Bcl-2 expressing T lymphocytes in multiple sclerosis lesions

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. T lymphocytes play a major role in the pathogenesis of the disease. The exact mechanisms by which the inflammation is regulated in MS have not yet been defined. Studies in animal models of MS suggest that apoptosis of T  cells is the main factor terminating inflammation. The process of apoptosis itself is regulated by a range of pro- and anti-apoptotic proteins. The bcl-2 gene family is an important member of these proteins. The present study investigated the expression of the anti-apoptotic protein bcl-2 in 11 chronic MS cases including five relapsing-remitting and six chronic progressive MS patients. A total of 35 lesions containing all stages of demyelinating activity were studied. The number of CD3-positive T  cells and the absolute and relative numbers of T  cells expressing bcl-2 were determined by double immunocytochemistry. Bcl-2 is expressed by T lymphocytes in MS plaques. Patients with chronic progressive MS have a higher proportion of bcl-2 expressing T  cells than patients with relapsing remitting disease. Highest numbers of bcl-2-positive T lymphocytes were found in remyelinating and demyelinated lesions, whereas active demyelinating lesions revealed lower numbers. These data indicate that cell-death-related proteins such as the anti-apoptotic protein bcl-2 are expressed in MS lesions and that they might have important effects on the regulation of elimination or persistence of inflammatory cells in the central nervous system.     

Lymphocyte responsiveness to oligodendrocytes in multiple sclerosis

Lymphocyte responsiveness to oligodendrocytes has been examined with a modification of the antigen-reactive early T cell test in a total of 206 blood samples [104 multiple sclerosis (MS); 62 other neurological diseases (OND); 14 non-neurologic diseases; and 26 normals]. Oligodendrocyte reactivity was detectable more frequently in MS (49%) than in OND (23%) and normals (8%) but was absent from patients with non-neurologic diseases. Percentages of lymphocytes binding oligodendrocyte antigens were determined by direct and indirect immunofluorescence and immunocyto-adherence. Comparable results were obtained from all 3 systems. Percentages of oligodendrocyte antigen-binding lymphocytes were higher in MS than in OND and normals. With the present battery of techniques, lymphocyte responsiveness to oligodendrocytes has been shown to be more common in MS but since it is also found among OND, it is not MS-specific and most likely represents an epiphenomenon associated with white matter destruction.     

Hypothalamic lesions in multiple sclerosis.

Demyelinating lesions of fiber bundles in and adjacent to the hypothalamus (i.e. the fornix. anterior commissure, internal capsule, and optic system) may be the basis for autonomic and endocrine alterations in multiple sclerosis (MS) patients. Therefore we investigated the presence and immunological activity of lesions in hypothalamic fiber bundles of 17 MS patients and 14 controls. In the MS group, 16 of 17 patients showed demyelinated lesions. The incidence of active lesions was high (60%) and outnumbered chronic inactive lesions in the internal capsule (p = 0.005). In 4 of 17 MS patients, axonal damage was observed and in 3 of 17 MS patients grey matter lesions were apparent. Duration of MS was inversely related to the active hypothalamic MS lesion score (r = -0.72, p = 0.001). Since comparison of hypothalamic lesions with MS lesions in other areas of the brain in the same patients (n = 7) showed a great similarity both as stage and appearance was concerned, this negative relation in all likelihood reflects the clinical consequences of high disease activity throughout the whole brain. In controls no demyelinating lesions were seen but in 11 control cases HLA expression was observed that was lower than that present in MS patients (p = 0.02). In the median eminence region that lacks a blood-brain barrier, all controls showed a strong HLA expression around the blood vessels. We conclude that systematic pathological investigation of the hypothalamus in MS patients reveals an unexpected high incidence of active lesions that may impact on hypothalamic functioning.     

VCAM-1-positive microglia target oligodendrocytes at the border of multiple sclerosis lesions

The distribution and lineage of vascular cell adhesion molecule-1 (VCAM-1)-positive cells was investigated in 43 lesions from the brain tissue of patients with multiple sclerosis (MS). Numerous VCAM-1-positive macrophages/microglia were detected at the edges of MS lesions. Quantitative analysis of 6 active, 7 chronic active, and 4 chronic inactive MS lesions identified most VCAM-1-positive cells at the actively demyelinating borders of active (102/mm3) and chronic active (29/mm3) lesions, but rarely in chronic inactive lesions (4/mm3). Further, approximately 17% of the VCAM-1-positive cells closely apposed or surrounded oligodendrocyte perikarya at the edges of active and chronic active lesions that were sites of ongoing demyelination. Endothelial cells were VCAM-1-negative in both lesion and non-lesion MS brain tissue. This report is the first to document direct microglial interaction with oligodendrocytes in MS.     

Tumour-like lesions in multiple sclerosis

The presence of tumefactive lesions on magnetic resonance imaging (MRI) in multiple sclerosis (MS) patients can cause diagnostic difficulties. It requires differential diagnosis between tumefactive demyelinating lesion (TDL) and the coexistence of neoplasm; it also implies further management. The precise assessment of such lesions at the first clinical manifestation of the disease is particularly important. We present three cases of MS presenting with tumour-like lesions of the brain. Based on serial MRI studies, stereotactic biopsy and the response to treatment with corticosteroids, the diagnosis of TDL was established in every case.     

Flow microfluorometry detects IgM autoantibody to oligodendrocytes in multiple sclerosis

Freshly isolated canine oligodendrocytes were reacted by indirect membrane immunofluorescence with 44 sera from patients with multiple sclerosis (MS). Using analysis by flow microfluorometry (FMF), we found significant IgM antibody binding to the surfaces of oligodendrocytes in the MS sera. The fluorescence intensity of cell surface reactions for MS sera (F.I. > 40 = 37.2±21.34%) was significantly different (P < 0.001) to that for 53 sera from normal subjects (10.0±8.97%), 15 sera from patients with Murray Valley encephalitis (6.18±5.3%), 22 with brain tumours (6.28±5.3%), 25 with SLE (13.42±3.04%). Cell surface binding was and 7 miscellaneous neurological disorders (6.87±3.045). Cell surface binding was restricted to oligodendrocytes and was absorbed out by oligodendrocytes but not by liver cells or kidney cells. Oligodendrocytes were identified by conventional histology, phase-contrast optics, electron microscopy (EM) and by cell surface reactions with anti-galactocerebroside, a specific immunocytological marker for oligodendrocytes. A cell sort of the single 0° FMF scatter peak followed by EM examination confirmed that the reactive cells consisted exclusively of oligodendrocytes. Viability of oligodendrocytes before and after the staining reactions, was>80% as assessed by trypan blue and fluorescein diacetate exclusion. The possibility that immune reactions mediated by the surface-reactive antibody with readily accessible cell surface autoantigens in vivo may contribute to the loss of oligodendrocytes and demyelination in MS is raised.     

Lidocaine unmasks silent demyelinative lesions in multiple sclerosis.

Blockage of a small number of sodium channels may prevent impulse conduction in some demyelinated segments of nerve fibers with low safety factors, thereby unmasking subclinical demyelinative lesions. On the basis of this hypothesis, lidocaine, a sodium channel blocker, was administered intravenously to 28 MS patients and to 19 normal subjects and seven patients with nondemyelinating diseases. As predicted, lidocaine (mean plasma level, 2.7 micrograms/ml) elicited reversible subclinical symptoms in 23 of the MS patients, but it had not effect on the control subjects. We made a quantitative study of the visual functions (visual acuity, color vision, visual evoked potential [VEP]) that were impaired in 15 MS patients. Of the 23 affected eyes, nine showed normal VEPs, indicative of the test's sensitivity to focal lesions. This test should be useful in the diagnosis of MS and in the evaluation of the subclinical activity of MS as well.     

Contrast-enhanced lesions on computerised tomography in multiple sclerosis.

Two patients are described in whom computerised tomography revealed contrast-enhanced lesions in the early stages of multiple sclerosis. Such lesions may be differentiated from tumours by their transient nature, lack of space-occupying effect, and localisation in the white matter. Contrast enhancement in demyelinating disease is probably related to local breakdown of the blood-brain barrier.     

Bcl-2 and its homologues in the brain of patients with multiple sclerosis

We measured the mRNA expression levels of molecules involved in scavenging free radicals and in apoptosis within normal appearing white and gray matter (NAWM and NAGM, respectively) and chronic active plaque containing frontal lobe specimens of patients with multiple sclerosis (MS). While no regional differences were detected in the mRNA levels of free radical scavengers, Bcl-XL was higher in plaques than in NAWMs, and both Bak and Bcl-2 were found to be increased in correlation with an immune marker (beta2-microglobulin--beta2Mg) in NAWM and plaque compared with corresponding cortical regions. We did not measure a similar white-gray matter difference in the expression of the latter genes in brains of normal or Alzheimer disease controls. This finding indicates that both pro- and anti-apoptotic mechanisms are activated, not only within but also outside of plaques.     

Gadolinium-enhanced brain lesions in multiple sclerosis relapse

ObjectiveTo study the clinico-radiological paradox in multiple sclerosis (MS) relapse by analyzing the number and location of gadolinium-enhanced (Gd+) lesions on brain MRI before methylprednisolone (MP) treatment.MethodsWe analyzed brain MRI from 90 relapsed MS patients in two Phase IV multicenter double-blind randomized clinical trials that showed the noninferiority of different routes and doses of MP administration. A 1.5- or 3-T brain MRI was performed at baseline before MP treatment and within 15 days of symptom onset. The number and location of Gd+ lesions were analyzed. Associations were studied using univariate analysis.ResultsSixty-two percent of patients had at least 1 Gd+ brain lesion; the median number was 1 (interquartile range 0–4), and 41% of patients had 2 or more lesions. The most frequent location of Gd+ lesions was subcortical (41.4%). Gd+ brain lesions were found in 71.4% of patients with brainstem-cerebellum symptoms, 57.1% with spinal cord symptoms and 55.5% with optic neuritis (ON). Thirty percent of patients with brain symptoms did not have Gd+ lesions, and only 43.6% of patients had symptomatic Gd+ lesions. The univariate analysis showed a negative correlation between age and the number of Gd+ lesions (p = 0.002).ConclusionMost patients with relapse showed several Gd+ lesions on brain MRI, even when the clinical manifestation was outside of the brain. Our findings illustrate the clinico-radiological paradox in MS relapse and support the value of brain MRI in this scenario.     

CDlb is expressed in multiple sclerosis lesions

Recent observations have shown that CD1 molecules act as restriction elements in the presentation of antigens to specialized subsets of T cells. To examine the expression of CD1 molecules in multiple sclerosis (MS) lesions, frozen sections of central nervous system (CNS) tissues from nine MS and three other neurological disease (OND) patients, one patient with Wilson's disease, and one non-neurological control were stained by immunocytochemistry. In chronic-active MS lesions, CDlb immunoreactivity was prominent on perivascular inflammatory cells whereas macrophages within the lesion showed little reactivity. At the lesion edge, intense immunoreactivity for CDlb was found on hypertrophie astrocytes. High level expression of CDlb in MS lesions was found to colocalize with the presence of GM-CSF in astrocytes. In chronic-silent lesions, CDlb expression was found on only a few perivascular astrocytic foot processes and the occasional perivascular macrophage. CDlb was not found in the tissues studied for control purposes. In contrast, MHC class II expression was detected on microglia in all tissues examined. The relatively low level expression of CDlb in normal-appearing tissues, chronic-silent lesions and in the OND controls supports the conclusion that the expression of CDlb in active MS lesions is significantly upregulated and could contribute to lesion development.     

Spinal cord lesions of multiple sclerosis

The neuropathological findings of the spinal cord lesions of six human multiple sclerosis cases are described. The spinal cord was extensively necrotic and occasionally cystic in five remitting and relapsing cases. The lesions became more severe as the disease course prolonged and relapses increased. The spinal cords of two cases in particular, with a duration of illness of more than 5 years, were severely atrophic. In these cases, peripheral type remyelination was prominent, although central type remyelination was minimal. In contrast, in mouse spinal cords, in which experimental demyelination and remyelination were induced by ethidium bromide, the degree of central type remyelination and peripheral type remyelination was almost the same. Longitudinal sections of the transitional zone between the areas of central type remyelination and peripheral type remyelination contrained Ranvier nodes, in which central type myelin and peripheral type myelin were situated side by side around a central type axon. These transitional zones were similar to those of the normal transitional zone between the central nervous system and peripheral nervous system of the nerve roots. One chronic progressive case, despite the very long duration of illness, showed classical sharply demarcated demyelinated lesions with marked fibrillary gliosis. The spinal cord of this case was not atrophic and axons were well preserved.     

Expression ratios of the Bcl-2 family proteins and disease activity in multiple sclerosis

There is emerging evidence that failure of apoptosis (programmed cell death) of potentially pathogenic T lymphocytes may be involved in the pathogenesis of multiple sclerosis (MS). The commitment of T lymphocytes to die is partly regulated by the Bcl-2 family proteins, which act as a checkpoint upstream of mitochondrial dysfunction. These proteins include the death antagonists Bcl-2 and Bcl-X(L), and death agonists Bax and Bad. Recent studies suggest that altered expression of Bcl-2 family proteins in T lymphocytes is involved in promoting cellular resistance to apoptosis in patients with MS. However, the relationship between these alterations in Bcl-2 proteins expression and clinical disease activity has not yet been evaluated. In this study, we analyzed the expression ratios of pro- to anti-apoptosis Bcl-2 family proteins in patients with clinically active MS and compared results to corresponding ratios in patients with stable MS and relevant control groups. We observed a significant reduction in the expression ratios of pro- to anti-apoptosis Bcl-2 members in peripheral lymphocytes from patients with active MS when compared to corresponding ratios in patients with stable MS or other controls. This imbalance in the expression ratios of pro- and anti-apoptosis proteins was functionally active in reducing cellular susceptibility to apoptosis in active MS. It also correlated with clinical features of disease activity, such as the number of gadolinium-enhancing MRI lesions and clinical relapses. Our findings indicate that dysregulated expression of Bcl-2 family proteins in peripheral lymphocytes is a feature of clinically active multiple sclerosis.     

Temporal and spatial profiles of ABCA2-expressing oligodendrocytes in the developing rat brain

ABCA2 protein belongs to the ABCA subclass of ATP-binding cassette (ABC) transporters proposed to exert critical functions in transmembrane transport of endogenous lipids. In this study, we found by immunoblot analyses that approximately 260 kDa of ABCA2 protein is expressed predominantly in oligodendrocytes, and that the expression of the protein is upregulated in the brain during maturation, especially between postnatal days 6 and 19. Parallel to the changes in expression of ABCA2, immunohistochemical analyses showed rapid spatial spread of ABCA2-immunolabeled oligodendrocytes in the brain during this period. These temporal and spatial changes in ABCA2 expression were in good agreement with findings in myeloarchitectonics reported previously. Further, double immunolabeling with ABCA2 and a major structural protein of myelin, myelin basic protein, demonstrated that onset of ABCA2 expression in oligodendrocytes coincides with the appearance of thick myelin segments immunolabeled with myelin basic protein. Because ABCA2 was abundantly expressed in adult cortex in white matter and gray matter, coexpression of ABCA2 and a marker for the oligodendroglial progenitors NG2 or platelet-derived growth factor alpha receptor was investigated. No cells coexpressing ABCA2 and the marker were observed, suggesting that ABCA2 is expressed predominantly in myelin-forming oligodendrocytes distinct from the adult oligodendroglial progenitors tested. These results suggested a role for ABCA2 in membrane transport of substrates such as the lipids that are closely linked to myelination processes.