Lesion development in Marburg's type of acute multiple sclerosis: from inflammation to demyelination
- 1 June 1999
- journal article
- research article
- Published by SAGE Publications in Multiple Sclerosis Journal
- Vol. 5 (3) , 138-146
- https://doi.org/10.1177/135245859900500302
Abstract
We report a patient who suffered from acute inflammatory CNS demyelination and underwent two consecutive diagnostic stereotactic brain biopsies during the early disease course. The first lesion was drawn 33 days after the onset of disseminated neurological symptoms. Macrophages and T lymphocytes diffusely infiltrated small vessel walls and the white matter. mRNA for tumor necrosis factor alpha (TNFa) and inducible nitric oxide synthase (iNOS) was abundantly expressed. Myelin sheaths were entirely preserved. The second biopsy 76 days later showed confluent demyelinating lesions with a diffuse infiltration of macrophages that were positive for myelin debris, activation markers and TNFa and iNOS mRNA. IgG and C9neo deposits were found along myelin sheaths. The patient had received intravenous immunoglobulins (IVIG) prior to biopsy. Findings from this single patient affirm that demyelination follows the migration of inflammatory cells from the circulation into the white matter with subsequent inflammation and demyelination. Inflammation alone may be sufficient to cause significant clinical deficits without demyelination. Inflammatory mediators such as TNFa and NO are involved at very early stages in the pathogenetic process. IVIG treatment may lead to the deposition of immunoglobulins and to the activation of the complement cascade, but the clinical relevance of this particular finding remains uncertain.Keywords
This publication has 27 references indexed in Scilit:
- Axonal damage in acute multiple sclerosis lesionsBrain, 1997
- Expression of ICAM-1 and TNF? in Human Alveolar Macrophages from Lung-Transplant RecipientsAnnals of the New York Academy of Sciences, 1996
- Distinct Patterns of Multiple Sclerosis Pathology Indicates Heterogeneity in PathogenesisBrain Pathology, 1996
- Evidence for neuronal apoptosis in pontosubicular neuron necrosisNeuropathology and Applied Neurobiology, 1996
- Monocyte/macrophage differentiation in early multiple sclerosis lesionsAnnals of Neurology, 1995
- Oligodendrocyte Injury Is an Early Event in Lesions of Multiple SclerosisMayo Clinic Proceedings, 1993
- Acute demyelinating disease. Classification and non-invasive diagnosisActa Neurologica Scandinavica, 1992
- The calcium‐binding proteins MRP8 and MRP14 form a membrane‐associated heterodimer in a subset of monocytes/macrophages present in acute but absent in chronic inflammatory lesionsEuropean Journal of Immunology, 1992
- Preliminary studies of cytokine-induced functional effects on the visual pathways in the rabbitJournal of Neuroimmunology, 1989
- Antibody responses in chronic relapsing experimental allergic encephalomyelitis: correlation of serum demyelinating activity with antibody titre to the myelin/oligodendrocyte glycoprotein (MOG)Journal of Neuroimmunology, 1987