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(American Journal of Pathology. 1999;154:447-455.)
© 1999 American Society for Investigative Pathology


Regular Articles

Nerve Terminal Damage by ß-Bungarotoxin

Its Clinical Significance

Rupert W. Dixon and John B. Harris

From the School of Neurosciences and Psychiatry, Department of Neurobiology, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom

We report here original data on the biological basis of prolonged neuromuscular paralysis caused by the toxic phospholipase A2 ß-bungarotoxin. Electron microscopy and immunocytochemical labeling with anti-synaptophysin and anti-neurofilament have been used to show that the early onset of paralysis is associated with the depletion of synaptic vesicles from the motor nerve terminals of skeletal muscle and that this is followed by the destruction of the motor nerve terminal and the degeneration of the cytoskeleton of the intramuscular axons. The postjunctional architecture of the junctions were unaffected and the binding of fluorescein-isothiocyanate-conjugated {alpha}-bungarotoxin to achetylcholine receptor was not apparently affected by exposure to ß-bungarotoxin. The re-innervation of the muscle fiber was associated by extensive pre- and post-terminal sprouting at 3 to 5 days but was stable by 7 days. Extensive collateral innervation of adjacent muscle fibers was a significant feature of the re-innervated neuromuscular junctions. These findings suggest that the prolonged and severe paralysis seen in victims of envenoming bites by kraits (elapid snakes of the genus Bungarus) and other related snakes of the family Elapidae is caused by the de-pletion of synaptic vesicles from motor nerve terminals and the degeneration of the motor nerve terminal and intramuscular axons.





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