Transport of lysine from cerebrospinal fluid of the cat

Guillain-Barré syndrome: clinical profile and management

INTRODUCTION

Guillain-Barré syndrome (GBS) is a fulminant polyradiculoneuropathy that is acute, frequently severe and autoimmune in nature. Etiology of GBS is incompletely understood, prognosis is usually good with early detection and prompt treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and electrodiagnostic features of patients with GBS and mode of management, complications and prognostic factors.

METHODS

Data of 1,166 patients admitted with GBS or presented to outpatient department (previous medical records) with GBS between January 2003 and January 2014 were analyzed.

RESULTS

No difference in genders noted. Around 35% of patients are above 50 years of age. Poor control of diabetes with mean HbA1c of 8.1 ± 2.11 is found on analysis. Seasonal occurrence in GBS is prominent in winter 484 (41.50%) and mechanically ventilated were 449 (38.50%) patients. 48 (4.11%) deaths were attributed to GBS. Neurological analysis revealed cranial nerve involvement in 407 (34.90%) patients, facial palsy in 401 (34.39%) and ataxia in 88 (7.54%) patients. Most patients in plasma exchange group belonged to the lower socio-economic status. Mean cerebrospinal fluid (CSF) protein levels was (n=962) 113.8 ± 11.8 mg/dl. Conduction block determined indirectly by absent H-reflex was noted in 891 (90.64%) patients. No difference in complications and outcome is found in treatment regimens of intravenous immunoglobulin (IVIG) and plasma exchange.

CONCLUSION

Seasonal occurrence predominantly in winter is noted. Peak flow test may be a predictor of assessing requirement of mechanical ventilation and prognosis. Conduction block is the major abnormality noted in electrophysiological studies and proximal nerve segment assessing with Erb's point stimulation has high predictive value. IVIG treatment is more expensive but is associated with less duration of hospital stay.

Kinetic analysis of glutamate transport by the miniswine choroid plexus in vitro

Transport of glutamic acid by the choroid plexus, the blood-cerebrospinal fluid (CSF) barrier, was investigated by using the isolated choroid plexi from the fourth (FVCP) and lateral ventricles (LVCP) of the young adult miniswine in vitro. Glutamic acid uptake was very pronounced, with concentrations 7-fold (LVCP) and 2.4-fold (FVCP) higher in tissue than in medium after only 5 min of incubation with 1 microM glutamic acid. Tissue/medium ratios reached steady state by 15 min at 30-fold (LVCP) and 11-fold (FVCP). Uptake was energy-dependent and inhibited by ouabain and hypothermia. L-Aspartic acid was shown to be inhibitory in a concentration-dependent manner, suggesting that it shares a common transport system, whereas neither octanoic acid nor okadaic acid (transported by a separate fatty acid system) inhibited glutamic acid transport. At the same temperature, the labeled metabolite of glutamate (glutamine) in the tissue was 64.7%, 73.2%, and 72.5% of total radioactivity at 5, 30, and 60 min, respectively. The estimated Km values for glutamate uptake by the choroid plexus are 264 microM (FVCP) and 196 microM (LVCP); Vmax values are 87 (FVCP) and 147 (LVCP) nmol/g/min, respectively. These results indicate that, in addition to the metabolism of glutamate to glutamine, an active uptake mechanism is present in the choroid plexus of miniswine which may serve to regulate glutamic acid concentration in the CSF.

Abnormalities of cerebrospinal fluid amino acids in patients with the Guillain-Barré syndrome

Measurements of cerebrospinal fluid (CSF) and plasma amino acid concentrations have been made in 12 patients with the Guillain-Barré syndrome. The CSF protein concentration was normal in seven specimens and raised in 13. Abnormalities of the CSF amino acid profile were found in all specimens but were more marked in those with a raised CSF protein concentration. The possible causes and diagnostic significance of these changes are discussed.

The transport of L-tryptophan from cerebrospinal fluid in the dog

1. Endogenous tryptophan is uniformly distributed in dog cerebrospinal fluid (c.s.f.) and is about one tenth of the normal fasting plasma level.2. Using a recirculatory ventriculo-cisternal perfusion technique in conscious dogs it was found that L-tryptophan was removed from c.s.f. by a non-saturable mechanism in addition to bulk absorption of c.s.f. The clearance of L-tryptophan from c.s.f. was unaffected by thiopentone anaesthesia.3. Dialysis of dog plasma against an artificial c.s.f. solution containing L-tryptophan demonstrated that a large proportion of the tryptophan in dog plasma was protein-bound and that the unbound diffusible proportion would equilibrate with tryptophan concentrations equivalent to those normally found in dog c.s.f.4. Use of an open-circuit ventriculo-cisternal perfusion system in unanaesthetized dogs revealed the presence of a saturable component in the transport of tryptophan from c.s.f.5. As [(14)C]L-tryptophan infused into a recirculatory perfusion system produced no radioactively labelled metabolites, it was concluded that removal of tryptophan from c.s.f. by cerebral metabolism does not contribute substantially to maintaining the low levels of tryptophan in c.s.f. but that brain uptake associated with protein-binding may give rise to a small saturable component. The results indicate that the actual concentration gradient of tryptophan between plasma and c.s.f. is much less than it appears from the total concentration of tryptophan in the two fluids, and that the mechanism by which the c.s.f. - plasma distribution of tryptophan is maintained is mainly attributable to simple diffusion.