Læknablaðið : fylgirit - 01.05.1978, Page 141

TABLE III
RELATIONSHIP OF GENERAL CLINICAL SEVERITY
OF CHOREA TO RESULT OF FLUORESCENT ANTIBODY TESTS
Mild
Moderate
Severe
strongest staining was consistently seen in
caudate and subthalamic nuclear neurons, however,
some sera also produced moderate staining of
neurons in cerebral cortex as well as medullary
nuclei.
Analyses of the clinical background of the
children with chorea, showed that patients with
the most severe and most prolonged attacks of
chorea were most likely to produce antibodies to
the brain tissue (Table III). Ail the carditis
patients with positive staining and carditis,
aiso had severe active carditis.
Absorption of positive sera with various group
A streptococcal antigens in addition to antigens
from the unrelated group D streptococci and a
non-bacterial protein, Cohn’s fraction IV, showed
that only group A streptococcal membranes
completely abolished the neuronal staining in
the Caudate nucleus, while absorption with group
D cell walls, group D membranes or Cohn’s
fraction IV did not affect the positive fluorescence
(Table IV). It is thus conceivable that antigens
of group A streptococcal m embr a nes cross-
react with cytoplasmic antigens of neurons lo-
cated particularly in the subthalamic and caudate
nuclei. Positive staining was also abolished by
absorption with isolated neurons from caudate
nucleus.
No■ pos./no. tested
2/13
7/12
5/12
In conclusion: 1. We have demonstrated
the presence of IgG antibodies in sera from
children with rheumatic fever reactive with
neuronal cytoplasmic antigens. 2. A higher
proportion of sera (477t) were positive in children
with chorea than in those with active carditis
(147o). 3. There was a direct correlation of
positive neuronal antibody reactions with the
length and severity of previous chorea attacks.
4. Reactivity of antibodies to neuronal cyto-
plasmic constituents appeared to be higher in
caudate and subthalamic structures than in other
cenlral nervous tissues tested. 5. Absorption
experiments suggested cross-reactivity between
antigens present in group A streptococcal
membranes and neuronal cytoplasm. The nature
of these cross-reacting antigens remains un-
known. 6. A complete or exclusive correlation
between neuronal cytoplasmic staining and chorea
was not evident since 147o of the children with
carditis alone who had never had detectable
chorea also showed weak but definite staining
reactions. 7. The relationship of the neuronal
antibodies to chorea remains unclear and must
await further studies such as serial studies of
individual patients. Such studies are now being
performed.
TABLE IV
RESULTS OF ABSORBTION OF SERUM SHOWING POSITIVE
IMMUNOFLUORESCENT REACTIONS WITH NEURONAL CYTOPLASM IN CAUDATE NUCLEI
USING STREPTOCOCCAL ANTIGENS
REACTION TESTED UNAB- SORBED GROUP A T6 MEM- BRANE GROUP A T6 CELL WALL GROUP A T6 CARBO- HYDRATE GROUP D MEM- BRANE GROUP D CELL WALL COHN'S FRACTION IV
SERUM 298 (CHOREA) UNDILUTED CAUDATE NUCLEUS NEURON STAINING + 0 + + + + +
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