[The pathogenesis of INH-neuropathy. II. Phase and electron microscopic studies of spinal cord, spinal ganglia and muscle spindles]

Morphometric evaluation of degenerative and regenerative changes in isoniazid-induced neuropathy

Morphometric studies of the pathologic changes were carried out on the peripheral nerves, spinal roots, and different levels of the Goll's tract in rats given isoniazid and killed 1, 2, 3, 4, 5, 6, 7, 14, and 30 days after intoxication. In teased fiber preparations, axonal degeneration was the main change present, and this was seen as early as day 2 in the peroneal and distal sural nerves. The frequency of myelinated fibers showing axonal degeneration was higher in the distal than the proximal sural nerve, and in the ventral than the dorsal root. In the group of rats killed on 5, 6, 7, and 14 days, a significant decrease of the myelinated fiber density was observed in the distal and proximal sural nerves, ventral root, and at the third cervical level of the Goll's tract. The degree of fiber degeneration was more severe in the distal than in the proximal sural nerve and in the third cervical than the fifth thoracic level of the Goll's tract. Preferential decrease of large myelinated fibers was noted in all the affected nerves. No definite abnormalities, however, were seen in nerve cells of the 6th lumbar spinal ganglia and anterior horn cells of the lumbar spinal cord on light microscopy. On 30 days, regeneration at varying degrees was discerned in all the affected nerves with significant increase of small myelinated fibers, particularly in the ventral root. The findings indicate that both centrally and peripherally directed myelinated axons are more affected in the distal than in the proximal segments while the neuronal cell bodies are spared. The spatio-temporal evolution of this pattern of change is compatible with the concept of the "dying back" process or central-peripheral distal axonopathy.

[On the fine structure of muscle spindle terminal in the lumbricalis muscles of the rat after section of the nerve (author's transl)]

The nerve endings in muscle spindles from lumbricalis muscles of the hindpaw of the rat were studied by electron microscopy from 10 h to 7 days after section of the sciatic nerve. No sensory endings were found after 5 days and no motor endings after 3 days. Early changes in sensory endings included accumulation of lamellar bodies, mitochondrial swelling or shrinkage, an edematous appearance of the cytoplasm and disruption of membranes. The predominant way of removal was phagocytosis by activated mesenchymal cells; other endings were incorporated into the sarcoplasm as electron dense bodies. Early changes in motor endings included aggregation or swelling of synaptic vesicles, swelling or shrinkage of mitochondria, edematous change of the cytoplasm and disruption of membranes. The predominant way of removal was incorporation into the cytoplasm of adjacent Schwann cells and degradation to phagolysosomes. Sites of removed sensory endings could be identified by basement membrane reduplication, while the intact subsynaptic apparatus of removed motor endings was either loosely covered by Schwann cell processes, or by fibrillar material, or appeared empty.

Studies on the early changes in acute isoniazid neuropathy in the rat

Large single doses if isoniazid by mouth (1--2g/kg) have been shown to produce in rats Wallerian degeneration visible with the light microscope from the third day onwards. By contrast, changes in axons are seen from 24 h onwards by electron microscopy. The earliest ultrastructural changes are associated with vacuoles appearing between axon and Schwann cells. These are large and focal, and often compress the axon. The adjacent axon may show changes in smooth ER, and in microtubular arrangement. Alterations in smooth membranes and in mitochondria are visible in Schwann cell cytoplasm, not necessarily related to the vacuole formation and axonal features. It is suggested that INH neuropathy is essentially a multifocal axonal lesion.

An ultrastructural study of nerve terminal degeneration in muscle spindles of the tenuissimus muscle of the cat

Muscle spindles in the tenuissimus muscle of the cat were studied between 12 and 168 h after cutting or freezing the nerve to this muscle. Degenerative changes in sensory and motor nerve terminals on intrafusal muscle fibres were observed using the electron microscope. Comparisons were made with spindles from unoperated or sham-operated cats. The earliest degenerative changes were seen in sensory and motor terminals at 20-24 h after the lesion. No nerve endings were seen by 114 h after denervation. The most consistent initial signs of degeneration were: (1) the presence of abnormal mitochondria and dense bodies in sensory terminals, and (2) a decrease in the number and clumping of synaptic vesicles combined with an increase in glycogen and neurofilaments in motor endings. Intrafusal fibres participate in the removal of degenerating sensory endings. Schwann cells phagocytose degenerating motor terminals. The disappearance of nerve terminals precedes the complete degeneration of preterminal myelinated fibres within the muscle spindle.

Sensory denervation of the plantar lumbrical muscle spindles in pyridoxine neuropathy

Male albino rats treated with excessive amounts of pyridoxine developed an impairment of neuromuscular function. The equatorial region of the plantar lumbrical intrafusal muscle fibres was studied in the electron microscope and the calibre of the nerve fibres was determined in semi-thin sections of the posterior tibial nerves. Degeneration of the primary sensory endings coincided with the onset of ataxia, and in more advanced stages of the neuropathy as well as after a 2-month treatment-free period the equatorial region was denervated. There was a corresponding decrease in the number of large nerve fibres. It is considered essential that primary sensory endings of lumbrical muscle spindles should be included in studies of distally accentuated sensory neuropathies.