Remodelling during remyelination in the peripheral nervous system

Nerve conduction studies and EMG in carpal tunnel syndrome: Do they add value?

This paper summarises the views of four experts on the place of neurophysiological testing (EDX) in patients presenting with possible carpal tunnel syndrome, in guiding their treatment, and in reevaluations. This is not meant to be a position paper or a literature review, and heterogeneous viewpoints are presented. Nerve conduction studies should be performed in patients presenting with possible carpal tunnel syndrome to assist diagnosis, and may need to be repeated at intervals in those managed conservatively. There is evidence that local corticosteroid injection is safe and effective for many patients, thereby avoiding or deferring surgical decompression. All patients should undergo EDX studies before any invasive procedure for CTS (injection or surgery). Needle EMG studies are not obligatory, but may be needed in those with severe disease and those in whom an alternate or concomitant diagnosis is suspected.

GJB1-associated X-linked Charcot-Marie-Tooth disease, a disorder affecting the central and peripheral nervous systems

Charcot-Marie-Tooth disease (CMT) is a group of inherited diseases characterized by exclusive or predominant involvement of the peripheral nervous system. Mutations in GJB1, the gene encoding Connexin 32 (Cx32), a gap-junction channel forming protein, cause the most common X-linked form of CMT, CMT1X. Cx32 is expressed in Schwann cells and oligodendrocytes, the myelinating glia of the peripheral and central nervous systems, respectively. Thus, patients with CMT1X have both central and peripheral nervous system manifestations. Study of the genetics of CMT1X and the phenotypes of patients with this disorder suggest that the peripheral manifestations of CMT1X are likely to be due to loss of function, while in the CNS gain of function may contribute. Mice with targeted ablation of Gjb1 develop a peripheral neuropathy similar to that seen in patients with CMT1X, supporting loss of function as a mechanism for the peripheral manifestations of this disorder. Possible roles for Cx32 include the establishment of a reflexive gap junction pathway in the peripheral and central nervous system and of a panglial syncitium in the central nervous system.

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.

Nerve injury and inflammatory cytokines modulate gap junctions in the peripheral nervous system

In the peripheral nervous system (PNS), myelinating Schwann cells express the gap junction protein connexin32 (Cx32) and lower levels of connexin43 (Cx43). Although the function of Cx43 in Schwann cells is not yet known, in adult mammals Cx32 is thought to form reflexive contacts within individual myelinating glial cells and provide direct pathways for intracellular ionic and metabolic exchange from the cell body to the innermost periaxonal cytoplasmic regions. In response to nerve injury, Schwann cells in the degenerating region down-regulate expression of Cx32 and there is increased expression of connexin46 (Cx46) mRNA and protein. The cascade of Schwann cell responses seen after the injury-induced decrease in Cx32, and the observation that dividing Schwann cells express Cx46, and possibly other connexins, and are coupled through gap junction channels, raise the intriguing possibility that there are coordinated changes in Schwann cell proliferation and connexin expression. Moreover, intercellular junctional coupling among cells in general may be important during injury responses. Consistent with this hypothesis, dividing Schwann cells are preferentially coupled through junctional channels as compared to non-dividing cells, which are generally uncoupled. Moreover, the strength of junctional coupling among cultured Schwann cells is modulated by a number of cytokines to which Schwann cells are exposed to in vivo after nerve injury, and Cx46 mRNA and protein levels correlate with the degree of coupling. Other injury-induced cellular changes in connexin expression that may be functionally important during injury responses include a transient increase in Cx43 in endoneurial fibroblasts. This paper reviews what is known about connexin expression and function in the adult mammalian PNS, and focuses on some of the changes that occur following nerve injury. Moreover, evidence that inflammatory cytokines released after injury modulate connexin expression and junctional coupling strength is presented.

Disruption and reorganization of sodium channels in experimental allergic neuritis

The axonal distribution of voltage-dependent Na+ channels was determined during inflammatory demyelinating disease of the peripheral nervous system. Experimental allergic neuritis was induced in Lewis rats by active immunization. In diseased spinal roots Na+ channel immunofluorescence at many nodes of Ranvier changed from a highly focal ring to a more diffuse pattern and, as the disease progressed, eventually became undetectable. The loss of nodal channels corresponded closely with the development of clinical signs. Electrophysiological measurements and computations showed that a lateral spread of nodal Na+ channels could contribute significantly to temperature sensitivity and conduction block. During recovery new clusters of Na+ channels were seen. In fibers with large-scale demyelination, the new aggregates formed at the edges of adhering Schwann cells and appeared to fuse to form new nodes. At nodes with demyelination limited to paranodal retraction, Na+ channels were often found divided into two symmetric highly focal clusters. These results suggest that reorganization of Na+ channels plays an important role in the pathogenesis of demyelinating neuropathies.

Role of axonal components during myelination

Myelination is a multistep ordered process whereby Schwann cells in the peripheral nervous system (PNS) and oligodendrocytes in the central nervous system (CNS), produce and extend membranous processes that envelop axons. Mechanisms that regulate this complex process are not well understood. Advances in deciphering the regulatory components of myelination have been carried out primarily in the PNS and although the mechanisms for triggering and directing myelination are not known, it is well established that myelination does not occur in the absence of axons or axon/neuron-derived factors. This appears to be true both in PNS and CNS. Progress in understanding CNS myelinogenesis has been relatively slow because of the unavailability of a suitable culture system, which, in turn, is partly due to complexity in the cellular organization of the CNS. Though the myelin composition differs between PNS and CNS, the regulation of myelination seems to parallel rather than differ between these two systems. This article reviews the regulatory role of axonal components during myelination. The first half consists of an overview of in vitro and in vivo studies carried out in the nervous system. The second half discusses the use of a cerebellar slice culture system and generation of anti-axolemma monoclonal antibodies to investigate the role of axonal membrane components that participate in myelination. It also describes the characterization of an axonal protein involved in myelination.

The clustering of axonal sodium channels during development of the peripheral nervous system

The distribution of Na+ channels in rat peripheral nerve was measured during development by using immunofluorescence. Small segments of sciatic nerve from postnatal day 0-13 (P0-P13) pups were labeled with an antibody raised against a well conserved region of the vertebrate Na+ channel. At day P0 axons contained almost no Na+ channel aggregates. The number of clusters increased dramatically throughout the first week. In almost all cases Na+ channels clustered in the vicinity of Schwann cell processes. At least four classes of aggregates were noted. Clusters formed singly at Schwann cell edges, in pairs or in broad regions between neighboring Schwann cells, and in more focal zones at presumptive nodes. Almost all Na+ channel aggregates had reached the latter stage by the end of the first week. Histograms plotting the frequency of occurrence of each cluster type suggested a sequence of events in node formation involving the initiation of channel aggregation by Schwann cell processes. The requirement for Schwann cells during sodium channel clustering was tested by blocking proliferation of these cells with the antimitotic agent mitomycin C. Na+ channel clustering was sharply reduced, whereas node formation was normal at a distal site along the same nerve. Immunocytochemical detection of myelin-associated glycoprotein (MAG) indicated that Schwann cells must begin to ensheathe axons before inducing Na+ channel clustering.

Clusters of axonal Na+ channels adjacent to remyelinating Schwann cells

Rat sciatic nerve fibres were demyelinated by injection of lysolecithin and examined at several stages as Schwann cells proliferated, adhered, and initiated remyelination. Immunoperoxidase EM has been used to follow the clustering of Na+ channels that represents an early step in the formation of new nodes of Ranvier. At the peak of demyelination, 1 week post-injection, only isolated sites, suggestive of the original nodes, were labelled. As Schwann cells adhered and extended processes along the axons, regions of axonal Na+ channel immunoreactivity were often found just beyond their leading edges. These channel aggregates were associated only with the axolemma and Na+ channels were not detected on glial membranes. Sites with more than one cluster in close proximity and broadly labelled aggregates between Schwann cells suggested that new nodes of Ranvier formed as neighbouring Na+ channel groups merged. Schwann cells thus seem to play a major role in ion channel distributions in the axolemma. In all of these stages Na+ channel label was found primarily just outside the region of close contact between axon and Schwann cell. This suggests that Schwann cell adherence acts in part to exclude Na+ channels, or that diffusible substances are involved and can act some distance from regions of direct contact.

Relations between axons and oligodendroglial cells during initial myelination. II. The individual axon

Axo-glial relations in the ventral funiculus of the spinal cord (SC) and in the corpus callosum (CC) of the cat were examined by electron microscopy during initial myelination. In addition to random transverse and longitudinal sections from several stages, two series of sections were studied. As a first step in myelination the axons become ensheathed by one to three uncompacted glial lamellae (E-sheaths). E-sheaths present a length range from less than 5 microns to 149 microns (SC) or to 93 microns (CC). E-sheaths are more frequent along SC-axons than CC-axons, and the mean E-sheath is 3.3-fold longer in the former compared to the latter. In both areas naked axon portions occur between successive E-sheaths, but these gaps are insufficient to allow elongation of all short E-sheaths into long ones. Sheaths composed of mixed compacted (M-sheaths) and uncompacted segments have a length range of 66-212 microns in the SC and 66-171 microns in the CC. In relation to the undifferentiated terminations of E-sheaths or mixed E/M-sheaths, undercoated axolemmal domains are always lacking. Fully compacted sheaths were not found in the series from the SC. In the CC, 141-212 microns long compact sheaths were found, with tight axoglial junctions at their terminations. Axolemmal domains with a 'nodal' undercoating occur in relation to some of these terminations. In both areas, individual developing axons present a chaotic mixture of naked, ensheathed and myelinated portions; bulges with clusters of vesiculotubular profiles are frequent along naked and ensheathed axonal portions, particularly in the SC. The axon diameter is clearly larger in myelinated than in naked portions of the same axon. On the basis of these results, we propose that the early glial sheaths of developing CNS axons actively elongate and undergo extensive remodelling before compaction. The maximal length of uncompacted E-sheaths, and the sheath length at which axoglial junctions and nodes of Ranvier form, are markedly different in the two areas.

Taxol-induced neuropathy after nerve crush: long-term effects on Schwann and endoneurial cells

The present investigation is a continuation of previous studies showing taxol-induced changes up to 4 weeks after a nerve crush. To evaluate the long-term cellular response to taxol, we have extended our morphological analysis of these changes in the taxol-treated nerve crush for up to 40 weeks after a single injection of taxol (PI). The results showed that Schwann cells exhibited a long-lasting and marked response when taxol was injected into the crushed peripheral nerve. During the first 2 months PI, taxol-induced giant axonal bulbs showed the formation of primitive nodes of Ranvier as a result of Schwann cell invaginations. The Schwann cell invaginations developed into nodes of Ranvier after 3-4 months PI together with the recovery of axonal bulbs. Ultrastructurally, cytoplasmic microtubule-related abnormalities were numerous up to 3 months PI and microtubules were seen to enclose degenerative myelin. Taxol-induced abnormalities in Schwann cells did not prevent their ability to produce myelin sheaths, although the accumulation of microtubules between myelin lamellae caused swellings of Schmidt-Lanterman incisures and paranodal myelin loops. Abnormal, extracellular collagen-like 5-nm-thin fibrils were noted closely associated with Schwann cells up to 10 weeks PI. Endoneurial cells, present as long rows without interconnections were noted in areas devoid of axonal sprouts up to 6-8 weeks PI. These cells showed marked cytoplasmic elongations and were covered by thickened basal lamina and contained several microtubule-related cytoplasmic structures, some of which have not been described previously. Taxol, when injected into crushed sciatic nerve induced a long-lasting response upon the Schwann cells with several ultrastructural abnormalities which correlate with changes in myelination and the development of nodes of Ranvier. These findings suggest that normal microtubule turnover is necessary for Schwann cells during nerve fiber regeneration.

The long-term cellular response to taxol in peripheral nerve: Schwann cell and endoneurial cell changes

Taxol, an agent known to stabilize and increase the assembly of microtubules, causes long-lasting nerve damage when injected into peripheral nerve. In the present study, the cellular response to taxol in rat sciatic nerve was studied for up to 6 months after a single injection. The initial response of Schwann cells to taxol at the lesion site involved the accumulation of cytoplasmic microtubules which persisted up to 4 months after injection. Some novel microtubule-related cytoplasmic structures were also noted; these included microtubule-lined cytoplasmic crypts and channels. Despite these structural abnormalities, Schwann cells were able to produce myelin sheaths around taxol-induced axonal bulbs. This myelination showed some anomalies up to 4 months consisting of the widening of myelin lamellae, variability in sheath thickness, paranodal myelin infoldings and myelin protrusions. With time the diameter of the axonal bulbs decreased and, concomitant with this, more normal-appearing remyelination occurred. By 5 months, the previously noted myelin abnormalities were rare. By 6 months only a few naked axonal segments occurred at the lesion site. In endoneurial fibroblasts and macrophages cytoplasmic lamellar microtubule formations were frequent at 10 weeks. Needle-like cytoplasmic structures appeared within endoneurial cells at the site of the lesion after 10 weeks. By 3 months these inclusions were numerous and were often surrounded by extended cytoplasmic processes. The needles were up to 50 microns long and 3 microns wide and probably represented cholesterol. By 4 months the number of cytoplasmic needles decreased and at 5 months onwards none was observed. The present findings confirm and extend previous findings that taxol has a long-lasting effect upon both Schwann cells and endoneurial cells and that this is related to abnormal tubulin synthesis.

Morphological and physiological properties of neurons after long-term axonal regeneration: observations on chronic and delayed sequelae of peripheral nerve injury

Axonal regeneration has been the focus of extensive investigation of mechanisms which mediate structural and functional recovery after injury to mammalian peripheral nerves and has proven to be a valuable model for development and plasticity in the nervous system. Although details of the acute morphological and physiological responses to nerve injury are well-described, less information is available to nerve injury are well-described, less information is available about long-term alterations which persist or develop after regenerated axons have established connections with their targets. The present paper briefly discusses the mammalian neuron's initial response to peripheral nerve injury and subsequent events which occur during regeneration. Morphological and physiological alterations observed in neurons after long-term axonal regeneration are described and are considered in the context of their potential implications for clinical recovery after nerve injury, as well as their potential contribution to the appearance of delayed neurological dysfunction. Selective responses to neuronal injury during development and in different fiber populations are discussed.

Myelin sheath remodelling in remyelinated rat sciatic nerve

In order to elicit de- and remyelination adult rat sciatic nerves were injected with diphtheria toxin dissolved in phosphate buffered saline (PBS). Control nerves were injected with PBS alone. After survival times of 1-10 weeks, the animals were perfused with glutaraldehyde. Specimens from the injected nerves were processed for light microscopic (LM) examination of teased fibres or for electron microscopic (EM) examination of longitudinal thin sections. LM examination of teased fibres after survival times of 6-10 weeks, showed that most remyelinated internodes are 150-300 microns long. In addition, some exceptionally short Schwann cell sheaths, with lengths of 15-150 microns, occur intercalated between conventional remyelinated internodes. EM analysis of thin sections showed that axonal evaginations penetrate in between the terminating myelin lamellae in fibres with nodal widening and/or paranodal demyelination, at early stages of demyelination. Such alterations are not present in relation to myelin sheaths formed during remyelination, which commences about 3 weeks after injection. In addition, some scattered contracted Schwann cell sheaths, which may be as short as 5-10 microns, occur at all stages. These are more frequent shortly after onset of remyelination than at later stages, and they are either composed of a cytoplasmic investment bordered by heminodes, or a more or less distorted myelin sheath bordered by nodes of Ranvier. This picture is very similar to the myelin sheath remodelling observed in regenerated rat sciatic nerves, and in some developing nerves with a mismatch between nerve growth and internodal elongation. It is concluded that a myelin sheath remodelling occurs in de- and remyelinated rat sciatic nerve, presumably as a result of the lack of longitudinal growth.

Diagnostic levels of ultrasound may disrupt myelination

Neonatal rats 3 to 5 days of age were exposed to the ultrasound beam from a medical ultrasound imaging system. Dorsal nerve roots were examined by electron microscopy. Comparison between exposed and sham-exposed controls revealed disruption of the nodes of Ranvier attributable to ultrasound. Morphologic changes ranged from vacuole formation in the paranodal region to frank demyelination and were still evident after 24 h of recovery. Rats of this age are at a stage of myelination similar to that of a human fetus 4 to 5 months. The ultrasound intensities used in this study are consistent with those used for human imaging (SPTA 0.135 mW/cm2, SATA 0.045 mW/cm2, SPTP 8.7 W/cm2, SPPA 1.9 W/cm2), but the relevance of these findings to clinical ultrasound will require further study.

Node of Ranvier formation along fibres regenerating through silicone tube implants: a freeze-fracture and thin-section electron microscopic study

Thin-section and freeze-fracture electron microscopy have been used to examine the morphogenesis of the node of Ranvier in peripheral nerves regenerating through silicone tubes. A major question posed by this study is whether node formation in fibres regenerating across a gap recapitulates that occurring in normal development. Node formation occurs concurrently with myelination and follows a similar spatial gradient of progression from a proximal to distal direction along the regenerated nerve. Presumptive nodal sites appear prior to myelin formation and are identified as a prominent subaxolemmal density in thin sections and axonal particle patches in freeze-fracture. Following the appearance of presumptive nodes in regenerating fibres, dimeric particles are inserted into the axolemma adjacent to the node. These particles are in close apposition to the overlying Schwann cell terminal processes and with maturity adopt the same circumferential orientation seen in adult nodes. The nodal axolemma of regenerating fibres shows a characteristic increase in the prominence of its subaxolemmal densification and number of heterogeneously sized particles. Mature regenerated nodes demonstrate a complete annulus of nodal particles indistinguishable from control nodes. The results of the present study show that the nodal architecture of regenerating fibres is a faithful reconstruction of normal mature nodes, thus indicating that the morphological correlates associated with saltatory conduction at the node are present in regenerated nodes.

Nodal spacing along regenerated axons following a crush lesion of the developing rat sciatic nerve

The relation between internodal length (L) and fibre diameter (D) was examined light microscopically in teased specimens from normal developing rat sciatic nerves, and from rat sciatic nerves which had regenerated following crush lesions at various postnatal ages. In newborn rat pups virtually all sciatic nerve axons are unmyelinated and myelination is an essentially postnatal event. Between 2 weeks and 6 months maximal L increases from 500 microns to 1400 microns and maximal D increases from 6-8 microns to 16 microns. The increase in L matches the length growth of the hindlimb. Signs of myelin sheath remodelling are absent during normal development. Examination of regenerated nerves showed that the lengths of the internodes along large-medium-sized axons, are strongly dependent on crush age. In neonatally crushed nerves, the slope is close to normal. With increasing crush age the inclination of the regression line gradually decreases. Signs of myelin sheath remodelling are not seen in regenerated nerves crushed at birth or 1-2 weeks after birth. However, such signs are present in regenerated nerves crushed 3 weeks or more after birth. These observations support the view that myelin sheath remodelling in regenerated rat sciatic nerves is directly related to a deficient length growth following myelination.

Remodelling of internodes in regenerated rat sciatic nerve: electron microscopic observations

Twelve adult rats received a crush lesion of the left sciatic nerve in the upper thigh. Following survival times of 2 weeks to 6 months, the animals were perfused with glutaraldehyde. Longitudinal thin sections from regenerated nerve segments were examined by electron microscopy. At survival periods of 2 weeks to 1 month, exceptionally short internodes composed of a Schwann cell lacking myelin, a more or less wrinkled Schwann cell-myelin sheath unit, or Schwann cell cytoplasm containing lamellated bodies and lipid droplets, were found intercalated between conventional regenerated myelin sheaths. Such intercalated sheaths were always bordered by sites with a nodal differentiation. Although much less frequent, short distorted myelin sheaths were also found at regeneration times of 2 and 3 months, but they have not been found in sections from 6-month specimens. In the long-term regenerated nerves many paranodes were distorted by prominent myelin folds and some nodes of Ranvier exhibited abnormal axon-Schwann cell networks and adaxonal Schwann cell protrusions. These observations show that internodes in regenerated rat sciatic nerves are subject to extensive remodelling. This includes internodal shortening and nodal migration, myelin sheath breakdown and demyelination, elimination of redundant Schwann cells and nodal fusion. These morphological changes may have important physiological implications.

Proliferation of Schwann cells in demyelinated rat sciatic nerve

Experimental demyelination was induced by intraneural injection of anti-galactocerebroside serum into the sciatic nerves of rats. Schwann cells undergoing mitotic division were observed between days 3 to 9 after the injection and demyelinated segments were still associated with macrophages. Dividing Schwann cells were often present in association with both unmyelinated and myelinated fibers. Whether or not, daughter Schwann cells migrate along the same fiber towards neighboring demyelinated segments remains unclear. When Schwann cells attached to axon membranes of demyelinated segments were studied at later time points, they were present in clusters randomly at various regions of the segments. There was no proximo-distal gradient for the wave of Schwann cell proliferation. Mean Schwann cell internuclear distances were around 40-50 microns at the earliest time of remyelination. Schwann cell redistribution and remyelination progressed regardless of the length of demyelinated segments.

Myelin sheath remodelling in regenerated rat sciatic nerve

Adult rat sciatic nerves were subjected to a crush lesion and allowed to survive during 2 weeks-11 months. Segments of regenerated nerve were removed from exsanguinated animals and subjected to physiological analysis and light microscopic examination of teased fibres. Application of the potassium channel blocking agent 4-aminopyridine (4-AP) to regenerated nerve segments had marked effects on action potential waveform and recovery properties. When applied to normal control nerves 4-AP had minimal effects. Examination of teased preparations from the same nerves revealed the presence of two classes of internodes along regenerated nerve fibres. A majority of conventional regenerated internodes exhibited lengths (L) of at least 150 microns. Maximal L reached about 350 microns after one month survival and 550 microns 10 months later. In the individual nerve the maximal L-values tended to increase with fibre size. Most convential regenerated internodes had L-values of 200-400 microns. In addition, scattered unusually short sheaths, with L-values of 10-150 microns, were found intercalated between conventional internodes. Some intercalated sheaths had a wrinkled irregular configuration and some lacked a light-microscopically distinct myelin layer. We suggest that the occurrence of unusually short and partly distorted sheaths along regenerated fibres reflects a nodal-internodal remodelling in response to longitudinal crowding. These sites might represent foci with aberrant functional properties, possibly accounting for the 4-AP sensitivity of regenerated nerve.

Balo's concentric sclerosis: new observations on lesion development

A 54-year-old woman with a four-month history of progressive neurological illness was found at postmortem examination to have lesions of Balo's concentric sclerosis. Balo lesions were found in several areas scattered widely throughout the central nervous system, including the spinal cord, a previously unreported location, and were studied by histological and ultrastructural methods. Balo lesions consisted of bands of intact myelin alternating with zones of demyelination. These lesions were centered on a perivascular cuff of inflammatory cells. The center of the lesion was the oldest area with the concentric rings of demyelination decreasing in age with increasing distance from the center. The bands of intact myelin comprised mainly remyelinated fibers, were similar to those seen at the edges of chronic active multiple sclerosis plaques, and may have represented the repaired margins of preceding episodes. The occurrence of small foci of acute demyelination centered on perivascular cuffs and other changes typical of both acute and chronic active multiple sclerosis may indicate that the lesion of Balo's concentric sclerosis represents an intermediate stage in the development of an established multiple sclerosis lesion.

Axon membrane remodeling in the lead-induced demyelinating neuropathy of the rat

Single-teased fibers stained with the ferric ion-ferrocyanide method allowed us to study axonal remodeling in the lead-induced demyelinating neuropathy of the rat. Our findings, in agreement with recent physiological data, pointed to a transitory reorganization of the demyelinated axons to maintain impulse conduction until remyelination and formation of new cytochemically normal nodes had restored a secure saltatory conduction.

Quantitation of the Schmidt-Lanterman incisures in juvenile, adult, remyelinated and regenerated fibres of the chicken sciatic nerve

Morphometric studies of peripheral nerves in various species have shown that the number of Schmidt-Lanterman incisures in an internode is proportional to the fibre diameter. In the rat sural nerve it appears that following remyelination, the relationship between the numbers of incisures per internode and the fibre diameter remains unaltered despite the fact that the remyelinated internodes are uniformly short. We quantitatively examined the insertion of incisures in adult, juvenile, remyelinated and regenerated fibres of the chicken sciatic nerve. Remyelinated fibres were examined 100 and 200 days following the intraneural injection of diphtheria toxin, and regenerated fibres 200 days after a nerve crush. Our results show that the incisures are more abundant in the chicken than in all other species previously reported, and for both juvenile and adult hens the number of incisures in an internode is proportional to the fibre diameter. Following both remyelination and regeneration the internodal lengths were shorter than control fibres and the distances between the incisures were reduced by approximately 20% for all fibre diameters. Significantly, the numbers of incisures in an internode were related to the length of the remyelinated or regenerated internode and not to the fibre diameter. This finding is in marked contrast to previous reports for rat peripheral nerve. Our findings are discussed in relation to the hypothesis that the Schmidt-Lanterman incisures are vital to the maintenance of the myelin sheath and/or the associated axon.

Nerve fibres in spinal cord impact injuries. Part 1. Changes in the myelin sheath during the initial 5 weeks

The spinal cords of cats were subjected to an impact injury using a "weight dropping" technique and sequential changes in the sheaths of non-degenerate myelinated fibres studied over a 3-week period. By 1 1/2 h after impact fibres showed retraction of some lateral loops from one paranode. The extent and severity of this change increased over the first week so that partial and full thickness demyelination were seen frequently. Partial demyelination most commonly resulted from the internodal termination of the innermost lamellae at an internodal location often associated with a Schmidt-Lantermann incisure. Remyelination by both Schwann cells and oligodendroglia occurred at the end of the second week. Oligodendroglial myelin showed many features of immaturity, similar to those found during development. It is suggested that the very earliest myelin damage is mechanical but is aggravated by other factor(s) one of which is probably ischaemia. Within the most severely injured areas there is death of oligodendroglia and any surviving axons are remyelinated principally by Schwann cells. In intermediate and minimally damaged areas of white matter oligodendroglial remyelination predominates.

Uncompacted myelin lamellae in two cases of peripheral neuropathy

Peripheral nerve biopsies from two patients with chronic sensorimotor neuropathy were studied. The first case was a non-Hodgkin malignant lymphoma and did not show any dysglobulinemia. The second case had a benign monoclonal gammopathy IgG, Lambda type. Direct immunofluorescence showed no deposits in the first case and slight deposits of anti IgG sera on a few myelinated fibers in the second case. There were numerous fibers showing uncompacted myelin lamellae, 7% in the first case and 4% in the second case. Some of these fibers had axons containing more tubules than filaments. The very few cases reported on neuropathies showing that uncompacted myelin lamellae were frequently associated with dysglobulinemic neuropathy. However, this ultrastructural abnormality of the myelin sheath can be observed without any dysglobulinemia.

Shaking pups: a disorder of central myelination in the spaniel dog. II. Ultrastructural observations on the white matter of the cervical spinal cord

The ultrastructure of the cervical cord is described in a new canine mutant with severe hypomyelination of the C.N.S. Axons were either non-myelinated or surrounded by a myelin sheath that was markedly reduced in both its thickness and length of internode. Myelinated and non-myelinated zones were present on a single axon. There was no paucity of oligodendrocytes but many of those present contained empty or granular vacuoles within the cytoplasm. Features suggesting immaturity of myelination were commonly found at paranodes and along the internode. Abnormal inter-relationships of oligodendrocytes and astrocytes were present at many paranodes. These observations suggest an intrinsic defect of oligodendrocyte metabolism such that they are incapable of normal extension of their plasma membranes, while the cytoplasmic vacuoles may represent breakdown of defective lipids.