Lymphocyte transformation in the Guillain-Barré syndrome

P2 specific lymphocyte transformation in Guillain-Barré syndrome and chronic idiopathic demyelinating polyradiculoneuropathy

Thymidine incorporation proliferation assays to whole bovine P2 protein and its 58-81 and 14-25 synthetic peptides were performed on blood mononuclear cells from ten patients with Guillain-Barré syndrome (GBS), six patients with chronic idiopathic demyelinating polyradiculoneuropathy (CIDP), and age and sex matched normal subjects. The only patients whose cells showed any response were two out of four with very early GBS. One responded to P2 and both synthetic peptides. One responded to P2 but to neither peptide. The results support a role for cell mediated immunity to P2 protein in some patients with Guillain-Barré syndrome.

Protection against experimental allergic neuritis with silica quartz dust

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.

Childhood chronic relapsing polyneuropathy: dramatic improvement following plasmapheresis

We present clinical data on two boys with chronic relapsing polyneuropathy. Their recurrent episodes of weakness had produced marked disability which was unresponsive to continuous prednisone therapy. Plasmapheresis produced dramatic improvement in muscle strength and functional ability. The remissions induced have been sustained despite withdrawal of steroid therapy.

Immunoglobulins in the cerebrospinal fluid of patients with Guillain-Barré syndrome

Increased immunoglobulin levels in the cerebrospinal fluid of patients with Guillain-Barré syndrome were found in association with increased protein levels. Evaluation of the immunoglobulin/protein ratios led us to conclude that the increase in immunoglobulin levels may be due to a leakage of plasma proteins and is unlikely to be caused by a local immune response to a preceding antigenic stimulus.

Cell-mediated immunity in idiopathic polyneuritis

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.

Progressive polyradiculoneuropathy: treatment with Azathioprine

A case is presented of a 64-year-old male with chronic inflammatory polyradiculoneuropathy (CIP) relentlessly progressing (despite steroids) to virtually complete quadriplegia over seven months. Once commenced on Azathioprine he dramatically improved over a six week period. The truly progressive form of CIP is rare. It is, however, immunologically similar to relapsing CIP and to the more common acute inflammatory polyradiculoneuropathy (AIP). Although the place of steroid therapy is still in doubt it would seem that cytotoxic immunosuppressives have something definite to offer in these conditions where there is progression beyond 4-5 weeks. In the largest series of CIP available (where the patients were untreated, or treated with steroids alone) the mortality rate was 11%, and the "complete recovery" rate only 5%. Although only isolated case reports are available, it would seem that if more aggressive immunosuppressive therapy was used more frequently, the prognosis might be considerably improved.

Relapsing neuropathy due to tetanus toxoid. Report of a case

A unique case history is presented, of a 42-year-old patient who has suffered three episodes of a demyelinating neuropathy, each of which followed an injection of tetanus toxoid. The clinical features on each occasion were characteristic of acute idiopathic polyneuropathy; a rapid onset of a mainly motor neuropathy with eventual recovery. Nerve conduction studies performed during the second and third episodes demonstrated grossly slowed motor conduction velocities. The sural nerve was biopsied after the third episode, and the features seen on light and electron microscopy included prominent hypertrophic changes, mononuclear cells associated with most "onion bulbs" and macrophage mediated demyelination. Studies of blastogenesis and macrophage migration inhibition, showed T lymphocyte responsiveness to both peripheral nerve myelin and tetanus toxoid. Typing for antigens of the HLA system indicated that the patient was homozygous for HLAB8.

Polyradicular neuritis and Hashimoto's thyroiditis

The case of a patient with a pluripotential immuneproliferative syndrome is reported. She suffered from Hashimoto's thyroiditis with secondary cold agglutination disease and from polyradicular neuritis. Polyradicular neuritis with albumino-cytological dissociation in the CSF had developed chronically and improved only when corticosteroid therapy was begun. Based on this case report fundamental considerations concerning the pathogenesis and therapy of Landry-Guillain-Barre-tstrohl syndrome are discussed.

Idiopathic polyneuritis: serial studies of nerve and immune functions

The clinical features of idiopathic polyneuritis in 22 patients admitted to the University of Kentucky Medical Center between July 1965 and June 1970 are described. Serial studies of peripheral nerve function in 12 patients followed to clinical recovery showed changes in nerve conduction velocity, distal motor latency, and/or muscle action potential amplitude. Six children and one adult, showing a change in all three parameters, exhibited a strong correlation between the degree of slowing and the shortness of their illness. Assessment of immune status, by quantitative measurement of cerebrospinal fluid immunoglobulin G(11 patients) and by the degree of lymphocyte transformation on exposure to specific brain protein and/or a homogenate of sciatic nerve (10 patients), bore no consistent relation to the severity or course of the illness. A double-blind trial of short-term, high dose adrenocorticotrophic hormone has yielded no valid evidence to date for or against the effectiveness of such therapy in this illness.