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Autoantibody markers of neural degeneration are associated with post-mortem histopathological alterations of a neurologically-injured pilot

Mohamed B. Abou-Donia,†,∗ F.R.W. van de Goot and M.F.A. Mulder§
Duke University Medical Center, Durham, North Carolina 27710, USA
Symbiant BV, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
§ Aviation Medical Consult, Karbouwstraat 14, 1402 VC Bussum, The Netherlands

DOI: 10.4024/05AB14A.jbpc.14.03
Publication date (web): 27 July 2014
Copyright © 2014 Collegium Basilea and AMSI

ABSTRACT. There are numerous concerns regarding the neurotoxicity of contaminated air inside pressurized aircraft. Neurological symptoms have been seen in many aircrew personnel who have reportedly been exposed to the potentially toxic breathable air in airliners. Symptoms, allegedly contracted by aircrew and passengers, are thought to be caused by a single large exposure or repetitive cumulative low-level exposures to toxic chemicals in the airliner internal air. Genetic variation plays a rôle. We report here the case of a 43-year old airline pilot who presented with neurological deficits and other symptoms. The pilot died without regaining good health. In vivo blood had been collected ante mortem. Analysis of the serum confirmed grossly elevated levels of serum autoantibody biomarkers for neuronal cell degeneration compared with a control group. At autopsy, various tissues underwent histopathological assessment. Brain and spinal tissues exhibited axonal degeneration and demyelination. Peripheral nerves showed T-lymphocyte infiltration and demyelination. T-lymphocytes had infiltrated the heart muscle tissue. The post-mortem tests and pathological examination of the nervous system confirm the autoantibody biomarker results. Differential diagnosis showed that the work environment, clinical condition, histopathology and serum biomarkers for nervous system injury are consistent with organophosphate-induced neurotoxicity. The results also showed that exposure to organophosphates rendered the nervous system and heart tissue sensitive and predisposed to further injury.

Special copy editor's note(s) for this paper:
References to be renumbered and corrected.
Precise scale to be added to all micrographs.