Cyclosporine and Multiple Sclerosis

Recent studies have shown that the administration of low-dose cyclosporine can convert acute experimental allergic encephalomyelitis into chronic relapsing EAE with large plaques of spinal cord demyelination

Recovery from Acute Experimental Allergic Encephalomyelitis in the Lewis Rat: Early Restoration of Nerve Conduction and Repair by Schwann Cells and Oligodendrocytes

Light and electron microscopic histological studies and electrophysiological studies were performed on Lewis rats with acute experimental allergic encephalomyelitis (EAE) induced by whole spinal cord or myelin basic protein to determine the mechanism of clinical recovery. In these animals, total clinical recovery from complete paraplegia may occur as early as 4 days after the onset of hindlimb weakness. These studies indicate that this recovery occurs at a time when there is restoration of nerve conduction in the peripheral nervous system (PNS) and central nervous system (CNS) and when most demyelinated fibres have been invested, and some partially remyelinated, by Schwann cells or oligodendrocytes in the PNS and CNS, respectively. These findings support the hypothesis that the neurological signs of acute EAE are due to demyelination in the PNS and CNS

The Pathophysiology of Chronic Relapsing Experimental Allergic Encephalomyelitis in the Lewis Rat

Electrophysiological studies were performed in Lewis rats with chronic relapsing experimental allergic encephalomyelitis (EAE) induced by inoculation with guinea-pig spinal cord and adjuvants and treatment with low dose cyclosporin A. During clinical episodes there was conduction failure in the central nervous system (CNS), namely the spinal cord dorsal columns, and in the afferent fibres in the peripheral nervous system (PNS). The following observations indicated that the conduction failure was mainly due to demyelination-induced conduction block: (1) rate-dependent conduction block in the CNS and PNS; (2) temporal dispersion due to slowing of PNS conduction; (3) restoration of PNS conduction by cooling; (4) restoration of CNS conduction by ouabain; (5) previously demonstrated histological evidence of primary demyelination in the dorsal columns, dorsal root ganglia and dorsal roots; and (6) the temporal association of restoration of conduction with remyelination. However, it is likely that CNS and PNS axonal degeneration, which occurs in this disease, also contributed to the conduction failure. In clinical remissions there was restoration of conduction in the CNS and PNS which can be explained by ensheathment/remyelination by oligodendrocytes and Schwann cells, respectively. In most rats during clinical episodes the cerebral somatosensory evoked potential was reduced in amplitude and prolonged in latency, which can be accounted for by demyelination and axonal degeneration in the CNS and PNS components of the afferent pathway. In 2 rats with episodes of EAE, however, this potential was markedly increased in amplitude, which might have been due to demyelination-induced conduction block of descending pathways that normally inhibit synaptic transmission in the afferent pathway. In well-established remission there was residual conduction failure in the CNS and PNS which can be mainly accounted for by axonal degeneration

Conduction Block in the Peripheral Nervous System in Experimental Allergic Encephalomyelitis

Experimental Allergic Encephalomyelitis (EAE) has been widely studied as a model of multiple sclerosis, a central nervous system (CNS) disease of unknown aetiology. The clinical features of both EAE and multiple sclerosis provide the only guide to the progress and severity of these diseases, and are used to assess the response to treatment. In such comparisons the clinical features of EAE are assumed to be due to lesions in the CNS, but in this disease there is also histological evidence of damage to the peripheral nervous system (1-8). However, the functional consequences of such peripheral lesions have been entirely ignored. To examine this, we have studied nerve conduction in rabbits with EAE. We report here that most of the large diameter afferent fibres are blocked in the region of the dorsal root ganglion and at the dorsal root entry zone, thus accounting for the loss of tendon jerks and also, through the severe loss of proprioceptive information, the ataxia of thse animals. We conclude that whenever clinical comparisons are made between EAE and multiple sclerosis, the pathophysiology associated with histological damage of the peripheral nervous system must be taken into account

The Pathophysiology of Acute Experimental Allergic Encephalomyelitis in the Rabbit

Clinical, histological and electrophysiological studies were performed on rabbits with acute experimental allergic encephalomyelitis (EAE). The clinical features were similar to those previously described, with the notable exception of the new findings of areflexia, respiratory slowing and hypothermia. The histological findings were also similar to those previously reported, with inflammatory demyelinating lesions both in the central and peripheral nervous system, especially the dorsal root ganglia. Electrophysiological studies performed one to nine days after the onset of neurological signs demonstrated conduction block in a high proportion of the large diameter afferents in the lumbosacral and thoracic dorsal root ganglia. Single fibre studies with spike-triggered averaging confirmed the conduction block in the dorsal root ganglia. That the conduction block was due to demyelination was indicated by slowing of conduction in large diameter fibres, normal conduction in unmyelinated fibres and the specific effects of temperature and of the potassium channel blocking agent, 4-aminopyridine. These conduction abnormalities in the peripheral nervous system, focused on the dorsal root ganglia, account for the postural disturbance, hypotonia, ataxia and areflexia in rabbits with EAE. Such conduction block is likely to mask the expression of any lesions of the central nervous system that alone could produce similar signs. The implications of these findings for the human demyelinating diseases are discussed

Microglia are more susceptible than macrophages to apoptosis in the central nervous system in experimental autoimmune Encephalomyelitis through a mechanism not involving Fas (CD95)

Morphological studies have shown that macrophages and microglia undergo apoptosis in the central nervous system (CNS) in acute experimental autoimmune encephalomyelitis (EAE) in the Lewis rat. To assess the relative levels of macrophage and microglial apoptosis, and the molecular mechanisms involved in this process, we used three-colour flow cytometry to identify CD45lowCD11b/c+ microglial cells and CD45highCD11b/c+ macrophages in the inflammatory cells isolated from the spinal cords of Lewis rats 13 days after immunization with myelin basic protein (MBP) and complete Freund's adjuvant. Simultaneously, we analyzed the DNA content of these cell populations to assess the proportions of cells undergoing apoptosis and in different stages of the cell cycle or examined their expression of three apoptosis-regulating proteins, i.e. Fas (CD95), Fas ligand (FasL) and Bcl-2. Microglia were highly vulnerable to apoptosis and were over-represented in the apoptotic population. Macrophages were less susceptible to apoptosis than microglia and underwent mitosis more frequently than microglia. The different susceptibilities of microglia and macrophages to apoptosis did not appear to be due to variations in Fas, FasL or Bcl-2 expression, as the proportions of microglia and macrophages expressing these proteins were similar, and were relatively high. Furthermore, in contrast to T cell apoptosis, apoptosis of microglia/macrophages did not occur more frequently in cells expressing Fas or FasL, or less frequently in cells expressing Bcl-2. These results indicate that the apoptosis of microglia and CNS macrophages in EAE is not mediated through the Fas pathway, and that Bcl-2 expression does not protect them from apoptosis. Expression of FasL by macrophages and microglia may contribute to the pathogenesis and immunoregulation of EAE through interactions with Fas+ oligodendrocytes and Fas+ T cells. The high level of microglial apoptosis in EAE indicates that microglial apoptosis may be an important homeostatic mechanism for controlling the number of microglia in the CNS following microglial activation and proliferation

Blood-Brain Barrier Disruption And Lesion Localisation In Experimental Autoimmune Encephalomyelitis With Predominant Cerebellar And Brainstem Involvement

The role of the blood-brain barrier (BBB) in determining lesion distribution was assessed in an atypical model of experimental autoimmune encephalomyelitis (EAE) induced in C3H/HeJ mice by immunisation with peptide 190-209 of myelin proteolipid protein, which can result in two distinct types of EAE, each with distinct lesion distribution. Areas of the BBB showing constitutively greater permeability in naive mice did not correlate with the lesion distribution in EAE. BBB disruption occurred only in sites of inflammatory cell infiltration. Irrespective of the clinical type, the BBB was disrupted in the cerebellum and brainstem. Pertussis toxin had no effect on lesion distribution. Thus, lesion distribution is not influenced solely by BBB permeability

Effects of Cyclosporin A Treatment on Clinical Course and Inflammatory Cell Apoptosis in Experimental Autoimmune Encephalomyelitis Induced in Lewis Rats by Inoculation with Myelin Basic Protein

Experimental autoimmune encephalomyelitis (EAE) was induced in Lewis rats by inoculation with myelin basic protein (MBP) and adjuvants. Rats were treated with second daily injections of saline or cyclosporin A (CsA) from the day of inoculation. Saline-treated rats had an acute episode of disease followed by clinical recovery. Rats treated with CsA 16 or 32 mg/kg had minimal signs of EAE at the usual time after inoculation, but developed signs of disease after treatment was ceased. Rats treated with CsA 8 mg/kg had a delayed first episode of disease and then developed a relapsing or a chronic persistent course of disease. CsA 4 mg/kg delayed the onset of disease. To study the effects of CsA on the inflammatory infiltrate, cells were extracted from the spinal cords of rats with EAE, 16 h after a single injection of CsA or saline. Extracted cells were labelled with antibodies to T cells, CD11b/c (macrophages/microglia), CD95 (Fas) and Fas ligand. CsA 4 mg/kg did not alter the composition of the inflammatory infiltrate. Treatment with higher single doses of CsA caused a dose-dependent decline in the percentage of T cell receptor (TCR)alpha beta+ cells in the inflammatory infiltrate. All doses of CsA caused a significant increase in the number and percentage of cells that were apoptotic. CsA treatment caused an increase in the percentages of CD5+ and TCR alpha beta+ cells that were apoptotic. There was a decline in the percentage of apoptotic T cells that were V beta 8.2+, compared to the percentage of non-apoptotic T cells that were V beta 8.2+, in CsA treated rats compared to saline-treated controls. This suggests that, while CsA treatment caused a non-specific increase in the overall level of T cell apoptosis in the spinal cord, it abrogated the selective apoptosis of V beta 8.2+ encephalitogenic T cells that normally occurs during spontaneous recovery from acute EAE

The Occurrence of Autoimmune Diseases in Patients with Multiple Sclerosis and Their Families

The aims of this study were to determine whether the occurrence of autoimmune diseases is increased in patients with multiple sclerosis (MS) and their families and whether this is influenced by the type of MS. We conducted a case-control study using a questionnaire design to determine whether the prevalence of 11 autoimmune diseases is increased in patients with MS and their first-degree relatives compared to a random population control group and their first-degree relatives. We found that the total combined prevalence of the 11autoimmune diseases was higher in the MS patients than in the controls, with an odds ratio of 1.7 (95% confidence interval 0.9-3.2; P= 0.10) increasing to 1.9 (1.0-3.5; P= 0.05) after adjusting for age. For persons aged under 60 years, the odds ratio was 2.3 (1.1-4.6). We also found that there was a significant increase in the total combined prevalence of the autoimmune diseases in the first-degree relatives of MS patients compared to the first-degree relatives of the control group (P= 0.003, odds ratio 2.2, confidence interval 1.3-3.7). Patients with primary progressive MS did not differ from patients with relapsing-remitting or secondary progressive MS in the personal or familial occurrence of autoimmune disease. In conclusion, although there were sources of possible bias, this study suggests that individuals with MS have a genetic predisposition to autoimmunity in general

Decreased T cell reactivity to Epstein–Barr virus infected lymphoblastoid cell lines in multiple sclerosis

Objective: To investigate T cell and antibody immunity to Epstein-Barr virus (EBV) in multiple sclerosis (MS)