Brains of 19 AIDS patients with HIV encephalitis were examined by immunohistochemistry and in situ hybridization using antisense HIV DNA and RNA probes. Double immunohistochemical labeling, using antibodies against viral and cell-type specific antigens, was utilized to study lesions in some brains. Other combined studies included use of in situ hybridization and immunohistochemical labeling of the same section, using antibodies against either viral or cell-type specific antigens. Hybridization signals were abundant and were concentrated mainly in the white matter. Heavy labeling was found in the subcortical white matter, the corpus callosum, the internal capsule, and white matter regions of the brainstem and cerebellum. Deeper cortical layers often contained cells with hybridized probe when the subcortical white matter was intensely labeled. HIV nucleic acid sequences were found almost exclusively in macrophages. Counts showed that 16-25% of macrophages contained viral antigens and exhibited hybridized HIV probe. Almost all of these macrophages contained proviral DNA, viral RNA and viral proteins; i.e. they were actively replicating HIV. We also examined brains from three AIDS cases without clinical or pathological evidence of HIV encephalitis; no HIV sequences or immunoreactive proteins were detected.
Eight patients with meningeal seeding by carcinoma or lymphomas were treated with intravenous (i.v.) and/or intrathecal (i.th.) Methotrexate (MTX). Seven patients received additional craniospinal irradiation and in all seven a fatal encephalopathy developed. On the bases of clinical and morphological findings we identified an acute and a delayed form of encephalopathy and concluded that the concurrent administration of Methotrexate and of craniospinal irradiation increases considerably the risk of brain damage.
Considering the possibility of a paracellular route for edema resolution we studied the microvasculature of the subependymal and subcortical white matter in hydrocephalic rats. Normal adult rats were used as controls. After injection of kaolin suspension into the cisterna magna, the animals were killed at intervals of 1, 2, 4, and 8 weeks. In hydrocephalic rats at 1 week after kaolin injection, widening of the interendothelical cleft between the tight junction (dehiscence) was seen in 27 of 76 (35%) vessels. At 2 weeks after kaolin injection, the number of the dehiscences had increased (39/7:56%) and some were enlarged, forming interendothelial blisters. At 4 weeks in hydrocephalic rats, both dehiscences and blisters were still prominent (45/73:63%) and at 8 weeks the dehiscences were still prominent, but the number of the blisters had decreased (25/81:31%). The blisters and dehiscences were most pronounced in the corpus callosum and occipital regions. Following i.v. injection of horseradish peroxidase, the interendothelial dehiscences and blisters were completely devoid of the marker substance. These findings indicate that in obstructive hydrocephalus the tight junctions may constitute part of a paracellular pathway for the resorption of interstitial edema fluid.
Considering the possibility of a paracellular pathway for edema resolution, we studied the intracerebral movement of proteins and ionic lanthanum in rats with experimental hydrocephalus. Hydrocephalus was induced by injection of kaolin suspension into the cisterna magna. After induction of hydrocephalus, horseradish peroxidase (HRP), microperoxidase (MP), or lanthanum chloride (LaCl3) were perfused into the ventricle system. HRP and MP were localized mainly in the intercellular spaces between ependymal cells, glial cells, and in perivascular spaces and were restricted by endothelial tight junctions. Ionic lanthanum (La3+), however, penetrated these tight junctions and moved between the blood and CSF cavities by paracellular pathways. These findings indicate that in obstructive hydrocephalus, the tight junctions may constitute part of a paracellular pathway for the transendothelial movement of small solutes, although they prevent the movement of larger molecules.
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