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Advances in dialysis encephalopathy research: a review. Neurol Sci 2018; 39:1151-1159. [PMID: 29721635 DOI: 10.1007/s10072-018-3426-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
Abstract
Dialysis encephalopathy (DE) is a progressive, fatal disease with a high mortality rate. Understanding the causes of this disease and the efforts to prevent and treat it would help improve the prognosis and quality of life of affected patients. This paper reviews the etiology, clinical features, methods of examining accessory features, diagnosis, treatment, and prevention of DE. We found that DE is likely to be related to aluminum poisoning. The clinical manifestations of DE include language disorders, mental and behavioral disorders, cognitive decline, and movement disorders. Electroencephalogram (EEG) findings mainly consist of an abundance of low waves, intermittent bilateral synchronous high-amplitude spikes, and ridge waves. Assessing the clinical features and obtaining an EEG are of great value in diagnosis, and DE is treated by both reducing aluminum intake and increasing aluminum excretion. Deferoxamine (DFO) is an effective treatment for DE.
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Boyer LA, Lee TI, Cole MF, Johnstone SE, Levine SS, Zucker JP, Guenther MG, Kumar RM, Murray HL, Jenner RG, Gifford DK, Melton DA, Jaenisch R, Young RA. Core transcriptional regulatory circuitry in human embryonic stem cells. Cell 2005; 122:947-56. [PMID: 16153702 PMCID: PMC3006442 DOI: 10.1016/j.cell.2005.08.020] [Citation(s) in RCA: 3300] [Impact Index Per Article: 173.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Revised: 07/08/2005] [Accepted: 08/17/2005] [Indexed: 02/06/2023]
Abstract
The transcription factors OCT4, SOX2, and NANOG have essential roles in early development and are required for the propagation of undifferentiated embryonic stem (ES) cells in culture. To gain insights into transcriptional regulation of human ES cells, we have identified OCT4, SOX2, and NANOG target genes using genome-scale location analysis. We found, surprisingly, that OCT4, SOX2, and NANOG co-occupy a substantial portion of their target genes. These target genes frequently encode transcription factors, many of which are developmentally important homeodomain proteins. Our data also indicate that OCT4, SOX2, and NANOG collaborate to form regulatory circuitry consisting of autoregulatory and feedforward loops. These results provide new insights into the transcriptional regulation of stem cells and reveal how OCT4, SOX2, and NANOG contribute to pluripotency and self-renewal.
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Affiliation(s)
- Laurie A. Boyer
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - Tong Ihn Lee
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - Megan F. Cole
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Sarah E. Johnstone
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Stuart S. Levine
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - Jacob P. Zucker
- Howard Hughes Medical Institute, Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts 02138
| | - Matthew G. Guenther
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - Roshan M. Kumar
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - Heather L. Murray
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - Richard G. Jenner
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
| | - David K. Gifford
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
- MIT Computer Science and Artificial Intelligence Laboratory (CSAIL), 32 Vassar Street, Cambridge, Massachusetts 02139
- Broad Institute of MIT and Harvard, One Kendall Square, Building 300, Cambridge, Massachusetts 02139
| | - Douglas A. Melton
- Howard Hughes Medical Institute, Department of Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts 02138
- Broad Institute of MIT and Harvard, One Kendall Square, Building 300, Cambridge, Massachusetts 02139
| | - Rudolf Jaenisch
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Richard A. Young
- Whitehead Institute for Biomedical Research, 9 Cambridge Center, Cambridge, Massachusetts 02142
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
- Broad Institute of MIT and Harvard, One Kendall Square, Building 300, Cambridge, Massachusetts 02139
- Correspondence:
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Abstract
Dialysis encephalopathy (DE) is a distinct neuropsychiatric syndrome typically occurring in patients undergoing longterm hemodialysis. It is characterized by electroencephalographic abnormalities in association with disturbances of speech, cognition, movement, affect, or behavior. Previously thought to be relentlessly progressive, recent evidence linking the illness to aluminum overload has led to advances in prevention and treatment. Early diagnosis aids in the reversal or amelioration of the syndrome and can be of immense value to the patient, the family and involved health personnel. The general features of the syndrome, etiologic considerations, differential diagnosis and treatment are discussed. Three case studies are included to illustrate salient features of the syndrome.
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Ziesat HA, Logue PE, McCarty SM. Psychological measurement of memory deficits in dialysis patients. Percept Mot Skills 1980; 50:311-8. [PMID: 7367184 DOI: 10.2466/pms.1980.50.1.311] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In light of recent research on "dialysis dementia," two questions were raised: (1) Is such dementia an all-or-none phenomenon or is it distributed in severity throughout the population of dialysis patients? (2) Is the dementia related to the uremia itself or to some aspect of dialysis? Memory decline was used as the operational definition of dementia. The Russell revision of the Wechsler Memory Scale was used to measure short- and long-term semantic and figural memory. Results suggested that both semantic and figural memory disturbances were distributed in varying degrees throughout the population of dialysis patients (n = 28). Further findings suggested that figural memory functioning was negatively correlated with the number of dialysis sessions and with the amount of time elapsed since the first dialysis session. Suggestions are made for further research and clinical considerations.
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Abstract
Sixty cases of distinctive progressive and fatal encephalopathy have been reported in patients undergoing long-term hemodialysis. An analysis of their records reveals that mean duration of hemodialysis prior to onset is 2.5 years, while mean duration of clinical course until death is 6.3 months. The most frequent clinical manifestations include disturbances in communication (87%), cognition (66%) and movement (93%). Nonspecific electroencephalographic abnormalities are present in all cases. The condition is possibly related to some yet unidentified metabolic disorder. There is no effective therapy.
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Mahurkar SD, Meyers L, Cohen J, Kamath RV, Dunea G. Electroencephalographic and radionuclide studies in dialysis dementia. Kidney Int 1978; 13:306-15. [PMID: 651129 DOI: 10.1038/ki.1978.44] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Six maintenance hemodialysis patients with dialysis dementia (severe mental deterioration, speech disturbances, apraxia, facial grimacing, and myoclonus) were studied. They were matched with respect to age, duration of dialysis, and underlying renal disease with six patients who had no dementia and who acted as controls for the electroencephalographic (EEC) studies. The dementia patients had marked slowing of the EEG rhythm to 5--7 Hz with high voltage biphasic or triphasic spikes, and were clearly separated by frequency distribution analysis from the controls. Radio-iodinated serum albumin (RISA) cisternography in dementia patients demonstrated ventricular reflux, prolonged stasis, late appearance of the parasagittal strip, and persistence of RISA for up to 72--96 hr, which suggest an alteration in cerebrospinal fluid (CSF) dynamics.
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Mahurkar SD, Smith EC, Mamdani BH, Dunea G. Dialysis dementia -- the Chicago experience. JOURNAL OF DIALYSIS 1978; 2:447-58. [PMID: 750611 DOI: 10.3109/08860227809080098] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the four years between 1972 and 1976 twenty out of 160 maintenance dialysis patients developed dialysis dementia. Their illness was characterized by an insidious onset of mental deterioration, speech disturbance, apraxia, and myoclonus. The disease progressed inexorably to a fatal outcome, the onset of seizures being an ominous sign, and the average duration of the illness being seven months. Routine biochemical studies were unremarkable, and osteodystrophy was not a prominent feature. Serial electroencephalograms (EEG) showed progressive slowing of the rhythm, usually antedating the neurologic symptoms. Brain scan and flow studies were normal. Radio-iodinated serum albumin (RISA) scans in seven patients showed changes suggesting altered cerebrospinal fluid (CSF) dynamics. Treatment was generally ineffective, but ventriculo-peritoneal shunting produced transient neurologic improvement in one patient. Epidemiologic investigations showed high aluminum levels in city water during the period of the outbreak.
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