[Preanalytical guidelines for clinical proteomics investigation of biological fluids]. / Recommandations préanalytiques pour les analyses de protéomique clinique des fluides biologiques.

Research of new diagnosis or prognosis biomarkers is a major challenge for the management of patients with complex pathologies like cancer. Clinical proteomics is one of the recent approaches to identify these biomarkers in biological fluids. Over the last five years, many problems related to the variability and the quality control of these analyses have been observed. This was notably related to the different preanalytical status of each sample. A strong need for standardization of the critical preanalytical phases (collection, transport, processing, storage...) has been therefore recognized. With this goal in mind, working groups of the "Institut national du cancer" (INCa) and the "Société française de biologie clinique" (SFBC) proposed here preanalytical proteomics guidelines for the most common biological fluids: plasma, serum, urine and cerebrospinal fluid. To goal is to provide the basis for the harmonization of the procedures in clinical laboratories and biobanks to allow an optimal use of biological collections.

An autopsy case of acute multiple sclerosis (Marburg's type) during pregnancy.

We report a case of a 9-month pregnant woman who presented acute psychiatric and neurological symptoms with extensive involvement of the white matter on MRI and no oligoclonal bands on CSF examination. Despite high doses of intravenous steroids, plasmapheresis and immunosuppressive drugs, a fatal outcome (coma) was noted 8 months later. Neuropathological examination confirmed the diagnosis of Marburg's type of multiple sclerosis showing sharp-edged lesions of demyelination, giant astrocytes, numerous macrophages and little perivascular inflammation. We discuss the definition and limits of the Marburg entity with reference to acute disseminated encephalomyelitis, impact of pregnancy, unusual MRI features, neuropathology and treatment.

Neurofilament high molecular weight-green fluorescent protein fusion is normally expressed in neurons and transported in axons: a neuronal marker to investigate the biology of neurofilaments.

The carboxy-terminal side arm of the neurofilament high subunit consists of a highly phosphorylated domain and a negatively charged region. Multiple evidences suggested that these domains are essential for the axonal phosphorylation and transport of neurofilaments and play a role in their abnormal accumulation following chemical intoxication or during neurodegenerative disorders such as amyotrophic lateral sclerosis. In order to investigate the consequences of altering this side arm of neurofilament high subunit we used a fusion protein (neurofilament high subunit-green fluorescent protein) between the mouse neurofilament high subunit missing a major part of the C-terminal domain and the reporter green fluorescent protein. In cell culture and in transgenic mice this fusion protein co-assembles and co-distributes with the endogenous intermediate filament network. Conditions known to disturb the cytoskeleton were also found to alter the distribution of the fusion protein in cell cultures. In transgenic mice the expression of the transgene evaluated by its fluorescent properties was found to be restricted to neurons, where the neurofilament high subunit-green fluorescent protein fusion protein is axonally transported. Biochemical approaches showed that the fusion protein is phosphorylated and co-purified with neurofilaments. Despite the presence of such an neurofilament high subunit-green fluorescent protein fusion protein, the axonal cytoskeletal density and the axonal caliber were not altered. Together these data show that removal of this portion of neurofilament high subunit does not affect the capacity of neurofilament high subunit to assemble and to be transported into axons, suggesting that this sequence is involved in another function. Moreover, the fluorescent properties of this fusion protein represent a useful marker.

Stable tubule only polypeptides (STOP) proteins co-aggregate with spheroid neurofilaments in amyotrophic lateral sclerosis.

A major cytopathological hallmark of amyotrophic lateral sclerosis (ALS) is the presence of axonal spheroids containing abnormally accumulated neurofilaments. The mechanism of their formation, their contribution to the disease, and the possibility of other co-aggregated components are still enigmatic. Here we analyze the composition of such lesions with special reference to stable tubule only polypeptide (STOP), a protein responsible for microtubule cold stabilization. In normal human brain and spinal cord, the distribution of STOP proteins is uniform between the cytoplasm and neurites of neurons. However, all the neurofilament-rich spheroids present in the tissues of affected patients are intensely labeled with 3 different anti-STOP antibodies. Moreover, when neurofilaments and microtubules are isolated from spinal cord and brain, STOP proteins are systematically co-purified with neurofilaments. By SDS-PAGE analysis, no alteration of the migration profile of STOP proteins is observed in pathological samples. Other microtubular proteins, like tubulin or kinesin, are inconstantly present in spheroids, suggesting that a microtubule destabilizing process may be involved in the pathogenesis of ALS. These results indicate that the selective co-aggregation of neurofilament and STOP proteins represent a new cytopathological marker for spheroids.

Aging and Alzheimer's disease: protease inhibitors in cerebrospinal fluid.

Recent advances suggested that proteases and their inhibitors could be implicated in the genesis and/or maturation of insoluble deposits associated with Alzheimer's disease (AD). This study was designed to measure the level of alpha 1-antichymotrypsin (ACT) and alpha 1-antitrypsin (AT) in cerebrospinal fluid (CSF) of patients with AD and nondemented humans at various ages. Our analysis failed to demonstrate a significant relationship between inhibitor content and disease. However, a positive correlation was observed between age and the ACT level for the normal control group. Such observation suggests a specific association of ACT with the mechanisms of brain aging.

A new monoclonal antibody recognizing the amino-terminal consensus sequence of vertebrate intermediate filament proteins.

The mouse monoclonal antibody ME 101 raised against human peripherin, an intermediate filament protein (IFP) specific to well defined neuronal populations, recognizes all the major classes of vertebrate IFP in immunoblotting assays. Desmin, GFAP, vimentin, peripherin and the lightest neurofilament protein (NF-L) were cleaved into carboxy- and amino-terminal halves by N-chlorosuccinimide at their unique trytophan residue. Whereas the antibody directed against the epitope common to every IFP (intermediate filament antigen or IFA) and located on the carboxy-terminal end of the rod domain recognizes the carboxy-terminal half, the ME 101 antibody, as the present study illustrates, recognizes specifically the amino-terminal half. From the amino acid sequence data of IFP, it is deduced that the cognate epitope is localized on the amino-terminal part of coil la.

Abnormal expression of actin in lymphocytes of Alzheimer's disease and Down's syndrome patients.

Alzheimer's disease (AD) is a degenerative disorder of the central nervous system accompanied by several immunological disturbances and a number of common features exist between AD and Down's syndrome (DS). High resolution two-dimensional electrophoresis of lymphocyte proteins demonstrates an actin abnormality in AD and DS: a double actin spot instead of the single spot observed in controls. This dual form was studied by pulse-chase experiments and seems to be related to extracellular factors which influence the post-translational modification of actin. These results agree with the immunological disturbances observed in AD and DS, and with the well established hypothesis that AD is a systemic as well as cerebral disease.

Biodegradation and brain tissue reaction to poly(D,L-lactide-co-glycolide) microspheres.

The therapeutic application of neuroactive molecules in neuroscience is limited, due to the problems posed by the administration of these drugs (peripheral metabolism, systemic effect and passage of the blood-brain barrier). One solution is the implantation in the brain of biodegradable polymer devices with controlled release of a neuroactive drug. The biodegradation and tissue reaction of the copolymer poly(D,L-lactide-co-glycolide) microspheres prepared by the solvent evaporation method, radiosterilized and stereotactically implanted in the rat brain were studied by routine staining, immunohistochemistry and transmission electronic microscopy. The brain tissue reaction observed was a non-specific astrocytic proliferation and a macrophagous-microglial cell reaction, typically found following damage to the central nervous system. Some foreign-body giant cells were observed and the inflammatory and macrophagous reaction decreased dramatically after 1 month and almost ended after 2 months when the microspheres were totally biodegraded. The copolymer poly(D,L-lactide-co-glycolide) microspheres may be considered biocompatible to the brain tissue.

Somatostatin and adrenocorticotrophic hormone like immunoreactivity in small cell carcinoma of the lung.

The immunocytological detection of adrenocorticotrophic hormone (ACTH) and somatotropin release inhibitor factor (SRIF) like immunoreactivity was carried out on tumour cells from bronchial brush smears in 39 cases of lung tumours. Results obtained were compared with the cytological and histological diagnosis and confirmed the high incidence of ACTH synthesis by malignant bronchial carcinoma cells: the same phenomenon also seems to occur for somatostatin. The concomitant detection of ACTH and SRIF like immunoreactivity seems to be highly suggestive of small cell carcinoma and indicates that the immunocytological detection of hormones carried out at the same time as cytological examination can improve the accuracy of the diagnosis.

A single intracerebral microinjection of platelet-derived growth factor (PDGF) accelerates the rate of remyelination in vivo.

We had demonstrated that platelet-derived growth factor (PDGF) enhanced the reconstruction of myelin-like membranes after their disruption by lysophosphatidylcholine (LPC) in vitro. To investigate its role in vivo, a demyelinating lesion of the corpus callosum was induced in adult Wistar rats by a stereotaxic microinjection of 1 microl LPC, then 63 pairs of rats received either 1 microg PDGF, or its vehicle buffer which were injected above LPC. The effects of PDGF were significant after 2 weeks: the number of oligodendrocytes (OL) expressing 2',3'-cyclic nucleotide 3'-phosphodiesterase in the lesion increased by 49%, mature OL labelled by in situ hybridization for myelin basic protein-mRNA increased by 27% (P<10(-2)), and the total volume of demyelination decreased by 60% compared to controls. The proliferation of cells of the OL lineage was also enhanced up to 67% by PDGF compared to LPC controls (P<2.5 x 10(-2)). Ultrastructural studies confirmed this dramatic improvement, and the ratio of remyelinated to demyelinated axons, determined at the maximal demyelination site, in the centre of the lesion, increased by 10-fold (P<2.5 x 10(-3)) in animals treated with PDGF. Remyelination was complete after 3 months for both treatments. Neither exacerbation of gliosis nor glial tumoural transformation were observed. Mechanisms through which PDGF improves remyelination could involve proliferation of OL progenitors, and/or of already differentiated surviving OLs, and a chemotactic effect, which had been identified in vitro.

Pure Schwann cell suspension grafts promote regeneration of the lesioned septo-hippocampal cholinergic pathway.

Regeneration of central nervous system (CNS) axons has been studied in the cholinergic septo-hippocampal system using various 'bridges' able to support fiber growth. In this study, a pure Schwann cell (Sc) suspension labeled with bisbenzimide (Hoechst 33342) was grafted in the lesioned septo-hippocampal pathway. At 2 weeks post-grafting, acetyl-cholinesterase (AChE)-positive fibers invaded the graft and grew in association with the Hoechst-labeled Sc, some of which expressed the low-affinity nerve growth factor receptor (NGF-R). At 2 months and 4 months post-grafting, the dorsal hippocampus was reinnervated with an apparently normal innervation pattern. Analysis of fiber growth in the hippocampus at four months post-grafting revealed a significant increase of reinnervation in the grafted animals (2 mm) compared to the non-grafted ones. No difference was observed in the number of cholinergic septal neurons expressing the NGF-R. These results demonstrate that a Sc suspension grafted into the lesioned septo-hippocampal system, integrates well into the host tissue, and supports axonal CNS outgrowth, implying that Sc by themselves provide an adequate environment for regeneration to occur.

Lipopolysaccharide intracerebral administration induces minimal inflammatory reaction in rat brain.

An inflammatory reaction, essential for defence against infection and for wound repair, may also induce irreversible tissue damage. It appears that the central nervous system has developed its own immunosuppressive strategy in order to limit the destructive effects of inflammation. To clarify this point, we have characterized in one unique model of inflammation induced in the rat by intracerebral lipopolysaccharide injection the kinetics of the inflammatory reaction, the participation of immunitary and glial cells and of three growth factors. Among these molecules, brain-derived neurotrophic factor mRNA expression was found decreased following LPS injection. No striking differences were observed in the brain parenchyma after stab lesion or inflammatory lesion apart from an increase in the number of monocytes/macrophages recruited early to the lesion area. Macrophages were later accumulated around the lesion when astroglia and microglia reactions occurred. Some of the macrophages and microglia expressed major histocompatibility complex class II antigens on their surface whereas no T or B lymphocytes were observed in the brain parenchyma. However, a subpopulation of CD3- and CD4-negative CD8-positive cells, likely natural killer cells, was observed around the lesion site; this recruitment was inhibited by the highest dose of LPS. This study therefore supports the hypothesis of a suppression of some aspects of cell-mediated immunity in the brain, mechanisms which need to be further characterized.

Autoantibodies against H- and M-subunits of neurofilaments are induced by PC12 cell grafts or lesions into different sites of rat brain.

Since autoantibodies against neurofilaments (NF) were frequently found in neurodegenerative disorders, this work is an attempt to investigate whether the same phenomenon occurs after intracerebral grafting or lesioning. We have thus either grafted PC12 cells or injected culture medium alone into three sites of rat central nervous system (CNS): olfactory bulb (OB), olfactory anterior nucleus (OAN) and hippocampus (HC), all three sites being impaired in Alzheimer's disease. At day 15, rat sera were collected and tested against NF by western blotting. Sera from grafted rats recognized the H- and M-subunits of NF; we have then quantified the autoantibody response by using an ELISA technique. We show that, in all cases of grafts, the autoantibody response against NF significantly increased when compared to controls (normal rats without grafts or lesions) for total immunoglobulin (Ig) amount. In contrast, concerning the Ig isotypes, some differences appeared depending on the implantation site: for grafts into OB, the immune response was of both the IgG and IgM isotypes, into OAN it was mainly of the IgM isotype and into HC, the isotype of antibodies against NF was mostly IgG. In the case of lesions alone into OAN and HC, no significant enhancement of autoantibody response was observed; in contrast, lesions into OB induced an increase in autoantibody response against NF which significantly differed from controls for all Ig isotypes tested. These data point out the diversity of the autoantibody responses following lesions or grafts according to the rat brain areas.

n-6 polyunsaturated fatty acids increase the neurite length of PC12 cells and embryonic chick motoneurons.

We have tested the action of three n-6 polyunsaturated fatty acids, either free or in the form of ethyl esters, on the neurite outgrowth in two neuronal models: a rat pheochromocytoma cell line (PC12) and embryonic chick motoneurons, after 7 days in culture. An inverted microscope coupled with the 'VIDS 4' software was used for measuring the neurite length. Free fatty acids were found to be cytotoxic at 10(-3) M and the maximal increase of the neurite length was obtained at 10(-5) M. In contrast, fatty acids in the form of ethylesters were not cytotoxic and at 10(-3) M induced the maximal increase in the neurite length. This increase (1.2 to 2 fold) significantly differed from the control and was dose-dependent. These results were discussed in relation to the action of fatty acids on enzyme activation and membrane fluidity.

Differential behaviour of PC12 cells grafted into rat hippocampus and striatum.

To investigate the mechanisms involved in graft survival, a rat cell line (PC12) that differentiates into sympathetic-like neurons by exposure to trophic factors has been grafted into rat striatum and hippocampus, two structures which differ in their amounts of trophic factors. Our results show that grafted PC12 cells behave differently depending on the area of implantation; they display a differentiated morphology in the hippocampus and proliferate as a tumor in the striatum. A qualitatively similar immunological reaction occurs in both structures, characterized by the invasion of T and B lymphocytes, macrophage-like cells and by the expression of major histocompatibility complex class I and II antigens around the graft.

Hepatocyte-derived cell lines express a functional receptor for cardiotrophin-1.

Cardiotrophin-1 (CT-1) is a recently isolated cytokine belonging to the interleukin-6 cytokine family. In the present study, we show that CT-1 binds to hepatocyte-derived cell lines of rat and human origin with high (Kd = 600-800 pM) and low (Kd approximately 3-6 nM) binding affinities. Treatment of HepG2 cells with CT-1 resulted in the induction of tyrosine phosphorylation of both transducing receptor subunits, gp130 and LIF receptor, and this phosphorylation was completely inhibited by a neutralizing anti-gp130 mAb. Addition of CT-1 to HepG2 or H35 cell cultures induced a dose-dependent production of several acute phase proteins (haptoglobin, fibrinogen, alpha1-acid glycoprotein, alpha2-macroglobulin). Moreover, the use of a neutralizing mAb to gp130 in cultures of HepG2 cells grown in the presence of CT-1, inhibited the induction of acute phase protein secretion, indicating an absolute requirement of gp130 in the formation of a functional CT-1 receptor. Altogether, these results suggest that CT-1 could play an important role in the regulation of hepatocyte metabolism in inflammatory responses.

Intravascular malignant lymphomatosis (so-called malignant angioendotheliomatosis): a case confined to the lumbosacral spinal cord and nerve roots.

Intravascular malignant lymphomatosis (IML), so-called malignant angioendotheliomatosis, was found in lumbosacral spinal cord and nerve roots of a 78-year-old women who died one month after the onset of symptoms. With regard to the majority of the 37 reviewed neurological cases in the literature, this report is unusual in that the disease was exclusively localized in the spinal cord and systemic involvement was absent. The usual clinical hallmark of the disease is a subacute dementia or encephalopathy, often associated with focal neurological signs, culminating in death within several months. The pathological features of IML characteristically include multiple small foci of necrosis of the whole brain, caused by occlusion of small vessels by noncohesive neoplastic cells and secondary changes of the vascular wall. All organs may be involved, especially the skin and the adrenals, sometimes with tumoral formations. Despite the fact that lymphoid tissues are usually spared, recent reports and the present case strongly suggest a lymphoid rather than endothelial origin of the malignant cells. The pathogenesis of this mainly intravascular lymphoma remains obscure.

[Malignant non-Hodgkin lymphoma presenting with Garcin's syndrome]. / Syndrome de Garcin révélant un lymphome malin non hodgkinien.

INTRODUCTION: R Garcin described progressive unilateral cranial nerve palsy in 1926. Garcin syndrome is characterized by progressive involvement of the cranial nerves culminating in total unilateral paralysis of all cranial nerves. Carcinoma of the skull base or ENT regions is the most common etiology. CASE REPORT: A 74-year-old man developed signs involving the left Vth (V2 and V3) cranial nerve then the VIth, VIIth and VIIIth cranial nerves and finally the IXth and Xth. MRI showed involvement of these cranial nerves with gadolinium uptake and involvement of the pons at the terminal phase. Careful ENT explorations failed to reveal a cause. The lymphocyte count was elevated in the cerebrospinal fluid. The patient died one year after diagnosis and the general autopsy was normal. The neuropathological studies led to the post-mortem diagnosis of type B non-Hodgkin lymphoma. CONCLUSION: In patients with Garcin syndrome, lymphoma is a possible diagnosis when carcinoma of the ENT regions or of the skull bases are not present.

[Polyneuropathies with IgM monoclonal gammopathy. 12 cases]. / Polyneuropathies avec gammapathie monoclonale IgM. 12 cas.

12 cases of polyneuropathy with IgM monoclonal gammapathy are reported. An analysis of the clinical, electrophysiological, histological and immunological features of these cases and of those reported in the literature allows to distinguish 2 groups. In the first group (8./12 cases), the neuropathy showed clinical and electrophysiological features of a mainly demyelinating mechanism involving large fibers. Electromicroscopy disclosed a widening of the spaces between the lamellae of the myelin in half of these cases. A monoclonal deposit of IgM was demonstrated by direct immunofluorescence, on the remaining myelinated fibers in most cases. In this first group, the M-component always reacted with the myelin sheaths of a monkey's peripheral nerve. The results of indirect immunofluorescence were closely correlated with those of immunoblotting, which revealed an anti-M.A.G. (Myelin Associated Glycoprotein) activity. The second group is more heterogeneous: there was an predominantly motor neuropathy (1 case), an asymmetrical and painful neuropathy with an endoneural deposit of IgM (1 case). In 2 other cases which in no other ways differed from those of the first group, the M-component seemed devoid of antimyelinic activity. Nevertheless, the presence of IgM on the myelin sheaths of these 2 cases suggested a relationship between the neuropathy and the gammapathy. In both groups, results from the association of apheresis and chlorambucil were difficult to assess and vary greatly. Therapy appeared beneficent in half of the cases, but only one patient was markedly improved.

[Chronic encephalitis with mesencephalic predominance. A clinico-pathologic case]. / Encéphalite chronique à prédominance mésencéphalique. Un cas clinico-pathologique.

A 70 year-old woman presented with a progressive supranuclear ophthalmoplegia, with "apraxia" of eyelid opening, axial akinesia and dementia. CT scan showed a mild cortico-subcortical atrophy and there was a high level of immunoglobulins, with an oligoclonal pattern, without cell reaction in the CSF. The patient died two years after the onset. Post-mortem examination, limited to CNS, showed subacute encephalitis confined to the tectal, pretectal, subthalamic areas and to Ammon's horns. These changes and their location were strongly suggestive of polioencephalomyelitis with or without cancer, in which such a prevalent midbrain involvement has been exceptionally described.