Loss of Lipid Carrier ApoE Exacerbates Brain Glial and Inflammatory Responses after Lysosomal GBA1 Inhibition

Tightly regulated and highly adaptive lipid metabolic and transport pathways are critical to maintaining brain cellular lipid homeostasis and responding to lipid and inflammatory stress to preserve brain function and health. Deficits in the lipid handling genes APOE and GBA1 are the most significant genetic risk factors for Lewy body dementia and related dementia syndromes. Parkinson's disease patients who carry both APOE4 and GBA1 variants have accelerated cognitive decline compared to single variant carriers. To investigate functional interactions between brain ApoE and GBA1, in vivo GBA1 inhibition was tested in WT versus ApoE-deficient mice. The experiments demonstrated glycolipid stress caused by GBA1 inhibition in WT mice induced ApoE expression in several brain regions associated with movement and dementia disorders. The absence of ApoE in ApoE-KO mice amplified complement C1q elevations, reactive microgliosis and astrocytosis after glycolipid stress. Mechanistically, GBA1 inhibition triggered increases in cell surface and intracellular lipid transporters ABCA1 and NPC1, respectively. Interestingly, the absence of NPC1 in mice also triggered elevations of brain ApoE levels. These new data show that brain ApoE, GBA1 and NPC1 functions are interconnected in vivo, and that the removal or reduction of ApoE would likely be detrimental to brain function. These results provide important insights into brain ApoE adaptive responses to increased lipid loads.

Viral-like TLR3 induction of cytokine networks and α-synuclein are reduced by complement C3 blockade in mouse brain

Inflammatory processes and mechanisms are of central importance in neurodegenerative diseases. In the brain, α-synucleinopathies such as Parkinson's disease (PD) and Lewy body dementia (LBD) show immune cytokine network activation and increased toll like receptor 3 (TLR3) levels for viral double-stranded RNA (dsRNA). Brain inflammatory reactions caused by TLR3 activation are also relevant to understand pathogenic cascades by viral SARS-CoV-2 infection causing post- COVID-19 brain-related syndromes. In the current study, following regional brain TLR3 activation induced by dsRNA in mice, an acute complement C3 response was seen at 2 days. A C3 splice-switching antisense oligonucleotide (ASO) that promotes the splicing of a non-productive C3 mRNA, prevented downstream cytokines, such as IL-6, and α-synuclein changes. This report is the first demonstration that α-synuclein increases occur downstream of complement C3 activation. Relevant to brain dysfunction, post-COVID-19 syndromes and pathological changes leading to PD and LBD, viral dsRNA TLR3 activation in the presence of C3 complement blockade further revealed significant interactions between complement systems, inflammatory cytokine networks and α-synuclein changes.

The neuronal ceroid lipofuscinosis protein Cln7 functions in the postsynaptic cell to regulate synapse development

The neuronal ceroid lipofuscinoses (NCLs) are a group of fatal, monogenic neurodegenerative disorders with an early onset in infancy or childhood. Despite identification of the genes disrupted in each form of the disease, their normal cellular role and how their deficits lead to disease pathology is not fully understood. Cln7, a major facilitator superfamily domain-containing protein, is affected in a late infantile-onset form of NCL. Cln7 is conserved across species suggesting a common function. Here we demonstrate that Cln7 is required for the normal growth of synapses at the Drosophila larval neuromuscular junction. In a Cln7 mutant, synapses fail to develop fully leading to reduced function and behavioral changes with dysregulation of TOR activity. Cln7 expression is restricted to the post-synaptic cell and the protein localizes to vesicles immediately adjacent to the post-synaptic membrane. Our data suggest an involvement for Cln7 in regulating trans-synaptic communication necessary for normal synapse development.

Do hyperactive children have motor organization and/or execution deficits?

Hyperactive children have been described as motorically clumsy. To explore the validity of this assertion, an experiment using the additive factor method was designed to examine motor organization and execution in hyperactive children. Four groups of boys aged 7 to 8 years took part in the study: (1) a pure hyperactive (HA) group, N=20; (2) a pure conduct-disordered (CD) group, N=18; (3) a mixed hyperactive/conduct-disordered (HA+CD) group, N=12; (4) a normal (N) control group, N=22. While the small sample size precluded a definitive conclusion, the results indicated that neither HA nor CD children showed any motor organization or execution deficit in a simple sequential key-tapping task. Given previous findings indicating that hyperactive children show deficits in more complex motor coordination skills, the generalizability of our negative results needs to be examined on other more complex tasks.

Test of two views of impulsivity in hyperactive and conduct-disordered children

The nature of impulsivity in hyperactive and conduct-disordered children was examined in two experiments, one involving a priming task, the other a delayed reaction time task. Four groups of children, aged 7 to 8 years and with IQs in the normal range, were recruited for study: (1) a pure hyperactive group (HA), (2) a hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N). When the stimulus configuration and presentation were simple and well organized, none of the three clinical groups displayed any sign of impulsivity at the input/perceptual stage; there was no tendency to rush responding before adequate consideration of the relevant stimuli, i.e. a trading of accuracy for speed. Instead, the HA children were found to be disinhibited at the output/motor stage, i.e. failing to temporarily withhold activated responses. This deficit was found to be specific to the HA children; it was not observed in the CD and HA+CD children.

Human figure drawings by schooled and unschooled children in Papua New Guinea

Human figure drawings were collected from 287 schooled and unschooled children, aged between 10 and 15 years, living in a remote region of the Western Highlands Province of Papua New Guinea, an area with no tradition of graphic art. A classification and ordinal scoring system was devised which encompassed graphic productions ranging from scribbles to conventional competent human figure drawings. The effects of school experience on drawing, even brief and indirect experience, were found to be significant. All the children attending school drew only conventional human figures, but the whole range of drawings, scribbles, transitional forms, and conventional human figure drawings were found in the unschooled children's attempts. Nonrepresentational scribbles and shapes were largely produced by unschooled children living in remote villages without a school, trade store, or mission. Some children appeared to be able to draw representations of the human figure without going through a scribbling stage. The material is considered in relation to other reports on drawings produced by children from societies with little or no indigenous graphic art. The results are discussed in relation to various theories on the development of drawing and representational abilities.

Distractibility in hyperactive and conduct-disordered children

Hyperactive children are often said to be inattentive and distractible. However, the results from a number of experimental studies are equivocal. To examine this discrepancy, a Chinese version of the Stroop Test was devised. Four groups of subjects recruited from a community sample of 1479 Chinese boys living in Hong Kong took part in the investigation. These were: (1) a pure hyperactive (HA) group; (2) a mixed hyperactive/conduct-disordered (HA + CD) group; (3) a pure conduct-disordered (CD) group; and (4) a normal (N) control group. The results revealed that HA children were more markedly affected by the introduction of distracting stimuli. This distractibility was probably a function of both stimulus potency and the random order in which stimuli were presented. The specificity of a greater distractibility to HA children indicates its diagnostic value with regard to hyperactivity. The failure to find a similar deficit in HA + CD children raises questions about the clinical identity of this mixed diagnostic group.

Variability and the development of skilled actions

Consistency and invariance in movements have been seen as the essential features of motor skill development. This emphasis on the stabilisation of action has led to the neglect of the processes whereby skills are modified and reorganised into new and more complex acts, that is the process of adaptation. It is argued that variability of motor behaviour has a major role to play in this process and hence in the development of skilled actions. The significance of variability for open systems and its implications for development are examined. A distinction is made between error variability and functional variability, the latter being used in the solution of motor problems. Two experiments on the acquisition of a skilled action by children are reported. A sequential coincident timing task which permitted an operational distinction between the macrostructure and microstructure of the task was used. The results support the argument that with development the action becomes increasingly consistent at the macrostructure level and that this is achieved by maintaining variability at the microstructure level.

Attentional difficulties in hyperactive and conduct-disordered children: a processing deficit

A random population sample of 1479 Chinese boys from Hong Kong was screened and diagnosed in a two-stage epidemiological study. Four groups, age 7-8, were distinguished: (1) a pure hyperactive group (HA), (2) a mixed hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N). On a visual search task, only the HA children showed a specific processing deficit in performance. This confirms the diagnostic value of such a deficit for hyperactivity, differentiating it from conduct disorder. The failure to find a similar deficit in the HA+CD group raises questions concerning the clinical identity of these children. Each group showed a performance decrement over time in the visual search task but the decrement did not differ between the four groups. This observation is not congruent with the reports of a short attention span in hyperactive children; explanations of this apparent contradiction are considered.

Coping strategies and psychological adjustment of couples presenting for IVF

The study was designed to examine the extent to which the psychological profiles of couples entering an IVF programme were influenced by evidence of previous fertility, the history of fertility investigations, the diagnosis made, and the coping strategies adopted. A sample of 152 couples was administered a number of standardized psychological instruments and a coping strategies questionnaire. They showed little variation from the normative range on the standardized measures. There was little evidence of differences between couples referred for primary or secondary infertility, between those with some evidence of fertility and those with none, or between different diagnostic groups. In relation to coping strategy, for women at least, taking direct action appears to be effective if it is associated with some degree of acceptance of one's position. For males, the picture is less clear, though direct action and acceptance again appear to be effective coping strategies.

An evaluation of counselling for couples undergoing treatment for in-vitro fertilization

Fertility difficulties, along with their investigation and treatment, are widely believed to cause significant psychological problems. This study was designed to investigate the efficacy of a non-directive counselling intervention with couples undertaking their first cycle of in-vitro fertilization treatment. Couples were randomly assigned to either a control group, given information about the treatment programme, or to an experimental group, given the same information plus three sessions of counselling before, during and on conclusion of the first treatment cycle. Psychological assessments were made at three points in the treatment process. Ratings were also obtained from the couples on the stress engendered by different parts of the treatment, the effects on their relationship and satisfaction with counselling. The results showed the patients to be generally well adjusted and anxiety levels dropped over the course of treatment. Counselling compared to information alone did not lead to any enhanced reduction in levels of anxiety or depression. The implications of the findings for service provision are discussed.

Key issues in generating a psychological-testing protocol

An individual's behavior is created by an amalgam of genetic, environmental, cultural, and historical variables working in concert and changing over time. Variations in nutrition are one class of environmental factors. Linking these to outcome effects requires carefully designed studies. Many considerations are involved, and this paper draws attention to some of the fundamental ones. Psychological and behavioral functions tend to be complex, in part because they are affected by a wide range of variables. Almost any given state--a particular constellation of psychological characteristics displayed by an individual at a given time--can be produced in a variety of ways.

Long-term follow-up of didanosine administered orally twice daily to patients with advanced human immunodeficiency virus infection and hematologic intolerance of zidovudine

This phase 1 trial was conducted to evaluate the safety and tolerance of didanosine (ddI) in subjects with AIDS or AIDS-related complex (ARC) who previously had demonstrated hematologic intolerance of zidovudine. Thirty subjects, 21 with AIDS and nine with ARC, were enrolled. Initially, didanosine was administered orally twice daily for a total daily dose of either 750 mg or 1,500 mg. Subsequently, the dosage for those receiving 1,500 mg/d was reduced to a maximum of 750 mg/d (375 mg twice daily) when data from this and other phase 1 studies showed that the dosage of 1,500 mg/d (750 mg twice daily) was associated with an unacceptable risk of developing neuropathy. The subjects were studied for 46 weeks (mean time; range, 7-122 weeks). The dose-limiting toxic effect observed was peripheral neuropathy, which occurred in eight patients. Other significant toxic effects included pancreatitis in three patients and xerostomia in eleven. In general, didanosine was well tolerated from a hematologic standpoint by the majority of patients during prolonged administration.

Infection, nutrition and cognitive performance in children

The paper considers briefly the nature of cognition and its relationship to intelligence. The information processing model of human cognition is outlined and IQ and DQ are explained. The literature dealing with the effects of malnutrition and parasitic infection on cognitive performance and development in children is selectively reviewed. A speculative hypothesis concerning the psychological effects of parasitic infection is sketched and brief consideration is given to models and measures in research on development.

The impact of infertility on psychological functioning

To explore the impact of infertility on psychological functioning 130 couples presenting with primary infertility were assessed at their initial visit to an infertility clinic. Of these, 116 couples were assessed on a second occasion some 7-9 months later when in most cases the medical tests were complete. Measures of personality, psychopathology, perceived social support, sex role identity and marital state were obtained from both partners. The set was subsequently divided into five subgroups on the basis of the diagnosis made or the outcome (female cause, male cause, female and male cause, unexplained and pregnant). The results show little evidence of psychopathology in the sample, depression scores remained low throughout the period of investigation. The results also indicated stable marital relationships. Scores on tests of anxiety and psychiatric morbidity declined between the first and second assessment except in the case of men who were diagnosed with a fertility problem. The implications of these findings are discussed in the increased use of donor insemination which circumvents rather than treats the problem of male infertility.

The measurement of handedness: a cross-cultural comparison of samples from England and Papua New Guinea

Handedness was compared in 125 English children and 185 young people from Papua New Guinea (PNG). Many of the latter were unfamiliar with implements such as pencils and spoons. The PNG subjects showed strong hand preferences, usually for the right, and on some items were more consistent in hand use than the English subjects. However, they had smaller hand differences on peg-moving and tapping than the English children. A factor analysis identified one factor with high loadings from items involving precise motor control, and another with positive loadings from only card-dealing, block-building and threading. The first factor was impervious to cultural influences, whereas the second showed considerable cultural variation.

Phase I study of 2'-3'-dideoxyinosine administered orally twice daily to patients with AIDS or AIDS-related complex and hematologic intolerance to zidovudine

PURPOSE

To evaluate the safety and hematologic tolerance of 2'-3'-dideoxyinosine (didanosine, ddI) in subjects with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex and prior hematologic intolerance to zidovudine.

PATIENTS AND METHODS

A Phase I trial with two dose groups at a single-center, university-affiliated hospital ambulatory care center. Of 30 subjects enrolled, 21 had AIDS and nine had AIDS-related complex. All had CD4 lymphocyte counts less than 0.2 x 10(9)/L at entry. Didanosine was administered orally twice daily at a total daily dose of 750 mg or 1,500 mg for 12 weeks. Subjects who completed the 12-week study continued to receive ddI at the lower dose. All subjects were monitored for toxicity. Virologic and immunologic response markers were also measured.

RESULTS

For the group as a whole, there was no significant decrease in mean hemoglobin level or leukocyte or platelet counts. The dose-limiting toxicity was peripheral neuropathy. Other significant toxicities included pancreatitis and hypocalcemia. Uric acid elevations were common but were without clinical consequence. A sustained decrease in serum p24 antigen of at least 50% was noted in 42% of subjects who were p24 antigen-positive at entry. The mean CD4 lymphocyte count showed an initial increase that was not sustained over the 12-week study. All subjects remained anergic to skin testing.

CONCLUSIONS

Didanosine is well tolerated hematologically in some patients with prior significant hematologic intolerance to zidovudine. The toxicity profile for ddI differs from that of zidovudine and includes peripheral neuropathy and pancreatitis. Changes in CD4 lymphocyte number and HIV p24 antigen levels in some patients suggest antiviral activity of ddI in this population.

The effects of parasite infections on cognitive processes in children

Two studies were carried out in the Nyuswa area of Natal to investigate the effects of parasitic infection on cognitive function in children. In the first study, children infected with intestinal helminths were given tests of information processing and perceptual speed before and after treatment with a single 500 mg dose of Mebendazole. The pattern of results was consistent with the hypothesis that parasitic infections combine with nutritional deficits to impair the efficiency of cognitive processes. There was, however, some confounding of variables, and the single drug treatment reduced but did not eliminate the parasites. The second study removed the confounding effects due to age and nutrition and employed a more comprehensive drug-treatment programme. A memory task and a test of sustained attention were administered. Poor performance on the attention task showed a significant association with parasite status, but no association was observed with educational attainment or memory function. The study also examined various ways of assessing parasite load, and an index weighted for estimated pathogenicity was found to give the best estimate. The results provide evidence of the effects of parasitic infection on attentional processes.

Effects of maternal iodine supplementation during pregnancy

Reduced maternal thyroid hormone concentrations during pregnancy can adversely affect fetal neurological development. In the context of national iodine supplementation programmes, concern has been expressed over the theoretical possibility that iodine supplementation during pregnancy might adversely affect fetal development as a result of maternal thyroid inhibition from the Wolff-Chaikoff effect. In a double blind controlled trial in five villages in Papua New Guinea, several measures of motor and cognitive function showed no significant differences at either age 11 or 15 years between those children whose mothers had received supplementary iodine during pregnancy and the control children whose mothers had received the placebo.

Relationship between maternal thyroxine levels during pregnancy and memory function in childhood

Two investigations are reported into the memory functions of a group of subjects for whom information on maternal thyroxine (T4) levels during pregnancy is available. The first study made when the subjects were aged 14-15 years examined forward and backward memory span. No relationship between maternal T4 levels and capacity of the short-term store, measured as length of forward memory span, was found. Backward memory span, which involves performing a mental operation on the material held in store, was found to be associated with maternal T4 level. The second study, made when the subjects were aged 16-17 years, found a relationship between maternal T4 levels during pregnancy and memory for serial position. Findings are discussed in terms of the role of maternal thyroxine in fetal brain development.

The acute aseptic meningitis syndrome

The acute aseptic meningitis syndrome is an entity that presents a diagnostic challenge to the clinician. Although many infectious and noninfectious etiologies exist for this syndrome, viruses, especially nonpolio enteroviruses, are the classic and most important agents encountered. The incidence of polio and mumps meningitis has declined dramatically in the vaccine era, but recently described pathogens, such as human immunodeficiency virus and Borrelia burgdorferi (Lyme disease agent) are now important considerations in the differential diagnosis. Specifically treatable entities (eg, mycobacterial or fungal meningitis, herpes simplex encephalitis, parameningeal infection) that may mimic aseptic meningitis in their initial presentations must not be overlooked. A careful approach to the patient and a rational use of laboratory studies are the basis for establishing a specific diagnosis and assuring a favorable outcome.

Development of kinaesthetic sensitivity and motor performance in children

Kinaesthetic acuity of 100 children, aged from four to 13 years, was assessed and a developmental trend is described. The relationship between kinaesthetic acuity and motor performance on a range of motor tests commonly used for assessing children was also examined, and contrary to expectation no evidence of a relationship was discovered. There is little reported evidence for this relationship in the literature, and some possible reasons for this are discussed. A staircase procedure for threshold estimation was used and is described in detail.

A controlled trial of iodinated oil for the prevention of endemic cretinism: a long-term follow-up

A double blind controlled trial designed to examine the effectiveness of intramuscular iodinated oil as a prophylactic for the nervous type of endemic cretinism was begun in 1966 in the highlands of Papua New Guinea. Infants born into the trial between 1966 and 1972 were followed up until 1982. The results showed that if the iodine supplement was given before conception the nervous form of endemic cretinism was prevented. Also a striking difference in the 15-year cumulative survival rate in favour of the test (iodinated oil) group was observed. Measures of motor and intellectual function revealed that children born to mothers given an iodine supplement performed significantly better. This observation shows that iodine deficiency leads to sub-clinical as well as clinical deficits. It also justifies the use of the term iodine deficiency disorder to cover the polymorphic nature of the abnormalities attributable to iodine deficiency.

Psychological aspects of infertility

It has often been claimed that psychological problems accompany infertility among some couples attending infertility clinics. Some authors have suggested that psychological factors may be a primary cause of infertility, others have suggested that the state of infertility itself can provoke psychological symptoms. The importance of psychological counselling for involuntarily childless couples has also been noted. This paper, which reviews studies that have attempted to investigate psychological aspects of infertility, is organized around three issues: psychological factors as a cause of infertility, the impact of infertility on psychological functioning, coping with infertility and the counselling needs of the infertile couple. While there seems little doubt that infertility has psychological consequences for some couples, many questions will remain unanswered unless carefully designed and conducted longitudinal studies are undertaken.

Measurement of kinaesthetic sensitivity

Two recent papers (Laszlo and Bairstow 1980, Bairstow and Laszlo 1981) have used the method of constant stimuli to measure kinaesthetic difference thresholds. If this method is used, however, certain constraints must be observed: these concern the values of the stimuli relative to the threshold, and the numbers of observations made at each value. Laszlo and Bairstow appear to have neglected these constraints, which must cast doubt on their results. In any case, the method of constant stimuli has largely been superseded by staircase techniques for threshold estimation, on grounds of economy of trials for a given level of accuracy in estimation. It is concluded, therefore, that the details of the method as described by Laszlo and Bairstow are unsuitable for testing kinaesthetic sensitivity, and that other methods are preferable.

Maternal thyroid hormone levels in pregnancy and the subsequent cognitive and motor performance of the children

Serum levels of thyroxine and triiodothyronine during pregnancy were measured in women from a severely iodine deficient region in the highlands of Papua New Guinea. Subsequently the children born to these women were examined when aged 10-12 years and measures made of intellectual ability and motor competence. A significant correlation between these measures in the children and the maternal thyroxine but not maternal triiodothyronine level was observed. It is speculated that maternal thyroxine and not triiodothyronine may be essential for normal neurological maturation of the fetus before the fetal thyroid becomes functional.

A classification of manipulative hand movements

The nature of manual manipulation of objects is discussed. It is argued that a functional distinction should be made between palmar grips which immobilise an object in the hand, and digital patterns which permit manipulation. Such a distinction is separate from any anatomically defined power and precision configurations. Manipulative hand movements may be grouped into three classes, based on differences between sequenced patterns of movement and synergies, the latter being further subdivided into simple and reciprocal patterns. Within each of the three classes, a number of individual movement patterns are described. These differ mainly in the number of digits involved and the way in which the thumb is employed. The classification is concerned with movements of the digits directed at manipulating an object within the hand. It is not concerned with movements of the hand as a whole, using the wrist or more proximal joints, while holding an immobilised object.

Fetal iodine deficiency and motor performance during childhood

Motor performance of children born to mothers living in an iodine-deficient region was assessed. The mothers were participants in a controlled trial of intramuscular iodised oil in the prevention of endemic cretinism carried out in the Western Highlands of Papua New Guinea. Mothers received either iodised oil or placebo saline. Children born to mothers given iodine were significantly faster and more accurate in tests of manual function than children from control mothers. The findings indicate that iodine deficiency may lead to a spectrum of subclinical deficits which place the children at a developmental disadvantage.

The effect of visual frame of reference on a judgement of plane stimulus orientation by children

Three studies are reported with children aged 4 1/2 to 9 1/2 years and also with educationally subnormal children, in which it was found that up to about 7 years children's selection of one of a pair of line stimuli as 'falling over' is affected by the nature of the visual surround contours provided. Both the form of the stimulus surround and the presence or absence of a baseline tilted 45 degrees relative to the horizontal were found to affect the children's judgements. The plane (horizontal or vertical) in which the stimuli were presented had no effect on the results. It is argued that while the results show the influence of the visual surround on children's comprehension of 'falling over', this may not be wholly explicable in terms of surround contour matching, as conventionally correct judgements were obtained in the absence of all straight line contours in the immediate surround.