The role of cortical connectivity in Alzheimer's disease pathogenesis: a review and model system

Here we review current evidence in support of the cortical disconnection/cortical connectivity model of Alzheimer disease (AD) pathogenesis, a model which predicts that one of the first events in AD is damage to the entorhinal cortex and/or subiculum resulting in the disconnection of the hippocampal formation and neocortex, and the subsequent progression of the disease in a stepwise fashion along cortico-cortical connections. Much of the evidence for this model has been obtained from studies involving the limbic system where investigators have demonstrated a precise correspondence between established patterns of connectivity and the degenerative changes associated with AD. In addition, some studies of the distribution of neuritic plaques (NP) and neuro-fibrillary tangles (NFT) in the neocortex and subcortical structures have yielded corroborative data. The validity of the cortical disconnection/connectivity model in the neocortex remains to be established or refuted. We propose that testing of this model can be accomplished with systematic studies of the laminar and regional distribution of NP and NFT in a series of sequentially interconnected cytoarchitectural regions that also form part of two functional hierarchies--the paralimbic and occipitotemporal visual systems. To adequately control for variation between brains affected by AD, it is imperative that such studies be conducted in a large but varied population of AD cases exhibiting differences in several variables, including clinical and/or neuropathological severity of the disease, temporal duration of the disease, and clinical/neuropsychological profile. We believe that further understanding of the relationship between characteristic AD pathology and intrinsic anatomico-functional circuits will contribute not only to our comprehension of AD pathogenesis but also to our general knowledge of the human brain.

Symptom assessment and management of outpatients receiving biotherapy: the application of a symptom report form

Patients treated with high doses of biologic response modifiers (BRMs) often require hospitalization for monitoring and management of toxicities. However, with careful symptom assessment and management, patients can be treated safely with low-dose, long-term BRM regimens in an outpatient setting. Quantifiable, consistent, and accurate symptom assessment sets the groundwork for regular, effective symptom management. A symptom report form or nursing care flow sheet is a helpful daily assessment tool for recording and quantifying the most common side effects experienced by patients receiving BRMs. Parameters can be established and converted to a numerical code to provide a consistent guide for evaluating a patient's toxicities during treatment. Additional space on the report form allows for narrative comments about symptoms or concerns not addressed elsewhere. To be safe and effective, outpatient therapy of this kind requires excellent patient education and compliance, with easy access to a health care professional when necessary.

Effects of dietary zinc deficiency on gonadotrophin secretion and testicular growth in young male sheep

The hypothesis that the secretion of gonadotrophins would be reduced by zinc deficiency was tested in five groups of four young Merino rams (initial liveweight 22 kg). Four groups were fed ad libitum with diets containing 4, 10, 17 or 27 micrograms Zn g-1. The effects of loss of appetite on the deficient diet was controlled by feeding a fifth group (pair-fed control) at a rate of 27 micrograms Zn g-1, but the amount of feed offered was restricted to that eaten voluntarily by the deficient (4 micrograms Zn g-1) group. Blood was sampled every 20 min for 32 h on two occasions before the treatments were imposed and 96 days later, at the end of the experiment. The rams were injected with gonadotrophin-releasing hormone (GnRH; 10 ng kg-1 i.v.) after each serial sampling, and with naloxone (1 mg kg-1 i.v.) 24 h after the end of the final GnRH test. In the group that were fed the diet with the lowest zinc content, the concentration of zinc in blood plasma was reduced to 18% of that in the pair-fed controls (P < 0.05) and was within the deficient range. The appetite of the deficient rams was half that of the controls fed 27 micrograms Zn g-1 ad libitum and there was no increase in liveweight or testicular diameter during pubertal development. Similar, but smaller, effects were observed in the pair-fed controls. There were no significant differences between pair-fed and deficient groups in the frequency of the luteinizing hormone (LH) pulses or in the concentration of follicle-stimulating hormone (FSH), but the secretion of gonadotrophins was markedly lower in both groups than in the control rams fed ad libitum. The response to GnRH was not affected by treatment, but the increase in LH pulse frequency evoked by naloxone was lower in the deficient animals than in other groups. The animals fed zinc at intermediate rates (10-17 micrograms g-1) showed similar responses to the controls fed ad libitum. It is concluded that the specific effects of zinc deficiency on testicular function were small. Most of the reduction in testicular growth in rams fed a deficient diet was not specifically related to the trace element, but was due to the fall in energy and protein intake caused by the loss of appetite. This leads to a reduction in the frequency of GnRH pulses secreted by the hypothalamus, and to low rates of gonadotrophin secretion by the pituitary gland.

Disease-specific patterns of locus coeruleus cell loss

Computer visualization techniques were used to map and to quantitatively reconstruct the entire locus coeruleus, including the nucleus subcoeruleus, to compare the topographic patterns of cell loss in postmortem brains from patients with Parkinson's disease, Alzheimer's disease, and Down syndrome. There was comparable cell loss in all three diseases (approximately 60%) compared with aged normal subjects, and there was a significant loss of nucleus subcoeruleus cells specifically in patients with Parkinson's disease (63%). There was a significant positive correlation between the magnitude of locus coeruleus cell loss and the duration of Alzheimer's disease, but no such correlation was found for Parkinson's disease. In patients with Parkinson's disease, there was comparable cell loss throughout the rostral-caudal extent of the nucleus; however, in patients with Alzheimer's disease and Down syndrome, the greatest cell loss always occurred within the rostral portion of the nucleus, with a relative sparing of caudal cells. These data are consistent with the hypothesis that cell loss in Parkinson's disease is the result of a pathological process that attacks the catecholaminergic cells of the locus coeruleus and the subcoeruleus in general; in Alzheimer's disease and Down syndrome, however, the pathological process only affects the rostral, cortical-projecting locus coeruleus cells and spares the caudal, noncortical-projecting cells.

MRI evaluation of amyloid myopathy

Amyloid myopathy is a rare complication of primary amyloidosis. The magnetic resonance imaging (MRI) features of two patients with amyloid myopathy were studied. Slight prolongation of muscle T1 and T2 relaxation times was evident but the striking abnormality was marked reticulation of the subcutaneous fat. The clinical findings of indurated extremities far exceeds the minimal signal intensity alteration seen in the muscles. The MR appearance of amyloid myopathy differs from that of other neuromuscular conditions in the minimal changes found in muscle, but the striking abnormality seen in subcutaneous fat makes it distinct from many neuromuscular conditions.

Protecting workers from pathogens. Employers must act now to comply with OSHA's new standard on bloodborne pathogens

A new standard set forth by the Occupational Safety and Health Administration (OSHA) requires healthcare employers to implement sweeping new controls in areas such as record keeping, engineering, hazard prevention, and work practice. Through the bloodborne pathogen standard, which went into effect on March 6, OSHA acknowledges that healthcare workers face significant health risks as a result of occupational exposure to blood and other infectious materials. Although most prudent healthcare providers already adhere to the Centers for Disease Control's universal precautions, the OSHA regulations include several additional mandatory measures that are more specific and stringent. The additional measures include the development of an exposure control plan, procedures for responding to an employee's exposure to bloodborne pathogens, the implementation of certain engineering and work practice controls to eliminate or minimize on-the-job exposure risks, and the provision of personal protective equipment and information and training programs. OSHA estimates that the greatest cost component of implementing procedures to bring a facility into compliance is attributable to the purchase of personal protective equipment. Although the costs of compliance are substantial, OSHA has estimated that these costs represent less than 1 percent of the healthcare industry's annual revenues. Violation of the bloodborne pathogen standard may result in penalties of up to $70,000, depending on the severity of the infraction. Criminal penalties are also possible for willful violations that result in worker death.

Postoperative pain incidence related to the type of emergency treatment of symptomatic pulpitis

Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.

A multi-element supplement for grazing sheep. II. Accumulation of trace elements in sheep fed different levels of supplement

Sheep were fed an oaten hayllupin mixture (88: 12 W/W) containing either 0, 1.7, 3.3, 6.3, 12 or 21% of a multi-element mineral mix for 6 months. Each sheep was fed sufficient ration to provide 800 g DM of the oaten hay/lupin mixture per day. The accumulation of essential and of potentially toxic elements in the tissues of the sheep was measured together with feed intake and growth. Some sheep which were offered 12% and all of the sheep which were offered 21% minerals in the diet refused to eat part or all of the ration and were removed from the experiment. All sheep in the other groups and two sheep which were fed 12% minerals ate all or most of the ration for 6 months. All sheep in the groups which were fed 0, 1.7, 3.3 and 6.3% (equivalent to 0, 15, 30 and 60 g/day of minerals) grew at 27-35 g/day and had similar dry matter intakes after intake of minerals was excluded from the calculation. The two sheep which were fed 12% mineral throughout (equivalent to 120 g/day) lost 6 g/day during the experiment. Intake of minerals increased selenium concentrations in whole blood and liver, and vitamin B12 in plasma. Selenium did not accumulate to levels that resulted in toxicity to the sheep nor exceed maximum permitted levels for human consumption. Fluorine in rib bone increased as mineral intake increased, and sheep which were fed 12% minerals in the diet were at risk of chronic fluorosis. The intake of mineral mix had no significant effect on the concentrations of copper and iron in the liver or the concentration of cadmium in the kidney.

A multi element supplement for grazing sheep. I. Intake, mineral status and production responses

The safety and effectiveness of a loose mineral lick containing all known essential elements was investigated in an experiment in which 96 Merino weaner wethers grazed subterranean clover/grass pastures during summer and autumn. The treatments were no supplement or mineral mix ad libitum; there were four plots of 12 sheep per treatment. The mean intake was 29 � 1 g/head per day of the mix and those offered the minerals had blood concentrations of P, S, Se and vitamin BIZ in the normal range. Unsupplemented Control sheep had blood concentrations of P, S and Se in the deficient range for all or part of the experimental period. There was an estimated 1.6-fold range in mineral intake between sheep, and none refused the mix. Concentrations of Cu, Cd and F in tissues and bone of sheep offered the mineral mix were within accepted safety margins. The mineral lick increased live weights by 4.5 kg during summer (P < 0 - 05), increased clean fleece weight by 240 g (9%), (P < 0.01), and increased wool staple strength by 15 N/kt (40%), (P < 0.01). The pasture concentrations of most macro elements decreased between November and March, respective concentrations being (g/kg DM): K, 17- 7 and 1.9; Na, 4-0 and 0.31; S, 1.6 and 0.9; N, 12.9 and 10; P, 1-95 and 1-08; Ca, 7-86 and 9-75; Mg, 2.29 and 1-38. Changes in trace element concentrations were small, the respective values being (mg/kg): Cu, 9.7 and 10-3; Mn, 47 and 67; Fe, 56 and 323; Zn, 20 and 20; Mo, 0-2 and 0.35; and Se, 0.015 and 0.032. The loose mineral lick was a safe and effective means of supplying macro and trace elements to grazing sheep during summer.

Alzheimer disease paired helical filament core structures contain glycolipid

The core structures of sodium dodecyl sulfate extracted, pronase digested paired helical filaments of Alzheimer disease were solubilized by heating in dimethyl sulfoxide. Electron microscopy revealed that after heating in dimethyl sulfoxide, intact paired helical filaments were no longer present in the dimethyl sulfoxide soluble fractions or in the insoluble lipofuscin-containing fractions. Enzyme-linked immunosorbent assays of the various fractions with the monospecific antibody A128 to paired helical filaments demonstrated 96% of the immunoreactivity to be in the dimethyl sulfoxide soluble fraction, and only 4% in the dimethyl sulfoxide insoluble fractions. Lyophilization of the dimethyl sulfoxide soluble supernatant and resuspension in water failed to reassociate the paired helical filaments, but did result in an insoluble precipitate. Analysis of the dimethyl sulfoxide solubilized paired helical filament fraction by nuclear magnetic resonance revealed it to be composed of glycolipid in a form that was distinct from similar fractions isolated from normal aged control brains. The aggregation of an altered glycolipid to form paired helical filaments in Alzheimer disease could explain their insolubility.

The neuropathology of human immunodeficiency virus infection. The Dallas, Texas, experience

Postmortem neuropathologic changes were evaluated in 141 consecutive patients dying with human immunodeficiency virus infection at publicly supported hospitals affiliated with the University of Texas Southwestern Medical Center in Dallas, between August 1984 and September 1990. Morphologic abnormalities were identified in 112 cases (79%). Cytomegalovirus was the most common opportunistic infection encountered, with characteristic viral inclusions identified in 23 patients, and presumptive evidence of infection in six additional patients. Progressive multifocal leukoencephalopathy was present in four patients. Gram-positive bacterial infections were identified in six patients, and mycobacterial infections in three patients. Opportunistic fungal infections included cryptococcosis (13 cases), histoplasmosis (two cases), and coccidioidomycosis (one case). Toxoplasmosis was uncommon, with active or quiescent lesions identified in five patients. Lymphoma was present in nine patients and was primary in the central nervous system in five patients. Multinucleate giant cell (human immunodeficiency virus) encephalitis was identified in 28 patients. In an additional 26 patients, microglial nodules and/or more generalized white-matter abnormalities were encountered in the absence of multinucleate giant cells, cytomegalovirus inclusions, or systemic cytomegalovirus infection. Vacuolar change was present in 21% of spinal cords, and was highly correlated with cytomegalovirus infection in the nervous system. Mixed infections and/or neoplasms were identified in 24 patients. This survey documents a high frequency of neuropathologic abnormalities in human immunodeficiency virus-infected individuals in a geographical region of the United States not represented in previous series. Variations noted in the frequencies of specific central nervous system disorders between this and other study populations reinforce the need for continuing documentation of geographical trends in human immunodeficiency virus-associated disorders.

A rapid one-step extraction procedure for the isolation of ubiquitin from human erythrocytes for antibody production

A procedure is described that employs 5% perchloric acid extraction to isolate ubiquitin from human erythrocytes. The procedure is rapid and economical as it requires no specialized equipment. The extracted protein appeared to be highly purified as judged by electrophoresis and was identified as ubiquitin by immunoblotting and total amino acid analysis. The extraction yields about 78% of the ubiquitin in the hemolysate, which is a higher yield than is obtained with other procedures. The purified ubiquitin was used to make a polyclonal antiserum. As ubiquitin is a small and highly conserved protein, it is necessary to couple it to a larger immunogen to elicit an immune response. This ubiquitin antiserum was produced using an immunogen system that produces an immune response to the ubiquitin, but not to the carrier protein.

Receptor-stimulated death pathway is opened by antigen in mature T cells

Clonal deletion provides an important mechanism for the elimination of autoreactive T cells. Deletion is accomplished by programmed cell death directed by interaction of the T-cell receptor (TCR) of the developing thymocyte with major histocompatibility complex elements in the thymic environment. In this report we present evidence to support the hypothesis that the activation and the maturation state of the T cell may be important in coupling the TCR to the "death program." We show that coupling of the TCR to the death program is open during maturation but closed in naive mature T cells. However, during primary antigenic stimulation, coupling between the TCR and the death program is reopened, as demonstrated by the stimulation of the death of these cells by immobilized anti-TCR. Our results suggest that further examination of mature cells that are either resistant or sensitive to receptor-stimulated death may lead to the identification of the components of the death pathway and may provide clues to the regulation of their coupling to TCR signals.

Transplants of mouse trisomy 16 hippocampus provide a model of Alzheimer's disease neuropathology

Alzheimer's disease, which is characterized by amyloid plaques and neurofibrillary tangles, may be attributed to the abnormal expression of gene(s) located on human chromosome 21. Genetic linkage studies have narrowed the region of candidate genes to 21q11.2-21q22 of the long arm of this chromosome. Several single copy sequences within this region, including the amyloid precursor protein (APP), have been mapped to mouse chromosome 16. Reliable strategies exist for breeding Trisomy 16 mice. However, the consequences of developmental overexpression of genes on chromosome 16 have not been previously investigated, because of the lethal effects of this aneuploidy during gestation. In the present report, we employ neural transplantation to study long-term survival and pathogenesis in Trisomy 16 central nervous system tissues. Immunocytochemical staining with antiserum raised against the synthetic APP, beta-A4 and alpha 1-antichymotrypsin revealed numerous densely stained cells within hippocampal grafts of Trisomy 16 mice. Similarly, a population of grafted cells were positively stained following incubation with an antiserum raised against components of the pathological neurofibrillary tangle and with the monoclonal antibodies Tau 6.423 and ubiquitin.

Zinc supplementation of lactating ewes and weaned lambs grazing improved mediterranean pastures

The effects of post-partum supplements of zinc (Zn) on the Zn status and growth of 40 ewes and their newborn lambs grazing grass-clover pastures were studied. A control group received no supplemental Zn; supplemented ewes received Zn as an intra-ruminal Zn pellet and lambs received a Zn pellet at weaning followed by an oral Zn drench. Zinc concentrations in pastures ranged from 10 mg/kg in autumn to >20 mg/kg in winter. Zinc supplementation increased the concentration of Zn in milk but had no effect on Zn in plasma or wool of ewes or lambs and no effect on weight gain or wool production. Zinc supplements had no adverse effects on the copper concentration of tissues or milk. Zinc supplied as pellets increased the activity of glutathione peroxidase in blood. The results indicate that, at least when pasture quality and quantity is too poor for sheep to gain weight, Zn requirements for growth and wool production of lactating ewes and lambs can be met on pastures containing 10-20 mg Zn/kg.

Intracarotid hydroxyethyl methacrylate solution causing stroke in dogs

Hydroxyethyl methacrylate (HEMA) has been advocated as a polymerizing solution with which to prevent deflation of detachable balloons in interventional neuroradiology. It is pertinent to know if unpolymerized HEMA would have untoward effects if accidentally released into the carotid artery by balloon rupture or deflation. Seven mongrel dogs underwent transfemoral catheterization of the common carotid artery and subsequent injection of HEMA solution in volumes of 1 cc in five dogs, 2 cc in one, and 4 cc in one. Angiography performed at the time of injection revealed evidence of intravascular thrombosis as well as possible spasm. Three surviving animals were sacrificed at 48 hours; the brains were fixed and examined histopathologically. One brain was normal and one was autolyzed and could not be examined. Five of the seven animals had histopathologically documented cerebral infarctions of varying size. No foreign substance was seen within the blood vessels to suggest intravascular polymerization. The animals injected with 2 or 4 cc HEMA solution did not survive 48 hours. Literature review reveals little documentation of the toxicology of intravascular HEMA. With its increasing popularity as a compound for polymerization in detachable balloons introduced into the brain, further investigations are warranted to understand the physical properties of the compound and potential risks of its use.

Production and characterization of a monospecific antiserum (A128) to disaggregated Alzheimer paired helical filaments

Paired helical filaments (PHF), which constitute neurofibrillary tangles (NFT) and neuritic plaque (NP) neurites, serve as a useful marker for Alzheimer disease (AD). We have isolated AD PHF in a highly purified and disaggregated form for use as an immunogen to produce a heterologous polyclonal antiserum in rabbits. One rabbit was maintained long-term for the high quality of the antiserum it produced. Through absorptions with normal brain tissue, we were able to produce a monospecific antiserum which reacts only with NFT and NP neurites in AD brain tissue sections. We further demonstrated the specificity of this antiserum by electron microscopic immunohistochemistry, gel diffusion analysis, and immunoblotting. This antiserum also showed immunoreactivity to NFT of Down syndrome and progressive supranuclear palsy, and to the Pick bodies of Pick disease, but not to the Lewy bodies of idiopathic Parkinson disease. This well-characterized antiserum, all from one rabbit, offers several unique advantages to the study of the nature, origin, and interrelationships of filamentous protein abnormalities in AD and other neurodegenerative disorders.

Paired helical filaments are not the major binding sites for wheat germ and Dolichos biflorus agglutinins in the neurofibrillary tangles of Alzheimer's disease

The isolated paired helical filaments (PHF) that occur in the neurofibrillary tangles of Alzheimer's disease were assayed to determine if they contained N-acetyl-glucosamine and N-acetyl-galactosamine residues. The enzyme-linked lectin assay was used to detect their total content in the PHF preparation. The assay employed biotinylated Dolichos biflorus and wheat germ agglutinins and was developed with avidin-horseradish peroxidase. The total PHF preparation was shown to contain very little of these glycosyl groups compared to equal amounts of highly glycosylated control proteins. Colloidal gold-labeled lectins were used to study the PHF by electron microscopy to assess whether the minor amount of lectin binding in the total preparation was directly associated with the PHF. These studies showed no significant association of the colloidal gold-labeled lectins with the isolated filaments. We conclude that the PHF themselves contain few or no N-acetyl-glucosamine or N-acetyl-galactosamine residues.

Polyadenylated messenger RNA in paired helical filament-immunoreactive neurons in Alzheimer disease

An antibody raised against isolated paired helical filaments (PHF) was used to identify tangle-bearing (PHF+) neurons in autopsy brain tissue from six Alzheimer disease (AD) patients and six age-matched controls (AMC). A comparison of the levels of polyadenylated messenger RNA [poly(A)+ mRNA] in PHF+ and PHF- neurons of similar cross-sectional area in temporal and parietal lobe and cerebellum from four AD and four AMC brains was made by analysis of in situ hybridization of [3H] polyuridylate [poly(U)] to intracellular poly(A)+ mRNA. In PHF+ neurons, the level of poly(A)+ mRNA was approximately two-thirds that in similar-sized PHF- neurons in either AD or AMC. The level of poly(A)+ mRNA in PHF- neurons in regions of the brain that have more of the histopathologically defined effect in AD was similar to that in regions with less effects.