The node of Ranvier in experimental allergic neuritis: an electron microscope study

Incidental Ultrastructural Findings in the Sural Nerve and Dorsal Root Ganglion of Aged Control Sprague Dawley Rats in a Nonclinical Carcinogenicity Study

Xenobiotic-induced peripheral nerve damage is a growing concern. Identifying relative risks that a new drug may cause peripheral nerve injury over long periods of administration is gathering importance in the evaluation of animal models. Separating out age-related changes in peripheral nerves of rats caused by compression injury from drug-induced effects has been difficult. Biopsy of the sural nerve is utilized in humans for investigations of peripheral neuropathy, because it is largely removed from the effects of nerve compression. This study used transmission electron microscopy to identify incidental findings in the sural nerves and dorsal root ganglia of aged control rats over time. The goal was to establish a baseline understanding of the range of possible changes that could be noted in controls compared to rats treated with any new investigative drug. In this evaluation, most sural nerve fibers from aged control rats had few ultrastructural abnormalities of pathologic significance. However, glycogenosomes, polyglucosan bodies, swollen mitochondria, autolysosomes, split myelin, Schwann cell processes, and endoneural macrophages with phagocytosed debris (considered an indication of ongoing degenerative changes) were occasionally noted.

Traditional Chinese medicine Yisui Tongjing relieved neural severity in experimental autoimmune neuritis rat model

OBJECTIVE

To study the effect of Yisui Tongjing (YSTJ) prescription on motor nerve conduction velocity (MNCV) and microstructure of the sciatic nerve in experimental autoimmune neuritis (EAN) rats, the Guillain-Barré syndrome classic animal models.

MATERIALS AND METHODS

In this study, we established an EAN model in Lewis rats by immunization. We evaluated the potential clinical application of a traditional Chinese medicine YSTJ by intragastric administration and compared its effect with immunoglobulin. The sciatic MNCV was measured by electrophysiology experiment. Hematoxylin-eosin staining and transmission electron microscope analysis were used to determine the pathologically morphological changes before and after YSTJ application.

RESULTS

We found that application of YSTJ could significantly alleviate the clinical signs in EAN rats. The treatment also increased MNCV in the sciatic nerve compared to that in the untreated nerve. Demyelination in the sciatic nerve in EAN rats was significantly ameliorated, and newly generated myelinated nerve fibers were observed with treatment of high dose of YSTJ.

CONCLUSION

This study showed that the traditional Chinese medicine YSTJ was likely to serve as a therapeutic medicine in autoimmune neuropathies, providing an effective and economic means to the treatment of Guillain-Barré syndrome.

Paranodal reorganization results in the depletion of transverse bands in the aged central nervous system

Paranodal axo-glial junctional complexes anchor the myelin sheath to the axon and breakdown of these complexes presumably facilitates demyelination. Myelin deterioration is also prominent in the aging central nervous system (CNS); however, the stability of the paranodal complexes in the aged CNS has not been examined. Here, we show that transverse bands, prominent components of paranodal junctions, are significantly reduced in the aged CNS; however, the number of paired clusters of both myelin and axonal paranodal proteins is not altered. Ultrastructural analyses also reveal that thicker myelin sheaths display a "piling" of paranodal loops, the cytoplasm-containing sacs that demarcate the paranode. Loops involved in piling are observed throughout the paranode and are not limited to loops positioned in either the nodal- or juxtanodal-most regions. Here, we propose that as myelination continues, previously anchored loops lose their transverse bands and recede away from the axolemma. Newly juxtaposed loops then lose their transverse bands, move laterally to fill in the gap left by the receded loops and finally reform their transverse bands. This paranodal reorganization results in conservation of paranodal length, which may be important in maintaining ion channel spacing and axonal function. Furthermore, we propose that transverse band reformation is less efficient in the aged CNS, resulting in the significant reduction of these junctional components. Although demyelination was not observed, we propose that loss of transverse bands facilitates myelin degeneration and may predispose the aged CNS to a poorer prognosis following a secondary insult.

The challenges of long-distance axon regeneration in the injured CNS

Injury to the central nervous system (CNS) that results in long-tract axonal damage typically leads to permanent functional deficits in areas innervated at, and below, the level of the lesion. The initial ischemia, inflammation, and neurodegeneration are followed by a progressive generation of scar tissue, dieback of transected axons, and demyelination, creating an area inhibitory to regrowth and recovery. Two ways to combat this inhibition is to therapeutically target the extrinsic and intrinsic properties of the axon-scar environment. Scar tissue within and surrounding the lesion site can be broken down using an enzyme known as chondroitinase. Negative regulators of adult neuronal growth, such as Nogo, can be neutralized with antibodies. Both therapies greatly improve functional recovery in animal models. Alternatively, modifying the intrinsic growth properties of CNS neurons through gene therapy or pharmacotherapy has also shown promising axonal regeneration after injury. Despite these promising therapies, the main challenge of long-distance axon regeneration still remains; achieving a level of functional and organized connectivity below the level of the lesion that mimics the intact CNS.

Nodes of ranvier and paranodes in chronic acquired neuropathies

Chronic acquired neuropathies of unknown origin are classified as chronic inflammatory demyelinating polyneuropathies (CIDP) and chronic idiopathic axonal polyneuropathies (CIAP). The diagnosis can be very difficult, although it has important therapeutic implications since CIDP can be improved by immunomodulating treatment. The aim of this study was to examine the possible abnormalities of nodal and paranodal regions in these two types of neuropathies. Longitudinal sections of superficial peroneal nerves were obtained from biopsy material from 12 patients with CIDP and 10 patients with CIAP and studied by immunofluorescence and in some cases electron microscopy. Electron microscopy revealed multiple alterations in the nodal and paranodal regions which predominated in Schwann cells in CIDP and in axons in CIAP. In CIDP paranodin/Caspr immunofluorescence was more widespread than in control nerves, extending along the axon in internodes where it appeared intense. Nodal channels Nav and KCNQ2 were less altered but were also detected in the internodes. In CIAP paranodes, paranodin labeling was irregular and/or decreased. To test the consequences of acquired primary Schwann cells alteration on axonal proteins, we used a mouse model based on induced deletion of the transcription factor Krox-20 gene. In the demyelinated sciatic nerves of these mice we observed alterations similar to those found in CIDP by immunofluorescence, and immunoblotting demonstrated increased levels of paranodin. Finally we examined whether the alterations in paranodin immunoreactivity could have a diagnosis value. In a sample of 16 biopsies, the study of paranodin immunofluorescence by blind evaluators led to correct diagnosis in 70 ± 4% of the cases. This study characterizes for the first time the abnormalities of nodes of Ranvier in CIAP and CIDP, and the altered expression and distribution of nodal and paranodal proteins. Marked differences were observed between CIDP and CIAP and the alterations in paranodin immunofluorescence may be an interesting tool for their differential diagnosis.

Schwann cell transplantation for repair of the adult spinal cord

The Schwann cell is one of the most widely studied cell types for repair of the spinal cord. These cells play a crucial role in endogenous repair of peripheral nerves due to their ability to dedifferentiate, migrate, proliferate, express growth promoting factors, and myelinate regenerating axons. Following trauma to the spinal cord, Schwann cells migrate from the periphery into the injury site, where they apparently participate in endogenous repair processes. For transplantation into the spinal cord, large numbers of Schwann cells are necessary to fill injury-induced cystic cavities. Several culture systems have been developed that provide large, highly purified populations of Schwann cells. Importantly, the development of in vitro systems to harvest human Schwann cells presents a unique opportunity for autologous transplantation in the clinic. In animal models of spinal cord injury (SCI), grafting Schwann cells or peripheral nerve into the lesion site has been shown to promote axonal regeneration and myelination. However, axons do not regenerate beyond the transplant due to the inhibitory nature of the glial scar surrounding the injury. To overcome the glial scar inhibition, additional approaches such as increasing the intrinsic capacity of axons to regenerate and/or removal of the inhibitory molecules associated with reactive astrocytes and/or oligodendrocyte myelin should be incorporated. Clearly, Schwann cells have great potential for repair of the injured spinal cord, but they need to be combined with other interventions to maximize axonal regeneration and functional recovery.

Acute demyelination disrupts the molecular organization of peripheral nervous system nodes

Intraneurally injected lysolecithin causes both segmental and paranodal demyelination. In demyelinated internodes, axonal components of nodes fragment and disappear, glial and axonal paranodal and juxtaparanodal proteins no longer cluster, and axonal Kv1.1/Kv1.2 K+ channels move from the juxtaparanodal region to appose the remaining heminodes. In paranodal demyelination, a gap separates two distinct heminodes, each of which contains the molecular components of normal nodes; paranodal and juxtaparanodal proteins are properly localized. As in normal nodes, widened nodal regions contain little or no band 4.1B. Lysolecithin also causes "unwinding" of paranodes: The spiral of Schwann cell membrane moves away from the paranodes, but the glial and axonal components of septate-like junctions remain colocalized. Thus, acute demyelination has distinct effects on the molecular organization of the nodal, paranodal, and juxtaparanodal region, reflecting altered axon-Schwann cell interactions.

Imbalances in N-CAM, SAM and polysialic acid may underlie the paranodal ion channel barrier defect in diabetic neuropathy

Breakdown of protective tissue barrier systems characterizes the chronic diabetic complications affecting the retina, and peripheral and central nerve tracts. The progressive damages to the blood-retina-, blood-nerve-, and paranodal ion channel barriers have pathophysiological consequences for the relentless progression of these complications. The continuing damage to the paranodal ion channel barrier in the spontaneously diabetic BB/W rat is associated with an increasingly irreversible nerve conduction defect, due to impaired nodal Na+ currents associated with displacement of nodal Na+ channels across the damaged paranodal barrier. The structural substrate for the mechanical barrier of the paranode is provided by electron-dense junctional complexes made up by a moiety of neural cell adhesive-(N-CAM), neural-glial adhesive (Ng-CAM), substrate adhesive molecules (SAMs) and polysialic acid (PSA). To further explore the mechanism underlying the protective barrier defect in diabetic neuropathy we examined the expression and immunolocalization of these molecules in peripheral nerve. In 6-month diabetic BB/W rats, direct and indirect ELISAs revealed significantly up-regulated N-CAM (P < 0.05), tenascin (Ng-CAM), (P < 0.001) and N-cadherin (A-CAM) (P < 0.03). On the other hand, SAMs showed little change, except for PSA which showed a significantly (P < 0.03) decreased concentration in the diabetic nerve. Immunocytochemical identification of these molecules revealed no visually detectable differences between diabetic and control rats. In conclusion, these data suggest that imbalances between highly interactive molecules responsible for the adhesiveness between terminal Schwann cell loops and the paranodal axolemma may underlie the critical paranodal barrier defect in diabetic neuropathy.

An orderly development of paranodal axoglial junctions and bracelets of Nageotte in the rat sural nerve

The present study was designed to assess the normal development of the paranodal apparatus with particular emphasis on axoglial junctions (AGJs) which constitute the paranodal barrier system. The sural nerve was examined in 10- and 31-day-old rats. During the early phase of myelination AGJ attachment of terminal myelin loops to the axolemma proceeded from the node to the internode. The frequency of terminal loops with AGJ attachment increased with fiber growth. As myelination advanced internodal-most loops became almost 100% attached to the axolemma by AGJs, whereas at the same time an increasing number of nodal-most loops were unattached, suggesting a lack of AGJ formation at this site. The formation of bracelets of Nageotte increased with the progressive addition of myelin loops. They formed most frequently at the juxtanodal interface between unattached and attached loops, probably reflecting crowding of terminal loops along the unchanged length of the paranodal axolemma. The findings suggest a complex but orderly age- and fiber size-dependent maturation process of the paranode and its structural barrier system. The present data will serve as a basis for the evaluation of this anatomical region in regenerating and remyelinating fibers in various neuropathies.

Developmental and pathological changes at the node and paranode in human sural nerves

The nodes and paranodes of peripheral nerve fibers are complex structures that are especially prone to artificial and pathological changes which have to be distinguished from normal developmental changes. Alterations during normal development are mainly caused by an increase in axonal diameter and myelin sheath thickness. The nodal, and paranodal axon diameters in human sural nerves reach their adult values at 3-5 years of age, simultaneously to the internodal diameter. The ratio between internodal and paranodal axon diameters remain relatively constant, with an average value of 1.8 to 2.0 (range: 1.6 to 2.5). Despite a considerable increase of the number of myelin lamellae, the length of the paranodal myelin sheath attachment zone at the axon does not increase correspondingly, because of (1) attenuation of the terminal myelin loops, (2) separation of some of these from the axolemma, and their piling up in the paranode. Separation of variable numbers of terminal myelin loops from the underlying axolemma results in the formation of the spines on the "double bracelet épineux" of Nageotte, while the transverse bands of these loops disappear. The adaptation of the paranodal myelin sheath to axonal expansion during development probably occurs by uneven gliding of the paranodal myelin loops simultaneously with internodal slippage of myelin lamellae. Artificial changes are caused by insufficient fixation or mechanical stress during excision and further handling (cutting, dedydrating, embedding) of nerves whereas pathological changes may be induced by a multitude of causes. An attempt to classify these changes is presented in Table 2.

Effects of mast cell degranulation on blood-nerve barrier permeability and nerve conduction in vivo

Changes in blood-nerve barrier (BNB) integrity and nerve conduction were assessed in rat tibial nerves in which mast cell degranulation was induced by intraneural injection of Compound 48/80 (C48/80). BNB permeability changes were quantitated by the endoneurial accumulation of Evan's blue-labelled albumin (EBA). Over 24 h following intraneural injections, nerves receiving saline showed a 6-fold increase in endoneurial extravasated EBA compared to non-injected nerves. Injection of 250 ng C48/80 produced a similar level of EBA accumulation as saline injections. Increasing the C48/80 dose to 1 microgram produced twice the EBA accumulation as control saline injections and a 12-fold increase over non-injected nerves. Tibial nerves injected with these C48/80 doses showed completely normal nerve conduction. In contrast, increasing the dose to 5 micrograms C48/80 induced, again, increased EBA accumulation over lower doses, but also significant axonal degeneration indicated by profound decreases in compound muscle action potential amplitudes measured with nerve stimulation distal to the injection site. Co-injection of Leupeptin and neutralizing anti-TNF-alpha antibodies with C48/80 failed to mitigate conduction abnormalities suggesting a direct toxic effect of C48/80 on nerve fibres. Time-kinetic studies showed rapid restoration of BNB integrity 24-48 h after injections in all nerves, but at these timepoints C48/80 injected nerves still showed significantly increased BNB permeability compared to nerves injected with saline. Neural mast cell stimulation in the absence of a primed immune response can produce profound temporary changes in blood-nerve barrier permeability and endoneurial fluid composition without affecting nerve conduction.

Developmental changes at the node and paranode in human sural nerves: morphometric and fine-structural evaluation

Developmental alterations of paranodal fiber segments have not been investigated systematically in human nerve fibers at the light- and electron-microscopic level. We have therefore analyzed developmental changes in the fine structure of the paranode in 43 human sural nerves during the axonal growth period up to 5 years of age, and during the subsequent myelin development up to 20 years and thereafter. The nodal, internodal, and paranodal axon diameters reach their adult values at 4-5 years of age. The ratio between internodal and paranodal axon diameters remains constant at 1.8-2.0. Despite a considerable increase in myelin sheath thickness, the length of the paranodal myelin sheath attachment zone at the axon does not increase correspondingly, because of attenuation, separation from the axolemma, and piling up of myelin loops in the paranode. Separation of variable numbers of terminal myelin loops from the underlying axolemma results in the formation of bracelets of Nageotte, whereas the transverse bands of these loops disappear. The adaptation of the paranodal myelin sheath to axonal expansion during development probably occurs by uneven gliding of the paranodal myelin loops simultaneously with internodal slippage of myelin lamellae. Since mechanically stabilizing structures (tight junctions and desmosomes between adjacent paranodal myelin processes; transverse bands between myelin loops and paranodal axolemma) are unevenly arranged, especially during rapid axonal growth, paranodal axonal growth with simultaneous adaptation of the myelin sheath is probably discontinuous with time.

Early myelin lesions in experimental allergic neuritis

We examined the evolution of demyelination in spinal roots of Lewis rats immunized with whole nerve and complete Freund's adjuvant. Roots were morphologically normal until 11 days after immunization, when we found endoneurial edema and myelin vesiculation in the absence of mononuclear cell contacts. Macrophage-associated myelin stripping was not detected until day 12. Macrophage infiltrations were extensive by day 14, but lymphocytes were sparse. These observations indicate that in experimental allergic neuritis, myelin injury may occur before macrophage-mediated demyelination, and provide support for an early role of serum factors in the development of this disorder.

Sural nerve biopsy in chronic inflammatory demyelinating polyradiculoneuropathy

We compared histologic features of sural nerve biopsies in 14 patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with those in other forms of neuropathy. In CIDP endoneurial pericapillary cellular infiltrates were found in 4 patients (29%), onion bulbs in 5 patients (36%), and predominant demyelination in 7 patients (50%). None of these abnormalities was specific, but cellular infiltrates and onion bulbs appear to be diagnostically useful when combined with clinical information. To detect macrophage infiltration of myelin, cell nuclei were counter-stained in 20 teased fiber preparations. Nine patients with CIDP had a significantly higher mean number of cells per centimeter of teased fiber than 11 patients with other neuropathies. Despite overlap, significant infiltration of myelin detected by this method suggests CIDP in an appropriate clinical setting.

Role of endoneural cells in experimental allergic neuritis and characterisation of a resident phagocytic cell

Electrophysiological, clinical and histological techniques were used to monitor the time course of events related to experimental allergic neuritis (EAN) in 48 Lewis rats. The primary lesion was found to be paranodal demyelination without cellular infiltration. Endoneural phagocytes derive from hematogenous ED1+ED2- monocytes and possibly from resident ED1-ED2+ monocytic cells, not from Schwann cells and fibroblasts. We demonstrate a population of monocytic Ia-bearing, ED1-ED2+ spindle-shaped cells residing in normal peripheral nerve and provide evidence for their transformation into macrophages in the course of EAN.

Ethylene oxide polyneuropathy: clinical follow-up study with morphometric and electron microscopic findings in a sural nerve biopsy

A case is reported of ethylene oxide polyneuropathy after 5 months of exposure. There was symmetrical distal weakness of both lower extremities and transitory reduced nerve conduction velocities with increased latencies. Sural nerve biopsy revealed nerve fibre degeneration of the Wallerian type, associated with reduction of axonal cross-sectional areas and some degree of nerve fibre regeneration that could be confirmed morphometrically. In addition, there was conspicuous paranodal vesicular disintegration of individual myelin lamellae. Unusual cisternae with introverted hemidesmosomes were noted in endoneurial fibroblasts.

Attachment of myelin to coated pits on macrophages in experimental allergic encephalomyelitis

In experimental allergic encephalomyelitis (EAE) invading macrophages appear to destroy the antigen-containing region of the plasma membrane of the myelinating cell, leaving the cell body intact. We report here that during myelin destruction and phagocytosis, myelin lamellae are attached to coated pits on the macrophage surface. As coated pits are sites where receptor-ligand complexes concentrate prior to endocytosis, we conclude that ligand-mediated phagocytosis may explain the targeted activity of macrophages in autoimmune demyelination.

Studies with antisera against peripheral nervous system myelin and myelin basic proteins. I. Effects of antiserum upon living cultures of nervous tissue

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.

Immunocytochemical study of P0 glycoprotein, P1 and P2 basic proteins, and myelin-associated glycoprotein (MAG) in lesions of idiopathic polyneuritis

To investigate the mechanism of myelin breakdown in idiopathic polyneuritis, paraffin and Epon sections of lesions were immunostained with antisera to four proteins in myelin sheaths. Three of these (P0, P2, and BP) are constituents of compact myelin whereas myelin-associated glycoprotein (MAG) is restricted to membranes near Schwann cell cytoplasm in periaxonal and paranodal regions and in Schmidt-Lanterman clefts. In early lesions, there were focal abnormalities in P2, P0, and BP immunostaining of paranodal and internodal myelin. No single protein was affected selectively and lesions occurred in fibres of all sizes, not just in larger fibres selectively stained by P2 antiserum. Early changes in MAG immunostaining occurred only in regions where myelin immunostaining also was abnormal. More severe, late changes in the distribution of P0, P2, and BP and MAG were consistent with the sequence of myelinated fibre alterations seen in segmental demyelination and Wallerian degeneration. In regenerating fibres, MAG antiserum stained periaxonal regions intensely; thin regenerating myelin sheaths were stained by P0, and BP antisera, but not by P2 antiserum. The results show that myelin sheath changes are identified more easily in immunostained sections than in conventional histological preparations. Our data also suggest that in idiopathic neuritis, myelin sheaths are the primary target and that the breakdown of myelin and its proteins is not secondary to Schwann cell damage.

A quantitative ultrastructural study of dorsal root regeneration

Regeneration in rat lumbo-sacral dorsal roots was studied 5-71 days following crush lesions. Wallerian degeneration occurred up to 20 days. At 11 days degenerating myelin was found in both Schwann cells and macrophages. Myelination was first observed 4 mm central to the crush at 7 days, and myelin became compact when the mesaxon exhibited 3.5 turns about the axon (about 11 days post-operatively). At 71 days, 69% of all fibres were myelinated, compared with 36% in normal roots. An example of 2 axons myelinating within the same Schwann cell occurred at 20 days. In normal roots curvilinear relationships were found between axon diameter and fibre diameter, myelin thickness and axon diameter, and between g and fibre diameter. In contrast, linear relationships between these parameters occurred in post-operative roots up to 71 days. Curvilinearity returned at 71 days. Alterations in the relationship between axon diameter and myelin thickness during regeneration indicated that myelin growth lagged behind axon growth throughout, but was more noticeable in larger calibre fibres. By 71 days, larger fibres exhibited disproportionately thin myelin, whilst small fibres possessed abnormally thick myelin compared to normal fibres of similar calibre. Regeneration was limited by axons failing to make successful central synaptic connections and by the poor metabolic response of dorsal root ganglion cells to sectioning of their central processes.

Pathology of the Guillain-Barré syndrome

The Guillain-Barré syndrome is a distinctive neuropathy characterized pathologically by the presence of inflammatory lesions which occur scattered throughout the peripheral nervous system. The lesions consist of circumscribed areas in which myelin is lost in the presence of lymphocytes and macrophages. Myelin damage of effected largely by macrophages, which penetrate the basement membrane around nerve fibers and strip what appears to be normal myelin away from the body of the Schwann cell and off the axon. While there is evidence that this activity is immune mediated, the precise mechanism that leads macrophages to seek out and amputate a specialized region of the Schwann cell plasma membrane remains unexplained.