Leukotrienes in patients with clinically active multiple sclerosis.

OBJECTIVES: The role of leukotrienes (LTs) in the pathophysiology of multiple sclerosis (MS) has been controversially discussed in the past. Studies of LTs in the cerebrospinal fluid (CSF) revealed different results mainly because of analytical difficulties. MATERIAL AND METHODS: In the present study we used highly sensitive and specific analytical methods for measuring LTs in the CSF as well as in urine samples from 20 patients with active MS and 20 control patients with noninflammatory neurological disorders. RESULTS: LTB4 concentrations in CSF were almost twice as high in MS patients compared with controls (P < 0.001). CSF concentrations of the cysteinyl-LTs (LTC4, LTD4 and LTE4) as well as urinary LTE4 showed no significant differences compared with controls (P > 0.05). In addition, there was no significant association between CSF pleocytosis, clinical severity or time of disease onset. CONCLUSIONS: The increased concentration of LTB4 in the CSF of MS patients may indicate a biological importance for this mediator in MS.

[Differential diagnosis and therapy of headache in general practice. Anamnesis is the alpha and omega]. / Differenzialdiagnose und Therapie des Kopfschmerzes in der Praxis. Die Anamnese ist das A und O.

Headache is one of the most common reasons for a patient to consult the doctor. Of prime importance are the correct differential diagnosis and effective treatment. A differentiation is made between primary and secondary headache. In the international classification, the primary headache syndromes include migraine with and without an aura, tension type headache, headache associated with misuse of analgesics, cluster headache, and a number of rare forms of headache with no structural lesion. The secondary headache syndromes occur symptomatically as sequelae of underlying disease, the spectrum of causes covering more than 300 different disorders. In patients with headache of unclear genesis, careful history-taking and thorough physical examination should be followed by a further diagnostic work-up.

Effects of boswellic acids extracted from a herbal medicine on the biosynthesis of leukotrienes and the course of experimental autoimmune encephalomyelitis.

Mixed acetylboswellic acids, pentacyclic triterpenes extracted from the gum resin of Boswellia serrata Roxb., significantly inhibited the ionophore-stimulated release of the leukotrienes (LT) B4 and C4 from intact human polymorphonuclear neutrophil leukocytes (PMNLs), with IC50 values of 8.48 micrograms/ml and 8.43 micrograms/ml, respectively. Purified acetyl-11-keto-beta-boswellic acid was about three times more potent as inhibitor of the formation of both LTB4 (IC50 = 2.53 micrograms/ml) and LTC4 (IC50 = 2.26 micrograms/ml) from human PMNLs in the same assay. The comparative agent MK 886 (3-[1-(4-chlorobenzyl)-3-t-butyl-thio-5-isopropylindol-2-yl]- 2,2-dimethylpropanoic acid, L-663,536, CAS 118, 414-82-7) was about 10 to 100-fold more active than the boswellic acids in inhibiting the formation of 5-lipoxygenase products in human PMNLs, with IC50 values of 0.0068 microgram/ml (LTB4) and 0.49 microgram/ml (LTC4). After daily intraperitoneal dosage the extract of mixed acetylboswellic acids (20 mg/kg) significantly reduced the clinical symptoms in guinea pigs with experimental autoimmune encephalomyelitis (EAE) between days 11 and 21. However, the inflammatory infiltrates in the brain and the spinal cord were not significantly less extensive in the treated animals than in the respective control group. The multiple intraperitoneal application of boswellic acids did not inhibit the ionophore-challenged ex vivo release of leukotrienes B4 and C4 from PMNLs separated from the blood of guinea pigs with EAE. The boswellic acids have thus been characterized as selective, non-redox and potent inhibitors of the biosynthesis of leukotrienes in vitro.

[Intraspinal manifestation of cysticercosis--Cysticercus racemosus. A case report and review of the literature]. / Intraspinale Manifestation der Zystizerkose--Cysticercus racemosus. Kasuistik und Literaturübersicht.

Neurocysticercosis is one of the most common, world-wide parasitic diseases of the central nervous system. On the basis of a case report and a review of the literature, the present paper describes the rare course of an intraspinal cysticercus racemosus infection. In conjunction with magnetic resonance imaging and computed tomography it is necessary to consider conventional myelography occupies an important position in the diagnosis of spinal manifestations of cysticercosis, cross-reactions, especially with Echinococcus antigens, by means of serological tests. In addition to the desirable surgical removal of the cysts, drug therapy with praziquantel and albendazole may be employed. Albendazole has recently been authorized for use in Germany.

Leukotrienes in the cerebrospinal fluid of multiple sclerosis patients.

The concentration of the leukotrienes B4 (LTB4) and C4 (LTC4) was measured in the cerebrospinal fluid (CSF) of 38 multiple sclerosis (MS) patients and 51 with other neurological diseases. The LTB4 and LTC4 levels were significantly elevated in MS compared with the controls. The findings suggest that lipoxygenase products might play a pathogenetic role in the early, encephalitogenic phase of MS. The administration of lipoxygenase inhibitors or leukotriene antagonists might well open new perspectives for the treatment of MS.

Suppression of experimental autoimmune encephalomyelitis by a new specific inhibitor of leukotriene biosynthesis.

The actions of the specific inhibitor of leukotriene synthesis, 3-[1-(4-chlorobenzyl)-3-t-butyl-thio-5-isopropylindol-2-yl]-2,2- dimethylpropanoic acid (L-663, 536, CAS 118414-82-7) were investigated in groups of guinea pigs that had been given both low and high doses of the encephalitogenic stimulant to induce experimental autoimmune encephalomyelitis (EAE). After daily intraperitoneal application over a period of 2 to 3 weeks the substance L-663, 536 (5 mg/kg) largely suppressed the clinical symptoms of EAE in some of the animals. The difference in the clinical symptoms between those animals that had been treated with L-663, 536 and those that had not was observed primarily in the experiment with a high encephalitogenic dose. The onset of progressive paralysis of the hind limbs that was observed in approximately 80% of the control animals only occurred in 40% of the guinea pigs that were treated with L-663, 536. No paresis at all was observed in about 25% of the treated animals. In both laboratory animals studies the CNS inflammatory infiltrates were significantly less extensive in the treated animals than in the respective control groups. The release of leukotrienes B4 and C4 by circulating neutrophil granulocytes in guinea pigs under treatment with L-663, 536 was also significantly reduced--in contrast to the untreated control animals. On the basis of the present results, it may be assumed that the L-663, 536-induced suppression of EAE in guinea pigs is attributable to the inhibition of leukotriene biosynthesis.

Suppression of experimental autoimmune encephalomyelitis by sulfasalazine.

It has recently been suggested that the sulfidopeptide leukotriene C4 (LTC4), a 5-lipoxygenase product of the arachidonic acid metabolism and one of the most potent mediators of vascular permeability, might be involved in the pathogenesis of experimental autoimmune encephalomyelitis (EAE) and multiple sclerosis (MS). Subsequently, 20 guinea pigs with EAE were treated with sulfasalazine, a substance with a proved leukotriene inhibiting effect, which has previously been described as exerting beneficial effects in patients with inflammatory bowel disease and rheumatoid arthritis. The sulfasalazine-treated guinea pigs showed a significantly better clinical outcome, as well as a significantly lower histological inflammation score compared with 19 controls.

Suppression of experimental autoimmune encephalomyelitis by dual cyclo-oxygenase and 5-lipoxygenase inhibition.

The release of leukotriene C4 (LTC4), an important 5-lipoxygenase product of the arachidonic acid metabolism from polymorphonuclear leucocytes (PMNLs) of guinea pigs with experimental allergic encephalomyelitis (EAE), the animal model of MS, has been found to be significantly increased compared with healthy animals. Subsequently, the dual cyclo-oxygenase and 5-lipoxygenase inhibitor BW755C was applied to 15 guinea pigs with EAE. Two control groups (15 each) were treated with the cyclo-oxygenase inhibitor indomethacin or physiological saline, respectively. In the BW755C treated group, no animal developed symptoms of the disease in contrast to, respectively, 5 and 3 animals in the 2 other groups. Histological examination of the CNS revealed a highly significantly lower inflammation score in the BW755C treated animals, and the release of LTC4 from PMNLs was highly significantly decreased in this group compared with each of the others. The findings suggest that the vascular permeability enhancing LTC4 plays a pathogenetic role in EAE and indicate that inhibition of this sulfidopeptide leukotriene suppresses the disease. Therefore, the application of leukotriene inhibitors could contribute to the future treatment of MS.

Leukotrienes B4 and C4 in MS.

Release of leukotriene B4 (LTB4) and leukotriene C4 (LTC4) from neutrophils and platelet-neutrophil suspensions in response to ionophore A23187 was measured in 12 multiple sclerosis (MS) patients and 8 healthy volunteers. LTC4 release from neutrophils, as well as from platelet-neutrophil suspensions, was significantly decreased in MS patients compared with the controls. There was no significant difference in the release of LTB4 between MS patients and controls. The findings suggest that permanent stimulation of platelets and neutrophils e.g., by encephalitogenic peptide leads to continuous LTC4 release with subsequent depletion of intracellular substrates serving as precursors for the formation of 5-lipoxygenase products. Since the target of microvascular actions of LTC4 are postcapillary venules, the release of this sulfidopeptide leukotriene might play a pathogenetic role in the formation of MS lesions.

[Herpes simplex encephalitis with cerebral hemorrhage]. / Herpes-simplex-Enzephalitis mit intrazerebraler Blutung.

In a 20-year-old woman with herpes simplex encephalitis the dominant feature was an intracerebral bleeding which was diagnosed by computed tomography in the initial stages of the disease. Since lesions in herpes simplex encephalitis typically present in the CT as hypodense zones in which petechial bleedings may occur, it is likely that the bleeding in this patient was caused by an inflammation in the area of an histologically confirmed arteriovenous angioma.

Encephalitogenic peptide and platelet aggregation in multiple sclerosis.

Platelet aggregation (PA) stimulated by encephalitogenic peptide (EP) and PA induced by ADP were measured in 83 multiple sclerosis (MS) patients and 70 control subjects with other neurological diseases (OND). EP-stimulated PA was significantly increased in MS patients as compared with the controls. There was no significant difference in ADP-induced PA between patients with MS and OND. The results are discussed in terms of EP-stimulated platelets playing a role in the pathogenesis of MS by affecting the venular permeability of the brain.

[Metabolic aspects of multiple sclerosis]. / Stoffwechselaspekte der Multiplen Sklerose.

According to the present opinion multiple sclerosis (MS) is caused by a concurreance of various factors. This predisposing factor seem to be related to a disturbance of the lipid- and fatty acid metabolism, characterized by decreased concentrations of polyunsaturated fatty acids (PUFA) and essential fatty acids (EFA) in the plasma, the blood cells, the cerebrospinal fluid (CSF) and white matter of the brain in patients with MS. A disturbed absorption of EFA could be excluded. Now the question arises whether there is a disturbed utilisation of EFA with the consequence of biochemical changes in myelin and blood cells. According to lipid-chemical and lipolytic enzymological studies a disturbance of the fatty acid elongation system as well as primary increased activation of the phospholipase A1 is conceivable. According to the demonstrated results the conception of a metabolic immunological caused generalised defect of the biological membranes - especially those of the myelin sheath and platelets - as predisposing factor for the increased platelet aggregation is possible. Even though these ideas do not yet allow a concrete pathogenetic conclusion, the prostaglandins (PG) might be of importance because their precursors are fatty acids and influence the immune mechanisms. Possibly, new approaches follow from the synopsis of present working hypotheses for an extended biochemical-immunological model of multiple sclerosis. Further immunological and laboratory methods should concentrate on differentiating MS from other diseases of the central nervous system and on diagnosing the disease in its early stage. The results of this work are fully discussed in other publications. Separate prints can be requested from the author.