Evaluation of brain perfusion with high resolution single photon emission tomography in the diagnosis of brain death

Nuclear Medicine studies performed with tomographic acquisition and tracers such as Technetium-99m hexamethyl-propyleneamine oxime (99mTc-HMPAO) are able to assess cerebral blood flow. A case is reported of a patient with a large intracranial tumor, of possible pituitary origin, with a clinical and electroencephalographic suspicion of brain death. The patient had endocrinous-metabolic impairments for a history of impotence, since 18 months, and diabetes insipidus with a urine output of 350 ml/hr in the first 24 hours from the clinical suspicion of brain death. Due to the endocrinous-metabolic impairments, according to Italian law, it was necessary to confirm the diagnosis of brain death by performing a study able to assess cerebral blood flow. A single Photon Emission Tomography (SPET) scan was performed after the intravenous administration of 99mTc-HMPAO using a high resolution, brain dedicated device. No tracer uptake was evident in cerebral, cerebellar and brain stem structures. The cerebral blood flow study by SPET confirmed the diagnosis of brain death and made the organ transplant possible in a short period of time. High resolution SPET studies are useful to confirm the diagnosis of brain death when there are factors that can influence clinical and electroencephalographic signs, reducing time to authorise the organ explant.

Ki-ras oncogene interferes with the expression of cyclic AMP-dependent promoters

The expression of thyroglobulin and other thyroid-specific markers depends upon the activation of protein kinase A (PKA) by cyclic AMP. A rat thyroid cell line dedifferentiates when transformed with Ki-ras oncogene. The decrease in thyroglobulin gene expression parallels a reduction in the level of PKA nuclear catalytic subunit. We find that the activity of cAMP-responsive elements and thyroglobulin promoters is down-regulated in Ras-transformed cells. Transcription of a third cAMP-regulated gene, H-ferritin, is similarly reduced. cAMP-responsive element and H-ferritin expression were stimulated when intracellular cAMP levels were increased. Reactivation of the thyroglobulin promoter required depletion of PKC in addition to increased cAMP. We also find that v-Ras activation leads to a significant increase in membrane-bound PKC. These data support the idea that v-Ras via PKC inhibits the transmission of cAMP-PKA signals to the nucleus. We suggest that the thyroglobulin promoter is more sensitive than other cAMP-dependent promoters to reduced nuclear levels of PKA catalytic subunit.