Immunologic reactions in amyotrophic lateral sclerosis brain and spinal cord tissue

Expression of proteins associated with immune function was investigated immunohistochemically in postmortem brain and spinal cord of patients with amyotrophic lateral sclerosis (ALS). Reactive microglia/macrophages displaying high levels of leukocyte common antigen (LCA), the immunoglobulin receptor Fc gamma R1, lymphocyte function associated molecule-1 (LFA-1), the complement receptors CR3 and CR4, the class II major histocompatibility complex molecules HLA-DR, HLA-DP and HLA-DQ and common determinants of the class I HLA-A,B,C complex were abundant in affected areas in ALS. These areas included the primary motor cortex, motor nuclei of the brain stem, the anterior horn of the spinal cord, and the full extent of the corticospinal tract. A significant number of T lymphocytes of the helper/inducer (CD4+) and cytotoxic/suppressor (CD8+) subtypes were observed marginating along the walls of capillaries and venules and extending into the parenchyma of affected areas. Clusters of complement activated oligodendroglia as well as degenerating neurites positive for C3d and C4d were frequently detected in ALS-affected areas. These data provide evidence of immune-effector changes in ALS. They are consistent with an autoimmune or slow virus theory of the disorder, but may reflect only secondary changes.

Administration of excitatory amino acid antagonists via microdialysis attenuates the increase in glucose utilization seen following concussive brain injury

Immediately following concussive brain injury, cells exhibit an increase of energy demand represented by the activation of glucose utilization. We have proposed that this trauma-induced hypermetabolism reflects the effort of cells to restore normal ionic balance disrupted by massive ionic fluxes through transmitter-gated ion channels. In the present study, changes in local CMRglc following fluid-percussion concussive injury were determined using [14C]2-deoxy-D-glucose autoradiography, and the effects of in situ administration (via microdialysis) of excitatory amino acid (EAA) antagonists [kynurenic acid (KYN), 2-amino-5-phosphonovaleric acid (APV; 100 microM, 1 mM, and 10 mM), and 6-cyano-7-nitroquinoxaline-2,3-dine (CNQX; 300 microM, 1 mM, and 10 mM] on glucose utilization were investigated. Animals that did not receive dialysis showed a remarkable increase (up to 181% of normal control) in cortical glucose utilization following injury. In contrast, this high demand for glucose was reduced in areas infiltrated with KYN, APV, and CNQX. These results indicate that EAA-activated ion channels are involved in the posttraumatic increase in glucose utilization, reflecting the energy demand of cells required to drive pumping mechanisms against an ionic perturbation seen immediately following the concussive injury. The effects of KYN, APV, and CNQX suggest that although all subtypes of the glutamate receptor appear to be involved in this phenomenon, N-methyl-D-aspartate-activated channels may play a major role.

Diffuse prolonged depression of cerebral oxidative metabolism following concussive brain injury in the rat: a cytochrome oxidase histochemistry study

Utilizing a lateral fluid percussion injury as a model of cerebral concussion, rats were studied histochemically measuring the degree of cytochrome oxidase activity present within different structures at different times following injury. After concussion, the cerebral cortex ipsilateral to the site of injury exhibited a diffuse decrease in its level of chromotome oxidase (CO) activity beginning at as soon as one day and lasting for up to 10 days after the insult. The ipsilateral dorsal hippocampus also exhibited an injury-induced decrease in CO activity, however, it was not as severe as in the cortex. These results indicate that oxidative metabolism is depressed primarily within the cerebral cortex and hippocampus for several days following a cerebral concussion. We propose that this period of metabolic depression may delineate a period of time during which the injured brain is unable to function normally and thus would be vulnerable to a second insult.

Dynamic changes in local cerebral glucose utilization following cerebral conclusion in rats: evidence of a hyper- and subsequent hypometabolic state

Following cerebral concussion, in which there is no evidence of direct morphological damage, cells are exposed to an increase in extracellular potassium as well as an accumulation of calcium. This concussion-induced ionic flux most likely alters the cellular energy demands thereby modifying metabolic processes. To investigate the metabolic changes after cerebral concussion, local cerebral metabolic rates for glucose (lCMRglc) utilizing [14C]2-deoxy-D-glucose were studied in rats (n = 98; 250-300 g) immediately, 30 min, 6 h, 1, 2, 3, 5 and 10 days following a unilateral frontoparietal fluid percussion (F-P) injury (3.7-4.3 atm). Compared to sham controls, animals exhibited bilateral hypermetabolism immediately following brain injury. However, this effect was more pronounced in structures ipsilateral to the site of F-P and was especially marked for the cerebral cortex (46.6-30.1% higher than control) and hippocampus (90.1-84.4% higher than control). By 30 min post-trauma many ipsilateral regions still showed evidence of hypermetabolism, although their lCMRglc had subsided. Beginning as early as 6 h following injury many regions within the ipsilateral cortex and hippocampus went into a state of metabolic depression (16.4-33.7% of control) which lasted for as long as 5 days. These results indicate that, although not mechanically damaged from the insult, cells exposed to concussive injury dramatically alter their metabolic functioning. This period of post-concussive metabolic dysfunction may delineate a period of time, following injury, during which cells are functionally compromised.

[A case showing the infraoptic course of the anterior cerebral artery associated with anterior cerebral artery aneurysm]

A ruptured anterior cerebral artery aneurysm with anomalous right infraoptic course of the anterior cerebral artery (ACA) was reported. A 40-year old male was admitted because of SAH episode, and computerized tomography (CT) on the day of admission revealed hemorrhage in both Sylvian and interhemispheric fissures. Four-vessel angiography was performed on the same day. A saccular aneurysm was demonstrated in the region of the anterior communicating artery (ACoA), and anomalous artery, which originated from the intradural right carotid artery at the level of the right ophthalmic artery was found to be running medially and superiorly. It supplied the bilateral callosomarginal arteries and the unpaired pericallosal artery. The fenestration of the vertebral artery, duplication of bilateral superior cerebellar arteries, and an occipital artery arising from the right internal carotid artery at the C3 level were found. Surgery was performed on the first day of admission, and the anterior interhemispheric approach was selected. The anomalous branch of the right ICA ran beneath the right optic nerve, ascended between the optic nerves, and supplied the ACoA system. The left hypoplastic A1 segment entered the ACoA. However, the right A1 segment could not be found. The aneurysmal neck, situated between the bilateral callosomarginal arteries and the unpaired pericallosal artery, was clipped with Sugitas curved clip. The postoperative course was uneventful and a follow-up angiograph revealed successful obliteration of the aneurysm.

Calcium-dependent glutamate release concomitant with massive potassium flux during cerebral ischemia in vivo

The changes in extracellular glutamate ([Glu]e) and potassium ([K+]e) in the rat hippocampus during cerebral ischemia were determined simultaneously by microdialysis in vivo. Biphasic increases in [Glu]e, i.e. an earlier rapid increase concomitant with an abrupt increase in [K+]e followed by a later slow increase, were observed. Dialysis with Ca(2+)-free perfusate containing Co2+ blocked the earlier rapid increase completely but the later slow increase only partially. These findings suggest that Ca(2+)-dependent exocytotic release from the presynaptic nerve terminals is involved predominantly in the earlier rapid increase in [Glu]d. The later slow increase in [Glu]d may be due in part to a breakdown of membrane function resulting from several causes, including a loss of the electrogenic component of the glutamate gradients across the plasma membrane, and a loss of function of the glutamate uptake system.

Reactions of the immune system in chronic degenerative neurological diseases

Elements consistent with a cell mediated immune response were identified immunohistochemically in amyotrophic lateral sclerosis (ALS) spinal cord and Alzheimer disease (AD) hippocampus. T helper/inducer and cytotoxic/suppressor lymphocytes were detected in affected tissues in both diseases. In addition, abundant reactive microglia were found expressing the major histocompatibility glycoproteins HLA-A,B,C and HLA-DR, as well as receptors for the Fc chain (Fc gamma R1), for complement 3 and 4, and for vitronectin. In AD, the complement proteins C1q, C4d, C3d and C5b-9 were found on dystrophic neurites, neuropile threads and some neurofibrillary tangles. In ALS, the only complement proteins identified were C4d and C3d. The integrin ligands vitronectin and ICAM-1 were also identified in affected tissues in both diseases.

[Clinicopathological studies of three cases of cerebral aneurysms associated with systemic lupus erythematosus]

We report three cases of ruptured cerebral aneurysms associated with systemic lupus erythematosus (SLE). A 52-year-old woman (case 1) with a fifteen-year history of systemic lupus erythematosus suddenly lost consciousness. She was admitted in a state of deep coma. A computed tomography (CT) scan revealed acute hydrocephalus and diffuse subarachnoid hemorrhage in the basal, interhemispheric and bilateral Sylvian cisterns. Fifteen years prior to this admission, cerebral angiograms demonstrated no cerebral aneurysm. She underwent ventricular drainage immediately. Postoperatively, her condition did not improve, and she died on the 18th day. During the autopsy, two saccular cerebral aneurysms were found: one aneurysm was at the right middle cerebral artery bifurcation, and another one was on the anterior communicating artery, which had disruption of the internal elastic lamina and medial smooth muscle, and infiltration of inflammatory cells. In the major cerebral arteries, for example the bilateral internal carotid arteries, disruption or dissection of the internal elastic lamina, intimal fibrosis and transmural infiltration of inflammatory cells were observed. The second patient, a 36-year-old woman with a six-year history of SLE, was admitted to our hospital with sudden severe headache. A CT scan showed subarachnoid hemorrhage, and cerebral angiograms disclosed saccular cerebral aneurysms on the anterior communicating artery and the left superior cerebellar artery, and a fusiform one on the left posterior cerebral artery. Surgery was not recommended because of her multiple medical problems. Her consciousness improved gradually over 2 months. She was transferred to the department of internal medicine for treatment of renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of amyloid P component with complement proteins in neurologically diseased brain tissue

Amyloid P component (AP) was detected in a number of lesions in human brain associated with chronic degenerative disease. These lesions included diffuse and consolidated amyloid deposits, cerebral amyloid angiopathy, neurofibrillary tangles, neuropil threads and complement activated oligodendroglia. The staining for AP generally paralleled that for complement proteins C4d and C3d, suggesting that AP may serve as an adjuvant for phagocytosis.

Immunohistochemical localization of vitronectin, its receptor and beta-3 integrin in Alzheimer brain tissue

The vitronectin receptor (VNR) is an integrin which consists of an alpha-subunit which can associate with multiple beta-subunits. A polyclonal antibody to this integrin weakly stained resting microglia in white matter of control brain and strongly stained reactive microglia in both gray and white matter of Alzheimer brain. This antibody, as well as a monoclonal antibody to beta 3, stained some platelets in capillaries of both control and Alzheimer tissue. When the antiserum was immunoabsorbed with a preparation enriched in the alpha-chain of the vitronectin receptor, it failed to stain microglial cells, but continued to stain platelets. When it was immunoabsorbed with a peripheral blood platelet preparation, all immunostaining was abolished. These results indicate that the vitronectin receptor of microglia is associated with a beta-chain different from beta 3, but that beta 3 is expressed by some platelets in brain capillaries. An antibody to vitronectin itself stained senile plaques and neurofibrillary tangles in Alzheimer entorhinal cortex, but only residual plasma in control tissue. Senile plaques positive for vitronectin had microglial cores strongly positive for the vitronectin receptor. The high levels of vitronectin receptor on reactive microglia in areas containing extracellular vitronectin suggest the possibility that vitronectin is serving an opsonizing function for microglial phagocytosis.

Detection of the membrane inhibitor of reactive lysis (CD59) in diseased neurons of Alzheimer brain

The membrane inhibitor of reactive lysis (MIRL) protects host cells from complement-mediated lysis. It was detected immunohistochemically in tangled neurons and dystrophic neurites of Alzheimer disease (AD) tissue in a pattern highly similar to that observed for the membrane attack complex of complement, C5b-9. MIRL was also detected in cultured IMR-32 neuroblastoma cells. The mRNA for MIRL was detected in RNA extracts of both AD and normal brain. These data provide the first evidence of brain neuronal expression of MIRL and its upregulation in neurons exposed to complement attack. They are consistent with the previously advanced hypothesis that complement-mediated neuronal injury may play a role in AD.

The histochemical demonstration of monoamine oxidase-containing neurons in the human hypothalamus

Monoamine oxidase activity was revealed in a population of neurons, glial cells and some vessels in the post mortem human hypothalamus with monoamine oxidase histochemistry. The monoamine oxidase-containing neurons were observed in the caudal two-thirds of the basal hypothalamus, including the lateral hypothalamic area, tuberomammillary and posterior hypothalamic nucleus. The positive neurons were multipolar or fusiform in shape. The neuronal somata were medium to large in size, although the majority of the positive neurons were of a large type. The topographic localization of the monoamine oxidase-containing neurons in the human hypothalamus has been found to be more widespread than in the rat and cat hypothalamus, suggesting that the hypothalamic monoamine oxidase cell group is phylogenetically more highly organized in man compared with in the lower mammals.

Expression of monoamine oxidase B activity in astrocytes of senile plaques

Monoamine oxidase (MAO) histochemistry has been performed in brains from patients with dementia of Alzheimer type (DAT) and aged controls. Conspicuous MAO-positive cell clusters were frequently observed in the amygdala, hippocampus, and insular cortex in the brains of DAT. Double staining with glial fibrillary acidic protein immunohistochemistry revealed that the cluster-forming MAO-positive cells were astrocytes. Using Bielschowsky's method, Congo red and thioflavin S counterstaining, this astrocytic mass was shown to be associated with senile plaques. By the enzyme inhibition experiment, MAO activity in senile plaques was revealed to be of type B. The present results clearly indicate that MAO-B activity is expressed in fibrillary astrocytes in or around senile plaques, suggesting that these astrocytes metabolize exogenous amines in senile plaques.

Effect of aging on NADPH-diaphorase neurons in laterodorsal tegmental nucleus and striatum of mice

Age-related changes of reduced nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d)-containing neurons were examined quantitatively in the laterodorsal tegmental nucleus (TLD) and the caudate-putamen of mice. Six 2-month-old and six 25- to 30-month-old DDD mice were studied using computer-assisted image analysis. Although no age-related changes in neuronal counts were found in the TLD, the cell size in this nucleus showed a statistically significant reduction with aging. In addition, the degree of the age-related neuronal shrinkage differed within the TLD; the most significant occurring in the rostral, less in the caudal third and no significant alteration being found in the middle third portion of TLD. In contrast, NADPH-d-positive neurons in the striatum did not show distinct age-related changes. NADPH-d-containing neurons in the TLD correspond to cholinergic cells, which project to the forebrain. Thus, the age-related shrinkage of NADPH-d neurons in the TLD may be related to the cholinergic dysfunctions seen in the forebrain of senescent mice.

The increase in local cerebral glucose utilization following fluid percussion brain injury is prevented with kynurenic acid and is associated with an increase in calcium

Immediately following a lateral fluid percussion brain injury, the cerebral cortex and hippocampus ipsilateral to the percussion show a marked accumulation of calcium and a pronounced increase in glucose metabolism. To determine if this increase in glucose metabolism was related to the indiscriminate release of the excitatory amino acid (EAA) glutamate, kynurenic acid (an EAA antagonist) was perfused into the cerebral cortex through a microdialysis probe for 30 min prior to injury. The results show that adding kynurenic acid to the extracellular space prior to trauma prevents the injury-induced increase in glucose utilization. These results indicate that calcium contributes to the ionic fluxes that are typically seen following brain injury and supports the concept of an increased energy demand upon cells to drive pumping mechanisms in order to restore membrane ionic balance.

Oedema fluid formation within contused brain tissue as a cause of medically uncontrollable elevation of intracranial pressure: the role of surgical therapy

In patients with focal cerebral contusions, medical therapies have generally been advocated unless haemorrhages significantly contributing to the elevated intracranial pressure (ICP) exist. We report here several lines of clinical evidence which indicate that (1) enormous amount of extracellular oedema fluid is formed within contused brain tissue, (2) the formation of extracellular oedema fluid within contused brain tissue alone can be a cause of medically uncontrollable elevation of ICP and (3) surgical excision of the contused brain tissue provides excellent control of the elevated ICP in such patients. The excision of contused brain tissue appears to be the only therapy currently available to alleviate the formation of extracellular oedema fluid in cerebral contusions. We believe that, if ICP is elevated primarily by extracellular oedema due to cerebral contusions and the elevated ICP is medically uncontrollable, surgical excision of contused brain tissue should be carried out without delay regardless of the size of associated haemorrhages.

A complete deletion mutant of the Escherichia coli dnaKdnaJ operon

Southern hydridization analyses of genomic DNAs from various dnaJ mutants of Escherichia coli showed that mutant K7052, which has well characterized dnaK706 and dnaJ705 double mutantions, is a deletion mutant. The deletion is about 8.0 kb long and encompasses the whole of the dnaKdnaJ operon.

[Primary torsion of the omentum--report of a case and review of the Japanese literature]

A case of primary torsion of the omentum is reported. A 37-year-old male was admitted with the chief complaint of RLQ pain of 3 day's duration on June 10, 1986. Tenderness and Blumberg's sign were found at Mc Burney's point with leucocytosis of 11,500/mm3. His body temperature was not elevated. Operation was carried out under the diagnosis of suspicion of acute appendicitis. Laparotomy revealed a dark-red omental mass of 12 X 5 X 1 cm which had been formed by torsion (7 times, clock-wise) and a little clear ascites. The omental mass was resected, and appendectomy was also performed. The postoperative course was uneventful. Eighteen cases including this case in the Japanese literature were reviewed and reported.

[Catecholaminergic systems in the amygdaloid complex of SDAT and aged controls: tyrosine hydroxylase immunohistochemistry]

Catecholaminergic systems in the amygdaloid complex in patients with senile dementia of Alzheimer type (SDAT) and aged controls have been studied with tyrosine hydroxylase (TH) immunohistochemistry. TH-immunoreactivity was found in fibers in all subnuclei of human amygdala, although varying in density in the subnuclei. The most dense catecholaminergic innervation was observed in the central, basal, and cortical nuclei of amygdala. The prominent finding in the amygdaloid complex of SDAT was that swollen and bulbous TH-immunoreactive neurites were found in association with neuritic plaques, which have not, rarely if any, been found in controls. The numerical density of neurites was mostly in parallel with that of TH-immunoreactive fibers except for the central nucleus. Thus, it is suggested that a class of populations of TH-immunoreactive neurons are selectively affected in the amygdaloid complex in SDAT.

Reduced nicotinamide adenine dinucleotide phosphate-diaphorase histochemistry in the pontomesencephalic region of the human brainstem

Reduced nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-diaphorase), which is specifically localized in neurons, has been histochemically demonstrated in human brain by using a perfusion-fixation procedure. With such fixed human brainstem, it was possible to study the topographic organization of NADPH-diaphorase-containing neurons that were visualized in fine detail for the first time. In the pontomesencephalic region, positive neurons were observed in nuclei around the decussation and arm of the superior cerebellar peduncle. These nuclei included the pedunculopontine tegmental, lateral parabrachial and oral pontine reticular nuclei. The positive somata were mainly multipolar in shape and medium to large in size. The positive neurons appeared to correspond to cholinergic neurons, at least partly in the brainstem, in terms of both the patterns of distribution and the cellular morphology.

[Ossified choroid plexus papilloma--case report]

While the calcification has been documented radiologically in 4 - 25 percent of the cases with choroid plexus papilloma, the ossification of choroid plexus papilloma has been reported only in 3 cases on literature. In this paper, we present a case of large ossified choroid plexus papilloma in the right lateral ventricle. A 35-year-old man was admitted with left hemiparesis and headache. Skull X-rays showed an abnormal calcified mass (25 mm x 23 mm x 14 mm) in the right temporal region. CT scan revealed an abnormal high density area protruding into the right lateral ventricle, and a low density area at the right corona radiata. Operation was carried out with a right temporal craniotomy. The mass was yellowish-elastic hard and protruded into the right inferior horn of the lateral ventricle. The histological examination of surgical specimen showed an ossified choroid plexus papilloma with some bone marrow formation and numerous calcification. Calcification of choroid plexus papilloma is found frequently, but ossification is a very rare neuropathological abnormality. Bone and/or cartilage formation in neuroepithelial neoplasms is an unusual event histopathologically. Several mechanisms have been proposed, such as (1) metaplasia of connective tissue, (2) transformation of neuroepithelial cells to mesenchymal tissue, (3) teratomatous nature, (4) heteroplasia, (5) mixed mesenchymal-neuroepithelial nature, and (6) ossification as an end stage of mucoid degeneration. In our case, it was considered that the bone formation resulted from metaplasia of connective tissue of choroid plexus papilloma.

Impaired hippocampal plasticity in experimental chronic hydrocephalus

Schaffer collateral responses recorded from CA1 pyramidal cell layers in the hippocampus were analysed in kaolin-induced hydrocephalic rats. Other features of this rat model of chronic hydrocephalus were evaluated from measurements of the intracranial pressure, Na-fluorescein migration from the ventricle to the cerebral parenchyma, and behavioural changes. The results indicated that: (1) the conduction velocity of the Schaffer collaterals was unchanged; (2) the threshold to elicit population spikes was decreased; (3) the paired-pulse facilitation of EPSP tended to increase; (4) the paired-pulse inhibition of population spikes was unchanged; and (5) the long-term potentiation of population spikes was clearly attenuated in the hydrocephalic rats. The changes seen in the long-term potentiation were less pronounced in rats which underwent kaolin injection but did not develop hydrocephalus. The above findings suggest that disturbance in the postsynaptic integration processes, rather than axonal conduction or synaptic transmission, are more important for the production of the neurological deficits seen in chronic hydrocephalus. Electron microscopic observations supporting this inference are also briefly described.