caused in vivo demyelination, although the activity was weaker and occurred less often than with GBS serum.

Long term culture of bovine oligodendroglia isolated with a Percoll gradient

Oligodendroglia were isolated from calf central nervous system (CNS) white matter by trypsinization in phosphate buffered saline and separation by centrifugation through Percoll. Using antisera to phenotypic markers and double labelling experiments we were able to identify essentially all cells in the cultures. The cells obtained were: (1) viable; (2) had intact plasma membranes and well preserved organelles, ribosomes and mitochondria; and (3) were greater than or equal to 95% oligodendroglia 16-20 h after isolation as determined by ability to bind antigalactocerebroside antibodies (anti-GalC). Oligodendroglia could be cultured for several weeks to months. Oligodendroglia established and maintained processes which bound anti-GalC. Myelin basic protein could be demonstrated in the cytoplasm of 40-60% of oligodendroglia cell bodies but not in the processes.

Axonal lesions in acute experimental demyelination: a sequential teased nerve fiber study

The relationship between axonal degeneration and primary demyelination was studied in isolated rat sciatic nerve fibers previously exposed to antiserum from rabbits with either experimental allergic neuritis or experimental allergic encephalomyelitis, or immunized with antigalactocerebroside antiserum. Continuous demyelination over one to eight or more internodes was seen in association with phagocytic cells or, later, with increased numbers of Schwann cells. Paranodal demyelination was prominent proximal ahd distal to the zone of continuous demyelination. Axonal degeneration affected 5 to 15% of myelinated fibers exposed to antiserum and was not related to the length of demyelination must proximal to the axonal changes. At times, there were seven or eight consecutive demyelinated internodes with no distal axonal degeneration; in contrast, one demyelinated internode was often associated with axonal degeneration beginning just distally. The inflammatory reaction could account for axonal degeneration in antiserum-mediated demyelination.