Review: low-grade gliomas as neurodevelopmental disorders: insights from mouse models of neurofibromatosis-1.

Over the past few years, the traditional view of brain tumorigenesis has been revolutionized by advances in genomic medicine, molecular biology, stem cell biology and genetically engineered small-animal modelling. We now appreciate that paediatric brain tumours arise following specific genetic mutations in specialized groups of progenitor cells in concert with permissive changes in the local tumour microenvironment. This interplay between preneoplastic/neoplastic cells and non-neoplastic stromal cells is nicely illustrated by the neurofibromatosis type 1-inherited cancer syndrome, in which affected children develop low-grade astrocytic gliomas. In this review, we will use neurofibromatosis type 1 as a model system to highlight the critical role of growth control pathways, non-neoplastic cellular elements and brain region-specific properties in the development of childhood gliomas. The insights derived from examining each of these contributing factors will be instructive in the design of new therapies for gliomas in the paediatric population.

Cerebrospinal fluid levels of a proliferation-inducing ligand (APRIL) are increased in patients with neuropsychiatric systemic lupus erythematosus.

OBJECTIVES: A proliferation-inducing ligand (APRIL) and B-cell activation factor (BAFF) are B-cell stimulation and survival molecules. We have investigated whether APRIL and/or BAFF activity is enhanced in the systemic and/or intrathechal compartment of patients with neuropsychiatric systemic lupus erythematosus (NPSLE). In particular, the association between fatigue and APRIL/BAFF activity was investigated. METHODS: Twenty-eight NPSLE patients were evaluated clinically, with sampling of cerebrospinal fluid (CSF) and blood, and magnetic resonance imaging (MRI). CSF and blood samples from 13 multiple sclerosis (MS) patients and 17 patients with other neurological diseases (OND) were used as controls. Protein levels of BAFF and APRIL were quantified in CSF and plasma, mRNA expression levels of BAFF and APRIL were determined in peripheral blood (PBMC) and CSF mononuclear cells (CSF-MC). The Fatigue Severity Scale (FSS) was used to quantify the degree of fatigue. RESULTS: NPSLE patients had higher levels of APRIL in CSF as compared to OND (p < 0.01). No corresponding increase in APRIL mRNA levels was detected in CSF-MC. BAFF levels in plasma were higher in NPSLE than in OND (p < 0.001). BAFF mRNA expression in PBMC was also higher in NPSLE patients than in controls (p < 0.05). FSS scores in patients with NPSLE correlated significantly with APRIL levels in CSF. CONCLUSIONS: Protein levels of APRIL in CSF were increased in NPSLE as compared to OND. Moreover, there was a positive correlation between CSF APRIL levels and fatigue. Our results suggest that APRIL and possibly also BAFF may be involved in the pathogenesis of NPSLE and in SLE-related fatigue.

Lipid-specific immunoglobulin M in CSF predicts adverse long-term outcome in multiple sclerosis.

BACKGROUND AND OBJECTIVE: The presence of lipid-specific immunoglobulin M bands in the cerebrospinal fluid (CSF) predicts an aggressive course in patients with relapsing-remitting multiple sclerosis (MS) during early stages of the disease. This study examined whether it is also a predictor of long-term prognosis in MS. METHODS: Eighty-one patients with MS and 22 headache controls were analyzed for anti-lipid IgM reactivity in CSF samples. The correlation between the presence of lipid-specific immunoglobulin M bands in CSF and disease progression was assessed in patients with MS who had been followed longitudinally for, on average, more than 11 years. RESULTS: Lipid-specific immunoglobulin M bands were detected in the CSF of 24 of 81 patients with MS and were absent in the CSF of all headache controls. Median time to conversion to a secondary progressive course was 11 years in patients with bands and 22 years in patients without bands. Median time to an Expanded Disability Status Scale score of 4 was 14 years in patients with bands and 24 years in patients without bands. CONCLUSION: The presence of lipid-specific immunoglobulin M bands in CSF predicts a more adverse long-term outcome in patients with MS; it may thus define a subset of patients who might benefit from aggressive treatment during the early phase of the disease.

The expression of BAFF-binding receptors is not altered in multiple sclerosis or myasthenia gravis.

Multiple sclerosis (MS) is a chronic, progressive disease of the central nervous system (CNS) characterized by consistent myelin injury. Antibody-mediated death of oligodendrocytes is a pathological feature in a subset of MS patients and may be of relevance to disease pathogenesis. In myasthenia gravis (MG), acetylcholine receptors (AChR) situated at the neuromuscular endplate are destroyed by autoreactive antibodies. B-cell activating factor of the tumour necrosis factor (TNF) superfamily (BAFF) is essential for B-cell survival. Using flow cytometry, we evaluated the expression of three BAFF-binding receptors, namely, BAFF-receptor (BAFF-R), B-cell maturation antigen (BCMA), and transmembrane activator and calcium modulating and cyclophilin ligand interactor (TACI) in peripheral-blood lymphocytes. Nearly all CD19(+) B cells and CD19(+)CD27(+) memory B cells expressed BAFF-R. The intensity of BAFF-R expression was not statistically different in MS or MG compared with healthy controls. Very few T cells expressed BAFF-R. BCMA expression was strictly limited to B cells. Although both B and T cells expressed TACI, levels were much higher on B cells compared with levels on T cells. The percentages of B and T cells expressing BCMA and TACI did not differ significantly in MS or MG versus controls. We conclude that the expression of BAFF-binding receptors is not appreciably altered in MS or MG.

A proliferation-inducing ligand (APRIL) is expressed by astrocytes and is increased in multiple sclerosis.

A proliferation-inducing ligand (APRIL) is a newly described member of the tumour necrosis factor (TNF) superfamily that was first identified as a factor favouring tumorigenesis. APRIL is also important for several immune functions, including B-cell survival. Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system (CNS) that is commonly diagnosed in early adulthood. Several TNF superfamily members have been identified in brains of patients with MS, although their exact function within the CNS is presently unknown. To investigate whether APRIL is expressed in the CNS, we studied APRIL protein expression by immunohistochemistry in MS patients and controls. Morphologically, APRIL-positive cells appeared to be astrocytes. A two-colour immunohistochemistry revealed that APRIL expression was cytoplasmic, granular and restricted to GFAP-positive cells. Conversely, HLA class II-positive microglial cells were negative for APRIL expression. APRIL-positive cells were fewer in brains of controls compared with those with MS. We further corroborated our findings by studying APRIL protein expression in several glioblastoma cell lines, and found APRIL to be expressed by most cell lines analysed. APRIL's binding partner syndecan-1 (CD138) was detected in brains of neither MS nor control patients. Furthermore, B cells were detectable in the brain of one of five patients with MS. We conclude that APRIL is expressed by reactive astrocytes in MS and may be of relevance in gliotic scar formation.