Increased immunoglobulin binding to cerebral endothelium in patients with antiphospholipid antibodies

BACKGROUND AND PURPOSE

There is a strong link between antiphospholipid antibodies and stroke. The mechanism of action of antiphospholipid antibodies is unknown. Most theories of pathogenesis center around platelet or endothelial cell dysfunction. Our aim was to determine if there were immunoglobulins in the sera of patients with antiphospholipid antibodies that bind human brain microvascular endothelial cells.

METHODS

We studied sera from three groups of subjects: patients with antiphospholipid antibodies and stroke (group 1), healthy control subjects (group 2), and patients with stroke but without antiphospholipid antibodies (group 3). We isolated human brain microvascular endothelial cells from temporal lobectomy specimens and used a cellular enzyme-linked immunosorbent assay (ELISA) to measure immunoglobulin binding to endothelial cells derived from human brain and from human umbilical vein. We used a chromium release assay to measure cytotoxicity.

RESULTS

Patients with antiphospholipid antibodies and stroke had significantly higher immunoglobulin binding to human brain microvascular endothelial cells than subjects in the other groups ([ELISA index+standard deviation], 63 +/- 37 [group 1] versus 7 +/- 7 [group 2] versus 7 +/- 7 [group 3], P < .001). There was, however, poor correlation between binding to brain endothelial cells and binding to cardiolipin. The binding to brain microvascular cells was not specific to brain endothelium, as similar results were found in an ELISA using human umbilical vein cells. There was no evidence of complement-mediated brain endothelial cell cytotoxicity.

CONCLUSIONS

Patients with stroke and antiphospholipid antibodies frequently have human brain microvascular endothelial-reactive antibodies in their serum. These antibodies are distinct from those to cardiolipin. We found no evidence that these antibodies are cytotoxic.

Coronary artery disease, myocardial infarction, and brain embolism

The incidence of in-hospital stroke complicating acute myocardial infarction is approximately 1%. This rate is largely unaffected by thrombolytic therapy. Large myocardial infarctions, anterior wall involvement, prior stroke, and increasing age are risk factors for ischemic stroke. Left ventricular thrombi commonly occur with anterior wall infarctions. There is some evidence that anticoagulation reduces their incidence and uncontrolled studies suggest that anticoagulation may reduce the risk of embolization. Left ventricular aneurysms have a low rate of embolization and do not require systemic anticoagulation. Treatment of acute myocardial infarction with t-PA and anisoylated plasminogen streptokinase activator complex are associated with a higher risk of stroke than treatment with streptokinase; this excess risk is attributable to an increased rate of cerebral hemorrhages.

Focal headache during balloon inflation in the vertebral and basilar arteries

BACKGROUND AND PURPOSE

Headache may be seen in acute cerebrovascular disease. The significance of localized headache in association with vertebrobasilar disease has not been recognized.

SUMMARY OF REPORT

We describe a patient with a cerebellar arteriovenous malformation who underwent intravascular balloon occlusion of the vertebral and basilar artery. He developed reproducible patterns of referred pain with balloon inflation at specific sites.

CONCLUSIONS

Well localized head pain in the setting of acute stroke should alert physicians to the possibility of localized arterial injury. The pattern seen in this patient has been documented in experimental situations, and should be of use in the setting of acute stroke.

Contrast sensitivity in 24- and 36-month-olds as assessed with the contrast sensitivity card procedure

We used a new card procedure to evaluate binocular contrast sensitivity (CS) in 24- and 36-month-old children. The test consists of 40 large (50 by 28 cm) matteboard cards, each of which contains a sine wave grafting with 1 of 5 spatial frequencies (0.4, 0.8, 1.6, 3.2, and 4.8 cpd at 80 cm) and with 1 of 8 contrast levels [from 33% (CS = 3) to 0.4% (CS = 260)]. Estimates of subjects' CS to each spatial frequency were obtained with a modified forced-choice preferential looking (FPL) technique similar to that developed for the Teller Acuity Cards (TAC). All 36-month-olds and 74% of the 24-month-olds completed the entire procedure in an average of 12 min per child. For both groups, the shape of the mean constant sensitivity functions (CSF's) resembled the characteristic inverted U shown by normal adults, except that the toddlers' functions were shifted to lower contrasts and spatial frequencies. Combined with previous results, it appears that the CS cards hold promise as a time-efficient means of assessing CS in infants and young children, and may provide the prototype for a clinical tool to help detect early visual and neurological dysfunction.

Neutralizing antibodies modulate replication of simian immunodeficiency virus SIVmac in primary macaque macrophages

Cultured macaque macrophages are permissive for the replication of SIVmac251, and inoculation with virus is followed by the production of viral p27. Neutralizing macaque polyclonal and murine monoclonal antibodies preincubated with the virus prevented infection but did not prevent cytopathic virus replication when added more than 3 days after inoculation with virus. However, application of the neutralizing antibodies to macrophages 24 h after inoculation with virus resulted in sustained, low-level production of viral antigen. Cell lysates and individual macrophages from treated cultures contained less viral protein by Western blot (immunoblot) and immunocytochemistry than untreated controls. In situ hybridization and polymerase chain reaction procedures for detecting and estimating relative amounts of viral RNA and DNA showed that both viral nucleic acids failed to increase beyond the levels obtained before the addition of neutralizing antibodies. The data suggest that macrophages may need to be infected with a minimum threshold of virus particles in order to reach their full potential for virus replication and that their exposure to neutralizing antibodies prior to reaching this threshold resulted in limited virus replication.

Pathogenesis of acute infection in rhesus macaques with a lymphocyte-tropic strain of simian immunodeficiency virus

The simian immunodeficiency virus, SIVmac, causes disease affecting multiple organ systems in macaques similar to human immunodeficiency virus infection in humans. Molecularly cloned SIVmac with a strong lymphocyte tropism was used in pathogenesis experiments to correlate viral cell tropism with disease. In 5 animals, exhaustive analyses on viruses from tissues and identification of infected precursor cells were done at multiple times during infection to ensure the virus had not mutated into a macrophage-tropic variant. Viral replication was measured by infectivity, infectious center assays, and in situ hybridization. Lymphocytes produced most virus in tissues, indicating the virus maintained its cell tropism in vivo. Lymphocytes in bone marrow were latently infected and those in the spleen and lymph nodes were productively infected. The virus failed to replicate in the brain after intracerebral inoculation. SIVmac that maintained a strong tropism for lymphocytes and a corresponding poor tropism for macrophages can cause persistent infection and AIDS but not other diseases such as primary pneumonia and encephalitis in rhesus macaques.

Transcranial Doppler correlation with cerebral angiography in sickle cell disease

BACKGROUND AND PURPOSE

Cerebral infarction in sickle cell disease is associated with arterial narrowing or occlusions of intracranial arteries. Primary stroke prevention would be feasible if a noninvasive screening test could be developed to detect intracranial disease in patients before symptoms develop.

METHODS

To determine the sensitivity and specificity of transcranial Doppler in detecting significant (greater than or equal to 50% lumen diameter reduction) intracranial arterial lesions, we compared transcranial Doppler and cerebral angiography in a primarily young, symptomatic group of 33 patients (18 males and 15 females) with sickle cell disease.

RESULTS

From a total of 34 examinations, transcranial Doppler detected significant abnormalities in 26 of 29 (sensitivity 90%, specificity 100%). Five were normal by both techniques. The transorbital examination detected abnormalities in two patients whose studies were otherwise unremarkable.

CONCLUSIONS

Transcranial Doppler is sensitive and specific for the detection of arterial vasculopathy of sickle cell disease. Screening should include a transorbital examination of the distal internal carotid artery as well as examination using the transtemporal approach.

A new technique to measure contrast sensitivity in human infants

We used a new time-efficient procedure to obtain binocular contrast sensitivity functions (CSFs) from 80 infants aged 1-, 3-, 6-, and 12-months-old. The test consisted of 5 sets of large (50 by 28 cm) cards constructed by mounting a 7.2 degrees circular sine wave grating with 1 of 5 spatial frequencies (0.3, 0.6, 1.2, 2.4, and 3.6 cpd at 60 cm) onto light gray matteboard. Each card also contained a second 7.2 degrees unpatterned patch of equal space-average luminance. Depending upon the set, the contrast within the gratings ranged from approximately 25 to 0.5%. To judge the subject's detection of each grating we used a rapid version of preferential looking (PL) similar to that developed for the Teller Acuity Cards. Results showed that compared to previous techniques, the card procedure allows one to estimate an infant's CSF much more simply, rapidly, and inexpensively.

Tumour necrosis factor and interleukin 6 production during interaction between activated CD4+ lymphocytes and simian immunodeficiency virus-infected macrophages

The mechanism for the gradual loss of CD4+ T lymphocytes and the development of the slowly progressive inflammatory/degenerative lesions that accompany human immunodeficiency virus infection are poorly understood. Using the Simian immunodeficiency virus (SIVmac) macaque model of AIDS, we found that persistently infected primary macrophages fuse with primary activated CD4+ lymphocytes and that this interaction results in production of tumour necrosis factor-alpha (TNF alpha) and interleukin 6 (IL-6). An earlier report had shown that SIV-infected macaque macrophages fuse with CEM174 cells (a human CD4+ cell line) and cause their lysis. In the present report, we have shown that TNF-alpha and IL-6 are also produced during the early stages of this interaction. Data from cocultivation of infected macrophages with several CD4+ T cell lines, including CEM174, suggested that the cytokines are produced by the T cells, and that cytokine production is restricted to those cells which not only express CD4, but are also capable of fusing with the infected macrophages. These data suggest that infected macrophages in vivo could fuse with and eliminate activated CD4+ lymphocytes and, during this interaction, release cytokines, which would contribute to the degenerative and inflammatory lesions characteristic of this disease.

Ovine lentivirus is macrophagetropic and does not replicate productively in T lymphocytes

The lentiviruses of sheep, goats, and horses cause chronic multiorgan disease in which macrophages are highly permissive for viral replication. Monocytes, which mature into macrophages, are thought to be latently infected with lentivirus, but the extent to which other leukocytes are infected is unknown. Dendritic cells have not been studied separately from monocytes and T-cell subsets have not been examined in previous attempts to identify infected cells in peripheral blood mononuclear cells (PBMC). We found no evidence of T-cell tropism using an animal-passaged, pathogenic ovine lentivirus. Phytohemagglutinin-stimulated infectious PBMC produced 20-fold less virus than differentiated macrophages, and cocultivation of infectious PBMC with fresh, uninfected phytohemagglutinin blasts did not facilitate virus replication. Furthermore, central lymph cells, the best in vivo source of purified lymphocytes, lacked virus and did not yield virus upon in vitro cultivation. In contrast, cultivated blood-derived macrophages were highly permissive for viral replication. To identify the latently infected PBMC, PBMC from infected sheep were selectively depleted of monocytes and B cells by passage over nylon wool and then of nonadherent cells bearing CD4, CD8, T19, gamma delta T-cell receptor, CD45RA, or major histocompatibility complex class II antigens by panning. Removal of adherent monocytes and B cells or of adherent cells and the three major T-cell subsets (CD4+, CD8+, T19+) did not decrease the infectivity of PBMC. The richest sources of infected cells in fresh PBMC were CD45RA+ and major histocompatibility complex class II+ nonadherent cells, which are three characteristics of dendritic cells. Thus, the dendritic cell, and not the monocyte or the CD4+ cell, is probably the predominant infected cell type in blood.

Acetazolamide treatment of paroxysmal dystonia in central demyelinating disease

We report successful treatment of paroxysmal dystonia (tonic seizures) in three patients with central demyelinating disease (CDD) using acetazolamide alone or in combination with carbamazepine. Acetazolamide is a useful alternative, or an adjunct, to carbamazepine in the treatment of paroxysmal dystonia in CDD.

Obstetrical medication and the newborn infant. II: The influence of meperidine (pethidine) on visual behaviour

The visual fixation of two groups of healthy newborn infants was tested at a mean age of three days. Mothers of the infants in one group received a single dose of meperidine (pethidine) during labour and delivery; those in the second group received no medication. Unlike infants of mothers who received a single dose of alphaprodine hydrochloride in a previous study, there were no differences between the groups in the present study. Moreover, longer drug-to-delivery intervals did not appear to potentiate the effects of meperidine. A single dose of meperidine appears to have few effects on neonates' sensory functioning, which is contrary to other reports.

Calcium-induced release of calcium regulates differentiation of cultured spinal neurons

Voltage-dependent calcium influx has been shown to regulate the differentiation of cultured amphibian spinal neurons. We have examined the transient elevation of intracellular calcium induced by depolarization, using calcium indicators and confocal microscopy with high temporal and spatial resolution. Rapid calcium elevations in both the nucleus and the cytosol are primarily due to calcium-dependent release of calcium from intracellular stores. Depletion of stores associated with the endoplasmic reticulum reduces all transients. Elevations diminish with neuronal maturation. Depletion of stores of intracellular calcium at early times affects neuronal differentiation in a manner similar to the prevention of influx. The results indicate that both influx and release are necessary to promote neuronal differentiation.

Contrast/color card procedure: a new test of young infants' color vision

We have developed a new test which can rapidly evaluate basic color vision in individual infants. The test consists of a series of large cards constructed with Munsell Hues. It uses a modified preferential looking procedure (FPL) and, to control brightness cues, incorporates a two-phase systematic variation of luminance. First, we evaluate an infant's ability to discriminate 9.5 by 16 degrees achromatic patches of varying luminance from a 26 by 65 degrees achromatic background of midrange luminance. In the second phase the test patch is chromatic and its luminance, relative to the background, is varied over a range of about 1.0 log cd/m2. The number of relative luminances chosen for each infant depends upon his/her performance in phase 1. Seventy 2- and 3-month-olds were tested with 4 broad-band chromatic patches, a red (dominant lambda = 660 nm), a yellow (dominant lambda = 580 nm), a green (dominant lambda = 520 nm), and a blue (dominant lambda = 475 nm). Results showed that 3-month-olds had little difficulty making any of the chromatic-achromatic discriminations but many 2-month-olds appeared to fail to discriminate the yellow and green from the background at relative luminances close to an adult brightness match. Most importantly, the test shows promise as a relatively simple, time-efficient, and portable tool for the assessment of early color vision.

Recovery of the simian immunodeficiency virus (SIV) and depression of colony formation in in vitro infected progenitor cell-enriched rhesus bone marrow (BM)

Rhesus progenitor-enriched BM was exposed overnight to SIV and cultured in a limiting dilution assay where the potential for progenitor interaction with lymphocytes or macrophages was low. Virus was consistently isolated late in culture, detection being aided by coculture with CEM174 lymphoblasts. Although infected cells had reduced clonogenic activity, colonies were indistinguishable from those derived from uninfected BM with respect to proliferative potential, morphology, and longevity in culture. Primate immunodeficiency viruses, therefore, may infect immature BM populations, directly affecting hematopoietic activity.

Deficiencies in human neonates' color vision: photoreceptoral and neural explanations

Several photoreceptoral and neural models have been proposed to account for the development of human vision. To further evaluate those applicable to color vision, the present study examined 40 neonates' (mean age = 3.2 days) chromatic-achromatic discriminations in the mid-spectral region by using an habituation procedure and measures to minimize achromatic cues. Results indicated that newborns showed evidence of discriminating broad-band orange (lambda peak = 595 nm) but not yellow-green (lambda peak = 565 nm) lights from achromatic lights of varying luminance. Collectively, these and previous results imply that although newborns have at least dichromatic color vision, they possess relatively poor chromatic-achromatic discrimination in two spectral regions - in the short-wavelengths (including stimuli of 470-480 nm) and in the mid-wavelengths (including 565 nm). Although several hypotheses were considered, newborns' chromatic 'neutral zones' are best accounted for by models proposing that early color vision is limited by a general inefficiency of preneural (photoreceptoral and optical) mechanisms and/or by a selective immaturity of the SWS cones or the B/Y opponent channel.

Allochiria vs allesthesia. Is there a misperception?

Allochiria is the mislocation of sensory stimuli to the corresponding opposite half of the body or space. Obersteiner (1882) introduced the term allochiria (Greek allos = other + chiria = hand), and more than 20 authors employed it in this context over the next 25 years. Stewart (1894) described a related phenomenon in which stimuli are displaced to a different point on the same extremity. He noted that the displacements were different than allochiria and coined the term allachaesthesia (ie, allesthesia) (Greek allaché = elsewhere + aisthésis = perception). Despite this historical background, Jones (1907) redefined both terms in an attempt to increase diagnostic specificity and attributed allochiria to hysteria. Jones' reinterpretation does not appear to be justified historically, etymologically, or scientifically and has resulted in contradictory definitions of allochiria and allesthesia in present-day medical dictionaries and neurologic textbooks. We advocate a return to usage consistent with the original descriptions and word derivations.

Anticardiolipin antibodies: a study of frequency in TIA and stroke

We undertook a prospective study of consecutive patients to determine the frequency of elevated IgG and IgM anticardiolipin antibodies in transient ischemic attack and ischemic stroke and found elevated IgG antibodies in 8.2% (9 of 110) and IgM in 9.1% (10 of 110), only the former being significantly greater than in a healthy control population. We suggest that anticardiolipin screening be concentrated on the young.

Rhesus monkey macrophages infected with simian immunodeficiency virus cause rapid lysis of CD4-bearing lymphocytes

Inoculation of simian immunodeficiency virus into cultures of primary rhesus monkey macrophages or CD4-bearing transformed T lymphocytes resulted in persistent infection, with minimal virus replication in the macrophages and extensive replication in the lymphocytes. However, uninfected T cells added to infected macrophages underwent rapid fusion and lysis and were almost completely eliminated without the production of virus particles. Lysis required direct contact between the T cells and the infected macrophages, which enabled binding between CD4 on the former and viral gp120 on the latter to occur. This process was blocked by soluble CD4 and dextran sulphate. Neutralizing antibodies in the serum of an infected macaque prevented cell fusion by preventing infection of the macrophages. However, these antibodies did not prevent fusion when added to previously infected macrophages. Infected macrophages were incorporated into the syncytia of lymphocytes and continued incorporation of new lymphocytes into the syncytia required infected macrophages to be metabolically active. One inference from these studies is that infected macrophages in vivo could help mediate the well known depletion of T4 cells in patients with AIDS.

Miller Fisher syndrome in systemic lupus erythematosus

We describe the first case of Miller Fisher syndrome, a Guillain Barré variant, complicating systemic lupus erythematosus. The symptoms and signs mimicked a brainstem syndrome. Despite treatment with high dose gamma globulin, our patient worsened and required mechanical ventilation. After plasma exchange, the patient improved.

The influence of isoflurane on the synaptic activity of 5-hydroxytryptamine

The effects of isoflurane on uptake of 5-hydroxytryptamine(serotonin; 5-HT) by rat brain synaptosomes and binding of 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) and ketanserin to 5-HT1A and 5-HT2 receptors were examined. Isoflurane caused a concentration-dependent decrease in synaptosomal 5-HT uptake that was kinetically defined as non-competitive; exposure to isoflurane decreased Vmax but had no effect on the apparent Km. Removal of the drug from the reaction mixture resulted in the return of 5-HT accumulation rates to control levels. Isoflurane inhibited 8-OH-DPAT binding to hippocampal membranes by up to 27 +/- 6% at 4.5 mM, but did not significantly affect ketanserin binding to 5-HT2 receptors. These findings suggest that presynaptic actions are more important than postsynaptic actions in the modulation of serotonergic neutrotransmission by isoflurane.

Visual acuity assessment from birth to three years using the acuity card procedure: cross-sectional and longitudinal samples

We used the Teller Acuity Cards (TAC) to test 7 groups of 20 healthy infants and children ranging in age from 1 week to 36 months. We also tested 27 of these children at least twice within their first year. We had two primary goals: (1) to provide normative data on the development of visual acuity as assessed with the new version of the TAC (Vistech, Inc.) and (2) to investigate the predictive value of the TAC. The results from the cross-sectional samples show that our estimates of visual acuity are consistent with those reported by other researchers who used earlier versions of the TAC. The longitudinal data indicate that, on the average, an early estimate of visual acuity was not predictive of a later estimate, at least within the first year. The results are discussed in terms of the usefulness of the TAC for testing normal and clinical populations.