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Kumar N. Nutritional Neuropathies. Continuum (Minneap Minn) 2023; 29:1469-1491. [PMID: 37851039 DOI: 10.1212/con.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article reviews the etiologies, presentations, and management of neuropathies related to nutritional deficiencies. LATEST DEVELOPMENTS Peripheral neuropathy can be the predominant or only manifestation of certain nutrient deficiencies. Cognitive difficulties or involvement of other parts of the central nervous system, such as the optic nerve and spinal cord, may accompany nutritional peripheral neuropathies. In most patients, the nutritional deficiency may have a single predominant cause, but in some cases, multiple causes may coexist. Obesity, for unclear reasons, can be associated with nutrient deficiencies. The rising rates of bariatric surgery and the incidence of nutrient deficiencies following bariatric surgery make this a particularly relevant topic for neurologists. ESSENTIAL POINTS Neuropathies caused by nutrient deficiencies are preventable with appropriate supplementation in high-risk situations. Early recognition and prompt treatment are essential to ensure an optimal outcome and minimize neurologic morbidity.
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Lu Y, Teo JN, Liu SQ. Fermented shellfish condiments: A comprehensive review. Compr Rev Food Sci Food Saf 2022; 21:4447-4477. [PMID: 36038528 DOI: 10.1111/1541-4337.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 01/28/2023]
Abstract
Fermented shellfish condiments are globally consumed especially among Asian countries. Condiments, commonly used as flavor enhancers, have unique sensory characteristics and are associated with umami and meaty aroma. The main reactions that occur during fermentation of shellfish include proteolysis by endogenous enzymes and microbial activities to produce peptides and amino acids. The actions of proteolytic enzymes and microorganisms (predominantly bacteria) are found to be largely responsible for the formation of taste and aroma compounds. This review elaborates different aspects of shellfish fermentation including classification, process, substrates, microbiota, changes in both physicochemical and biochemical components, alterations in nutritional composition, flavor characteristics and sensory profiles, and biological activities and their undesirable impacts on health. The characteristics of traditional shellfish production such as long duration and high salt concentration not only limit nutritional value but also inhibit the formation of toxic biogenic amines. In addition, this review article also covers novel bioprocesses such as low salt fermentation and use of novel starter cultures and/or novel enzymes to accelerate fermentation and produce shellfish condiments that are of better quality and safer for consumption. Practical Application: The review paper summarized the comprehensive information on shellfish fermentation to provide alternative strategies to produce shellfish comdiments that are of better quality and safer for consumption.
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Affiliation(s)
- Yuyun Lu
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore
| | - Jun Ning Teo
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore
| | - Shao Quan Liu
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore.,National University of Singapore (Suzhou) Research Institute, Suzhou, China
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Oh J, Bar-Or A. Emerging therapies to target CNS pathophysiology in multiple sclerosis. Nat Rev Neurol 2022; 18:466-475. [PMID: 35697862 DOI: 10.1038/s41582-022-00675-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 12/13/2022]
Abstract
The rapidly evolving therapeutic landscape of multiple sclerosis (MS) has contributed to paradigm shifts in our understanding of the biological mechanisms that contribute to CNS injury and in treatment philosophies. Opportunities remain to further improve treatment of relapsing-remitting MS, but two major therapeutic gaps are the limiting of progressive disease mechanisms and the repair of CNS injury. In this Review, we provide an overview of selected emerging therapies that predominantly target processes within the CNS that are thought to be involved in limiting non-relapsing, progressive disease injury or promoting tissue repair. Among these, we consider agents that modulate adaptive and innate CNS-compartmentalized inflammation, which can be mediated by infiltrating immune cells and/or resident CNS cells, including microglia and astrocytes. We also discuss agents that target degenerative disease mechanisms, agents that might confer neuroprotection, and agents that create a more favourable environment for or actively contribute to oligodendrocyte precursor cell differentiation, remyelination and axonal regeneration. We focus on agents that are novel for MS, that are known to or are presumed to penetrate the CNS, and that have already entered early stages of development in MS clinical trials.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.,Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Gündüz AK, Mirzayev I. Surgical Approach in Intraocular Tumors. Turk J Ophthalmol 2022; 52:125-138. [PMID: 35481734 PMCID: PMC9069084 DOI: 10.4274/tjo.galenos.2021.24376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Surgery in intraocular tumors is done for excision/biopsy and the management of complications secondary to the treatment of these tumors. Excision/biopsy of intraocular tumors can be done via fine-needle aspiration biopsy (FNAB), transretinal biopsy (TRB), partial lamellar sclerouvectomy (PLSU), and endoresection. FNAB, TRB, and PLSU can be used in tumors that cannot be diagnosed by clinical examination and other ancillary testing methods. PLSU is employed in tumors involving the iridociliary region and choroid anterior to the equator. Excisional PLSU is performed for iridociliary and ciliary body tumors with less than 3 clock hours of iris and ciliary body involvement and choroidal tumors with a base diameter less than 15 mm. However, for biopsy, PLSU can be employed with any size tumor. Endoresection is a procedure whereby the intraocular tumor is excised using vitrectomy techniques. The rationale for performing endoresection is based on the fact that irradiated uveal melanomas may cause complications such as exudation, neovascular glaucoma, and intraocular pigment and tumor dissemination (toxic tumor syndrome), and removing the dead tumor tissue may contribute to better visual outcome. Endoresection is recommended 1-2 weeks after external radiotherapy. Pars plana vitrectomy is also used in the management of complications including vitreous hemorrhage, retinal detachment, and epiretinal membrane that can occur after treatment of posterior segment tumors using radiotherapy and transpupillary thermotherapy. It is important to make sure the intraocular tumor has been eradicated before embarking on such treatment.
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Affiliation(s)
- Ahmet Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ibadulla Mirzayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Englezou C, Liang D. Subacute combined degeneration of the spinal cord in functional vitamin B12 Deficiency states. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2021. [DOI: 10.47795/buwp1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Vitamin B12 is an essential enzymatic cofactor in multiple cellular metabolic pathways. Deficiency states can arise as a result of both depletion of absolute systemic levels and pathological processes that block its ability to act as an enzymatic cofactor. The latter is also known as functional vitamin B12 deficiency. This can cause a variety of systemic, haematological, and neurological manifestations, some of which may be irreversible if not promptly treated. Neurological syndromes include subacute combined degeneration of the cord (SCDC), peripheral, optic, and autonomic neuropathies, and neuropsychiatric or cognitive deficits. This review presents a case series of vitamin B12 deficiencies leading to SCDC, and we include the clinical features, significant investigations, treatments, and prognoses.
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Tarhan B, Rahman S, Joseph N, Hyder D, Zingariello C, Borum PR, Sladky J, Winesett SP. Vitamins are Indeed Vital Amines: A Discussion of 3 Deficiencies With Neurologic Manifestations. Child Neurol Open 2021; 8:2329048X211046440. [PMID: 34708143 PMCID: PMC8544767 DOI: 10.1177/2329048x211046440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/27/2021] [Indexed: 11/15/2022] Open
Abstract
Optimal functioning of the human nervous system depends on a constant supply of nutrients, vitamins, and minerals. In the developed world, nutritional deficiencies are relatively rare and infrequently present with neurologic manifestations. These neurologic disorders can be mistaken for inflammatory and/or autoimmune phenomena. This manuscript describes 2 pediatric cases with neurologic signs/symptoms arising from vitamin deficiencies-(1) optic neuropathy and (2) Wernicke encephalopathy associated with a Guillain-Barre-like pattern of weakness. The 2 cases and the subsequent discussion of vitamin A, B1, and B12 deficiencies underscore the value of taking a thorough dietary history and emphasize risk factors for these 3 nutritional deficiencies.
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Affiliation(s)
- Bedirhan Tarhan
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Sydur Rahman
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy Joseph
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Douglas Hyder
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Peggy R. Borum
- University of Florida College of Medicine, Gainesville, FL, USA
| | - John Sladky
- University of Florida College of Medicine, Gainesville, FL, USA
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[Severe encephalopathy and vitamin B12 deficiency: reversibility after nutritional therapy]. NUTR HOSP 2020; 37:1285-1288. [PMID: 33241939 DOI: 10.20960/nh.03293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Introduction: the vitamin cobalamin is essential for a proper functioning of the CNS, hematopoiesis, and DNA synthesis. Its deficiency is frequently secondary to pernicious anemia or strict vegetarian diets. Case report: an 18-month-old male infant presented with a decreased level of consciousness and movement disorder (tremor and choreiform movements) of several hours' standing. He had a history of delayed acquisition of motor milestones (not standing, monosyllabic language), and progressive loss of these over the last few weeks (head support and sitting). He had been breastfed from birth. His family has a vegetarian diet. In neuroimages, cranial CT and MRI scans showed generalized supratentorial atrophy involving both matters and the basal ganglia. Treatment was started with intramuscular vitamin B12, which increased its levels. Subsequently, the patient was subjected to dietary diversification and oral cyanocobalamin, with clinical normalization after 6 months and radiological normalization after 7 months. Conclusions: we emphasize the importance of vitamin B12 supplementation during pregnancy and lactation in vegetarina mothers and their infants.
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Escobedo-Monge MF, Barrado E, Alonso Vicente C, Escobedo-Monge MA, Torres-Hinojal MC, Marugán-Miguelsanz JM, Redondo del Río MP. Copper and Copper/Zinc Ratio in a Series of Cystic Fibrosis Patients. Nutrients 2020; 12:E3344. [PMID: 33143143 PMCID: PMC7692365 DOI: 10.3390/nu12113344] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
Cystic fibrosis (CF) patients require a stable and sufficient supply of micronutrients. Since copper is an essential micronutrient for human development, a cross-sectional study was carried out to investigate the serum copper levels, serum copper/zinc (Cu/Zn) ratios, and their relationship with nutritional indicators in a group of CF patients. Anthropometric, biochemical, and dietary measurements, an abdominal ultrasound, and respiratory and pancreatic tests were conducted. Seventeen CF patients were studied (10 females, 59%), 76.5% of whom were ∆F580. Their mean serum copper (113 ± 23 μg/dL) was normal, and there was only one teenager with hypocupremia (6%) and two children with hypercupremia (18%). A significant association between serum copper and zinc levels was discovered. The Cu/Zn ratio was higher than 1.00 for 94% of patients, which is an indicator of an inflammation status. There was no significant correlation between the serum copper concentrations and respiratory and pancreatic function, respiratory colonization, and the results of the abdominal ultrasound. Linear regression analysis showed that serum copper had a positive association with both the Z-score body mass index (BMI) and mean bone conduction speed (BCS). Therefore, since 94% of CF patients had a Cu/Zn ratio > 1.00, this factor must alert us to consider the risk of zinc deficiency and high inflammatory response. The measurement of serum zinc alone does not show one's zinc status. However, the Cu/Zn ratio may be an indicator of zinc deficiency and the inflammatory status of CF patients.
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Affiliation(s)
- Marlene Fabiola Escobedo-Monge
- Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (M.C.T.-H.); (M.P.R.d.R.)
| | - Enrique Barrado
- Department of Analytical Chemistry, Science Faculty, Campus Miguel Delibes, University of Valladolid, Calle Paseo de Belén, 7, 47011 Valladolid, Spain;
| | - Carmen Alonso Vicente
- Department of Pediatrics of the Faculty of Medicine, Valladolid University, Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (C.A.V.); (J.M.M.-M.)
| | | | - María Carmen Torres-Hinojal
- Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (M.C.T.-H.); (M.P.R.d.R.)
| | - José Manuel Marugán-Miguelsanz
- Department of Pediatrics of the Faculty of Medicine, Valladolid University, Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (C.A.V.); (J.M.M.-M.)
| | - María Paz Redondo del Río
- Faculty of Medicine, Valladolid University, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (M.C.T.-H.); (M.P.R.d.R.)
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Medeiros RDCN, Moraes JO, Rodrigues SDC, Pereira LM, Aguiar HQDS, de Cordova CAS, Yim Júnior A, de Cordova FM. Thiamine Deficiency Modulates p38 MAPK and Heme Oxygenase-1 in Mouse Brain: Association with Early Tissue and Behavioral Changes. Neurochem Res 2020; 45:940-955. [PMID: 31989470 DOI: 10.1007/s11064-020-02975-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
Abstract
Thiamine deficiency (TD) produces severe neurodegenerative lesions. Studies have suggested that primary neurodegenerative events are associated with both oxidative stress and inflammation. Very little is known about the downstream effects on intracellular signaling pathways involved in neuronal death. The primary aim of this work was to evaluate the modulation of p38MAPK and the expression of heme oxygenase 1 (HO-1) in the central nervous system (CNS). Behavioral, metabolic, and morphological parameters were assessed. Mice were separated into six groups: control (Cont), TD with pyrithiamine (Ptd), TD with pyrithiamine and Trolox (Ptd + Tr), TD with pyrithiamine and dimethyl sulfoxide (Ptd + Dmso), Trolox (Tr) and DMSO (Dmso) control groups and treated for 9 days. Control groups received standard feed (AIN-93M), while TD groups received thiamine deficient feed (AIN-93DT). All the groups were subjected to behavioral tests, and CNS samples were collected for cell viability, histopathology and western blot analyses. The Ptd group showed a reduction in weight gain and feed intake, as well as a reduction in locomotor, grooming, and motor coordination activities. Also, Ptd group showed a robust increase in p38MAPK phosphorylation and mild HO-1 expression in the cerebral cortex and thalamus. The Ptd group showed a decreased cell viability, hemorrhage, spongiosis, and astrocytic swelling in the thalamus. Groups treated with Trolox and DMSO displayed diminished p38MAPK phosphorylation in both the structures, as well as attenuated thalamic lesions and behavioral activities. These data suggest that p38MAPK and HO-1 are involved in the TD-induced neurodegeneration in vivo, possibly modulated by oxidative stress and neuroinflammation.
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Affiliation(s)
- Rita de Cássia Noronha Medeiros
- Programa de Pós-Graduação em Sanidade Animal e Saúde Pública nos Trópicos, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | - Juliana Oliveira Moraes
- Programa de Pós-Graduação em Sanidade Animal e Saúde Pública nos Trópicos, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | | | - Leidiano Martins Pereira
- Curso de Medicina Veterinária, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | - Helen Quézia da Silva Aguiar
- Curso de Medicina Veterinária, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | | | - Alberto Yim Júnior
- Curso de Medicina Veterinária, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | - Fabiano Mendes de Cordova
- Programa de Pós-Graduação em Sanidade Animal e Saúde Pública nos Trópicos, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil.
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Moraes JO, Rodrigues SDC, Pereira LM, Medeiros RDCN, de Cordova CAS, de Cordova FM. Amprolium exposure alters mice behavior and metabolism in vivo. Animal Model Exp Med 2018; 1:272-281. [PMID: 30891577 PMCID: PMC6388078 DOI: 10.1002/ame2.12040] [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] [Received: 08/28/2018] [Revised: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Thiamine deficiency (TD) models have been developed, mainly using the thiamine analog pyrithiamine. Other analogs have not been used in rodents. We aimed to evaluate the effects and mechanisms of intraperitoneal (ip) amprolium-induced TD in mice. We also evaluated the associated pathogenesis using antioxidant and anti-inflammatory compounds (Trolox, dimethyl sulfoxide). METHODS Male mice were separated into two groups, one receiving a standard diet (control animals), and the other a TD diet (deficient groups) for 20 days. Control mice were further subdivided into three groups receiving daily ip injections of saline (NaCl 0.9%; Cont group), Tolox (Tr group) or dimethyl sulfoxide (DMSO; Dmso group). The three TD groups received amprolium (Amp group), amprolium and Trolox (Amp+Tr group), or amprolium and DMSO (Amp+Dmso group). The animals were subjected to behavioral tests and then euthanized. The brain and viscera were analyzed. RESULTS Amprolium exposure induced weight loss with hyporexia, reduced the behavioral parameters (locomotion, exploratory activity, and motor coordination), and induced changes in the brain (lower cortical cell viability) and liver (steatosis). Trolox co-treatment partially improved these conditions, but to a lesser extent than DMSO. CONCLUSIONS Amprolium-induced TD may be an interesting model, allowing the deficiency to develop more slowly and to a lesser extent. Amprolium exposure also seems to involve oxidative stress and inflammation, suggested as the main mechanisms of cell dysfunction in TD.
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Affiliation(s)
- Juliana Oliveira Moraes
- Programa de Pós‐Graduação em Sanidade Animal e Saúde Pública nos TrópicosUniversidade Federal do TocantinsAraguaínaTOBrazil
| | | | | | | | | | - Fabiano Mendes de Cordova
- Programa de Pós‐Graduação em Sanidade Animal e Saúde Pública nos TrópicosUniversidade Federal do TocantinsAraguaínaTOBrazil
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