Autonomous requirements of the Menkes disease protein in the nervous system

Menkes disease is a fatal neurodegenerative disorder arising from a systemic copper deficiency caused by loss-of-function mutations in a ubiquitously expressed copper transporter, ATP7A. Although this disorder reveals an essential role for copper in the developing human nervous system, the role of ATP7A in the pathogenesis of signs and symptoms in affected patients, including severe mental retardation, ataxia, and excitotoxic seizures, remains unknown. To directly examine the role of ATP7A within the central nervous system, we generated Atp7a(Nes) mice, in which the Atp7a gene was specifically deleted within neural and glial cell precursors without impairing systemic copper homeostasis, and compared these mice with the mottled brindle (mo-br) mutant, a murine model of Menkes disease in which Atp7a is defective in all cells. Whereas mo-br mice displayed neurodegeneration, demyelination, and 100% mortality prior to weaning, the Atp7a(Nes) mice showed none of these phenotypes, exhibiting only mild sensorimotor deficits, increased anxiety, and susceptibility to NMDA-induced seizure. Our results indicate that the pathophysiology of severe neurological signs and symptoms in Menkes disease is the result of copper deficiency within the central nervous system secondary to impaired systemic copper homeostasis and does not arise from an intrinsic lack of ATP7A within the developing brain. Furthermore, the sensorimotor deficits, hypophagia, anxiety, and sensitivity to NMDA-induced seizure in the Atp7a(Nes) mice reveal unique autonomous requirements for ATP7A in the nervous system. Taken together, these data reveal essential roles for copper acquisition in the central nervous system in early development and suggest novel therapeutic approaches in affected patients.

Effects of endothelial growth media on proepicardial cell gene expression and morphogenesis in 3D collagen matrices

Proepicardial cells (PE) contribute to embryonic coronary vessel and epicardial development. Cells from the PE region can differentiate into coronary vascular smooth muscle cells and fibroblasts in vitro, but the endothelial specification capability of these cells is controversial. We sought to examine the effects of endothelial cell growth media on gene expression and the morphogenic properties of proepicardial cells in three-dimensional (3D) matrices. A primary culture of avian PE cells was subjected to molecular characterization with selected endothelial specific markers. Morphogenic properties of PE cells were assessed by in vitro assays of coronary vasculogenesis and invasion, which utilized highly defined, serum free, three-dimensional matrix conditions. PE cells maintained mixed cell population properties in the culture based on morphogenic features, immunohistochemistry, and the gene expression data. When suspended in a 3D vasculogenesis in vitro assay, PE cells formed intracellular vacuoles and assembled into multicellular tubes. Further, ultrastructural analysis revealed the presence of pinocytic vacuoles, intercellular junctions, and endothelial specific Weibel Palade bodies. In the invasion assay, PE cells spontaneously invaded control matrices. This invasion was markedly enhanced by lysophosphatidic acid (94±9.6 vs. 285.6±54.9, p<0.05) and was completely blocked with synthetic broad-spectrum metalloproteinase inhibitor GM6001. Isolated PE cells grown in endothelial cell media represent mixed-cell population, characterized by both smooth muscle and endothelial gene expression. When placed in 3D in vitro assays, PE cells manifest morphogenic properties, including multicellular tube assembly and invasion.

How healthcare professionals contribute to hope in patients with cancer

PURPOSE/OBJECTIVES

To explore whether healthcare professionals influence the level of hope in patients with cancer and, if so, how they influence their hope.

DESIGN

Descriptive, qualitative design.

SETTING

An adult hematology/oncology unit in the upper midwestern United States.

SAMPLE

Thirty-two men and women receiving active or supportive treatment or palliative care for cancer.

METHODS

Semistructured interviews conducted in the participants' hospital rooms. Ten investigators and two consultants transcribed and analyzed the interview data using content analysis. They identified themes and subthemes that described healthcare professionals' roles.

MAIN RESEARCH VARIABLES

Healthcare professionals' contributions to hope as described by patients with cancer.

FINDINGS

Healthcare professionals positively and negatively influenced hope in this sample. Hope was facilitated by being present, giving information, and demonstrating caring behaviors. Negative influences on hope primarily concerned the way in which healthcare professionals gave information.

CONCLUSION

Healthcare professionals do influence patients' perceptions of their hope. Although most nursing actions are hope enhancing, nurses can reduce a patient's sense of hope if information provided or attitude toward the patient is insensitive or disrespectful.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can increase patients' hope by being present, taking time to talk, and being helpful. They must provide information and answer questions in a compassionate, positive, honest, and respectful manner. Caring behaviors such as thoughtful gestures, showing warmth and genuineness, and being friendly and polite also increase patients' hope.