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Showing posts with label Autoimmunity. Show all posts
Showing posts with label Autoimmunity. Show all posts
Monday, July 28, 2014
A Sensible Green Salad
It's both an irritant and a sputtering baby flame of hope that one wishes to privately tend, teasing with tendrils of dried moss, carefully offered wafts of fresh but humid air, then cautiously covered with a high tech cake dome, perfected "air" mixture piped in from the Perfected "Air" Mixture canister standing by. We who tend are dressed, variously, in protective suiting: high density yellow paper cloaks with plastic self-ties, elbow length dress gloves, Michael-Jacksonian masks (with some adjustments to the nose clip) mixed with slight variants of that wondrous Guy Fawkes, Anonymous hacktivists, V for Vendetta and Occupists masks, now wonderfully ubiquitous, even in my world where soma meets psyche for afternoon sex. A little Marvin Gaye, some ripe figs.
What? You're lost, you say? Are you sure you should've revived this blog, profderien, O Retired Educator?
What fire are we nursing now with such ridiculous, ambiguous imagination -- and to mention hope so early on, have you finally lost your faculties?
There's a team of researchers, a joint sort of affair, kind of -- affiliated with the University of Liverpool’s Institute of Translational Medicine and the University of Pecs in Hungary -- that is bandying about the word "cure" and CRPS within the same sentence. I know, I just recently posted about it... but then a few neural sparks made me search mine own blog, using as search term the very odd "Liverpool."
And I remembered Dr. Andreas Goebel.
And I remembered this craze of optimism, this careful tending of a flame, and the eventual realization that Goebel's pony has but one trick.
And that the trick is tantalizing, infuriating. Tantalizingly infuriating?
The source of the piss on the baby fire? Common sense, common experiences. To say that CRPS is not a neurological disorder at all, and not (often) the result of trauma is to belie the experience of... well, almost everyone with CRPS, and almost every physician who has observed its onset and evolution.
The air up here in Hope Land is thin, and hallucination likely.
I'll spare myself the shame of reviewing every sarcastic post born of my anger at those pushing "cure" and "CRPS" within the same paragraph -- and here I'd temporarily lost my bearings over another Goebel article, another IVIG paean, another sweeping claim.
My return to sanity came from an effort to eat popcorn. You take the hand, you approach it to the bowl of puffed grain, you grasp one (my preference) and you bring it to your mouth. Except, as has been the case for a few days, my hand would not cooperate, despite the oxygen-deprived fish mouthing of my face, hungry for popcorn. It either would decline to pick up a piece of the lightly salted kernel, or would manage that feat, only to drop it three inches below my gaping maw.
My return to sanity was bolstered by the pain and trophic changes of a now dragging right foot, the gift of an ignorant neurologist who conducted an ignorant neurological exam, the very definition of trauma.
My return to sanity has most especially been paved by the searing path of pouring boiling water on my thighs three mornings in a row during that incredibly complicated process of making coffee.
And my return to earlier convictions cleared completely when I remembered that Dr. Goebel headed an earlier team which published a paper -- just in December 2012 -- that included a line that has haunted me, and driven me:
There are only few treatments, and there is no cure. The condition has continued to puzzle investigators. Bizarre aspects of its presentation have continued to emerge over the past 110 years, and although we now understand that CRPS is indeed associated with an initial local inflammatory response – without reported neutrophil invasion or overt tissue destruction [8] – the underlying cause has remained elusive. Over the course of the disease, initial limb signs generally mellow [9], however about 15% of patients continue to have unrelenting pain [5]; these patients' quality of life remains amongst the lowest reported in medical conditions [6].
Tonight, Fred and I cranked up the air conditioner and dined on a sensible green salad dressed with red balsamic vinegar, because we are out of white.
© 2013 L. Ryan
Wednesday, July 2, 2014
CRPS in the Context of (Neuro?) Autoimmunity (With Thanks to Mice)
Researchers at the University of Liverpool have taken a major step forward in understanding the causes of a disorder which causes chronic pain in sufferers.
Complex Regional Pain Syndrome (CRPS) is a serious condition affecting a limb after an – often small – accident or operation. It can cause severe pain lasting many years, as well as limb swelling, hair and nail growth changes, and muscle atrophy, but until now there has been no clear evidence of the cause.
Now the research team from the University’s Institute of Translational Medicine alongside colleagues at the University of Pécs, Hungary have successfully transferred antibodies from the serum of patients with CRPS to mice, causing many of the same symptoms to be replicated.
Dr Andreas Goebel *, who works in the University of Liverpool and is a Consultant in Pain Medicine at The Walton Centre NHS Foundation Trust, led the study. He said: “CRPS is a serious condition which isn’t fully understood. The findings of this study hint at a cause for it – harmful serum-autoantibodies – and raise the possibility of finding a treatment.”[Read more of the story HERE from HealthCanal - Health News]
[ * Dr. Goebel's considerable research in chronic pain and CRPS HERE]
What to say? It sounds momentous, yes? But really, quite a bit of research, years old already, has been done that points to "clear evidence of the cause." Unfortunately, "THE cause" sort of thinking goes hand-in-hand with the "Silver Bullet Cure" crowd, and denies the complexity of the "syndrome." Be that as it may, it's a reflection more on the dumbing-down of pseudo-medical journalism, and not a reflection on the quality or bounds of the research on which the article is "reporting."
Why, for instance, do proponents of immunological causation feel the need to ignore the brain? Just thought I'd toss that out there, as something not particularly helpful, but indicative of either/or thinking that just does not fly when dealing with the intricate relations and processes of the human body. The peripheral and central nervous systems and their functional counterparts as parasympathetic and sympathetic impulses/small fibre neuropathy/glands run amok (hypothalamic-pituitary-adrenal -- HPA -- axis dysfunction)/immune system dysfunction/inflammation/psychosocial and environmental influences/and the darned partridge in a pear tree.
*********** ********** ********** ***********
A CRPS-IgG-transfer-trauma model reproducing inflammatory
and positive sensory signs associated with complex regional pain syndrome
ABSTRACT
The aetiology of complex regional pain syndrome (CRPS), a highly painful, usually post-traumatic condition affecting the limbs, is unknown, but recent results have suggested an autoimmune contribution. To confirm a role for pathogenic autoantibodies, we established a passive-transfer trauma model. Prior to undergoing incision of hind limb plantar skin and muscle, mice were injected either with serum IgG obtained from chronic CRPS patients or matched healthy volunteers, or with saline. Unilateral hind limb plantar skin and muscle incision was performed to induce typical, mild tissue injury. Mechanical hyperalgesia, paw swelling, heat and cold sensitivity, weight-bearing ability, locomotor activity, motor coordination, paw temperature, and body weight were investigated for 8 days. After sacrifice, proinflammatory sensory neuropeptides and cytokines were measured in paw tissues. CRPS patient IgG treatment significantly increased hind limb mechanical hyperalgesia and oedema in the incised paw compared with IgG from healthy subjects or saline. Plantar incision induced a remarkable elevation of substance P immunoreactivity on day 8, which was significantly increased by CRPS-IgG. In this IgG-transfer-trauma model for CRPS, serum IgG from chronic CRPS patients induced clinical and laboratory features resembling the human disease. These results support the hypothesis that autoantibodies may contribute to the pathophysiology of CRPS, and that autoantibody-removing therapies may be effective treatments for long-standing CRPS.
An interesting site: Centre for Immune Studies in Chronic Pain
© 2013 L. Ryan
Wednesday, May 18, 2011
Autoimmunity and CRPS
The passive transfer of immunoglobulin G serum antibodies from patients with longstanding Complex Regional Pain Syndrome
Andreas Goebel, Mar Liete, Li Yang, Robert Deacon, Cruz M. Cendan, Andrew Fox-Lewis, Angela Vincent
European Journal of Pain
Volume 15, Issue 5, Pages 504.e1-504.e6
May 2011
ABSTRACT
Background
The aetiology of Complex Regional Pain Syndrome (CRPS) is unknown. Recent evidence suggests that there may be autoantibodies directed against peripheral nerves, but it is unclear whether such autoantibodies are merely biomarkers or whether they cause or contribute to the underlying pathology. The transfer of disease after injection of a patient’s serum or IgG fraction into mice (‘passive transfer’) is the classic way to demonstrate a functional role of autoantibodies.
Aims
Based on previous preliminary results, we wished to investigate whether the transfer of IgG antibodies affected mouse behaviour or produced signs of CRPS.
Methods
We injected purified serum-IgG from 12 patients and 12 controls into groups of 6–10 mice (∼17mg/mouse intraperitoneally) on 2 consecutive days and looked for any evidence for altered behaviour or signs of CRPS. The observer, blinded as to test or control group, measured behaviour in the open field, stimulus-evoked pain and motor coordination, and inspected limbs for autonomic CRPS signs.
Results
Stimulus-evoked pain and autonomic signs were not detected, but CRPS-IgG induced significant depression of rearing behaviour (17.9 rears/3min (n=84) vs. 22.1 rears/3min (n=83), p=0.0004), confirming previous observations in a single case study. Moreover, motor impairment, one of the four cardinal signs of CRPS, was evident in the three CRPS-IgG injected groups tested with a sensitive rota-rod protocol (p<0.0001 vs. control-IgG injected groups).
Conclusions
These results lend support to a pathophysiological role for IgG autoantibodies in CRPS.
REFERENCES:
1.Abrahamsen B, Zhao J, Asante CO, Cendan CM, Marsh S, Martinez-Barbera JP, et al. The cell and molecular basis of mechanical, cold, and inflammatory pain. Science. 2008;321:702–705
2.Birklein F. Complex regional pain syndrome. J Neurol. 2005;252:131–138
3.Blackburn-Munro G. Pain-like behaviours in animals – how human are they?. Trends Pharmacol Sci. 2004;25:299–305
4.Blaes F, Schmitz K, Tschernatsch M, Kaps M, Krasenbrink I, Hempelmann G, et al. Autoimmune etiology of complex regional pain syndrome (M. Sudeck). Neurology. 2004;63:1734–1736
5.Buckley C, Vincent A. Autoimmune channelopathies. Nat Clin Pract Neurol. 2005;1:22–33
6.Cerbone A, Sadile AG. Behavioral habituation to spatial novelty: interference and noninterference studies. Neurosci Biobehav Rev. 1994;18:497–518
7.Contet C, Rawlins JN, Deacon RM. A comparison of 129S2/SvHsd and C57BL/6JOlaHsd mice on a test battery assessing sensorimotor, affective and cognitive behaviours: implications for the study of genetically modified mice. Behav Brain Res. 2001;124:33–46
8.Dalakas M. IVIG in other autoimmune neurological disorders: current status and future prospects. J Neurol. 2008;255(Suppl. 3):12–16
9.Deacon RM, Croucher A, Rawlins JN. Hippocampal cytotoxic lesion effects on species-typical behaviours in mice. Behav Brain Res. 2002;132:203–213
10.Goebel A, Baranowski AP, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of complex regional pain syndrome: a randomized trial. Ann Int Med. 2010;152:152–158
11.Goebel A, Stock M, Deacon R, Sprotte G, Vincent A. Intravenous immunoglobulin response and evidence for pathogenic antibodies in a case of complex regional pain syndrome 1. Ann Neurol. 2005;57:463–464
12.Goebel A, Vogel H, Caneris O, Bajwa Z, Clover L, Roewer N, et al. Immune responses to Campylobacter and serum autoantibodies in patients with complex regional pain syndrome. J Neuroimmunol. 2005;162:184–189
13.Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326–331
14.Inoue I, Yanai K, Kitamura D, Taniuchi I, Kobayashi T, Niimura K, et al. Impaired locomotor activity and exploratory behavior in mice lacking histamine H1 receptors. Proc Natl Acad Sci USA. 1996;93:13316–13320
15.Jones BJ, Roberts DJ. A rotarod suitable for quantitative measurements of motor incoordination in naive mice. N-S Arch Exp Pathol Pharmakol. 1968;259:211
16.Kohr D, Tschernatsch M, Schmitz K, Singh P, Kaps M, Schafer KH, et al. Autoantibodies in complex regional pain syndrome bind to a differentiation-dependent neuronal surface autoantigen. Pain. 2009;143:246–251
17.Maihofner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, et al. The motor system shows adaptive changes in complex regional pain syndrome. Brain. 2007;130:2671–2687
18.Mense S, Schiltenwolf M. Fatigue and pain; what is the connection?. Pain. 2010;148:177–178
19.Mills CD, Grady JJ, Hulsebosch CE. Changes in exploratory behavior as a measure of chronic central pain following spinal cord injury. J Neurotrauma. 2001;18:1091–1105
20.Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain. 2004;108:192–198
21.Rose NR, Bona C. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol Today. 1993;14:426–430
22.Teeling JL, Felton LM, Deacon RM, Cunningham C, Rawlins JN, Perry VH. Sub-pyrogenic systemic inflammation impacts on brain and behavior, independent of cytokines. Brain Behav Immun. 2007;21:836–850
23.Toyka KV, Brachman DB, Pestronk A, Kao I. Myasthenia gravis: passive transfer from man to mouse. Science. 1975;190:397–399
24.Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet. 1993;342:1012–1016
25.Zimmermann K, Leffler A, Babes A, Cendan CM, Carr RW, Kobayashi J, et al. Sensory neuron sodium channel Nav1.8 is essential for pain at low temperatures. Nature. 2007;447:855–858
26.Zlomuzica A, Viggiano D, De Souza Silva MA, Ishizuka T, Gironi Carnevale UA, Ruocco LA, et al. The histamine H1-receptor mediates the motivational effects of novelty. Eur J Neurosci. 2008;27:1461–1474
Andreas Goebel, Mar Liete, Li Yang, Robert Deacon, Cruz M. Cendan, Andrew Fox-Lewis, Angela Vincent
European Journal of Pain
Volume 15, Issue 5, Pages 504.e1-504.e6
May 2011
ABSTRACT
Background
The aetiology of Complex Regional Pain Syndrome (CRPS) is unknown. Recent evidence suggests that there may be autoantibodies directed against peripheral nerves, but it is unclear whether such autoantibodies are merely biomarkers or whether they cause or contribute to the underlying pathology. The transfer of disease after injection of a patient’s serum or IgG fraction into mice (‘passive transfer’) is the classic way to demonstrate a functional role of autoantibodies.
Aims
Based on previous preliminary results, we wished to investigate whether the transfer of IgG antibodies affected mouse behaviour or produced signs of CRPS.
Methods
We injected purified serum-IgG from 12 patients and 12 controls into groups of 6–10 mice (∼17mg/mouse intraperitoneally) on 2 consecutive days and looked for any evidence for altered behaviour or signs of CRPS. The observer, blinded as to test or control group, measured behaviour in the open field, stimulus-evoked pain and motor coordination, and inspected limbs for autonomic CRPS signs.
Results
Stimulus-evoked pain and autonomic signs were not detected, but CRPS-IgG induced significant depression of rearing behaviour (17.9 rears/3min (n=84) vs. 22.1 rears/3min (n=83), p=0.0004), confirming previous observations in a single case study. Moreover, motor impairment, one of the four cardinal signs of CRPS, was evident in the three CRPS-IgG injected groups tested with a sensitive rota-rod protocol (p<0.0001 vs. control-IgG injected groups).
Conclusions
These results lend support to a pathophysiological role for IgG autoantibodies in CRPS.
REFERENCES:
1.Abrahamsen B, Zhao J, Asante CO, Cendan CM, Marsh S, Martinez-Barbera JP, et al. The cell and molecular basis of mechanical, cold, and inflammatory pain. Science. 2008;321:702–705
2.Birklein F. Complex regional pain syndrome. J Neurol. 2005;252:131–138
3.Blackburn-Munro G. Pain-like behaviours in animals – how human are they?. Trends Pharmacol Sci. 2004;25:299–305
4.Blaes F, Schmitz K, Tschernatsch M, Kaps M, Krasenbrink I, Hempelmann G, et al. Autoimmune etiology of complex regional pain syndrome (M. Sudeck). Neurology. 2004;63:1734–1736
5.Buckley C, Vincent A. Autoimmune channelopathies. Nat Clin Pract Neurol. 2005;1:22–33
6.Cerbone A, Sadile AG. Behavioral habituation to spatial novelty: interference and noninterference studies. Neurosci Biobehav Rev. 1994;18:497–518
7.Contet C, Rawlins JN, Deacon RM. A comparison of 129S2/SvHsd and C57BL/6JOlaHsd mice on a test battery assessing sensorimotor, affective and cognitive behaviours: implications for the study of genetically modified mice. Behav Brain Res. 2001;124:33–46
8.Dalakas M. IVIG in other autoimmune neurological disorders: current status and future prospects. J Neurol. 2008;255(Suppl. 3):12–16
9.Deacon RM, Croucher A, Rawlins JN. Hippocampal cytotoxic lesion effects on species-typical behaviours in mice. Behav Brain Res. 2002;132:203–213
10.Goebel A, Baranowski AP, Maurer K, Ghiai A, McCabe C, Ambler G. Intravenous immunoglobulin treatment of complex regional pain syndrome: a randomized trial. Ann Int Med. 2010;152:152–158
11.Goebel A, Stock M, Deacon R, Sprotte G, Vincent A. Intravenous immunoglobulin response and evidence for pathogenic antibodies in a case of complex regional pain syndrome 1. Ann Neurol. 2005;57:463–464
12.Goebel A, Vogel H, Caneris O, Bajwa Z, Clover L, Roewer N, et al. Immune responses to Campylobacter and serum autoantibodies in patients with complex regional pain syndrome. J Neuroimmunol. 2005;162:184–189
13.Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326–331
14.Inoue I, Yanai K, Kitamura D, Taniuchi I, Kobayashi T, Niimura K, et al. Impaired locomotor activity and exploratory behavior in mice lacking histamine H1 receptors. Proc Natl Acad Sci USA. 1996;93:13316–13320
15.Jones BJ, Roberts DJ. A rotarod suitable for quantitative measurements of motor incoordination in naive mice. N-S Arch Exp Pathol Pharmakol. 1968;259:211
16.Kohr D, Tschernatsch M, Schmitz K, Singh P, Kaps M, Schafer KH, et al. Autoantibodies in complex regional pain syndrome bind to a differentiation-dependent neuronal surface autoantigen. Pain. 2009;143:246–251
17.Maihofner C, Baron R, DeCol R, Binder A, Birklein F, Deuschl G, et al. The motor system shows adaptive changes in complex regional pain syndrome. Brain. 2007;130:2671–2687
18.Mense S, Schiltenwolf M. Fatigue and pain; what is the connection?. Pain. 2010;148:177–178
19.Mills CD, Grady JJ, Hulsebosch CE. Changes in exploratory behavior as a measure of chronic central pain following spinal cord injury. J Neurotrauma. 2001;18:1091–1105
20.Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain. 2004;108:192–198
21.Rose NR, Bona C. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol Today. 1993;14:426–430
22.Teeling JL, Felton LM, Deacon RM, Cunningham C, Rawlins JN, Perry VH. Sub-pyrogenic systemic inflammation impacts on brain and behavior, independent of cytokines. Brain Behav Immun. 2007;21:836–850
23.Toyka KV, Brachman DB, Pestronk A, Kao I. Myasthenia gravis: passive transfer from man to mouse. Science. 1975;190:397–399
24.Veldman PH, Reynen HM, Arntz IE, Goris RJ. Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients. Lancet. 1993;342:1012–1016
25.Zimmermann K, Leffler A, Babes A, Cendan CM, Carr RW, Kobayashi J, et al. Sensory neuron sodium channel Nav1.8 is essential for pain at low temperatures. Nature. 2007;447:855–858
26.Zlomuzica A, Viggiano D, De Souza Silva MA, Ishizuka T, Gironi Carnevale UA, Ruocco LA, et al. The histamine H1-receptor mediates the motivational effects of novelty. Eur J Neurosci. 2008;27:1461–1474
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