Genetic variants affecting NQO1 protein levels impact the efficacy of idebenone treatment in Leber hereditary optic neuropathy

Idebenone, the only approved treatment for Leber hereditary optic neuropathy (LHON), promotes recovery of visual function in up to 50% of patients, but we can neither predict nor understand the non-responders. Idebenone is reduced by the cytosolic NAD(P)H oxidoreductase I (NQO1) and directly shuttles electrons to respiratory complex III, bypassing complex I affected in LHON. We show here that two polymorphic variants drastically reduce NQO1 protein levels when homozygous or compound heterozygous. This hampers idebenone reduction. In its oxidized form, idebenone inhibits complex I, decreasing respiratory function in cells. By retrospectively analyzing a large cohort of idebenone-treated LHON patients, classified by their response to therapy, we show that patients with homozygous or compound heterozygous NQO1 variants have the poorest therapy response, particularly if carrying the m.3460G>A/MT-ND1 LHON mutation. These results suggest consideration of patient NQO1 genotype and mitochondrial DNA mutation in the context of idebenone therapy.

Comparison of nurse attended and unattended automated office blood pressure with conventional measurement techniques in clinical practice

Accuracy in blood pressure measurement is critical for proper hypertension diagnosis and treatment in clinical practice. Automated office blood pressure (AOBP) can simplify the measurement process, reducing human error and minimizing the white-coat effect in the unattended mode. The aim of this study was to compare AOBP, both unattended and nurse attended, with conventional office and out-of-office blood pressure measurement techniques. Four different methods of blood pressure measurement were performed in a cohort of hypertensive patients: conventional office blood pressure (OBP), unattended automated office blood pressure (uAOBP), nurse attended automated office blood pressure (nAOBP), and home blood pressure monitoring (HBPM). uAOBP and nAOBP were conducted with the same rigorous standardized procedure. We enrolled 118 consecutive patients. nAOBP values were slightly higher than uAOBP ones (respectively 132.8/73.3 ± 19.4/12.9 and 129.2/71.1 ± 19.0/12.3 mmHg), even if the difference was influenced by order of execution of AOBP measurement. nAOBP was significantly lower than HBPM and OBP (mean values 135.2/80.9 ± 16.6/8.1 and 140.9/84.6 ± 18.7/10.8 mmHg, respectively). AOBP, either attended or unattended, provides lower values than conventional OBP. uAOBP and nAOBP values showed small differences, even if they are not completely interchangeable. This evidence reflects a lower white-coat effect, even in nurse attended technique, but is also due to a lower measurement error through the application of a rigorous standardized protocol.

P-009 A novel sperm selection technique using a progesterone gradient

Study question

Is it possible to select spermatozoa using progesterone gradients? Does chemotaxis improve sperm selection compared to a classical density gradient or swim up?

Summary answer

Spermatozoa selected using progesterone gradients yield higher percentages of high quality spermatozoa with lower DNA fragmentation and better morphology compared to classic sperm selection.

What is known already

There are few studies which aim at improving sperm selection, even though it is known to be a vital parameter for IVF success. DNA integrity is fundamental for embryo development although it is currently underestimated.

Progesterone has been suggested to be a major chemoattractant for spermatozoa in the fallopian tubes and therefore using gradients in a clinical setting may lead to a more physiologically improved selection method.

Study design, size, duration

19 normo spermic patients (according to W.H.O. parameters) were selected. After standard semen analysis the sample was split in two halves. One half was treated using classical swim up and the remaining half was treated on a progesterone gradient. The treated samples were then tested for fragmentation, motility and morphology. Sperm motility was analyzed using SCA computer system. DNA fragmentation using the TUNEL assay.

Participants/materials, setting, methods

The patients enrolled in the study were all normospermic. The results were compared using ANOVA one way. Progesterone gradients was obtaining using an horizontal density gradients with added progesterone.

Main results and the role of chance

The percentages of rapid progressive spermatozoa were 12,89 ± 4,50%; 56,37 ± 13,61% and 29,84±12,52% in the untreated sample (US), treated sample (TS) and control group (C)respectively; p < 0,005. Normal sperm morphology rates were 3,474 ± 1,46; 5,500 ±1,57 and 3,684 ± 1,15 in US, TS and C respectively. Sperm fragmentation rates were 9,77 ± 9,012,50 ± 2,66 and 7,94 ± 6,68 in US, TS and C respectively.

Limitations, reasons for caution

The number of normospermic patients enrolled in the study was limited. Moreover, the sperm concentration obtained in this kind of selection is lower than in the conventional techniques and therefore may be harder to use in patients with a very low sperm count.

Wider implications of the findings

Our data shows a significant improvement in sperm selection using chemotaxis gradient compared to the control group by all the parameters considered in this study. Chemotaxis gradients may be useful in a clinical setting to improve spermatozoa selection, lowering the rates of sperm with damaged DNA potentially increasing embryo quality.

Trial registration number

Not applicable

A structured physical activity program in an adolescent population with overweight and obesity: a prospective interventional study

BACKGROUND

Obesity is a significant health problem, with increasing involvement of young population worldwide. The aim of this study was to evaluate the effects of two different types of physical exercise (resistance vs combined aerobic-resistance) on cardiovascular and anthropometric profile of a sample of sedentary adolescents with overweight and obesity.

METHODS

After undergoing clinical, cardiovascular and anthropometric-metabolic evaluation (T0), subjects with overweight and obesity were randomized to a 6-months resistance or combined aerobic-resistance training program. Clinical, cardiovascular and anthropometric-metabolic evaluations were repeated after 6 months of training (T1) and after 3 months of detraining (T2).

RESULTS

Thirty adolescents with overweight/obesity were enrolled; 20 subjects completed training program. A significant improvement in body composition was detected after 6 months, with a reduction of BMI (32.1 [30.5-34.4] vs 31.1 [29.6-33.4] kg/m2, p=0.02) and adipose tissue (45.5 [41.1-49.7] vs 41.6 [37.0-49.2] Kg, p<0.01). A reduction in Diastolic blood pressure (75.5 ± 8.9 vs 68.2 ± 6.4 mmHg, p=0.02) and Pulse Wave Velocity (5.7 [5.1-5.9] vs 5.2 [4.7-5.7] m/s, p=0.04) was also observed. Persistence of the effect on the most important parameters was observed also after detraining period.

CONCLUSIONS

Regular physical exercise induces positive metabolic and cardiovascular effects, with persistence also after brief discontinuation. Novelty bullets. Physical exercise induces positive effect on cardiovascular risk profile. Positive effects persist also after brief discontinuation. Physical exercise reduces early signs of autonomic disfunction.

Knowledge on arterial hypertension in general population: Results from a community pharmacy screening program

BACKGROUNDS AND AIMS

Hypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers.

METHODS AND RESULTS

A questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03).

CONCLUSION

Knowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.

DAAM1 and PREP are involved in human spermatogenesis

During differentiation of the male gamete, there is a massive remodelling in the shape and architecture of all the cells in the seminiferous epithelium. The cytoskeleton, as well as many associated proteins, plays a pivotal role in this process. To better characterise the factors involved, we analysed two proteins: the formin, dishevelled-associated activator of morphogenesis 1 (DAAM1), which participates in the regulation of actin polymerisation, and the protease, prolyl endopeptidase (PREP), engaged in microtubule-associated processes. In our previous studies we demonstrated their involvement in cytoskeletal dynamics necessary for correct postnatal development of the rat testis. Here, we used samples of testicular tissue obtained from infertile men by testicular sperm extraction and the spermatozoa of asthenoteratozoospermic patients. By western blot and immunofluorescent analysis, we found that DAAM1 and PREP expression and localisation were impaired in both the testis and spermatozoa, and in particular in the midpiece as well as in the principal and end-pieces of the flagella, as compared with spermatozoa of normospermic men. Our results provide new knowledge of the dynamics of spermatogenesis, raising the possibility of using DAAM1 and PREP as new markers of normal fertility.

First evidence of DAAM1 localization in mouse seminal vesicles and its possible involvement during regulated exocytosis

Dishevelled-associated activator of morphogenesis 1 (DAAM1) is a protein belonging to the formin family, which regulates, together with the small GTPase RhoA, the nucleation and the assembly of actin fibres through Wnt-Dishevelled PCP pathway. Its role has been investigated in essential biological processes, such as cell polarity, movement and adhesion during morphogenesis and organogenesis. In this work, we studied the expression of DAAM1 mRNA and protein by PCR and Western blot analyses and its co-localization with actin in adult mouse seminal vesicles by immunofluorescence. We show that both proteins are cytoplasmic: actin is evident at cell-cell junctions and at cell cortex; DAAM1 had a more diffused localization, but is also prominent at the apical plasmatic membrane of epithelial cells. These findings support our hypothesis of a role of DAAM1 in cytoskeletal rearrangement that occurs during the exocytosis of secretory vesicles, and in particular concerning actin filaments. We were also able to detect DAAM1 and actin association in the smooth muscle cells that surround the epithelium too. In this case, we could only speculate the possible involvement of this formin in muscular cells in the maintenance and the regulation of the contractile structures. The present results strongly suggest that DAAM1 could have a pivotal role in vesicle exocytosis and in the physiology of mouse seminal vesicles.

Temporal and spatial expression of insulin-like peptide (insl5a and insl5b) paralog genes during the embryogenesis of Danio rerio

Relaxin (RLN) and insulin (INSL)-like peptides are member of the INSL/RLN superfamily, which are encoded by seven genes in humans and can activate the G-protein coupled receptor RXFP 1-4. These peptides evolved from a common ancestor, RLN3-like gene. Two rounds of whole genome duplication (WGD) in early vertebrate evolution, together with an additional WGD in the teleost lineage, caused an expansion of RLN genes set in the genome of Danio rerio. In particular, six RLN genes are present: a single copy of rln and insl3 genes, and two paralogs for the rln3 gene (rln3a and rln3b), and the insl5 gene (insl5a and insl5b). We have already reported the presence of rln3a and rln3b genes in the developing zebrafish brain, as well as the expression of rln gene in the developing zebrafish brain and extraneural territories, such as thyroid gland and pancreas. Here, we report for the first time the expression of the two parologs genes for insl5, insl5a, and insl5b in D. rerio embryonic development. The corresponding transcripts of both the paralogs are present in all embryonic stages analyzed by RT-qPCR. In situ hybridization analyses showed a restricted signal in intestinal cells and the pancreatic region at 72 hpf for insl5a, while at 96 hpf both genes are expressed in specific intestinal cells. Furthermore, in adult zebrafish intestine tissue, in situ hybridation experiments showed that insl5a transcript is specifically localized in the goblet cells, while insl5b transcript is in enteroendocrine cells. These data revealed a high degree of gene expression pattern conservation for such genes in vertebrate evolution.

Chronic activation of the D2 autoreceptor inhibits both glutamate and dopamine synapse formation and alters the intrinsic properties of mesencephalic dopamine neurons in vitro

Dysfunctional dopamine (DA)-mediated signaling is implicated in several diseases including Parkinson's disease, schizophrenia and attention deficit and hyperactivity disorder. Chronic treatment with DA receptor agonists or antagonists is often used in pharmacotherapy, but the consequences of these treatments on DA neuron function are unclear. It was recently demonstrated that chronic D2 autoreceptor (D2R) activation in DA neurons decreases DA release and inhibits synapse formation. Given that DA neurons can establish synapses that release glutamate in addition to DA, we evaluated the synapse specificity of the functional and structural plasticity induced by chronic D2R activation. We show that chronic activation of the D2R with quinpirole in vitro caused a parallel decrease in the number of dopaminergic and glutamatergic axon terminals. The capacity of DA neurons to synthesize DA was not altered, as indicated by the lack of change in protein kinase A-mediated Ser(40) phosphorylation of tyrosine hydroxylase. However, the spontaneous firing rate of DA neurons was decreased and was associated with altered intrinsic properties as revealed by a prolonged latency to first spike after release from hyperpolarization. Moreover, D2R function was decreased after its chronic activation. Our results demonstrate that chronic activation of the D2R induces a complex neuronal reorganization involving the inhibition of both DA and glutamate synapse formation and an alteration in electrical activity, but not in DA synthesis. A better understanding of D2R-induced morphological and functional long-term plasticity may lead to improved pharmacotherapy of DA-related neurological and psychiatric disorders.

Modulation by C2 ceramide of the nicotinic transmission within the coeliac ganglion in the rabbit

We have investigated the modulation by ceramide of the nicotinic activation of the prevertebral sympathetic neurons. Our study was performed in vitro in rabbit isolated coeliac ganglion, using intracellular recording techniques. We have used C(2) ceramide, a permeant analog of ceramide. The effects of C(2) ceramide were first assessed when nicotinic activation was elicited without modulatory mechanisms (fast excitatory postsynaptic potentials triggered by stimulation of the thoracic splanchnic nerves with a single pulse). In all the neurons tested, C(2) ceramide triggered an increase in the amplitude of the fast excitatory postsynaptic potentials demonstrating a direct facilitatory effect on the nicotinic activation. We then investigated the effects of C(2) ceramide on modulatory mechanisms of this activation. These mechanisms occur when a train of pulses of supramaximum intensity is applied on the splanchnic nerves. During the train, a gradual depression of fast nicotinic activation occurred: the pulses failed to systematically elicit action potentials. We have previously demonstrated that this regulatory phenomenon is partly modulated by nitric oxide which exerts a dual effect: facilitation or inhibition of the nicotinic activation. In all the neurons tested, C(2) ceramide decreased the number of action potentials fired during a train of pulses, demonstrating an indirect inhibitory effect on the nicotinic activation. The use of 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (nitric oxide scavenger) suppressed the inhibitory effect of C(2) ceramide, demonstrating that this effect is mediated through the nitric oxide pathway. C(2) dihydro-ceramide, an inactive analog of ceramide, was without effect on the nicotinic activation of the ganglionic neurons. These results demonstrate that ceramide exerts a complex modulation of the nicotinic activation of the prevertebral neurons: direct facilitation and indirect inhibition involving the nitric oxide pathway. In fact, C(2) ceramide plays a key gating role in the dual effect of the nitric oxide pathway by activating the inhibitory effect. The existence of this gating mechanism involving ceramide and nitric oxide opens new perspectives in terms of our understanding of the modulation of synaptic transmission within the prevertebral ganglia. Our study demonstrates that sphingolipids are involved in complex modulations of the synaptic activation within the prevertebral ganglia, and thus contribute to their integrative properties.

Evidence for a recessive inheritance of Turcot's syndrome caused by compound heterozygous mutations within the PMS2 gene

Turcot's syndrome is a genetic disease characterized by the concurrence of primary brain tumors and colon cancers and/or multiple colorectal adenomas. We report a Turcot family with no parental consanguinity, in which two affected sisters, with no history of tumors in their parents, died of a brain tumor and of a colorectal tumor, respectively, at a very early age. The proband had a severe microsatellite instability (MIN) phenotype in both tumor and normal colon mucosa, and mutations in the TGFbeta-RII and APC genes in the colorectal tumor. We identified two germline mutations within the PMS2 gene: a G deletion (1221delG) in exon 11 and a four-base-pair deletion (2361delCTTC) in exon 14, both of which were inherited from the patient's unaffected parents. These results represent the first evidence that two germline frameshift mutations in PMS2, an MMR gene which is only rarely involved in HNPCC, are not pathogenic per se, but become so when occurring together in a compound heterozygote. The compound heterozygosity for two mutations in the PMS2 gene has implications for the role of protein PMS2 in the mismatch repair mechanism, as well as for the presymptomatic molecular diagnosis of at-risk family members. Furthermore, our data support and enlarge the notion that high DNA instability in normal tissues might trigger the development of cancer in this syndrome.

Coeliac disease and unfavourable outcome of pregnancy

BACKGROUND

Up to 50% of women with untreated coeliac disease experience miscarriage or an unfavourable outcome of pregnancy. In most cases, after 6-12 months of a gluten free diet, no excess of unfavourable outcome of pregnancy is observed. The prevalence of undiagnosed coeliac disease among pregnant women is not known.

AIM

To determine the prevalence of untreated coeliac disease among women attending the obstetrics-gynaecological department.

METHODS

Endomysial antibodies, which are specific and sensitive for coeliac disease, were evaluated in all women attending the obstetrics-gynaecology department of a large city hospital over a 90 day period.

RESULTS

Of 845 pregnant women screened, 12 were identified as having coeliac disease. Three had previously been diagnosed but were not following a gluten free diet. The remaining nine underwent a small intestinal biopsy, which confirmed the diagnosis. The outcome of pregnancy was unfavourable in seven of these 12 women. Six healthy babies were born with no problems after the women had been on a gluten free diet for one year.

CONCLUSIONS

Overall, 1 in 70 women was affected by coeliac disease, either not diagnosed (nine cases) or not treated (three cases). Their history of miscarriages, anaemia, low birth weight babies, and unfavourable outcome of pregnancy suggests that testing for coeliac disease should be included in the battery of tests prescribed for pregnant women. Coeliac disease is considerably more common than most of the diseases for which pregnant women are routinely screened. Unfavourable events associated with coeliac disease may be prevented by a gluten free diet.

Fluconazole treatment of neonates and infants with severe fungal infections not treatable with conventional agents

Fluconazole was evaluated prospectively in 40 neonates and infants between the ages of 2 days and 3 months in whom conventional antifungal therapy was ineffective or contraindicated. The patients received therapy on an individual compassionate request basis for microbiologically documented or presumed fungal infection. The mean fluconazole dosage was 5.3 mg/kg/day (range 1-16 mg/kg/day) and the mean duration of therapy was 26 days (range 2-80 days). Efficacy was evaluated in neonates with proven fungal infection as documented by the presence of a pathogen at baseline. A positive clinical response was achieved in 97% (31/32) of the clinically evaluable patients; eradication of the fungal organism was achieved in 97% (30/31) of evaluable patients. Adverse events occurred in two patients (5%); therapy was not discontinued in either patient. These favorable safety and efficacy data are similar to results obtained with fluconazole in older children and adults.

Fluconazole treatment of children with severe fungal infections not treatable with conventional agents

Fluconazole was evaluated prospectively in 173 children aged between 4 months and 16 years in whom conventional antifungal therapy was ineffective or contraindicated. Children entered the study on an individual compassionate request basis for treatment of confirmed or presumed fungal infection or for prophylaxis of fungal infections. Sixty-two children had cancer, 40 had undergone transplantation, 14 had AIDS and 52 had other conditions. The mean fluconazole dosage was 3.4 mg/kg/day (range 0.16-11.1 mg/kg/day) and the mean duration of therapy was 36 days (range 1-340 days). Efficacy was evaluated in 63 children with confirmed fungal infection as documented by the presence of a fungal pathogen at baseline; clinical cure or improvement was achieved in 83% (52/63), pathogen eradication in 73% (43/59). All 173 children were assessed for safety. Related or possibly related adverse events occurred in 6% (11/173) of patients; seven children were withdrawn from therapy because of adverse events. Results of this study demonstrate that the clinical efficacy and safety profile of fluconazole in the treatment of fungal infections in children are favorable, results being similar to those obtained in adults.