Characterization of lipids from human brain tissues by multinuclear magnetic resonance spectroscopy

Multinuclear ((1)H, (13)C, and (31)P) magnetic resonance spectroscopy are applied to the biochemical characterization of the total lipid fraction of healthy and neoplastic human brain tissues. Lipid extracts from normal brains, glioblastomas, anaplastic oligodendrogliomas, oligodendrogliomas, and meningiomas are examined. Moreover, the unknown liquid content of a cyst adjacent to a meningioma is analyzed. Two biopsies from glioblastomas are directly studied by (1)H-NMR without any treatment (ex vivo NMR). The (1)H- and (13)C-NMR analysis allows full characterization of the lipid component of the cerebral tissues. In particular, the presence of cholesteryl esters and triglycerides in the extracts of high grade tumors is correlated to the vascular proliferation degree, which is different from normal brain tissue and low grade neoplasms. The (31)P spectra show that phosphatidylcholine is the prominent phospholipid and its relative amount, which is higher in gliomas, is correlated to the low grade of differentiation of tumor cells and an altered membrane turnover. The ex vivo (1)H-NMR data on the glioblastoma samples show the presence of mobile lipids that are correlated to cell necrotic phenomena. Our data allow a direct correlation between biochemical results obtained by NMR and the histopathological factors (vascular and cell proliferations, differentiation, and necrosis) that are prominent in determining brain tumor grading.

Molecular characterization of human healthy and neoplastic cerebral and renal tissues by in vitro (1)H NMR spectroscopy (review)

The clinical impact of (1)H NMR spectroscopy in the study of human organs, brain and kidney in particular, is well demonstrated. The in vitro (1)H NMR technique is a powerful tool for monitoring changes in intracellular metabolites of human normal and neoplastic cerebral and renal tissues. Healthy and tumoral tissues of different histologic types have been fully characterized from a biochemical standpoint. Molecular characterization is performed on both the aqueous and lipid extracts of surgically removed tissue biopsies yielding a full picture of tissue biochemistry. These analyses have disclosed markers of healthy brain and kidney and of their respective neoplastic lesions. Moreover, some biochemical features can differentiate neoplasms within the same histological type. In particular, lipidic components, like cholesteryl esters (namely oleate), detected in highest grade tumors, warrant further investigation. A better understanding of the biochemistry of diseased human tissues could open the way to new diagnostic and treatment strategies.

In vivo and in vitro nuclear magnetic resonance spectroscopy investigation of an intracranial mass

This study shows how 1H magnetic resonance spectroscopy (1H MRS) can help to elucidate a clinical case when MR images suggest a diagnosis of central nervous system (CNS) neoplasm. The in vivo MRS metabolic profile in our cases did not correspond to literature reports of brain tumors, but reflected the histopathological response of hematoma and the in vitro 1H MR spectra of the biopsy obtained at surgery. The in vitro spectrum of the aqueous extracts of the examined lesion were compared with those of two common CNS tumors. The lipid fraction spectrum of the lesion agreed with both the spectrum of the aqueous extracts and the histological diagnosis.

Cryoglobulinemic neuropathy related to hepatitis C virus infection. Clinical, laboratory and neurophysiological study

Peripheral neuropathy is frequently reported in mixed cryoglobulinemia. As a close relationship has been established between mixed cryoglobulinemia and hepatitis C virus (HCV), the clinical, neurophysiological, and serologic findings of five patients affected by neuropathy, cryoglobulinemia and HCV infection were investigated. HCV infection was ascertained by the presence in the serum of anti-HCV antibodies detected by enzyme-linked immunosorbent assay(ELISA), and of HCV RNA assessed by polymerase chain reaction (PCR). Initial symptoms included paresthesias and painful dysesthesias in the legs. Later on, the patients developed a mainly asymmetric axonal polyneuropathy or a multifocal neuropathy associated with signs of systemic vasculitis. In this case series we report the short-term prognosis, as well as the response to interferon (IFN) alpha and conventional treatment. The presence of HCV RNA supports the hypothesis that a persistent HCV infection might be involved in the pathogenesis of mixed cryoglobulinemia and cryoglobulinemia-associated disorders.

Neurological involvement in primary Sjögren's syndrome: clinical and instrumental evaluation in a cohort of Italian patients

To evaluate nervous system involvement in a cohort of Italian patients with primary Sjögren's syndrome (pSS), 87 unselected patients (83 female, and four male) observed consecutively at our institution over a period of 5 years were screened by clinical and instrumental (MRI, SPECT, electrophysiological testing, CSF analysis) investigations for peripheral and central neurological abnormalities. Seroimmunological parameters and extraglandular features other than neurological manifestations were also evaluated. Seven patients had central nervous system (CNS) disease (8%), mostly non-focal dysfunction, and 12 had peripheral nervous system (PNS) disease (13.8%), mostly mild or severe sensory or sensory-motor polyneuropathies. One patient had concomitant CNS and PNS involvement. Compared with CNS disease, PNS involvement occurred in older patients (> 50 years), independent of the disease duration. Patients with and without neurological abnormalities did not differ for seroimmunological parameters (including antiphospholipid antibodies) or extraglandular manifestations. From a statistical point of view, the only relevant finding was the detection of a slight increase in serum IgA and IgM levels (p < 0.05) in patients with an intact nervous system. Neurological involvement in pSS, be it central or peripheral, is not a rare finding. A careful clinical neurological evaluation, combined with a multiplicity of instrumental investigations, is recommended in the global assessment of pSS patients.

High-performance liquid chromatographic analysis of physiological amino acids in human brain tumors by pre-column derivatization with phenylisothiocyanate

A reversed-phase high-performance liquid chromatographic technique for the determination of free amino acids in five biopsies of human brain tumors (two meningiomas, one glioblastoma and two oligodendrogliomas) is described. The frozen tissues were homogenized, deproteinized with perchloric acid and neutralized with potassium hydroxide. Aliquots of the supernatant containing the physiological amino acids are used for pre-column derivatization with phenylisothiocyanate. The derivatized PTC-amino acids (phenylthiocarbamyl derivatives) are stable for a five day period if stored as a powder at -20 degrees C in an inert atmosphere and they can be analyzed on a reversed-phase column (PicoTag) using a gradient of two eluents with absorption detection at a wavelength of 254 nm. Good resolution of several amino acids (>30) is achieved within ca. 60 min. For most amino acids this method is suitable for an accurate measurement over a wide range of physiological concentrations (50-400 pmol) starting from a very small amount of sample.

Hyperhidrosis and sympathetic skin response in chronic alcoholic patients

Palmoplantar hyperhidrosis is frequently observed in patients with a clinical history of chronic abnormal alcoholic intake. It can be related to peripheral or central mechanisms such as abnormal spontaneous activity in peripheral damaged fibres; receptor hypersensitivity; compensatory incremented activity in segmentary anhidrosis; or impairment of central sweat control. With the aim of quantifying this phenomenon and of identifying its possible origin, sympathetic skin response (SSR) analysis was performed in 20 chronic alcoholic patients with clinical diffuse acral hyperhidrosis, compared with 30 normal subjects and 2 patients affected by primary palmoplantar hyperhidrosis (PPH). SSRs were recorded by disc electrodes place on the hands and feet, simultaneously. At the hand level two recording sites were selected: palm-dorsum proximally and ventral-dorsal tip of the third finger distally. Attention was paid to the number of SSR after a single endogenous or exogenous stimulus. The alcoholic patients were divided into two groups, with and without mild polyneuropathy. Both patient groups showed synchronous SSR at recording sites, with the same pattern and the normal delay between upper and lower arms. In the control group one response was generally related to a single stimulus; if more responses were elicited an evident adaptation was shown; in the two groups of patients an increase of the waves was observed in all the recording sites without any adaptation. The SSR profile described in alcoholic patients was observed also in PPH. The pattern of SSR waves in alcoholic patients seems to suggest a possible central origin of this type of hyperhidrosis.

Different time courses of recovery after poisoning with botulinum neurotoxin serotypes A and E in humans

Botulinum toxin serotypes A and E (BoNT/A and /E) cleave the carboxy-terminus of synaptosomal associated protein-25 (SNAP-25) removing nine and 26 residues, respectively. To investigate the effect of these lesions of the same target molecule, 11 volunteers were injected with 3 IU of BoNT/A in the extensor digitorum brevis (EDB) muscle of one foot and with 3 IU of BoNT/E in the contralateral one. In addition, seven volunteers were similarly injected with mixtures of BoNT/A + BoNT/E. Compound muscular action potential (CMAP) was measured at different time intervals and the percentage variation of CMAP (%CMAP) was calculated. Unexpectedly, a much faster recovery of %CMAP after BoNT/E injections was observed. Double poisoned EBD muscles recovered similarly to BoNT/E. So, a larger deletion of the SNAP-25 molecule caused by BoNT/E leads to a faster functional recovery.

Magnetic resonance spectroscopy study of low grade extra and intracerebral human neoplasms

In this study we report an in vitro 1H magnetic resonance spectroscopy (MRS) characterization of water soluble metabolites obtained from 17 low grade extra and intracerebral human tumors (8 meningiomas, 5 oligodendrogliomas, 2 subependimomas and 2 ependimomas). In addition, the in vivo localized 1H MRS results for 4 of the meningiomas are reported. The main metabolic features characterizing low grade tumors were investigated. Meningiomas are characterized by high Cho/Cr and Ala/Cr ratios; in many cases both in the in vitro and the in vivo spectra these ratios cannot be evaluated, due to the absence of the Cr metabolite. Low grade oligodendrogliomas are characterized by low Cho/Cr ratios. High amounts of myo-inositol are found in the spectra of ependimomas and subependimomas which are distinguished by different Cho/Cr ratio values and by a different Ala content.

On the action of botulinum neurotoxins A and E at cholinergic terminals

Botulinum neurotoxins type A and E (BoNT/A and /E) are metalloproteases with a unique specificity for SNAP-25 (synaptosomal-associated protein of 25 kDa), an essential protein component of the neuroexocytotic machinery. It was proposed that this specificity is based on the recognition of a nine-residue sequence, termed SNARE motif, which is common to the other two SNARE proteins: VAMP (vesicle-associated membrane protein) and syntaxin, the only known substrates of the other six clostridial neurotoxins. Here we report on recent studies which provide evidence for the involvement of the SNARE motif present in SNAP-25 in its interaction with BoNT/A and /E by following the kinetics of proteolysis of SNAP-25 mutants deleted of SNARE motifs. We show that a single copy of the motif is sufficient for BoNT/A and /E to recognise SNAP-25. While the copy of the motif proximal to the cleavage site is clearly involved in recognition, in its absence, other more distant copies of the motif are able to support proteolysis. We also report on studies of poisoning human neuromuscular junctions with either BoNT/A or BoNT/E and describe the unexpected finding that the time of recovery of function after poisoning is much shorter in the case of type E with respect to type A intoxication. These data are discussed in terms of the different sites of action of the two toxins within SNAP-25.

In vivo single voxel 1H MRS of glial brain tumors: correlation with tissue histology and in vitro MRS

Eighteen patients affected by glial brain tumors were examined by localized single voxel magnetic resonance spectroscopy (1H MRS). For all patients histological diagnosis was obtained after stereotactic biopsy or surgical removal of the tumor. Histological nuclear atypia, tumor cellularity, necrosis, vascular proliferation and percentage of Ki-67 positive cells in the total cell populations were evaluated. It was found that some of the in vivo 1H MRS parameters were related to the histological features of the tumor. In particular, the Choi/Cri metabolite ratio obtained from the neoplastic tissues paralleled the Ki-67 cell proliferation index. For some of the patients 1H and 13C in vitro high resolution magnetic spectroscopy of surgical specimens was also carried out. 1H MRS of aqueous extracts from different biopsy specimens of the same tumor furnished fine biochemical information on intratumor heterogeneity. The degree of histological vascular proliferation of the tumor was correlated to the presence of cholesteryl esters in the 13C spectrum of the lipid fraction of surgical specimens.

Botulinum neurotoxin serotype C: a novel effective botulinum toxin therapy in human

Botulinum neurotoxin (BoNT) serotype A is commonly used in the treatment of focal dystonia. Nevertheless, some patients are or become resistant to this serotype. Consequently, other different serotypes have to be used. A comparison of the neuromuscular blockade induced by BoNT type A and C in the extensor digitorum brevis muscles of voluntary subjects was studied, by evaluating the amplitude variation over the time (until 90 days) of the compound muscular action potential elicited by supramaximal electrical stimulation of the peroneal nerve at the ankle. A very similar effect and temporal profile, was observed for each serotype. On this basis, two patients with idiopathic facial hemispasm and one with blepharospasm were treated with BoNT serotype C with very beneficial long lasting effects.

The variability in the clinical effect induced by botulinum toxin type A: the role of muscle activity in humans

When botulinum toxin (BT) is administered for the first time at fixed doses, variable clinical responses can be observed in patients with the same form of dystonic disorder. Many factors may contribute to this phenomenon, including the variability rate of absorption of the drug. Animal experimental models (rat diaphragm preparation) have demonstrated an increased absorption of BT in the terminal nerve endings of the muscle under repetitive electrical stimulation, suggesting that "muscle activity" also may play an important role. The aim of our study was to evaluate in humans the role of the muscle activity on the variability of the effect induced by BT type A. Eleven patients with blepharospasm and idiopathic facial hemispasm were studied by using neurophysiologic techniques. In nine patients, both extensor digitorum brevis (EDB) muscles were injected with low (3 IU), fixed doses of type A BT. For the first 24 h after administration of the drug, periodic electrical stimulation of only one EDB was used. The subsequent percentage changes in compound muscle action potential (CMAP) amplitude was calculated at different intervals over a 30-day period. The percentage in the CMAP for the stimulated EDB was compared with that of the contralateral nonstimulated side. We found that the effect of the induced neuromuscular blockade was significantly greater for the stimulated side. In the other two patients, we injected BT in one EDB and the same volume of normal saline solution in the contralateral muscle to assess the stability of the CMAP in untreated muscle over time. We observed that the CMAP was unchanged in the untreated EDB; therefore we concluded that muscle activity plays an important role in the variability of clinical response often seen.

Botulinum neurotoxins: mechanism of action and therapeutic applications

Recent studies have led to the discovery of the molecular lesions in motor neurons caused by botulinum neurotoxins. These neurotoxins are metalloproteinases that enter the cytosol and very specifically cleave protein components of the neuroexocytosis apparatus. Consequently, acetylcholine cannot be released and the muscle is paralysed. For this reason, botulinum neurotoxins are increasingly being used to treat a variety of conditions where a functional paralysis of neuromuscular junctions is useful as therapy.

In vivo 1H MRS and in vitro multinuclear MR study of human brain tumors

Localized in vivo 1H MR spectra of four patients with brain tumors and in vitro multinuclear (1H, 13C and 31P) MR characterization of water soluble and lipid components of the same tumors after surgical removal are reported herein. The in vivo spectra of the neoplastic regions of all patients showed N-Acetyl-Aspartate/Choline (NAA/Cho), Choline/Creatine (Cho/Cr) and N-Acetyl-Aspartate/Creatine (NAA/Cr) metabolite ratios markedly different from those of the controlateral healthy tissue. In vitro 1H MR measurements allowed for the identification of a much larger number of metabolites than those measured in vivo. Indeed, well resolved 1H, 13C and 31P MR spectra were obtained for water soluble and lipid components in all cases. Our data confirm that some metabolites observed in vitro could be specific markers of brain tumors.

Botulinum toxin treatment in the facial muscles of humans: evidence of an action in untreated near muscles by peripheral local diffusion

In a population of subjects with blepharospasm and facial hemispasm treated for the first time with botulinum toxin type A (BT) in the orbicularis oculi muscle, we performed an electrophysiologic study (compound muscle action potential and motor evoked potential) to assess whether BT effect could be detected in near untreated muscles (orbicularis oris and masseter). There was a significant BT action in nearly untreated muscles with different peripheral innervation that can be explained by local diffusion of the drug.

Sympathetic skin response in patients with Duchenne muscular dystrophy

To verify an eventual disfunction of the palmar sympathetic skin activity in Duchenne Muscular Dystrophy, we studied the sympathetic skin response (SSR) with endogenous, Deep Breathing (DB-SSR), exogenous Startle (SE-SSR) and Electric type stimuli (EE-SSR) in a group of patients and a control group. At the same time as the SSR, the heart rate (HR) and the basic R-R interval variation (RRIV) as well as the EMG diaphragmatic activity were checked. In this way, significant differences in the latency (p = 0.02) and amplitude (p = 0.009) values of the EE-SSR and in the amplitude values of the SE-SSR (p = 0.001) and of the DB-SSR (p = 0.02) were noted in the DMD group compared to the control group. In the group of patients the rise in latency of the EE-SSR correlates with the age (p = 0.0001) and with the reduction of its amplitude (p = 0.03). This last parameter correlates with the stage of the illness (p = 0.02). In the control group the mean amplitude of the EE-SSR is approximately 30% greater than that of startle and 50% of deep breathing. Although with amplitudes homogeneously reduced, these ratios are also conserved in the DMD group. Moreover the HR is greater (p = 0.0001) whilst the RRIV is reduced (p = 0.02) in the group of the patients. However these parameters do not correlated either to the cardiac involvement or to the stage of the illness. The presence of the SSR for all the modalities of stimulation indicates the substantial integrity of the afferent and the efferent paths of the ANS. The alterations in latency and amplitude of the SSR in the patients could be the consequence of a lack of dystrophin at the level of the sudoriparous myopithelium in analogy to what has been demonstrated in the mdx mouse.

Neurophysiological evaluation of the muscular hypotrophy after immobilization

Muscular hypotrophy due to arm or leg immobilization (MH) in absence of neuromuscular pathologies was tested by EMG spectral analysis, in order to identify a possible neurophysiological method able to analyze this kind of particular clinical picture. Two different groups of patients were tested. In group 1 the patients were suffering from vastus medialis muscle MH due to meniscus surgery, in group 2 the patients were suffering from biceps brachii muscle MH after humerus fracture. A significant difference between normal and pathological muscles was found and the methods may be useful in the neurophysiological evaluation of MH.

Molecular interactions between nucleic acids and antitumor substances by Raman and NMR spectroscopy

1-Methyladenosine (1-MeAdo) and protonated 1-Methyladenosine (1-MeAdo.H+) were chosen as a model to study the molecular interactions between the carcinogen dimethylsulphate (DMS) and the base adenine, and the interactions between the antitumoral electrophilic cis-diamminedichlorophatinum (II) (cis-Pt) and the methylation product of the base, respectively. Raman and multinuclear NMR studies show the molecular perturbations caused by the carcinogen on the base and those of the antitumoral substance on the reaction product base-carcinogen.

Pattern electroretinogram in multiple sclerosis

The pattern electroretinogram obtained in patients affected by multiple sclerosis were compared with those in a normal population. The pattern electroretinogram amplitude in multiple sclerosis optic neuritis frequently appeared normal, but pattern electroretinogram amplitude abnormalities were found in patients suffering from recurrent multiple sclerosis optic neuritis. Pattern electroretinogram examination appears a useful method in the differential diagnosis between axonal and demyelinating optic nerve impairment.

[The origin of the electroretinogram induced by structured stimuli in man]

The Authors studied the checkerboard pattern electroretinogram (PERG) behaviour in normal subjects and in patients suffering from traumatic lesion of optic nerve, demyelinating optic neuritis, axonal optic neuritis, retinal vascular disorders and retinitis pigmentosa in order to verify the PERG origin. According to our data the PERG appears to originate from ganglion cells since the signal diminished or disappeared in axonal lesion of optic nerve, as a result of retrograde ganglion cell degeneration. Furthermore, the demyelinating lesions of optic nerve were not able to modify the PERG wave. In patients suffering from retinal receptor disturbances the flash electroretinogram (FERG), which is probably an expression of receptor activity, was greatly impaired, whereas PERGs were either normal or less impaired than FERGs. These data demonstrate the different origin of PERG and FERG.

[The effect of fatigue on the biopotential of muscle fiber cells]

Muscular fatigue is a biological situation which is very difficult to quantify. The Authors studied through a computer analysis the power spectrum of electromyogram, recorded from abductor digiti minimi muscle during maximal and minimal contraction effort before and after fatigue and after muscle prolonged relaxation in 8 normal subjects. No significant spectrum differences were found between maximal and minimal effort in each trial, and between the spectra obtained before fatigue and after muscle prolonged relaxation. On the contrary significant differences were found between the spectra obtained after fatigue and the other conditions. The power spectrum analysis appears, also, to be a reliable neurophysiological parameter for the study of biological aspects of muscular fatigue.

[The effect of thoracic pressoreceptors on heart rate in man]

Sinus arrhythmia (SA) is a physiological event related to the respiratory activity. The aim of this study was to find a relation between SA and different deep breathings. A transductor monitored the chest respiratory movements and a cardiotachometer calculated and plotted the instantaneous heart rate, synchronously during different breathing efforts. In 10 normal subjects a good linear correlation was found between the breathing depth and SA quantifying the relation between the chest receptor activity and SA also with limited chest expansion.

[The conduction of optic nerve fibers using different visual patterns]

The Authors have studied the behaviour of checkerboard pattern visual evoked potential (VEP) latencies by using different spatial frequency stimuli and different stimulating visual fields in order to demonstrate whether spatial frequency might constitute a parameter capable of exciting different retinal regions like different stimulus fields. According to the recent literature low spatial frequency stimuli generate VEP with latencies which are significantly shorter than high spatial frequency stimuli, making this method more reliable for the differentiation of macular and peripheral retinal fields.

Muscle-nerve ephaptic excitation in some repetitive after-discharges

We describe high frequency muscular repetitive after-discharges (MRDs), induced by maximal or near maximal electrical nerve stimulation, in 5 patients suffering from different peripheral neuropathies. No MRDs were observed at rest or during voluntary contraction. In all the MRDs the interval between the onset of the M wave and the onset of the MRD did not change in relation to the nerve stimulation point; double supramaximal stimulation with adequate delay, delivered at the same nerve site, could suppress the MRDs. From the electrophysiological features the authors suggest an interpretative model: the muscular electric field of the M wave could reexcite ephaptically an intramuscular axon, with defective repolarizing capacity, producing a muscle-nerve reverberating loop.

Posterior interosseous nerve palsy. Report of three unusual cases

Three unusual cases of posterior interosseous nerve palsy involving an entrapment mechanism are described. The findings in these three cases seem to support the view that PIN entrapment usually results from interaction of exogenous factors (occupation, pregnancy, compression during sleep, etc.) with anatomical anomalies at the level of the supinator brevis muscle.

Static vestibulospinal influences in relation to different body tilts in man

In this study, H-reflex testing was used to identify possible static vestibular influences on soleus alpha motoneuron excitability in man in relation to different body tilts. Ten normal adult volunteers and one labyrinthine-defective patient were tested in an experimental situation designed to minimize all afferent inputs except the vestibular ones. Each subject was fixed to a rigid platform inclinable from the horizontal (0 degree) to the vertical (90 degrees) position and vice versa. On each subject, 10 consecutive H reflexes were recorded for each of the following positions: 0 degree, 15 degrees, 30 degrees, 45 degrees, 60 degrees, 75 degrees, 90 degrees and 90 degrees, 75 degrees, 60 degrees, 45 degrees, 30 degrees, 15 degrees, 0 degree. In all normal subjects, we observed a significant increase in amplitude of the H reflex as the body was tilted from horizontal to vertical, and a significant decrease when the body was returned to the original position. These progressive changes in spinal motoneuron excitability were linearly related to the tilt angles. By contrast, no significant change in H-reflex amplitude was observed in the labyrinthine-defective patient. These results would seem to indicate that the vestibular system exerts some influences on antigravity muscles in static tilts and that these influences are behaviorally adequate to provide for the postural stability.