Adle-Biassette H, Levy Y, Colombel M, Poron F, Natchev S, Keohane C, Gray F
Department of Pathology (Neuropathology), Hôpital H. Mondor, Université Paris-Val de Marne, Créteil, France.
Neuropathol Appl Neurobiol. 1995 Jun;21(3):218-27. doi: 10.1111/j.1365-2990.1995.tb01053.x.
Productive infection of the central nervous system by HIV predominantly involves the white matter and basal ganglia. Involvement of the cerebral cortex with neuronal loss is also described in AIDS patients but not in asymptomatic HIV-positive patients. The mechanism of neuronal damage is unknown. To enquire whether neuronal loss in AIDS may be due to an apoptotic process, we examined the cerebral cortex from 12 patients who died from AIDS using two different methods: in situ end labelling and gel electrophoresis of DNA to demonstrate DNA fragmentation. None of the patients had cerebral opportunistic infection or tumour. Four patients had no significant neuropathological changes, eight patients had variable cerebral atrophy and four of them also had productive HIV infection of the brain. These patients were compared with four HIV-positive asymptomatic patients, five seronegative asymptomatic controls, and two seronegative patients with Alzheimer's disease. We demonstrated neuronal apoptosis in the cortex in all AIDS patients, as well as in the Alzheimer's patients. Apoptosis was not observed in the asymptomatic cases whether seropositive or seronegative. Neuronal apoptosis was more severe in atrophic brains, and did not directly correlate with productive HIV infection, suggesting an indirect mechanism of neuronal damage is most likely.
HIV对中枢神经系统的有效感染主要累及白质和基底神经节。艾滋病患者中也有大脑皮质受累伴神经元丧失的情况，但无症状HIV阳性患者中未见此现象。神经元损伤的机制尚不清楚。为探究艾滋病患者的神经元丧失是否可能归因于凋亡过程，我们使用两种不同方法检查了12例死于艾滋病患者的大脑皮质：原位末端标记法和DNA凝胶电泳以证明DNA片段化。所有患者均无脑部机会性感染或肿瘤。4例患者无明显神经病理学改变，8例患者有不同程度的脑萎缩，其中4例还存在脑部的有效HIV感染。将这些患者与4例无症状HIV阳性患者、5例血清学阴性无症状对照者以及2例患阿尔茨海默病的血清学阴性患者进行比较。我们发现在所有艾滋病患者以及阿尔茨海默病患者的皮质中均存在神经元凋亡。无论是血清学阳性还是阴性的无症状病例中均未观察到凋亡现象。萎缩性大脑中的神经元凋亡更为严重，且与有效的HIV感染无直接关联，这表明最可能存在一种间接的神经元损伤机制。
