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Kim CK, Won JS, An JY, Lee HJ, Nam AJ, Nam H, Lee JY, Lee KH, Lee SH, Joo KM. Significant Therapeutic Effects of Adult Human Neural Stem Cells for Spinal Cord Injury Are Mediated by Monocyte Chemoattractant Protein-1 (MCP-1). Int J Mol Sci 2022; 23:ijms23084267. [PMID: 35457084 PMCID: PMC9029183 DOI: 10.3390/ijms23084267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 12/11/2022] Open
Abstract
The limited capability of regeneration in the human central nervous system leads to severe and permanent disabilities following spinal cord injury (SCI) while patients suffer from no viable treatment option. Adult human neural stem cells (ahNSCs) are unique cells derived from the adult human brain, which have the essential characteristics of NSCs. The objective of this study was to characterize the therapeutic effects of ahNSCs isolated from the temporal lobes of focal cortical dysplasia type IIIa for SCI and to elucidate their treatment mechanisms. Results showed that the recovery of motor functions was significantly improved in groups transplanted with ahNSCs, where, in damaged regions of spinal cords, the numbers of both spread and regenerated nerve fibers were observed to be higher than the vehicle group. In addition, the distance between neuronal nuclei in damaged spinal cord tissue was significantly closer in treatment groups than the vehicle group. Based on an immunohistochemistry analysis, those neuroprotective effects of ahNSCs in SCI were found to be mediated by inhibiting apoptosis of spinal cord neurons. Moreover, the analysis of the conditioned medium (CM) of ahNSCs revealed that such neuroprotective effects were mediated by paracrine effects with various types of cytokines released from ahNSCs, where monocyte chemoattractant protein-1 (MCP-1, also known as CCL2) was identified as a key paracrine mediator. These results of ahNSCs could be utilized further in the preclinical and clinical development of effective and safe cell therapeutics for SCI, with no available therapeutic options at present.
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Affiliation(s)
- Chung Kwon Kim
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, Korea
| | - Jeong-Seob Won
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
| | - Jae Yeol An
- Department of Anatomy, Seoul National University College of Medicine, Seoul 03880, Korea; (J.Y.A.); (J.Y.L.)
- Healthcare Division, Partners Investment Co., Ltd., Seoul 06152, Korea
| | - Ho Jin Lee
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Ah-Jin Nam
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Hyun Nam
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ji Yeoun Lee
- Department of Anatomy, Seoul National University College of Medicine, Seoul 03880, Korea; (J.Y.A.); (J.Y.L.)
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul 03080, Korea
| | - Kyung-Hoon Lee
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
| | - Sun-Ho Lee
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: (S.-H.L.); (K.M.J.); Tel.: +82-2-3410-2457 (S.-H.L.); +82-31-299-6073 (K.M.J.); Fax: +82-2-3410-0048 (S.-H.L.); +82-31-299-6029 (K.M.J.)
| | - Kyeung Min Joo
- Medical Innovation Technology Inc. (MEDINNO Inc.), Ace High-End Tower Classic 26, Seoul 08517, Korea; (C.K.K.); (J.-S.W.); (H.N.)
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon 16419, Korea
- Stem Cell and Regenerative Medicine Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
- Single Cell Network Research Center, Sungkyunkwan University School of Medicine, Suwon 16419, Korea; (H.J.L.); (K.-H.L.)
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
- Department of Anatomy & Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea;
- Correspondence: (S.-H.L.); (K.M.J.); Tel.: +82-2-3410-2457 (S.-H.L.); +82-31-299-6073 (K.M.J.); Fax: +82-2-3410-0048 (S.-H.L.); +82-31-299-6029 (K.M.J.)
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Abstract
Neuropathological examination of the temporal lobe provides a better understanding and management of a wide spectrum of diseases. We focused on inflammatory diseases, epilepsy, and neurodegenerative diseases, and highlighted how the temporal lobe is particularly involved in those conditions. Although all these diseases are not specific or restricted to the temporal lobe, the temporal lobe is a key structure to understand their pathophysiology. The main histological lesions, immunohistochemical markers, and molecular alterations relevant for the neuropathological diagnostic reasoning are presented in relation to epidemiology, clinical presentation, and radiological findings. The inflammatory diseases section addressed infectious encephalitides and auto-immune encephalitides. The epilepsy section addressed (i) susceptibility of the temporal lobe to epileptogenesis, (ii) epilepsy-associated hippocampal sclerosis, (iii) malformations of cortical development, (iv) changes secondary to epilepsy, (v) long-term epilepsy-associated tumors, (vi) vascular malformations, and (vii) the absence of histological lesion in some epilepsy surgery samples. The neurodegenerative diseases section addressed (i) Alzheimer's disease, (ii) the spectrum of frontotemporal lobar degeneration, (iii) limbic-predominant age-related TDP-43 encephalopathy, and (iv) α-synucleinopathies. Finally, inflammatory diseases, epilepsy, and neurodegenerative diseases are considered as interdependent as some pathophysiological processes cross the boundaries of this classification.
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Affiliation(s)
- Susana Boluda
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, Paris, France; Neuropathology Department, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Danielle Seilhean
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, Paris, France; Neuropathology Department, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Franck Bielle
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, Paris, France; Neuropathology Department, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France.
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Braun CM, Elie-Fortier J. Epilepsy and autism: How does age at seizure onset factor in? JOURNAL OF EPILEPTOLOGY 2021. [DOI: 10.21307/jepil-2021-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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4
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Walker JM, Richardson TE, Farrell K, Iida MA, Foong C, Shang P, Attems J, Ayalon G, Beach TG, Bigio EH, Budson A, Cairns NJ, Corrada M, Cortes E, Dickson DW, Fischer P, Flanagan ME, Franklin E, Gearing M, Glass J, Hansen LA, Haroutunian V, Hof PR, Honig L, Kawas C, Keene CD, Kofler J, Kovacs GG, Lee EB, Lutz MI, Mao Q, Masliah E, McKee AC, McMillan CT, Mesulam MM, Murray M, Nelson PT, Perrin R, Pham T, Poon W, Purohit DP, Rissman RA, Sakai K, Sano M, Schneider JA, Stein TD, Teich AF, Trojanowski JQ, Troncoso JC, Vonsattel JP, Weintraub S, Wolk DA, Woltjer RL, Yamada M, Yu L, White CL, Crary JF. Early Selective Vulnerability of the CA2 Hippocampal Subfield in Primary Age-Related Tauopathy. J Neuropathol Exp Neurol 2021; 80:102-111. [PMID: 33367843 PMCID: PMC8453611 DOI: 10.1093/jnen/nlaa153] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary age-related tauopathy (PART) is a neurodegenerative entity defined as Alzheimer-type neurofibrillary degeneration primarily affecting the medial temporal lobe with minimal to absent amyloid-β (Aβ) plaque deposition. The extent to which PART can be differentiated pathoanatomically from Alzheimer disease (AD) is unclear. Here, we examined the regional distribution of tau pathology in a large cohort of postmortem brains (n = 914). We found an early vulnerability of the CA2 subregion of the hippocampus to neurofibrillary degeneration in PART, and semiquantitative assessment of neurofibrillary degeneration in CA2 was significantly greater than in CA1 in PART. In contrast, subjects harboring intermediate-to-high AD neuropathologic change (ADNC) displayed relative sparing of CA2 until later stages of their disease course. In addition, the CA2/CA1 ratio of neurofibrillary degeneration in PART was significantly higher than in subjects with intermediate-to-high ADNC burden. Furthermore, the distribution of tau pathology in PART diverges from the Braak NFT staging system and Braak stage does not correlate with cognitive function in PART as it does in individuals with intermediate-to-high ADNC. These findings highlight the need for a better understanding of the contribution of PART to cognitive impairment and how neurofibrillary degeneration interacts with Aβ pathology in AD and PART.
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Affiliation(s)
- Jamie M Walker
- From the Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Timothy E Richardson
- From the Department of Pathology, University of Texas Health Science Center, San Antonio, Texas, USA
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, Texas, USA
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, New York, USA
| | - Kurt Farrell
- Department of Pathology and Nash Family Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan A Iida
- Department of Pathology and Nash Family Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chan Foong
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ping Shang
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Johannes Attems
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gai Ayalon
- Department of Neuroscience, Genentech Inc., South San Francisco, California, USA
| | - Thomas G Beach
- Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Eileen H Bigio
- Department of Pathology, Northwestern Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Budson
- Department of Pathology, VA Medical Center & Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nigel J Cairns
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - María Corrada
- Institute for Memory Impairments and Neurological Disorders, UC Irvine, Irvine, California, USA
| | - Etty Cortes
- Department of Pathology and Nash Family Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Peter Fischer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Laboratory Medicine Program, University Health Network, and Tanz Centre for Research in Neurodegenerative Disease, Krembil Brain Institute, Toronto, Ontario, Canada
| | - Margaret E Flanagan
- Department of Pathology, Northwestern Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin Franklin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marla Gearing
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan Glass
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lawrence A Hansen
- Departments of Neurosciences and Pathology, University of California, San Diego, La Jolla, California, USA
| | - Vahram Haroutunian
- Department of Psychiatry and Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Patrick R Hof
- Department of Pathology and Nash Family Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lawrence Honig
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Claudia Kawas
- Institute for Memory Impairments and Neurological Disorders, UC Irvine, Irvine, California, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Julia Kofler
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabor G Kovacs
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Laboratory Medicine Program, University Health Network, and Tanz Centre for Research in Neurodegenerative Disease, Krembil Brain Institute, Toronto, Ontario, Canada
| | - Edward B Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mirjam I Lutz
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Qinwen Mao
- Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Eliezer Masliah
- Departments of Neurosciences and Pathology, University of California, San Diego, La Jolla, California, USA
| | - Ann C McKee
- Department of Pathology, VA Medical Center & Boston University School of Medicine, Boston, Massachusetts, USA
| | - Corey T McMillan
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Marsel Mesulam
- Department of Pathology, Northwestern Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - Peter T Nelson
- Department of Pathology and Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA
| | - Richard Perrin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thao Pham
- Department of Pathology, Oregon Health Sciences University, Portland, Oregon, USA
| | - Wayne Poon
- Institute for Memory Impairments and Neurological Disorders, UC Irvine, Irvine, California, USA
| | - Dushyant P Purohit
- Department of Pathology and Nash Family Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert A Rissman
- Departments of Neurosciences and Pathology, University of California, San Diego, La Jolla, California, USA
| | - Kenji Sakai
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Mary Sano
- Department of Psychiatry and Alzheimer’s Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Thor D Stein
- Department of Pathology, VA Medical Center & Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrew F Teich
- Department of Pathology & Cell Biology and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juan C Troncoso
- Division of Neuropathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jean-Paul Vonsattel
- Department of Pathology & Cell Biology and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Sandra Weintraub
- Department of Pathology, Northwestern Cognitive Neurology and Alzheimer Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David A Wolk
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Randall L Woltjer
- Department of Pathology, Oregon Health Sciences University, Portland, Oregon, USA
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Lei Yu
- Departments of Pathology and Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Charles L White
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John F Crary
- Department of Pathology and Nash Family Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Neuropathology Brain Bank & Research Core, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Ronald M. Loeb Center for Alzheimer’s Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lévesque M, Avoli M. The subiculum and its role in focal epileptic disorders. Rev Neurosci 2020; 32:249-273. [PMID: 33661586 DOI: 10.1515/revneuro-2020-0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023]
Abstract
The subicular complex (hereafter referred as subiculum), which is reciprocally connected with the hippocampus and rhinal cortices, exerts a major control on hippocampal outputs. Over the last three decades, several studies have revealed that the subiculum plays a pivotal role in learning and memory but also in pathological conditions such as mesial temporal lobe epilepsy (MTLE). Indeed, subicular networks actively contribute to seizure generation and this structure is relatively spared from the cell loss encountered in this focal epileptic disorder. In this review, we will address: (i) the functional properties of subicular principal cells under normal and pathological conditions; (ii) the subiculum role in sustaining seizures in in vivo models of MTLE and in in vitro models of epileptiform synchronization; (iii) its presumptive role in human MTLE; and (iv) evidence underscoring the relationship between subiculum and antiepileptic drug effects. The studies reviewed here reinforce the view that the subiculum represents a limbic area with relevant, as yet unexplored, roles in focal epilepsy.
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Affiliation(s)
- Maxime Lévesque
- Departments of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, 3801 University Street, Montreal, H3A 2B4Québec, Canada
| | - Massimo Avoli
- Departments of Neurology, Neurosurgery, and Physiology, Montreal Neurological Institute-Hospital, McGill University, 3801 University Street, Montreal, H3A 2B4Québec, Canada
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Tran S, Mathon B, Morcos-Sauvain E, Lerond J, Navarro V, Bielle F. [Neuropathology of epilepsy]. Ann Pathol 2020; 40:447-460. [PMID: 33092907 DOI: 10.1016/j.annpat.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
The neuropathology of epilepsy aims at diagnosing the cerebral lesions underlying epilepsy that are obtained from epilepsy surgery, or rarely from biopsy or autopsy. The main histopathological and immunohistochemical characteristics of several entities are described: epilepsy-associated hippocampal sclerosis, long-term epilepsy-associated tumours, cortical malformations, vascular malformations, glial scars, encephalitides, and focal neuronal lipofuscinosis. The diagnostic approach, the differential diagnosis and the histochemical and immunohistochemical tools are detailed in order to provide the pathologist with a summarized toolkit to handle the broad range of epileptogenic lesions.
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Affiliation(s)
- Suzanne Tran
- Département de neuropathologie, laboratoire Escourolle, hôpital de la Pitié-Salpêtrière, AP-HP, 46-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Bertrand Mathon
- Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; Service de neurochirurgie, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Elise Morcos-Sauvain
- Département de neuropathologie, laboratoire Escourolle, hôpital de la Pitié-Salpêtrière, AP-HP, 46-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Julie Lerond
- Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; SiRIC curamus (cancer united research associating medicine, university & society), site de recherche intégrée sur le cancer IUC, Sorbonne université, AP-HP, Paris, France
| | - Vincent Navarro
- Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; Service de neurologie, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Centre de référence des épilepsies rares, Paris, France
| | - Franck Bielle
- Département de neuropathologie, laboratoire Escourolle, hôpital de la Pitié-Salpêtrière, AP-HP, 46-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; SiRIC curamus (cancer united research associating medicine, university & society), site de recherche intégrée sur le cancer IUC, Sorbonne université, AP-HP, Paris, France.
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Miyata H, Sudo S, Kuwashige H, Miyao S, Nakamoto H, Kubota Y, Yoshida Y. Dual pathology in a patient with temporal lobe epilepsy associated with neocortical glial scar after brain abscess and end folium sclerosis/hippocampal sclerosis type 3. Neuropathology 2020; 41:42-48. [PMID: 33094499 DOI: 10.1111/neup.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
End folium sclerosis or hippocampal sclerosis (HS) type 3 is often associated with another coexisting epileptogenic lesion (dual pathology); however, the pathogenesis of HS type 3 remains elusive. A 46-year-old man presented with medically intractable focal aware seizures and focal impaired awareness seizures (FIAS) with occasional focal to bilateral tonic-clonic seizures (FBTCS) two years after surgical treatment with extensive cranial reconstruction for a brain abscess in the right temporal lobe associated with intracranial extension of ipsilateral cholesteatoma. Head magnetic resonance imaging (MRI) at age 49 revealed atrophy of the right cerebral hemisphere including the hippocampus and amygdala. The patient's first epilepsy surgery was a lateral temporal lobectomy, in which the mesial temporal structures were preserved because no epileptiform discharge was detected on the intraoperative electrocorticogram. However, FIAS with FBTCS started 15 months after the operation. The second surgery, amygdalohippocampectomy, at age 52, resulted in the patient being seizure-free again for one year before seizures of the right lateral temporal origin recurred. He underwent a third surgery, resection of the Heschl's and supramarginal gyri, at age 53, but he continued to have drug-resistant epilepsy over two years after that. Histopathological examination revealed dual pathology consisting of glial scar in the lateral temporal lobe and ipsilateral HS type 3 with an unusually severe lesion in the subiculum. No significant inflammatory change was observed. The clinicopathological features in the present case indicate that HS developed secondarily in the context of neocortical epilepsy due to glial scar, suggesting a role of repetitive abnormal electrical input from neocortical epileptogenic lesions into the hippocampus finally via the perforant pathway in the pathogenesis of HS type 3. Severe hippocampal atrophy on preoperative MRI together with its silent electrocorticogram recording at initial epilepsy surgery may represent clinically pre-epileptogenic HS in a seizure-free "silent or latent period" before completion of hippocampal epileptogenesis to the extent that clinical epileptic seizures occur.
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Affiliation(s)
- Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Saeko Sudo
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Haruka Kuwashige
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Satoru Miyao
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.,Department of Neurosurgery, Saiseikai Kurihashi Hospital, Saitama, Japan
| | | | - Yuichi Kubota
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.,Department of Neurosurgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Yasuji Yoshida
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
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Kumar S, Goel RK. Pharmacokinetic, pharmacodynamic, and neurochemical investigations of lamotrigine-pentylenetetrazole kindled mice to ascertain it as a reliable model for clinical drug-resistant epilepsy. Animal Model Exp Med 2020; 3:245-255. [PMID: 33024946 PMCID: PMC7529331 DOI: 10.1002/ame2.12131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pentylenetetrazole kindling has long been used for the screening of investigational antiseizure drugs. The presence of lamotrigine, at a very low dose, does not hamper kindling in mice; rather it modifies this epileptogenesis process into drug-resistant epilepsy. The lamotrigine-pentylenetetrazole kindled mice show resistance to lamotrigine, phenytoin, and carbamazepine. It may also be possible that other licensed antiseizure drugs, like the mentioned drugs, remain ineffective in this model; therefore, this was the subject of this study. METHODS Swiss albino mice were kindled with pentylenetetrazole for 35 days in the presence of either methylcellulose vehicle or lamotrigine (subtherapeutic dose, ie, 5 mg/kg). Vehicle vs lamotrigine-kindled mice were compared in terms of (a) resistance/response toward nine antiseizure drugs applied as monotherapies and two drug combinations; (b) lamotrigine bioavailability in blood and brain; (c) blood-brain barrier integrity; and (d) amino acids and monoamines in the cerebral cortex and hippocampus. RESULTS Lamotrigine vs vehicle-kindled mice are similar (or not significantly different P > .05 from each other) in terms of (a) response toward drug combinations; (b) lamotrigine bioavailability; and (c) blood-brain barrier integrity except for, significantly (P < .05) reduced taurine and increased glutamate in the cerebral cortex and hippocampus. Aside from these, lamotrigine-kindled mice show significant (P < .05) resistant to lamotrigine (15 mg/kg), levetiracetam (40 mg/kg); carbamazepine (40 mg/kg), zonisamide (100 mg/kg), gabapentin (224 mg/kg), pregabalin (30 mg/kg), phenytoin (35 mg/kg), and topiramate (300 mg/kg). CONCLUSION Lamotrigine-pentylenetetrazole kindling takes longer to develop (~5 weeks) in comparison to lamotrigine-amygdale (~4 weeks) and lamotrigine-corneal (~2 weeks) kindling models. However, drug screening through this model may yield superior drugs with novel antiseizure mechanisms.
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Affiliation(s)
- Sandeep Kumar
- Department of Pharmaceutical Sciences & Drug Research Punjabi University Patiala Punjab India
| | - Rajesh K Goel
- Department of Pharmaceutical Sciences & Drug Research Punjabi University Patiala Punjab India
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9
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Hata Y, Oku Y, Taneichi H, Tanaka T, Igarashi N, Niida Y, Nishida N. Two autopsy cases of sudden unexpected death from Dravet syndrome with novel de novo SCN1A variants. Brain Dev 2020; 42:171-178. [PMID: 31677916 DOI: 10.1016/j.braindev.2019.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/06/2019] [Accepted: 10/10/2019] [Indexed: 01/19/2023]
Abstract
AIM Dravet syndrome (DS) is characterized by high epilepsy-related premature mortality with a markedly young age at death, however, autopsy report of sudden unexpected death with DS has been fewer than expected. METHODS We report two autopsy cases with sudden unexpected death from DS. Case 1 was a 13-year-old male who drowned in a bathtub, and Case 2 was a 3-year-old female who died while sleeping. In Case 1, the blood concentration of the anticonvulsant, valproic acid, was below the recommended therapeutic range. Neuropathological investigation and genetic analysis of 402 cardiovascular disease-related and 146 epilepsy-related genes by next generation sequencing were applied. RESULTS No significant neuronal loss with gliosis was observed in the brain of either patient. Although possible mild malformations of cortical development were found in both, the degree thereof was similar to that of age-matched controls. Genetic analysis identified a novel variant in SCN1A intron 23 (c.4477-3T > C) in Case 1 that falls outside of the minor splicing consensus sequence. In vitro splicing functional assays with minigene constructs revealed that this intronic variant leads to a 2-bp insertion immediately before exon 24 that results in protein truncation. Similarly, a novel de novo missense mutation of unknown significance, SCN1A_Arg187Pro, was identified in Case 2. In both cases, we also identified cardiomyopathy-related variants classified as likely pathogenic; however, the effect of these variants at death was minimal because there was an absence of pathological change indicating inherited cardiomyopathy. CONCLUSION The present cases emphasize the need for multifaceted examination of DS cases so as to obtain a definitive autopsy diagnosis and to explore the mechanism of sudden unexpected death.
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Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Yuko Oku
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Hiromichi Taneichi
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Tomomi Tanaka
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Noboru Igarashi
- Department of Pediatrics, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yo Niida
- Division of Genomic Medicine, Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan.
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10
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Thompson KW, Suchomelova L, Wasterlain CG. Treatment of early life status epilepticus: What can we learn from animal models? Epilepsia Open 2018; 3:169-179. [PMID: 30564776 PMCID: PMC6293069 DOI: 10.1002/epi4.12271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Treatment of status epilepticus (SE) in infants and children is challenging. There is a recognition that a broad set of developmental processes need to be considered to fully appreciate the physiologic complexity of severe seizures, and seizure outcomes, in infants and children. The development and use of basic models to elucidate important mechanisms will help further our understanding of these processes. Here we review some of the key experimental models and consider several areas relevant to treatment that could lead to productive translational research. Terminating seizures quickly is essential. Understanding pharmacoresistance of SE as it relates to receptor trafficking will be critical to seizure termination. Once a severe seizure is terminated, how will the developing brain respond? Basic studies suggest that there are important acute and long‐term histopathologic, and pathophysiologic, consequences that, if left unaddressed, will produce long‐lasting deficits on the form and function of the central nervous system. To fully utilize the evidence that basic models produce, age‐ and development‐ and model‐specific frameworks have to be considered carefully. Studies have demonstrated that severe seizures can cause perturbations to developmental processes during critical periods of development that lead to life‐long deficits. Unfortunately, some of the drugs that are commonly used to treat seizures may also produce negative outcomes by enhancing Cl‐‐mediated depolarization, or by accelerating programmed cell death. More research is needed to understand these phenomena and their relevance to the human condition, and to develop rational drugs that protect the developing brain from severe seizures to the fullest extent possible.
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Affiliation(s)
- Kerry W Thompson
- Department of Biology Occidental College Los Angeles California U.S.A
| | - Lucie Suchomelova
- Department of Neurology David Geffen School of Medicine at UCLA Los Angeles California U.S.A
| | - Claude G Wasterlain
- VA Greater Los Angeles Health Care System Los Angeles California U.S.A.,Department of Neurology David Geffen School of Medicine at UCLA Los Angeles California U.S.A.,Brain Research Institute UCLA Los Angeles California U.S.A
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11
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Orlowski HLP, Smyth MD, Parsons MS, Dahiya S, Sharifai N, Hildebolt C, Sharma A. Enhancing contrast to noise ratio of hippocampi affected with mesial temporal sclerosis: A case-control study in children undergoing epilepsy surgeries. Clin Neurol Neurosurg 2018; 174:144-148. [PMID: 30241008 DOI: 10.1016/j.clineuro.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Detection of mesial temporal sclerosis (MTS) in children with epilepsy is important. We assessed whether an image-processing algorithm (Correlative Image Enhancement, CIE) could facilitate recognition of hippocampal signal abnormality in the presence of MTS by increasing contrast to noise ratio between affected hippocampus and normal gray matter. PATIENTS AND METHODS Baseline coronal FLAIR images from brain MRIs of 27 children with epilepsy who underwent hippocampal resection were processed using CIE. These included 19 hippocampi with biopsy proven MTS and 8 biopsy proven normal hippocampi resected in conjunction with hemispherotomy. We assessed the effect of processing on contrast to noise ratio (CNR) between hippocampus and normal insular gray matter, and on assessment of hippocampal signal abnormality by two masked neuroradiologists. RESULTS Processing resulted in a significant increase in mean CNR (from 3.9 ± 5.3 to 25.3 ± 25.8; P < 0.01) for hippocampi with MTS, with a substantial (>100%) increase from baseline seen in 15/19 (78.9%) cases. Baseline CNR of 1.7 ± 5.3 for normal hippocampi did not change significantly after processing (1.8 ± 5.3; P = 1.00). For one reader, baseline sensitivity (14/19; 73.6%) was unaffected but the specificity improved from 62.5% (5/8) to 100%. An increase in both sensitivity (from 73.6% to 78.9%) and specificity (from 62.5% to 75%) was seen for the second reader. CONCLUSION By enhancing CNR for diseased hippocampi while leaving normal hippocampi relatively unaffected, CIE may improve the diagnostic accuracies of radiologists in detecting MTS-related signal alteration within the affected hippocampus.
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Affiliation(s)
- Hilary L P Orlowski
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Boulevard, St. Louis, MO 63110, United States.
| | - Matthew D Smyth
- Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid, Box 8057, St. Louis, MO 63110, United States.
| | - Matthew S Parsons
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Boulevard, St. Louis, MO 63110, United States.
| | - Sonika Dahiya
- Department of Pathology & Immunology, Washington University School of Medicine, 509 S. Euclid Ave, St. Louis, MO 63110, United States.
| | - Nima Sharifai
- Department of Pathology & Immunology, Washington University School of Medicine, 509 S. Euclid Ave, St. Louis, MO 63110, United States.
| | - Charles Hildebolt
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave. St. Louis, MO 63110, United States.
| | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Boulevard, St. Louis, MO 63110, United States.
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Vinters HV, Zarow C, Borys E, Whitman JD, Tung S, Ellis WG, Zheng L, Chui HC. Review: Vascular dementia: clinicopathologic and genetic considerations. Neuropathol Appl Neurobiol 2018; 44:247-266. [DOI: 10.1111/nan.12472] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- H. V. Vinters
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - C. Zarow
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - E. Borys
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
- Department of Pathology; Loyola University Medical Center; Maywood IL USA
| | - J. D. Whitman
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Departments of Pathology & Laboratory Medicine; UC San Francisco Medical Center; San Francisco CA USA
| | - S. Tung
- Departments of Pathology & Laboratory Medicine (Neuropathology) and Neurology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - W. G. Ellis
- Department of Pathology; University of California Davis School of Medicine; Sacramento CA USA
| | - L. Zheng
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
| | - H. C. Chui
- Department of Neurology; Keck School of Medicine at University of Southern California; Los Angeles CA USA
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13
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Comparative analysis of cytokine/chemokine regulatory networks in patients with hippocampal sclerosis (HS) and focal cortical dysplasia (FCD). Sci Rep 2017; 7:15904. [PMID: 29162878 PMCID: PMC5698416 DOI: 10.1038/s41598-017-16041-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/06/2017] [Indexed: 01/22/2023] Open
Abstract
Experimental and clinical evidence have demonstrated aberrant expression of cytokines/chemokines and their receptors in patients with hippocampal sclerosis (HS) and focal cortical dysplasia (FCD). However, there is limited information regarding the modulation of cytokine/chemokine-regulatory networks, suggesting contribution of miRNAs and downstream transcription factors/receptors in these pathologies. Hence, we studied the levels of multiple inflammatory mediators (IL1β, IL1Ra, IL6, IL10, CCL3, CCL4, TNFα and VEGF) along with transcriptional changes of nine related miRNAs and mRNA levels of downstream effectors of significantly altered cytokines/chemokines in brain tissues obtained from patients with HS (n = 26) and FCD (n = 26). Up regulation of IL1β, IL6, CCL3, CCL4, STAT-3, C-JUN and CCR5, and down regulation of IL 10 were observed in both HS and FCD cases (p < 0.05). CCR5 was significantly up regulated in FCD as compared to HS (p < 0.001). Both, HS and FCD presented decreased miR-223-3p, miR-21-5p, miR-204-5p and let-7a-5p and increased miR-155-5p expression (p < 0.05). As compared to HS, miR-204-5p (upstream to CCR5 and IL1β) and miR-195-5p (upstream to CCL4) were significantly decreased in FCD patients (p < 0.01). Our results suggest differential alteration of cytokine/chemokine regulatory networks in HS and FCD and provide a rationale for developing pathology specific therapy.
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14
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Chen YC, Shi L, Zhu GY, Wang X, Liu DF, Liu YY, Jiang Y, Zhang X, Zhang JG. Effects of anterior thalamic nuclei deep brain stimulation on neurogenesis in epileptic and healthy rats. Brain Res 2017; 1672:65-72. [PMID: 28764934 DOI: 10.1016/j.brainres.2017.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The efficacy of anterior thalamic nuclei (ANT) deep brain stimulation (DBS) in mitigating epileptic seizures has been established. Though the neuroprotection of ANT-DBS has been illustrated, the seizure mitigating mechanism of ANT-DBS has not been thoroughly elucidated. In particular, the effect of ANT-DBS on neurogenesis has not been reported previously. METHOD Thirty-two male Sprague Dawley rats were randomly assigned to the following groups: sham-DBS-healthy (HL) (n=8), DBS-HL (n=8), sham-DBS-epilepsy (EP) (n=8) and DBS-EP (n=8). Normal saline and kainic acid were injected, respectively, into the former and later two groups, and seizures were monitored. One month later, rats received electrode implantation. Stimulation was exerted in the DBS group but not in the sham-DBS group. Next, all rats were sacrificed, and the ipsilateral hippocampus was dissected and prepared for quantitative real time PCR (qPCR) and western blot analysis in order to measure neuronal nuclear (NeuN), brain-derived neurotrophic factor (BDNF), doublecortin (DCX) and Ki-67 expressions. RESULTS A 44.4% seizure frequency reduction was obtained after ANT-DBS, and no seizures was observed in healthy rats. NeuN, BDNF, Ki-67 and DCX expression levels were significantly decreased in the epileptic rats compared to healthy rats (P<0.01 or P<0.05). Obvious increases in NeuN, Ki-67 and DCX expressions were observed in epileptic and healthy rats receiving stimulation compared to rats receiving no stimulation (all Ps<0.01). However, BDNF expression was not affected by ANT-DBS (all Ps>0.05). CONCLUSIONS (1) ANT-DBS reduces neuronal loss during the chronic stage of epilepsy. (2) Neurogenesis is elevated by ANT-DBS in both epileptic and healthy rats, and this elevation may not be regulated via a BDNF pathway.
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Affiliation(s)
- Ying-Chuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Guan-Yu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - De-Feng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Yu-Ye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China.
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China.
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Beijing 100050, China.
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15
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Berdichevsky Y, Saponjian Y, Park K, Roach B, Pouliot W, Lu K, Swiercz W, Dudek FE, Staley KJ. Staged anticonvulsant screening for chronic epilepsy. Ann Clin Transl Neurol 2016; 3:908-923. [PMID: 28097203 PMCID: PMC5224819 DOI: 10.1002/acn3.364] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Current anticonvulsant screening programs are based on seizures evoked in normal animals. One-third of epileptic patients do not respond to the anticonvulsants discovered with these models. We evaluated a tiered program based on chronic epilepsy and spontaneous seizures, with compounds advancing from high-throughput in vitro models to low-throughput in vivo models. METHODS Epileptogenesis in organotypic hippocampal slice cultures was quantified by lactate production and lactate dehydrogenase release into culture media as rapid assays for seizure-like activity and cell death, respectively. Compounds that reduced these biochemical measures were retested with in vitro electrophysiological confirmation (i.e., second stage). The third stage involved crossover testing in the kainate model of chronic epilepsy, with blinded analysis of spontaneous seizures after continuous electrographic recordings. RESULTS We screened 407 compound-concentration combinations. The cyclooxygenase inhibitor, celecoxib, had no effect on seizures evoked in normal brain tissue but demonstrated robust antiseizure activity in all tested models of chronic epilepsy. INTERPRETATION The use of organotypic hippocampal cultures, where epileptogenesis occurs on a compressed time scale, and where seizure-like activity and seizure-induced cell death can be easily quantified with biomarker assays, allowed us to circumvent the throughput limitations of in vivo chronic epilepsy models. Ability to rapidly screen compounds in a chronic model of epilepsy allowed us to find an anticonvulsant that would be missed by screening in acute models.
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Affiliation(s)
- Yevgeny Berdichevsky
- Department of Electrical and Computer Engineering and Bioengineering ProgramLehigh UniversityBethlehemPennsylvania18015
| | - Yero Saponjian
- Department of NeurologyMassachusetts General HospitalBostonMassachusetts02129
- Harvard Medical SchoolBostonMassachusetts02129
| | - Kyung‐Il Park
- Department of NeurologySeoul National University Hospital Healthcare System Gangnam CenterSeoulSouth Korea06236
| | - Bonnie Roach
- Department of NeurosurgeryUniversity of Utah School of MedicineSalt Lake CityUtah84108
| | - Wendy Pouliot
- Department of NeurosurgeryUniversity of Utah School of MedicineSalt Lake CityUtah84108
| | - Kimberly Lu
- Boston University School of MedicineBostonMassachusetts02119
| | - Waldemar Swiercz
- Department of NeurologyMassachusetts General HospitalBostonMassachusetts02129
- Harvard Medical SchoolBostonMassachusetts02129
| | - F. Edward Dudek
- Department of NeurosurgeryUniversity of Utah School of MedicineSalt Lake CityUtah84108
| | - Kevin J. Staley
- Department of NeurologyMassachusetts General HospitalBostonMassachusetts02129
- Harvard Medical SchoolBostonMassachusetts02129
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16
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Computational analysis in epilepsy neuroimaging: A survey of features and methods. NEUROIMAGE-CLINICAL 2016; 11:515-529. [PMID: 27114900 PMCID: PMC4833048 DOI: 10.1016/j.nicl.2016.02.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 12/15/2022]
Abstract
Epilepsy affects 65 million people worldwide, a third of whom have seizures that are resistant to anti-epileptic medications. Some of these patients may be amenable to surgical therapy or treatment with implantable devices, but this usually requires delineation of discrete structural or functional lesion(s), which is challenging in a large percentage of these patients. Advances in neuroimaging and machine learning allow semi-automated detection of malformations of cortical development (MCDs), a common cause of drug resistant epilepsy. A frequently asked question in the field is what techniques currently exist to assist radiologists in identifying these lesions, especially subtle forms of MCDs such as focal cortical dysplasia (FCD) Type I and low grade glial tumors. Below we introduce some of the common lesions encountered in patients with epilepsy and the common imaging findings that radiologists look for in these patients. We then review and discuss the computational techniques introduced over the past 10 years for quantifying and automatically detecting these imaging findings. Due to large variations in the accuracy and implementation of these studies, specific techniques are traditionally used at individual centers, often guided by local expertise, as well as selection bias introduced by the varying prevalence of specific patient populations in different epilepsy centers. We discuss the need for a multi-institutional study that combines features from different imaging modalities as well as computational techniques to definitively assess the utility of specific automated approaches to epilepsy imaging. We conclude that sharing and comparing these different computational techniques through a common data platform provides an opportunity to rigorously test and compare the accuracy of these tools across different patient populations and geographical locations. We propose that these kinds of tools, quantitative imaging analysis methods and open data platforms for aggregating and sharing data and algorithms, can play a vital role in reducing the cost of care, the risks of invasive treatments, and improve overall outcomes for patients with epilepsy. We introduce common epileptogenic lesions encountered in patients with drug resistant epilepsy. We discuss state of the art computational techniques used to detect lesions. There is a need for multi-institutional studies that combine these techniques. Clinically validated pipelines alongside the advances in imaging and electrophysiology will improve outcomes.
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Key Words
- DRE, drug resistant epilepsy
- DTI, diffusion tensor imaging
- DWI, diffusion weighted imaging
- Drug resistant epilepsy
- Epilepsy
- FCD, focal cortical dysplasia
- FLAIR, fluid-attenuated inversion recovery
- Focal cortical dysplasia
- GM, gray matter
- GW, gray-white junction
- HARDI, high angular resolution diffusion imaging
- MEG, magnetoencephalography
- MRS, magnetic resonance spectroscopy imaging
- Machine learning
- Malformations of cortical development
- Multimodal neuroimaging
- PET, positron emission tomography
- PNH, periventricular nodular heterotopia
- SBM, surface-based morphometry
- T1W, T1-weighted MRI
- T2W, T2-weighted MRI
- VBM, voxel-based morphometry
- WM, white matter
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Gales JM, Prayson RA. Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy. Hum Pathol 2016; 48:111-6. [DOI: 10.1016/j.humpath.2015.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/02/2015] [Accepted: 09/16/2015] [Indexed: 11/16/2022]
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18
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Congenital and Acquired Conditions of the Mesial Temporal Lobe: A Pictorial Essay. Can Assoc Radiol J 2015; 66:238-51. [DOI: 10.1016/j.carj.2014.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 12/04/2014] [Accepted: 12/10/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose Our goal is to pictorially review a wide spectrum of congenital and acquired conditions affecting the medial aspect of the temporal lobe. Conclusion After completing this article, the reader will have knowledge of the imaging appearance of diverse developmental, malformative, and acquired lesions of the mesial temporal lobe, which will be useful when evaluating pathology in this location.
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Martinoni M, Marucci G, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Naldi I, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Giulioni M. Focal cortical dysplasias in temporal lobe epilepsy surgery: Challenge in defining unusual variants according to the last ILAE classification. Epilepsy Behav 2015; 45:212-6. [PMID: 25812941 DOI: 10.1016/j.yebeh.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) represent a common architectural cortical disorder underlying pharmacoresistant focal epilepsy. The recent ILAE classification defines different types of FCDs based on their histopathological features, MRI imaging, and presumed pathogenesis; however, their clinical features and their prognostic significance are still incompletely defined. In addition, the combination of different histopathological abnormalities can represent "unusual" subtypes that can be difficult to classify. The aim of our study was to analyze the incidence and the significance of these "unusual" subtypes of FCDs in drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS We retrospectively analyzed 133 patients consecutively submitted to tailored anteromesial temporal lobe resection for pharmacoresistant MTLE. Seizure onset, seizure duration, age at surgery, and postoperative seizure outcome were evaluated in relation to the different neuropathological groups defined according to the new ILAE classification. RESULTS Focal cortical dysplasias were found in 80 out of 133 patients. Six patients were affected by isolated FCD type I, 12 patients by FCD type II, and 44 patients by FCD type III. Furthermore, we found 18 "atypical" cases (20.5% of all FCD cases and 26.6% of FCDs associated with a principal lesion): 10 cases of associated FCD type II-hippocampal sclerosis (HS) and 8 cases associated with FCD II-epilepsy-associated tumors (EATs). CONCLUSION Our results indicate that "unusual" subtypes of FCDs, in particular associated FCD type II, are not uncommon findings, suggesting that they deserve a classification recognition. Similarities in seizure outcome and immunohistochemical and molecular evidences, shared by FCD type II+EATs and EATs, suggest a common pathogenic link. The choice to create a specific unifying class or, on the contrary, to also include "associated FCD type II" in the definition of the new unifying class FCD type III should be further discussed.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology "M.Malpighi", Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Dianalund, Denmark
| | - Lilia Volpi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Ilaria Naldi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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Thom M. Review: Hippocampal sclerosis in epilepsy: a neuropathology review. Neuropathol Appl Neurobiol 2015; 40:520-43. [PMID: 24762203 PMCID: PMC4265206 DOI: 10.1111/nan.12150] [Citation(s) in RCA: 328] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/23/2014] [Indexed: 12/12/2022]
Abstract
Hippocampal sclerosis (HS) is a common pathology encountered in mesial temporal lobe epilepsy (MTLE) as well as other epilepsy syndromes and in both surgical and post-mortem practice. The 2013 International League Against Epilepsy (ILAE) classification segregates HS into typical (type 1) and atypical (type 2 and 3) groups, based on the histological patterns of subfield neuronal loss and gliosis. In addition, granule cell reorganization and alterations of interneuronal populations, neuropeptide fibre networks and mossy fibre sprouting are distinctive features of HS associated with epilepsies; they can be useful diagnostic aids to discriminate from other causes of HS, as well as highlighting potential mechanisms of hippocampal epileptogenesis. The cause of HS remains elusive and may be multifactorial; the contribution of febrile seizures, genetic susceptibility, inflammatory and neurodevelopmental factors are discussed. Post-mortem based research in HS, as an addition to studies on surgical samples, has the added advantage of enabling the study of the wider network changes associated with HS, the long-term effects of epilepsy on the pathology and associated comorbidities. It is likely that HS is heterogeneous in aspects of its cause, epileptogenetic mechanisms, network alterations and response to medical and surgical treatments. Future neuropathological studies will contribute to better recognition and understanding of these clinical and patho-aetiological subtypes of HS.
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Affiliation(s)
- Maria Thom
- Departments of Neuropathology and Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
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Na M, Ge H, Shi C, Shen H, Wang Y, Pu S, Liu L, Wang H, Xie C, Zhu M, Wang J, Shi C, Lin Z. Long-term seizure outcome for international consensus classification of hippocampal sclerosis: a survival analysis. Seizure 2014; 25:141-6. [PMID: 25455728 DOI: 10.1016/j.seizure.2014.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 09/05/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy (MTLE) as a result of hippocampal sclerosis (HS). However, approximately one-third of patients with intractable epilepsy did not become seizure-free after tailored resection strategies. It would be compelling to identify predictive factors of postoperative seizure outcomes. Our aim was to assess the correlation between HS classification and long-term postoperative seizure outcome in patients with MTLE due to HS. METHODS To investigate HS classification, semi-quantitative analysis and immunohistochemical staining of neuronal nuclei (NeuN) were performed on 100 postoperative hippocampal specimens. All patients had a 1-7 year postoperative follow-up. The postoperative seizure outcome was evaluated using International League Against Epilepsy (ILAE) outcome classification. RESULTS Three types of HS were recognized. The highest incidence of initial precipitating injury (IPI) was noted in the HS ILAE type 1 group (53.1%). The most favorable long-term seizure outcome was also noted in the HS ILAE type 1 group. The shortest epilepsy duration was recorded in the HS ILAE type 2 group (mean epilepsy duration=6.64 ± 5.83 years). The completely seizure free rate of patients in all groups declined with an increase in time. CONCLUSIONS Our study for the first time demonstrated a significant correlation between HS ILAE types and long-term postoperative seizure outcome in patients with MTLE due to HS. Therefore, HS ILAE types have predictive value in long-term seizure outcome following epilepsy surgery.
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Affiliation(s)
- Meng Na
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haitao Ge
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chen Shi
- Department of Neurosurgery, New York University Langone Medical Center and School of Medicine, New York, NY, USA
| | - Hong Shen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Song Pu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Li Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Haiyang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chuncheng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Minwei Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jiabin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Changbin Shi
- Section of Neurosurgery/Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Zhiguo Lin
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
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Bandopadhyay R, Liu JYW, Sisodiya SM, Thom M. A comparative study of the dentate gyrus in hippocampal sclerosis in epilepsy and dementia. Neuropathol Appl Neurobiol 2014; 40:177-90. [PMID: 24028428 PMCID: PMC4282449 DOI: 10.1111/nan.12087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/04/2013] [Indexed: 12/25/2022]
Abstract
Aims: Hippocampal sclerosis (HS) is long-recognized in association with epilepsy (HSE) and more recently in the context of cognitive decline or dementia in the elderly (HSD), in some cases as a component of neurodegenerative diseases, including Alzheimer's disease (AD) and fronto-temporal lobe dementia (FTLD). There is an increased risk of seizures in AD and spontaneous epileptiform discharges in the dentate gyrus of transgenic AD models; epilepsy can be associated with an age-accelerated increase in AD-type pathology and cognitive decline. The convergence between these disease processes could be related to hippocampal pathology. HSE typically shows re-organization of both excitatory and inhibitory neuronal networks in the dentate gyrus, and is considered to be relevant to hippocampal excitability. We sought to compare the pathology of HSE and HSD, focusing on re-organization in the dentate gyrus. Methods: In nine post mortem cases with HSE and bilateral damage, 18 HSD and 11 controls we carried out immunostaining for mossy fibres (dynorphin), and interneuronal networks (NPY, calbindin and calretinin) on sections from the mid-hippocampal body. Fibre sprouting (FS) or loss of expression in the dentate gyrus was semi-quantitatively graded from grade 0 (normal) to grade 3 (marked alteration). Results: Significantly more re-organization was seen with all four markers in the HSE than HSD group (P < 0.01). Mild alterations were noted in HSD group with dynorphin (FS in 3 cases), calretinin (FS in 6 cases), NPY (FS in 11 cases) and calbindin (loss in 10 cases). In eight HSD cases, alteration was seen with more than one antibody but in no cases were the highest grades seen. We also noted NPY and, to a lesser extent, calretinin labelling of Hirano bodies in CA1 of AD cases and some older controls, but not in HSE. Conclusion: Reorganization of excitatory and inhibitory networks in the dentate gyrus is more typical of HSE. Subtle alterations in HSD may be a result of increased hippocampal excitability, including unrecognized seizure activity. An unexpected finding was the identification of NPY-positive Hirano bodies in HSD but not HSE, which may be a consequence of the relative vulnerabilities of interneurons in these conditions.
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Affiliation(s)
- R Bandopadhyay
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Hippocampal sclerosis in dementia, epilepsy, and ischemic injury: differential vulnerability of hippocampal subfields. J Neuropathol Exp Neurol 2014; 91:S30-3. [PMID: 24423638 DOI: 10.1097/opx.0000000000000170] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Severe neuronal loss in the hippocampus, that is, hippocampal sclerosis (HS), can be seen in 3 main clinical contexts: dementia (particularly frontotemporal lobar degeneration [FTLD]), temporal lobe epilepsy (TLE), and hippocampal ischemic injury (H-I). It has been suggested that shared pathogenetic mechanisms may underlie selective vulnerability of the hippocampal subfields such as the CA1 in these conditions. We determined the extent of neuronal loss in cases of HS-FTLD (n=14), HS-TLE (n=35), and H-I (n=20). Immunohistochemistry for zinc transporter 3 was used to help define the CA3/CA2 border in the routinely processed human autopsy tissue samples. The subiculum was involved in 57% of HS-FTLD, 10% of H-I, and 0% of HS-TLE cases (p<0.0001). The CA regions other than CA1 were involved in 57% of HS-TLE, 30% of H-I, and 0% of HS-FTLD cases (p=0.0003). The distal third of CA1 was involved in 79% of HS-FTLD, 35% of H-I, and 37% of HS-TLE cases (p=0.02). The distal third of CA1 was the only area involved in 29% of HS-FTLD, 3% of HS-TLE, and 0% of H-I cases (p=0.019). The proximal-middle CA1 was the only area affected in 50% of H-I, 29% of HS-TLE, and 0% of HS-FTLD cases (p=0.004). These findings support heterogeneity in the pathogenesis of HS.
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Hatanpaa KJ, Raisanen JM, Herndon E, Burns DK, Foong C, Habib AA, White CL. Hippocampal Sclerosis in Dementia, Epilepsy, and Ischemic Injury: Differential Vulnerability of Hippocampal Subfields. J Neuropathol Exp Neurol 2014. [DOI: 10.1093/jnen/73.2.136] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Boison D, Sandau US, Ruskin DN, Kawamura M, Masino SA. Homeostatic control of brain function - new approaches to understand epileptogenesis. Front Cell Neurosci 2013; 7:109. [PMID: 23882181 PMCID: PMC3712329 DOI: 10.3389/fncel.2013.00109] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/22/2013] [Indexed: 12/31/2022] Open
Abstract
Neuronal excitability of the brain and ongoing homeostasis depend not only on intrinsic neuronal properties, but also on external environmental factors; together these determine the functionality of neuronal networks. Homeostatic factors become critically important during epileptogenesis, a process that involves complex disruption of self-regulatory mechanisms. Here we focus on the bioenergetic homeostatic network regulator adenosine, a purine nucleoside whose availability is largely regulated by astrocytes. Endogenous adenosine modulates complex network function through multiple mechanisms including adenosine receptor-mediated pathways, mitochondrial bioenergetics, and adenosine receptor-independent changes to the epigenome. Accumulating evidence from our laboratories shows that disruption of adenosine homeostasis plays a major role in epileptogenesis. Conversely, we have found that reconstruction of adenosine's homeostatic functions provides new hope for the prevention of epileptogenesis. We will discuss how adenosine-based therapeutic approaches may interfere with epileptogenesis on an epigenetic level, and how dietary interventions can be used to restore network homeostasis in the brain. We conclude that reconstruction of homeostatic functions in the brain offers a new conceptual advance for the treatment of neurological conditions which goes far beyond current target-centric treatment approaches.
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Affiliation(s)
- Detlev Boison
- Robert Stone Dow Neurobiology Laboratories, Legacy Research Institute Portland, OR, USA
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