Simvastatin strongly reduces levels of Alzheimer's disease beta -amyloid peptides Abeta 42 and Abeta 40 in vitro and in vivo

Recent epidemiological studies show a strong reduction in the incidence of Alzheimer's disease in patients treated with cholesterol-lowering statins. Moreover, elevated Abeta42 levels and the varepsilon4 allele of the lipid-carrier apolipoprotein E are regarded as risk factors for sporadic and familial Alzheimer's disease. Here we demonstrate that the widely used cholesterol-lowering drugs simvastatin and lovastatin reduce intracellular and extracellular levels of Abeta42 and Abeta40 peptides in primary cultures of hippocampal neurons and mixed cortical neurons. Likewise, guinea pigs treated with high doses of simvastatin showed a strong and reversible reduction of cerebral Abeta42 and Abeta40 levels in the cerebrospinal fluid and brain homogenate. These results suggest that lipids are playing an important role in the development of Alzheimer's disease. Lowered levels of Abeta42 may provide the mechanism for the observed reduced incidence of dementia in statin-treated patients and may open up avenues for therapeutic interventions.

[Reference values of the red blood profile in beagle, German shepherd and golden retriever puppies]

In the present study, blood samples were taken from clinically healthy puppies of the breeds Beagle, German Shepherd, and Golden Retriever between days 1 and 3 (n = 146), 8 and 10 (n = 137), 28 and 33 (n = 151), and 50 and 58 (n = 129) post natum. Measurements for red blood cell count, haemoglobin concentration, haematocrit, mean erythrocyte volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were performed by a semi-automatic blood cell counter; the normoblast number was counted visually. Between the 1st and 3rd day of life, the erythrocyte number of the puppies was 4.57 +/- 0.68 10(6)/microliter and, as such, was clearly below the reference range for adult animals. It further decreased by the 2nd measurement (8th to 10th day of life) to 3.59 +/- 0.41 10(6)/microliter, and then increased again to 4.75 +/- 0.68 10(6)/microliter (reference range: 3.73-6.25 10(6)/microliter, 2.5% to 97.5% percentile) by the final measurement (50th to 58th day of life). The measurement values of the haemoglobin concentration (13.5 +/- 2.0 g/dl) and haematocrit (41.0 +/- 6.5%) after birth were only insignificantly below or around the lower limit of the reference range for adult animals. Both parameters decreased to a more pronounced extent than did the erythrocyte count. They reached a minimum of 8.4 +/- 1.0 g/dl and 26.8 +/- 3.2%, respectively, between the 28th and 33rd day of life. Even at the end of the examination period (50th to 58th day of life), the values of these parameters (10.1 +/- 1.1 g/dl, reference range: 7.5-11.8 g/dl; 32.1 +/- 4.2%, reference range: 24.8 to 40.8%) were remarkably lower than the minimum of reference range for adult dogs. At the 1st sampling (between 1st and 3rd day of life), MCV (89.8 +/- 6.7 fl) and MCH (29.6 +/- 1.9 pg) were distinctly higher than the reference values for adult dogs. Both parameters decreased with increasing age. Thus, from the 50th-58th day of life, the results were comparable to those of adults. No considerable age dependence was found for MCHC. During the first days of life a relatively high number of normoblasts (8 +/- 7/100 Leukozyten) was found; it decreased rapidly. The study revealed significant differences between the breeds, e.g. German Shepherd dogs had lower initial values of erythrocyte count, haemoglobin concentration, and haematocrit when compared to the other breeds. Puppies of this breed also had higher normoblast numbers than the Beagle and Golden Retriever puppies at the 2nd and 3rd samplings. No clear sex differences in the studied parameters were observed. The results of this study reflect the replacement of fetal erythrocytes by postnatal erythrocytes. Moreover, they illustrate the need to use age as well as breed-specific reference ranges.

[Reference values of chemical blood parameters in puppies during the first eight weeks of life]

Reference values were determined for blood plasma concentrations of albumin, total protein, glucose, total bilirubin, urea, creatinine, cholesterin, triglycerides, total calcium und anorganic phosphate as well as the activities of alkaline phosphatase, alanine-amino-transferase (ALT) and glutamate-dehydrogenase based on 109-124 healthy puppies at different times (1st-3rd, 8th-10th, 28th-33rd, and 50th-58th day of life). In addition, all the results were calculated separately for the breeds involved in this study (Beagle [n = 34-40], German Shepherd [n = 32-35] and Golden Retriever [n = 43-53]). Furthermore, male and female puppies were compared. All examined parameters showed remarkable dynamics during the suckling period. Often the values exceeded respectively fell below the reference ranges for adult dogs. Significant systematic breed influences as for instance a significantly lower glucose concentration for the German Shepherd puppies were also found for other parameters, especially for alkaline phosphatase and ALT. However, differences between male and female animals were only present sporadically and were of minor clinical relevance. The gathered breed differences show that it is worthwhile not only to acquire age specific reference ranges but also breed specific reference ranges for selected parameters. On the other hand, reference ranges without the definition of the breed can only be used for orientation.

[Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). II: Side-effects of nCPAP therapy. Effect on long-term acceptance]

BACKGROUND

nCPAP is a well established method for the management of OSAS. The aim of this study was to evaluate long-term side effects and complications of nCPAP therapy and their influence on the patients compliance with treatment.

PATIENTS AND METHODS

Forty-one patients with OSAS were interviewed by questionnaire to elucidate the problems and adverse effects of their nCPAP therapy. The patients were divided into responders and non-responders. Non-responding OSAS patients were using their nCPAP devices less then 5 hours each night by definition.

RESULTS

The number of side effects and type of complication during nCPAP therapy were the same in both the responding and non-responding groups. The most frequently reported problems were a tender region on the bridge of the nose and discomfort associated with a dry nasal mucosa. Although nCPAP treatment was initially accepted by most patients, adverse effects and other difficulties decreased patient compliance, with time, in many cases.

CONCLUSIONS

Despite there being no difference between responders and non-responders with respect to the number and severity of complications, it should not be presumed that these side effects do not influence long-term patient compliance with nCPAP therapy. Patients who suffer from symptoms of OSAS tend to accept these adverse effects, while those who do not feel limited by their disease are less persistent in their use of this treatment modality. Identification and elimination of the problems associated with the use of nCPAP equipment may increase longterm patient compliance. Close monitoring in the outpatient department combined with intermittent inpatient assessment in the sleep laboratory will also help to improve acceptance of nCPAP therapy.

[Isolated histiocytosis X as rare differential diagnosis of indistinguishable neck lymph node swelling. A case report]

Cervical lymphadenopathies are widespread diseases in otorhinolaryngology. There are many differential diagnoses which have to be considered when swelling persists. To gain further information it is advisable to perform sonographically controlled fine needle aspiration biopsy (FNP). If there is no reliable result, it is necessary to remove a lymph node. We report on the rare case of isolated histiocytosis X in lymph nodes. A 63-year-old male had noticed a swelling of the right side of the neck about 6 weeks previously. The preliminary examinations (FNP/blood examinations) revealed no pathological findings. Only the histological examination delivered the diagnosis of histiocytosis X. Systemic manifestation was excluded by staging examinations. No further therapy was necessary after lymph node extirpation. The report demonstrates how to diagnose and treat this rare disease.

[Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). I: Long-term acceptance of nasal CPAP]

BACKGROUND

Nocturnal ventilation with nCPAP has been established as the safest and most efficient nonsurgical treatment for OSAS. Long-term results, however, are determined by the patients' compliance with therapy. The aim of this study was the objective measurement of long-term acceptability of nCPAP therapy in all patients receiving this treatment in our sleep laboratory between January 1990 and March 1995.

METHODS

We prospectively investigated 41 patients (36 male, 5 female) with moderate to severe OSAS who received nCPAP therapy. Mean time of follow-up was 20.6 months, ranging from 1.2 to 53.5 months. Therapy was indicated when OSAS was confirmed by cardiorespiratory polygraphy and either (1) the patient complained of daytime sleepiness or (2) the patient possessed an apnea-hypopnea index greater than 30/h or when the mean oxygen desaturation was below 80% regardless of the presenting symptoms. The compliance with treatment was defined as a mean rate of use of over 5 hours per night calculated from the time counter on the nCPAP machine.

RESULTS

33 patients (88.5%) have continued using nCPAP until the present time but only 24 patients (59%) met our criteria for long-term acceptance and this group was identified as responders. We found no significant differences in age, body mass index, apnea-hypopnea index, and nCPAP-pressure between responders and non-responders.

CONCLUSION

Although nCPAP is the safest treatment for OSAS, there is still a large group of patients with moderate to severe OSAS who are not efficiently treated with nCPAP because of the low long-term acceptability of this therapy. With respect to this group of patients, surgical approaches have to be considered as an alternative therapy.