Ion Channels and Ionotropic Receptors in Astrocytes: Physiological Functions and Alterations in Alzheimer's Disease and Glioblastoma

The human brain is composed of nearly one hundred billion neurons and an equal number of glial cells, including macroglia, i.e., astrocytes and oligodendrocytes, and microglia, the resident immune cells of the brain. In the last few decades, compelling evidence has revealed that glial cells are far more active and complex than previously thought. In particular, astrocytes, the most abundant glial cell population, not only take part in brain development, metabolism, and defense against pathogens and insults, but they also affect sensory, motor, and cognitive functions by constantly modulating synaptic activity. Not surprisingly, astrocytes are actively involved in neurodegenerative diseases (NDs) and other neurological disorders like brain tumors, in which they rapidly become reactive and mediate neuroinflammation. Reactive astrocytes acquire or lose specific functions that differently modulate disease progression and symptoms, including cognitive impairments. Astrocytes express several types of ion channels, including K+, Na+, and Ca2+ channels, transient receptor potential channels (TRP), aquaporins, mechanoreceptors, and anion channels, whose properties and functions are only partially understood, particularly in small processes that contact synapses. In addition, astrocytes express ionotropic receptors for several neurotransmitters. Here, we provide an extensive and up-to-date review of the roles of ion channels and ionotropic receptors in astrocyte physiology and pathology. As examples of two different brain pathologies, we focus on Alzheimer's disease (AD), one of the most diffuse neurodegenerative disorders, and glioblastoma (GBM), the most common brain tumor. Understanding how ion channels and ionotropic receptors in astrocytes participate in NDs and tumors is necessary for developing new therapeutic tools for these increasingly common neurological conditions.

Two decades of astrocytes in neurovascular coupling

The brain is a highly energy demanding organ, which accounts in humans for the 20% of total energy consumption at resting state although comprising only 2% of the body mass. The necessary delivery of nutrients to brain parenchyma is ensured by the cerebral circulatory system, through the exchange of glucose and oxygen (O2) at the capillary level. Notably, a tight spatial and temporal correlation exists between local increases in neuronal activity and the subsequent changes in regional cerebral blood flow. The recognized concept of neurovascular coupling (NVC), also named functional hyperemia, expresses this close relationship and stands at the basis of the modern functional brain imaging techniques. Different cellular and molecular mechanisms have been proposed to mediate this tight coupling. In this context, astrocytes are ideally positioned to act as relay elements that sense neuronal activity through their perisynaptic processes and release vasodilator agents at their endfeet in contact with brain parenchymal vessels. Two decades after the astrocyte involvement in neurovascular coupling has been proposed, we here review the experimental evidence that contributed to unraveling the molecular and cellular mechanisms underlying cerebral blood flow regulation. While traveling through the different controversies that moved the research in this field, we keep a peculiar focus on those exploring the role of astrocytes in neurovascular coupling and conclude with two sections related to methodological aspects in neurovascular research and to some pathological conditions resulting in altered neurovascular coupling.

Rescue of astrocyte activity by the calcium sensor STIM1 restores long-term synaptic plasticity in female mice modelling Alzheimer's disease

Calcium dynamics in astrocytes represent a fundamental signal that through gliotransmitter release regulates synaptic plasticity and behaviour. Here we present a longitudinal study in the PS2APP mouse model of Alzheimer's disease (AD) linking astrocyte Ca²⁺ hypoactivity to memory loss. At the onset of plaque deposition, somatosensory cortical astrocytes of AD female mice exhibit a drastic reduction of Ca²⁺ signaling, closely associated with decreased endoplasmic reticulum Ca²⁺ concentration and reduced expression of the Ca²⁺ sensor STIM1. In parallel, astrocyte-dependent long-term synaptic plasticity declines in the somatosensory circuitry, anticipating specific tactile memory loss. Notably, we show that both astrocyte Ca²⁺ signaling and long-term synaptic plasticity are fully recovered by selective STIM1 overexpression in astrocytes. Our data unveil astrocyte Ca²⁺ hypoactivity in neocortical astrocytes as a functional hallmark of early AD stages and indicate astrocytic STIM1 as a target to rescue memory deficits.

Astrocytes mediate long-lasting synaptic regulation of ventral tegmental area dopamine neurons

The plasticity of glutamatergic transmission in the ventral tegmental area (VTA) represents a fundamental mechanism in the modulation of dopamine neuron burst firing and phasic dopamine release at target regions. These processes encode basic behavioral responses, including locomotor activity, learning and motivated behaviors. Here we describe a hitherto unidentified mechanism of long-term synaptic plasticity in mouse VTA. We found that the burst firing in individual dopamine neurons induces a long-lasting potentiation of excitatory synapses on adjacent dopamine neurons that crucially depends on Ca²⁺ elevations in astrocytes, mediated by endocannabinoid CB1 and dopamine D2 receptors co-localized at the same astrocytic process, and activation of pre-synaptic metabotropic glutamate receptors. Consistent with these findings, selective in vivo activation of astrocytes increases the burst firing of dopamine neurons in the VTA and induces locomotor hyperactivity. Astrocytes play, therefore, a key role in the modulation of VTA dopamine neuron functional activity.

Mitochondrial Ca2+ Signaling and Bioenergetics in Alzheimer's Disease

Alzheimer's disease (AD) is a hereditary and sporadic neurodegenerative illness defined by the gradual and cumulative loss of neurons in specific brain areas. The processes that cause AD are still under investigation and there are no available therapies to halt it. Current progress puts at the forefront the "calcium (Ca2+) hypothesis" as a key AD pathogenic pathway, impacting neuronal, astrocyte and microglial function. In this review, we focused on mitochondrial Ca2+ alterations in AD, their causes and bioenergetic consequences in neuronal and glial cells, summarizing the possible mechanisms linking detrimental mitochondrial Ca2+ signals to neuronal death in different experimental AD models.

Dysbindin-1A modulation of astrocytic dopamine and basal ganglia dependent behaviors relevant to schizophrenia

The mechanisms underlying the dichotomic cortical/basal ganglia dopaminergic abnormalities in schizophrenia are unclear. Astrocytes are important non-neuronal modulators of brain circuits, but their role in dopaminergic system remains poorly explored. Microarray analyses, immunohistochemistry, and two-photon laser scanning microscopy revealed that Dys1 hypofunction increases the reactivity of astrocytes, which express only the Dys1A isoform. Notably, behavioral and electrochemical assessments in mice selectively lacking the Dys1A isoform unraveled a more prominent impact of Dys1A in behavioral and dopaminergic/D2 alterations related to basal ganglia, but not cortical functioning. Ex vivo electron microscopy and protein expression analyses indicated that selective Dys1A disruption might alter intracellular trafficking in astrocytes, but not in neurons. In agreement, Dys1A disruption only in astrocytes resulted in decreased motivation and sensorimotor gating deficits, increased astrocytic dopamine D2 receptors and decreased dopaminergic tone within basal ganglia. These processes might have clinical relevance because the caudate, but not the cortex, of patients with schizophrenia shows a reduction of the Dys1A isoform. Therefore, we started to show a hitherto unknown role for the Dys1A isoform in astrocytic-related modulation of basal ganglia behavioral and dopaminergic phenotypes, with relevance to schizophrenia.

Calcium Signals in Astrocyte Microdomains, a Decade of Great Advances

The glial cells astrocytes have long been recognized as important neuron-supporting elements in brain development, homeostasis, and metabolism. After the discovery that the reciprocal communication between astrocytes and neurons is a fundamental mechanism in the modulation of neuronal synaptic communication, over the last two decades astrocytes became a hot topic in neuroscience research. Crucial to their functional interactions with neurons are the cytosolic Ca²⁺ elevations that mediate gliotransmission. Large attention has been posed to the so-called Ca²⁺microdomains, dynamic Ca²⁺ changes spatially restricted to fine astrocytic processes including perisynaptic astrocytic processes (PAPs). With presynaptic terminals and postsynaptic neuronal membranes, PAPs compose the tripartite synapse. The distinct spatial-temporal features and functional roles of astrocyte microdomain Ca²⁺ activity remain poorly defined. However, thanks to the development of genetically encoded Ca²⁺ indicators (GECIs), advanced microscopy techniques, and innovative analytical approaches, Ca²⁺ transients in astrocyte microdomains were recently studied in unprecedented detail. These events have been observed to occur much more frequently (∼50–100-fold) and dynamically than somatic Ca²⁺ elevations with mechanisms that likely involve both IP₃-dependent and -independent pathways. Further progress aimed to clarify the complex, dynamic machinery responsible for astrocytic Ca²⁺ activity at microdomains is a crucial step in our understanding of the astrocyte role in brain function and may also reveal astrocytes as novel therapeutic targets for different brain diseases. Here, we review the most recent studies that improve our mechanistic understanding of the essential features of astrocyte Ca²⁺ microdomains.

THU0344 CLINICAL AND HISTOLOGICAL SPECTRUM OF ANTI-MI2 DERMATOMYOSITIS: A MULTICENTRE RETROSPECTIVE COHORT

Background:

Dermatomyositis (DM) shows a wide clinical spectrum that seems to be different based on the type of autoantibody status. Furthermore, less is known regarding to the histopathology of different serological subsets of DM

Objectives:

The aim of our study was to investigate clinical and histopathological hallmarks in adult DM patients positive for anti-Mi2 (Mi2+) antibody compared to DM patients negative for anti-Mi2 (Mi2-)

Methods:

All clinical data of adult DM patients admitted in three tertiary Rheumatology Units, who fulfilled EULAR/ACR 2017 classification criteria1, were included in this study. Overlap syndrome and antisynthetase syndrome were exclusion criterion. Serum samples were tested in the local reference laboratories using line immunoassays methods for Myositis specific and associated antibodies. Histopathological study was carried out from muscle biopsies performed for diagnostic purpose in outpatient clinic of Bari (Italy) University. Quantitative analysis was performed for myofiber and capillary features, whereas semi-quantitative analysis (score from 0 to 3) was performed for inflammatory cells infiltrate, both at endomysial and perimysial sites

Results:

A total of 95 DM patients, followed for a median (IQR) follow-up of 28 (9-85) months, were analyzed. Of these, 23 (24.2%) patients (87% female, mean age at onset 55.4±16.2 years) were anti-Mi2+, while 72 (75.8%) patients were Mi2- (72.2% female, mean age at onset 55.2±17 years). All Mi2+ patients showed muscle involvement. Moreover, Mi2+ DM showed higher levels of serum creatine kinase (CK) at onset compared to Mi2- (CK (IQR): 2649 UI/l (1130-6000) vs 575 UI/l (164-1617), p<0.001). Prevalence of interstitial lung disease (ILD) was lower in Mi2+ patients (8.7% vs 30.6%, p=0.05), and no case of rapidly progressive ILD (RP-ILD) was found. Survival analysis at 5-years follow-up highlighted good survival for Mi2+ patients, but not different from Mi2- (95.7% vs 83.1%, p=0.151). Multivariate analysis showed that age at onset (HR:1.07), RP-ILD (HR:36.2) and cancer associated myositis (HR:6.1) correlated with a poor prognosis. Finally, a total of 26 biopsies (12 Mi2+ and 14 Mi2-) were included into the histological analysis showing higher prevalence of necrotic/degenerating myofibers (median (IQR) 2.6 (0.7-11)% vs 0.6 (0.4-1.1)%, p=0.009) and sarcoplasmic deposit of membrane attack complex (MAC) (median (IQR) 0.2 (0-1.2)% vs (0(0-0)%,p=0.009) in Mi2+ patients. In addition, the endomysial macrophage score was higher in Mi-2+ patients (median 1.5 (0.25-2) vs (0.5 (0-1), p=0.031)

Conclusion:

Mi2+ patients represent a specific DM subset with higher muscle damage, sarcoplasmic MAC deposits and endomysial macrophages infiltration as histological hallmarks

References:

[1]Ann Rheum Dis. 2017 Dec;76(12):1955-1964

Disclosure of Interests:

Marco Fornaro: None declared, Francesco Girolamo: None declared, Lorenzo Cavagna: None declared, Franco Franceschini: None declared, margherita giannini: None declared, Giovanni Zanframundo: None declared, Micaela Fredi: None declared, Marilin Tampoia: None declared, Angela Amati: None declared, Luigi Serlenga: None declared, Anna Lia: None declared, Liala Moschetti: None declared, Dario Dabbicco: None declared, Laura Coladonato: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD

ALS-Associated SOD1(G93A) Decreases SERCA Pump Levels and Increases Store-Operated Ca2+ Entry in Primary Spinal Cord Astrocytes from a Transgenic Mouse Model

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by the selective death of motor neurons (MNs), probably by a combination of cell- and non-cell-autonomous processes. The past decades have brought many important insights into the role of astrocytes in nervous system function and disease, including the implication in ALS pathogenesis possibly through the impairment of Ca²⁺-dependent astrocyte-MN cross-talk. In this respect, it has been recently proposed that altered astrocytic store-operated Ca²⁺ entry (SOCE) may underlie aberrant gliotransmitter release and astrocyte-mediated neurotoxicity in ALS. These observations prompted us to a thorough investigation of SOCE in primary astrocytes from the spinal cord of the SOD1(G93A) ALS mouse model in comparison with the SOD1(WT)-expressing controls. To this purpose, we employed, for the first time in the field, genetically-encoded Ca²⁺ indicators, allowing the direct assessment of Ca²⁺ fluctuations in different cell domains. We found increased SOCE, associated with decreased expression of the sarco-endoplasmic reticulum Ca²⁺-ATPase and lower ER resting Ca²⁺ concentration in SOD1(G93A) astrocytes compared to control cells. Such findings add novel insights into the involvement of astrocytes in ALS MN damage.

mCerulean3-Based Cameleon Sensor to Explore Mitochondrial Ca2+ Dynamics In Vivo

Genetically Encoded Ca²⁺ Indicators (GECIs) are extensively used to study organelle Ca²⁺ homeostasis, although some available probes are still plagued by a number of problems, e.g., low fluorescence intensity, partial mistargeting, and pH sensitivity. Furthermore, in the most commonly used mitochondrial Förster Resonance Energy Transfer based-GECIs, the donor protein ECFP is characterized by a double exponential lifetime that complicates the fluorescence lifetime analysis. We have modified the cytosolic and mitochondria-targeted Cameleon GECIs by (1) substituting the donor ECFP with mCerulean3, a brighter and more stable fluorescent protein with a single exponential lifetime; (2) extensively modifying the constructs to improve targeting efficiency and fluorescence changes caused by Ca²⁺ binding; and (3) inserting the cDNAs into adeno-associated viral vectors for in vivo expression. The probes have been thoroughly characterized in situ by fluorescence microscopy and Fluorescence Lifetime Imaging Microscopy, and examples of their ex vivo and in vivo applications are described.

•

Donor substitution in a mitochondrial Ca²⁺ sensor improves photo-physical properties

•

Mitochondria-targeting sequence amelioration enhances the sensor localization

•

Donor substitution allows FLIM-FRET analysis, with a compensation for pH bias

•

The performance of the sensor is improved in situ, ex vivo, and in vivo

Dynamic interactions between GABAergic and astrocytic networks

Brain network activity derives from the concerted action of different cell populations. Together with interneurons, astrocytes play fundamental roles in shaping the inhibition in brain circuitries and modulating neuronal transmission. In this review, we summarize past and recent findings that reveal in neural networks the importance of the interaction between GABAergic signaling and astrocytes and discuss its physiological and pathological relevance.

Suspension Made with Amniotic Membrane: Clinical Trial

Purpose

To investigate if a suspension made with amniotic membrane could have a beneficial effect on ocular surface diseases.

Methods

In the Imola branch of the Eye Bank of Emilia Romagna, the authors prepared a suspension containing homogenized amniotic membrane previously conserved at −80 degrees Celsius. Subsequently, the authors gave this preparation to 21 patients: 8 had undergone lamellar keratoplasty, 4 had undergone penetrating keratoplasty, 2 had undergone photorefractive keratectomy with a delay of epithelialization, 3 had neurotrophic corneal ulcers, 2 had corneal burning, 1 had torpid corneal ulcer, and 1 had Sjögren syndrome. Each patient had been treated with conventional therapy for at least, 4 months without any clinical improvement. In this sample of eyes the authors evaluated the transparency and integrity of epithelium before and after the therapy by means of a fluorescein staining test, examining the area of epithelial defect as well as the phlogistic situation and the symptoms referred by patients. Nine eyes from this group of patients were studied by impression cytology before and after 3 months of use of suspension. The follow-up was 5 months of once-weekly visits.

Results

In all patients, after 15 to 30 days the corneas became negative to fluorescein staining test and the epithelium seemed more complete and regular, there was an evident decrease of phlogistic situation in the conjunctiva, and an improvement of symptoms was referred by patients. The situation was stable during the whole follow-up. No side effects were noted. The impression cytology repeated 3 months after the treatment showed a significant corneal recovery of the cytologic situation with an important decrease of CK19 + cells on the corneal surface.

Conclusions

This new therapy, which is less traumatic than an implant of amniotic membrane, is safe, and can be repeated for a long period, could help patients with corneal superficial defects.

Interneuron-specific signaling evokes distinctive somatostatin-mediated responses in adult cortical astrocytes

The signaling diversity of GABAergic interneurons to post-synaptic neurons is crucial to generate the functional heterogeneity that characterizes brain circuits. Whether this diversity applies to other brain cells, such as the glial cells astrocytes, remains unexplored. Using optogenetics and two-photon functional imaging in the adult mouse neocortex, we here reveal that parvalbumin- and somatostatin-expressing interneurons, two key interneuron classes in the brain, differentially signal to astrocytes inducing weak and robust GABA_B receptor-mediated Ca²⁺ elevations, respectively. Furthermore, the astrocyte response depresses upon parvalbumin interneuron repetitive stimulations and potentiates upon somatostatin interneuron repetitive stimulations, revealing a distinguished astrocyte plasticity. Remarkably, the potentiated response crucially depends on the neuropeptide somatostatin, released by somatostatin interneurons, which activates somatostatin receptors at astrocytic processes. Our study unveils, in the living brain, a hitherto unidentified signaling specificity between interneuron subtypes and astrocytes opening a new perspective into the role of astrocytes as non-neuronal components of inhibitory circuits.

Overexpression of autophagic proteins in the skeletal muscle of sporadic inclusion body myositis

AIMS

Sporadic inclusion body myositis (s-IBM) is characterized by rimmed vacuole formation and misfolded protein accumulation. Intracellular protein aggregates are cleared by autophagy. When autophagy is blocked aggregates accumulate, resulting in abnormal rimmed vacuole formation. This study investigated the autophagy-lysosome pathway contribution to rimmed vacuole accumulation.

METHODS

Autophagy was studied in muscle biopsy specimens obtained from eleven s-IBM patients, one suspected hereditary IBM patient, nine patients with other inflammatory myopathies and nine non-myopathic patients as controls. The analysis employed morphometric methods applied to immunohistochemistry using the endosome marker Clathrin, essential proteins of the autophagic cascade such as AuTophaGy-related protein ATG5, splicing variants of microtubule-associated protein light chain 3a (LC3a) and LC3b, compared with Beclin 1, the major autophagy regulator of both the initiation phase and late endosome/lysosome fusion of the autophagy-lysosome pathway.

RESULTS

In muscle biopsies of s-IBM patients, an increased expression of Clathrin, ATG5, LC3a, LC3b and Beclin 1 was shown. Moreover, the inflammatory components of the disease, essentially lymphocytes, were preferentially distributed around the Beclin 1(+) myofibres. These affected myofibres also showed a moderate sarcoplasmic accumulation of SMI-31(+) phospho-tau paired helical filaments.

CONCLUSION

The overexpression of autophagy markers linked to the decreased clearance of misfolded proteins, including SMI-31, and rimmed vacuoles accumulation may exhaust cellular resources and lead to cell death.

Mutant ftsI genes in the emergence of penicillin-binding protein-mediated beta-lactam resistance in Haemophilus influenzae in Norway

The most important mechanism for beta-lactam resistance in beta-lactamase-negative ampicillin-resistant (BLNAR) isolates of Haemophilus influenzae is the alteration of penicillin-binding protein 3 (PBP3) as a result of ftsI gene mutations. The present study aimed to map PBP3 alterations and to determine the correlation to beta-lactam resistance in respiratory tract isolates of H. influenzae in Norway, as well as assess the contribution of clonal spread to the emergence of PBP3-mediated resistance. Twenty-three beta-lactamase negative respiratory tract isolates with resistance to penicillins and 23 susceptible control isolates were examined by determination of beta-lactam MICs, ftsI sequencing and molecular typing by pulsed-field gel electrophoresis (PFGE). Ampicillin MIC ranges in the resistant group and the control group were 1-2 mg/L and 0.125-0.5 mg/L, respectively. All isolates in the resistant group had the PBP3 substitution Asn526-->Lys and were thus categorized as group II low-BLNAR. No control isolate met the genetic BLNAR (gBLNAR) criteria. The PBP3 substitution patterns corresponded well to those observed in previous European studies. Eighty-three percent (19/23) of the resistant isolates belonged to two clones, demonstrating the capability of low-BLNAR strains of clonal dissemination. Combined analysis of ftsI DNA sequences and PFGE patterns revealed distinctly different ftsI alleles in genetically indistinguishable isolates and identical copies of the same ftsI allele in unrelated isolates. A possible explanation of this observation is the recombinational exchange of ftsI alleles. This phenomenon, as well as the possibility of endemic European gBLNAR strains, should be further investigated.

Preparation of donor corneas: a study of the endothelial population

PURPOSE

To quantify the endothelial damage in corneal rim excisions prepared in different ways.

METHODS

From the Imola branch of Eye Bank of Emilia Romagna, 24 corneal rim excisions which belonged to 12 pairs of enucleated eye globes were selected. The endothelial mortality was quantified by Trypan blue staining and counting the endothelial cells in a central area of about 5 square mm of each cornea. The mate corneas of each pair were prepared in two different ways: one with an epithelium-endothelium cut using a Hanna trephine with an artificial chamber and the other with an endothelium-epithelium cut using a Hanna trephine with punch. After the cut the endothelium was studied again in the same way as described above.

RESULTS

The cell mortality in the corneas before and after the epithelium-endothelium cut using the artificial chamber was increased by 0.9% and the percentage of endothelial loss was increased by 3.9+/-6.8%. In the corneas prepared with endothelium-epithelium cut using a punch the mortality before and after the cut increased by 8.8% and the percentage of endothelial loss was 20.7+/-10.9%.

CONCLUSIONS

The authors found that in terms of endothelial mortality and endothelial cell density there is less damage to the endothelial population using the epithelium-endothelium cut as compared to the endothelium-epithelium cut.

Glatiramer acetate induces pro-apoptotic mechanisms involving Bcl-2, Bax and Cyt-c in peripheral lymphocytes from multiple sclerosis patients

Apoptotic deletion of autoreactive T-cells is defective in patients with multiple sclerosis (MS). Glatiramer acetate (GA) treatment seems to restore apoptosis of detrimental T-cells. We analyzed the mitochondria membrane pro- (Bax) and anti-apoptotic (Bcl- 2) and cytosolic pro-apoptotic (Cyt-c, APAF-1) proteins expression in peripheral lymphocytes from relapsing-remitting (RR) MS patients during GA treatment. Blood samples were collected from 8 healthy controls (HCs) and from 8 RR MS patients prior to and every three months during the 9 months of GA treatment. Peripheral blood mononuclear cells (PBMNCs) Bcl-2, Bax, Cyt-c and APAF-1 were quantified by western blot followed by densitometric scanning and Bax/Bcl-2, cytosolic Cyt-c/Bcl-2 and APAF-1/Bcl-2 ratios were calculated. T-cells were in vitro tested for oxygen consumption by a respirometric analysis. Bax/Bcl-2, cytosolic Cyt-c/Bcl-2 and APAF-1/Bcl-2 ratios in untreated MS patients were significantly (p < 0.05) lower than in HCs. Bax/Bcl-2 ratio increased (p = 0.03) and Cyt-c/Bcl-2 ratio showed a trend to increase during the 9 months of GA treatment in MS patients. A reduction of 58% and 59% in oxygen consumption by PBMNCs was evident after GA treatment in vitro or when GA treated patients' cells were compared with those from HCs, respectively. Our findings suggest that GA exerts a regulatory effect on peripheral T lymphocytes through pro-apoptosis mechanisms involving mitochondria and cytosolic proteins.

Suspension made with amniotic membrane: clinical trial

PURPOSE

To investigate if a suspension made with amniotic membrane could have a beneficial effect on ocular surface diseases.

METHODS

In the Imola branch of the Eye Bank of Emilia Romagna, the authors prepared a suspension containing homogenized amniotic membrane previously conserved at -80 degrees Celsius. Subsequently, the authors gave this preparation to 21 patients: 8 had undergone lamellar keratoplasty, 4 had undergone penetrating keratoplasty, 2 had undergone photorefractive keratectomy with a delay of epithelialization, 3 had neurotrophic corneal ulcers, 2 had corneal burning, 1 had torpid corneal ulcer, and 1 had Sjogren syndrome. Each patient had been treated with conventional therapy for at least, 4 months without any clinical improvement. In this sample of eyes the authors evaluated the transparency and integrity of epithelium before and after the therapy by means of a fluorescein staining test, examining the area of epithelial defect as well as the phlogistic situation and the symptoms referred by patients. Nine eyes from this group of patients were studied by impression cytology before and after 3 months of use of suspension. The follow-up was 5 months of once-weekly visits.

RESULTS

In all patients, after 15 to 30 days the corneas became negative to fluorescein staining test and the epithelium seemed more complete and regular, there was an evident decrease of phlogistic situation in the conjunctiva, and an improvement of symptoms was referred by patients. The situation was stable during the whole follow-up. No side effects were noted. The impression cytology repeated 3 months after the treatment showed a significant corneal recovery of the cytologic situation with an important decrease of CK19+ cells on the corneal surface.

CONCLUSIONS

This new therapy, which is less traumatic than an implant of amniotic membrane, is safe, and can be repeated for a long period, could help patients with corneal superficial defects.

Laboratory handling of Helicobacter pylori critically influences the results of in-vitro metronidazole resistance determination

In-vitro metronidazole resistance rates of Helicobacter pylori determined by Etest are high, and the predictive value of metronidazole resistance is low. It was hypothesised that altered laboratory methods could reduce the overestimation of resistance and improve the predictive value of the Etest. Pre-treatment isolates (n = 150) of H. pylori from 150 patients were investigated by Etest with incubation for 72 h. Treatment with metronidazole, tetracycline and bismuth for 10 days failed to eradicate H. pylori in 23 patients. After isolate storage for 3 years, resistance determination results by agar dilution and Etest, with incubation for 72 and 31 h, were compared. The rate of metronidazole resistance was reduced significantly during storage, and instability of resistance was associated significantly with treatment outcome. Isolates that retained in-vitro resistance had significantly (p 0.008) higher treatment failure rates (n = 13; 42%) than isolates that lost resistance (n = 3; 9%). The reproducibility achieved by dual testing with agar dilution and Etest was 41% and 70% for +/- 1 and +/- 2 log2 dilutions, respectively, after incubation for 72 h, and 85% and 92%, respectively, after incubation for 31 h. Thus, the predictive value was improved from 25% to 50% by the altered laboratory conditions (p 0.04). MIC values of 2-8 mg/L signified an intermediate risk of treatment failure.

Congenital heart disease in a patient with microform cleft lip

OBJECTIVE

Microform cleft lip (MCL), also known as congenital healed cleft lip, is a rare anomaly that is thought to be a spontaneously healed variant of the more common clefting of lip and palate. Although conventional clefting is known to be associated with congenital heart disease (CHD), MCL has not been similarly associated. We present one patient with MCL and CHD in the form of coarctation of the aorta, an association not previously described.

CONCLUSION

As is done in patients with cleft lip, cleft palate, or both, patients with MCL should be carefully examined for evidence of CHD and referred to a pediatric cardiologist if deemed advisable.

[Presence of plant sterols in the diet and the hypocholesterolemic effects of plant sterols]

BACKGROUND

A high intake of fat, and in particular saturated fat, is associated with an increased risk of coronary heart disease. Reduced intake of spreads had therefore generally been recommended. A special type of "heart-friendly" margarine, a plant sterol enriched margarine, has been a commercial success since it was introduced in 1995. Such margarine may be defined as a functional food, and is not available in Norway. The aim of this article is to give an overview of plant sterols and their distribution in different foods as well as of their hypocholesterolaemic effects.

MATERIAL AND METHODS

The Medline database was used to identify relevant literature.

RESULTS

An intake of 2-3 grams of plant sterols/day is associated with a 10% reduction of total cholesterol and a 13-15% reduction of LDL cholesterol, whereas HDL cholesterol remains largely unchanged. This amount of plant sterols may be incorporated into approximately 20 grams of margarine. Subjects that are poor responders to treatment with statins may benefit from such margarine, and also children with familial hypercholesterolaemia. Such margarine may have a potential in addition to dietary treatment, as an additional hypocholesterolaemic effect is observed in subjects who already have a healthy diet.

INTERPRETATION

A daily intake of approximately 20 grams of plant sterol enriched margarine is associated with significant reductions of both total and LDL cholesterol. However, use of plant sterol enriched margarine can not replace the overall beneficial effects of a well balanced heart-friendly diet.

Assessment of optimal atmospheric conditions for growth of Helicobacter pylori

The number and diameter of colonies of Helicobacter pylori isolates growing on agar plates were determined to compare five methods that produce a culture atmosphere. No catalyst was applied. No significant difference was found between two hydrogen-based kits that have a different capacity for production of H2. These hydrogen-based methods were significantly better than all others evaluated, including one kit that produces ascorbic acid that binds with oxygen. Growth was significantly improved when the atmosphere outside the plastic incubation jars was enriched with 10% CO2, but carbon dioxide enrichment alone (i.e., no reduction of the oxygen concentration) gave a very poor yield. The colony diameter was a sensitive and reliable measure of atmospheric conditions, as the mean intra- and interobserver difference between repeated readings was < or = 0.1 mm for 82% and < or = 0.2 mm for 95% of the isolates.

Soy sterol esters and beta-sitostanol ester as inhibitors of cholesterol absorption in human small bowel

BACKGROUND

Plant sterols are natural dietary components with serum cholesterol-lowering properties. The lowering of serum cholesterol by plant sterols is believed to be the result of an inhibition of cholesterol absorption in the small bowel, although increased bile acid excretion has also been suggested. The difference in effect of saturated and unsaturated plant sterols on cholesterol absorption needs to be elucidated further.

OBJECTIVE

The primary aim of this study was to measure small-bowel cholesterol absorption and sterol excretion in addition to hepatic cholesterol synthesis after intake of soy sterol esters and beta-sitostanol ester corresponding to 1.5 g plant sterols/d.

DESIGN

Seven ileostomy subjects were studied during a control period and 2 intervention periods when either soy sterol esters or beta-sitostanol ester was added to a basal diet. Ileostomy bags were collected every other hour and frozen immediately for analysis of nutrients and sterols.

RESULTS

Cholesterol absorption was 56% (43-65%) in the control period and decreased to 38% (32-46%) in the soy sterol ester period (P = 0.00) and to 39% (30-48%) in the beta-sitostanol ester period (P = 0.00).

CONCLUSION

Esterified soy sterols and beta-sitostanol inhibited cholesterol absorption equally, despite the different structures of the plant sterols.

Postprandial lipemia in relation to sterol and fat excretion in ileostomy subjects given oat-bran and wheat test meals

To investigate the mechanisms behind the serum cholesterol-lowering effect of oat fiber, we simultaneously measured postprandial lipid responses, serum lathosterol concentrations, and small bowel excretion of fat and sterols in ileostomy subjects given test meals high or low in oat fiber. Six ileostomy subjects (three women and three men) were served an oat-bran test meal (OB; 16.3 g fiber) and a wheat test meal (6.3 g fiber) in random order. After the postprandial 7-h period, a controlled, low-fat, cholesterol-free diet was served and ileostomy effluent was sampled throughout the 24-h period. Bile acid and fat excretion (24 h) increased by 93% and 146%, respectively (P < 0.05), and total and endogenous cholesterol excretion decreased by 14% and 19%, respectively (P < 0.05), after the OB test meal. The change in hepatic cholesterol synthesis was strongly related to the change in bile acid excretion (Spearman r = 0.89, P < 0.02). The postprandial chylomicron lipid concentration tended to be lower after the OB test meal (-43% for cholesterol, P = 0.07) whereas there was no difference in cholesterol absorption measured by isotope in five subjects. The main effect of the viscous oat beta-glucan seems to be related to increased bile acid excretion and subsequent changes in synthesis and endogenous excretion of cholesterol. An additional effect may have been a delay in the micellar lipid solubilization process and a consequent reduction in the secretion of chylomicrons into the circulation.

A simple method for determining metronidazole resistance of Helicobacter pylori

The reliability of methods for determination of Helicobacter pylori resistance to metronidazole has been found to depend upon the incubation time. Because the disk diffusion method is more vulnerable than other methods to prolonged incubation, this method has not been recommended for H. pylori. However, because media designed for rapid growth of H. pylori have been introduced, the time has come to look at the clinical usefulness of this inexpensive and simple method again. The correlation of readings obtained with the E test (AB Biodisk, Solna, Sweden) and Rosco's (Taastrup, Denmark) disk diffusion method for in vitro metronidazole resistance determination for H. pylori with a short incubation time (24 to 31 h) was studied. Plates which could not be read after 24 to 31 h were reincubated for another night. Fifty-seven consecutive clinical strains were tested. Because the rate of regrowth of H. pylori depends upon the age of the colonies inoculated, the reproducibility of resistance test results for young colonies versus old colonies was also studied. Resistance plates could be read after 24 to 31 h of incubation for 28 of 29 strains when the inoculum consisted of young colonies (3 to 4 days old). For these 29 strains, a high correlation (r = -0.937) was found between results obtained with the E test and those obtained with the disk diffusion test. A poorer correlation was found for old colonies (> or = 5 days old) (r = -0.742), which required a prolonged incubation for 8 of 23 strains. In conclusion, short incubation was successfully applied with young colonies. Results obtained with the simple and inexpensive disk diffusion method correlated well with those obtained with the E test.

Mixed-linked beta-glucan from breads of different cereals is partly degraded in the human ileostomy model

The purpose of this investigation was to study the degradation of beta-glucan in the small intestine and the molecular weight of beta-glucan in the excreta of nine ileostomy subjects after consumption of different diets based on bread made with oat bran (oat bread), a fiber-rich barley fraction (barley bread), or wheat flour (wheat bread) as the main ingredients. Oat bread with enzymatically degraded beta-glucan was also used (oat + enzyme bread). The beta-glucan intake from the four diets was 12.5, 12.9, 1.1, and 4.0 g/d, respectively. On the basis of dry matter, the night effluents accounted for approximately 15% of the total amount of the excreta, with the highest proportion (22%) being for the wheat-bread diet. A notable loss of beta-glucan (0.7-2.4 g/d, or 13-64%) was found when intake was compared with excretion. In vitro, a higher viscosity development with time for dispersions of oat bread compared with barley bread was noted, which could be related to the higher molecular weight of the beta-glucan in this bread. There seemed to be a depolymerization of the beta-glucan both during bread making and transit through the upper gastrointestinal tract.

Substrates available for colonic fermentation from oat, barley and wheat bread diets. A study in ileostomy subjects

Nutrients not absorbed in the small bowel will form substrates for microbial growth in the colon which may have implication for the development of colon cancer. The aim of the present study was to investigate whether fibre-rich oat and barley diets increase the excretion of energy-supplying nutrients from the small bowel compared with a low-fibre wheat diet, and whether a possible increase could be related to the beta-glucan content. Nine ileostomy subjects were served four types of bread together with a low-fibre basal diet (12 g dietary fibre/d). The breads were based on either wheat flour (W diet, 7 g dietary fibre/d), oat bran (OB diet, 29 g dietary fibre/d), the same amount of oat bran with addition of beta-glucanase (EC 3.2.1.4) (OBE diet, 19 g dietary fibre/d) or a fibre-rich barley fraction (B diet, 35 g dietary fibre/d). An increased ileal excretion of starch was observed with the barley diet but no effect of the oat beta-glucan on starch recovery was found. The NSP + Klason lignin in the ileostomy effluents accounted only for 24, 31, 24 and 35% of the gross energy excretion in the W, OB, OBE and B diet periods respectively. A large part of the dry weight and energy (30, 21, 28 and 27%, in the W, OB, OBE and B diets respectively) in the effluents could not be identified as fat, protein, total starch or NSP + Klason lignin. This unidentified part was probably made up of oligosaccharides, endogenous losses and nutrient complexes. Methods for identifying and analysing these components should be developed and their role as substrates for colonic fermentation and colon cancer development ought to be investigated.

Oat beta-glucan increases bile acid excretion and a fiber-rich barley fraction increases cholesterol excretion in ileostomy subjects

The purpose of this study was to investigate whether oat beta-glucan is responsible for the increased bile acid excretion previously observed with oat-fiber diets. The excretion patterns in ileostomy subjects given diets containing oat-bran bread with and without added beta-glucanase, a beta-glucan-degrading enzyme, were compared. The effect of a beta-glucan-rich barley fraction on sterol excretion was also investigated. Nine ileostomy subjects were served four diets in random order, each diet for 2 consecutive days. Four different kinds of bread, mainly made from oat bran (OB diet, 12.5 g beta-glucan/d), oat bran with beta-glucanase (OBE diet, 3.8 g beta-glucan/d), barley (B diet, 13.0 g beta-glucan/d), or wheat flour (W diet, 1.2 g beta-glucan/d) were added to a basal diet. The 24-h excretion of bile acids was 53% higher in the OB diet period than in the OBE diet period (P < 0.05) and also was significantly higher than in the B and W diet periods (P < 0.05). Median (range) bile acid excretion was 851 (232-1550), 463 (123-1414), 755 (133-1187), and 606 (101-980) mg/d in the OB, OBE, B, and W diet periods, respectively. The excretion of cholesterol was significantly higher in the B diet period than in the OBE and W diet periods (P < 0.05), but the mechanism behind this effect of barley fiber is unknown. In oat bran, however, beta-glucan mediates an increase in bile acid excretion, which most probably explains the effect of oat fiber in lowering serum lipids.