Early-onset Alzheimer's disease in 2 large Belgian families.

Familial Alzheimer's disease (FAD) is a dominantly inherited condition that may present with an early onset, and myoclonus occurs frequently in the course of the disease. We report clinical and neuropathologic data on 2 large Belgian families with FAD in which we obtained 17 autopsies of the CNS. In family A, each of 11 autopsies had the typical neuropathologic features of Alzheimer's disease (AD), and there were a few cerebellar plaques in the molecular layer. In family B, in addition to the typical characteristics of AD in 6 autopsies, there were numerous amyloid plaques in the cortical cerebellar layers. In both families, we immunostained the amyloid deposits for the A4 protein, and they were negative for prion-associated protein immunoreactivity.

Absence of genetic linkage of Charcot-Marie-Tooth disease (HMSN Ia) with chromosome 1 gene markers.

We previously reported a large Charcot-Marie-Tooth family not linked to the Duffy blood group marker, supporting the existence of genetic heterogeneity in this neuropathy. In order to investigate the possibility of another disease locus on chromosome 1, we analyzed this family further, using DNA polymorphisms of 6 genes. Absence of linkage makes a second disease locus on chromosome 1 unlikely.

A multivalent antibody radioimmunoassay (MARIA) for screening specific antibody secretion by lymphocyte hybridoma cultures.

A new radioimmunoassay which is suitable for screening lymphocyte hybridoma cultures for monoclonal antibody production is described. Solid-phase antigen is first incubated with the sample, and secondly with soluble 125I-labeled antigen. When the sample contains multivalent specific antibody, the labeled antigen will be bound to the solid-phase antigen. Because no anti-immunoglobulin reagent is used as a second reagent, this type of radioimmunoassay offers several advantages, in particular for the production of monoclonal anti-idiotypic antibodies.

A two-site immunoradiometric assay for the determination of alpha-albumin.

A two-site immunoradiometric assay for a brain specific protein (alpha-albumin or glial fibrillary acidic protein) is described which may be applied to other proteins. The assay variables studied are immunoadsorbent dilution, temperature, incubation times, reactivity of the labelled antibodies and effect of the washing. Each of these factors is optimalised, resulting in a sensitive, specific, reliable assay. The working range is 5--5000 ng/ml, the within-assay variance is 5%. No high dose hook effect is seen in this range. The method is applied for the measurement of alpha-albumin present in cerebrospinal fluid, nervous tissue extracts and cell cultures.

Isolation of IgG1-secreting switch variants from IgM hybridomas produced after in vitro immunization.

IgG1-secreting variants have been isolated from three different IgM-secreting hybridomas, in two instances following in vitro immunization. The method used was based on sequential sublining in combination with selection by an IgG1-specific two-site ELISA system employing two different IgG1-specific polyclonal antisera. Idiotypic identity between the IgG1 variants and their respective IgM parent was demonstrated using syngeneic anti-idiotypic antisera. The antigen binding specificity in the IgG1 variants was also conserved. Isolation of naturally occurring IgG1 switch variants from IgM-secreting hybridomas that are produced after in vivo immunization offers a solution to the major disadvantages associated with the generation of IgM hybridomas.

A monoclonal antibody raised against Alzheimer cortex that specifically recognizes a subpopulation of microglial cells.

A monoclonal antibody (MAb), termed AMC30, was raised after in vitro immunization with sonicated neurofibrillary tangle (NFT)-enriched fractions prepared from Alzheimer's brain. The antigen to which AMC30 is directed was expressed by microglial cells in senile plaques of Alzheimer's disease (AD). Microglia in the parenchyma surrounding brain tumors or infarctions, multinuclear giant cells, perivascular and parenchymal macrophages throughout the brain of AIDS patients were also labeled. Different non-nervous system lesions in which macrophages participate were also stained. Microglial cells in normal areas of the cortex or white matter were not labeled with MAb AMC30. The antigen to which AMC30 is directed was not detected in normal bone marrow, lymph nodes, lung, or spleen monocytes or macrophages. The epitope recognized by MAb AMC30 was present after formalin fixation and paraffin embedding. Our findings suggest that this MAb is directed against an antigen that is specifically expressed in a subpopulation of microglial cells and macrophages reactive to various pathological conditions.

Safety and pharmacokinetics of the neuroprotective drug lubeluzole in patients with ischemic stroke.

A total of 22 patients with acute ischemic stroke participated in two randomized, single-masked, placebo-controlled studies that evaluated the safety and pharmacokinetics of single escalating intravenous doses of lubeluzole. The first dose of study medication in all patients was given within 6 hours of the first sign of stroke onset. In the first study, 6 patients received a single 1-hour intravenous infusion of 5 mg of lubeluzole; 4 of these patients received an additional 10-mg dose 3 to 4 days later. Two additional patients received placebo. In the second study, 4 patients received a single 1-hour infusion of 10 mg of lubeluzole, and 2 patients received placebo. After a safety evaluation of the second study, 6 additional patients received 15 mg of lubeluzole, and 2 other patients received placebo. Lubeluzole had no clinically relevant effects on any cardiovascular variable compared with placebo. The majority of adverse experiences were mild to moderate and resolved during treatment. No unexpected electroencephalogram abnormalities were observed, and no evidence of epileptiform discharges was found in any of the patients. At the end of the infusion, plasma lubeluzole concentrations decayed biphasically, with mean distribution half-lives of 46.3 to 101.0 minutes and mean terminal half-lives of 20.8 to 27.7 hours. Comparisons of the dose-normalized value of the individual plasma concentrations at the end of the infusion and the total area under the curve from time 0 to infinity suggested that lubeluzole exhibited linear kinetics over the dose range evaluated in patients with ischemic stroke. In the small number of patients studied, lubeluzole's favorable safety profile was demonstrated by the lack of clinically relevant effects on cardiovascular variables and by neurologic examination and clinical laboratory findings.

Demonstration of a novel neurofilament associated antigen with the neurofibrillary pathology of Alzheimer and related diseases.

A monoclonal antibody, termed NFT200, was raised after in vitro immunization with sonicated neurofibrillary tangle (NFT)-enriched fractions prepared from Alzheimer brain. The antigen to which NFT200 is directed was expressed in the paired helical filaments of NFT in sporadic and familial Alzheimer disease (AD), in the straight filaments of NFT in AD, progressive supranuclear palsy and of Pick bodies, and the NFT in several other conditions such as Parkinson-dementia complex of Guam and subacute sclerosing panencephalitis. Granulovacuolar degeneration of AD was also labeled with NFT200. Hirano bodies and amyloid deposits in AD, as well as Lewy bodies of idiopathic Parkinson disease lacked in the antigen. The NFT200-antigen was also expressed as a phosphatase-insensitive antigen in normal neurofilaments found in spinal cord and peripheral nerve axons but was absent from the perikaryal accumulation of neurofilaments induced by aluminum intoxication. Nevertheless, immunoblot studies failed to detect the NFT200 in isolated preparations of the neurofilament proteins, MAP-2, tau, ubiquitin or A4-amyloid peptide. The results indicate that the NFT200 monoclonal antibody is directed against a phosphatase-insensitive epitope of an axonal protein associated with neurofilaments but is labile to isolation and expressed as a stable epitope of a 200 kDa component of NFT.

alpha-Albumin (glial fibrillary acidic protein) in normal and pathological human brain and cerebrospinal fluid.

alpha-Albumin, a specific brain protein observed after agar gel electrophoresis and shown to be identical to the later described GFA, has been determined in normal and pathological human central nervous system and cerebrospinal fluid. The outcome of this study underlines the value of the detection of specific proteins of the brain in biological fluids.

Long term follow-up of multiple sclerosis by standardized, non-contrast-enhanced magnetic resonance imaging.

The usefulness of non-contrast-enhanced, standardized magnetic resonance imaging for the longterm follow-up of MS patients was evaluated in a retrospective study in 36 patients with clinically definite MS. All had remitting-relapsing diseases courses. Sixteen patients remained clinically stable during follow-up. Mean duration of follow-up was 22 months (SD: 11). A mean number of 3 MRI examinations was performed in each of the patients (SD: 1). Subclinical evolution was detected in 56% of the stable patients, indicating that clinical data alone are insufficient to assess disease activity. The relapsing patients showed significantly more and larger changes on MRI than stable patients (P less than 0.001), indicating that MRI is well suited as a follow-up parameter in conjunction with clinical data. The time courses of these quantitative changes and of the qualitative changes of putative MS lesions on MRI are discussed. It is concluded that MRI is a good indicator of global disease activity in multiple sclerosis patients, which makes MRI very useful for the evaluation of therapeutic trials.

Absence of linkage with the Duffy blood group in a family with Charcot-Marie-Tooth neuropathy.

We report a large Belgian family with Charcot-Marie-Tooth disease (CMT) or hereditary motor and sensory neuropathy type I (HMSN-I). The pedigree consists of 5 generations with 350 family members comprising 42 patients. The disease is transmitted according to an autosomal dominant inheritance pattern. Several HMSN-I families have been reported to be closely linked to the Duffy blood group marker on chromosome 1. These families were designated HMSN-Ib families, opposed to the HMSN-Ia families which do not show evidence for such a linkage. Therefore we examined our family for the Duffy linkage relationship. We found no evidence for a strong linkage of the disease to the Duffy blood group locus, indicating that this family is of genetic subtype Ia.

Improved correlation of magnetic resonance imaging (MRI) with clinical status in multiple sclerosis (MS) by use of an extensive standardized imaging-protocol.

In a previous study we have shown that the sensitivity of magnetic resonance imaging (MRI) for the detection of multiple sclerosis (MS) lesions was improved significantly, especially in the infratentorial region, by use of an extensive standardized MRI-protocol consisting of sagittal T1, axial protondensity and axial T2, and sagittal protondensity and sagittal moderately T2-weighted images. The goal of the present study was to assess whether the clinical correlation of the visualized lesions had improved accordingly. Using a scoring system based on lesion dimensions, we compared 70 MRI examinations performed in 25 patients with definite MS, with the relevant clinical data as given by the Expanded Disability Status Scale (EDSS) and Functional System scale (FS). We found a significant correlation (r = 0.66, P = 0.0001) between the MRI score and the EDSS. Significant correlations also existed between MRI scores and cerebellar and brainstem FS scores. These correlations were consistently higher than those reported by other authors. We conclude that a standardized MRI examination, including sagittal protondensity and moderately T2-weighted images, should be performed in every MS patient. The improved clinical correlation could be of importance in follow-up studies when assessing the efficacity of therapy.

Value of glial fibrillary acidic protein determination in amniotic fluid for prenatal diagnosis of neural tube defects.

Glial fibrillary acidic protein (GFAp), an intracellular protein specific to astrocytes of the central nervous system, was determined by 2-site immunoradiometric assay in amniotic fluid from 78 pregnancies with a normal, and 100 with an abnormal outcome. GFAp was not detectable in any of the normal pregnancies, but there were measurable, and so raised, levels in 23 out of 25 cases of anencephaly and 4 out of 7 cases of spina bifida, which therefore allowed prenatal diagnosis. GFAp was also increased in 4 of 6 cases of fetal intrauterine death, but not in other congenital malformations associated with elevated alphafetoprotein levels or abnormal acetylcholinesterase banding pattern, such as exomphalos, other gastrointestinal malformations or renal abnormalities. GFAp is therefore specific for diagnosing open neural tube defects. The determination of GFAp in amniotic fluid was slightly less efficient overall than AFP for the prenatal diagnosis of neural tube defects, but can be a useful ancillary test and has the advantage of specificity.

Lazarus sign and extensor posturing in a brain-dead patient. Case report.

A man was declared brain dead after having sustained a gunshot wound to the head. All clinical criteria for the diagnosis of brain death were met. The electroencephalogram was isoelectric, and four-vessel angiography demonstrated the absence of cerebral blood flow. However, stereotypic spontaneous movements were observed which persisted for several hours. The possible mechanism is discussed and a short review of the literature is given.

Improved sensitivity of MRI in multiple sclerosis by use of extensive standardized procedures.

The relative value of two different MRI procedures for the assessment of infratentorial extension in multiple sclerosis (MS) was studied. Multislice spin-echo techniques were used overall. Procedure A consisted of parasagittal T1-weighted images (500/30) and axial T2-weighted images (2500/30, 2500/120). Procedure B consisted of parasagittal T2-weighted images (1600/35, 1600/90). In the parasagittal T2-weighted images clear visualization of MS lesions is achieved because signal intensities of CSF and normal nervous tissue are nearly identical. All images were performed with a 0.5 Tesla MR system. Data were obtained in 98 patients with definite (N = 30) or probable MS (N = 68). Areas with abnormal signal intensity in the infratentorial regions (brainstem, cerebellum, and/or cervical spinal cord) were identified in 44% of the patients with procedure A and in 64% with procedure B. The standard application of the combination of both procedures improves the sensitivity of the MR examination for the diagnosis of MS, the delineation of infratentorial lesions and the correlation between clinical and MR data without excessively increasing imaging time.

The safety and tolerability of single intravenous doses of lubeluzole (Prosynap) in healthy volunteers.

The safety and tolerability of single escalating doses of lubeluzole were evaluated in healthy male volunteers in 2 studies. In the first of 2 randomized, single-blind, placebo-controlled, dose-escalation studies, 6 subjects received single 30-minute infusions of 2.5, 5, and 10 mg of lubeluzole, and 2 additional subjects received placebo. In the second study 6 different subjects received a 1-hour infusion of 15 mg of lubeluzole, 5 of whom received the 20-mg dose, and 2 received 25 mg of lubeluzole. Two additional subjects received placebo. Small increases and decreases in PQ, QRS, QT, QTc, and QTm intervals were noted after infusion of all lubeluzole doses and placebo, however, these changes were within the normal ranges for these values except for the QTc for the 25-mg dose of lubeluzole. Significant prolongation of the QTc interval was observed at the end of the 1-hour infusion in both subjects receiving the 25-mg dose of lubeluzole. No clinically relevant changes in systolic time intervals, heart rate, blood pressure, and clinical laboratory values were noted in subjects receiving 2.5-25 mg of lubeluzole or placebo. Adverse experiences, predominantly lightheadedness and dizziness, were reported by subjects receiving doses of lubeluzole greater than or equal to 10 mg. Lubeluzole, administered as single intravenous doses of 2.5-15 mg, is safe and well tolerated in healthy male volunteers.

Hospital referral of stroke patients: a survey of attitudes in general practice, and consideration of entry times for clinical trials.

Two major issues in clinical trials in stroke are the criteria used for the selection of patients expected to benefit from the proposed treatment, and the entry time of those patients. We surveyed 507 Belgian general practitioners (GPs) on their opinions on referral of stroke patients to hospital and also on their actual referral behaviour. The feasibility of a 6-hour entry time was included in the investigation. Stroke is considered to require an urgent response: 88% of GPs visited the patient immediately on concluding that such an event had occurred. The mean time between the onset of the first clinical symptoms and the arrival of the GP at the patient's residence was about 30 minutes. Within 6 h of the insult, 95% of the patients referred to hospital had been admitted. Information on the GP's most recent stroke patient revealed that 72.4% of these stroke patients were admitted to hospital. Patients referred to hospital were significantly younger, had a significantly more severe stroke, and were significantly more likely to have had a first stroke and to have lived independently before the insult than patients not admitted to hospital. We think that Belgian GPs need to change their referral behaviour with respect to stroke patients and refer more of those who have suffered more mildly. There is every reason to be optimistic about this re-education, since the patients whom GPs do refer to hospital are referred rapidly enough to profit from a possibly efficacious treatment.

Comparison of the brain specific protein alpha-albumin and GFA (glial fibrillary acidic protein).

In this study, the brain specific proteins alpha-albumin and glial fibrillary acidic protein (GFA) are compared by several biochemical and immunological methods. It is concluded that alpha-albumin and GFA are immunologically identical and biochemically narrowly related. The existence of two forms of this protein, a water soluble and a water insoluble, under physiological conditions is discussed by comparing the results of quantitative determinations and histoimmunological localizations.

Autoantibodies to brain specific proteins in human serum from normal and several pathological conditions.

Autoantibodies to three nervous tissue specific proteins [alpha Albumin (GFA, Eng et al., 1971), S100 (Moore et al., 1968) and MBP (Eylar et al., 1969)] were determined in sera from 270 neurological patients. Control values were established in sera from 21 blood donors. Differences between the control group and several pathological conditions were found, positive results were obtained in sera of patients affected with MS, polyneuropathy and astroglial tumors.