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Holzbauer SM, DeVries AS, Sejvar JJ, Lees CH, Adjemian J, McQuiston JH, Medus C, Lexau CA, Harris JR, Recuenco SE, Belay ED, Howell JF, Buss BF, Hornig M, Gibbins JD, Brueck SE, Smith KE, Danila RN, Lipkin WI, Lachance DH, Dyck PJB, Lynfield R. Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain. PLoS One 2010; 5:e9782. [PMID: 20333310 PMCID: PMC2841649 DOI: 10.1371/journal.pone.0009782] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 03/01/2010] [Indexed: 11/18/2022] Open
Abstract
Background In October 2007, a cluster of patients experiencing a novel polyradiculoneuropathy was identified at a pork abattoir (Plant A). Patients worked in the primary carcass processing area (warm room); the majority processed severed heads (head-table). An investigation was initiated to determine risk factors for illness. Methods and Results Symptoms of the reported patients were unlike previously described occupational associated illnesses. A case-control study was conducted at Plant A. A case was defined as evidence of symptoms of peripheral neuropathy and compatible electrodiagnostic testing in a pork abattoir worker. Two control groups were used - randomly selected non-ill warm-room workers (n = 49), and all non-ill head-table workers (n = 56). Consenting cases and controls were interviewed and blood and throat swabs were collected. The 26 largest U.S. pork abattoirs were surveyed to identify additional cases. Fifteen cases were identified at Plant A; illness onsets occurred during May 2004–November 2007. Median age was 32 years (range, 21–55 years). Cases were more likely than warm-room controls to have ever worked at the head-table (adjusted odds ratio [AOR], 6.6; 95% confidence interval [CI], 1.6–26.7), removed brains or removed muscle from the backs of heads (AOR, 10.3; 95% CI, 1.5–68.5), and worked within 0–10 feet of the brain removal operation (AOR, 9.9; 95% CI, 1.2–80.0). Associations remained when comparing head-table cases and head-table controls. Workers removed brains by using compressed air that liquefied brain and generated aerosolized droplets, exposing themselves and nearby workers. Eight additional cases were identified in the only two other abattoirs using this technique. The three abattoirs that used this technique have stopped brain removal, and no new cases have been reported after 24 months of follow up. Cases compared to controls had higher median interferon-gamma (IFNγ) levels (21.7 pg/ml; vs 14.8 pg/ml, P<0.001). Discussion This novel polyradiculoneuropathy was associated with removing porcine brains with compressed air. An autoimmune mechanism is supported by higher levels of IFNγ in cases than in controls consistent with other immune mediated illnesses occurring in association with neural tissue exposure. Abattoirs should not use compressed air to remove brains and should avoid procedures that aerosolize CNS tissue. This outbreak highlights the potential for respiratory or mucosal exposure to cause an immune-mediated illness in an occupational setting.
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Affiliation(s)
- Stacy M. Holzbauer
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aaron S. DeVries
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
- * E-mail:
| | - James J. Sejvar
- Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christine H. Lees
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Jennifer Adjemian
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer H. McQuiston
- Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carlota Medus
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Catherine A. Lexau
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Julie R. Harris
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sergio E. Recuenco
- Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ermias D. Belay
- Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James F. Howell
- Public Health Preparedness and Emergency Response, Indiana State Department of Health, Indianapolis, Indiana, United States of America
| | - Bryan F. Buss
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, Nebraska, United States of America
| | - Mady Hornig
- Center for Infection and Immunity, Columbia University, New York, New York, United States of America
| | - John D. Gibbins
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - Scott E. Brueck
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of America
| | - Kirk E. Smith
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - Richard N. Danila
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
| | - W. Ian Lipkin
- Center for Infection and Immunity, Columbia University, New York, New York, United States of America
| | - Daniel H. Lachance
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - P. James. B. Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ruth Lynfield
- Infectious Disease, Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, United States of America
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Adjemian JZ, Howell J, Holzbauer S, Harris J, Recuenco S, McQuiston J, Chester T, Lynfield R, Devries A, Belay E, Sejvar J. A clustering of immune-mediated polyradiculoneuropathy among swine abattoir workers exposed to aerosolized porcine brains, Indiana, United States. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2009; 15:331-8. [PMID: 19886343 DOI: 10.1179/oeh.2009.15.4.331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In November 2007 a novel neuropathy, immune-mediated polyradiculoneuropathy (IP), was identified among workers at a Minnesota swine abattoir where a unique compressed air technique was used to remove porcine brains. An epidemiologic investigation at another abattoir in Indiana that also uses this process was launched to evaluate workers self-reporting neurologic illness compatible with IP. A nested case-control study was performed to identify cases and risk factors. Six confirmed, one probable, and three possible IP cases were detected. IP cases were 28-52 years old, of Latino origin, and 62.5% female. Onset dates ranged from April 2005-December 2007; 60% were hospitalized. IP cases at this plant were similar in clinical presentation and exposure risks to those detected in Minnesota. Swine abattoirs using similar brain extraction methods should discontinue this process.
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Cavaletti G, Matà S, Fasano A, Lolli F, Riccio P, Celon S, Marmiroli P, Tredici G. Lipid-free versus lipid-bound P2 protein-induced experimental allergic neuritis: clinicopathological, neurophysiological, and immunological study. J Neurosci Res 2000; 62:709-16. [PMID: 11104509 DOI: 10.1002/1097-4547(20001201)62:5<709::aid-jnr10>3.0.co;2-t] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The P2 protein of the peripheral nervous system myelin is a neuritogenic protein capable of inducing experimental allergic neuritis (EAN) in the Lewis rat. It has been suggested that the addition of some lipids to the protein isolated in the lipid-free form might enhance its immunogenicity. In this study, we compared lipid-free P2 (the EAN factor) and the corresponding lipid-bound form of the protein regarding their ability to induce EAN. Lipid-bound P2, copurified with all the myelin lipids, shows a conformation different from that of LF-P2. The timing of disease and the clinical scores of lipid-bound P2-induced EAN animals (n = 23) did not differ statistically from those injected with lipid-free P2 (n = 23), with only a tendency to higher clinical severity in the former group. Tail nerve conduction velocities did not differ in the two groups and in both were significantly lower in comparison to Freund adjuvant controls (n = 8). Inflammation and demyelination predominated in the spinal roots and were less evident in the sciatic nerve for both groups of animals. The ELISA determination of antibodies to lipid-free and lipid-bound P2 revealed the development of antibodies recognizing the lipid-free form of the protein in both groups of animals. Our results stand in contrast to results of previous studies performed after addition of exogenous lipids to the P2 purified in the lipid-free form and indicate that lipid-bound P2 is not significantly more immunogenic than lipid-depleted P2.
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MESH Headings
- Adjuvants, Immunologic
- Animals
- Antibodies/blood
- Cattle
- Lipids/chemistry
- Myelin P2 Protein/chemistry
- Myelin P2 Protein/immunology
- Neuritis, Autoimmune, Experimental/chemically induced
- Neuritis, Autoimmune, Experimental/immunology
- Neuritis, Autoimmune, Experimental/pathology
- Neuritis, Autoimmune, Experimental/physiopathology
- Rats
- Rats, Inbred Lew
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Affiliation(s)
- G Cavaletti
- Department of Neuroscience, Neurology Unit, S. Gerardo Hospital, Monza, Italy.
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Arnon R. The development of Cop 1 (Copaxone), an innovative drug for the treatment of multiple sclerosis: personal reflections. Immunol Lett 1996; 50:1-15. [PMID: 8793553 DOI: 10.1016/0165-2478(96)02506-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R Arnon
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
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5
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Weishaupt A, Giegerich G, Jung S, Gold R, Enders U, Pette M, Hayasaka K, Hartung HP, Toyka KV. T cell antigenic and neuritogenic activity of recombinant human peripheral myelin P2 protein. J Neuroimmunol 1995; 63:149-56. [PMID: 8550812 DOI: 10.1016/0165-5728(95)00139-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The major neuritogenic protein of peripheral nerve myelin is the P2 protein. Human P2 is a candidate autoantigen in inflammatory demyelinating diseases of the peripheral nervous system. Since human P2 is not readily available, we produced full-length recombinant human P2 protein (rhP2) in Escherichia coli. RhP2 was recognized by neuritogenic rat T cell lines and induced experimental autoimmune neuritis in Lewis rats. Production of rhP2 allowed the generation of human T cell lines reactive to the autologous protein. Studies of human T cell autoreactivity as well as efforts to use hP2 as a tolerogen will be facilitated by the large-scale expression of rhP2.
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Affiliation(s)
- A Weishaupt
- Department of Neurology, Bayerische Julius-Maximilians-Universität, Würzburg, Germany
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6
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Stevens A, Schabet M, Wiethölter H, Schott K. Prednisolone therapy of experimental allergic neuritis in Lewis rats does not induce relapsing or chronic disease. J Neuroimmunol 1990; 28:141-51. [PMID: 2362015 DOI: 10.1016/0165-5728(90)90028-l] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of therapeutic prednisolone treatment on experimental allergic neuritis (EAN) in Lewis rats were evaluated in a controlled clinical and electrophysiological study. Since steroid therapy has been suspected to cause relapsing or chronic disease, monitoring was extended over 200 days. Short-term steroid treatment (5 days of 15 mg/kg prednisolone, n = 8) with sudden steroid withdrawal was compared with long-term application (30 days, beginning at 7.5 mg/kg) in descending dosage (n = 8). The experiment included saline-injected controls (n = 8) and controls for stress possibly exerted by the handling of the animals. Treatment was begun at the onset of clinical signs. The clinical and electrophysiological data indicated that deterioration, recovery and mild (insignificant) relapse (after day 30 and day 108) occurred in all groups at the same time. Both steroid application schemes significantly (p less than 0.03) attenuated the severity and shortened the duration of EAN. Relapse was not aggravated after steroid treatment. The clinical course and electrophysiological findings were unaltered by the experimental procedures and by mild experimental stress.
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Affiliation(s)
- A Stevens
- Department of Neurology, University of Tübingen, F.R.G
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7
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8
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Adam AM, Atkinson PF, Hall SM, Hughes RA, Taylor WA. Chronic experimental allergic neuritis in Lewis rats. Neuropathol Appl Neurobiol 1989; 15:249-64. [PMID: 2787483 DOI: 10.1111/j.1365-2990.1989.tb01226.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
An experimental chronic relapsing demyelinating neuropathy was produced by immunizing adult Lewis rats with bovine myelin in low (2.5 mg) and high (5 mg) doses, with and without Mycobacterium tuberculosis in the adjuvant. Each regime produced a similar disease course: acute severe hind limb weakness was followed by apparent recovery and then reappearance of mild neurological deficit with occasional spontaneous exacerbations. The partially recovered animals were relatively resistant to reimmunization with myelin. Immunization of four-week-old rats with myelin in complete adjuvant produced disease with a similar course. Subsequent immunization of these juvenile rats with adjuvant alone precipitated exacerbations. In the late stages, the prominent changes in peripheral nerves and nerve roots were axon loss, axonal regeneration and remyelination while inflammatory cell infiltration was confined to occasional foci. Onion bulb formation was extremely common in the dorsal root ganglia and affected in particular the nerve fibres close to the dorsal root ganglion cells. The cells forming the onion bulbs resembled the satellite cells surrounding the axon hillocks. Onion bulb formation also occurred in the portion of the ventral roots adjacent to the dorsal root ganglion but was rare elsewhere. Immunocytochemistry revealed only occasional lymphocyte infiltration but there was increased Class I and Class II MHC antigen expression throughout the peripheral nervous system. The results are relevant to the interpretation of biopsies from patients with chronic demyelinating neuropathy of possible inflammatory or autoimmune origin.
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Affiliation(s)
- A M Adam
- Department of Neurology, United Medical School of Guy's Hospital, London
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9
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Ohno R, Hamaguchi K, Nomura K, Sowa K, Tanaka H, Negishi T, Yamashita T. Immune responses in experimental allergic neuritis treated with corticosteroids. Acta Neurol Scand 1988; 77:468-73. [PMID: 2457290 DOI: 10.1111/j.1600-0404.1988.tb05942.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The preventive and suppressive effects of methylprednisolone (MP) were investigated in 22 rabbits immunized with peripheral nerve myelin. Cellular reactivity to bovine P2 protein (P2) and anti-P2 antibody were also examined serially in these animals, using the lymphocyte proliferation test or enzyme-linked immunosorbent assay. Seven animals (preventive group), given 15 mg/day of MP subcutaneously from Days 0-28, showed a significant reduction in maximal severity and a delay in onset in comparison with 8 control animals. The remaining 7 animals (suppressive group), given the same dose of MP from Days 11-28, also showed significantly milder clinical signs than those observed in the controls. However, cellular hypersensitivity to P2 were manifested at Day 14 (just after clinical onset) in the controls, as well as in the preventive or suppressive groups. Furthermore, anti-P2 antibody was detected in each group after Day 14. These results suggested that the interference of inflammatory processes of immune-mediated disease might respond to the preventive and suppressive effects of MP.
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Affiliation(s)
- R Ohno
- Department of Neurology, Saitama Medical School, Japan
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10
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Winer JB, Gray IA, Gregson NA, Hughes RA, Leibowitz S, Shepherd P, Taylor WA, Yewdall V. A prospective study of acute idiopathic neuropathy. III. Immunological studies. J Neurol Neurosurg Psychiatry 1988; 51:619-25. [PMID: 2969956 PMCID: PMC1033064 DOI: 10.1136/jnnp.51.5.619] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The immune responses of 100 patients who presented with an acute idiopathic neuropathy were compared with those of age and sex matched controls. Blood lymphocytes and their subsets were counted with a fluorescent activated cell sorter. CD8+ (putative suppressor) lymphocytes were significantly reduced in the first week of the disease but total lymphocytes, total T and CD4+ (putative helper) cells were not altered. This reduction depended on the nature of the preceding infection. Serum complement C3 and C4 concentrations remained normal and immune complexes were rarely detected with a C1q binding assay. Complement-fixing antibodies to human peripheral nerve antigens were discovered in the serum of 7% of patients but only 1% of controls. Complement-fixing antibodies to galactocerebroside were not discovered in any sera. Enzyme-linked immunoassays detected increased antibody responses to galactocerebroside but none at all to human P2 myelin protein in the patient sera. Forty microliter of serum from five patients injected into the sciatic nerves of rats did not induce significantly more demyelination than the serum from control patients. It is concluded that auto-immune responses can only be detected by these techniques in a small minority of patients with acute idiopathic neuropathy.
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Affiliation(s)
- J B Winer
- Department of Neurology, United Medical School, Guy's Hospital, London, UK
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11
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Nomura K, Hamaguchi K, Ohno R, Hosokawa T, Negishi T, Yamashita T, Suzuki M, Uyemura K. Cell-mediated immunity to bovine P2 protein and neuritogenic synthetic peptide in experimental allergic neuritis. J Neuroimmunol 1987; 15:25-35. [PMID: 2437152 DOI: 10.1016/0165-5728(87)90004-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cellular reactivity to bovine P2 protein (P2) and its two synthetic peptides, SP66-78 and SP70-78, was serially examined by the lymphocyte proliferation test in animals with experimental allergic neuritis (EAN). SP66-78 and SP70-78 correspond to residues 66-78 and 70-78 of bovine P2. Proliferative response to SP66-78 as well as P2 appeared at day 7 before the onset of EAN and was clearly manifested at day 14 in the active stage, thereafter disappearing in the stable stage, whereas no response to SP70-78 was detected during the course of the disease. These results suggest that cell-mediated immune response to P2 and the specific part residues 66-78 of P2 play an important role in the pathogenesis of EAN.
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12
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Steiner I, Abramsky O. Immunology of Guillain-Barré syndrome. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1985; 8:165-76. [PMID: 3901366 DOI: 10.1007/bf00197294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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13
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Suzumura A, Sobue G, Sugimura K, Matsuoka Y, Sobue I. Chronic experimental allergic neuritis (EAN) in juvenile guinea pigs: immunological comparison with acute EAN in adult guinea pigs. Acta Neurol Scand 1985; 71:364-72. [PMID: 4013660 DOI: 10.1111/j.1600-0404.1985.tb03214.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In order to approach the mechanism of chronic or relapsing course in human chronic inflammatory demyelinating polyradiculoneuropathy, we established a chronic model of experimental allergic neuritis (EAN) in juvenile guinea pigs, and investigated the underlying cellular immune phenomenon in comparison with acute EAN in adult animals of the same strain. Two-week-old Hartley guinea pigs, sensitized with bovine peripheral nerve homogenate, developed chronic or relapsing EAN, whereas all adult animals developed acute monophasic EAN. Morphological examination of both the chronic and acute forms revealed scattered demyelination and mononuclear cell infiltrates which were essentially restricted to the peripheral nervous system, and indistinguishable from each other. Both the in vitro lymphocyte mitogenic response and in vivo skin testing revealed a significantly lower response to neuritogenic antigens (P2 protein and peripheral nerve myelin) in juvenile chronic EAN than in adult acute EAN throughout their respective courses. In addition, we showed, by means of assessing peripheral blood lymphocyte number and its subpopulations, that normal 2-week-old Hartley guinea pigs have not fully developed immunologically. These observations suggested that there was some immunological incompetence especially in cellular immunity in 2-week-old juvenile guinea pigs and that this might be one possible factor leading to chronic EAN.
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Rosenberg NL, Lacy JR, Kennaugh RC, Holers VM, Neville HE, Kotzin BL. Treatment of refractory chronic demyelinating polyneuropathy with lymphoid irradiation. Muscle Nerve 1985; 8:223-32. [PMID: 3877236 DOI: 10.1002/mus.880080308] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Four patients with refractory or poorly responsive chronic progressive demyelinating polyneuropathy (CPDP) were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study. All patients had previously failed conventional therapy for CPDP, as well as other unconventional treatments. During a follow-up period of 7 to 12 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic subset) to Leu-3 (helper/inducer subset) T cells in the blood. Three of the four patients demonstrated improvement in distal muscle strength, and this was associated with increased functional capabilities in two patients. In contrast, no clinical improvement in sensation was noted in any patient. Nerve conduction studies showed patchy improvement in three patients. The results of this preliminary uncontrolled study indicate that radiotherapy deserves further study in the treatment of CPDP.
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Abstract
Corticosteroids were administered to rats and guinea pigs with experimental allergic neuritis, from the time of inoculation with antigen or from the onset of signs of disease. No statistically significant effects were observed in guinea pigs. In rats, to which large doses of corticosteroids were administered, disease severity was slightly but significantly reduced in both groups and recovery was more rapid in the animals treated from the time of induction of disease. These results were comparable with those obtained in trials of corticosteroids in acute inflammatory polyneuropathy in man, which have also not demonstrated any striking effects.
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Szymanska I, Ramwani J, Eylar EH. The passive transfer of severe allergic neuritis in Lewis rats with lymphoid cells preincubated with P2 protein. Cell Immunol 1983; 82:422-5. [PMID: 6197195 DOI: 10.1016/0008-8749(83)90175-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The passive transfer of both clinical signs and histologic lesions characteristic of allergic neuritis was successfully performed in Lewis rats using pooled spleen and lymph node cells, or T lymphocytes therefrom, if first preincubated in petri dishes with P2 protein for 72 hr. For passive transfer, cells were taken from donors 8-16 days after sensitization with P2 protein or myelin in Freund's complete adjuvant, and administered via the tail vein; clinical signs appeared 12-13 days later. This study supports the importance of cell-mediated immunity in EAN and the antigenic role of the P2 protein.
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Saida K, Saida T, Pleasure DE, Nishitani H. P2 protein-induced experimental allergic neuritis. An ultrastructural study. J Neurol Sci 1983; 62:77-93. [PMID: 6199467 DOI: 10.1016/0022-510x(83)90191-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Gilbert JJ, Feasby TE, Hahn AF. Intraneural injection of lymphocytes in experimental allergic neuritis. Acta Neuropathol 1983; 61:61-4. [PMID: 6624386 DOI: 10.1007/bf00688387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Passive transfer of experimental allergic neuritis (EAN) lymph node cells (LNC) by intraneural injection did not produce significant demyelination. EAN-LNC stimulated with myelin in vitro produced mild demyelination while those incubated with Concanavalin A had no effect. The lack of demyelination by unstimulated EAN-LNC is in contrast to the marked demyelination produced by intraneural injection of EAN serum. The mononuclear cell infiltration and demyelination of classical EAN seem to require both cellular and humoral immune responses.
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Mithen FA, Agrawal HC, Eylar EH, Fishman MA, Blank W, Bunge RP. Studies with antisera against peripheral nervous system myelin and myelin basic proteins. I. Effects of antiserum upon living cultures of nervous tissue. Brain Res 1982; 250:321-31. [PMID: 6184122 DOI: 10.1016/0006-8993(82)90426-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We studied the effects of antiserum against rat peripheral nervous system (PNS) myelin, rat or chicken central nervous system myelin basic protein (BP), or rabbit P2 protein from PNS myelin on myelinated cultures containing only rat dorsal root ganglion neurons and Schwann cells. While anti-PNS myelin serum consistently produced segmental PNS demyelination, anti-BP serum and anti-P2 serum did not. The culture results suggest that the myelin PNS proteins P1 (identical to basic protein from central nervous system myelin) and P2 are not exposed on the extracellular surfaces of myelin-related Schwann cells in tissue culture.
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Abstract
Lewis rats sensitized against peripheral nervous system antigens can be protected against experimental allergic neuritis (EAN) by the intraperitoneal injection of silica quartz dust. Two doses of 200 mg silica given 8 and 11 days post-inoculation (dpi) protected against the development of both clinical and pathological disease. A single dose of 200 mg silica 8 dpi gave significant protection against clinical disease but all animals developed pathological signs. A single injection of 200 mg silica 11 dpi, after the onset of early signs, protected against further progression of disease. The protection was long lasting. Given the known toxic effects of silica for macrophages, these results would support the conclusion that macrophages function during the effector stage in the clinical and pathological expression of EAN in the Lewis rat.
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21
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Hughes RA, Kadlubowski M, Gray IA, Leibowitz S. Immune responses in experimental allergic neuritis. J Neurol Neurosurg Psychiatry 1981; 44:565-9. [PMID: 6974764 PMCID: PMC491059 DOI: 10.1136/jnnp.44.7.565] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The antibody and cell mediated immune responses were investigated in inbred Lewis rats with experimental allergic neuritis (EAN) induced by either P2, a protein purified from the bovine cauda equina nerve roots, or whole bovine nerve root myelin. In the P2 immunised animals both antibodies to P2 detected by radioimmunoassay and cell-mediated immunity to P2 assayed by skin testing appeared before the onset of EAN and persisted during and after the disease. In the myelin immunised animals the antibody titres were lower and somewhat delayed and the skin tests became negative at the height of the disease. Complement-fixing antibodies to galactocerebroside, which have been implicated in the production of demyelination under some circumstances, could not be detected in the serum after immunisation with either P2 or myelin. EAN was transferred passively with lymph node cells from rats immunised with either P2 or myelin although anti-P2 antibodies could not be detected in the serum of recipients with EAN. The results favour a cell-mediated immune response to P2 as the most important pathogenetic mechanism in EAN induced wtih whole myelin in the rat.
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22
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Seil FJ, Kies MW, Bacon ML. A comparison of demyelinating and myelination-inhibiting factor induction by whole peripheral nerve tissue and P2 protein. Brain Res 1981; 210:441-8. [PMID: 6164446 DOI: 10.1016/0006-8993(81)90924-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sera from rabbits sensitized with whole bovine spinal roots demyelinated and inhibited myelination in both peripheral and central nervous system tissue cultures. Antisera directed against the peripheral nerve myelin basic protein, P2, demonstrated no antimyelin activity in vitro. These results suggest that demyelinating and myelination-inhibiting factors are directed against some peripheral nerve component(s) other than the P2 protein.
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23
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Abstract
Most patients with acute inflammatory polyneuropathy (AIP) recover spontaneously, but the time course of the illness is unpredictable so that the results of treatment are difficult to assess. Three decades of retrospective reports of steroid treatment fail to demonstrate any striking beneficial effect. In a randomized trial of prednisolone, starting dose 60 mg daily, 21 treated patients improved more slowly than 19 untreated patients. By contrast, in rats immunized with bovine nerve root myelin, prednisolone at 10 mg/kg reduced the severity and duration of experimental allergic neuritis (EAN), the putative animal model for AIP. This discrepancy might reflect the greater difficulty of clinical as opposed to animal therapeutic trials or indicate that EAN is not the appropriate model for the human disease. Immunosuppressive drugs, plasmapheresis and other agents have also been employed, but their efficacy cannot be decided from the available case report. The role of similar agents in chronic progressive and relapsing inflammatory neuropathy cannot yet be resolved, but in some patients steroids do appear to be valuable.
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24
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Abstract
The role of cell-mediated immunity (CMI) in the pathogenesis of idiopathic polyneuritis (IP) is discussed. Of significance has been the finding of a decreased suppressor T cell response in IP. This may provide an important common denominator linking the numerous antecedent events which trigger IP to the disease. The role of humoral immunity in IP and chronic relapsing inflammatory polyneuritis (CRIP) remains controversial, but has awakened renewed interest in view of recent reports of favorable response to plasmapheresis in IP and CRIP patients. P2 protein is an important neuritogenic factor in experimental allergic neuritis (EAN), but we failed to find antibody directed against P2 in either IP or CRIP even though anti-P2 antibody was regularly detected in EAN. Whether CMI response to P2 occurs in IP or CRIP remains controversial. We did not detect CMI response to P2 in IP or CRIP. It may be that the neuritogenic factor (or factors) in IP and CRIP remains to be found.
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25
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Saida T, Saida K, Silberberg DH, Brown MJ. Experimental allergic neuritis induced by galactocerebroside. Ann Neurol 1981; 9 Suppl:87-101. [PMID: 7224618 DOI: 10.1002/ana.410090714] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Experimental allergic neuritis (EAN), an animal model of human demyelinative neuritis, was induced by sensitization with galactocerebroside, a glycolipid hapten common in central and peripheral nervous system myelin. Between two months and one year after the initial sensitization, 11 of 24 rabbits immunized repeatedly with bovine brain galactocerebroside (GC) in complete Freund's adjuvant developed a neurological disorder manifested by flaccid quadriparesis, limb hypesthesia, and respiratory paralysis. Seventeen of 20 autopsied rabbits, including all those with clinical illness, had small multiple perivascular foci of demyelinative lesions in roots, dorsal root ganglia, proximal peripheral nerves adjacent to ganglia, and, less frequently, in distal nerves. No change was found in the central nervous system. Demyelination started around venules, with splitting and vesiculation of the outer myelin sheaths of adjacent fibers, and later progressed to form confluent lesions. The lesions were associated with infiltration of phagocytic mononuclear cells, mostly macrophages, which insinuated themselves between myelin lamellae, phagocytized myelin, and subsequently denuded axons. Perivenular infiltration of small lymphocytes, comparable to that seen in whole nerve- induced EAN, was not encountered. The distribution of demyelinative lesions seems to correspond to areas known to have a defective blood-nerve barrier.
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26
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Kadlubowski M, Hughes RA. The neuritogenicity and encephalitogenicity of P2 in the rat, guinea-pig and rabbit. J Neurol Sci 1980; 48:171-8. [PMID: 6159457 DOI: 10.1016/0022-510x(80)90198-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In inbred Lewis rats, P2 basic protein from bovine peripheral nervous system (PNS) myelin produced experimental allergic neuritis (EAN) without involvement of the brain or spinal cord. In guinea-pigs, bovine P2 did not produce EAN but large doses produced mild experimental allergic encephalomyelitis (EAE). In rabbits, bovine P2 produced both mild EAE and EAN. Human P2 produced severe EAN in the Lewis rat, but only mild EAN with quite marked EAE in the guinea-pig. Material cross-reacting with bovine P on immunodiffusion was identified in the extracts from the nerves of all three species but only in the spinal cord of the guinea-pig and rabbit, not in the rat spinal cord. The species differences in response to immunisation with P2 cannot be simply explained by the presence or absence of P2 in their PNS or CNS, but may reflect differences in the immune response.
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27
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Hoffman PM, Powers JM, Weise MJ, Brostoff SW. Experimental allergic neuritis. I. Rat strain differences in the response to bovine myelin antigens. Brain Res 1980; 195:355-62. [PMID: 6249443 DOI: 10.1016/0006-8993(80)90071-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Strain differences among rats to the induction and severity of experimental allergic neuritis (EAN) in response to whole PNS myelin were observed. Lewis rats were highly susceptible and developed severe EAN without central nervous system lesions (EAE), while Brown Norway rats were most resistant. Wistar, Sprague-Dawley, and Buffalo rats were susceptible but developed less severe disease than Lewis rats. Only Lewis rats consistantly developed EAN in response to isolated P2 protein. The severity of EAN was enhanced by treatment of the P2 with mercaptoethanol prior to injection. None of the strains developed EAN in response to galactocerebroside and none developed the lesions of EAE in response to any of the bovine myelin antigens tested. Myelin protein profiles from these rat strains were similar which suggests that factors other than target tissue differences, such as genetically determined immune responses to bovine myelin antigens, must be involved in these differing responses.
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28
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Kadlubowski M, Hughes RA, Gregson NA. Experimental allergic neuritis in the Lewis rat: characterization of the activity of peripheral myelin and its major basic protein,P2. Brain Res 1980; 184:439-54. [PMID: 6153287 DOI: 10.1016/0006-8993(80)90811-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Experimental allergic neuritis has been produced in the inbred Lewis rat in the absence of experimental allergic encephalomyelitis (EAE) using bovine intradural root myelin. The lack of EAE is probably because P1 is only weakly encephalitogenic in the rat. One of the basic proteins of bovine peripheral myelin, P2, was isolated and demonstrated to be pure by amino acid analysis and SDS PAGE. It was found to have a molecular weight of 15,400 and contained 4 mol 1/2-cystine/mol. This P2 was found to be highly neuritogenic and is probably the sole neuritogenic antigen in this system. The successful demonstration of its neuritogenicity must be due in large part to the use of the inbred Lewis rat and bovine P2, but an explanation could also involve the omission of denaturing organic solvents, the prevention of oxidative denaturation and presumably the fact that any changes which may occur are not sufficient to prevent recognition of the active site by the immune system of the inbred Lewis rat. P2 was neuritogenic down to 5 micrograms/animal. Its activity was enhanced by but not dependent on the presence of Mycobacterium in the adjuvant. This suggested that release of P2 could possibly break tolerance and produce an auto-immune disease such as the Guillain--Barre syndrome.
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29
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Sobue G, Koizumi K. Alterations of lipid and protein composition in myelin of acute experimental allergic neuritis. J Neurol Sci 1980; 44:229-39. [PMID: 7354368 DOI: 10.1016/0022-510x(80)90130-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Lipid and protein components of the myelin isolated from the spinal roots of rabbits at the acute stage of experimental allergic neuritis (EAN) and of control rabbits were analyzed. The results obtained from the EAN myelin in comparison with the control myelin were as follows: (1) The content of cholesterol increased and that of cerebroside significantly decreased, while the content of plasmalogen and phospholipid was not changed. The level of cholesterol ester was negligible both in EAN and control myelin. (2) The sum of saturated fatty acids increased while the sum of unsaturated fatty acids decreased. (3) The decrease of the basic proteins P1 and P2 was more noticeable than that of the PO + Y protein. Concomitant to these observations, with 1,6-diphenyl 1,3,5-hexatriene as a fluorescent probe, the microviscosity of the isolated myelin was measured. The results indicated that myelin obtained from EAN was less fluid. Diminished myelin fluidity in EAN was consistent with the results of the lipid and fatty acid analyses.
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30
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Hahn AF, Gilbert JJ, Feasby TE. Passive transfer of demyelination by experimental allergic neuritis serum. Acta Neuropathol 1980; 49:169-76. [PMID: 7368896 DOI: 10.1007/bf00707103] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Serum from rabbits with experimental allergic neuritis (EAN) when injected into rat sciatic nerves produced rapidly evolving demyelination followed by remyelination. Myelinating and non-meylinating Schwann cells as well as myelin itself were damaged by 15 min after injection. Myelin degradation was well advanced prior to involvement by macrophages at 12 h. The demyelinating factor was myelin-specific and complement-dependent. The evidence suggests that the EAN antigen may reside in Schwann cell membranes as well as in myelin.
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31
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Saida T, Saida K, Dorfman SH, Silberberg DH, Sumner AJ, Manning MC, Lisak RP, Brown MJ. Experimental allergic neuritis induced by sensitization with galactocerebroside. Science 1979; 204:1103-6. [PMID: 451555 DOI: 10.1126/science.451555] [Citation(s) in RCA: 194] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Thirteen of 31 rabbits immunized repeatedly with bovine brain galactocerebroside developed experimental allergic neuritis, manifested by flaccid paresis and hypesthesia of four limbs, 2 to 11 months after the initial inoculation. Electrophysiological studies revealed multifocal conduction block of peripheral nerves. Perivenular demyelinative lesions associated with phagocytic mononuclear cells occurred in spinal ganglia, roots, and less frequently in distal nerves.
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32
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Kadlubowski M, Hughes RA. Identification of the neuritogen for experimental allergic neuritis. Nature 1979; 277:140-1. [PMID: 310522 DOI: 10.1038/277140a0] [Citation(s) in RCA: 159] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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33
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Restoration of activity for induction of experimental allergic peripheral neuritis by a combination of myelin basic protein P2 and gangliosides from peripheral nerve. Neurosci Lett 1978; 8:247-54. [DOI: 10.1016/0304-3940(78)90130-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/1978] [Revised: 03/25/1978] [Accepted: 03/28/1978] [Indexed: 11/21/2022]
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