Functional improvements associated with cranioplasty after stroke and traumatic brain injury: a cohort study

OBJECTIVE

Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke.

METHODS

In this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial η2.

RESULTS

A total of 20 TBI and 14 stroke patients were included (mean age 42 ± 14 years; 52.9% male; average schooling 9.5 ± 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial η2 = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial η2 0.106-0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes.

CONCLUSION

Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.

Treatment of Facioscapulohumeral Muscular Dystrophy (FSHD): A Systematic Review

Facioscapulohumeral muscular dystrophy (FSHD) is the third most common type of muscular dystrophy. This disease presents as a slowly progressive asymmetric muscle weakness that involves the facial, scapular, and upper arm muscles mainly. Currently, there is no established consensus on this disease treatment in terms of medications. We assessed the response to the treatment of the drugs utilized in clinical trials by performing a systematic literature review in English using the preferred reporting items for systematic reviews (PRISMA) and meta-analyses. We only used human clinical trials in patients diagnosed with FSHD that received consistent pharmacological treatment. We included 11 clinical trials that fulfilled our criteria. We concluded that albuterol had statistically significant results in three out of four clinical trials, with improved elbow flexors muscle strength. Vitamin C, vitamin E, zinc gluconate, and selenomethionine showed significant improvement in the maximal voluntary contraction and endurance limit time of quadriceps muscle. At the same time, diltiazem and MYO-029 demonstrate no improvement in function, strength, or muscle mass. Losmapimod, currently in phase I of the ReDUX4 trial, showed promising results. Peradventure, more clinical trials are still needed to address this subject. Nevertheless, this review provides a clear and concise update on the treatment for this disease.

Adjuvant Treatment for Protocadherin 19 (PCDH19) Syndrome

Protocadherin 19 (PCDH19) syndrome is inherited as an X-linked pattern and affects mainly females. This syndrome is caused by a mutation in the PCDH19 gene encoding for the protocadherin protein. It is characterized by refractory seizures during febrile episodes with neuropsychiatric manifestations. There is no consensus on the treatment of PCDH19. We conducted a literature review to investigate the main drugs used for this syndrome, and to evaluate the best possible course of adjuvant treatment for these patients. We used an advanced PubMed search strategy with the following inclusion criteria: a) full-text papers, b) English Language, and c) studies conducted in humans. Exclusion criteria: a) literature reviews, b) systematic reviews, and c) metanalysis. We gathered 26 observational papers to conduct this literature review on clobazam and bromide which have been shown to reduce seizures by 50%. Corticosteroids improved neurological symptoms during the episodes in a few patients. Nevertheless, they recurred after a few months. Preliminary results of ganaxolone, which is still under study, demonstrated a reduction of 60% in seizure episodes. A ketogenic diet has been studied to treat several refractory epilepsies, including PCDH19; it has promising results as effective adjuvant therapy in the resolution of status epilepticus, suggesting it could be used as part of the treatment in early childhood. Stiripentol was given as adjuvant therapy in a patient with PCDH19 epilepsy resulting in the most extended period of seizure-free episodes, but more studies must be performed to assess its efficacy.

Cell surface carbohydrates and in vivo infectivity of glucantime-sensitive and resistant Leishmania (Viannia) guyjanensis cell lines

The cell surface plays an important role in the interaction of parasites with their hosts. Drug resistance in the protozoan Leishmania may involve changes in cell-surface composition, although it is not known whether infectivity is also affected. One sensitive and two glucantime-resistant lines of Leishmania (Viannia) guyanensis previously isolated were inoculated into hamsters. The sensitive line caused the disease to manifest earlier than the resistant lines. Imprinting analyses of infected macrophages showed that the sensitive line was more infective than the resistant cell lines. In vitro drug resistance was evaluated and the comparative analyses of dose-response curves showed that the susceptibility pattern of the sensitive line did not change after passage in animals, but a decrease in drug resistance was observed in resistant cell lines recovered from the mammalian host. Cell surface carbohydrates of sensitive and resistant cell lines were analysed before and after passage in animals by agglutination tests with several plant lectins. Passage in animals changed the agglutination pattern for many lectins from all three cell lines. Loss of reactivity to lectins seemed to be correlated with a decrease in infectivity of the parasite-resistant cell lines. This study opens possibilities for exploring the relationship between drug susceptibility, infectivity and surface carbohydrate composition of protozoan parasites.

Spontaneous subarachnoid hemorrhage as the primary manifestation of carotid cavernous fistulas: case report

We report the case of a 19-year old male patient initially admitted to our service after a motor vehicle accident with a normal neurologic evaluation and a CT scan that revealed no abnormalities. Nineteen months later, he was readmitted after a subtle headache episode, followed by a brief loss of consciousness. He was submitted to a complete evaluation, which revealed no abnormalities (even in the neurologic and ophthalmologic exams). A CT was performed revealing a diffuse subarachnoid hemorrhage. Contrast enhancement displayed a right paraselar lesion, which was first interpreted as a giant aneurysm. The patient underwent a cerebral angiography which showed a right carotid-cavernous fistula with retrograde venous drainage through the superior and inferior petrosal sinuses. Filling of various cortical vessels was observed. The patient was treated with endovascular technique and a control angiographic study assured the complete closure of the fistula. He had an excellent clinical recovery, being discharged in good conditions.

Corynebacterium diphtheriae surface proteins as adhesins to human erythrocytes

Corynebacterium diphtheriae strains express non-fimbrial surface proteins able to recognize and bind to specific host cells receptors. Protein extracts were obtained from bacterial cells by mechanical process and ammonium sulfate precipitation at 25 and 45% (w/v) saturation. SDS-PAGE analysis of the extracts detected two polypeptide bands of 67 and 72 kDa, named 67-72 p. The 67-72 p, rabbit anti-67-72 p IgG antibodies as well as human gastric mucin, N-acetylneuraminic acid and N-acetyl D-glucosamine molecules were able to inhibit bacterial hemagglutination. Hemagglutination assays using 67-72 p-coated latex beads and Western blot analysis of biotin-labeled 67-72 p and erythrocyte receptors demonstrated the binding of 67-72 p to human erythrocyte membranes. Immunolabeled colloidal gold-A protein transmission electron microscopy using anti-67-72 p revealed a diffuse distribution of non-fimbrial 67-72 p on the surface of C. diphtheriae strains of both sucrose-fermenting and non-fermenting biotypes. Non-fimbrial lectin-like surface 67-72 p may play a role as adhesins in bacterial attachment thereby facilitating the early steps in pathogenesis of both toxigenic and non-toxigenic C. diphtheriae.

Detection of Porphyromonas endodontalis in infected root canals by 16S rRNA gene-directed polymerase chain reaction

Porphyromonas endodontalis has been isolated from the endodontic infections mainly in symptomatic teeth. This study evaluated the occurrence of P. endodontalis in both symptomatic and asymptomatic endodontic infections using 16S rRNA gene-directed polymerase chain reaction. P. endodontalis was detected in 39.5% of the cases (17 of 43 teeth). It was present in 4 of the 6 cases with acute periradicular abscess (66.7%) and in 13 of the 37 other cases (35.1%). The presence of P. endodontalis was associated with an asymptomatic periradicular lesion in 6 cases (25%) and in 10 teeth with tenderness to percussion (52.6%). P. endodontalis was also found in one asymptomatic case without evidence of periradicular pathosis. Our results indicated that, although P. endodontalis is commonly detected in symptomatic cases, it can be present in asymptomatic root canal infections. Further studies should determine if this bacterial species is really an important endodontopathogen.

Lectin-binding properties of different Leishmania species

Carbohydrate cell-surface residues on stationary promastigotes of 19 isolates of Leishmania were studied with a panel of 27 highly purified lectins, which were specific for N-acetyl-D-glucosamine, D-mannose, L-fucose, D-galactose, N-acetyl-D-galactosamine, and sialic acid. The specificity of the cell-surface carbohydrates was analyzed by agglutination and radioiodinated lectin-binding assays. L. (L.) amazonensis and L. (L.) donovani were agglutinated by 12 and 10 of the 27 lectins used, respectively. Artocarpus integrifolia lectin (Jacalin) was incapable of agglutinating the tested species of the donovani complex, and this result was confirmed by radioiodinated Jacalin-binding assays. Jacalin had an average of 3.8 x 10(6) receptors/L. (L) amazonensis promastigote and bound with an association constant of 5 x 10(6) M(-1).

Characterization of surface saccharides in two Corynebacterium diphtheriae strains

Two Corynebacterium diphtheriae strains were analyzed by assays employing a battery of highly purified fluorescent lectins. From 22 lectins tested only seven with affinity to receptor molecules containing N-acetylglucosamine (D-GlcNAc), N-acetylgalactosamine (D-GalNAc), galactose (D-Gal), mannose-like (D-Man-like) and sialic acid residues showed positive fluorescent labeling. A higher reactivity of Triticum vulgaris (WGA), which binds to sialic acid and/or beta-D-GlcNAc-containing residues, and Bandeiraea simplicifolia II (BS-II), which recognizes alpha and beta-D-GlcNAc units, was shown by the sucrose-fermenting strain. Ricinus communis (RCA-I), which recognizes D-Gal units in addition to both Glycine max (SBA) and Artocarpus integrifolia (Jacaline) agglutinins that bind to D-GalNAc-containing residues, reacted preferentially with the sucrose-negative strain. Canavalia ensiformis (Con A), which recognizes D-Man-like receptors, reacted with both sucrose-fermenting and non-sucrose-fermenting C. diphtheriae biotypes. However, higher interaction was observed with the non-sucrose-fermenting strain. Fluorescence of WGA binding was significantly decreased by neuraminidase treatment suggesting the presence of an exposed sialic acid moiety on C. diphtheriae surfaces. Binding assay using radiolabeled [125I]WGA essentially confirmed the lectin fluorescence studies. N-Acetylneuraminic acid moieties were detected in whole cell hydrolysates as assessed by thin-layer and gas-liquid chromatography. The data indicate differences on the cell surface saccharide ligands between the sucrose-fermenting and the non-sucrose-fermenting C. diphtheriae strains.

Purification and immunocytochemical localization of neuraminidase from Tritrichomonas foetus

Lysis of Tritrichomonas foetus with a solution of the non-ionic detergent Triton X-114 at 0 degree C, followed by low-speed centrifugation, resulted in a detergent-insoluble pellet and a detergent-soluble supernatant. The supernatant was further fractionated by phase separation at 30 degrees C into a detergent-rich phase and an aqueous phase. Neuraminidase activity was mostly located in the detergent-insoluble pellet. When the parasites were incubated with bacterial phosphatidylinositol phospholipase C (PI-PLC) prior to detergent solubilization and phase separation neuraminidase activity was predominantly recovered in aqueous phase, rather than in the pellet and detergent phase. The molecular mass determined by gel permeation in high performance liquid chromatography (HPLC) and SDS-PAGE was 80,000 Da. Indirect immunofluorescence microscopy using polyclonal antibodies raised in rabbits against the purified neuraminidase, indicated that the enzyme is exposed on the cell surface. Previous treatment of the cells with PI-PLC significantly reduced antibody binding. Incubation of cryo-sections with the antibodies followed by detection using gold-labelled anti-rabbit IgG confirmed the presence of neuraminidase in the plasma membrane enclosing the cell body and flagella and in the membrane of vesicles preferentially located at the peripheral region of the protozoan.

Cell surface hydrophobicity of sucrose fermenting and nonfermenting Corynebacterium diphtheriae strains evaluated by different methods

Corynebacterium diphtheriae strains expressed variation in hydrophobic characteristics dependent on the method used. Results of single assays are not a reliable representation of C. diphtheriae hydrophobicity. All 12 strains adhered to polystyrene surfaces; three showed spontaneous aggregation (SA) in Trypticase Soy Broth (TSB) medium, and eight exhibited autoagglutination in phosphate-buffered saline (PBS; AA-positive). The salt aggregation test (SAT) values </=0.002 or >/=1.6 represented breakpoints for groups of strains with differing hydrophobicity. C. diphtheriae strains showed affinity towards n-hexadecane. Percentages of adhesion varied from 31% to 63% and were not directly related to morphological n-hexadecane adhesion patterns. Diffuse and localized adhesion patterns were noted predominantly among sucrose-positive and sucrose-negative strains, respectively. Strains of the sucrose-negative biotype expressed a higher degree of hydrophobicity. The choice of the growth medium influenced the hydrophobicity, not the hemagglutinating activity (HA) of C. diphtheriae. Heating bacterial suspensions at 121 degrees C decreased both HA and hydrophobicity of three strains. However, hydrophobins and hemagglutinins were trypsin and detergent resistant. The treatment of microorganisms with Clostridium perfringens neuraminidase increased the hydrophobicity but not the HA titers of strains tested. Hemagglutinins were partially responsible for hydrophobicity. Hydrophilic AA-negative strains adhered strongly to glass but expressed weak HA. Sialylglycoconjugates functioned as hydrophilins on C. diphtheriae surfaces.

Trans-sialidase activity for sialic acid incorporation on Corynebacterium diphtheriae

A rapid and sensitive assay for neuraminidase using peanut lectin hemagglutination was used to study the prevalence of neuraminidase activity among sucrose-fermenting and non-sucrose-fermenting toxigenic Corynebacterium diphtheriae strains. Neuraminidase activity was found in 15 (100%) isolates regardless of biotype, hemagglutinating activity and site of isolation of bacteria. Besides expressing the neuraminidase activity that hydrolyzes sialic acid from glycoconjugates, C. diphtheriae was also capable of transferring sialic acid residues from a sialyl-lactose donor. A single molecule probably expresses both neuraminidase and trans-sialidase activity. The trans-sialidase activity was documented by observations of the interactions of bacterial cells with wheat germ agglutinin and peanut lectins. C. diphtheriae expressed a trans-sialidase activity located on the cell surface that produced asialoglycoconjugates from a sialyl donor substrate and at the same time generated bacterial sialyl derivatives of beta-Gal acceptors.

Trichomonas vaginalis and Tritrichomonas foetus: expression of chitin at the cell surface

The expression of chitin as a structural component of Trichomonas vaginalis and Tritrichomonas foetus was demonstrated by using enzymatic hydrolysis by recombinant (rec-) chitinase, chemical analysis, lectin, fluorescent Calcofluor and antibody binding, glycosidases of known specificity, high-performance liquid chromatography (HPLC), and flow cytometry. Chitinous structures were characterized by their insolubility in hot alkali and by releasing glucosamine on hydrolysis with 6 N HCl. N,N'-Diacetylchitobiose and N,N,'N''-triacetylchitotriose were identified by HPLC as enzymatic hydrolysis products of the alkali-resistant polysaccharide. The location of chitin on the surface of T. vaginalis and T. foetus was inferred from the decreased reactivity with whole parasites of ligands such as Lycopersicon esculentum (TOL) and Solanum tuberosum lectins, fluorescent Calcofluor, and anti-chitin antibody, after cell treatment with rec-chitinase. Binding of [125I]TOL showed that, in T. vaginalis and T. foetus, the numbers of lectin receptors per cell were 4.2 x 10(5) and 3.0 x 10(5), respectively. Binding of the lectin to the trichomonad surface was markedly decreased by treatment with rec-chitinase. TOL interaction with the parasites was not affected by N-acetyl-beta-D-glucosaminidase treatment, showing that the lectin receptors consisted of beta-linked GlcNAc polymers and not of terminal beta-linked GlcNAc residues.

Carcinoembryonic antigen in breast nipple aspirate fluid

New diagnostic tools are needed to complement mammography and physical examinations for early detection of breast cancer, particularly among younger women. We evaluated the tumor biomarker, carcinoembryonic antigen (CEA), in 215 nipple aspirate fluid (NAF) samples collected from one or both breasts of 147 women, ages 27-87 years. Most subjects were recruited at the time of mammography examination. The 215 nipple fluid CEAs range from undetectable levels to 8400 ng/ml (median, 1100 ng/ml). Normal serum CEA levels are less than 6 ng/ml. There are no significant differences between the CEAs in fluid from normal breasts (112 samples) and breasts with various histories of tumors (total, 103 samples). Analyses for determinants of CEAs in fluids from normal breasts show higher levels among current smokers (P = 0.03) and marginal elevations among nulliparous women (P = 0.07). CEAs in these samples are not correlated with age, menopausal status, current hormone use, prior breastfeeding, or family history of breast cancer. Follow-up studies of these women and comparisons of CEAs in fluids from normal and cancer-containing breasts will help clarify whether this biomarker is useful for risk assessment or early cancer detection.

Cell surface analysis of trypanosomes of the subgenus Schizotrypanum isolated from bats

Two stocks (M5, M29) of trypanosomes of the subgenus Schizotrypanum were isolated from the bat Phyllostomus hastatus and analyzed for cell electrophoretic mobility (EPM) and lectin binding surface sites. Epimastigotes from the M5 and M29 stocks presented a mean EPM of around -0.57 and -0.56 microns. s-1.V-1.cm respectively. Differences in the agglutination profiles were detected between epimastigotes or trypomastigotes from the two parasite populations using lectins with specificity for D-GlcNAc, D-GalNAc, D-Gal and D-Man as probe. Major variation was observed between epimastigote forms. Additionally, the D-GlcNAc binding lectins WGA and BS II strongly interacted with the trypomastigote from both M5 and M29 stocks; this fact is evidence that these trypanosomes are distinct from Trypanosoma (Schizotrypanum) cruzi.

Occurrence of N-acetyl- and N-O-diacetyl-neuraminic acid derivatives in wild and mutant Crithidia fasciculata

The cell-surface expression of sialic acids in wild-type Crithidia fasciculata and three drug-resistant mutants (FU(R)11, TR3, and TFRR1) was analyzed using fluorescein-labeled Limulus polyphemus agglutinin (LPA) binding, glycosidase of known sugar specificity, and thin-layer chromatography (TLC). Gas-liquid chromatography-mass spectrometry (GC-MS) analysis using both electron-impact (EI-MS) and chemical ionization (CI-MS) by isobutane with selected ion monitoring (SIM) was also used. The surface location of sialic acid was inferred from LPA binding to whole cells abrogated by previous treatment with neuraminidase. An exception occurred with the TFRR1 strain, which after incubation with neuraminidase showed increased reactivity with the fluorescent lectin. Both N-acetyl- and N-O-diacetyl-neuraminic acids were identified in the flagellates by TLC, with a clear predominance being noted for the former derivative. However, the content of N-O-diacetyl-neuraminic acid was preferentially found in the TFRR1 strain. The GC-MS analysis of the acidic component of the TFRR1 mutant strain confirmed the occurrence of N-acetyl-neuraminic acid (Neu5Ac) by the presence of the diagnostic ions (m/z values: 684 and 594 for CI-MS and 478, 298, and 317 for EI-MS) and also by comparison with the standard Neu5Ac retention time. GC-MS analysis also showed fragments (m/z values: 654 and 564 for CI-MS and 594, 478, 298, and 317 for EI-MS) expected for the 7-O- and 9-O-acetyl-N-acetyl-neuraminic acids (Neu5,7Ac2 and Neu 5,9Ac2, respectively).

Phospholipase C-mediated release of neuraminidase from Tritrichomonas foetus cell surface

The release of the Tritrichomonas foetus plasma-membrane ectoenzyme neuraminidase by exogenous specific phospholipase C (PI-PLC) was investigated. Neuraminidase activity was determined using both the peanut agglutinin (PNA) hemagglutination test and the specific substrate N-acetylneuramin-lactose in a colorimetric assay. The release of the neuraminidase by PI-PLC was dependent on the reaction time and the concentration of PI-PLC. Neuraminidase activity was also detected in supernatant of untreated T. foetus. Spontaneous or PI-PLC-induced release of neuraminidase from protozoan cells was markedly decreased by 10 mM ZnCl2, suggesting the occurrence of an endogenous PI-PLC in the parasite. After T. foetus lysis at 37 degrees C with a solution of Triton X-114, neuraminidase activity was preferentially found in the aqueous phase rather than in the detergent phase, again suggesting that the parasite contains an endogenous PI-PLC that converts the hydrophobic form of neuraminidase anchored to the T. foetus cell membrane into a hydrophilic form. These results show that neuraminidase is linked to the T. foetus plasma membrane via a glycosylphosphatidylinositol anchor.

Chitin: a cell-surface component of Phytomonas françai

The occurrence of chitin as a structural component of the surface of the phytopathogenic protozoan Phytomonas françai was demonstrated by paper and gas-liquid chromatographic analysis of the products of enzymatic and chemical hydrolysis of alkali-resistant polysaccharides, lectin binding, glycosidase digestion, and infrared spectra. Chitin was characterized by its insolubility in hot alkali and chromatographic immobility as well as by the release of glucosamine on hydrolysis with strong acid and of N-acetylglucosamine (GlcNAc) on hydrolysis with chitinase. The presence of chitin was also shown directly by binding of wheat-germ agglutinin (WGA), which recognizes GlcNAc units, to the parasite surface. Fluorescein-labeled WGA binding was completely abolished by treatment with chitinase. This effect was specific since it could be prevented by incubating the enzyme with chitin before treatment of the phytomonads. These findings indicate that chitin is an exposed cell-surface polysaccharide in Phytomonas françai. The data were confirmed by the infrared spectrum of an alkali-insoluble residue, which showed a pattern typical of chitin.

Sialic acid as receptor of Bacteroides fragilis lectin-like adhesin

It was observed that sialic acid and macromolecules rich in this sugar were able to inhibit the hemagglutination activity (HA) of Bacteroides fragilis strains in low concentrations. Reversion of the HA and also of the adsorption to beads of Sepharose coupled to bovine submaxillary mucin, by this sugar residue corroborated the recognition capacity of the bacterial lectin-like adhesin. However, when erythrocytes were treated with clostridial neuraminidase, an increase in the HA of some strains was observed. Protease treatment of erythrocytes abolished the HA, indicating that cell receptors of B. fragilis are probably a glycoprotein moiety.

[Neurologic changes in congenital heart diseases: a neuropathologic study]

A neuropathologic study in 190 consecutive autopsies of patients with congenital cardiopathy was performed: 116 cases underwent a surgical procedure (S group) and the remaining 74 were non-surgical (NS group). Neuropathologic alterations were observed in 71 cases (41 in the S group and 30 in the NS group). However, most of the 129 cases with a normal examination had died in the first 72 hours either after surgery or the clinical events responsible for the death. Almost all the neuropathologic alterations were hypoxic ischemic. Infarctions, single or multiple, were found in 41 cases (23 in the S and 18 in the NS group). An embolic mechanism could be detected in 12 cases. Diffuse hypoxic changes were present in 17 cases (10 in the S and 7 in the NS group). Hemorrhages were found in 11 (6 in the S and 5 in NS group), 4 of which were related to a disseminated intravascular coagulation. In 17 cases (5 in the NS and 12 in the S group), the picture was of a periventricular leukomalacia. All these cases concerned children under 6 months of age. In 7 cases inflammatory alterations were present (diffuse micro-abscesses in 6 and a frontal lobe abscess in 1). Almost all cases in both groups presented clinical complications, isolated or associated, potentially harmful to the brain, as cardiac arrest, cardiac low output, hypoxemia, and respiratory distress. If was impossible to determine in each case the magnitude of the factor or factors responsible for the correspondent pattern of neuropathologic damage. There was no difference as to the neuropathologic pattern between congenital cardiopathies leading to increased or decreased pulmonary blood flow.

Structural features and antigenic properties of carbohydrate-containing components of Trypanosoma conorhini

Aqueous and phenolic extracts of Trypanosoma conorhini were fractionated and high molecular weight, carbohydrate-rich fractions obtained. Their antigenic characteristics, reactivity with lectins and partial chemical structure were determined. The major component, the phenolic extract, was electrophoretically diffuse and consisted of 15% protein, 5% phosphorus, hexosamine, and 67% neutral carbohydrate, which contained mannose, galactose, and xylose in a molar ratio of 1.0:1.8:1.8. Chemical analyses and lectin agglutination experiments showed nonreducing end-groups of beta-D-galactopyranose, beta-xylopyranose, and alpha-D-mannopyranose. Phosphate esters occurred, apparently, at O-6 of hexopyranosyl units. Hexosamine was present as nonacetylated units of 2-amino-2-deoxy-alpha-D-glucopyranosyl units that were extremely resistant to acid hydrolysis. On double immunodiffusion tests, the major component gave a precipitation line with rabbit serum against whole cells of Trypanosoma cruzi, suggesting the presence of common antigenic determinant(s) on the cell surface of each trypanosomatid.

Involvement of the macrophage mannose-6-phosphate receptor in the recognition of Leishmania mexicana amazonensis

Significant differences were found in the ability of resident mouse peritoneal macrophages to ingest amastigote and promastigote forms of Leishmania mexicana amazonensis. Differences in the association index of the parasites to the macrophages were also found between infective and non-infective promastigotes. Evidence was obtained suggesting that the macrophage receptor, which recognizes mannose-6-phosphate-containing units found in lysosomal enzymes, is involved in the association with the macrophage of promastigotes, but not of amastigotes. Addition of mannose-6-phosphate, its structural analogue fructose-1-phosphate, Hansenula holstii phosphomannan or the mannose-6-phosphate-containing lysosomal enzyme alpha-D-mannosidase to the interaction medium, markedly inhibits the association of the parasites with macrophages.

Cell surface carbohydrate of Leishmania mexicana amazonensis: differences between infective and non-infective forms

The cell surface carbohydrates of Leishmania mexicana amazonensis (amastigotes and promastigotes, both infective and non-infective forms) were comparatively analyzed by agglutination assay employing 28 highly purified lectins, and by binding assay using 125I-labeled lectins. Among the D-GalNAc binding lectins, Bandeiraea simplicifolia-I, Dolichos biflorus, Phaseolus vulgaris and Glycine max were highly specific for the amastigotes, while that from Maclura aurantiaca selectively agglutinated promastigotes. The lectins from Wistaria floribunda, Phaseolus lunatus (D-GalNAc), Arachis hypogaea (D-Gal) and Triticum vulgaris (D-GlcNAc) were selective for the infective forms (both amastigotes and promastigotes), not reacting with the non-infective ones. Conversely, no parasite agglutination occurred with the L-fucose binding lectins Lotus tetragonolobus and Ulex europaeus-I. Binding studies with 125I-labeled lectins from Wistaria floribunda, Triticum vulgaris and Arachis hypogaea were performed to find whether unagglutinated non-infective promastigotes might have receptors for these lectins, in which case absence of agglutination could be due to a peculiar arrangement of the receptors. These assays essentially confirmed the selectivity, demonstrated in the agglutination assays of these lectins for the infective promastigotes.

Incorporation of sialic acid into Trypanosoma cruzi macromolecules. A proposal for a new metabolic route

Sialo- and asialoglycoconjugates were isolated from Trypanosoma cruzi epimastigotes and their composition determined. Sialoglycoconjugates bound to wheat germ agglutinin (WGA)-Sepharose and were precipitated by concanavalin A, Wistaria floribunda hemagglutinin and WGA. Asialoglycoconjugate bound to concanavalin A-Sepharose and precipitated with concanavalin-A and W. floribunda hemagglutinin but not with WGA. Cells grown in the presence of fetal calf serum were agglutinated by WGA but not by peanut agglutinin. The reverse was true for cells grown without fetal calf serum. Neuraminidase-treated cells incorporated sialic acid or its 7-carbon analog, 5-acetamido-3,5-dideoxy-L-arabino-2-heptulosonic acid (AcNeu7) from sialylated compounds such as fetuin or sialyl-lactose but did not incorporate free sialic acid. Restoration of the WGA sialylreceptors in neuraminidase-treated cells, as determined by cell agglutination with WGA, was also obtained by incubation with fetuin or sialyl-lactose but not with free sialic acid. Moreover, restoration of agglutinability by WGA in neuraminidase-treated cells or cells grown in medium without fetal calf serum occurred equally well in energy-rich or energy-depleted cells. A transglycosilase reaction for sialic acid incorporation in T. cruzi epimastigotes is suggested.

Purification of tissue forms (Amastigotes) of Trypanosoma cruzi by immunoaffinity chromatography

A rapid and simple method for the purification of amastigotes of Trypanosoma cruzi from spleens of infected mice is described. A protein A-Sepharose 4B immunoadsorbent column bound with antisera to epimastigotes of T. cruzi was used to purify the tissue forms of this parasite. Host cells and debris are not retained, and parasites can be eluted in high yields and purity. Studies of surface glycoproteins and glycolipids of the purified amastigotes with 18 lectins of various specificities revealed the presence on the parasites of receptors for N-acetylglucosamine, N-acetylgalactosamine, D-galactose, and D-mannose binding lectins.

The occurrence of N-acetyl- and N-glycoloylneuraminic acid in Trypanosoma cruzi

Different strain of Trypanosoma cruzi were analysed to have 65--105 micrograms of sialic acids per 10(10) cells. By thin-layer chromatography, and in part by gas liquid chromatography and gas-liquid chromatography-mass spectrometry, all strains were found to contain N-acetyl- and N-glycoloylneuraminic acid in various ratios. After incubation of the parasites with either [3H]acetate or N-acetyl-[3H]mannosamine, no radioactivity was found in the sialic acids, thus leading to the suggestion that the parasites are unable to synthesize sialic acids from their precursors.

Cell surface carbohydrates in Crithidia deanei: influence of the endosymbiote

The cell surface of the symbiote-containing and symbiote-free strains of Crithidia deanei were characterized comparatively by using 22 highly purified lectins with specificities for N-acetyl glucosamine, N-acetyl galactosamine, galactose, mannose-like residues, fucose and sialic acid. The specificity of the cell surface carbohydrate in both strains were analyzed by agglutination and lectin-binding assays. C. deanei with or without endosymbiote was specifically agglutinated by lectins from Triticum vulgaris (WGA) and Aaptos papillata suggesting the presence of D-GlcNAc residues. However, agglutination was stronger with the symbiote-free cells than with symbiote-containing organisms. The D-GalNAc-binding lectin from Wistaria floribunda also reacted most effectively with symbiote-free flagellates. Among D-Gal-binding lectins it was observed that those from Axinella polypoides and Ricinus communis I selectively agglutinated symbiote-free cells. In contrast the lectin from Arachys hypogaeae bound preferentially to the symbiote containing organisms. Both strains of C. deanei agglutinated strongly with the lectins concanavalin A and that from Lens culinaris (lectins for D-mannose-like residues). Conversely no cell agglutination occurred with the L-fucose-binding lectins Lotus tetragonolobus and Ulex europeus. The pattern of agglutination induced by the lectin from Limulus polyphemus of symbiote-free organisms was similar to that of symbiote-containing cells indicating the presence of sialic acid on the cell surface of both strains of C. deanei. These results indicate that the presence of the endosymbiote changes the lectin-binding sites at C. deanei surface membrane.

Lectins of distinct specificity in Rhodnius prolixus interact selectively with Trypanosoma cruzi

Lectins of different activities were found in the crop, midgut, and hemolymph of the insect Rhodnius prolixus. These were not specific for N-acetyl-D-mannosamine, alpha-N-acetyl-D-galactosamine, and alpha- and beta-galactose, respectively. Lectin receptors were detectable in epimastigote but not in trypomastigote forms of Trypanosoma cruzi, a protozoan parasite of the insect and of humans.

Lectin receptors as markers for Trypanosoma cruzi. Developmental stages and a study of the interaction of wheat germ agglutinin with sialic acid residues on epimastigote cells

Trypanosoma cruzi at various stages of maturation and differentiation have been isolated by conventional cellular fractionation procedures and characterized by cell surface markers using 30 highly purified lectins encompassing all known sugar specificities. Cell surface carbohydrates of the various T. cruzi stages were analyzed by agglutination and lectin-binding assays. Specific receptors for wheat germ agglutinin (WGA), Helix pomatia, Sophora japonica, and Bandeiraea simplicifolia lectin II were found only in culture epimastigotes, whereas peanut agglutinin (PNA) sites were present exclusively in amastigotes, those for Phaseolus vulgaris in bloodstream trypomastigotes and amastigotes, and for Wistaria floribunda hemagglutinin predominantly in culture forms of T. cruzi. The N-acetylgalactosamine (DGalNAc)-binding lectin from Bauhinia purpurea agglutinated and inhibited the movement of epimastigotes and bloodstream trypomastigotes, but it only inhibited--without agglutinating--culture trypomastigotes. Because both the agglutination and inhibition of movement were reversed by specific sugar haptens, Bauhinia purpurea sites were present in all the flagellated parasites. On the other hand, PNA sites were detectable on epimastigotes after the cells were treated with sialidase, whereas, at the same time, WGA receptors were completely removed and those for the other sialic acid-binding proteins, Aaptos papillata lectin II and Limulus polyphemus, were partially eliminated; moreover, the activity of Wistaria floribunda hemagglutinin, a DGalNAc-binding lectin, increased 4,000 times. Trypsinization and lyzozyme treatment of epimastigote cells did not significantly affect lectin agglutination or lectin binding. WGA reacted solely with sialic acid residues on epimastigote cell surface with an apparent association constant of 2 x 10(6) M-1, each epimastigote having an estimated average of 3 x 10(6) WGA sites, as determined by binding experiments and a minimum of 7.7 x 10(6) sialic acid residues, as calculated by colorimetric method after sialidase digestion. Evidences are presented that the sialyl residues are rapidly regenerated (in approximately 4 h) and that they, at least for the most part, are not adsorbed from the culture medium. The receptor for the D-mannose-binding lectins (concanavalin A [Con A] and Lens culinaris) must either be on the same carbohydrate moiety having the WGA site, or, if in a distinct molecule, both carrier molecules of Con A and WGA sites must be located close to each other in the plasma membrane of the parasite.

Anterior floor meningoencephaloceles surgical treatment. Experience based on eleven cases

The authors relate their experience in the anterior floor meningoencephaloceles surgical treatment, excised by the intracranial pathway and extradural approach. They compare their results on five cases operated according to this technique, with other six cases treated in the same Department using other surgical procedures and with those in the literature.