Demyelination of Sternarchus electrocyte fibers by injection of diphtheria toxin

Diphtheria toxin was injected into the electric organ of the gymnotid fish, Sternarchus albifrons. After 10 days, there was extensive demeylination of electrocyte fibers in the area of injection. Electron microscopy showed that paranodal loops of myelin do not separately cleanly from the axon, and remnants of the myelin loops may persist after demyelination of the internodes is nearly complete. The dense cytoplasmic undercoating of the nodal axolemma may disappear before the paranodal junctions are completely gone. Observations of demyelination of internodes between the elaborate, inexcitable nodes suggest that the presence of myelin may not be necessary for the maintenance of structural differentiation of this region of the axolemma. Use of diphtheria toxin to demyelinate Sternarchus electrocytes may provide a useful system for experimental neuropathological studies.     

Acute conduction block associated with experimental antiserum-mediated demyelination of peripheral nerve

Intraneural injection of antisera from rabbits with high antigalactocerebroside antibody levels into rat sciatic nerve produced acute nerve conduction block. This was first apparent in some motor axons between 30 and 60 minutes after injection and progressed to completion within 2 to 4 hours. Concurrent morphological evidence of demyelination was present, but structural changes at the time of onset of block were mild and were restricted to the myelin and Schwann cell, particularly at the paranodal areas and Schmidt-Lanterman clefts. It is suggested that paranodal lesions could account for the observed conduction block.     

Effects of IDPN-induced axonal swellings on conduction in motor nerve fibers

Paranodal demyelination produces a reduction of conduction velocity and conduction block. The relative proportions of these changes appear to vary among different demyelinating disorders. In this study we have examined the effects on conduction of paranodal demyelination produced by giant axonal swellings. The axonal swellings were induced in rats by administration of beta, beta'-iminodipropionitrile (IDPN). In this experimental model synchronous axonal swellings occur in the proximal region of virtually every alpha-motorneuron without evidence of segmental demyelination or fiber loss. Conduction across the motor neuron was evaluated by two methods: a monosynaptic reflex pathway and intracellular recording from single motor neurons. Increases in the delay across the central region of the monosynaptic reflex pathway began between 2 and 4 days after toxin administration. Intracellular studies confirmed that the slowing occurred across the proximal regions of the motor axons; more distal regions of the motor axons were unaffected. The substantial reduction in conduction velocity over the swollen segment occurs with only moderate evidence of conduction block, as assayed by a reduction in the H-reflex/M-response amplitude ratio. Parallel morphological studies showed that in the enlarged fibers the myelin terminal loops maintained contact with the axon but were displaced from the paranodal region into the internode. The appearance of this "passive" paranodal demyelination correlated closely with the increase in conduction delay. We suggest that the contact maintained by the displaced myelin terminal loops with the axolemma allows saltatory conduction to continue, and explains the paucity of conduction block in this model despite the prominent conduction slowing.     

Morphologic basis of conduction block]

Conduction block is electrophysiologically defined and is shown to be an important pathologic condition encountered in both central and peripheral nervous system disorders. The conduction block is encountered most frequently in peripheral nerve injuries, which are the results of compression and ischemia. It is impossible to study morphologically the particular myelinated fibers showing the conduction block in human cases, but the alterations of myelinated fibers in the experimental models have been studied. The disturbance and/or destruction of the axoglial junction, with or without subsequent paranodal and segmental demyelination, is the major cause of the conduction block and is relatively easily identified morphologically in teased fiber and electron microscopic preparations of myelinated fibers. Following paranodal and segmental demyelination, the compensatory increase of large intramembranous particles, probably corresponding to the sodium channel, may enable the continuous conduction to be successful across the demyelinated axon. The abnormality of the nodal axolemma, dysfunction and/or loss of sodium channels, is another major cause and is not easily proven by light and electron microscopic techniques. Both causes may be concomitant under certain clinical and experimental conditions. Clinical and experimental conditions characterized by the conduction block are also listed.     

Multifocal motor neuropathy: pathologic alterations at the site of conduction block

The pathologic changes of nerves in multifocal motor neuropathy (MMN), a rare neuropathy with selective focal conduction block of motor fibers in mixed nerves, remain essentially unstudied. Fascicular nerve biopsy of 8 forearm or arm nerves in 7 patients with typical MMN was undertaken for diagnostic reasons at the site of the conduction block. Abnormalities were seen in 7 of 8 nerves, including a varying degree of multifocal fiber degeneration and loss, an altered fiber size distribution with fewer large fibers, an increased frequency of remyelinated fiber profiles, and frequent and prominent regenerating fiber clusters. Small epineurial perivascular inflammatory infiltrates were observed in 2 nerves. We did not observe overt segmental demyelination or onion bulb formation. We hypothesize that an antibody-mediated attack directed against components of axolemma at nodes of Ranvier could cause conduction block, transitory paranodal demyelination and remyelination, and axonal degeneration and regeneration. Alternatively, the antibody attack could be directed at components of paranodal myelin. We favor the first hypothesis because in nerves studied by us, axonal pathological alteration predominated over myelin pathology. Irrespective of which mechanism is involved, we conclude that the unequivocal multifocal fiber degeneration and loss and regenerative clusters at sites of conduction block explains the observed clinical muscle weakness and atrophy and alterations of motor unit potentials. The occurrence of conduction block and multifocal fiber degeneration and regeneration at the same sites suggests that the processes of conduction block and fiber degeneration and regeneration are linked. Finding discrete multifocal fiber degeneration may also provide an explanation for why the functional abnormalities remain unchanged over long periods of time at discrete proximal to distal levels of nerve and may emphasize a need for early intervention (assuming that efficacious treatment is available).     

Peripheral nervous system and central nervous system pathology in rapidly progressive lower motor neuron syndrome with immunoglobulin M anti-GM1 ganglioside antibody

Pathological studies, including novel teased peripheral nerve fiber studies, were performed in a patient who presented with a rapidly progressive, lower motor neuron syndrome and high titer of immunoglobulin M anti-GM1 ganglioside antibody. In the central nervous system, there was a severe loss of motor neurons and central chromatolysis with ubiquitin immunopositive cytoplasmic inclusions in residual motor neurons. In the peripheral nervous system, axonal degeneration of myelinated fibers in the anterior nerve roots was evident. Pathologic evidence of sensory nerve involvement was also found despite the absence of clinical or electrophysiological sensory abnormalities. Sectional studies of single myelinated nerve fibers from an antemortem sural nerve biopsy showed remyelination and globular paranodal swellings due to focal complex myelin folding and degeneration in 13% of fibers. Postmortem studies of the sural nerves 4 weeks later showed paranodal demyelination (90% of fibers), but no paranodal swellings and similar findings were present in samples of the ulnar, radial, median, tibial, and common peroneal nerves. Paranodal abnormalities of enlargement of the adaxonal space, myelin degeneration, and axonal compaction were found on cross-sectional studies of individual teased fibers, which on conventional light microscopic assessment appeared normal. These changes suggest a disturbance of paranodal axonal-myelin adhesion due to binding of the anti-GM1 ganglioside antibody to the common epitope known to be present on the myelin sheath and nodal axolemma in the paranodal region of both motor and sensory nerves.     

Reversible diabetic nerve dysfunction: structural correlates to electrophysiological abnormalities

Structural alterations of the nodal and paranodal areas were examined in the posterior tibial nerve in insulin-depleted and insulin-treated diabetic BB rats. The early metabolic phase of the distal symmetrical polyneuropathy was characterized by paranodal axonal swellings and nodal bulgings of the axon. These alterations correlate with intraaxonal sodium accumulation and decreased sodium equilibrium potentials which account for the early nerve conduction defect. Both the structural and electrophysiological abnormalities were completely normalized after vigorous insulin therapy. In the chronic diabetic polyneuropathy the paranodal area showed loss of paranodal axoglial junctions and paranodal myelin retraction. These changes may be partially responsible for the impaired electrical activity at the node as exemplified by irreversibly impaired sodium permeability and nerve conduction.     

CIDP - the relevance of recent advances in Schwann cell/axonal neurobiology

Early pathological studies in patients with acute and chronic inflammatory demyelinating neuropathies, and the animal model experimental autoimmune neuritis (EAN) showed similarities in the process of demyelination. These studies focused on compact myelin proteins and peptides as targets of immune attack in Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and EAN. However, serological studies in patients with subsets of GBS highlighted the importance of gangliosides - glycolipids enriched in non-compact Schwann cell regions and the node, paranodal, and internodal axolemma. In the acute motor axonal neuropathy (AMAN) rabbit model, antibodies to the ganglioside GM1 bind in the nodal region, impair Na channel clustering and disturb Schwann cell/axon organisation. Schwann cell neurobiological studies now highlight the importance of adhesion molecules, including neurofascins, gliomedin, contactins, and NrCAM to Schwann cell/axon integrity. Changes to nodal fine structure by immune responses against such molecules may provide a mechanism for reversible conduction failure or block. Recovery of patients with CIDP or multifocal motor neuropathy (MMN) following treatment may sometimes be better explained by reversal of conduction failure than remyelination or regeneration. This review considers the importance of the intricate molecular arrangements at the nodal and paranodal regions in inflammatory neuropathies such as CIDP. Early images of compact myelin stripping and phagocytosis, may have diverted the research focus away from these vital non-compact myelin Schwann cell areas.     

Morphological progression of myelin abnormalities in IgM-monoclonal gammopathy of undetermined significance anti-myelin-associated glycoprotein neuropathy

To characterize the morphological progression of neuropathy associated with immunoglobulin M-monoclonal gammopathy of undetermined significance with anti-myelin-associated glycoprotein antibody, we assessed histopathologic features of sural nerve specimens from 15 patients, emphasizing widely spaced myelin (WSM), demyelination, and tomaculous changes. The frequency of WSM correlated with that of demyelination and tomaculous appearance in teased-fiber preparations. In longitudinal sections at nodes of Ranvier and paranodal regions, the spaces between terminal myelin loops, particularly those adjacent to the node of Ranvier, were widened, indicating an early change before demyelination, and there was concomitant swelling of terminal myelin loops. Some conspicuously swollen terminal myelin loops were detached from the paranodal axolemma, thereby widening the nodes of Ranvier. Tomacula coexisted frequently with redundant myelin loops and WSM, particularly in the outermost layer of myelin sheaths, suggesting that loosening of the outer layers contributes to their formation. By immunofluorescence microscopy, immunoglobulin M and myelin-associated glycoprotein were colocalized in paranodal regions and Schmidt-Lanterman incisures. Confocal analysis revealed colocalization of immunoglobulin M and complement product C3d corresponding to the area of WSM. Thus, morphological changes in terminal myelin loops, formation of WSM at paranodes, and subsequent dissociation from paranodal axolemma (which may be associated with activation of the complement pathway) likely contribute to demyelination in this condition. Loosening of compact myelin seems to contribute to tomacula formation.     

Nodal and paranodal structure during Wallerian degeneration in frog spinal nerve

The nodal and paranodal regions of myelinated peripheral nerve fibers in frogs were examined at sequential times (1-24 days) during Wallerian degeneration. In the region up to 3 mm distal to the transection, paranodal demyelination and axoplasmic degeneration became apparent on day 4 and progressed to involve most of the nodes by day 8. The E-fracture face of the axolemma showed a patchy distribution of nodal particles and some paranodal demyelination on days 4 and 6. On day 8, nodal particles were evenly distributed at low concentration and the adjacent demyelinated paranodal regions showed a corresponding increase in particle density, suggesting redistribution of the nodal particles. The sequence of changes seen in comparable to that in Wallerian degeneration of central nervous system (CNS) fibers but progressed more rapidly in the peripheral nervous system (PNS). In addition a higher proportion of PNS fibers shows pathological changes at corresponding time periods.     

IgM deposits at nodes of Ranvier in a patient with amyotrophic lateral sclerosis, anti-GM1 antibodies, and multifocal motor conduction block

We studied a patient with amyotrophic lateral sclerosis, multifocal motor conduction block, and IgM anti-GM1 antibodies. A sural nerve biopsy demonstrated deposits of IgM at nodes of Ranvier by direct immunofluorescence. The deposits were granular and located in the nodal gap between adjacent myelin internodes, and in some instances, they extended along the surface of the paranodal myelin sheath. When injected into rat sciatic nerve, the serum IgM bound to the nodes of Ranvier, and the binding activity was removed by preincubation with GM1. These observations suggest that anti-GM1 antibodies may have caused motor dysfunction by binding to the nodal and paranodal regions of peripheral nerve.     

Age-related molecular reorganization at the node of Ranvier

In myelinated axons, action potential conduction is dependent on the discrete clustering of ion channels at specialized regions of the axon, termed nodes of Ranvier. This organization is controlled, at least in part, by the adherence of myelin sheaths to the axolemma in the adjacent region of the paranode. Age-related disruption in the integrity of internodal myelin sheaths is well described and includes splitting of myelin sheaths, redundant myelin, and fluctuations in biochemical constituents of myelin. These changes have been proposed to contribute to age-related cognitive decline; in previous studies of monkeys, myelin changes correlate with cognitive performance. In the present study, we hypothesize that age-dependent myelin breakdown results in concomitant disruption at sites of axoglial contact, in particular at the paranode, and that this disruption alters the molecular organization in this region. In aged monkey and rat optic nerves, immunolabeling for voltage-dependent potassium channels of the Shaker family (Kv1.2), normally localizing in the adjacent juxtaparanode, were mislocalized to the paranode. Similarly, immunolabeling for the paranodal marker caspr reveals irregular caspr-labeled paranodal profiles, suggesting that there may be age-related changes in paranodal structure. Ultrastructural analysis of paranodal segments from optic nerve of aged monkeys shows that, in a subset of myelinated axons with thick sheaths, some paranodal loops fail to contact the axolemma. Thus, age-dependent myelin alterations affect axonal protein localization and may be detrimental to maintenance of axonal conduction.     

Quantitative analysis of myelin and axolemma particle distribution in C57BL/Ks diabetic mice and the effects of ganglioside treatment

By freeze-fracture technique we estimated myelin and axolemma intramembranous particle density in C57BL/Ks mice. A decrease in myelin particle content compared to controls is present in both 180 and 280 day old genetic diabetic mice. In addition, the axolemma of myelinated axons is affected in interparanodal regions while no modification was detected at nodal level. Such alterations of myelin membrane structure may also be responsible for the lower motor nerve conduction velocity (MNCV) observed in these diabetic mice; however this hypothesis cannot be taken into consideration for the reduction in MNCV at the early stage of the neuropathy (prior to 180 days of life). Therefore the structural changes of both myelin sheath and interparanodal axolemma as visualized by freeze-fracture are most likely related to late complications of the disease instead of being responsible for the changes in excitability. The low myelin and axolemma particle density of diabetic mice was found normal after 30 days' treatment with gangliosides. Such findings are in agreement with previous results on a significant effect of ganglioside treatment on MNCV and axonal area alterations in 180 and 280 day old genetic diabetic mice.     

Ultracytochemical localization of ouabain-sensitive K-dependent, p-nitrophenyl phosphatase in myelin

Ouabain-sensitive, K+-dependent p-nitrophenyl phosphatase (K-NPPase) activity was demonstrated ultracytochemically in the myelin of nerve fibers in peripheral and central white matter. Enzyme activity was more prominent in paranodal than compact myelin, and it was absent from nodal and interparanodal axolemma. Since K-NPPase is part of the Na-KATPase complex, we consider myelin as an important site of the sodium pump and believe that myelin participates in cationic regulation of the nervous tissue.     

Paranodal dysmyelination in peripheral nerves of Trembler mice

Subtle defects in paranodes of myelinated nerve fibers can cause significant physiological malfunction. We have investigated myelinated fibers in the peripheral nervous system (PNS) of the Trembler mouse, a model of CMT‐1A neuropathy, for evidence of such defects. Ultrastructural analysis shows that the “transverse bands,” which attach the myelin sheath to the axon at the paranodal axoglial junction, are grossly diminished in number in Trembler nerve fibers. Although paranodes often appear to be greatly elongated, it is only a short region immediately adjacent to the node of Ranvier that displays transverse bands. Where transverse bands are missing, the junctional gap widens, thus reducing resistance to short circuiting of nodal action currents during saltatory conduction and increasing the likelihood that axonal K⁺ channels under the myelin sheath will be activated. In addition, we find evidence that structural domains in Trembler axons are incompletely differentiated, consistent with diminution in nodal Na channel density, which could further compromise conduction. Deficiency of transverse bands may also increase susceptibility to disruption of the paranodal junction and retraction of the myelin sheath. We conclude that Trembler PNS myelinated fibers display subtle defects in paranodal and nodal regions that could contribute significantly to conduction defects and increased risk of myelin detachment. © 2014 Wiley Periodicals, Inc.     

Acute peripheral nerve compression in the baboon

As a model of acute pressure neuropathy (“Saturday night palsy”) in man, a weighted nylon cord lying across the limb has been used to produce local compression of the ulnar and anterior tibial nerves in anaesthetised baboons. Motor nerve conduction studies were carried out 18–24 hr after compression; in some animals they were repeated at intervals for periods of up to 16 weeks.In the ulnar nerve the results were variable, but in the anterior tibial nerve, compression by a 1.5 kg weight for 90 min regularly produced a severe or complete conduction block. In such cases the pressure on the skin over the nerve ranged from 1.6–2.1 kg/cm². A pressure of approximately 1.0 kg/cm² caused a partial conduction block with a conduction delay in the unblocked fibres. A pressure of 0.75 kg/cm² or less caused no conduction defect.When the periods of compression were extended from 90 min to 120, 150 or 180 min, the conduction blocks were accompanied by increasing amounts of Wallerian degeneration. The local blocks produced by the longer periods of compression were also slower to recover.The histological features of the lesions were basically similar to those described previously after nerve compression by a pneumatic tourniquet. In the large myelinated fibres there was displacement of the nodes of Ranvier along the fibres away from the site of pressure. This movement occurred in 2 zones near the edges of the lesion, the nodes at the centre of the lesion being spared. Accompanying the nodal displacement there was stretching of the paranodal myelin on one side of the node and invagination on the other. At the extreme edges of the lesion there was sometimes distension of the paranodal regions with thinning of the myelin.These changes were followed by demyelination and finally by remyelination. In the recovery phase irregular myelin swellings were seen which were similar in appearance to those seen previously in recovering nerves after a pneumatic tourniquet.These results, together with those described previously, indicate that in “Saturday night palsy” and similar pressure lesions of peripheral nerves, the conduction block is due to a direct mechanical effect of the applied pressure on myelinated fibres, and that ischaemia, due to compression of the intra-neural blood vessels, plays little if any part.     

Schwann cell proliferation and migration during paranodal demyelination

This study examined Schwann cell behavior during paranodal demyelination induced by beta,beta'-iminodipropionitrile (IDPN). The stimuli for Schwann cell proliferation, extensively studied in vitro, are less well understood in vivo. Most in vivo systems previously used to examine Schwann cell proliferation in disease are dominated by loss of internodal myelin sheaths. As used in this study, IDPN administration produces neurofilamentous axonal swellings and paranodal demyelination, without segmental demyelination or fiber degeneration. We asked whether Schwann cells would proliferate following the restricted paranodal demyelination that accompanies the axonal swellings, and if so what the sources and distributions of new Schwann cells might be. IDPN was given as a single large dose (2 ml/kg) to 21-d-old rats. Neurofilamentous axonal swellings formed in the proximal regions of motor axons, reaching their greatest enlargement in the root exit zone 8 d after IDPN administration. These swellings subsequently migrated distally down the nerves at rates approaching 1 mm/d. The axonal enlargement was consistently associated with displacement of the myelin sheath attachment sites into internodal regions, and consequent paranodal demyelination. This stage was associated with perikaryal changes, including nucleolar enlargement, "girdling" of the perikaryon, and formation of attenuated stalks separating the perinuclear region from the external cytoplasmic collar. Schwann cells proliferated abundantly during this stage. Daughter Schwann cells migrated within the endoneurial space (outside the nerve fiber basal laminae) to overlie the demyelinated paranodes of swollen nerve fibers. In these regions, local proliferation of Schwann cells continued, resulting in large paranodal clusters of Schwann cells. As the axonal calibers subsequently returned to normal, the outermost myelin lamellae of the original internodes returned to their paranodal attachment sites and the supernumerary Schwann cells disappeared. Formation of short internodes, segmental demyelination, and nerve fiber loss were rare phenomena. These results indicate that paranodal demyelination is a sufficient stimulus to excite abundant Schwann cell proliferation; neither internodal demyelination nor myelin breakdown is a necessary stimulus for mitosis. The 3H-thymidine incorporation studies indicated that the sources of new Schwann cells included markedly increased division of the Schwann cells of unmyelinated fibers and, as they formed, supernumerary Schwann cells. In addition, there were rare examples of 3H-thymidine incorporation by Schwann cells associated with myelinated nerve fibers.(ABSTRACT TRUNCATED AT 400 WORDS)     

Nodal and paranodal structural changes in mouse and rat optic nerve during Wallerian degeneration

Ultrastructural changes in nodal and paranodal regions of myelinated mouse and rat optic nerve fibers were followed between 4 h and 28 days during the course of Wallerian degeneration. In the mouse, axoplasmic changes, including accumulation of organelles and segregation of microtubules, were detectable 4 h after transection, and progressed to a maximum level on day 4, at which time many axons were markedly swollen. Dense axoplasm was seen as early as 16 h and was a common feature of degenerating axoplasm at later times. Paranodal changes, which first appeared as early as 16 h after injury, included detachment of terminal loops of myelin from the axolemma, disconnection of terminal loops from compact myelin lamellae and broadening of terminal loops, or separation of the loops from each other, resulting in paranodal elongation. In freeze-fracture replicas, the E-face of the axolemma showed the normal particle distribution as late as days 3-5. By day 8, however, the nodal particles were patchy and the overall nodal particle density was reduced to approximately half normal. Some normal-looking fibers were present at all stages examined, but their number had declined to about half the total population on day 5 and to less than 10% on day 11. In the rat, the overall sequence of events and time course were comparable to those in the mouse. Thus, the morphological changes found follow approximately the same sequence as that described previously in frog nerves, but progress more rapidly in the mouse and rat.     

COPPER BINDING AT PNS NODES OF RANVIER DURING DEMYELINATION AND REMYELINATION IN THE PERINEURIAL WINDOW

Nodes of Ranvier of peripheral nerves are associated with mucopolysaccharide which is capable of binding a wide variety of cations. The present study has determined the changes in the binding properties of the node of Ranvier during demyelination and remyelination in the perineurial window. The location of copper ion binding, visualized as a dense copper ferrocyanide precipitate, was studied in teased fibres from 60 rat peroneal nerves with single perineurial windows and from 8 normal nerves. In normal nerves, precipitate was present over the nodal axon and at the borders of the paranodal axon. Before demyelination, severely beaded fibres sited within the perineurial window displayed a reduction or a loss of nodal precipitate. During the period of myelin phagocytosis and demyelination, precipitate was absent throughout the denuded axon but present at adjacent, uninvolved nodes. At the commencement of remyelination, precipitate appeared at the newlycreated nodal and paranodal regions and at interfaces between preserved and remyelinating internodes. The density increased with myelin thickening. These findings indicate: (1) severely beaded regions lose their normal binding property before undergoing demyelination, (2) demyelinated regions do not bind copper ions, (3) remyelinating fibres bind copper ions at newly-created nodes and (4) Schwann cells are responsible for the production of nodal mucopolysaccharides.     

Remyelination following viral-induced demyelination: ferric ion-ferrocyanide staining of nodes of Ranvier within the CNS

Ferric ion-ferrocyanide (Fe-FeCN) staining was used to stain nodes of Ranvier in remyelinating central nervous system (CNS) axons following viral-induced demyelination. As at normal nodes, Fe-FeCN staining was observed on the cytoplasmic surface of the nodal axolemma of remyelinated fibers. These fibers were identified on the basis of inappropriately short internode lengths and thin myelin sheaths. Thus, newly formed nodes along remyelinated CNS axons recapitulate at least one normal nodal membrane property.