Virilization at puberty in adolescent girls may reveal a 46,XY disorder of sexual development

Although hyperandrogenism is a frequent cause of consultation in adolescent girls, more severe forms with virilization must lead to suspicion of an adrenal or ovarian tumor. However, they may also reveal a 46,XY disorder of sexual development (DSD). Here, we describe four adolescent girls referred for pubertal virilization and in whom we diagnosed a 46,XY DSD. We performed gene mutation screening by Sanger sequencing (all patients) and by next-generation sequencing (NGS) in patient #4. We identified new heterozygous NR5A1 gene variants in patients #1 and #2 and a homozygous SRD5A2 gene deletion in patient #3. Patient #4 received a diagnosis of complete androgen insensitivity in childhood; however, due the unusual pubertal virilization, we completed the gene analysis by NGS that revealed two heterozygous HSD17B3 variants. This work underlines the importance of considering the hypothesis of 46,XY DSD in adolescent girls with unexplained virilization at puberty.

Photosensitized reactions initiated by 6-carboxypterin: singlet and triplet reactivity

The photophysical and photochemical properties of 6-carboxypterin, a model compound for the pterin derivatives present at the sea surface microlayer, were studied and its singlet and triplet reactivity toward halides and selected organics demonstrated.

Genome-wide paternal uniparental disomy as a cause of Beckwith-Wiedemann syndrome associated with recurrent virilizing adrenocortical tumors

Beckwith-Wiedemann syndrome (BWS) is an overgrowth syndrome characterized by fetal macrosomia, macroglossia, and abdominal wall defects. BWS patients are at risk to develop Wilms tumor, neuroblastoma, hepatoblastoma, and adrenal tumors. A young woman with BWS features, but with inconclusive genetic evidence for the disease, came to clinical observation for signs of virilization at the age of 16 years. An adrenocortical tumor was diagnosed and surgically resected. The tumor underwent 2 local relapses that were also surgically treated. The patient was also operated to remove a breast fibroadenoma. SNP arrays were used to analyze chromosome abnormalities in normal and tumor samples from the patient and her parents. The patient presented genome-wide mosaic paternal uniparental disomy (patUPD) both in the adrenocortical and the breast tumors, with different degrees of loss of heterozygosity (LOH). The more recent relapses of the adrenocortical tumor showed a loss of part of chromosome 17p that was absent in the first tumor. Analysis of a skin biopsy sample also showed mosaic patUPD with partial LOH, while no LOH was detected in leukocyte DNA. This case shows that virilizing adrenocortical tumors may be a clinical feature of patients with BWS. The SNP array technology is useful to diagnose genome-wide patUPD mosaicism in BWS patients with an inconclusive molecular diagnosis and underlines the tumorigenic potential of the absence of the maternal genome combined with an excess of the paternal genome.

Beckwith-Wiedemann syndrome: growth pattern and tumor risk according to molecular mechanism, and guidelines for tumor surveillance

BACKGROUND

Beckwith-Wiedemann syndrome (BWS) is an overgrowth syndrome associated with an increased risk of pediatric tumors. The underlying molecular abnormalities may be genetic (CDKN1C mutations or 11p15 paternal uniparental isodisomy, pUPD) or epigenetic (imprinting center region 1, ICR1, gain of methylation, ICR1 GOM, or ICR2 loss of methylation, ICR2 LOM).

AIM

We aimed to describe a cohort of 407 BWS patients with molecular defects of the 11p15 domain followed prospectively after molecular diagnosis.

RESULTS

Birth weight and length were significantly higher in patients with ICR1 GOM than in the other groups. ICR2 LOM and CDKN1C mutations were associated with a higher prevalence of exomphalos. Mean adult height (regardless of molecular subtype, n = 35) was 1.8 ± 1.2 SDS, with 18 patients having a final height above +2 SDS. The prevalence of tumors was 8.6% in the whole population; 28.6 and 17.3% of the patients with ICR1 GOM (all Wilms tumors) and 11p15 pUPD, respectively, developed a tumor during infancy. Conversely, the prevalence of tumors in patients with ICR2 LOM and CDKN1C mutations were 3.1 and 8.8%, respectively, with no Wilms tumors.

CONCLUSION

Based on these results for a large cohort, we formulated guidelines for the follow-up of these patients according to the molecular subtype of BWS.

Malformations, genetic abnormalities, and Wilms tumor

BACKGROUND

Wilms Tumor (WT) can occur in association with tumor predisposition syndromes and/or with clinical malformations. These associations have not been fully characterized at a clinical and molecular genetic level. This study aims to describe clinical malformations, genetic abnormalities, and tumor predisposition syndromes in patients with WT and to propose guidelines regarding indications for clinical and molecular genetic explorations.

PROCEDURE

This retrospective study analyzed clinical abnormalities and predisposition syndromes among 295 patients treated for WT between 1986 and 2009 in a single pediatric oncological center.

RESULTS

Clinically identified malformations and predisposition syndromes were observed in 52/295 patients (17.6%). Genetically proven tumor predisposition syndromes (n = 14) frequently observed were syndromes associated with alterations of the chromosome WT1 region such as WAGR (n = 6) and Denys-Drash syndromes (n = 3), syndromes associated with alterations of the WT2 region (Beckwith-Wiedeman syndrome, n = 3), and Fanconi anemia (n = 2). Hemihypertrophy and genito-urinary malformations (n = 12 and n = 16, respectively) were the most frequently identified malformations. Other different syndromes or malformations (n = 10) were less frequent. Median age of WT diagnosis was significantly earlier for children with malformations than those without (27 months vs. 37 months, P = 0.0009). There was no significant difference in terms of 5-year EFS and OS between WT patients without or with malformations.

CONCLUSIONS

The frequency of malformations observed in patients with WT underline the need of genetic counseling and molecular genetic explorations for a better follow-up of these patients, with a frequently good outcome. A decisional tree, based on clinical observations of patients with WT, is proposed to guide clinicians for further molecular genetic explorations.

CDKN1C mutation affecting the PCNA-binding domain as a cause of familial Russell Silver syndrome

BACKGROUND

Russell Silver syndrome (RSS) leads to prenatal and postnatal growth retardation. About 55% of RSS patients present a loss-of-methylation of the paternal ICR1 domain on chromosome 11p15. CDKN1C is a cell proliferation inhibitor encoded by an imprinted gene in the 11p15 ICR2 domain. CDKN1C mutations lead to Beckwith Wiedemann syndrome (BWS, overgrowth syndrome) and in IMAGe syndrome which associates growth retardation and adrenal insufficiency. We searched for CDKN1C mutations in a cohort of clinically diagnosed RSS patients with no molecular anomaly.

METHOD

The coding sequence and intron-exon boundaries of CDKN1C were analysed in 97 RSS patients. The impact of CDKN1C variants on the cell cycle in vitro were determined by flow cytometry. Stability of CDKN1C was studied by western immunoblotting after inhibition of translation with cycloheximide.

RESULTS

We identified the novel c.836G>[G;T] (p.Arg279Leu) mutation in a familial case of intrauterine growth retardation (IUGR) with RSS phenotype and no evidence of IMAGe. All the RSS patients inherited this mutation from their mothers (consistent with monoallelic expression from the maternal allele of the gene). A mutation of this amino acid (p.Arg279Pro) has been reported in cases of IMAGe. Functional analysis showed that Arg279Leu (RSS) did not affect the cell cycle, whereas the Arg279Pro mutation (IMAGe) led to a gain of function. Arg279Leu (RSS) led to an increased stability which could explain an increased activity of CDKN1C.

CONCLUSIONS

CDKN1C mutations cause dominant maternally transmitted RSS, completing the molecular mirror with BWS. CDKN1C should be investigated in cases with family history of RSS.

Beckwith-Wiedemann syndrome and long QT syndrome due to familial-balanced translocation t(11;17)(p15.5;q21.3) involving the KCNQ1 gene

We report a child with Beckwith-Wiedemann syndrome (BWS) as the consequence of an apparently balanced, maternally inherited reciprocal translocation t(11;17)(p15.5;q21.3). His mother and aunt, who inherited the translocation from their father, did not have BWS. At birth, long QT syndrome (LQTS) was diagnosed in this child and, secondarily, among apparently healthy family members carrying the translocation. By FISH analysis, the breakpoint in 11p15.5 interrupts the KCNQ1 gene between exons 2 and 10 and causes a loss of methylation of the IC2 (and thus BWS) on the maternally inherited der(11) chromosome. To explain the presence of LQTS segregating with the t(11;17) translocation in this family, we hypothesize that the translocation that interrupts KCNQ1 allow translation of an abnormal short allele that interferes in a dominant negative way with the normal isoform 1 of KCNQ1 in the heart (where this allele is not subject to parental imprint). This appears to be the first report of BWS with congenital LQTS, which should be considered as a rare but serious complication to be searched systematically in patients with BWS due to 11p15 rearrangements.

Wallerian degeneration after spinal cord lesions in cats detected with diffusion tensor imaging

One goal of in vivo neuroimaging is the detection of neurodegenerative processes and anatomical reorganizations after spinal cord (SC) injury. Non-invasive examination of white matter fibers in the living SC can be conducted using magnetic resonance diffusion-weighted imaging. However, this technique is challenging at the spinal level due to the small cross-sectional size of the cord and the presence of physiological motion and susceptibility artifacts. In this study, we acquired in vivo high angular resolution diffusion imaging (HARDI) data at 3T in cats submitted to partial SC injury. Cats were imaged before, 3 and 21 days after injury. Spatial resolution was enhanced to 1.5 × 1.5 × 1 mm(3) using super-resolution technique and distortions were corrected using the reversed gradient method. Tractography-derived regions of interest were generated in the dorsal, ventral, right and left quadrants, to evaluate diffusion tensor imaging (DTI) and Q-Ball imaging metrics with regards to their sensitivity in detecting primary and secondary lesions. A three-way ANOVA tested the effect of session (intact, D3, D21), cross-sectional region (left, right, dorsal and ventral) and rostrocaudal location. Significant effect of session was found for FA (P<0.001), GFA (P<0.05) and radial diffusivity (P<0.001). Post-hoc paired T-test corrected for multiple comparisons showed significant changes at the lesion epicenter (P<0.005). More interestingly, significant changes were also found several centimeters from the lesion epicenter at both 3 and 21 days. This decrease was specific to the type of fibers, i.e., rostrally to the lesion on the dorsal aspect of the cord and caudally to the lesion ipsilaterally, suggesting the detection of Wallerian degeneration.

Demyelination and degeneration in the injured human spinal cord detected with diffusion and magnetization transfer MRI

Characterizing demyelination/degeneration of spinal pathways in traumatic spinal cord injured (SCI) patients is crucial for assessing the prognosis of functional rehabilitation. Novel techniques based on diffusion-weighted (DW) magnetic resonance imaging (MRI) and magnetization transfer (MT) imaging provide sensitive and specific markers of white matter pathology. In this paper we combined for the first time high angular resolution diffusion-weighted imaging (HARDI), MT imaging and atrophy measurements to evaluate the cervical spinal cord of fourteen SCI patients and age-matched controls. We used high in-plane resolution to delineate dorsal and ventrolateral pathways. Significant differences were detected between patients and controls in the normal-appearing white matter for fractional anisotropy (FA, p<0.0001), axial diffusivity (p<0.05), radial diffusivity (p<0.05), generalized fractional anisotropy (GFA, p<0.0001), magnetization transfer ratio (MTR, p<0.0001) and cord area (p<0.05). No significant difference was detected in mean diffusivity (p=0.41), T1-weighted (p=0.76) and T2-weighted (p=0.09) signals. MRI metrics were remarkably well correlated with clinical disability (Pearson's correlations, FA: p<0.01, GFA: p<0.01, radial diffusivity: p=0.01, MTR: p=0.04 and atrophy: p<0.01). Stepwise linear regressions showed that measures of MTR in the dorsal spinal cord predicted the sensory disability whereas measures of MTR in the ventro-lateral spinal cord predicted the motor disability (ASIA score). However, diffusion metrics were not specific to the sensorimotor scores. Due to the specificity of axial and radial diffusivity and MT measurements, results suggest the detection of demyelination and degeneration in SCI patients. Combining HARDI with MT imaging is a promising approach to gain specificity in characterizing spinal cord pathways in traumatic injury.

Changes in CNS structures after spinal cord lesions implications for BMI

It is well established that a spinal circuitry can generate locomotor movements of the hindlimbs in absence of descending supraspinal inputs. This is based, among others, on the observation that after a complete spinalization, cats can walk with the hindlimbs on a treadmill. Does this spinal pattern generator (CPG) also participate in the recovery of locomotion after a partial spinal cord lesion (SCI)? After such SCI, functional reorganization can occur spontaneously along the whole neuraxis, namely the spinal cord circuitry below the lesion (CPG) and in supraspinal structures still partially connected to the spinal cord. This review focuses mainly on the capacity of the spinal and supraspinal structures to reorganize spontaneously after incomplete SCI in animals (rats and cats). BMI approaches to foster recovery of functions after various types of SCI should take into account these changes at the various levels of the CNS.

Ruthenium versus platinum on cerium materials in wet air oxidation of acetic acid

This study was a comparison between Ru-catalysts and similar, previously investigated, Pt-catalysts. In this paper, ruthenium catalysts for catalytic wet air oxidation are prepared, characterized and tested. Both catalysts were supported on commercial CeO2 as well as mixed oxide Zr(0.1)(Ce(0.75)Pr(0.25))(0.9)O2. The catalysts were characterized by measuring the oxygen storage capacities (OSC), BET, XRD, FTIR and chemisorption of hydrogen. In addition, the effect of sintering (treatments under H2) was compared with both of the catalysts. The comparison of the results showed that initial intrinsic activity of ruthenium is not significantly influenced by the type of the support, which is contrast to platinum. Furthermore, the particle size of Ru had an important effect on CWAO activity: the higher the particle size, the better the activity. This was different with Pt-catalysts, where the optimal particle size was smaller, having about 15% of metal dispersion.

A semi-automated software tool to study treadmill locomotion in the rat: from experiment videos to statistical gait analysis

A computer-aided method for the tracking of morphological markers in fluoroscopic images of a rat walking on a treadmill is presented and validated. The markers correspond to bone articulations in a hind leg and are used to define the hip, knee, ankle and metatarsophalangeal joints. The method allows a user to identify, using a computer mouse, about 20% of the marker positions in a video and interpolate their trajectories from frame-to-frame. This results in a seven-fold speed improvement in detecting markers. This also eliminates confusion problems due to legs crossing and blurred images. The video images are corrected for geometric distortions from the X-ray camera, wavelet denoised, to preserve the sharpness of minute bone structures, and contrast enhanced. From those images, the marker positions across video frames are extracted, corrected for rat "solid body" motions on the treadmill, and used to compute the positional and angular gait patterns. Robust Bootstrap estimates of those gait patterns and their prediction and confidence bands are finally generated. The gait patterns are invaluable tools to study the locomotion of healthy animals or the complex process of locomotion recovery in animals with injuries. The method could, in principle, be adapted to analyze the locomotion of other animals as long as a fluoroscopic imager and a treadmill are available.

Re-expression of Locomotor Function After Partial Spinal Cord Injury

After a complete spinal section, quadruped mammals (cats, rats, and mice) can generally regain hindlimb locomotion on a treadmill because the spinal cord below the lesion can express locomotion through a neural circuitry termed the central pattern generator (CPG). In this review, we propose that the spinal CPG also plays a crucial role in the locomotor recovery after incomplete spinal cord injury.

Partial denervation of ankle extensors prior to spinalization in cats impacts the expression of locomotion and the phasic modulation of reflexes

Following peripheral nerve sections some locomotor deficits appear which are gradually compensated for by spinal and supraspinal mechanisms. The present work is aimed at identifying contributions of both types of mechanisms. We performed a denervation of the left lateral gastrocnemius-soleus (LGS) muscles in three cats which was followed by a spinalization at the 13th thoracic segment. Three other cats were not denervated prior to spinalization (i.e. intact) and served as controls. Over the years, in our laboratory, there have been no instances in which cats did not express spinal locomotion with treadmill training and/or clonidine administration. After spinalization, cats were trained on a treadmill to express spinal locomotion. Reflexes, evoked by stimulating the left tibial nerve at the ankle, the electromyography of several hindlimb muscles, and kinematics were recorded during locomotion before and after denervation, during recovery, and following complete spinalization. Denervating the left LGS before spinalization induced considerable variability in the expression of spinal locomotion from one cat to another, which was not observed in the three controls. Variability ranged from a greater ankle yield in the denervated limb in one cat to inability to recover locomotion after spinalization in another. In the two denervated cats that recovered locomotion after spinalization, some reflex changes differed from "normal" spinal cats (i.e. intact at the time of spinalization), suggesting that reorganization of spinal circuits after spinalization is dissimilar to what normally takes place if denervation is performed before spinalization. First, we conclude that the transient locomotor deficits initially incurred following the LGS denervation in cats with an intact spinal cord reappear after complete spinalization indicating that supraspinal mechanisms were involved in maintaining the adapted locomotion. Second, the reappearance of locomotor deficits and/or impairment in expressing spinal locomotion suggests that spinal mechanisms were profoundly altered to compensate for the initial denervation partly because the reflex modulation is abnormal. If the same denervation is performed after spinalization only transient deficits are observed and spinal locomotion is not compromised.

Impact of realignment on spinal functional MRI time series

Functional magnetic resonance imaging (fMRI) of the spinal cord produces dataset that are particularly noisy because of cardiac-related motions. Realignment methods allowing subject motion correction might be sensitive to such noisy dataset. By realigning and quantifying cardiac variance on spinal dataset, we showed that such procedures decrease cardiac noise within the volumes. This has a direct and positive impact on functional imaging when estimating the T-score by means of the general linear model.

In vivo DTI of the healthy and injured cat spinal cord at high spatial and angular resolution

Spinal cord diffusion tensor imaging (DTI) is challenging in many ways: the small size of the cord, physiological motion and susceptibility artifacts pose daunting obstacles to the acquisition of high-quality data. Here, we present DTI results computed from in vivo studies of the healthy and injured spinal cord of five cats. Both high spatial (1.1 mm3) and angular (55 directions) resolutions were used to optimise modelling of the diffusion process. Also, particular effort was directed towards a strategy that limits susceptibility artifacts. For validation purposes, acquisitions were repeated in two cats before and after making a spinal lesion. As a result, various axonal trajectories were identified by tractography including dorsal and ventral columns as well as lateral tracts. Also, fibre bundles showed robust disruption at the site of spinal cord injuries (partial and complete) via tractography, accompanied with significantly lower fractional anisotropy values at the site of lesions. Important outcomes of this work are (i) tractography-based localisation of anatomical tracts in the thoraco-lumbar spinal cord and (ii) in vivo assessment of axonal integrity following experimental spinal cord injury.

Activation detection in diffuse optical imaging by means of the general linear model

Due to its non-invasive nature and low cost, diffuse optical imaging (DOI) is becoming a commonly used technique to assess functional activation in the brain. When imaging with DOI, two major issues arise in the data analysis: (i) the separation of noise of physiological origin and the recovery of the functional response; (ii) the tomographic image reconstruction problem. This paper focuses on the first issue. Although the general linear model (GLM) has been extensively used in functional magnetic resonance imaging (fMRI), DOI has mostly relied on filtering and averaging of raw data to recover brain functional activation. This is mainly due to the high temporal resolution of DOI which implies a new design of the drift basis modelling physiology. In this paper, we provide (i) a filtering method based on cosine functions that is more adapted than standard averaging techniques for DOI specifically; (ii) a new mode-locking technique to recover small signals and locate them temporally with high precision (shift method). Results on real data show the capability of the shift method to retrieve HbR and HbO(2) peak locations.

Characteristics and mechanisms of locomotion induced by intraspinal microstimulation and dorsal root stimulation in spinal cats

Intraspinal microstimulation (ISMS) through a single microelectrode can induce locomotion in cats spinalized at T(13) 1 wk before (untrained) or after 3-5 wk of treadmill training. Here we study the optimal parameters of ISMS and the characteristics of locomotion evoked. ISMS was applied in the dorsal region of segments L(3)-S(1) at different lateralities (midline to 2.5 mm) and after an intravenous injection of clonidine (noradrenergic agonist). Kinematics and electromyographic recordings were used to characterize locomotion. ISMS could induce a bilateral locomotor pattern similar to that obtained with perineal stimulation, and the characteristics of locomotion varied according to the spinal segment stimulated. Mechanisms by which ISMS could evoke locomotion were then investigated by stimulating, inactivating, or lesioning different spinal structures. Dorsal root stimulation (DRS), just like ISMS, could evoke a variety of ipsi- and bilateral nonlocomotor movements as well as locomotor responses. This suggests that sensory afferent pathways are involved in the production of locomotion by ISMS. Microinjections of yohimbine (noradrenergic antagonist) in L(3) and L(4) segments or a complete second spinal lesion at L(3)-L(4) abolished all locomotor activity evoked by ISMS applied at more caudal segments. Progressive dorsoventral spinal lesions at L(3) or L(4) and restricted ventral lesions at L(4) further suggest that the integrity of the ventral or ventrolateral funiculi as well as the L(3)-L(4) segments are critical for the induction of locomotion by ISMS at L(5) to S(1) or by DRS at these caudal segments.

The epigenetic imprinting defect of patients with Beckwith-Wiedemann syndrome born after assisted reproductive technology is not restricted to the 11p15 region

BACKGROUND

Genomic imprinting refers to an epigenetic marking resulting in monoallelic gene expression and has a critical role in fetal development. Various imprinting diseases have recently been reported in humans and animals born after the use of assisted reproductive technology (ART). All the epimutations implicated involve a loss of methylation of the maternal allele (demethylation of KvDMR1/KCNQ1OT1 in Beckwith-Wiedemann syndrome (BWS), demethylation of SNRPN in Angelman syndrome and demethylation of DMR2/IGF2R in large offspring syndrome), suggesting that ART impairs the acquisition or maintenance of methylation marks on maternal imprinted genes. However, it is unknown whether this epigenetic imprinting error is random or restricted to a specific imprinted domain.

AIM

To analyse the methylation status of various imprinted genes (IGF2R gene at 6q26, PEG1/MEST at 7q32, KCNQ1OT1 and H19 at 11p15.5, and SNRPN at 15q11-13) in 40 patients with BWS showing a loss of methylation at KCNQ1OT1 (11 patients with BWS born after the use of ART and 29 patients with BWS conceived naturally).

RESULTS

3 of the 11 (27%) patients conceived using ART and 7 of the 29 (24%) patients conceived normally displayed an abnormal methylation at a locus other than KCNQ1OT1.

CONCLUSIONS

Some patients with BWS show abnormal methylation at loci other than the 11p15 region, and the involvement of other loci is not restricted to patients with BWS born after ART was used. Moreover, the mosaic distribution of epimutations suggests that imprinting is lost after fertilisation owing to a failure to maintain methylation marks during pre-implantation development.

Silver-Russell syndrome and its genetic origins

Silver-Russell syndrome (SRS) is both clinically and genetically a heterogeneous congenital disorder. Patients are characterised by severe intrauterine and post-natal growth retardation, dysmorphic facial features and, asymmetry. Various chromosome abnormalities have been associated with the disease, involving most often chromosome 7 and 17. In about 7% of sporadic cases, maternal uniparental disomy of chromosome 7 has been detected. Most recent findings suggest that imprinting defects within the 11p15 region also play a role in SRS.

Mid-Lumbar Segments Are Needed for the Expression of Locomotion in Chronic Spinal Cats

In acute experiments performed in decerebrated and spinalized (T13) cats, an intraspinal injection of clonidine, a noradrenergic agonist, restricted to mid-lumbar segments L3–L4, can induce hindlimb locomotion, whereas yohimbine, a noradrenergic antagonist, can block spinal locomotion, and a second spinal lesion at L4 can abolish all locomotor activity. In the present study, we investigated whether the abolition of locomotion after this second spinal lesion was due to an acute spinal shock or to the functional disconnection of the rostral and caudal lumbar segments. In seven cats, first spinalized at T13 and having recovered treadmill locomotion, a second transection was performed at lower lumbar levels. Video and electromyographic recordings were used to evaluate locomotor performance. Results show that after a second transection at L2 or rostral L3 levels, spinal locomotion was maintained; when the second lesion was performed at caudal L3 or L4, all locomotor activity was abolished even after several weeks of attempted locomotor training; vigorous fast paw shakes (FPS) were observed in all cases; and after an intraperitoneal injection of clonidine in cats with a second transection below L4, perineal stimulation induced hyperextension of the hindlimbs but no locomotion. Considering that the main motoneuron pools of the hindlimbs are caudal to L4 and are still functional after the second spinal transection, as evidenced by the presence of FPS, we conclude that the mid-lumbar spinal segments are essential for the specific expression of spinal locomotion but not necessarily for other rhythmic motor patterns.

Adaptive changes of locomotion after central and peripheral lesions

This paper reviews findings on the adaptive changes of locomotion in cats after spinal cord or peripheral nerve lesions. From the results obtained after lesions of the ventral/ventrolateral pathways or the dorsal/dorsolateral pathways, we conclude that with extensive but partial spinal lesions, cats can regain voluntary quadrupedal locomotion on a treadmill. Although tract-specific deficits remain after such lesions, intact descending tracts can compensate for the lesioned tracts and access the spinal network to generate voluntary locomotion. Such neuroplasticity of locomotor control mechanisms is also demonstrated after peripheral nerve lesions in cats with intact or lesioned spinal cords. Some models have shown that recovery from such peripheral nerve lesions probably involves changes at the supra spinal and spinal levels. In the case of somesthesic denervation of the hindpaws, we demonstrated that cats with a complete spinal section need some cutaneous inputs to walk with a plantigrade locomotion, and that even in this spinal state, cats can adapt their locomotion to partial cutaneous denervation. Altogether, these results suggest that there is significant plasticity in spinal and supraspinal locomotor controls to justify the beneficial effects of early proactive and sustained locomotor training after central (Rossignol and Barbeau 1995; Barbeau et al. 1998) or peripheral lesions.Key words: spinal lesions, nerve lesions, locomotion, neuroplisticity, locomotor training.

Contribution of cutaneous inputs from the hindpaw to the control of locomotion. II. Spinal cats

The goal of these experiments was to define the contribution of hindpaw cutaneous inputs in the expression of spinal locomotion in cats. In 3 cats, some (n = 1) or all (n = 2) cutaneous nerves were cut bilaterally at ankle level before spinalization. This denervation caused small deficits that were gradually compensated as reported in the companion study. After spinalization, the completely denervated cats never recovered plantar foot placement or weight bearing of the hindquarters despite more than 35 days of treadmill training. Although normal electromyographic rhythmic activity developed at the hip and knee, ankle flexors and extensors were abnormally coactivated during stance. In contrast, the partially denervated cat regained foot placement and weight support 15 days after spinalization. However, after completing the denervation, foot placement and weight bearing were lost as in previous cats. In a 4th cat, spinalization was performed before denervation and the cutaneous nerves were cut sequentially in the right hindlimb only. Rapid locomotor adaptation occurred after cutting the deep peroneal, saphenous, and sural nerves. Later, cutting the superficial peroneal nerve produced paw drag, which was compensated within 8 days. On cutting the last cutaneous nerve (tibial), plantar foot placement was lost despite another 71 days of training. On the one hand, these experiments show that some cutaneous inputs are necessary for appropriate plantar foot placement and weight bearing of the hindquarters during spinal locomotion and, on the other hand, that locomotor compensation to partial cutaneous denervation after spinalization reveals important adaptive capacities of the spinal cord.

Contribution of cutaneous inputs from the hindpaw to the control of locomotion. I. Intact cats

The goal of this study was to evaluate the role of hindpaw cutaneous feedback in the control of locomotion, by cutting some (in one cat) or all (in 2 cats) cutaneous nerves bilaterally at ankle level. Kinematic and electromyographic (EMG) recordings were obtained before and for several weeks after denervation during level and incline (15 degrees up and down) treadmill walking. Ladder walking and ground reaction forces were also documented sporadically. Early after the denervation (1-3 days), cats could not walk across a ladder, although deficits were small during level treadmill walking. Increased knee flexion velocity caused a 14% reduction in swing phase duration. EMG activity was consistently increased in knee, ankle, and toe flexors, and in at least one knee or ankle extensor. The adaptive changes during walking on the incline were much reduced after denervation. Ladder walking gradually recovered within 3-7 wk. By this time, level treadmill walking kinematics had completely returned to normal, but EMG activity in flexors remained above control. Incline walking improved but did not return to normal. Mediolateral ground reaction forces during overground walking were increased by 200%. It is concluded that in intact cats, cutaneous inputs contribute more to demanding situations such as walking on a ladder or on inclines than to level walking. Active adaptive mechanisms are likely involved given that the EMG locomotor pattern never returned to control level. The companion paper shows on the other hand that when the same cats are spinalized, these cutaneous inputs become critical for foot placement during locomotion.

Recovery of locomotion in the cat following spinal cord lesions

In most species, locomotor function beneath the level of a spinal cord lesion can be restored even if the cord is completely transected. This suggests that there is, within the spinal cord, an autonomous network of neurons capable of generating a locomotor pattern independently of supraspinal inputs. Recent studies suggest that several physiological and neurochemical changes have to occur in the neuronal networks located caudally to the lesion to allow the expression of spinal locomotion. Some evidence of this plasticity will be addressed in this review. In addition, original data on the functional organisation of the lumbar spinal cord will also be presented. Recent works in our lab show that segmental responsiveness of the spinal cord of the cat to locally micro-injected drugs in different lumbar segments, in combination with complete lesions at various level of the spinal cord, suggest a rostro-caudal organisation of spinal locomotor control. Moreover, the integrity of midlumbar segments seems to be crucial for the expression of spinal locomotion. These data suggest that the regions of critical importance for locomotion can be confined to a restricted portion of the spinal cord. Later, these midlumbar segments could be targeted by electrical stimulation or grafts to improve recovery of function. Understanding the changes in spinal cord neurophysiology and neurochemistry after a lesion is of critical importance to the improvement of treatments for locomotor rehabilitation in spinal-cord-injured patients.

Comparison of the effect of intrathecal administration of clonidine and yohimbine on the locomotion of intact and spinal cats

Several studies have shown that noradrenergic mechanisms are important for locomotion. For instance, L-dihydroxyphenylalanine (L-DOPA) can initiate "fictive" locomotion in immobilized acutely spinalized cats and alpha(2)-noradrenergic agonists, such as 2,6,-dichloro-N-2-imidazolidinylid-enebenzenamine (clonidine), can induce treadmill locomotion soon after spinalization. However, the activation of noradrenergic receptors may be not essential for the basic locomotor rhythmicity because chronic spinal cats can walk with the hindlimbs on a treadmill in the absence of noradrenergic stimulation because the descending pathways are completely severed. This suggests that locomotion, in intact and spinal conditions, is probably expressed and controlled through different neurotransmitter mechanisms. To test this hypothesis, we compared the effect of the alpha(2) agonist, clonidine, and the antagonist (16 alpha, 17 alpha)-17-hydroxy yohimbine-16-carboxylic acid methyl ester hydrochloride (yohimbine), injected intrathecally at L(3)--L(4) before and after spinalization in the same cats chronically implanted with electrodes to record electromyograms (EMGs). In intact cats, clonidine (50-150 microg/100 microl) modulated the locomotor pattern slightly causing a decrease in duration of the step cycle accompanied with some variation of EMG burst amplitude and duration. In the spinal state, clonidine could trigger robust and sustained hind limb locomotion in the first week after the spinalization at a time when the cats were paraplegic. Later, after the spontaneous recovery of a stable locomotor pattern, clonidine prolonged the cycle duration, increased the amplitude and duration of flexor and extensor bursts, and augmented the foot drag at the onset of swing. In intact cats, yohimbine at high doses (800--1600 microg/100 microl) caused major walking difficulties characterized by asymmetric stepping, stumbling with poor lateral stability, and, at smaller doses (400 microg/100 microl), only had slight effects such as abduction of one of the hindlimbs and the turning of the hindquarters to one side. After spinalization, yohimbine had no effect even at the largest doses. These results indicate that, in the intact state, noradrenergic mechanisms probably play an important role in the control of locomotion since blocking the receptors results in a marked disruption of walking. In the spinal state, although the receptors are still present and functional since they can be activated by clonidine, they are seemingly not critical for the spontaneous expression of spinal locomotion since their blockade by yohimbine does not impair spinal locomotion. It is postulated therefore that the expression of spinal locomotion must depend on the activation of other types of receptors, probably related to excitatory amino acids.

Pharmacological aids to locomotor training after spinal injury in the cat

This Topical Review summarizes some of the work we have done mainly in the cat using agonists and antagonists of various neurotransmitter systems injected intravenously or intrathecally to initiate or modulate the expression of hindlimb locomotion after a spinal lesion at T13. The effects of the same drugs are compared in various preparations: complete spinal, partial spinal or intact cats. This has revealed that there can be major differences in these effects. In turn, this suggests that although the locomotor rhythm might normally be triggered and modulated by the activation of a variety of receptors (noradrenaline, serotonin, glutamate), after spinalization there appears to be a predominance of glutamatergic mechanisms. Recent work also suggests that, in the cat, the integrity of the midlumbar segments is crucial for the expression of spinal locomotion. Taken together, this work raises some hope that a targeted pharmacotherapy with better understood drugs and mode and locus of delivery could become a clinical reality.

Adaptive locomotor plasticity in chronic spinal cats after ankle extensors neurectomy

After lateral gastrocnemius-soleus (LGS) nerve section in intact cats, a rapid locomotor compensation involving synergistic muscles occurs and is accompanied by spinal reflex changes. Only some of these changes are maintained after acute spinalization, indicating the involvement of descending pathways in functional recovery. Here, we address whether the development of these adaptive changes is dependent on descending pathways. The left LGS nerve was cut in three chronic spinal cats. Combined kinematics and electromyographic (EMG) recordings were obtained before and for 8 d after the neurectomy. An increased yield at the ankle was present early after neurectomy and, as in nonspinal cats, was gradually reduced within 8 d. Compensation involved transient changes in step cycle structure and a longer term increase in postcontact medial gastrocnemius (MG) EMG activity. Precontact MG EMG only increased in one of three cats. In a terminal experiment, the influence of group I afferents from MG and LGS on stance duration was measured in two cats. LGS effectiveness at increasing stance duration was largely decreased in both cats. MG effectiveness was only slightly changed: increased in one cat and decreased in another. In cat 3, the plantaris nerve was cut after LGS recovery. The recovery time courses from both neurectomies were similar (p > 0.8), suggesting that this spinal compensation is likely a generalizable adaptive strategy. From a functional perspective, the spinal cord therefore must be considered capable of adaptive locomotor plasticity after motor nerve lesions. This finding is of prime importance to the understanding of functional plasticity after spinal injury.

Locomotion and its recovery after spinal injury

Recent advances indicate not only that the spinal cord has great potential for locomotor recovery after lesion but also that locomotor training can optimise this recovery through some form of 'learning'. Improvement of residual function can also be achieved through the use of various drugs and treatments such as spinal grafts. In spinal-cord-injured humans, a number of recent studies have allowed an objective quantification of the improvement of locomotion through various forms of training and stimulation.

Initiating or blocking locomotion in spinal cats by applying noradrenergic drugs to restricted lumbar spinal segments

After an acute low thoracic spinal transection (T13), cats can be made to walk with the hindlimbs on a treadmill with clonidine, an alpha2-noradrenergic agonist. Because previous studies of neonatal rat spinal cord in vitro suggest that the most important lumbar segments for rhythmogenesis are L1-L2, we investigated the role of various lumbar segments in the initiation of walking movements on a treadmill of adult cats spinalized (T13), 5-6 d earlier. The locomotor activities were evaluated from electromyographic and video recordings. The results show that: (1) localized topical application of clonidine in restricted baths over either the L3-L4 or the L5-L7 segments was sufficient to induce walking movements. Yohimbine, an alpha2-noradrenergic antagonist, could block this locomotion when applied over L3-L4 or L5-L7; (2) microinjections of clonidine in one or two lumbar segments from L3 to L5 could also induce locomotion; (3) after an intravenous injection of clonidine, locomotion was blocked by microinjections of yohimbine in segments L3, L4, or L5 but not if the injection was in L6; (4) locomotion was also blocked in all cases by additional spinal transections at L3 or L4. These results show that it is possible to initiate walking in the adult spinal cat with a pharmacological stimulation of a restricted number of lumbar segments and also that the integrity of the L3-L4 segments is necessary to sustain the locomotor activity.