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Karalok ZS, Taskin BD, Yanginlar ZB, Gurkas E, Guven A, Degerliyurt A, Unlu E, Kose G. Guillain-Barré syndrome in children: subtypes and outcome. Childs Nerv Syst 2018; 34:2291-2297. [PMID: 29948140 DOI: 10.1007/s00381-018-3856-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study reviews the clinical features, subtypes, and outcomes of childhood Guillain-Barré syndrome (GBS). METHODS Fifty-four children who attended a tertiary care training and research hospital in Turkey were enrolled in the study. RESULTS The mean age was 6.5 ± 4.2 years and 32 patients (59.5%) were male. The most common subtype of GBS was acute inflammatory demyelinating polyneuropathy (AIDP), which was seen in 27 patients (50%). Having antecedent history, especially upper respiratory tract infection was significantly more common in AIDP (P = 0.028). Sensorial symptoms were significantly more frequent in axonal type GBS (P = 0.001). When we compare the demyelinating and axonal forms, all of the groups had favorable outcome. CONCLUSION The diagnosis of pediatric GBS can be delayed because of its variable presentation. Early admission to hospital and early treatment are important for decreasing the need for respiratory support and improving the outcome.
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Affiliation(s)
- Zeynep Selen Karalok
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey.
| | - Birce Dilge Taskin
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Zeliha Brohi Yanginlar
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Esra Gurkas
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Alev Guven
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Aydan Degerliyurt
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, 06110, Dıskapı/Ankara, Turkey
| | - Ece Unlu
- Department of Physical Medicine and Rehabilitation, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Gulsen Kose
- Department of Pediatric Neurology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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Langert KA, Goshu B, Stubbs EB. Attenuation of experimental autoimmune neuritis with locally administered lovastatin-encapsulating poly(lactic-co-glycolic) acid nanoparticles. J Neurochem 2016; 140:334-346. [PMID: 27861905 DOI: 10.1111/jnc.13892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/28/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
Abstract
Acute inflammatory demyelinating polyneuropathy (AIDP) is an aggressive antibody- and T-cell-mediated variant of Guillain-Barré Syndrome (GBS), a prominent and debilitating autoimmune disorder of the peripheral nervous system. Despite advancements in clinical management, treatment of patients with AIDP/GBS and its chronic variant CIDP remains palliative and relies on the use of non-specific immunemodulating therapies. Our laboratory has previously reported that therapeutic administration of statins safely attenuates the clinical severity of experimental autoimmune neuritis (EAN), a well-characterized animal model of AIDP/GBS, by restricting the migration of autoreactive leukocytes across peripheral nerve microvascular endoneurial endothelial cells that form the blood-nerve barrier. Despite these advancements, the clinical application of systemically administered statins for the management of inflammatory disorders remains controversial as a result of disappointingly inconclusive phase trials. Here, poly(lactic-co-glycolic) acid (PLGA) nanoparticles were evaluated as an alternative strategy by which to locally administer statins for the management of EAN. When tested in vitro, lovastatin-encapsulating PLGA nanoparticles elicited a marked increase in RhoB mRNA content in peripheral nerve microvascular endoneurial endothelial cells, similar to cells treated with activated unencapsulated lovastatin. Unilateral peri-neural administration of lovastatin-encapsulating PLGA nanoparticles, but not empty nanoparticles, to naïve Lewis rats similarly enhanced RhoB mRNA content in adjacent nerve and muscle tissue. When administered in this manner, serum levels of lovastatin were below the level of detection. Bilateral peri-neural administration of lovastatin-encapsulating PLGA nanoparticles to EAN-induced Lewis rats significantly attenuated EAN clinical severity while protecting against EAN-induced peripheral nerve morphological and functional deficits. This study provides the first proof-of-concept approach for the application of a nanoparticle-based local drug delivery platform for the management of inflammatory demyelinating diseases, including AIDP/GBS.
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Affiliation(s)
- Kelly A Langert
- Research Service, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Bruktawit Goshu
- Research Service, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA
| | - Evan B Stubbs
- Research Service, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois, USA.,Program of Neuroscience, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.,Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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Samadi M, Kazemi B, Golzari Oskoui S, Barzegar M. Assessment of autonomic dysfunction in childhood guillain-barré syndrome. J Cardiovasc Thorac Res 2013; 5:81-5. [PMID: 24252981 DOI: 10.5681/jcvtr.2013.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/08/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Autonomic dysfunction (AD) is a common and important complication in Guillain-Barré syndrome (GBS) and may be the cause of significant morbidity or death. Limited studies have evaluated this complication in childhood GBS. Our objectives were to show the prevalence of AD in children with GBS and investigate its association with the severity of the disease. METHODS Study included 28 children admitted with a diagnosis of GBS. Heart rate variability (HRV), motor function disability of the upper limbs and GBS disability scores were measured at admission and the results were compared with 20 healthy age/gender matched subjects (2-13 years; 43% male). GBS subtypes were defined by electromyography: acute inflammatory demyelinating polyneuropathy (AIDP) or acute motor axonal neuropathy (AMAN). RESULTS The mean age was 5.5±3.4 years (range 1.5-14 years; 50% male). AIDP and AMAN subtypes comprised 57.1% and 42.9% of cases, respectively. In the upper limbs, 85.7% and in the GBS disability grading, 50% of patients had ≤ 3 scores, implying less severe motor dysfunction. There was no difference in the mean heart rate between patients vs. controls (103.9 vs. 98.2 bpm; P= 0.16), but half of patients showed AD and HRV was significantly reduced in patients compared to controls. Of the 16 patients with AIDP, 11 (68.8%) showed reduced HRV compared to 3 (25%) out of 12 AMAN cases (P= 0.02). There was no significant relation between HRV and motor disability scores. CONCLUSION AD was present in half of children with mild GBS and it showed no significant association with disease severity.
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Affiliation(s)
- Mahmood Samadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Cicero G, Fulfaro F, Caraceni A, Arcara C, Badalamenti G, Intrivici C, Gebbia N. A Case of Guillain-Barré Syndrome in a Patient with Non Small Cell Lung Cancer Treated with Chemotherapy. J Chemother 2013; 18:325-7. [PMID: 17129846 DOI: 10.1179/joc.2006.18.3.325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Guillain-Barré Syndrome (GBS) is a demyelinating polyneuropathy of probable autoimmune pathogenesis characterized by rapidly progressive symmetric paralysis. In the literature some cases of GBS associated with anticancer chemotherapy are reported. We present a case of a 55-year old woman who complained of progressive motor deficit in four limbs, areflexia in lower limbs and facial nerve paralysis one week after beginning cisplatin-gemcitabine chemotherapy for metastatic lung cancer. The cerebrospinal fluid analysis showed a strong positive Pandy reaction with 435 mg/dl total protein. The electromyography and the electroneuronography established the diagnosis of inflammatory demyelinating polyneuropathy. Specific therapy with intravenous immunoglobulin 25 g/day in 5 administrations for 5 days was started with complete benefit.
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Affiliation(s)
- G Cicero
- Operative Unit of Medical Oncology, Department of Oncology, Università degli Studi di Palermo, Italy
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Tumour necrosis factor α enhances CCL2 and ICAM-1 expression in peripheral nerve microvascular endoneurial endothelial cells. ASN Neuro 2013; 5:e00104. [PMID: 23293927 PMCID: PMC3565377 DOI: 10.1042/an20120048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recruitment and trafficking of autoreactive leucocytes across the BNB (blood-nerve barrier) is an early pathological insult in GBS (Guillain-Barré syndrome), an aggressive autoimmune disorder of the PNS (peripheral nervous system). Whereas the aetiology and pathogenesis of GBS remain unclear, pro-inflammatory cytokines, including TNFα (tumour necrosis factor α), are reported to be elevated early in the course of GBS and may initiate nerve injury by activating the BNB. Previously, we reported that disrupting leucocyte trafficking in vivo therapeutically attenuates the course of an established animal model of GBS. Here, PNMECs (peripheral nerve microvascular endothelial cells) that form the BNB were harvested from rat sciatic nerves, immortalized by SV40 (simian virus 40) large T antigen transduction and subsequently challenged with TNFα. Relative changes in CCL2 (chemokine ligand 2) and ICAM-1 (intercellular adhesion molecule 1) expression were determined. We report that TNFα elicits marked dose- and time-dependent increases in CCL2 and ICAM-1 mRNA and protein content and promotes secretion of functional CCL2 from immortalized and primary PNMEC cultures. TNFα-mediated secretion of CCL2 promotes, in vitro, the transendothelial migration of CCR2-expressing THP-1 monocytes. Increased CCL2 and ICAM-1 expression in response to TNFα may facilitate recruitment and trafficking of autoreactive leucocytes across the BNB in autoimmune disorders, including GBS.
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Dalakas MC. Autoimmune peripheral neuropathies. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Asati A, Kachurina O, Kachurin A. Simultaneous measurements of auto-immune and infectious disease specific antibodies using a high throughput multiplexing tool. PLoS One 2012; 7:e42681. [PMID: 22952605 PMCID: PMC3431397 DOI: 10.1371/journal.pone.0042681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/11/2012] [Indexed: 11/18/2022] Open
Abstract
Considering importance of ganglioside antibodies as biomarkers in various immune-mediated neuropathies and neurological disorders, we developed a high throughput multiplexing tool for the assessment of gangliosides-specific antibodies based on Biolpex/Luminex platform. In this report, we demonstrate that the ganglioside high throughput multiplexing tool is robust, highly specific and demonstrating ∼100-fold higher concentration sensitivity for IgG detection than ELISA. In addition to the ganglioside-coated array, the high throughput multiplexing tool contains beads coated with influenza hemagglutinins derived from H1N1 A/Brisbane/59/07 and H1N1 A/California/07/09 strains. Influenza beads provided an added advantage of simultaneous detection of ganglioside- and influenza-specific antibodies, a capacity important for the assay of both infectious antigen-specific and autoimmune antibodies following vaccination or disease. Taken together, these results support the potential adoption of the ganglioside high throughput multiplexing tool for measuring ganglioside antibodies in various neuropathic and neurological disorders.
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Affiliation(s)
| | | | - Anatoly Kachurin
- Sanofi Pasteur, VaxDesign Campus, Orlando, Florida, United States of America
- * E-mail:
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Abstract
This investigation correlated incidence and degree of autonomic dysfunction with the degree of motor impairment in children hospitalized with Guillain-Barré syndrome. Motor weakness varies, as does the effect on autonomic function including heart rate, vasomotor stability, sweating, continence, and blood pressure. After Institutional Review Board approval, hospitalized patients with Guillain-Barré syndrome <19 years were included for retrospective chart review. There were 26 patients (12 boys), with a mean age of 11.3 years (range, 6-17 years). The average hospital stay was 10.6 days. Twenty-four (92%) recovered by 2 to 6 months without functional disability. Bradycardia and sweating disturbances were not observed. Hypertension occurred in 18 of 26 (69%) and tachycardia in 20 of 26 (77%) patients. The proportion of children with hypertension and/or tachycardia increased, as did the motor disability grade (P < .043 and P < .018, respectively). Hypertension occurred 9 to 15 days from symptom onset and within 24 to 48 hours of maximum motor disability in 89%. Multiple autonomic disturbances compound the course of childhood Guillain-Barré syndrome.
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Affiliation(s)
- Francis J Dimario
- Division of Neurology, Department of Pediatrics, The University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
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Ziganshin RK, Arapidi GP, Azarkin IV, Balmasova IP, Timchenko OL, Fed'kina IA, Morozova EA, Piradov MA, Suponeva NA, Iushchuk ND, Govorun VM. [Proteomic technologies for identification of serum potential biomarkers of autoimmune demyelinating polyneuropathies]. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2011; 37:36-44. [PMID: 21460879 DOI: 10.1134/s1068162011010171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Time-of-flight MALDI mass spectrometry (MALDI-TOF-MS) profiling of blood serum of patients with Guillain-Barré syndrome (GBS, 36 samples), chronic inflammatory demyelinating polyneuropathy (CIDP, 24 samples) and practically healthy donors (HD) (35 samples) was carried out in order to identify potential biomarkers of autoimmune demyelinating polyneuropathies (ADP). To simplify the peptide-protein mixture of serum prior to MALDI-TOF-MS analysis samples were pre-fractionated on magnetic microparticles with a weak cation-exchange (MB-WCX) surface. Comparative analysis of mass spectrometric data using the classification algorithms (genetic and neural network-controlled) revealed a characteristic set of peaks, agreed change area with a high specificity and sensitivity of the differentiated mass spectrometry profiles of the blood serum of patients with DPNP and healthy donors (for GBS values of these characteristics reached 100 and 100, and for CIDP 94.1 and 100% respectively). Comparative analysis of mass spectrometric profiles of serum samples obtained from patients with GBS and CIDP, allowed to build a classification model to differentiate these diseases from each other, with a specificity of 88.9 and a sensitivity of 80%.
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Güngör L, Güngör I, Oztürk HE, Onar MK. Visual evoked potentials in guillain-barré syndrome. J Clin Neurol 2011; 7:34-9. [PMID: 21519525 PMCID: PMC3079158 DOI: 10.3988/jcn.2011.7.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/17/2010] [Accepted: 08/17/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Guillain-Barré syndrome (GBS) is an acute demyelinating polyneuropathy with various clinical features. Optic neuritis occurs in rare cases. In this study we determined the incidence and patterns of visual evoked potential (VEP) abnormality in GBS in association with ophthalmologic findings. METHODS Thirty-two patients with a diagnosis of GBS were included in the study. The correlation between pathologic VEPs and categories of neurologic deficit and electrophysiological findings were examined statistically. RESULTS The patients ranged in age from 19 to 77 years. Five cases (16%) had abnormal VEPs. All five of these patients exhibited increased P100 latency differences between the two eyes. Other abnormalities were prolonged p100 latency, increased interocular amplitude difference, and distorted p100 configuration. Pathologic signs on ophthalmologic examination were observed in 80% of patients with abnormal VEPs. VEP abnormality was never present in pure axonal forms. There was no significant correlation between pathologic VEP and cerebrospinal fluid protein level or categories of neurologic deficits. CONCLUSIONS Involvement of the optic pathways is not a frequent finding in GBS. When present it is always asymmetric and generally accompanied with pathologic findings on ophthalmologic examination. VEPs may be abnormal in different clinical variants of GBS, and especially in demyelinating forms.
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Affiliation(s)
- Levent Güngör
- Department of Neurology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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Randall DP. Guillain-Barré syndrome. Dis Mon 2010; 56:256-61. [PMID: 20493302 DOI: 10.1016/j.disamonth.2010.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Hao HN, Peduzzi-Nelson JD, VandeVord PJ, Barami K, DeSilva SP, Pelinkovic D, Morawa LG. Lipopolysaccharide-induced inflammatory cytokine production by Schwann's cells dependent upon TLR4 expression. J Neuroimmunol 2009; 212:26-34. [PMID: 19525014 DOI: 10.1016/j.jneuroim.2009.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/09/2009] [Accepted: 04/20/2009] [Indexed: 12/22/2022]
Abstract
Signaling of Toll-like receptor-4 (TLR4) through its cognate ligand endotoxin appears critical in tissue inflammation associated with bacterial infection. We found that anti-GM1 antibody (Ab) enhances TLR4 expression in Schwann's cells (SCs) in vivo and in vitro. The anti-GM1 Ab-treated SC also showed increased release of pro-inflammation cytokines IL-1beta and TNF-alpha after incubation with lipopolysaccharide (LPS). Furthermore, down-regulation of TLR4 expression using antisense oligonucleotides targeted to TLR4 mRNA suppressed cytokine production in LPS stimulated cultures. These findings suggest that elevation of TLR4 expression increases sensitivity of SC to LPS and production of inflammatory mediators that may be responsible for peripheral nerve dysfunction.
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Affiliation(s)
- Hsiao-Nan Hao
- Department of Orthopaedic Surgery, Wayne State University, Detroit, MI 48823, United States.
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Huberle A, Beyeen AD, Ockinger J, Ayturan M, Jagodic M, de Graaf KL, Fissolo N, Marta M, Olofsson P, Hultqvist M, Holmdahl R, Olsson T, Weissert R. Advanced Intercross Line Mapping Suggests That Ncf1 (Ean6) Regulates Severity in an Animal Model of Guillain-Barré Syndrome. THE JOURNAL OF IMMUNOLOGY 2009; 182:4432-8. [PMID: 19299744 DOI: 10.4049/jimmunol.0803847] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Animals
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoantigens/immunology
- Chromosome Mapping
- Enzyme-Linked Immunosorbent Assay
- Female
- Genetic Linkage
- Genotype
- Guillain-Barre Syndrome/genetics
- Guillain-Barre Syndrome/immunology
- Guillain-Barre Syndrome/pathology
- Interferon-gamma/immunology
- Interferon-gamma/metabolism
- Male
- Multienzyme Complexes/genetics
- Multienzyme Complexes/immunology
- Multienzyme Complexes/metabolism
- NADH, NADPH Oxidoreductases/genetics
- NADH, NADPH Oxidoreductases/immunology
- NADH, NADPH Oxidoreductases/metabolism
- NADPH Oxidases/genetics
- Neuritis, Autoimmune, Experimental/genetics
- Neuritis, Autoimmune, Experimental/immunology
- Neuritis, Autoimmune, Experimental/pathology
- Phytol/pharmacology
- Polymorphism, Genetic
- Quantitative Trait Loci
- Rats
- Respiratory Burst/physiology
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Affiliation(s)
- Alexander Huberle
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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Markoula S, Giannopoulos S, Sarmas I, Tzavidi S, Kyritsis AP, Lagos G. Guillain-Barré syndrome in northwest Greece. Acta Neurol Scand 2007; 115:167-73. [PMID: 17295711 DOI: 10.1111/j.1600-0404.2006.00731.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We present the epidemiological and clinical-laboratory features of Guillain-Barré syndrome (GBS) in northwest Greece over a 9.5-year period. MATERIALS AND METHODS We studied all the patients with GBS who were admitted to our neurology inpatient service from January 1996 to May 2005 and compared them with previously published series. RESULTS Forty-six patients were hospitalized during this period. The average crude incidence rate was 1.22/100,000 populations per year, and males were more susceptible than females. There was a spring clustering, as 52.17% presented the syndrome during spring. The axonal type of GBS was recorded in 13.04% of the patients. The most frequent presenting symptom was dysesthetic numbness (52.17%). A large number of patients (56.52%) had up to three times the elevation of liver function values that resolved in a few weeks. Most patients had an excellent recovery and no deaths were recorded. CONCLUSIONS In our series, there was no difference in the incidence rate and subtypes of GBS but there was a significant seasonality with spring clustering. A transient elevation of transaminases of undetermined etiology was noted in more than a half of our patients. Although seven patients (15.21%) had significant neurologic sequelae, no deaths occurred.
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Affiliation(s)
- S Markoula
- Department of Neurology, University of Ioannina, Medical School, Ioannina, Greece.
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Sarkey JP, Richards MP, Stubbs EB. Lovastatin attenuates nerve injury in an animal model of Guillain-Barré syndrome. J Neurochem 2006; 100:1265-77. [PMID: 17286627 DOI: 10.1111/j.1471-4159.2006.04309.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Statins, widely used as clinically effective inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, exhibit anti-inflammatory properties that may be of therapeutic benefit for the management of some neurological disorders. In this study, a short-term course of lovastatin treatment is shown to markedly inhibit the development of experimental autoimmune neuritis (EAN) in the absence of hepatotoxic or myotoxic complications. Independent of cholesterol reduction, lovastatin treatment prevented EAN-induced peripheral nerve conduction deficits and morphologic nerve injury. Co-administration with mevalonate neutralized the prophylactic effects of lovastatin. When administered therapeutically, lovastatin significantly shortened the disease course. Autoreactive immunity, measured in vitro by myelin-stimulated proliferation of splenocytes, was significantly diminished by in vivo lovastatin treatment. Th1-dominant immune responses, measured by cytokine profiling, however, were not affected by lovastatin. Sciatic nerves of lovastatin-treated immunized rats showed markedly reduced levels of cellular infiltrates. Treating peripheral nerve endothelial monolayers with lovastatin significantly inhibited the in vitro migration of autoreactive splenocytes. Together, these data demonstrate that a short-term course of lovastatin attenuates the development and progression of EAN in Lewis rats by limiting the proliferation and migration of autoreactive leukocytes.
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Affiliation(s)
- Jason P Sarkey
- Research Service, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, Illinois 60141, USA
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Abstract
This review gives an overview of various neuroimmunological diseases in terms of incidence and prevalence rates, age and sex distribution, and the frequency of subtypes, if applicable. The disorders selected for review are inflammatory muscle disorders (polymyositis, dermatomyositis and inclusion body myositis), myasthenia gravis, immune-mediated polyneuropathies (Guillain-Barré syndrome, chronic polyneuritis and vasculitic neuropathies), and multiple sclerosis.
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Affiliation(s)
- Peter Flachenecker
- Neurological Rehabilitation Center "Quellenhof", Kuranlagenallee 2, 75323, Bad Wildbad, Germany.
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Campylobacter infection and Guillain–Barré syndrome: public health concerns from a microbial food safety perspective. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cair.2005.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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DiMario FJ. Intravenous immunoglobulin in the treatment of childhood Guillain-Barré syndrome: a randomized trial. Pediatrics 2005; 116:226-8. [PMID: 15995056 DOI: 10.1542/peds.2005-1022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Francis J DiMario
- Department of Pediatrics, Connecticut Children's Medical Center, 282 Washington St, Suite 2A, Hartford, CT 06106, USA.
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Zhu W, Mix E, Nennesmo I, Adem A, Zhu J. Anti-cytokine autoantibodies in experimental autoimmune neuritis in Lewis rats. Exp Neurol 2004; 190:486-94. [PMID: 15530887 DOI: 10.1016/j.expneurol.2004.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2004] [Revised: 08/23/2004] [Accepted: 08/23/2004] [Indexed: 11/24/2022]
Abstract
Experimental autoimmune neuritis (EAN) is a CD4+ T-cell-mediated, inflammatory demyelinating disease of the peripheral nervous system (PNS) that serves as a model for Guillain-Barre syndrome (GBS) in humans. Cytokine production has been suggested to act a pathogenic role for EAN. To study the potential role of cytokines in context with cytokine autoantibodies (Aabs) in EAN, we used in situ hybridization to detect mRNA expression of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, IL-4, IL-10, and transforming growth factor (TGF)-beta in lymph node mononuclear cell (MNC) and in sciatic nerve sections, as well as ELISA for detection of their autoantibodies in sera and cerebrospinal fluid (CSF) over the course of EAN. Increased mRNA expression for IFN-gamma and TNF-alpha was registered correlating with the peak of clinical signs of EAN, and high levels of mRNA expression for IL-4, IL-10, and TGF-beta were associated with EAN recovery. The levels of cytokine mRNAs were generally inversely correlated to their autoantibodies in serum and CSF, whereby the CSF levels were equal to or lower than the serum levels. Autoantibodies to IFN-gamma dose-dependently inhibited IFN-gamma-induced MHC expression by peritoneal macrophages proving a neutralizing biological effect of these autoantibodies. Our data demonstrate the existence of the anti-cytokine autoantibodies in the sera and CSF of rats with EAN; however, the role of anti-cytokine autoantibodies in the disease process of EAN remains to be resolved.
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Affiliation(s)
- Wei Zhu
- Department of Otorhinolaryngology, the First Hospital, JiLin University, Changchun, China
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Auvin S, Imiela A, Cuvellier JC, Catteau B, Vallée L, Martinot A. Asymmetric periflexural exanthem of childhood in a child with axonal Guillain-Barre syndrome. Br J Dermatol 2004; 150:396-7. [PMID: 14996133 DOI: 10.1111/j.1365-2133.2003.05798.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The compound sensory nerve action potential (SNAP) is the result of phase summation and cancellation of single fiber potentials (SFAPs) with amplitudes that depend on fiber diameter, and the amplitude and shape of the SNAP is determined by the distribution of fiber diameters. Conduction velocities at different conduction distances are determined by summation of SFAPs of varying fiber diameters, and differ in this respect, also, from the compound muscle action potential (CMAP) for which conduction velocities are determined by the very fastest fibers in the nerve. The effect and extent of temporal dispersion over increasing conduction distance is greater for the SNAP than CMAP, and demonstration of conduction block is therefore difficult. In addition, the effect of temporal dispersion on amplitude and shape is strongly dependent on the number of conducting fibers and their distribution, and, with fiber loss or increased conduction velocity variability changes of the SNAP may be smaller than expected from normal nerve. The biophysical characteristics of sensory and motor fibers differ, and this may to some extent determine divergent pathophysiological changes in sensory and motor fibers in different polyneuropathies. In this review, different factors that characterize sensory fibers and set the SNAP apart from the CMAP are discussed to emphasize the supplementary and complementary information that can be obtained from sensory conduction studies. Sensory conduction studies require particular effort and attention to theory and practical detail that may be time consuming.
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Affiliation(s)
- Christian Krarup
- Department of Clinical Neurophysiology NF3063, The Neuroscience Center, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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25
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Ifergane G, Bersudsky M, Kachko L, Wirguin I. Induction of conduction block by Campylobacter jejuni lipopolysaccharides and focal neural insult. J Neurol Sci 2003; 213:11-4. [PMID: 12873748 DOI: 10.1016/s0022-510x(03)00123-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A systemic exposure to gram negative LPS have caused transient conduction abnormalities in a certain strain of rats probably associated with the action of cytokines secreted by macrophages. Our previous studies demonstrated that anti-GM1 antibodies induced in rats by the cross-reactive Cj-LPS, caused no conduction abnormalities. We designed the present study to evaluate the effect of systemic exposure to Cj-LPS on nerve conduction after a focal minor neural trauma. Female Lewis rats were sensitized against KLH by repetitive subcutaneous injections. After 28 days rats were intraneurally injected with saline in the right sciatic nerve and concomitantly with intraperitoneal Cj-LPS. Sciatic nerve conduction studies were performed on days 0, 1, 2, 3, and 7 after injections. Nerve conduction blocks developed in all the rats (n=10) which received an intraneural injection of saline concomitantly with the systemic Cj-LPS exposure, before titers of anti-ganglioside antibodies were detected. We conclude that humoral factors (possibly cytokines), other than antibodies are secreted by lymphocytes and macrophages stimulated by gram negative LPS, and cause functional conduction abnormalities when the blood-nerve barrier is disrupted.
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Affiliation(s)
- Gal Ifergane
- Neuroimmunology Unit, Department of Neurology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva 84101, Israel.
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26
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Buchwald B, Ahangari R, Toyka KV. Differential blocking effects of the monoclonal anti-GQ1b IgM antibody and alpha-latrotoxin in the absence of complement at the mouse neuromuscular junction. Neurosci Lett 2002; 334:25-8. [PMID: 12431767 DOI: 10.1016/s0304-3940(02)01037-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Numerous in vitro electrophysiological studies found different effects of anti-ganglioside antibodies on neuromuscular transmission. Since a complement-dependent, latrotoxin-like effect has been described for the mouse monoclonal anti-GQ1b IgM antibody (termed CGM3), we here investigated the effect of CGM3 and alpha-latrotoxin by means of the perfused macro-patch clamp electrode in mice hemidiaphragms in the absence of complement. The CGM3 mab depressed evoked quantal release dose-dependently, whereas the rate of spontaneous releases and the amplitude of postsynaptic currents was not significantly affected. Alpha-latrotoxin induced an increase in spontaneous releases followed by a blockade of evoked quantal release, this was not altered by CGM3. The complement-independent presynaptic block by CGM3 was different from the action of alpha-latrotoxin.
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Affiliation(s)
- Brigitte Buchwald
- Neurologische Klinik der Universität Würzburg, Josef Schneider Strasse 11, 97080 Würzburg, Germany.
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27
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Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute paralysis, yet the pathogenesis has still not been fully elucidated and specific evidence-based consensus management guidelines have not been developed. This paper reviews the research of the past year dedicated to determining the pathogenesis of GBS, optimizing current management, and searching for more efficacious treatment alternatives. Several recent studies have investigated whether there are any particular factors that might predict the course of illness and, thereby, dictate the optimal treatment. Proposed evidence-based guidelines for elective intubation, admission to the intensive care unit, and overall management of GBS are summarized. Therapeutic plasma exchange and intravenous immunoglobulin are both treatments that have been shown to have a beneficial effect on the course of GBS. Various modifications of plasmapheresis, as well as other alternative therapies, are currently being investigated.
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Affiliation(s)
- Deborah M Green
- The Queen's Medical Center, Neuroscience Institute, 1301 Punchbowl Street, Honolulu, HI 96813, USA.
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28
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Hartung HP, Willison HJ, Kieseier BC. Acute immunoinflammatory neuropathy: update on Guillain-Barré syndrome. Curr Opin Neurol 2002; 15:571-7. [PMID: 12352001 DOI: 10.1097/00019052-200210000-00008] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Abstract
PURPOSE OF THE REVIEW Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating poly(radiculo)neuropathy (CIDP) and multifocal motor neuropathy (MMN) are potentially treatable disorders. The use of appropriate assessment scales to evaluate the effects of treatment is essential. Recent therapeutic trials and the question of whether patients with mild disease or other variants of these disorders need to be treated are discussed. RECENT FINDINGS Recent clinical trials and Cochrane reviews give new information on the effect of various treatments in patients with GBS, CIDP and MMN. Intravenous immunoglobulin remains the only treatment proven to be effective in MMN. Combinations of treatment may be even more effective in GBS. Studies on prognostic factors related to improvement have been reported. Whether patients with Miller-Fisher syndrome or those with mild GBS should also be treated is still debated. New assessment scales at the disability and handicap level have now been evaluated for GBS and CIDP, and are ready for use. Results of studies in experimental models contribute to our understanding of the mechanism of action of intravenous immunoglobulin. SUMMARY Recent new information on the use of intravenous immunoglobulin and steroids indicates that the former should remain the cornerstone of treatment for GBS and MMN, and probably also for CIDP. Whether steroids not only suppress disease activity in CIDP but also eradicate the disease remains to be established. Some GBS patients have secondary deterioration or finally turn out to have CIDP; additional information in this group of patients may lead to more appropriate disease management. Most patients with CIDP and those with MMN need long-term treatment. New treatment strategies should now focus also on the effect and the costs of treatment over long-term follow up.
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Affiliation(s)
- Pieter A Van Doorn
- Department of Neurology, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
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30
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Dalakas MC. Blockade of blocking antibodies in Guillain-Barré syndromes: "unblocking" the mystery of action of intravenous immunoglobulin. Ann Neurol 2002; 51:667-9. [PMID: 12112069 DOI: 10.1002/ana.10259] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Tsang RSW. The relationship of Campylobacter jejuni infection and the development of Guillain-Barré syndrome. Curr Opin Infect Dis 2002; 15:221-8. [PMID: 12015454 DOI: 10.1097/00001432-200206000-00002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Campylobacter jejuni is recognized as the most common infectious agent associated with the development of Guillain-Barré syndrome. Available information on the complete genome sequence of C. jejuni NCTC 11168 has helped researchers to identify polysaccharide capsules as well as genetic mechanisms in the synthesis of ganglioside-like cell surface molecules in this bacteria. Toxins may contribute to the host's inflammatory response seen in Guillain-Barré syndrome.
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Affiliation(s)
- Raymond S W Tsang
- Central Nervous System Infection and Vaccine Preventable Bacterial Diseases Division, National Microbiology Laboratory, Population and Public Health Branch, Health Canada, Winnipeg, Manitoba, Canada.
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Gordon AJ, Meriggioli MN. Clinical immunopharmacology of autoimmune neuropathies and myopathies. Clin Neuropharmacol 2002; 25:174-81. [PMID: 12023571 DOI: 10.1097/00002826-200205000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew J Gordon
- Department of Neurological Sciences, Section of Neuromuscular Diseases, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
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