Immune responses in experimental allergic neuritis

Autoantigen specific IL-2 activated CD4+CD25+T regulatory cells inhibit induction of experimental autoimmune neuritis

Experimental autoimmune neuritis (EAN) induced by peripheral nerve myelin (PNM) is self-limiting and re-immunization with PNM does not re-activate disease. This study showed inhibition of EAN by CD4⁺CD25⁺T cells both from sensitized hosts or from naïve hosts after ex-vivo activation by PNM and rIL-2. Transfer of naïve CD4⁺CD25⁺T cells has no effect on EAN, nor did naïve CD4⁺CD25⁺T cells activated with rIL-2 and renal tubular antigen. Culture of naive CD4⁺CD25⁺Treg with rIL-2 and PNM induced mRNA for the IFN-gamma receptor. We showed naïve CD4⁺CD25⁺T cells activated by specific auto-antigen and rIL-2 produced more potent antigen-specific Treg that may have therapeutic potential.

Animal models of autoimmune neuropathy

The peripheral nervous system (PNS) comprises the cranial nerves, the spinal nerves with their roots and rami, dorsal root ganglia neurons, the peripheral nerves, and peripheral components of the autonomic nervous system. Cell-mediated or antibody-mediated immune attack on the PNS results in distinct clinical syndromes, which are classified based on the tempo of illness, PNS component(s) involved, and the culprit antigen(s) identified. Insights into the pathogenesis of autoimmune neuropathy have been provided by ex vivo immunologic studies, biopsy materials, electrophysiologic studies, and experimental models. This review article summarizes earlier seminal observations and highlights the recent progress in our understanding of immunopathogenesis of autoimmune neuropathies based on data from animal models.

Endoneurial injection of antisera to myelin antigens

When antisera to purified myelin antigens were injected into rat sciatic nerves, some produced significant demyelination, whereas others merely induced an inflammatory infiltrate. Extensive demyelination was produced by antisera to galactocerebroside and the peripheral nerve glycoprotein P0. Demyelination resulting from injections of antisera to ganglioside GM1, P2, myelin basic protein, sulfatide, and glucocerebroside did not exceed that produced by normal rabbit serum. Addition of guinea pig complement had no effect. It is of interest that the greatest demyelination followed injection of antisera to two molecules, galactocerebroside and P0, the main antigenic determinants of which present at the Schwann cell surface.

Polygenic control of autoimmune peripheral nerve inflammation in rat

Experimental autoimmune neuritis (EAN) is the principal animal model for Guillain-Barré syndrome (GBS), an inflammatory disease of the peripheral nervous system. Little is known on the genetic regulation of these diseases. We provide the first genetic linkage analysis of EAN. Susceptibility to EAN in a rat F2 population segregated with high levels of anti-PNM IgG, as well as IgG2b and IgG2c isotype levels, which support that disease genes regulate preferential Th1/Th2 differentiation. Linkage analysis demonstrated co-localization of EAN loci with reported susceptibility loci for experimental arthritis and/or encephalomyelitis and a new region on chromosome 17. Further dissection of these loci may disclose disease pathways in GBS.

Guillain-Barré syndrome serum and anti-Campylobacter antibody do not exacerbate experimental autoimmune neuritis

To investigate whether antibodies are pathogenic in Guillain-Barré syndrome (GBS), we injected pre-treatment serum from 11 GBS patients intraperitoneally into rats in which the blood-nerve barrier had been opened by induction of mild adoptive transfer experimental autoimmune neuritis. There was no significant clinical, neurophysiological or pathological difference between rats receiving GBS serum compared with those receiving control serum, except that GBS serum caused minor excess weight loss. Murine monoclonal antibody to Campylobacter jejuni and gangliosides also did not exacerbate disease. This experiment failed to show antibody-mediated disease exacerbation and so does not support an antibody-mediated mechanism in GBS.

Dominance of autoreactive T cell-mediated delayed-type hypersensitivity or antibody-mediated demyelination results in distinct forms of experimental autoimmune neuritis in the Lewis rat

The role of anti-myelin antibodies in the pathogenesis of experimental autoimmune neuritis (EAN) induced in the Lewis rat by immunization with peripheral nerve myelin has been assessed. Passive transfer with lymph node cells (LNC) or purified serum immunoglobulin from rats with EAN was employed to directly measure the contribution of B cells and anti-myelin antibodies to demyelination and disease. Lewis rats with EAN transferred by LNC or purified serum immunoglobulin from EAN donors in conjunction with a low dose of P2-specific CD4+ T cells demonstrated profound histopathological and neurophysiological evidence of demyelination during disease. In contrast, the classical adoptive transfer model of EAN in the Lewis rat induced by the injection of P2-specific CD4+ T cells was characterized by histopathological and neurophysiological evidence of axonal dysfunction and degeneration with limited demyelination. These findings demonstrate that the synergistic action of T cells and anti-myelin antibodies mediating demyelination or purely T cell mediated axonal dysfunction and degeneration are distinct pathways by which a specific autoimmune response in the peripheral nervous system can cause neurological disease.

Lipid-free versus lipid-bound P2 protein-induced experimental allergic neuritis: clinicopathological, neurophysiological, and immunological study

The P2 protein of the peripheral nervous system myelin is a neuritogenic protein capable of inducing experimental allergic neuritis (EAN) in the Lewis rat. It has been suggested that the addition of some lipids to the protein isolated in the lipid-free form might enhance its immunogenicity. In this study, we compared lipid-free P2 (the EAN factor) and the corresponding lipid-bound form of the protein regarding their ability to induce EAN. Lipid-bound P2, copurified with all the myelin lipids, shows a conformation different from that of LF-P2. The timing of disease and the clinical scores of lipid-bound P2-induced EAN animals (n = 23) did not differ statistically from those injected with lipid-free P2 (n = 23), with only a tendency to higher clinical severity in the former group. Tail nerve conduction velocities did not differ in the two groups and in both were significantly lower in comparison to Freund adjuvant controls (n = 8). Inflammation and demyelination predominated in the spinal roots and were less evident in the sciatic nerve for both groups of animals. The ELISA determination of antibodies to lipid-free and lipid-bound P2 revealed the development of antibodies recognizing the lipid-free form of the protein in both groups of animals. Our results stand in contrast to results of previous studies performed after addition of exogenous lipids to the P2 purified in the lipid-free form and indicate that lipid-bound P2 is not significantly more immunogenic than lipid-depleted P2.

Restimulation of resting autoreactive T cells by Schwann cells in vitro

This study demonstrates that rat Schwann cells can reactivate resting experimental allergic neuritis generating P(2) and P(2) peptide specific CD4(+) T cell lines. T cell proliferation was significantly greater to P(2) than to P(2) peptide (SP-26) or ovalbumin (OA). Four-level analysis of variance showed that T cell proliferation with endogenous or exogenous P(2) was not significantly different for Schwann cells plus cytokine IFN-gamma (P = 0.5071) unlike P(2) peptide or OA specific T cells (P = 0.0056 and 0.0003, respectively). Untreated Schwann cells were more effective inducers than irradiated or fixed Schwann cells. As stimulated CD4(+) P(2) T cells produce IFN-gamma and TNF-alpha, this could exacerbate blood nerve barrier breakdown that has been increasingly implicated in inflammatory demyelinating neuropathies (IDNs). This would permit entry of antibodies and complement, thereby contributing to the demyelination process. Schwann cell induced reactivation of CD4(+) T cells may therefore play a role in IDNs.

Human autoimmune neuropathies

Peripheral nerve diseases are among the most prevalent disorders of the nervous system. Because of the accessibility of the peripheral nervous system (PNS) to direct physiological and pathological study, neuropathies have traditionally played a unique role in developing our understanding of basic mechanism of nervous system injury and repair. At present they are providing new insight into the mechanisms of immune injury to the nervous system. A rapidly growing catalogue of PNS disorders are now suspected to be immune-mediated, and in the best understood of these disorders, the molecular and cellular targets of immune attack are known, and the pathophysiology follows directly from the specific immune injury. This review summarizes the immunologically relevant features of the PNS, then considers selected immune-mediated neuropathies, focusing on pathogenetic mechanisms. Finally, the PNS is providing a testing ground for new immunotherapies and approaches to protection and regeneration, including the use of trophic factors. The current status of treatment and implications for future approaches is reviewed.

The antibody repertoire in experimental allergic neuritis: evidence for PMP-22 as a novel neuritogen

Experimental allergic neuritis (EAN) is an autoimmune disease that serves as an animal model for the Guillain-Barré syndrome (GBS). In both disorders there is still great uncertainty as to the significance and diversity of autoantibodies involved. We focused on the characterization of serum antibody production in response to various peripheral nervous system (PNS) myelin proteins during the course of actively induced EAN in Lewis rats. These data were compared with EAN induced by adoptive transfer of P2-specific CD4+ T cells (AT-EAN) and with inoculation with complete Freund's adjuvant (CFA) alone. Semiquantitative Western blotting was applied to measure serum IgM and IgG titers against specific myelin proteins, including P2, P0, myelin basic protein (MBP), myelin-associated glycoprotein (MAG) and PMP-22. Considerable differences in the dynamics of antibody titers against individual myelin proteins were observed in active EAN and after inoculation with CFA alone. Our data suggest a pathogenic role of IgM antibodies against HNK adhesion carbohydrate epitope expressing PNS proteins P0, MAG and PMP-22. Among these, PMP-22, a novel candidate neuritogen may be of particular relevance. Thus, we provide evidence for the involvement of antibody-mediated immune response in actively induced EAN and a basis for similar studies on related human disorders such as GBS or other demyelinating neuropathies.

Synergy between antibody and P2-reactive T cells in experimental allergic neuritis

Studies were conducted in experimental allergic neuritis (EAN) to evaluate the possible interaction of cellular and humoral immune mechanisms in the demyelinating process. EAN was induced in Lewis rats by passive transfer of T cells reactive to P2 myelin protein or by active immunisation with whole myelin. Animals were then given systemic antimyelin antibody or control serum and assessed clinically, electrophysiologically and with semiquantitative histological studies. Animals given intraperitoneal (i.p.) P2-reactive T cells and systemic antimyelin antibody developed much more severe disease than those given i.p. T cells alone (P < 0.001). In actively immunised animals, the addition of systemic antimyelin antibody did not significantly alter disease severity. We believe the more severe disease in animals receiving T cells and antimyelin antibody reflects synergy between cellular and humoral immune mechanisms whereby neural antigen-specific T cells breach the blood-nerve barrier, allowing demyelinating antibody access to the endoneurium. In EAN induced by active immunisation with whole myelin it is likely that both B and T cell activation occurs and that the more severe demyelination characteristic of this disease reflects the involvement of both humoral and cellular immunity.

Cellular mRNA expression of interferon-gamma, IL-4 and transforming growth factor-beta (TGF-beta) by rat mononuclear cells stimulated with peripheral nerve myelin antigens in experimental allergic neuritis

Experimental allergic neuritis (EAN) serves as a useful model for inflammation in the peripheral nervous system. To study the potential role of important immunoregulatory and effector cytokines in EAN, we examined the expression of mRNA for interferon-gamma (IFN-gamma), IL-4 and TGF-beta by in situ hybridization in lymph node and splenic cells cultured with bovine peripheral nerve myelin (BPM), P2 and P0 during the course of EAN in Lewis rats. Levels of IFN-gamma mRNA-expressing mononuclear cells (MNC) from lymph nodes and spleens roughly correlated with clinical status, consistent with a disease-promoting role for IFN-gamma. BPM, P0 and P2-reactive IFN-gamma mRNA-expressing T cells appeared in lymph nodes and spleen before onset of the disease, whereas a significant TGF-beta response to BPM, P2 and P0 was observed at lower levels than the IFN-gamma response and at onset of recovery, consistent with a disease down-regulating role of TGF-beta. IL-4 mRNA-expressing cells were found at levels similar to TGF-beta mRNA-expressing cells, and with the latest peak of the three cytokines examined. This result suggests that IL-4 may also suppress IFN-gamma expression at late recovery phase of EAN.

The B cell repertoire in experimental allergic neuritis involves multiple myelin proteins and GM1

Experimental allergic neuritis (EAN) is a T cell mediated disease associated with inflammation and demyelination of peripheral nerves. EAN is an experimental model of Guillain-Barré syndrome. The peripheral nerve myelin components P2 and P0 represent major neuritogens, but the diversity and quantity of B cell responses in EAN are unknown. Lewis rats were immunized with bovine peripheral nerve myelin (BPM), and levels of B cells secreting IgM and IgG antibodies to BPM, P2 and P0, the glycolipid GM1 and five peptides of myelin-associated glycoprotein (MAG) were determined. Already on day 7 post-immunization (p.i.), i.e. before the onset of clinical EAN, lymph nodes contained elevated levels of cells secreting IgM antibodies of all specificities examined. Maximum numbers of IgG antibodies secreting cells were generally reached at the height of clinical disease. The numbers of cells secreting IgG antibodies to BPM, P2, P0, GM1 and MAG peptides were also elevated before disease onset, but they were mostly higher than those of IgM antibodies and they reached their maximum only after recovery. The results imply that EAN is associated with strong B cell responses to all myelin antigens under study without restriction to any immunodominant myelin component or MAG peptides.

Antigalactocerebroside antibody increases demyelination in adoptive transfer experimental allergic neuritis

There is suggestive but inconclusive evidence for a contribution of T cells and antimyelin antibodies to the pathogenesis of the Guillain-Barré polyneuropathy. We have studied the potential synergism of cellular and humoral immunity in the adoptive transfer model of EAN. EAN was induced in Lewis rats by injecting varying doses of P2 peptide (SP26)-sensitized T lymphocytes. Disease severity was dose-dependent. The addition of intravenous GC-AB to a subclinical dose of SP26-sensitized T cells resulted in overt clinical disease and markedly enhanced demyelination. Intravenous injection of antibody alone had no effect. We conclude that activated neuritogenic T cells, while entering into peripheral nerves, alter the blood-nerve barrier, which gives circulating demyelinating antibodies access to the endoneurium. The observations support the concept of a synergistic role of T-cell autoimmunity and humoral responses in the inflammatory demyelination of Lewis rat EAN.

Detection and quantification of antibodies to the extracellular domain of P0 during experimental allergic neuritis

Quantification of the peripheral nerve myelin glycoprotein P0 and antibodies to P0 is difficult due to insolubility of P0 in physiological solutions. We have overcome this problem by using the water-soluble recombinant form of the extracellular domain of P0 (P0-ED) and describe newly developed assays which allow detection and quantitation of P0 and antibodies to P0, in serum and cerebrospinal fluid (CSF). These sensitive and specific assays based on the ELISA technique were used to study humoral immune responses to P0 during experimental autoimmune ("allergic") neuritis (EAN). In order to establish these tests, monoclonal antibodies to different epitopes of rodent and human P0-ED were produced. A two-antibody sandwich-ELISA allowing quantitation of P0 (lower detection limit of 0.5 ng/ml or 30 fmol/ml) and an antibody-capture ELISA (lower detection limit 1 ng specific antibody/ml) to detect antibodies to P0 in serum and CSF were developed. EAN was induced in rats by active immunization with bovine myelin or the neuritogenic protein P2 or by adoptive transfer using P2 specific CD4 positive T cells. Serum and CSF were assayed for the presence of P0-ED and antibodies to P0-ED or P2. Antibodies to P0-ED were detected during active myelin-induced EAN, but not during P2-induced or adoptive transfer EAN. The anti-P0-ED antibodies in the CSF showed a correlation with disease activity. In contrast, in the same model antibodies to P2 persisted long after the disease ceased. No soluble P0-like fragments could be found in serum or CSF during any of the three types of EAN. We conclude that P0 may be a B-cell epitope in EAN. These findings warrant a screen for antibodies to P0-ED in human immune neuropathies.

Presence of the terminal complement complex (C5b-9) precedes myelin degradation in immune-mediated demyelination of the rat peripheral nervous system

In this study, the terminal complement complex C5b-9 (TCC) was localized by immunocytochemistry at different clinical stages of experimental autoimmune neuritis. Deposits of TCC were found on the surface of Schwann cells and their myelin sheaths, and to some extent in the extracellular space at predilective sites of impending demyelination before onset of clinical signs and for a short period thereafter. Additionally, TCC was deposited on the surface of W3/13 positive leukocytes. No TCC immunoreactivity was seen in the distal stump of transected sciatic nerves 1 to 15 days after axotomy. The early and transient deposition of TCC on Schwann cells and myelin sheaths in experimental autoimmune neuritis before overt demyelination suggests that complement activation plays a pathogenic role in the initiation of immune-mediated myelin damage. The lack of TCC immunoreactivity after nerve transection excludes a nonspecific activation process. The signals involved in local TCC formation in demyelinating peripheral nervous system disorders have yet to be explored.

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

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

Peptide 53-78 of myelin P2 protein is a T cell epitope for the induction of experimental autoimmune neuritis

We have recently described the clinical and pathological features of experimental autoimmune neuritis (EAN) in Lewis rats inoculated with varying doses of a synthetic peptide corresponding to the amino acid residues 53-78 of bovine P2 protein (SP-26). Immunization with this synthetic peptide was able to induce severe clinical and pathological characteristics of EAN. We are now reporting that, SP-26 T cell lines derived from spleen and lymph node cell populations of such immunized rats, upon being triggered by SP-26, can adoptively transfer severe clinical and histological signs of EAN to naive syngeneic recipients. The disease appears 7-8 days postinoculation of the cells and persist 5-10 days. The pathological features were indistinguishable from SP-26-induced active EAN which appears 12-15 days after sensitization. Examination of the surface phenotype of the cells that were used for the passive transfer of EAN by FACS analysis, showed majority of the cells to be CD4+, Ia+ cells.

Early myelin lesions in experimental allergic neuritis

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

T-cell and macrophage activation in experimental autoimmune neuritis and Guillain-Barré syndrome

Evidence implicating cellular immune responses in the pathogenesis of experimental autoimmune neuritis (EAN) and Guillain-Barré syndrome (GBS) is reviewed. In EAN the decisive role of T-lymphocytes in the initiation of immune-mediated nerve damage has been firmly established by adoptive transfer experiments. Macrophages but not Schwann cells express major histocompatibility complex class II gene products in situ and hence may function as antigen presenters. Macrophages are crucial in the amplification and effector phase and damage the myelin sheath by phagocytic attack and release of inflammatory mediators such as toxic oxygen radicals, arachidonic acid metabolites, complement, or hydrolases. Macrophage activation in EAN is achieved by interferon-gamma. Attempts to detect specific sensitization of T-lymphocytes to nerve antigens in patients with GBS have so far been unsuccessful. However, circulating activated T cells can be found in patients with GBS, as evidenced by augmented expression of HLA-DR antigen, the transferrin receptor, and the interleukin-2 receptor on the surface of peripheral blood T cells, and by increased serum concentrations of interleukin-2 and the soluble interleukin-2 receptor. In addition, we present data indicating macrophage activation in GBS.

T lymphocyte activation antigens in Guillain-Barré syndrome and chronic idiopathic demyelinating polyradiculoneuropathy

Activated circulating T lymphocytes were measured in ten patients with Guillain-Barré syndrome (GBS) and in ten with chronic idiopathic demyelinating polyradiculoneuropathy (CIDP), each paired with an age- and sex-matched healthy control. Activated T cells were identified by double labelling with phycoerythrin-conjugated anti-CD3 antibody and biotinylated antibodies to activation antigens: human leucocyte antigen (HLA)-DR, transferrin receptor (TFR) or interleukin-2 receptor (IL-2R) visualised with an avidin-biotin-fluorescein system. The frequency of activated T cells was increased in the GBS group. The median of the DR-positive T cells in the patients was 3.4% (range 0.5-9.4%), compared with 1.4% (range 0-4.3%) in the controls (P less than 0.01). For TFR the corresponding medians were 3.3% (range 0.5-6.2%) in the patients and 0% (range 0-2.5%) in the controls (P less than 0.01), and for IL-2R 3.7% (range 0-6.0%) in the patients compared with 0% (range 0-2.9%) in the controls (P less than 0.01). In the CIDP group the median percentage of activated T cells was also increased but the differences were less significant: for DR, patients 2.4% (range 0-3.8%), controls 0.5% (range 0-2.0%, P less than 0.05); for TFR, patients 0% (range 0-5.3%), controls 0% (range 0-1.0%, not significant), and for IL-2R, patients 0% (range 0-2.5%), controls 0% (range 0-0.5%, not significant). The activated cells might be directed against microbial antigens encountered during the infection preceding GBS, autoantigens, bacterial antigens encountered during concurrent infection, or a combination of these.

Responsiveness to P2 of blood- and cauda equina-derived lymphocytes in experimental allergic neuritis in the Lewis rat: preliminary characterisation of a P2-specific cauda equina-derived T cell line

Experimental allergic neuritis (EAN) was induced in Lewis rats by immunisation with bovine spinal root myelin. Neurological signs appeared on day 12 and persisted for 10-15 days. A transient protein P2-specific proliferative response of circulating mononuclear cells was detected on days 10 and 14 after immunisation but not on days 17 and 35. Mononuclear cells recovered from cauda equina infiltrates on days 14 and 17 showed greater responsiveness to P2 than circulating cells. A P2-specific, interleukin-2-dependent T cell line has been developed from cauda equina (CE)-derived lymphocytes. In adoptive transfer experiments this cell line did not induce EAN but did protect normal recipients from actively induced EAN.

Guillain-Barré syndrome and serum activities of gamma-glutamyltransferase and glutamic-pyruvic transaminase

Objective laboratory indicators of alcohol consumption (mean corpuscular volume and serum glutamic-pyruvic transaminase (GPT), glutamyltransferase (gamma-GT), and glutamic-oxaloacetic transaminase (GOT] were measured in 18 patients with Guillain-Barré syndrome (GBS) and 710 control patients. All of the indicators examined were more frequently found to be pathological in GBS patients, reaching significance for gamma-GT and GPT. Some explanations for this result are discussed. It is concluded that alcohol consumption may be a risk factor for GBS.

A prospective study of acute idiopathic neuropathy. III. Immunological studies

The immune responses of 100 patients who presented with an acute idiopathic neuropathy were compared with those of age and sex matched controls. Blood lymphocytes and their subsets were counted with a fluorescent activated cell sorter. CD8+ (putative suppressor) lymphocytes were significantly reduced in the first week of the disease but total lymphocytes, total T and CD4+ (putative helper) cells were not altered. This reduction depended on the nature of the preceding infection. Serum complement C3 and C4 concentrations remained normal and immune complexes were rarely detected with a C1q binding assay. Complement-fixing antibodies to human peripheral nerve antigens were discovered in the serum of 7% of patients but only 1% of controls. Complement-fixing antibodies to galactocerebroside were not discovered in any sera. Enzyme-linked immunoassays detected increased antibody responses to galactocerebroside but none at all to human P2 myelin protein in the patient sera. Forty microliter of serum from five patients injected into the sciatic nerves of rats did not induce significantly more demyelination than the serum from control patients. It is concluded that auto-immune responses can only be detected by these techniques in a small minority of patients with acute idiopathic neuropathy.

The role of macrophages in experimental autoimmune neuritis induced by a P2-specific T-cell line

A P2-specific T-cell line with a helper/inducer phenotype (W3/25+) mediates experimental autoimmune neuritis in the Lewis rat after adoptive transfer to naive recipients. Moderately severe disease was induced in these experiments by the injection of 1 x 10(7) T cells. Motor and mixed afferent nerve conduction, F responses, H reflexes, and lumbar somatosensory evoked potentials were monitored, and morphological alterations were scored semiquantitatively at the end of the experiments. The role of macrophages and macrophage-derived inflammatory mediators in the effector phase of the disease was investigated by administering different inhibitors of macrophage metabolism, including silica, dexamethasone, and a variety of cyclooxygenase and lipoxygenase blockers. Silica and dexamethasone suppressed the clinical, electrophysiological, and morphological manifestations of the disease almost completely, indicating that macrophages are essential for the generation of inflammatory lesions. The inhibitors of arachidonic acid conversion failed to mitigate the severity of the disease. This is in contrast to observations in actively induced experimental autoimmune neuritis in which eicosanoid biosynthesis seems to play a decisive role in the pathogenesis of the disease.

Modulation of experimental allergic neuritis in rats by in vivo treatment with monoclonal anti T cell antibodies

Monoclonal antibodies (MCA) to different T lymphocyte cell surface antigens have been used to treat rats during different phases of the development of experimental allergic neuritis (EAN). The effects of this treatment were followed by clinical evaluation and in some instances by immunohistochemical analysis of lymphoid organs and affected nerves of the antibody-treated rats. Several MCA, W3/13 (pan T cell reactive), W3/25 (anti-rat CD4), Ox 8 (anti-rat CD8) as well as Ox 6 (anti-Ia) partly prevented clinical signs of EAN when given shortly before expected onset of disease, whereas W3/13 and Ox 8 given at the height of disease did not further affect disease development. However, Ox 19 (anti-rat CD5) given at the same time as immunization partly prevented clinical signs of EAN, while Ox 19 given shortly before expected onset of disease or during height of disease drastically exaggerated disease symptoms. Immunohistochemical studies after Ox 8 or Ox 19 treatment showed a complete absence of staining for the respective antibodies, while staining was preserved with the other MCA. It is concluded that: (1) Ox 8 positive "suppressor/cytotoxic" T lymphocytes do not exert any suppressive effects on EAN during the now investigated phases of disease, and that (2) anti T lymphocyte antibodies (here Ox 19) may exert opposite effects on autoimmune disease when given at different phases of disease development. This may have implications for potential therapeutic trials of MCA therapy for putative autoimmune demyelinating diseases in man.

Electrophysiological follow up of experimental allergic neuritis mediated by a permanent T cell line in rats

Acute experimental allergic neuritis (EAN) was produced in Lewis rats by transfer of lymphocytes from a permanent T cell line specific for bovine P2 protein. In 3 groups of rats receiving 10(4), 10(5) and 10(6) total injected P2-specific lymphocytes, respectively, the time course of illness was followed by measuring several electrophysiological parameters including the H reflex or F wave and lumbospinal somatosensory evoked potentials (SEP). The severity and time course of both the electrophysiological and clinical (e.g., loss of weight and development of paresis) parameters of illness depended on the number of injected lymphocytes. Lower numbers of injected cells were correlated with a later onset and less severe symptoms as well as with an earlier and more complete recovery. According to clinical observation EAN mediated by lymphocytes is a monophasic illness. According to our electrophysiological measurements, however, the disease can be described by the following successive stages: (a) an early stage of hyperexcitability; (b) a stage of acute partial conduction block; (c) 14 days later a stage of maximal demyelination; and (d) a recovery phase. Although demyelination is the prominent feature of the disease, axonal degeneration also occurs to an extent directly related to the number of cells injected. Degeneration was not observed in rats from the group with the lowest number (10(4] of injected lymphocytes.

Complement depletion suppresses Lewis rat experimental allergic neuritis

Lewis rats immunized with myelin and complete Freund's adjuvant were treated with cobra venom factor (CVF) which depletes the C3 component of complement. CVF given at day 9 delayed the onset of experimental allergic neuritis (EAN) by 2-3 days and when given at days 9 and 12 delayed the onset of EAN by 4-5 days. Lumbar nerve roots of CVF-treated rats had significantly less demyelination than those from control EAN rats.

Neuritis of the cauda equina

Although the specific etiology of NCE remains unknown, many advances have been made in recent years. It is hoped that we can expect continued success in this area. Etiologic and pathophysiologic determination of NCE is the key to developing an appropriate therapeutic regimen.

P0 myelin protein produces experimental allergic neuritis in Lewis rats

P0 protein was prepared from bovine spinal root myelin. The purity was shown by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunostaining with affinity purified antisera. P0 in the presence of lysophosphatidylcholine induced paralysis and histological lesions resembling experimental allergic neuritis in Lewis rats. Lysophosphatidylcholine also enhanced the ability of P2 to produce neuritis. The conformation of these proteins may be important in determining their ability to induce experimental allergic neuritis. P0 deserves consideration as an antigen relevant to Guillain-Barré syndrome.

T-lymphocyte subsets, functional deficits, and morphology in sciatic nerves during experimental allergic neuritis

Conduction velocities, demyelination, "macrophage/dendritic" cells, different sets of T-lymphocytes, and immunoglobulins were estimated in sciatic nerves during various phases of experimental allergic neuritis in Lewis rats. Demyelination was minimal day 15 postimmunization (p.i.) when conduction velocity already was reduced, somewhat more pronounced day 17 p.i. when nerve conduction was blocked, and most pronounced day 23 p.i. when nerve conduction partially had recovered. This suggests a dissociation between the degree of demyelination and the functional deficits. Decrease of sciatic nerve conduction velocities coincided with endoneurial appearance of T-lymphocytes and "macrophage/dendritic" cells, as well as endoneurial immunoglobulins, day 15 p.i. Later partial functional recovery occurred in parallel with the disappearance of T-cells. The degree of functional deficits thus correlated with the number of endoneurial T-lymphocytes. T-cells may, directly or indirectly, initiate several of the disease components in experimental allergic neuritis, including the nerve conduction deficit.

Reduced susceptibility of T cell-deficient rats to induction of experimental allergic neuritis

Lewis rats were made deficient in T cells by adult thymectomy and lethal irradiation, and then reconstituted with T cell-free bone marrow. Their ability to develop experimental allergic neuritis (EAN) was compared with normal rats. The majority of T cell-deficient rats remained clinically and histologically unaffected, whereas all but one of the normal rats developed severe EAN. Those T cell-deficient animals which succumbed to EAN were found to have a significantly higher percentage of residual blood T lymphocytes than those which did not. Full susceptibility to EAN was restored by an inoculum of whole thoracic duct lymphocytes (TDL) from normal animals but not by TDL depleted of T cells. The results therefore provide direct confirmation that T cells are a requirement for the development of EAN.

Use of an ELISA in the differential diagnosis of cauda equina neuritis and other equine neuropathies

In 27 potential neuropathies an enzyme-linked immunosorbent assay, using P2 preparations from either bovine or equine myelin, detected all cases of cauda equina neuritis in which there was caudal involvement. The test was of limited value in differentiating neuropathies involving only cranial or other peripheral nerves.

T cell subsets and Ia-positive cells in the sciatic nerve during the course of experimental allergic neuritis

The changes of T cell subsets and Ia-positive cells in the sciatic nerve during the course of experimental allergic neuritis (EAN) in Lewis rats were studied using immunohistochemical techniques. OX-6+ Ia-positive cells and W3/13+ total T cells were found at the clinical onset of EAN. OX-6+ cells were more numerous than W3/13+ cells during all phases of the disease. In the acute phase, more W3/25+ helper T cells were found than OX-8+ suppressor/cytotoxic T cells in the sciatic nerve. In the recovery phase, W3/25+ cells were slightly fewer than OX-8+ cells. It is suggested that these changes in T cell subsets and Ia-positive cells are related to the self-limiting monophasic course of EAN.

Role of nonspecific myelin destruction by delayed type hypersensitivity in primary demyelination

To clarify the role of nonspecific myelin destruction mediated by delayed type hypersensitivity (DTH) in primary demyelination, DTH to tuberculin was induced within the endoneurium by intraneural injection of purified protein derivative (PPD) or sonicated Mycobacterium tuberculosis into the sciatic nerves of Lewis rats and guinea pigs which had previously been sensitized to tuberculin. The morphological features of the nerves proximal to the site of needle insertion were assessed 5 days after injection. By changing the PPD concentration of solution for intraneural injection, various degrees of DTH reaction could be produced in the nerve. Infiltration of mononuclear cells including macrophages was observed around the vessels and in the vicinity of the myelin sheaths. Although nonspecific damage of axons, myelin sheaths and Schwann cells was observed in areas heavily infiltrated with inflammatory cells, primary demyelination was hardly recognized. Another group of Lewis rats previously immunized with galactocerebroside (GC), the major glycolipid hapten of myelin, in Freund's complete adjuvant received intraneural injection of PPD or GC liposomes. Neither cellular nor humoral immunity to GC was detected in these rats. The nerves injected with GC liposomes showed no inflammatory cell infiltration except for a few macrophages containing liposomes and those injected with PPD showed infiltration of mononuclear cells without primary demyelination. Our findings reveal that nonspecific myelin destruction induced by DTH does not play an important role in immune-mediated demyelination.

Conduction failure and nerve conduction slowing in experimental allergic neuritis induced by P2-specific T-cell lines

P2-specific T cells (LiP2/A) mediate experimental allergic neuritis (EAN) in the Lewis rat after adoptive transfer to naive recipients. After a latent period of 4 days, injection of 2 X 10(6) line cells induced fulminant paraplegia and complete conduction failure in the peripheral nerves and roots, resembling acute axonal breakdown. Injection with 10(6) cells caused milder clinical signs, nerve conduction failure, and conduction slowing. Clinical and electrophysiological recovery from adoptively transferred EAN was nearly complete and its time course was inversely correlated to the initial severity of EAN. These findings suggest that EAN induced by the P2-specific T-cell line can lead to a profound and rapidly evolving nerve dysfunction in a dose-dependent fashion.

Macrophage procoagulant activity as a measure of cell-mediated immunity to P2 protein of peripheral nerves in the Guillain-Barré syndrome

Cell-mediated and humoral immunity to purified nerve proteins has been assessed in GBS patients and compared with that of patients with other neurological diseases and healthy controls. A strong and specific cell-mediated response to the neuritogenic basic protein P2 occurred in 13/16 GBS patients tested. Extremely low levels of P2 (0.01 micrograms/culture) induced monocyte/macrophage procoagulant activity (MPCA) on peripheral blood mononuclear cells (PBM) from GBS patients (P = 0.007) whereas higher concentrations (2 micrograms/culture) of myelin basic protein (MBP) and sciatic nerve myelin (SNM) were required to stimulate similar levels of activity. These concentrations of nerve antigens failed to induce significant MPCA on peripheral blood mononuclear cells of patients with other neuropathies or healthy controls. Lipopolysaccharide, a non-specific stimulant of macrophage procoagulant activity, induced similar procoagulant levels on PBM from each group. The MPCA assay was a sensitive, quantitative and specific indicator of cell-mediated immunity to the neuritogenic peptide, P2 in GBS patients. Serum antibodies to P2, P0 and SNM were detected by a sensitive solid-phase radioimmunoassay. Naturally occurring antibodies to peripheral nerve antigens were observed in sera of healthy subjects and these levels were not significantly different from patients with GBS or those with other neuropathies. Our results indicate that the autoimmune cell-mediated response to the neuritogenic peptide P2 plays a major role in the pathogenesis of GBS.

Autonomic dysfunction in experimental allergic neuritis

Beat-to-beat variation (R-R variation) in the electrocardiogram was studied in experimental allergic neuritis in the Sprague-Dawley rat. Reduced R-R variations were found in 2 of 10 animals, probably as a sign of autonomic dysfunction. The vagal nerves from these two animals, studied in vitro, showed disturbed conduction. In one animal prolonged conduction latencies to supramaximal electrical stimuli were found. Vagal nerves from controls and from animals without clinical symptoms showed normal conduction. Histologically, the vagal nerves from affected animals showed a slight inflammatory cell infiltration and signs of demyelination but there was no evidence of involvement of the brainstem vasomotor nuclei. Thus, we suggest that the autonomic dysfunction in experimental allergic neuritis, measured as reduced R-R variations, is caused by a peripheral vagal neuropathy.

Chronic experimental allergic neuritis (EAN) in juvenile guinea pigs: immunological comparison with acute EAN in adult guinea pigs

In order to approach the mechanism of chronic or relapsing course in human chronic inflammatory demyelinating polyradiculoneuropathy, we established a chronic model of experimental allergic neuritis (EAN) in juvenile guinea pigs, and investigated the underlying cellular immune phenomenon in comparison with acute EAN in adult animals of the same strain. Two-week-old Hartley guinea pigs, sensitized with bovine peripheral nerve homogenate, developed chronic or relapsing EAN, whereas all adult animals developed acute monophasic EAN. Morphological examination of both the chronic and acute forms revealed scattered demyelination and mononuclear cell infiltrates which were essentially restricted to the peripheral nervous system, and indistinguishable from each other. Both the in vitro lymphocyte mitogenic response and in vivo skin testing revealed a significantly lower response to neuritogenic antigens (P2 protein and peripheral nerve myelin) in juvenile chronic EAN than in adult acute EAN throughout their respective courses. In addition, we showed, by means of assessing peripheral blood lymphocyte number and its subpopulations, that normal 2-week-old Hartley guinea pigs have not fully developed immunologically. These observations suggested that there was some immunological incompetence especially in cellular immunity in 2-week-old juvenile guinea pigs and that this might be one possible factor leading to chronic EAN.

Transfer of experimental allergic neuritis with P2-reactive T-cell lines

Experimental allergic neuritis (EAN) was induced in normal Lewis rats by systemic passive transfer of T-cell lines responding to P2 protein. These cells had predominantly helper phenotype and could induce EAN within 7 days following adoptive transfer. There was no anti-P2 antibody response in the recipients of the P2-reactive cells recovered from donors with high anti-P2 antibody levels. This study provides direct evidence that T cells are important for the induction of EAN. Furthermore, there was no evidence of a pathogenic role for anti-P2 antibody in passive EAN.

Treatment of refractory chronic demyelinating polyneuropathy with lymphoid irradiation

Four patients with refractory or poorly responsive chronic progressive demyelinating polyneuropathy (CPDP) were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study. All patients had previously failed conventional therapy for CPDP, as well as other unconventional treatments. During a follow-up period of 7 to 12 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic subset) to Leu-3 (helper/inducer subset) T cells in the blood. Three of the four patients demonstrated improvement in distal muscle strength, and this was associated with increased functional capabilities in two patients. In contrast, no clinical improvement in sensation was noted in any patient. Nerve conduction studies showed patchy improvement in three patients. The results of this preliminary uncontrolled study indicate that radiotherapy deserves further study in the treatment of CPDP.

Autonomic nerves in experimental allergic neuritis in the rat

After experimental allergic neuritis (EAN) was induced in 16 male Lewis rats with bovine peripheral myelin and adjuvants, peripheral nerves were examined morphologically at intervals of 12-21 days post inoculation (dpi). Signs of motor involvement were present in ten rats and were first elicited 12 dpi. They ranged from tail droop to complete lower limb paralysis. Autonomic nervous system (ANS) involvement was studied by contrasting morphological findings in the cervical sympathetic nerves (CSN), which are poorly myelinated and vagal nerves (VN) which contain numerous myelinated fibers in the endoneurium. Edema, perivenular infiltrates, and demyelination appeared in the VN of seven of nine neurologically affected rats, while the CSN showed edema and infiltrates in only one rat. ELISA assays were negative for anti-galactocerebroside antibody, and electron microscopy failed to show abnormalities of Schwann cells.