Multiple sclerosis: local synthesis of electrophoretically restricted measles, rubella, mumps and herpes simplex virus antibodies in the central nervous system

Clinical associations and characteristics of the polyspecific intrathecal immune response in elderly patients with non-multiple sclerosis chronic autoimmune-inflammatory neurological diseases - a retrospective cross-sectional study

Introduction

The polyspecific intrathecal immune response (PSIIR), aka MRZ reaction (M = measles, R = rubella, Z = zoster, optionally Herpes simplex virus, HSV) is defined as intrathecal immunoglobulin synthesis (IIS) for two or more unrelated viruses. Although an established cerebrospinal fluid (CSF) biomarker for multiple sclerosis (MS), a chronic autoimmune-inflammatory neurological disease (CAIND) of the central nervous system (CNS) usually starting in young adulthood, the full spectrum of CAINDs with a positive PSIIR remains ill defined.

Methods

In this retrospective, cross-sectional study, patients with CSF-positive oligoclonal bands (OCB) and - to enrich for non-MS diagnoses - aged ≥50 years were enrolled.

Results

Of 415 with PSIIR testing results (MRZ, HSV optional), 76 were PSIIR-positive. Of these, 25 (33%) did not meet the diagnostic criteria for MS spectrum diseases (MS-S) comprising clinically or radiologically isolated syndrome (CIS/RIS) or MS. PSIIR-positive non-MS-S phenotypes were heterogenous with CNS, peripheral nerve and motor neuron involvement and often defied unequivocal diagnostic classification. A rating by neuroimmunology experts suggested non-MS CAINDs in 16/25 (64%). Long-term follow-up available in 13 always showed a chronically progressive course. Four of five responded to immunotherapy. Compared to MS-S patients, non-MS CAIND patients showed less frequent CNS regions with demyelination (25% vs. 75%) and quantitative IgG IIS (31% vs. 81%). MRZ-specific IIS did not differ between both groups, while additional HSV-specific IIS was characteristic for non-MS CAIND patients.

Discussion

In conclusion, PSIIR positivity occurs frequently in non-MS-S patients ≥50 years. Although sometimes apparently coincidental, the PSIIR seems to represent a suitable biomarker for previously unnoticed chronic neurologic autoimmunities, which require further characterization.

Chronic viral infections of the central nervous system: Aspects specific to multiple sclerosis

The involvement of a viral infection in the physiopathology of multiple sclerosis has been said to cause certain viruses to target the central nervous system and induce neuroinflammation leading to cell dysfunction, as seen, for example, by demyelination or neuronal death. The most recent results of the literature have focused on the Herpes family viruses (HHV-6 and HHV-4/Epstein-Barr virus) and their possible role in the development of multiple sclerosis. Even if no virus has been identified so far as the multiple sclerosis etiological agent, our aim here is to show that some viruses may be responsible for triggering or sustaining neurological diseases. This is particularly the case for Paramyxoviruses, in the late appearance of functional alterations, Picornaviruses, in inducing a breakdown of immune tolerance, epitope spreading and demyelination, and Herpes viruses in inducing T and B lymphocyte activation, T lymphocytes dysregulation and autoimmunity after their reactivation. Therefore, “common” viruses can play a role as potential modulators of the immune and nervous systems which, in the specific context of dysimmunity and genetic susceptibility, stimulate a favorable background to the development of multiple sclerosis. Tracing and studying viruses in multiple sclerosis patients may improve our understanding of their actual involvement in multiple sclerosis physiopathology.

MS and clinically isolated syndromes: shared specificity but diverging clonal patterns of virus-specific IgG antibodies produced in vivo and by CSF B cells in vitro

BACKGROUND

Intrathecal synthesis of oligoclonal IgG antibodies against measles virus (MeV), varicella zoster virus (VZV) and herpes simplex virus type-1 (HSV-1) is a characteristic feature multiple sclerosis (MS).

METHODS

We have used isoelectric focusing-immunoblot to define the clonal patterns of IgG and of IgG antibodies to MeV, VZV and HSV-1 in supernatants of in vitro cultures of peripheral blood lymphocytes (PBL) and cerebrospinal fluid (CSF) cells and in sera and CSF from three patients with MS and three patients with clinically isolated syndromes (CIS) suspective of demyelinating disease.

RESULTS

In vitro synthesis of IgG by PBL was not detected in any patient. In contrast, in vitro synthesis by CSF cells of oligoclonal IgG and oligoclonal IgG antibodies to one or two of the three viruses tested was observed in all six patients. The clonal patterns of the in vitro synthesized IgG and virus specific IgG differed to varying extent from those synthesized intrathecally in vivo. However, in each patient, the in vitro and in vivo intrathecally produced antibodies displayed specificity for the same viruses. The addition of B cell activating factor (BAFF) had no effect on the amounts or clonal patterns of either total IgG or virus-specific IgG produced by CSF cells in vitro.

CONCLUSION

Virus specific B cells capable of spontaneous IgG synthesis are clonally expanded in the CSF of patients with MS. The B-cell repertoire in CSF samples is only partially representative of the intrathecal B-cell repertoire.

Intrathecal synthesis of virus-specific oligoclonal IgG, and of free kappa and free lambda oligoclonal bands in acute monosymptomatic optic neuritis. Comparison with brain MRI

Twenty-seven patients with acute monosymptomatic optic neuritis were randomly selected from a population-based cohort of patients extensively screened for known etiologies of ON. Paired serum and CSF obtained median 20 days from onset were examined for oligoclonal IgG, free kappa and free lambda chains, and virus-specific oligoclonal IgG antibodies by an affinity-mediated capillary blot technique. CSF-restricted oligoclonal IgG bands, free kappa and free lambda chain bands were observed in 17, 15 and nine patients, respectively. In addition, 16 patients showed a polyspecific intrathecal synthesis of oligoclonal IgG antibodies against one or more viruses (12 measles, nine varicella zoster, six rubella, six mumps) compared to all the 18 examined patients with definite multiple sclerosis (P = 0.0014). The presence of virus-specific oligoclonal IgG was significantly related to the results of oligoclonal IgG (P = 0.0034), free kappa chain bands (P = 0.0020), and brain MRI abnormalities (P = 0.0402). At 1 year follow-up five patients had developed clinically definite multiple sclerosis; all had virus-specific oligoclonal IgG antibodies, oligoclonal IgG and abnormal MRI at onset.

A retroviral implication in multiple sclerosis?

The etiology of multiple sclerosis (MS) is still unexplained. Epidemiological studies indicate that environmental agents are involved, and MS shares both clinical and histopathological features with retrovirus-mediated neurological diseases in animals and humans. Thus, combining the fields of microbiology and epidemiology may throw new light on the many unanswered questions posed by MS.

Lyme arthritis: oligoclonal anti-Borrelia burgdorferi IgG antibodies occur in joint fluid and serum

The antibody response to Borrelia (B.) burgdorferi, and to measles virus as control antigen, was analysed by agarose isoelectric focusing (AIF) and immunoblot of joint fluid and serum from 10 patients with Lyme arthritis and 10 controls with rheumatoid arthritis. Among the Lyme arthritis patients, six had oligoclonal anti-B. burgdorferi IgG antibody bands in joint fluid and corresponding serum, one patient had oligoclonal antibody bands in joint fluid only and also an elevated B. burgdorferi-specific joint fluid to serum antibody ratio as evidence of intra-joint production of specific antibodies, and the remaining three patients were negative for oligoclonal-specific antibody bands. Absorption with B. burgdorferi antigen confirmed the specificity of the oligoclonal antibody bands. They comigrated only partially on AIF with oligoclonal bands of total IgG, and the specificity of most oligoclonal IgG in joint fluid and serum in Lyme arthritis remains undefined. Among the controls, no anti-B, burgdorferi IgG antibodies were detected by AIF and immunoblot. Instead, 9 of the 10 rheumatoid arthritis patients had oligoclonal anti-measles IgG antibody bands which were restricted to the joint fluid in three of them, indicating local production. We conclude that Lyme arthritis is often accompanied by an oligoclonal specific antibody response in joint fluid and serum simultaneously, and occasionally by intrasynovial synthesis of oligoclonal-specific antibodies.

Immunoglobulins within the central nervous system in primary Sjögren's syndrome

Cerebrospinal fluid (CSF) and sera from 17 patients with primary Sjögren's syndrome (PSS) with or without clinical evidence of nervous system involvement were studied. Intrathecal IgG synthesis as measured by oligoclonal IgG bands on agarose isoelectric focusing or elevated IgG index in CSF was found in 6 of 8 patients with clinical nervous system involvement but also in 5 of 9 patients without clinical nervous system involvement. Elevated IgM-index in CSF was found in 7 of 8 patients with clinical nervous system involvement and in 6 of 9 patients without clinical nervous system involvement. By immunoblotting, CSF IgG-antibodies against myelin basic protein (MBP) were found in 3 of 12 patients with multiple sclerosis (MS), but in none of the patients with PSS or in the 12 controls. Intrathecal anti-viral IgG-antibodies, as measured by immunoblotting against measles, mumps, varicella or herpes simplex, were found in 8 of 17 patients with PSS, and in 7 of 12 patients with MS, but were not detected in the controls. Our observations support the concept that the central nervous system (CNS) is included in the multiple immunological phenomena of PSS. Interestingly, in some PSS patients intrathecal IgG synthesis occurred without overt clinical nervous system involvement and thus the clinical significance of intrathecal IgG synthesis in PSS is uncertain. The similarities with MS regarding intrathecal antiviral antibody production may be interpreted as the result of polyclonal B-cell activation.

Production of viral antibodies in vitro by CSF cells from mumps meningitis and multiple sclerosis patients

Cerebrospinal fluid (CSF) cells from 4 mumps meningitis and 11 multiple sclerosis (MS) patients were cultured in vitro for 7 days with and without pokeweed mitogen (PWM) stimulation. The cells produced varying amounts of IgG without stimulation and no significant increase of IgG synthesis was observed after PWM stimulation. Antibodies against mumps, measles, rubella, herpes simplex, and adeno viruses were measured in the supernatants of the cultures by a sensitive enzyme immunoassay. In the mumps meningitis patients, the largest amount of antibody was against mumps virus but low amounts of antibodies with other specificities were also synthesized by CSF cells of one patient. The most commonly detected specificities in MS patients were against measles and rubella viruses, whereas antibodies against adeno and mumps viruses were detected in only one CSF cell supernatant. No antibodies produced against herpes simplex virus in vitro were detected in any of the supernatants. The amounts of viral antibodies produced in vitro and intrathecally were only partially correlated.

Extended repertoire of specific antibodies in CSF of patients with subacute sclerosing panencephalitis compared to those with multiple sclerosis: anti-bacterial antibodies are also increased

Serum and cerebrospinal fluid (CSF) from eight patients with subacute sclerosing panencephalitis (SSPE), 21 with multiple sclerosis (MS) and 16 controls were analyzed for IgG subclass pattern of anti-viral and anti-bacterial antibodies. In CSF of SSPE and MS patients IgG1 and IgG4 antibodies to measles and IgG1 to mumps were increased compared to the controls. In addition, the SSPE patients had elevated levels of IgG1 to PPD, teichoic acid, and to dextran in CSF. The group of MS patients had decreased levels of IgG1 antibodies to Staphylococcus aureus alpha-toxin.

Current concepts of the pathogenesis of optic neuritis associated with multiple sclerosis

Optic neuritis may occur as an isolated entity or as a manifestation of multiple sclerosis (MS), a widespread central nervous system demyelinating disease. Clinical, electrophysiological, magnetic resonance imaging and neuropathologic data support the hypothesis that "idiopathic" optic neuritis represents a restricted form of MS. The current evidence for viral, cell mediated, and antibody-induced etiologies of MS and optic neuritis are reviewed.

Oligoclonal and polyclonal synthesis of IgG in the central nervous system: an isoelectric focusing study

The IgG pattern in isoelectric focusing (IEF) has been studied in 90 paired samples of cerebrospinal fluid (CSF) and sera obtained from patients in which intrathecal synthesis of IgG without barrier damage was detectable by Reiber's graph and formula (1980, J. Neurol. 224, 89). Thirty patients were affected by multiple sclerosis (MS), 30 by other inflammatory nervous diseases (OID), and 30 by noninflammatory nervous diseases (NID). At IEF two distinct pathological patterns of CSF IgG were detected: oligoclonal bands (OB), prevailing in the MS group (83% of cases), and a "polyclonal"--i.e., diffuse, uniform--increase of CSF IgG, prevailing in the NID (90%). The OID group was intermediate, 57% of cases with OB and 43% with polyclonal CSF IgG patterns. Overall, only 45 of 90 patients synthesizing IgG in the CNS had CSF OB. This suggests that the CNS immune response can imply either the synthesis of IgG of restricted heterogeneity (i.e., OB) or a polyclonal IgG synthesis, giving in IEF a serum-like pattern to the CSF.

The intrathecal immune response in the early stage of multiple sclerosis

Sequential pairs of cerebrospinal fluid (CSF) and serum samples from 10 patients followed for 2.5-12 years after onset of unilateral optic neuritis (ON) were studied. Eight patients developed definite multiple sclerosis (MS) during the observation period. All patients had normal CSF protein patterns on agar or agarose gel electrophoresis at onset. Six patients developed oligoclonal immunoglobulin (Ig) bands in the CSF during the observation period. Imprint immunofixation of electrofocused specimens disclosed intrathecal synthesis of oligoclonal IgG antibodies to 1 or more of 6 viruses (measles, herpes simplex type 1, varicella-zoster, cytomegalo, mumps, rota) during the observation period in 8 patients. Changes in patterns of intrathecally synthesized viral antibodies, characterized by the appearance of "new" antibody populations and the waxing or waning of others were observed in 6 patients. The results suggest that the early stage of MS in some patients is associated with transient as well as permanent recruitment of B cell clones producing viral antibodies of different specificities.

The prevalence of locally-synthesized virus antibodies in various forms of multiple sclerosis

In 125 patients with multiple sclerosis, intrathecally synthesized antibodies against measles, rubella and zoster viruses were determined with an ELISA. 70% of patients with chronic progressive disease synthesized measles antibodies in comparison to 50% with a relapsing course. Women suffering from chronic progressive multiple sclerosis exhibited zoster antibodies 3 times as frequent as the other patients. These data indicate that relapsing and chronic progressive forms of multiple sclerosis exhibit different antiviral responses within the central nervous system which remain stable during the course of the disease.

Isoelectric point restriction of cerebrospinal fluid and serum IgG antibodies to measles virus polypeptides in multiple sclerosis

Thirty consecutive isoelectric point (pI)-discrete IgG fractions were isolated from multiple sclerosis (MS) cerebrospinal fluid (CSF) and used to immune precipitate measles virus (MV) polypeptides. Most basic fractions were enriched in activity against nucleocapsid protein (NP), and to a lesser extent against hemagglutinin (H) protein; intermediate fractions were enriched in activity against H and fusion (F) proteins; and more anodic pI fractions were almost exclusively enriched in activity against the large (L) protein of MV. In MS there are marked differences between CSF and autologous serum in regard to antibody activity to MV. In contrast, there were similar profiles of antibody response to MV proteins in SSPE CSF and serum.

Intrathecal synthesis of antibodies to staphylococcal antigens in multiple sclerosis patients

Human serum and cerebrospinal fluid (CSF) antibodies against three staphylococcal antigens were measured using the ELISA technique. Antibody levels in sera from patients with multiple sclerosis (MS) were lower than those found in sera from patients with other neurological diseases (OND) and from healthy individuals (N). The CSF antibody mean titres for patients with relapsing remittent MS were about twofold higher than those found for the other groups. Both serum and CSF antibodies were of the IgG class while IgM could only be detected in serum samples. Elevated IgG-indexes, indicating intrathecal immunoglobulin synthesis, were found only among individuals in the MS patient groups. Some of the patients also had elevated indexes of specific antibodies to the staphylococcal antigens used, i.e. lipoteichoic acid (LTA), peptidoglycan (PG) and beta-ribitol teichoic acid (beta-RTA). This indicates that some MS patients have synthesized staphylococcal antibodies intrathecally.

Humoral immune responses within the human central nervous system following systemic immunization

We investigated sequential humoral immune responses in the CSF and blood of 6 stable multiple sclerosis (MS) patients without decreases in the blood-brain barrier. Anti-tetanus toxoid antibodies (anti-TT Ab) increased to a similar relative degree within the CSF and blood starting within 2 weeks after subcutaneous booster injection of TT. In 3 of 4 subjects, CSF lymphocytes obtained at 2 weeks secreted anti-TT Ab to the same degree as autologous blood lymphocytes when cultured with pokeweed mitogen. These findings suggest a prompt antibody response within the CSF to systemically administered antigen, not due to diffusion from the serum, with active trafficking of TT-sensitized lymphocytes into the central nervous system.

Cerebrospinal fluid virus antibodies. A diagnostic indicator for multiple sclerosis?

Specific antibody activities (antibody per weight unit IgG) of serum and CSF against a broad variety of viruses were compared in multiple sclerosis and certain inflammatory diseases of the central nervous system, e.g. neurosyphilis, as well as herpes simplex and zoster encephalitis. No "unspecific" antiviral activities within the CSF compartment were found in the non-MS diseases. The most frequent antibodies locally produced were directed against measles, rubella and zoster antigens. A diagnostic test with these three viruses would give positive results in about 80% of patients with MS. This finding is not as frequent as the oligoclonal pattern of the CSF gamma-globulins but would have a considerably greater diagnostic significance.

Cerebrospinal fluid immunoglobulin abnormalities in systemic lupus erythematosus

Central nervous system (CNS) involvement is a common and important complication in systemic lupus erythematosus. The mechanisms for CNS involvement are poorly understood and reliable diagnostic procedures are lacking. Pairs of serum and cerebrospinal fluid (CSF) specimens from 17 patients with clinical and serological manifestations of systemic lupus erythematosus were analysed. All 11 patients with definite or suspect clinical CNS disorder revealed some kind of abnormality in the CSF, in contrast to three of seven systemic lupus erythematosus patients without CNS disorder. The most prominent findings in systemic lupus erythematosus patients with CNS disorder were immune aberrations with oligoclonal bands on agarose isoelectric focusing (AIF) and elevation of IgG and IgM index, probably reflecting intrathecal production of IgG and IgM respectively. Intrathecal production of antiviral antibodies was found in four of 12 patients by AIF followed by immunofixation and subsequent autoradiography. An enzyme-linked immunoabsorbent assay (ELISA) could not detect autoantibodies against structural brain antigens.

Intrathecal synthesis of IgG antibodies to varicella-zoster virus in two cases of acute aseptic meningitis syndrome with no cutaneous lesions

IgG antibodies to varicella-zoster virus (VZV) were detected by indirect enzyme-immunoassay (EIA) in CSF of two patients with acute aseptic meningitis syndrome (AAMS) not associated with evident cutaneous lesion or recent history of zoster infection. Their characteristic features and serological data are compared with those observed in two patients with AAMS and zoster cutaneous lesions, and in 13 patients with AAMS of unknown or other etiology. According to several indexes applied to assess the origin of the detected antibodies, it is concluded that VZV IgG antibodies are of intrathecal production. The possible etiologic relationship between the neurological syndrome and the detection of VZV antibodies in CSF is discussed. Routine serological procedures are proposed for the diagnosis of CNS acute infections of probable viral etiology that should provide additional data on these rarely described cases.

Viral immunoblotting: a sensitive method for detecting viral-specific oliogoclonal bands in unconcentrated cerebrospinal fluid

A new method for detecting viral antibodies in cerebrospinal fluid is described. The technique has many advantages over previously published methods in that it is highly sensitive eliminating the need to concentrate the CSF, takes 5 h to complete, avoids the use of radionucleides, and most importantly circumvents problems associated with prozone effects which occur in immunoprecipitation reaction since the viral antigen is immobilized on nitrocellulose membranes.

Can viral envelope glycolipids produce auto-immunity, with reference to the CNS and multiple sclerosis?

Many viruses, with lipid envelopes derived from the host cell membranes, have been implicated in the aetiology of multiple sclerosis (MS), and epidemiological studies support an infectious agent. Alternatively the disease is thought by other workers to be auto-immune in nature, and recently much attention has been focused on immunological sensitivity to glycolipids in MS patients. In this paper it is proposed that CNS demyelination could arise in susceptible individuals (HLA type) from an immune response to glycolipids, triggered by the carrier effect of one or more enveloped neurotropic viruses.

Optic neuritis: oligoclonal bands increase the risk of multiple sclerosis

In 1974 we examined 30 patients 0.5-14 (mean 5) years after acute unilateral optic neuritis (ON), when no clinical signs of multiple sclerosis (MS) were discernible. 11 of the patients had oligoclonal bands in the cerebrospinal fluid (CSF). Re-examination after an additional 6 years revealed that 9 of the 11 ON patients with oligoclonal bands (but only 1 of the 19 without this CSF abnormality) had developed MS. The occurrence of oligoclonal bands in CSF in a patient with ON is--within the limits of the present observation time--accompanied by a significantly increased risk of the future development of MS. Recurrent ON also occurred significantly more often in those ON patients who later developed MS.

Occurrence of oligoclonal bands in multiple sclerosis and other CNS diseases

The results of cerebrospinal fluid agarose gel electrophoresis in 300 consecutive patients were correlated with neurological examinations and diagnoses, other cerebrospinal fluid studies, and the results of evoked potential examinations. The presence of oligoclonal bands was the most sensitive test for multiple sclerosis (MS); bands were present in from 100% (11/11) of patients with definite MS to 82% (27/33) of those with possible MS (classified by McAlpine criteria). The visual evoked response was the next most sensitive study. Thirty-eight patients without MS or related disorders had bands in the IgG region. Three patients had plasma cell dyscrasias. Seven patients had thick single bands. Single bands did not correlate with chronic polyneuropathy but appeared to be an artifact of storage. Twenty-eight patients had active neurological disease, including cerebral infarction (in 5), viral infection (in 4), remote effect of carcinoma (in 4), and acute and chronic polyneuropathies (in 6). In acute illnesses (i.e., vascular insults), repeat electrophoresis showed disappearance of bands. In continually active disease, bands persisted. These results indicate that the presence of oligoclonal bands provides sensitive supporting evidence for the diagnosis of MS but that bands may be present in other disorders, including those not directly related to infection or abnormal immune response. The data suggest that oligoclonal bands may represent an immune response to neurological injury that is prominent in disorders with a particularly intense or continuous antigenic stimulus.

Sensitization of cerebrospinal fluid and peripheral blood lymphocytes to myelin basic protein in multiple sclerosis

Cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocyte sensitization to rabbit myelin basic protein (MBP) in 44 multiple sclerosis (MS) patients, 21 patients with other neurological diseases (OND) and 14 persons with neurosis was studied with the antigen-active rosette forming cells (Ag-ARFC) assay. The frequency of sensitization of CSF lymphocytes to MBP in groups of MS patients in the relapse stage and the chronic progressive stage was higher than in the group of MS patients in the stable stage and the OND patients. None of the healthy subjects showed a positive reaction with MBP. In BP there were no differences in the incidence of sensitization to MBP between patients in various stages of the disease, but it was higher than in the group of patients with OND and neuroses. In the patients who had suffered from MS for less than 4 years, sensitization to MBP was more common in CSF lymphocytes than in BP lymphocytes. The results suggest that primary sensitization to MBP occurs in CSF, and is probably secondary to myelin damage. However at present it is difficult to determine the extent to which sensitization of CSF and PB lymphocytes to MBP play a role in further demyelination processes.

Mumps meningitis: specific and non-specific antibody responses in the central nervous system

Intrathecal production of oligoclonal mumps-specific IgG was demonstrated in nine out of 10 children with mumps meningitis by imprint immunofixation (IIF) of sera and cerebrospinal fluids (CSF) separated by agarose electropheresis and by thin-layer electrofocusing. Four of the patients had intrathecal mumps antibody synthesis demonstrable also by conventional serological tests. Oligoclonal CSF IgG was demonstrable by agarose electrophoresis in four of the patients. A dominance of lambda over k type oligoclonal Ig and mumps antibodies was observed in the CSF of three of these patients. The bulk of the oligoclonal CSF IgG was concluded to represent mumps-specific antibodies on the basis of the IIF as well as virus absorption analysis. Intrathecal production of oligoclonal IgG antibodies to one, two, or three other (measles, rubella, herpes simplex) viruses was demonstrated by IIF in four patients. These antibodies were not associated with the oligoclonal CSF IgG present in three of the patients. It is concluded that a specific intrathecal IgG antibody response is a common feature in children with mumps meningitis. This response sometimes reaches a magnitude that permits detection of oligoclonal IgG in the CSF. In some patients, the specific response appears to be associated with a non-specific activation of cells producing antibodies of other (unrelated) specificity.

Multiple sclerosis. Electrofocused "bands" of oligoclonal CSF IgG do not carry antibody activity against measles, varicella-zoster or rotaviruses

Electrofocused serum and cerebrospinal fluid (CSF) specimens from patients with multiple sclerosis (MS) were analysed for immunoglobulins (Ig) and for antibodies to measles, varicella-zoster and rotaviruses by an imprint immunofixation method. Patterns of intrathecally synthesized antibodies to the 3 viruses differed from patterns of oligoclonal IgG in the CSF. A variable proportion of virus antibody bands (average 19% for measles antibodies, 8% for varicella-zoster antibodies, 31% for rotavirus antibodies) displayed isoelectric points identical to bands of IgG, but absorption with measles, varicella-zoster and rotavirus antigens produced no change in the bands of IgG and no quantifiable decrease of the CSF IgG. The results confirm previous evidence that the intrathecally synthesized viral antibodies so far demonstrated in MS are not carried by the oligoclonal bands of CSF IgG and account for only a minor fraction of the CSF IgG.

Specificity of immunoglobulins synthesized within the central nervous system in neurosyphilis

Cerebrospinal fluid from four patients with serologically and clinically verified neurosyphilis contained oligoclonal bands when analysed by isoelectric focusing. By antiserum immunofixation these bands consisted by IgG, and by antigen immunofixation and autoradiography the bands were shown to contain treponemal antibodies. Treponemal antibodies synthesized within the CNS were also detected in polyclonal CSF IgG fractions in two of the patients. In one patient with neurosyphilis followed over 2.5 years, local synthesis of IgM and IgA disappeared within 1 year after treatment, while IgG synthesis persisted. In this patient, besides treponemal antibodies, antibodies against herpes simplex virus were also detected in oligoclonal and polyclonal IgG fractions of CSF. The presence of treponemal antibodies synthesized within the CNS was identified in 2 of 16 controls with negative serological tests for syphilis. This might reflect a previous contact with apathogenic treponemes, and the intrathecal antibody synthesis might be a result of an unspecific activation of memory lymphocytes in CNS.

Antibodies against viruses and structural brain components in oligoclonal IgG obtained from multiple sclerosis brain

Immunoglobulin G (IgG) was isolated from three multiple sclerosis (MS) and two control brains by Protein A Sepharose affinity chromatography and was characterized by thin-layer polyacrylamide gel isoelectric focusing (PAG IEF) and antiserum immunofixation. The three MS brains contained oligoclonal IgG. Immunofixation with measles, herpes simplex, varicella, rubella, mumps and cytomegalovirus as antigens and autoradiography revealed that some of the oligoclonal IgG bands separated by PAG IEF contained antibodies against herpes simplex in one, measles in two and varicella virus in all three MS brains. No antibodies were detected with this technique against structural human (crude saline, lipid-proteolipid, ganglioside, and myelin basic protein extracts of MS and normal human brain) and bovine (purified myelin myelin basic protein and oligodendrocytes of bovine brain) brain components. The finding of viral antibodies and the absence of antibodies against structural brain proteins in oligoclonal MS brain IgG is similar to that previously recorded in MS cerebrospinal fluid (CSF).

Neurosyphilis: intrathecal synthesis of oligoclonal antibodies to Treponema pallidum

Oligoclonal IgG was present in the cerebrospinal fluid (CSF) of each of three patients with neurosyphilis studied. Conventional serological tests disclosed reduced serum/CSF ratios of antibodies to Treponema pallidum (TP) in each patient, consistent with intrathecal production of treponemal antibodies. Antibody analyses of electrofocused specimens by an immunofixation technique disclosed intrathecal production of oligoclonal TP antibodies in all patients. Treponemal antibody light chains showed a close correlation with the light chains of the oligoclonal CSF IgG. Absorption of the CSF with TP caused removal of the oligoclonal IgG. The results provide strong evidence that the oligoclonal CSF IgG in neurosyphilis represents TP antibodies, reflecting a specific immune response in the central nervous system to the infectious agent.

Antibodies to staphylococcal lipoteichoic acid in serum and in cerebrospinal fluid from patients with multiple sclerosis

Antibodies to staphylococcal lipoteichoic acid (LTA) were determined in serum and in cerebrospinal fluid (CSF) from a group of patients with multiple sclerosis (MS) and a group of healthy individuals. Sera from 11 out of 74 MS patients, i.e. 15 per cent, contained precipitating antibodies demonstrated by the double diffusion in agar test, compared to 48 out of 94 control sera, i.e. 51 per cent. By using an indirect haemagglutination test, antibodies to LTA were found in all sera from both patients and controls. On the other hand, LTA antibodies were detected in a higher proportion of the CSF samples from MS patients than from controls. A reduced serum to CSF ration of LTA antibodies compared with the ratio for a reference antibody was demonstrated in 7 out of 10 MS patients, suggesting a local synthesis within the central nervous system. Absorption of seven MS CSF samples with LTA removed one to three of the cathodic oligoclonal IgG bands demonstrated by agarose electrophoresis and reduced the IgG concentration.

Antibodies in oligoclonal immunoglobulins in CSF from patients with acute cerebrovascular disease

Thin-layer polyacrylamide gel isoelectric focusing (PAG IEF) of CSF and serum, and subsequent immunofixation with viral and structural brain components followed by autoradiography revealed in eight out of nine selected patients with oligoclonal CSF IgG and cerebrovascular disease local synthesis within the CNS of antibodies against one or more of the viruses tested: six patients against measles, five against herpes simplex virus type 1, and two against varicella virus. This finding may reflect a polyclonal B cell activation secondary to brain damage and elaboration of certain structural brain components. None of the patients had local synthesis of antibodies against the other viruses tested (mumps, rubella and cytomegalovirus), or against structural brain components (crude saline, lipid-proteolipid, myelin basic protein extracts from human brain and purified bovine myelin basic protein).

Viral antibodies in oligoclonal and polyclonal IgG synthesized within the central nervous system over the course of mumps meningitis

The occurrence of viral antibodies in relation to IgG separated by thin-layer polyacrylamide gel isoelectric focusing was studied in CSF and serum from 24 patients with mumps meningitis by immunofixation with viral antigens and autoradiography. Eleven of the patients displayed on the autoradiograms evidence of locally in the central nervous system synthesized mumps virus antibodies which were related to oligoclonal IgG bands in all 5 patients who displayed this CSF abnormality, otherwise to polyclonal IgG bands. Local synthesis of mumps virus antibodies was detectable in 43% of specimens obtained 1-13 days after onset, and in 75% obtained 27-47 days after onset. Only one patient displayed local synthesis of antibodies to other viruses (measles and herpes simplex) which could then be traced to polyclonal IgG bands.

Intrathecal synthesis of antibodies to diphtheria and tetanus toxoids in multiple sclerosis patients

Antibodies to diphtheria and tetanus toxoids were measured in 30 multiple sclerosis (MS) patients and 30 neurological control patients by enzyme-immunoassays. The frequency of antibody-positive patients and the titer distribution were similar in both groups. In spite of this, some MS patients had intrathecal antibody synthesis to these toxoids. The histories of these patents did not reveal any diseases caused by diphtheria of tetanus bacteria but they had been vaccinated 2-24 years before the first clinical symptoms of MS. The findings suggest that lymphocytes earlier committed to specific antibody synthesis outside the brain compartment could enter the brain before or after the clinical onset of MS.

Viral antibody activity of oligoclonal and polyclonal immunoglobulins synthesized within the central nervous system in multiple sclerosis

Thin-layer polyacrylamide gel isoelectric focusing (PAG IEF), a very high capacity method for separating immunoglobulins (Ig), was performed on cerebrospinal fluid (CSF) and serum. It was followed by antigen immunofixation with measles, mumps, herpes simplex (HSV), and rubella virus antigens and anti-human Ig autoradiography in order to demonstrate viral antibodies in separated Ig zones. Two of 11 control patients and 21 of 25 patients with multiple sclerosis (MS) displayed one or more zones of viral antibodies in the CSF without any counterpart, or with distinctly fainter zones, in the serum. Such reaction patterns were taken to indicate the possibility of intrathecal antibody synthesis. Antibody synthesis to measles was found in one to five zones in 76% of the patients with MS; antibody zones were found to HSV in 36% of the patients, to mumps in 12%, and to rubella in 12%. In 36% of the patients, two or three different antibody specificities (of which one was always measles) were found simultaneously in individual autoradiogram zones. For all viral antibodies detected in the CSF autoradiograms, their counterparts in oligoclonal or polyclonal IgG zones (or both) were demonstrable by PAG IEF of the corresponding CSF. The majority of patients with MS also had one or more oligoclonal CSF IgG zones without known antibody specificity. Antigen immunofixation and autoradiography are mainly qualitative. It is not known whether the viral antibodies present in oligoclonal or polyclonal IgG zones in MS CSF reflect a polyclonal B cell activation, a disease-specific immune reaction, or both.

Analysis of a predominant immunoglobulin population in the cerebrospinal fluid of a multiple sclerosis patient by means of an anti-idiotypic hybridoma antibody

We have produced hybridoma antibodies directed against immunoglobulins present in the cerebrospinal fluid of a patient with multiple sclerosis (MS). One hybridoma antibody recognized an idiotypic determinant of an immunoglobulin population [an idiotype (Id)] which constituted approximately 1% of the immunoglobulin present in the cerebrospinal fluid. The Id focused in the pH range 8.0-8.4. It was present at roughly 10- to 15-fold higher relative (compared to total immunoglobulin) concentration in cerebrospinal fluid than in serum of the homologous MS patient. The Id could not be detected in three cerebrospinal fluid samples and 28 serum samples of heterologous MS patients or in the serum of 43 optic neuritis patients. The Id persisted in the homologous MS patient at increased concentration over the entire (6 years) observation period. The Id could be shown to react with a Theiler murine encephalomyelitis virus strain WW which was isolated from mice after inoculation with periplaque white matter from brain in a histologically confirmed case of MS.

Measles antibodies, kappa-lambda light chain distribution and immunoglobulins in serum, cerebrospinal fluid and brain of a patient affected with multiple sclerosis

The serum, cerebrospinal (CSF) and brain of a patient (NAG) affected with multiple sclerosis (MS) were examined for measles antibodies with CF and HI techniques, and the kappa-lambda light chain ratios of all samples available were evaluated, kappa-lambda populations of the matched serum, CSF and brain specimens were all lambda-predominant and in agreement with each other; the light chain distribution f the brain specimens confirmed previous findings [3]. Only the serum immunoglobulins showed significant measles antibody titers, but slightly increased measles antibody titers were also observed in ventricular plaques. The amount of immunoglobulin G (IgG) synthesized per day by the central nervous system (CNS) was estimated. The IgG synthesis in CNS NAG (11.6 mg/day) was above the upper limit of the normal range (3.3 mg/day), but apparently there was no positive correlation between the intracerebral IgG synthesis and specific anti-measles IgG.

Abnormal regulation of in vitro IgG production in multiple sclerosis

A pokeweed mitogen-stimulated IgG synthesis assay was used to evaluate T suppressor cell function in peripheral blood lymphocytes (PBL) obtained from multiple sclerosis (MS) patients. Autochthonous cultures of fractionated and recombined MS B and T cells exhibited less suppression of IgG synthesis than similar cultures of PBL from control subjects. No difference occurred in the levels of suppression among MS patients grouped according to disease states. When allogenic cultures of MS B and normal T cells or normal B and MS T cells were compared to autochthonous cultures of control cells, no differences were observed. The results suggest that the lower levels of suppression observed in autologous MS cell cultures are not a result of T suppressor cell dysfunction alone.

Cerebrospinal fluid antibodies to neuronal cells: association with neuropsychiatric manifestations of systemic lupus erythematosus

The validity of the hypothesis that some of the neuropsychiatric manifestations of systemic lupus erythematosus (SLE) are mediated by the direct effects of antibody binding to neuronal cell membranes is dependent on the demonstration of antineuronal activity within the central nervous system of patients with active central nervous system disease. Using a radiolabelled staphylococcal protein A assay, we tested cerebrospinal fluid from 27 patients with SLE and central nervous system manifestations, and cerebrospinal fluid from 18 additional patients with SLE but free of central nervous system disease for antibody reactive with the cultured human neuronal cell line SK-N-SH. Cerebrospinal fluid from 20 of 27 patients with active lupus central nervous system disease had increased immunoglobulin G (IgG) antineuronal activity compared with cerebrospinal fluid from two of 18 patients with SLE without central nervous system disease. Ninety percent of the patients with psychosis, organic brain syndrome or generalized seizures had increased IgG antineuronal activity as compared with only 25 percent of the patients who presented with hemiparesis or with chorea/hemiballismus. Antineuronal activity per microgram of IgG was concentrated eightfold in the cerebrospinal fluid of patients with active central nervous system disease as compared with the serum activity. Patients with or without active central nervous system disease did not differ significantly in the amount of serum antineuronal binding activity. The results are consistent with the hypothesis that the more diffuse central nervous system manifestations of SLE are a direct result of the interaction of antibody with neuronal cell membranes.

Antibodies to viral and non-viral antigens in subacute sclerosing panencephalitis and multiple sclerosis demonstrated by thin-layer polyacrylamide gel isoelectric focusing, antigen immunofixation and autoradiography

Antibody activity in IgG zones separated by thin-layer polyacrylamide gel isoelectric focusing (PAG IEF) was determined in 3 patients with subacute sclerosing panencephalitis (SSPE), 4 patients with multiple sclerosis (MS) and 4 subjects with psychosomatic disorders, using antigen immunofixation and autoradiography. Viral (measles herpes simplex type 1, mumps) and non-viral (purified bovine myelin, bovine myelin basic protein, bovine oligodendrocytes, MS and normal human brain extract) were used as antigens. All oligoclonal and some of the polyclonal CSF IgG zones in the patients with SSPE contained measles virus antibodies, as did some of the oligoclonal and polyclonal CSF IgG zones in 3 of the patients with MS. No antibodies were detectable in CSF or serum IgG zones against any of the non-viral antigens tested.

Local production of mumps IgG and IgM antibodies in the cerebrospinal fluid of meningitis patients

Immunoglobulin G (IgG) and M (IgM) antibodies against mumps virus were measured by an enzyme-linked immunosorbent assay (ELISA) in the serum and cerebrospinal fluid (CSF) specimens of patients with mumps meningitis. The CSF IgG antibodies correlated well with the respective antibody titers in serum. On the contrary, in only about half of the patients a moderate correlation was found between the CSF and serum IgM antibody titers, while the other patients did not have detectable mumps IgM antibodies in CSF irrespective of intermediate to high titers in serum. Two different immunologic mechanisms may be involved in these two groups which, however, did not show any clinical differences. The lack of IgM antibodies in the CSF of many patients diminished the value of CSF in the laboratory diagnosis of mumps meningitis compared to use of serum specimens. Intrathecal synthesis of mumps IgG antibodies was demonstrated in 83% of the patients, and of IgM antibodies in at least 67% of those patients with detectable IgM antibodies in CSF. The ratio between mumps IgG and IgM antibodies was higher in CSF than in serum, suggesting that the synthesis of IgG antibodies in central nervous system was more efficient than that of IgM antibodies.

Isoelectric focusing of IgG eluted from multiple sclerosis and subacute sclerosing panencephalitis brains

Elevated IgG distributed in oligoclonal bands is characteristically observed in the cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) or subacute sclerosing panencephalitis (SSPE). Similarly, IgG in bands has been detected in neutral saline (NS) and acid eluates of brain material from these two diseases. We have now used isoelectric focusing (IEF) to compare IgG eluted from control brain, three plaques and a white matter pool of an MS brain, and three regions of an SSPE brain. A direct peroxidase-conjugated anti-human IgG staining technique was used to stain IgG exclusively and to visualize the minute amounts of IgG obtained from individual MS plaques. Eluates from individual MS plaques have distinct IgG patterns; in contrast, those from separate SSPE brain areas have essentially identical IgG patterns. The identical IgG patterns in three areas of SSPE brain suggest a common response to the same antigen. The different IgG patterns among MS plaques suggest: (1) variable response to the same 'MS antigen' in each plaque, (2) response to different MS antigens in different plaques, (3) synthesis of 'nonsense' antibodies irrelevant to the pathogenesis of MS in each plaque, or (4) some combination of the above.

Viral and bacterial antibody responses in multiple sclerosis

An imprint electroimmunofixation method (IEIF) was used to characterize antibodies to eight viral antigens (measles, mumps, rubella, herpes simplex type 1, varicella-zoster, vaccinia, cytomegalovirus, adenovirus) and four bacterial antigens (beta-hemolytic streptococcus, Hemophilus influenzae type B, Escherichia coli, enterococcus) in serum and cerebrospinal fluid (CSF) of 12 patients with multiple sclerosis (MS). Twelve patients matched for age and sex sex served as controls. Evidence for intrathecal synthesis of oligoclonal antibodies to one or more antigens was found in all 12 MS patients and in 1 of the controls. In the MS group, antibodies to viruses with neurotropic properties were more frequently associated with local synthesis than antibodies to other viruses and bacteria. The types and number of locally synthesized antibodies showed no correlation with disease duration and severity. The antibodies were not associated with oligoclonal CSF IgG and appear to account for only a minor fraction of the locally synthesized CSF IgG in MS.

Optic neuritis: local synthesis in the central nervous system of oligoclonal antibodies to measles, mumps, rubella, and herpes simplex viruses

Antibodies to measles, mumps, rubella and herpes simplex type 1 viruses in serum and CSF of 10 patients with acute monosymptomatic optic neuritis were characterized by imprint electro-immunofixation (IEIF). Comparisons of the IEIF antibody patterns in serum and CSF indicated that a local synthesis in the central nervous system of oligoclonal virus antibodies took place in five of the 10 patients. Three of the five patients had a local synthesis of antibody to more than one type of virus. Oligoclonal IgG was detected by agarose electrophoresis of the CSF in four of the five patients with a local synthesis of virus antibodies. There was, however, no association between the locally synthesized antibodies and the oligoclonal CSF IgG, indicating that they account for only a minor fraction of the locally synthesized IgG in these patients. In the fifth patient, distinct fractions of locally synthesized virus-specific oligoclonal Ig were detected by the IEIF method, although the agarose electrophoresis showed a normal pattern of CSF IgG.

Immunoglobulins to tick-borne encephalitis in the cerebrospinal fluid of man

Antibodies of IgM and IgG type were detected in the CSF of patients with recent tick-borne encephalitis (TBE) by means of ELISA. No false-positive results were obtained with CSF specimens from patients suffering from meningitis or other illnesses. The ratio of the antibodies in serum to CSF clearly indicated that both IgM and IgG antibodies were produced in the brain itself. In patients who had previously suffered from TBE now with a different inaseptic meningitis, TBE antibodies could also be detected in CSF but only of the IgG class. Again the serum-to-CSF antibody ratio indicated that the antibodies were produced within the central nervous system. For routine diagnosis the micro-ELISA method was found to be useful; antigen-coated plates can be stored as long as three months at +4 degrees C.