Robert L. Knobler

Neuropsychological and structural brain lesions in multiple sclerosis A regional analysis

Quantified lesion scores derived from MRI correlate significantly with neuropsychological testing in patients with multiple sclerosis (MS). Variables used to reflect disease severity include total lesion area (TLA), ventricular-brain ratio, and size of the corpus callosum. We used these general measures of cerebral lesion involvement as well as specific ratings of lesion involvement by frontal, temporal, and parieto-occipital regions to quantify the topographic distribution of lesions and consequent effects upon cognitive function. Lesions were heavily distributed in the parieto-occipital regions bilaterally. Neuropsychological tests were highly related to all generalized measures of cerebral involvement, with TLA being the best predictor of neuropsychological deficit. Mean TLA for the cognitively impaired group was 28.30 cm2 versus 7.41 cm2 for the cognitively intact group (p < 0.0001). Multiple regression analyses revealed that left frontal lobe involvement best predicted impaired abstract problem solving, memory, and word fluency. Left parieto-occipital lesion involvement best predicted deficits in verbal learning and complex visual-integrative skills. Analysis of regional cerebral lesion load may assist in understanding the particular pattern and course of cognitive deficits in MS.

Monoclonal Anti-Gamma Interferon Antibodies Enhance Experimental Allergic Encephalomyelitis

Interferon-gamma (IFN-gamma) is a cytokine with multiple activities on a variety of cells. Under various circumstances, IFN-gamma can exhibit either pro-inflammatory or inhibitory actions. Treatment of SJL/J mice with a monoclonal antibody (Mab) to IFN-gamma during the afferent limb of the immune response to myelin protein produced an enhancement of acute experimental allergic encephalomyelitis (EAE), with increased morbidity, mortality and earlier onset of disease. Systemic administration of IFN-gamma did not improve or worsen clinical outcome, but delayed disease onset. Passive transfer of immune lymph node cells co-activated with MBP and anti-IFN-gamma Mab resulted in more sever disease than that induced by MBP stimulated cells or MBP and IFN-gamma co-stimulated cells. However, in vitro proliferation of an MBP specific T cell line was not influenced by IFN-gamma nor anti-IFN-gamma treatment. Mab to IFN-gamma inhibited suppressor function, in a non-specific assay. These in vivo and in vitro results suggest that systemic IFN-gamma serves as a physiological regulator of a suppressor mechanism in EAE. The abrogation of this regulatory mechanism by anti-IFN-gamma administration contributes to a more severe form of experimental allergic encephalomyelitis.

Role of cell cycle regulators in tumor formation in transgenic mice expressing the human neurotropic virus, JCV, early protein

Transgenic mice harboring the early genome from the human neurotropic JC virus, JCV, develop massive abdominal tumors of neural crest origin during 6–8 months after birth and succumb to death a few weeks later. The viral early protein, T‐antigen, which possesses the ability to transform cells of neural origin, is highly expressed in the tumor cells. Immunoblot analysis of protein extract from tumor tissue shows high level expression of the tumor suppressor protein, p53, in complex with T‐antigen. Expression of p21, a downstream target for p53, which controls cell cycle progression by regulating the activity of cyclins and their associated kinases during the G1 phase, is extremely low in the tumor cells. Whereas the level of expression and activity of cyclin D1 and its associated kinase, cdk6, was modest in tumor cells, both cyclin A and E, and their kinase partners, cdk2 and cdk4, were highly expressed and exhibited significant kinase activity. The retinoblastoma gene product, pRb, which upon phosphorylation by cyclins:cdk induces rapid cell proliferation, was found in the phosphorylated state in tumor cell extracts, and was detected in association with JCV T‐antigen. The transcription factor, E2F‐1, which dissociates from the pRb–E2F‐1 complex and stimulates S phase‐specific genes upon phosphorylation of pRb and/or complexation of pRb with the viral transforming protein, was highly expressed in tumor cells. Accordingly, high level expression of the E2F‐1‐responsive gene, proliferating cell nuclear antigen (PCNA), was detected in the tumor cells. These observations suggest a potential regulating pathway that, upon expression of JCV T‐antigen, induces formation and progression of tumors of neural origin in a whole animal system. J Cell. Biochem. 67:223–230, 1997.

Suppression of acute and relapsing experimental allergic encephalomyelitis with mitoxantrone

The effect of treatment with the antineoplastic, immunomodulatory agent mitoxantrone on the course of acute and relapsing experimental allergic encephalomyelitis (EAE) in the mouse has been studied. Untreated mice immunized to produce acute EAE had an 81% incidence of clinical disease and 100% incidence of pathologic disease. Mice treated with mitoxantrone at a dose of 0.5 mg/kg daily for the 10 days following immunization did not develop any clinical signs and had minimal pathologic signs of disease. A dose of 0.25 mg/kg gave an intermediate response. Untreated mice immunized for relapsing EAE had a 100% incidence of disease with an average onset of disease on Day 148. Mice treated with mitoxantrone at a dose of 0.05 mg/kg three times weekly for 12 weeks following immunization had a 67% incidence of clinical disease with a significant delay in the average onset date to Day 279. These results indicate that mitoxantrone was highly effective in suppressing development of acute EAE. Mitoxantrone delayed the onset of relapsing EAE in mice, but did not fully inhibit the eventual expression of the disease. These studies suggest that the use of cytotoxic therapies in the treatment of autoimmune diseases may require periodic cycles of therapy to block disease expression.

The sensitivity of the Mini‐Mental State Exam in the white matter dementia of multiple sclerosis

Fifty-six patients diagnosed with definite multiple sclerosis (MS) according to Poser criteria were administered the Mini-Mental State Examination (MMSE) and a comprehensive battery of neuropsychological tests. Extent of cerebral lesion involvement was determined by quantitative magnetic resonance imaging (MRI) ratings. The MMSE correlated with overall levels of physical disability, but did not correlate with total lesion area on MRI. Sensitivity of the MMSE to the subcortical dementia of MS was low (28%) when performance on the neuropsychological testing battery was used as the criterion. Impairment on tests of memory, speed of information processing, abstract reasoning, naming/verbal fluency, as well as visuoperceptual organization, were correlated highly with total lesion area on MRI. The low sensitivity of the MMSE to cognitive impairment in MS is discussed in terms of its item composition and the characteristic pattern of deficits found in MS.

Down-regulation of interferon-γ-induced class II expression on human glioma cells by recombinant interferon-β-effects of dosage treatment schedule

Abstract We have examined the influence of human recombinant interferon-β (IFN-β) and interferon-γ (IFN-γ) on class II antigen expression on cultured glioblastoma multiforme cells by flow cytometry. Class II molecules were not constitutively expressed on these cells, nor induced by IFN-β. IFN-γ increased class II expression in a dose-dependent fashion. We demonstrate that IFN-β is either antagonistic or synergistic with IFN-γ in class II induction depending upon dose and schedule of administration. Both interferons at 100 IU/ml reduce class II expression by 18%, compared to IFN-γ alone. Pretreatment with IFN-β for 72 h, followed by both interferons yielded a 90% reduction. In contrast, lower concentrations (10 IU/ml) of both interferons were synergistic.

Interferon-γ-inducible endothelial cell class II major histocompatibility complex expression correlates with strain- and site-specific susceptibility to experimental allergic encephalomyelitis

Abstract The interaction between encephalitogenic lymphocytes and the cerebral microvascular lining is considered to be an important initial step in the recruitment of immune cells into the central nervous system (CNS) under pathological conditions such as multiple sclerosis (MS) and its investigative analog, experimental allergic encephalomyelitis (EAE). This study was conducted in order to examine whether differences in microvascular endothelial cell expression of several molecules involved in lymphovascular interactions correlate with the strain and organ-specific development of EAE. Cerebral and epididymal microvascular endothelial cells (EC) were isolated from SJL and B10.S mice, which, despite MHC-compatibility (H-2s), differ in their ability to develop EAE. The subcultured cells were then analyzed by flow cytometry for their ability to express class I MHC, class II MHC and ICAM-1 molecules in response to treatment with murine recombinant interferon-γ (IFN-γ). Over a range of doses and times, cerebral EC cultures derived from EAE-susceptible SJL mice expressed two-fold higher levels and higher cell surface densities of class II molecules than cerebral EC cultures derived from EAE-resistant B10.S mice, whereas class I and ICAM-1 molecules were comparably upregulated on both SJL and B10.S cerebral EC. In contrast, both SJL and B10.S epididymal EC cultures expressed lower but comparable levels of class II molecules in response to IFN-γ. Class I and ICAM-1 molecules, however, were upregulated to at least the same degree as that observed on cerebral EC derived from both strains. The strain and site-dependent variations in microvascular endothelial cell inducible class II expression suggest a potential role for this molecule at the cerebral vascular lining in determining susceptibility to the development of EAE in this murine model.

Utililization of experimental animal model for correlative multispectral MRI and pathological analysis of brain tumors.

Magnetic resonance imaging is the method of choice for non-invasive detection and evaluation of tumors of the central nervous system. However, discrimination of tumor boundaries from normal tissue, and the evaluation of heterogeneous lesions have proven to be limitations in traditional magnetic resonance imaging. The use of post-image acquisition processing techniques, such as multispectral tissue segmentation analysis, may provide more accurate clinical information. In this report, we have employed an experimental animal model for brain tumors induced by glial cells transformed by the human neurotropic JC virus to examine the utility of multispectral tissue segmentation for tumor cell identification. Six individual tissue types were discriminated by segmentation analysis, including heterogeneous tumor tissue, a clear demarcation of the boundary between tumor and non-tumor tissue, deep and cortical gray matter, and cerebrospinal fluid. Furthermore, the segmentation analysis was confirmed by histopathological evaluation. The use of multispectral tissue segmentation analysis may optimize the non-invasive determination and volumetric analysis of CNS neoplasms, thus providing improved clinical evaluation of tumor growth and evaluation of the effectiveness of therapeutic treatments.

Distribution of the blood-brain barrier in heterotopic brain transplants and its relationship to the lesions of EAE

The blood-brain barrier (BBB) is recognized as a barrier to the trafficking of molecules and cellular elements into the central nervous system (CNS). Horseradish peroxidase (HRP) exclusion is used as a measure of BBB integrity. The BBB is altered and becomes permeable during the course of experimental allergic encephalomyelitis (EAE). Heterotopic brain transplantation into the anterior eye chamber is a technique for studying genetic influences and the role of individual cell types on the development of EAE. Prior to EAE induction, HRP is excluded from the central portion of the transplant, demonstrating an intact BBB. In contrast, HRP localization is found at the periphery of the transplant, suggesting an incomplete barrier. However, EAE lesions typically occur within the more central regions of the transplant, where the BBB is intact, and not at peripherally located “leaky” areas. This suggests that endothelial cells at intact BBB sites may direct trafficking of lymphocytes (gating) into the CNS during the development of EAE, rather than the passive entry of lymphocytes into the CNS through a leaky BBB.

Heterotopic brain transplants in the study of experimental allergic encephalomyelitis

A heterotopic transplant paradigm was developed for its potential usefulness in dissecting genetically determined immune and central nervous system (CNS) components in the induction of experimental allergic encephalomyelitis (EAE). EAE is a cell-mediated, organ-specific, autoimmune disease producing inflammatory demyelination in the CNS. Susceptibility to EAE is determined by multiple genes and reflects both immune competence and target tissue responses. Syngeneic fetal CNS was heterotopically transplanted into the anterior chamber of the eye or beneath the capsule of the kidney of adult SJL or (SJL X BALB/c)F1 mice. Transplants usually survived better in the eye than the kidney. Six to eight weeks after transplantation, some mice were immunized for EAE. Immunized mice developed clinical and pathological signs of EAE in 12 to 15 days. The placement of CNS tissue into the eye or kidney prior to immunization did not suppress induction of EAE. Transplants in either location, in immunized mice, manifested perivascular inflammation and demyelination similar to that seen in the host CNS. However, transplants in mice not immunized for EAE, but maintained an equal time period after transplantation, did not demonstrate these features. The ability to produce the specific pathologic lesions of EAE in CNS tissue transplanted outside the CNS allows the design of studies of the tissue localization of genetic restrictions to development of EAE.