An immunoglobulin agent (IVIG) inhibits NF-kappaB activation in cultured endothelial cells of coronary arteries in vitro.

OBJECTIVE: Kawasaki disease (KD) is an acute febrile vasculitis of unknown etiology that may lead to cardiovascular disorders. High-dose intravenous immunoglobulin (IVIG) therapy is well established as a standard therapy for KD. Tumor necrosis factor-alpha (TNF-alpha) is responsible for the pathogenesis of acute KD. We examined whether or not IVIG inhibits TNF-alpha-induced activation of transcription factor NF-kappaB, a factor that is essential for the expression of proinflammatory cytokines, in human coronary artery endothelial cells (CAEC). METHODS: The inhibitory effect of IVIG on NF-kappaB activation induced by TNF-alpha was evaluated by Western blot analysis and ELISA. Moreover, the inhibitory effects of IVIG on IkappaBalpha degradation, interleukin-6 (IL-6) production, and E-selectin expression induced by TNF-alpha were evaluated by Western blot analysis, ELISA, and flow cytometry, respectively. RESULTS: Western blot analysis and ELISA demonstrated that IVIG inhibits NF-kappaB activation induced by TNF-alpha in CAEC. Moreover, IVIG inhibited IkappaBalpha degradation, IL-6 production, and E-selectin expression induced by TNF-alpha in CAEC. CONCLUSION: The data suggest that IVIG inhibits NF-kappaB activation induced by TNF-alpha in CAEC, thereby possibly modulating IL-6 production and E-selectin expression.

NF-kappaB activation in peripheral blood mononuclear cells in neonatal asphyxia.

Neonatal asphyxia results in hypoxic-ischaemic encephalopathy. Previous studies have demonstrated that brain hypoxia and ischaemia lead to the production of proinflammatory cytokines, including tumour necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1) and IL-6. Transcription factor NF-kappaB is essential for the expression of these cytokines. We examined whether or not NF-kappaB is activated in peripheral mononuclear cells (PBMC) in neonatal asphyxia by flow cytometry. In addition, we examined the relationship between NF-kappaB activation in PBMC and the neurological prognosis. Flow cytometry analysis demonstrated that the level of NF-kappaB activation in CD14+ monocytes/macrophages of the patients with asphyxia who had neurological sequelae was significantly higher than in the controls, and in the patients with asphyxia who survived (31.7 +/- 7.2%versus 2.5 +/- 0.9%, P = 0.008, and versus 1.6 +/- 1.4%, P = 0.014, respectively). Our findings suggest that NF-kappaB activation in peripheral blood CD14+ monocytes/macrophages in neonatal asphyxia is important for predicting the subsequent neurological sequelae.

CD8+ T-lymphocytes infiltrate the myocardium in fulminant herpes virus myocarditis.

We report two cases of fulminant viral myocarditis in previously healthy children. They were caused by herpes simplex virus (HSV)-1 (in a boy aged 3 years) and Epstein-Barr virus (EBV) (in a boy aged 12 months). We obtained the diagnosis of HSV-1 myocarditis by immunohistochemistry and the diagnosis of EBV myocarditis by in situ hybridization. Histologic examination of heart tissue from the two boys revealed mononuclear cell infiltration of the myocardium. Immunohistochemical staining identified these cells as CD8+ T-lymphocytes. CD8+ T-lymphocytes induced by herpes virus infections may play an important role in the damage to heart muscle fibers seen in fulminant myocarditis in previously healthy children. To our knowledge, this is the first report of HSV-1 or EBV myocarditis (at least in children) in which viral infection has been demonstrated in the myocardium.

Neuron death and glial response in pontosubicular necrosis. The role of the growth inhibition factor.

AIM AND METHODS: Fluorochrome and immunohistochemical studies were performed on neonates with pontosubicular necrosis (PSN), aged 26 - 42 weeks of gestation (GW), compared with preterm and term controls aged from 10 GW to 3 months of age. RESULTS: A fluorochrome study using a confocal microscope revealed that nuclear DNA changes occurred earlier than cytoplasm degeneration with diminished RNA orange-red fluorescence. These changes were restricted to the small immature neurons in the pons and subiculum with PSN. On the other hand, although glial fibrillary acidic protein-positive reactive astrocytes were not increased in number, growth inhibitory factor- (GIF) immunoreactive glia with vesicular large nuclei were increased in number within the gray matter of the pons, subiculum, and cerebral cortex in the PSN group. The nuclei of GIF-containing astrocytes became round and vesicular, nearly twice in size and increased in number. Thus, the neuronal death began at the nuclei of selective neurons in specific areas in PSN, although GIFcontaining astrocytes were increased in widespread areas. CONCLUSION: These facts suggest that immature neurons in the pontine nuclei and subiculum are selectively vulnerable to some insults such as hypocarbia and hyperoxygenation, and PSN involves a possible apoptotic neuron death mechanism and a characteristic glial response.

[Mental stress of visiting-nursing staff in cases of severely handicapped children with respirators].

We evaluated the actual condition of work and mental stress on visiting nursing staff, for the purposes of establishing a suitable visiting-nursing system for severely handicapped children. The subjects were 13 visiting nurses involved in the care of two children with Werdnig-Hoffman disease. The visiting-nursing staff was examined by questionnaire. Of these staff, 77% felt a burden from their work. They felt a burden due to the special needs of pediatric patients and the relationship between the staff and parents. The relationship between visiting-nursing staff and other medical staff, including doctors, was another main factor in this burden. The younger nurses felt this burden more strongly.

Fetal brain infection with human parvovirus B19.

Intrauterine parvovirus B19 infection is known to be one of the causes of hydrops fetalis. However, there are few reports of the pathologic changes in the central nervous system. Postmortem examination of a fetus revealed multinucleated giant cells of macrophage/microglia lineage and many small calcifications around the vessels, predominantly in the cerebral white matter. Parvovirus B19 genome DNA was detected in the nucleus of the multinucleated giant cells and solitary endothelial cells by polymerase chain reaction amplification and in situ polymerase chain reaction methods. Capsid antigen was also demonstrated in the cytoplasm of the endothelial cells by immunofluorescent assay. Thus, intrauterine B19 parvovirus infection could be associated with marked neuropathologic changes in the fetal brain at the midembryonal period. Neurologic follow-up of complications may be necessary for children who survive the intrauterine infection.

Three siblings of fatal infantile encephalopathy with olivopontocerebellar hypoplasia and microcephaly.

We report three male siblings born with fatal encephalopathy comprising microcephaly, myoclonus and muscle hypertonia. All three patients died during infancy. Postmortem examination on the brain revealed that all infants had neuronal loss in the cerebellar cortex, inferior olivary and pontine nuclei, which were more pronounced in the older subject than the younger ones. In addition, they were associated with polymicrogyria in the cerebral cortex of the insula, olivary and dentate nuclear dysplasia, and a hypoplastic corticospinal tract. The clinical and neuropathological findings in our cases were identical to those in fatal infantile encephalopathy with olivopontocerebellar hypoplasia and microencephaly [Albrecht et al., Acta Neuropathol 1993;85:394-399], but an association of malformations suggests a new genetic factor in pathogenesis of olivopontocerebellar hypoplasia.

Expression of a 45K subunit of platelet-activating factor acetylhydrolase in the developing mouse cerebellum.

The 45K subunit of platelet-activating factor acetylhydrolase (PAFAH-45K) is the product of a candidate gene for Miller-Dieker lissencephaly. We studied the expression of this protein in the developing mouse cerebellar cortex by immunochemical and immunohistochemical methods. Western blotting studies indicated that PAFAH-45K is more abundant in the fetal than the postnatal period. Immunohistochemical studies revealed developmental changes in the localization of PAFAH-45K-immunoreactivity, which shifted from the somata of Purkinje cells to the neuropil of the molecular layer. Our findings indicate that PAFAH expression is developmentally regulated and suggest its role in histogenetic processes in the cerebellar cortex other than neuronal migration.

Neuropathological characteristics and alteration of the dopamine D2 receptor in hypoxic-ischemic basal ganglia necrosis.

The neuropathological characteristics and alteration of the dopamine D2 receptor (D2R) were investigated in 27 cases of hypoxic-ischemic basal ganglia necrosis (BGN) by means of neuropathological and immunohistochemical methods. Perinatal hypoxic-ischemic BGN manifested neuronal karyorrhexis as well as eosinophilia, karyorrhexis being more predominant in preterm infants and eosinophilia more predominant in full-term infants. Immunoreactivity to D2R was detected in the cytoplasm and dendrites of small and large neurons in the basal ganglia, and increased with neuronal maturation during the late gestational period in normal human basal ganglia. The number of D2R-positive neurons was smaller in all cases of acute BGN than that in controls, the areas of decreased D2R-positive neurons corresponding to the damaged regions observed on HE staining. Furthermore, neurons showed high expression of D2R in a few cases of remote BGN, suggesting some plasticity as to the recovery of D2R. Thus, the neuropathological characteristics of perinatal hypoxic-ischemic BGN may be related to neuronal maturation during different developmental stages in each region, and D2R development may play a role in the basal ganglia vulnerability to hypoxic-ischemia.

A developmental expression of AMPA-selective glutamate receptor subunits in human basal ganglia.

The development of AMPA-selective glutamate receptors (GluR1 and GluR2-3) in human basal ganglia (BG) was investigated in 23 normal brains by means of an immunohistochemical method. Immunoreactivity to GluR1 and 2-3 was detected in the cytoplasm and dendrites of small and large neurons in the BG. GluR2-3 immunoreactivity-positive neurons were clearly observed at 23-24 gestational weeks (GW) in the globus pallidus and at 32 GW in the neostriatum, and reached a peak at 32 GW and 39 GW, respectively. GluR2-3 positive neurons in the BG began to decrease at 1-4 months of age, reaching the low level of adults by 7 months of age. The developmental pattern of GluR1 was similar to that of GluR2-3 in the BG, but the immunoreactivity to GluR1 was a little weaker than that of GluR2-3 in the neostriatum. Furthermore, GluR1 and 2-3 subunit Western blotting confirmed the specificity of the immunohistochemistry. Our results suggest that the development of GluR1 and 2-3 in the BG is consistent with neuronal development in the BG, which supports further that GluR1 and 2-3 play an important role in neuronal differentiation and maturation of the BG.

Differential development of the human cerebellar vermis: immunohistochemical and morphometrical evaluation.

Differential development of regions of the human cerebellar vermis was evaluated immunohistochemically and morphometrically between 18 weeks of gestation and 10 years of age. The density of Purkinje cells in the cerebellar vermis decreased rapidly until 38 weeks of gestation and slowly thereafter. At all stages of development, the density was higher in the posterior (lobules VI-IX) than the anterior vermis (lobules I-V). The area of cut sections of the anterior and posterior vermis in the mid-sagittal section increased rapidly before 40 weeks of gestation and gradually after birth, whereas growth was slower in the nodules. These developmental characteristics may be related to the selective susceptibility of cerebellar regions to environmental insults.

Hypoxia-induced ABR change and heat shock protein expression in the pontine auditory pathway of young rabbits.

The auditory brainstem response (ABR) was compared with the immunohistochemical expression of heat shock protein (HSP-72) and microtubule-associated protein 2 (MAP-2) of the brainstem auditory pathway in young rabbits subjected to hypoxic stress. Severe hypoxia for 2 h produced significant prolongation and decreased amplitude of the later component of ABR. HSP-72 expression was distinctly increased in the cochlear nucleus, but there was less induction in the inferior colliculus under severe hypoxia. MAP-2 immunostaining of neuropiles in the inferior collicular nucleus was decreased slightly after severe-long hypoxia, but cytoplasmic staining did not change. The present ABR change, which was produced by brainstem hypoxia-ischemia and acidosis, may be due to the neural cytoarchitectural derangement and less induction of stress proteins in the upper brainstem.

Expression of the LIS-1 gene product in brain anomalies with a migration disorder.

Miller-Dieker syndrome (MDS) is a prototype of brain malformations characterized by abnormal neuronal migration. To clarify the pathomechanisms underlying these anomalies, we performed immunohistochemical studies using specific antibodies against the protein product of LIS-1, the candidate gene responsible for the MDS phenotype. The LIS-1 protein was present abundantly and ubiquitously in normally developing brains. Loss of LIS-1 immunoreactivity was observed in brains with MDS, but not in brains with other malformations, such as isolated lissencephaly, holoprosencephaly, Fukuyama-type congenital muscular dystrophy, and Zellweger syndrome. These results suggest that the pathomechanism underlying abnormal neuronal migration in MDS may be specific to this particular type of malformation.