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Moya M, San Felipe D, Ballesta A, Alén F, Rodríguez de Fonseca F, García-Bueno B, Marco EM, Orio L. Cerebellar and cortical TLR4 activation and behavioral impairments in Wernicke-Korsakoff Syndrome: Pharmacological effects of oleoylethanolamide. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110190. [PMID: 33271211 DOI: 10.1016/j.pnpbp.2020.110190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/19/2023]
Abstract
Wernicke-Korsakoff Syndrome (WKS) is a neuropsychiatric disorder whose etiology is a thiamine deficiency (TD), with alcoholism being the main underlying cause. Previous evidence suggests the presence of initial neuroinflammation and oxidative/nitrosative stress in the physiopathology, although the specific molecular mechanisms underlying TD-induced brain damage and behavioral disabilities are unknown. We explored the specific role of the innate immune receptor TLR4 in three murine models of WKS, based on the combination of a thiamine-deficient diet and pyrithiamine injections (0.25 mg/kg, i.p.) over time. The Symptomatic Model (SM) allowed us to describe the complete neurological/neurobehavioral symptomatology over 16 days of TD. Animals showed an upregulation of the TLR4 signaling pathway both in the frontal cortex (FC) and cerebellum and clear motor impairments related with cerebellar dysfunction. However, in the Pre-Symptomatic Model (PSM), 12 days of TD induced the TLR4 pathway upregulation in the FC, which correlated with disinhibited-like behavior, but not in the cerebellum, and no motor impairments. In addition, we tested the effects of the biolipid oleoylethanolamide (OEA, 10 mg/kg, i.p., once daily, starting before any symptom of the pathology is manifested) through the Glucose-Precipitated Model (GPM), which was generated by glucose loading (5 g/kg, i.v., last day) in thiamine-deficient animals to accelerate damage. Pretreatment with OEA prevented the TLR4-induced signature in the FC, as well as an underlying incipient memory disability and disinhibited-like behavior. This study suggests a key role for TLR4 in TD-induced neuroinflammation in the FC and cerebellum, and it reveals different vulnerability of these brain regions in WKS over time. Pre-treatment with OEA counteracts TD-induced TLR4-associated neuroinflammation and may serve as co-adjuvant therapy to prevent WKS-induced neurobehavioral alterations.
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Affiliation(s)
- Marta Moya
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid (UCM), Madrid, Spain; Red de Trastornos Adictivos (RTA) del Instituto de Salud Carlos III (ISCIII), Spain
| | - Diego San Felipe
- Department of Genetics, Physiology and Microbiology, Faculty of Biology, UCM, Spain
| | - Antonio Ballesta
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Francisco Alén
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Fernando Rodríguez de Fonseca
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), UGC Salud Mental, Hospital Regional de Málaga, Spain; Red de Trastornos Adictivos (RTA) del Instituto de Salud Carlos III (ISCIII), Spain
| | - Borja García-Bueno
- Department of Pharmacology and Toxicology, Faculty of Medicine, UCM, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Instituto Universitario de Investigación en Neuroquímica UCM, Spain
| | - Eva M Marco
- Department of Genetics, Physiology and Microbiology, Faculty of Biology, UCM, Spain; Red de Trastornos Adictivos (RTA) del Instituto de Salud Carlos III (ISCIII), Spain
| | - Laura Orio
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid (UCM), Madrid, Spain; Red de Trastornos Adictivos (RTA) del Instituto de Salud Carlos III (ISCIII), Spain.
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Abstract
Ethanol intoxication and ethanol use are associated with a variety of metabolic derangements encountered in the Emergency Department. In this article, the authors discuss alcohol intoxication and its treatment, dispel the myth that alcohol intoxication is associated with hypoglycemia, comment on electrolyte derangements and their management, review alcoholic ketoacidosis, and end with a section on alcoholic encephalopathy.
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Affiliation(s)
- Michael G Allison
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Baltimore, MD 21201, USA
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 South Paca Street, 2nd Floor, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Baltimore, MD 21201, USA.
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Abstract
Altered mental status is a common chief compliant among older patients in the emergency department (ED). Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. Although stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute changes in mental status the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple causes may exist concurrently.
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Affiliation(s)
- Jin H. Han
- Center for Quality Aging, Assistant Professor of Emergency Medicine, Vanderbilt University School of Medicine, Department of Emergency Medicine, 703 Oxford House, Nashville, TN 37232-4700, Phone: 615-936-1434, Fax: 615-936-1316
| | - Scott T. Wilber
- Emergency Medicine Research Center, Associate Professor of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Medical University, 525 East Market Street, Akron, Ohio 44309, Phone: 330-375-7530, Fax: 330-375-7564
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Schabelman E, Kuo D. Glucose before Thiamine for Wernicke Encephalopathy: A Literature Review. J Emerg Med 2012; 42:488-94. [DOI: 10.1016/j.jemermed.2011.05.076] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 11/29/2010] [Accepted: 05/25/2011] [Indexed: 11/16/2022]
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Enneking D. The nutritive value of grasspea (Lathyrus sativus) and allied species, their toxicity to animals and the role of malnutrition in neurolathyrism. Food Chem Toxicol 2011; 49:694-709. [DOI: 10.1016/j.fct.2010.11.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 11/14/2010] [Accepted: 11/22/2010] [Indexed: 12/12/2022]
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Walker J, Kepner A. Wernicke's encephalopathy presenting as acute psychosis after gastric bypass. J Emerg Med 2009; 43:811-4. [PMID: 19406605 DOI: 10.1016/j.jemermed.2009.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Revised: 01/29/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients frequently present to the Emergency Department (ED) with psychiatric complaints. The differential diagnosis for acute psychosis is extensive, and determining a possible etiology requires a thorough history and physical. Small details can help the physician in differentiating organic disease from non-organic disease. Many times patients are thought to be "crazy" without a thorough history and physical being done. CASE REPORT In this case, the diagnosis hinged on the history of having gastric bypass surgery. A thorough physical examination was performed, and the patient had neurologic findings suggestive of severe thiamine deficiency. The patient's thiamine level was low. The patient was started on i.v. thiamine and slowly began to recover. CONCLUSION Cerebral beriberi, more commonly known as Wernicke's encephalopathy, is a difficult diagnosis to make in the ED. A thorough neurologic examination is difficult to perform in the ED environment, but it is necessary when trying to determine the etiology of the patient's altered mental status. The number of patients with Wernicke's encephalopathy may increase with bariatric surgery becoming more common. This disease can present with a wide variety of findings, and the classic triad is not very common. With this in mind, the physician should have a low threshold for administering thiamine intravenously.
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Affiliation(s)
- Jonathan Walker
- Emergency Medicine Residency, York Hospital, York, Pennsylvania 17404, USA
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McCormick LM, Keel PK, Brumm MC, Bowers W, Swayze V, Andersen A, Andreasen N. Implications of starvation-induced change in right dorsal anterior cingulate volume in anorexia nervosa. Int J Eat Disord 2008; 41:602-10. [PMID: 18473337 PMCID: PMC3652574 DOI: 10.1002/eat.20549] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Converging evidence suggests a role for the anterior cingulate cortex (ACC) in the pathophysiology of anorexia nervosa (AN). This study sought to determine whether ACC volume was affected by starvation in active AN and, if so, whether this had any clinical significance. METHOD Eighteen patients with active AN and age- and gender-matched normal controls underwent magnetic resonance imaging (MRI). Sixteen patients (89%) with AN had intelligence quotients (IQ) testing at intake, 14 (78%) had repeat MRIs after weight normalization, and 10 (56%) had outcome data at 1-year posthospitalization. RESULTS Right dorsal ACC volume was significantly reduced in active AN patients versus controls and was correlated with lower performance IQ. While ACC normalization occurred with weight restoration, smaller change in right dorsal ACC volume prospectively predicted relapse after treatment. CONCLUSION Reduced right dorsal ACC volume during active AN relates to deficits in perceptual organization and conceptual reasoning. The degree of right dorsal ACC normalization during treatment is related to outcome.
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Affiliation(s)
- Laurie M. McCormick
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa,Correspondence to: Laurie McCormick, Department of Psychiatry, University of Iowa, Carver College of Medicine, Psychiatric Iowa Neuroimaging Center, 200 Hawkins Drive, W278 GH, Iowa City, IA 52242.
| | - Pamela K. Keel
- Department of Psychology, University of Iowa, Iowa City, Iowa
| | - Michael C. Brumm
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Wayne Bowers
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Victor Swayze
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa,Department of Psychiatry, Veterans Administration, Iowa City, Iowa
| | - Arnold Andersen
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Nancy Andreasen
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, Iowa
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Nixon PF, Jordan L, Zimitat C, Rose SE, Zelaya F. Choroid Plexus Dysfunction: The Initial Event in the Pathogenesis of Wernicke’s Encephalopathy and Ethanol Intoxication. Alcohol Clin Exp Res 2008; 32:1513-23. [DOI: 10.1111/j.1530-0277.2008.00723.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Navarro D, Zwingmann C, Butterworth RF. Region-selective alterations of glucose oxidation and amino acid synthesis in the thiamine-deficient rat brain: a re-evaluation using1H13C nuclear magnetic resonance spectroscopy. J Neurochem 2008; 106:603-12. [DOI: 10.1111/j.1471-4159.2008.05410.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Donnino MW, Vega J, Miller J, Walsh M. Myths and misconceptions of Wernicke's encephalopathy: what every emergency physician should know. Ann Emerg Med 2007; 50:715-21. [PMID: 17681641 DOI: 10.1016/j.annemergmed.2007.02.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 01/20/2007] [Accepted: 02/06/2007] [Indexed: 12/25/2022]
Abstract
First described in 1881, Wernicke's encephalopathy continues to be an unrecognized and often misunderstood disease. The cause of Wernicke's encephalopathy is thiamine deficiency as a result of any nutritionally deficient state, though many physicians erroneously consider this disease to be confined only to alcoholics. Unfortunately, the syndrome is most often recognized only on autopsy, especially among nonalcoholics. Despite advances in magnetic resonance imaging, Wernicke's encephalopathy remains primarily a clinical diagnosis. The common clinical findings include mental status changes, ocular dysfunction, and gait ataxia. Additional signs may be present, or 1 or more of the common findings may be absent. Treatment mandates timely intravenous thiamine therapy, for which the optimum dosage remains controversial. This review traces the history of Wernicke's encephalopathy from the first description to our current understanding of the disease and includes many of the misconceptions, myths, and controversies that surround this disease. Emergency physicians need to be well versed in the varied presentation of Wernicke's encephalopathy because most of these patients will present to the emergency department and are oftentimes unrecognized. Further, physician knowledge of this disease is vital because the failure to diagnose results in severe neurologic morbidity and possible mortality, but the treatment is safe and effective.
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Affiliation(s)
- Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Clark JA, Burny I, Sarnaik AP, Audhya TK. Acute thiamine deficiency in diabetic ketoacidosis: Diagnosis and management. Pediatr Crit Care Med 2006; 7:595-9. [PMID: 17006386 DOI: 10.1097/01.pcc.0000244463.59230.da] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Persistent encephalopathy in a patient with diabetic ketoacidosis is often feared as a sign of cerebral edema. Although thiamine deficiency is a rare diagnosis in children, marginal nutritional status and osmotic diuresis may be risk factors. The objective was to describe a heretofore unreported cause of encephalopathy in a child with diabetic ketoacidosis and review the mechanisms and pathophysiology of thiamine deficiency in this clinical scenario. DESIGN Case report and review of the literature. SETTING Pediatric intensive care unit of a tertiary care pediatric hospital. PATIENT A 13-yr-old girl. INTERVENTIONS Treatment of dehydration and hyperglycemia, osmotherapy, and intravenous thiamine administration. MEASUREMENTS AND MAIN RESULTS The patient presented with new-onset diabetes mellitus, severe diabetic ketoacidosis, and significant encephalopathy. Despite biochemical improvement with treatment of dehydration and hyperglycemia, her encephalopathy persisted. Computed tomography did not show cerebral edema and she showed no response to osmotherapy. Quantitative and functional assays revealed severe thiamine deficiency. The patient showed an immediate and dramatic response to intravenous thiamine administration. CONCLUSIONS The clinical improvement as well as lab investigations suggests that thiamine deficiency was the cause of this child's encephalopathy. Because potential mechanisms exist for thiamine deficiency in diabetes mellitus and institution of insulin and glucose therapy may stress thiamine body stores, thiamine deficiency should be considered in children with diabetic ketoacidosis whose encephalopathy does not improve with improvement of biochemical status.
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Affiliation(s)
- Jeff A Clark
- Division of Critical Care Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA
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12
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Abstract
Thiamine or vitamin B(1), an essential nutrient absorbed from the diet, is involved in vital brain metabolic and cellular functions, including carbohydrate metabolism and neurotransmitter production. Diencephalic regions and, in particular, the cerebellum demonstrate lesions in cases of prolonged thiamine deficiency, such as that observed in alcohol-dependent individuals or in patients with cancer or AIDS. The purpose of this review is to demonstrate recent evidence of cerebellar dysfunction resulting from thiamine deficiency and to assemble theories as to why the cerebellum may be sensitive to this type of insult. A brief outline on cerebellar structure and function, as well as a short discussion on thiamine and thiamine deficiency are provided before detailing the conditions and mechanisms underlying thiamine deficiency-induced cerebellar dysfunction. Although much is known regarding cell loss from a lack of thiamine, further work is still required to identify the sequelae of events leading to the susceptibility of the cerebellum to injury stemming from a thiamine deficient diet or impaired thiamine utilization.
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Affiliation(s)
- Patrick J Mulholland
- Medical University of South Carolina, Center for Drug and Alcohol Programs, Charleston, 29425, USA.
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13
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Depeint F, Bruce WR, Shangari N, Mehta R, O'Brien PJ. Mitochondrial function and toxicity: role of the B vitamin family on mitochondrial energy metabolism. Chem Biol Interact 2006; 163:94-112. [PMID: 16765926 DOI: 10.1016/j.cbi.2006.04.014] [Citation(s) in RCA: 268] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 04/18/2006] [Accepted: 04/18/2006] [Indexed: 01/19/2023]
Abstract
The B vitamins are water-soluble vitamins required as coenzymes for enzymes essential for cell function. This review focuses on their essential role in maintaining mitochondrial function and on how mitochondria are compromised by a deficiency of any B vitamin. Thiamin (B1) is essential for the oxidative decarboxylation of the multienzyme branched-chain ketoacid dehydrogenase complexes of the citric acid cycle. Riboflavin (B2) is required for the flavoenzymes of the respiratory chain, while NADH is synthesized from niacin (B3) and is required to supply protons for oxidative phosphorylation. Pantothenic acid (B5) is required for coenzyme A formation and is also essential for alpha-ketoglutarate and pyruvate dehydrogenase complexes as well as fatty acid oxidation. Biotin (B7) is the coenzyme of decarboxylases required for gluconeogenesis and fatty acid oxidation. Pyridoxal (B6), folate and cobalamin (B12) properties are reviewed elsewhere in this issue. The experimental animal and clinical evidence that vitamin B therapy alleviates B deficiency symptoms and prevents mitochondrial toxicity is also reviewed. The effectiveness of B vitamins as antioxidants preventing oxidative stress toxicity is also reviewed.
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Affiliation(s)
- Flore Depeint
- Department of Pharmaceutical Sciences, University of Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Canada
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Ferdinands MD, Seneviratne J, White O. Visual deterioration in hyperemesis gravidarum. Med J Aust 2005; 182:585-6. [PMID: 15938688 DOI: 10.5694/j.1326-5377.2005.tb06820.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 04/04/2005] [Indexed: 11/17/2022]
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Navarro D, Zwingmann C, Hazell AS, Butterworth RF. Brain lactate synthesis in thiamine deficiency: A re-evaluation using1H-13C nuclear magnetic resonance spectroscopy. J Neurosci Res 2004; 79:33-41. [PMID: 15573405 DOI: 10.1002/jnr.20290] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Region-selective accumulation of brain lactate occurs in TD; however, the mechanisms responsible have not been elucidated fully. (1)H and (13)C nuclear magnetic resonance (NMR) spectroscopy were therefore used to investigate de novo lactate synthesis from [1-(13)C]glucose in vulnerable (medial thalamus) and nonvulnerable (frontal cortex) brain regions of rats made thiamine deficient by administration of the central thiamine antagonist pyrithiamine. De novo synthesis of lactate was increased in the medial thalamus to 148% and 226% of pair-fed control values at presymptomatic and symptomatic stages of thiamine deficiency, respectively, whereas no such changes were observed in the frontal cortex. Administration of a glucose load selectively worsened the changes in medial thalamus. Pyruvate recycling and peripherally derived lactate did not contribute significantly to the lactate increase within the thiamine-deficient brain. Increases in immunolabeling of the lactate dehydrogenase isoenzymes (LDH1 and LDH5) were observed in the medial thalamus of thiamine-deficient animals. Metabolic impairment due to thiamine deficiency thus results in increased glycolysis, increased LDH immunolabeling of neurons and astrocytes and increased de novo synthesis of lactate in brain regions vulnerable to thiamine deficiency. These results are consistent with the notion that focal lactate accumulation participates in the worsening of neurologic symptoms in thiamine-deficient patients.
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Affiliation(s)
- Darren Navarro
- Neuroscience Research Unit, CHUM (Campus Saint-Luc), University of Montreal, 1058 Saint-Denis Street, Montreal, Province of Quebec H2X 3J4, Canada
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Fairbanks LD, Jacomelli G, Micheli V, Slade T, Simmonds HA. Severe pyridine nucleotide depletion in fibroblasts from Lesch-Nyhan patients. Biochem J 2002; 366:265-72. [PMID: 11996669 PMCID: PMC1222752 DOI: 10.1042/bj20020148] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2002] [Revised: 04/23/2002] [Accepted: 05/08/2002] [Indexed: 11/17/2022]
Abstract
The relationship between a complete deficiency of the purine enzyme hypoxanthine-guanine phosphoribosyltransferase and the neurobehavioural abnormalities in Lesch-Nyhan disease remains an enigma. In vitro studies using lymphoblasts or fibroblasts have evaluated purine and pyrimidine metabolism with conflicting results. This study focused on pyridine nucleotide metabolism in control and Lesch-Nyhan fibroblasts using radiolabelled salvage precursors to couple the extent of uptake with endocellular nucleotide concentrations. The novel finding, highlighted by specific culture conditions, was a marked NAD depletion in Lesch-Nyhan fibroblasts. ATP and GTP were also 50% of the control, as reported in lymphoblasts. A 6-fold greater incorporation of [(14)C]nicotinic acid into nicotinic acid- adenine dinucleotide by Lesch-Nyhan fibroblasts, with no unmetabolized substrate (20% in controls), supported disturbed pyridine metabolism, NAD depletion being related to utilization by poly(ADP-ribose) polymerase in DNA repair. Although pyrimidine nucleotide concentrations were similar to controls, Lesch-Nyhan cells showed reduced [(14)C]cytidine/uridine salvage into UDP sugars. Incorporation of [(14)C]uridine into CTP by both was minimal, with more than 50% [(14)C]cytidine metabolized to UTP, indicating that fibroblasts, unlike lymphoblasts, lack active CTP synthetase, but possess cytidine deaminase. Restricted culture conditions may be neccesary to mimic the situation in human brain cells at an early developmental stage. Cell type may be equally important. NAD plus ATP depletion in developing brain could restrict DNA repair, leading to neuronal damage/loss by apoptosis, and, with GTP depletion, affect neurotransmitter synthesis and basal ganglia dopaminergic neuronal systems. Thus aberrant pyridine nucleotide metabolism could play a vital role in the pathophysiology of Lesch-Nyhan disease.
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Affiliation(s)
- Lynette D Fairbanks
- Purine Research Unit, Department of Chemical Pathology, GKT, Guy's Hospital, London SE1 9RT, U.K.
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Southgate T, Bain D, Fairbanks LD, Morelli A, Larregina A, Simmonds HA, Castro M, Lowenstein P. Adenoviruses encoding HPRT correct the biochemical abnormalities fully only in HPRT-deficient human cell lines: importance of species differences. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2002; 486:35-40. [PMID: 11783514 DOI: 10.1007/0-306-46843-3_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- T Southgate
- Molecular Medicine and Gene Therapy Unit, School of Medicine, University of Manchester, GB
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Hung SC, Hung SH, Tarng DC, Yang WC, Chen TW, Huang TP. Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis 2001; 38:941-7. [PMID: 11684545 DOI: 10.1053/ajkd.2001.28578] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with end-stage renal disease undergoing regular dialysis are prone to encephalopathy, but the cause is often unclear. Dialysis patients are at risk for thiamine deficiency, which may mimic many uremic complications, including encephalopathy. To determine whether unexplained encephalopathy in regular dialysis patients is associated with thiamine deficiency, we conducted a prospective study that enrolled 30 consecutive dialysis patients with altered mental status admitted to a referred hospital during a 1-year period. A complete history, physical and neurological examinations, laboratory investigations, and computed tomographic scans or magnetic resonance imaging of the brain were obtained for each subject. In 10 of the 30 patients, diagnoses remained obscure after the initial workup. Manifestations included confusion, chorea, acute visual loss, rapidly progressive dementia, myoclonus, convulsions, and coma. Intravenous thiamine was administered to these 10 patients. All 10 patients had thiamine deficiency confirmed by a marked response to thiamine supplementation and/or a low serum thiamine concentration (35.3 +/- 6.0 nmol/L; normal, >50 nmol/L). Nine patients recovered, but one patient failed to respond because of delayed treatment. We conclude that in regular dialysis patients, unexplained encephalopathy can be mainly attributed to thiamine deficiency. This condition is fatal if unrecognized and can be successfully treated with prompt thiamine replacement.
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Affiliation(s)
- S C Hung
- Department of Medicine, Division of Nephrology, TaipeiVeterans General Hospital, Taiwan
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19
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Abstract
Glucose loading of rats made thiamin deficient by dietary deprivation of thiamin and the administration of pyrithiamin (40 microg/100 g, i.p.) precipitates an acute neuropathy, a model of Wernicke's encephalopathy in man (Zimitat and Nixon, Metab. Brain Dis. 1999;14:1-20). Immunohistochemical detection of Fos proteins was used as a marker to identify neuronal populations in the thiamin-deficient rat brain affected by glucose loading. As thiamin deficiency progressed, the extent and intensity of Fos-like immunoreactivity (FLI) in brain structures typically affected by thiamin deficiency (the thalamus, mammillary bodies, inferior colliculus, vestibular nucleus and inferior olives) were markedly increased when compared to thiamin-replete controls. Glucose loading for 1-3 days further increased the intensity of FLI in these same regions, consistent with a dependence of Fos expression on carbohydrate metabolism as well as on thiamin deficiency. The timed acute changes that follow a bolus glucose load administered to thiamin-deficient animals may provide a sequential account of events in the pathogenesis of brain damage in this model of Wernicke's encephalopathy.
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Affiliation(s)
- C Zimitat
- Department of Biochemistry, The University of Queensland, Queensland, Brisbane, Australia 4072
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Ciccia RM, Langlais PJ. An Examination of the Synergistic Interaction of Ethanol and Thiamine Deficiency in the Development of Neurological Signs and Long-Term Cognitive and Memory Impairments. Alcohol Clin Exp Res 2000. [DOI: 10.1111/j.1530-0277.2000.tb02033.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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