Thalamic involvement in patients with neurologic impairment due to Shiga toxin 2
Article first published online: 19 FEB 2013
Copyright © 2013 American Neurological Association
Annals of Neurology
Volume 73, Issue 3, pages 419–429, March 2013
How to Cite
Meuth, S. G., Göbel, K., Kanyshkova, T., Ehling, P., Ritter, M. A., Schwindt, W., Bielaszewska, M., Lebiedz, P., Coulon, P., Herrmann, A. M., Storck, W., Kohmann, D., Müthing, J., Pavenstädt, H., Kuhlmann, T., Karch, H., Peters, G., Budde, T., Wiendl, H. and Pape, H.-C. (2013), Thalamic involvement in patients with neurologic impairment due to Shiga toxin 2. Ann Neurol., 73: 419–429. doi: 10.1002/ana.23814
- Issue published online: 17 APR 2013
- Article first published online: 19 FEB 2013
- Accepted manuscript online: 24 NOV 2012 04:50AM EST
- Manuscript Revised: 13 NOV 2012
- Manuscript Accepted: 13 NOV 2012
- Manuscript Received: 13 FEB 2012
The outbreak of hemolytic–uremic syndrome and diarrhea caused by Shiga toxin–producing Escherichia coli O104:H4 in Germany during May to July 2011 involved severe and characteristic neurologic manifestations with a strong female preponderance. Owing to these observations, we designed a series of experimental studies to evaluate the underlying mechanism of action of this clinical picture.
A magnetic resonance imaging and electroencephalographic study of patients was performed to evaluate the clinical picture in detail. Thereafter, combinations of different experimental settings, including electrophysiological and histological analyses, as well as calcium imaging in brain slices of rats, were conducted.
We report on 7 female patients with neurologic symptoms and signs including bilateral thalamic lesions and encephalopathic changes indicative of a predominant involvement of the thalamus. Experimental studies in rats revealed an enhanced expression of the Shiga toxin receptor globotriaosylceramide on thalamic neurons in female rats as compared to other brain regions in the same rats and to male animals. Incubation of brain slices with Shiga toxin 2 evoked a strong membrane depolarization and intracellular calcium accumulation in neurons, associated with neuronal apoptosis, predominantly in the thalamic area.
These findings suggest that the direct cytotoxic effect of Shiga toxin 2 in the thalamus might contribute to the pathophysiology of neuronal complications in hemolytic–uremic syndrome. ANN NEUROL 2013;73:419–429