Early results of nerve transfers for restoring function in severe cases of acute flaccid myelitis.

OBJECTIVE: To describe early functional outcomes of nerve transfer surgery in a relatively large cohort of patients with acute flaccid myelitis (AFM). METHODS: A retrospective case analysis was made of patients with AFM treated with nerve transfer surgery between 2007 and 2018. Surgical criteria were persistent motor deficits after 6 months from onset and available donor nerves. Thirty-two patients with AFM were evaluated; 16 underwent nerve transfer surgeries. Motor function was evaluated by a licensed occupational therapist using the Active Movement Scale preoperatively and during follow-up examinations. Patients with 6 or more months of follow-up were included in the analysis. Patients with procedures other than nerve transfers were excluded. RESULTS: Sixteen patients with AFM had nerve transfers, with a male predominance (75%) and median age of 2.5 years (range = 4 months-12 years). Eleven patients had a minimum 6 months of follow-up. Nerve transfers to restore elbow function had 87% excellent recovery for elbow flexion and 67% for elbow extension. Finger and thumb extension were full against gravity in 1 patient (100%). Shoulder external rotation was excellent in 50% of patients and shoulder abduction in only 20%. Nine of 10 patients (90%) had resolution of shoulder pseudosubluxation following nerve transfer to the suprascapular nerve. INTERPRETATION: Patients with AFM with persistent motor deficits 6 to 9 months after onset benefit from nerve transfer surgery. Restoration of elbow function was more reliable than restoration of shoulder function. We recommend early referral of patients with incomplete recovery to a center experienced in nerve transfers for timely evaluation and treatment. ANN NEUROL 2019;86:607-615.

Acute flaccid myelitis: A clinical review of US cases 2012-2015.

This review highlights clinical features of the increasing cases of acute flaccid paralysis associated with anterior myelitis noted in the United States from 2012 to 2015. Acute flaccid myelitis refers to acute flaccid limb weakness with spinal cord gray matter lesions on imaging or evidence of spinal cord motor neuron injury on electrodiagnostic testing. Although some individuals demonstrated improvement in motor weakness and functional deficits, most have residual weakness a year or more after onset. Epidemiological evidence and biological plausibility support an association between enterovirus D68 and the recent increase in acute flaccid myelitis cases in the United States. Ann Neurol 2016;80:326-338.

Tolerogenic dendritic cells in the control of autoimmune neuroinflammation: an emerging role of protein-glycan interactions.

During the past decade, a great deal of information has contributed to our understanding of the immunosuppressive pathways that operate during the resolution of autoimmune pathology, including central nervous system (CNS) inflammation. Activation of these pathways is accomplished through the integration of an intricate network of inhibitory signals and immune suppressive cells, including regulatory T cells, myeloid-derived suppressor cells, 'alternatively activated' macrophages and tolerogenic dendritic cells (DCs). During the course of inflammatory diseases, immature or mature DCs may be licensed by different stimuli (e.g. cytokines, neuropeptides and growth factors) to become tolerogenic and suppress pathogenic T cell responses, thus emphasizing the outstanding plasticity of these cells. Recent findings have shed light to an immunoregulatory circuit by which galectin-1, an endogenous glycan-binding protein, favors the differentiation of regulatory DCs which promote T cell tolerance and contribute to resolution of autoimmune pathology through mechanisms involving IL-27 and IL-10. Together with the ability of galectin-1-glycan interactions to selectively blunt T helper (Th)1 and Th17 responses, this effect provides a rational explanation for the broad immunosuppressive effects of this glycan-binding protein in several experimental models of chronic inflammation and cancer. In this mini review, we will summarize the regulatory signals leading to the differentiation of tolerogenic DCs and their participation in CNS inflammation. In addition, we will underscore recent findings on the emerging role of galectin-glycan interactions in the establishment of immunosuppressive networks during the resolution of chronic inflammation.

Neurodegeneration and increased production of nitrotyrosine, nitric oxide synthase, IFN-gamma and S100beta protein in the spinal cord of IL-12p40-deficient mice infected with Trypanosoma cruzi.

BACKGROUND/AIM: Chagas' disease is caused by Trypanosoma cruzi and occurs in most Latin American countries. The protozoan may colonize the central nervous system (CNS) of immune-compromised human hosts, thus causing neuronal disorders. Systemic control of the intracellular forms of the parasite greatly depends on the establishment of a TH1 response and subsequent nitric oxide (NO) release. At the CNS, it is known that low concentrations of NO promote neuronal survival and growth, while high concentrations exert toxic effects and neuron death. Accounting for NO production by astrocytes is the glia-derived factor S100beta, which is overproduced in some neurodegenerative diseases. In the current work, we studied the expression of NO, interferon (IFN)-gamma and S100beta in the spinal cord tissue of IL-12p40KO mice infected with T. cruzi, a model of neurodegenerative process. METHODS: IL-12p40KO and wild-type (WT) female mice infected with T. cruzi Sylvio X10/4 (10(5) trypomastigotes, intraperitoneally) were euthanized when IL-12p40KO individuals presented limb paralysis. Spinal cord sections were submitted to immunohistochemical procedures for localization of neurofilament, laminin, nitrotyrosine, NO synthases (NOS), IFN-gamma and S100beta. The total number of neurons was estimated by stereological analysis and the area and intensity of immunoreactivities were assessed by microdensitometric/morphometric image analysis. RESULTS: No lesion was found in the spinal cord sections of WT mice, while morphological disarrangements, many inflammatory foci, enlarged vessels, amastigote nests and dying neurons were seen at various levels of IL-12p40KO spinal cord. Compared to WT mice, IL-12p40KO mice presented a decrement on total number of neurons (46.4%, p < 0.05) and showed increased values of immunoreactive area for nitrotyrosine (239%, p < 0.01) and NOS (544%, p < 0.001). Moreover, the intensity of nitrotyrosine (16%, p < 0.01), NOS (38%, p < 0.05) and S100beta (21%, p < 0.001) immunoreactivities were also augmented. No IFN-gamma-labeled cells were seen in WT spinal cord tissue, contrary to IL-12p40KO tissue that displayed inflammatory infiltrating cells and also some parenchymal cells positively labeled. CONCLUSION: We suggest that overproduction of NO may account for neuronal death at the spinal cord of T. cruzi-infected IL-12p40KO mice and that IFN-gamma and S100beta may contribute to NOS activation in the absence of IL-12.

Meningoencefalite e polioencefalomalacia causadas por Herpesvírus bovino-5 no estado do Pará / Meningoencephalitis and polioencephalomalacia caused by bovine herpesvirus-5 in the state of Pará, northern Brazil

O presente trabalho relata quatro casos de meningoencefalite por BHV-5 em quatro municípios no estado do Pará afetando bovinos de 1-2 anos, criados extensivamente. Três casos ocorreram de forma isolada e em um caso foram atingidos 3 animais do rebanho. Os principais sinais clínicos observados foram incoordenação, depressão acentuada, cegueira, decúbito lateral, opistótono e morte. O curso clínico foi de 3-4 dias. Macroscopicamente observaram-se áreas amolecidas, amareladas e cavitações no córtex cerebral. Microscopicamente observaram-se poliencefalomalacia no córtex cerebral, tálamo e núcleos da base, encefalite e meningite não supurativa e corpúsculos de inclusão intranucleares eosinofílicos em astrócitos. O diagnóstico foi realizado com base nos achados histológicos característicos.(AU)

Four outbreaks of meningoencephalitis in 1 to 2 years old cattle caused by Bovine herpesvirus-5 are reported in four municipalities in the state of Pará, northern Brazil. In three outbreaks only one animal was affected, in another 3 cattle were affected. Main clinical signs were incoordination, dullness, blindness, recumbence, and opisthotonus. Death occurred after a clinical manifestation period of 3-4 days. Softening and yellowish areas were observed grossly in the cerebral cortex. The histology revealed poliencephalomalacia in the cerebral cortex, thalamus and basal nuclei, and non suppurative encephalitis and meningitis, and eosinophilic intranuclear inclusion bodies in astrocytes. The diagnosis was based on the typical microscopic lesions.(AU)

Meningoencefalite e polioencefalomalacia causadas por Herpesvírus bovino-5 no estado do Pará / Meningoencephalitis and polioencephalomalacia caused by bovine herpesvirus-5 in the state of Pará, northern Brazil

O presente trabalho relata quatro casos de meningoencefalite por BHV-5 em quatro municípios no estado do Pará afetando bovinos de 1-2 anos, criados extensivamente. Três casos ocorreram de forma isolada e em um caso foram atingidos 3 animais do rebanho. Os principais sinais clínicos observados foram incoordenação, depressão acentuada, cegueira, decúbito lateral, opistótono e morte. O curso clínico foi de 3-4 dias. Macroscopicamente observaram-se áreas amolecidas, amareladas e cavitações no córtex cerebral. Microscopicamente observaram-se poliencefalomalacia no córtex cerebral, tálamo e núcleos da base, encefalite e meningite não supurativa e corpúsculos de inclusão intranucleares eosinofílicos em astrócitos. O diagnóstico foi realizado com base nos achados histológicos característicos.