Ultrastructural effects of Guillain-Barré serum in cultures containing only rat Schwann cells and dorsal root ganglion neurons.

Serum from patients with the acute form of the Guillain-Barré syndrome was applied to cultures containing only rat dorsal root ganglion neurons and Schwann cells. Serum taken from 4 of 10 patients during the first 1-3 weeks of clinical onset had previously been shown to have significant demyelinating activity in this culture system when observed at the light microscopic level. More detailed assessment made at the ultrastructural level showed that: (1) wide-spread myelin-related Schwann cell lysis occurred in concert with vesicular myelin breakdown; (2) non-myelin-related Schwann cells avidly phagocytized necrotic cell debris and fragments of compact myelin; and (3) neurites and non-myelin-related Schwann cells remained structurally undamaged. Cultures treated with convalescent phase serum from patients whose acute phase serum had cytolytic activity displayed no significant ultrastructural damage to either neurites or Schwann cells. This is the first electron microscopic study to provide direct evidence that acute Guillain-Barré serum can be cytolytic for myelin-related Schwann cells and peripheral myelin in an experimental setting free of leukocytes, lymphocytes and mononuclear phagocytes.