Analysis of normal C9orf72 repeat length as possible disease modifier in amyotrophic lateral sclerosis

The C9orf72 hexanucleotide repeat (HR) expansion is the main genetic cause of amyotrophic lateral sclerosis (ALS), with expansion size from 30 to >4000 units. Normal C9orf72 HR length is polymorphic (2-23 repeats) with alleles >8 units showing a low frequency in the general population. This study aimed to investigate if the normal C9orf72 HR length influences C9orf72 gene expression and acts as disease modifier in ALS patients negative for C9orf72 mutation (ALS-C9Neg). We found that the distribution of HR alleles was similar in 325 ALS-C9Neg and 303 healthy controls. Gene expression analysis in blood revealed a significant increase of total C9orf72 and V3 mRNA levels in ALS-C9Neg carrying two long alleles (L/L; ≥8 units) compared to patients homozygous for the 2-unit short allele (S/S). However, HR allele genotypes (L/L, S/L, S/S) correlated with no clinical parameters. Our data suggest that normal C9orf72 HR length does not act as disease modifier in ALS-C9Neg despite increasing gene expression.

Human motor neurons derived from induced pluripotent stem cells are susceptible to SARS-CoV-2 infection

Introduction

COVID-19 typically causes Q7 respiratory disorders, but a high proportion of patients also reports neurological and neuromuscular symptoms during and after SARSCoV-2 infection. Despite a number of studies documenting SARS-CoV-2 infection of various neuronal cell populations, the impact of SARS-CoV-2 exposure on motor neuronal cells specifically has not been investigated so far.

Methods

Thus, by using human iPSC-derived motor neurons (iPSC-MNs) we assessed: (i) the expression of SARS-CoV-2 main receptors; (ii) iPSC-MN infectability by SARS-CoV-2; and (iii) the effect of SARS-CoV-2 exposure on iPSC-MN transcriptome.

Results

Gene expression profiling and immunofluorescence (IF) analysis of the main host cell receptors recognized by SARS-CoV-2 revealed that all of them are expressed in iPSC-MNs, with CD147 and NRP1 being the most represented ones. By analyzing SARS-CoV-2 N1 and N2 gene expression over time, we observed that human iPSC-MNs were productively infected by SARS-CoV-2 in the absence of cytopathic effect. Supernatants collected from SARS-CoV-2-infected iPSC-MNs were able to re-infect VeroE6 cells. Image analyses of SARS-CoV-2 nucleocapsid proteins by IF confirmed iPSC-MN infectability. Furthermore, SARS-CoV-2 infection in iPSCMNs significantly altered the expression of genes (IL-6, ANG, S1PR1, BCL2, BAX, Casp8, HLA-A, ERAP1, CD147, MX1) associated with cell survival and metabolism, as well as antiviral and inflammatory response.

Discussion

These results suggest for the very first time that SARS-CoV-2 can productively infect human iPSC-derived MNs probably by binding CD147 and NRP1 receptors. Such information will be important to unveil the biological bases of neuromuscular disorders characterizing SARS-CoV-2 infection and the so called long-COVID symptoms.

Association of the risk factor UNC13A with survival and upper motor neuron involvement in amyotrophic lateral sclerosis

Background

The UNC13A gene is an established susceptibility locus for amyotrophic lateral sclerosis (ALS) and a determinant of shorter survival after disease onset, with up to 33.0 months difference in life expectancy for carriers of the rs12608932 risk genotype. However, its overall effect on other clinical features and ALS phenotypic variability is controversial.

Methods

Genotype data of the UNC13A rs12608932 SNP (A-major allele; C-minor allele) was obtained from a cohort of 972 ALS patients. Demographic and clinical variables were collected, including cognitive and behavioral profiles, evaluated through the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) - Italian version and the Frontal Behavioral Inventory (FBI); upper and lower motor neuron involvement, assessed by the Penn Upper Motor Neuron Score (PUMNS) and the Lower Motor Neuron Score (LMNS)/Medical Research Council (MRC) scores, respectively; the ALS Functional Rating Scale Revised (ALSFRS-R) score at evaluation and progression rate; age and site of onset; survival. The comparison between the three rs12608932 genotypes (AA, AC, and CC) was performed using the additive, dominant, and recessive genetic models.

Results

The rs12608932 minor allele frequency was 0.31 in our ALS cohort, in comparison to 0.33-0.41 reported in other Caucasian ALS populations. Carriers of at least one minor C allele (AC + CC genotypes) had a shorter median survival than patients with the wild-type AA genotype (-11.7 months, p = 0.013), even after adjusting for age and site of onset, C9orf72 mutational status and gender. Patients harboring at least one major A allele (AA + AC genotypes) and particularly those with the wild-type AA genotype showed a significantly higher PUMNS compared to CC carriers (p = 0.015 and p_adj = 0.037, respectively), thus indicating a more severe upper motor neuron involvement. Our analysis did not detect significant associations with all the other clinical parameters considered.

Conclusion

Overall, our findings confirm the role of UNC13A as a determinant of survival in ALS patients and show the association of this locus also with upper motor neuron involvement.

Immunomodulation mediated by a herbal syrup containing a standardized Echinacea root extract: a pilot study in healthy human subjects on cytokine gene expression

In this study, the immunomodulatory effect of a triply standardized Echinacea angustifolia root extract (Polinacea(®)) was evaluated in 10 healthy subjects. Ten ml of syrup containing one hundred mg of extract (corresponding to 4.7 mg of Echinacoside and 8.0mg of a high molecular weight-20,000 Da- polysaccharide) were administered as a herbal syrup once a day for one month. The immunomodulatory effect was evaluated before and after herbal syrup administration evaluating the expression levels of the cytokines IL-2, IL-8, IL-6 and TNF-α. Cytokine expression was studied in lympho-monocytes and in plasma samples measuring the mRNA and protein levels, respectively. The results were analysed by ANOVA and non-parametric Friedman rank sum tests; when possible it was adopted a pair-wise comparisons at different post-treatment times, using the paired t-tests with Holm correction. The correlation between the variations of cytokine plasma levels and the respective mRNA was carried out using a linear regression model. In lympho-monocytes our data indicate the up-regulation of the mRNA levels of IL-2 and IL-8 and the down regulation of the mRNA levels of the pro-inflammatory cytokines TNF-α and IL6. The differential regulation was maximal after 14 days of treatment. IL-2 up-regulation and IL-6 down-regulation were also confirmed at the protein level in plasma. Finally, the up-regulation of the mRNA of IL-2/IL-8 and the down-regulation of IL-6 positively correlated with the protein levels detected in the plasma. In conclusion, this pilot study suggests a relevant role for the standardized Echinacea angustifolia root extract in the control of cytokine expression. This first demonstration of the immuno-modulating activity of Echinacea angustifolia root extract in the healthy subject, supports at least in part the common use of such products as health promoting supplement.

Pharmacokinetics and immunomodulatory effects of phytotherapeutic lozenges (bonbons) with Echinacea purpurea extract

The relative bioavailability of the major alkamides, dodeca-2E,4E,8Z,10E/Z-tetraenoic acid isobutylamides, from Echinacea purpurea phytotherapeutic lozenges at three different dose levels (0.07, 0.21 and 0.9 mg) was evaluated in a pharmacokinetic study in humans and the possible effects on the immunological system were measured. Alkamides were found to be rapidly absorbed and measurable in plasma 10 min after administration of 0.21 and 0.9 mg lozenges and remained detectable for 3h for the 0.21 mg lozenges and for more then 3h for the 0.9 mg lozenges; 0.07 mg lozenges were measurable 20 min after administration and remained detectable for only 2h after the administration. A significant dose-independent down-regulation of the pro-inflammatory cytokines IL-12p70, IL-8, IL-6, IL-10 and TNF was observed 24h after oral administration. The results of non-compartmental pharmacokinetic analysis revealed that a C(max) of (0.65+/-0.41 ng/ml) was reached at 32 min with the 0.07 mg lozenges, (1.00+/-0.21ng/ml) at 25 min with the 0.21 mg lozenges and (8.88+/-5.89 ng/ml) at 19 with the 0.9mg lozenges. As evidenced by the dose-exposure relationship, no significant departure from dose proportionality was observed, indicating linearity in pharmacokinetics. To get a further insight in pharmacokinetics of dodeca-2E,4E,8Z,10E/Z-tetraenoic isobutylamides a compartmental population pharmacokinetic model was developed applying mixed effect modelling procedure. The results demonstrate that within the dose range studied pharmacokinetics of dodeca-2E,4E,8Z,10E/Z-tetraenoic isobutylamides are linear and that absorption is very rapid (t(1/2)=6 min) with apparently no lag time, thus indicating the possibility that a fraction of the drug is absorbed through the oral mucosa.

Acute Spontaneous Rupture of Retroperitoneal Extrarenal Angiomyolipoma

The authors report a case of retroperitoneal extrarenal angiomyolipoma, an exceptional finding, and discuss the aetiological possibilities of such disease.

Un raro caso di leiomioma renale

Benign solid tumours of the kidney are rare and their anatomo-pathological features are given according to Lakey's classification. Although reports of such tumours are few (0.24%) in a wide study using abdominal echography, some post-mortem data assign an incidence of 5.2% to renal leiomyomas. The authors report a case of right kidney leiomyoma in a 69-year-old man who had undergone right radical nephrectomy. Diagnosis was only possible after the histological examination.

Tumori del tratto urinario ed attività lavorativa nella provincia di Lecco: Studio caso-controllo

To examine occupational risk factors of bladder cancer, a hospital-based case-control study was carried out on incident cases in the province of Lecco between 1 January 1994 and 31 December 1995. The study involved 146 subjects with bladder cancer and 187 controls with non-neoplastic diseases. Sociodemographic characteristics, smoking and drinking habits, lifetime occupational history and exposure to a set of 18 occupational substances suspected as carcinogenic for urinary bladder epithelium were recorded by means of a structured questionnaire. Chi square and logistic regression methods were used for the analysis. Significantly increased risks were found in workers assigned to machinery manufacture (OR=2.2), white-collar workers (OR=1.9) and traders (OR=3.8). Higher risks were seen in men occupationally exposed to aluminium, dyes and paints or varnishes, flour, diesel or traffic fumes and mineral oils. In conclusion, occupational exposure seems to contribute to bladder cancer risk in the area under study.

Funicle-epididymal metastasis from renal cell carcinoma

Metastatic neoplasms of testicular adnexa are extremely rare, particularly the ones spreading from renal cell carcinoma. The authors refer to a case of metachronous metastasis spread from kidney to funicle and para-epididymal tissue, in a 73-year-old male, who had undergone left nephrectomy for adenocarcinoma (seven months before). They review the statistics reported in literature and discuss the possible physiopathology of the way of spreading (in this case left varicocele was associated). Ultrasonography diagnosis of left testis tumour was confirmed by histological test after inguinal orchifunicolectomy.

Voluntary vasectomy: Medico-legal aspects

In Italy, although voluntary sterilisation was decriminalised with act No. 194/78, which abrogated section 552 of the criminal code, there is no regulation as yet ratified by law. The authors refer to the trend shown by some sentences, the most important of which is No. 438 of 18.03.1987 (Court of Cassation), highlighting some aspects of physical and psychic health and “informed” consent. The surgical technique of male sterilisation and possible complications are dealt with, as well as the unresolved medico-legal aspects concerning the irreversibility of the operation or vice versa, failure of reversal. The possible judicial implications of claims for compensation for damages caused by malpractice, negligence or imprudence are also discussed. In conclusion, it is hoped that a law regulating this matter will soon be passed, while in the meantime a protocol to avoid legal liability is suggested.

[Bladder hernia: a clinical case]

The Authors report a case of inguinal bladder hernia and briefly refer about the different kinds of this rare pathology which is often associated to the commonest inguinal hernia. They, moreover, point out the surgical treatment which has to aim to the repositioning of the bladder and to solve the cervicovesical obstruction.

Occupational factors and development of bladder cancer in Lecco (North-West Italy). Preliminary results

— To examine whether occupational factors can be related to the development of bladder cancer, we investigated the occupational histories of patients with bladder transitional cell carcinoma, living in the province of Lecco (North-West Italy) and compared the distribution of their occupations and that of all residents in the same area. A standardized questionnaire (covering family, medical, occupational and residential history, socioeconomics factors and various dietary factors) constituted the study instrument. 358 subjects, of whom 48 at first diagnosis were studied. Tobacco smoking, employment in the transport and communications and in the services sectors were found as possible factors of increased risk in developing bladder cancer. To obtain more definite information a hospital-based case-control study on bladder cancer incidence will be conducted.

Clinical and Medico-legal Aspects of Renal Transplantation: Review of 74 Patients

The authors report on 74 patients who have undergone renal transplantation and are in out-patient follow-up, considering many clinico-statistical parameters (age, pathology, dialysis period, transplantation time, immunosuppressant therapy, current renal functionality) related to their social and work reinstatement. Welfare and pension provisions have also been considered, related to dialysis and transplantation age, in order to grade the remaining working capacity.

Rottura spontanea acuta di angiomiolipoma in rene unico chirurgico

The Authors report a case of angiomyolipoma in sole surgical kidney (preceding right nephrectomy for neoplasia with re-examined diagnosis) in acute spontaneous rupture. Emergency nephrectomy has led to discussion about conservative surgery in cases of angiomyolipoma over 4 cm.

Nuovi aspetti medico-legali nella normativa a proposito del prelievo di organi (rene) a scopo di trapianto

The Authors re-examine the laws and ordinances related to the matter of cadaver organ removal for therapeutic transplantation. They highlight the main medico-legal aspects (proof of death, observation period, consent) and conclude hoping for up-to-date rules according to the recent ordinance by “Regione Lombardia” (April 1994).

[A new biological irradiator for the laboratory]

The use of high doses (15-20 Gy) of X- or gamma-rays to irradiate blood-derived materials is a common practice by now. It is usual especially when materials must be transfused into non-immunocompetent patients. This is done to avoid the so-called GVH disease. Nowadays, for this purpose, units containing radioactive gamma-emitting sources with high activity and long half-life (usually 137Cs) are on the market. The characteristics of these "irradiators" allow their implementation in any laboratory with no need of structural shieldings. In spite of it, serious accidents (e.g., fire, fallings, etc.) which could imply hazards for the operating staff and even the general population, cannot be excluded. At the same time, the problem of long-term disposal of exhausted sources cannot be neglected. For these reasons, a new type of self-shielded irradiator was designed. It is equipped with an X-ray tube, operating at nearly 200-kV voltage, with 12-mA anodic current. The system is water- and oil-cooled and can work for a long time without thermal overloads. In this paper, the environmental and dosimetric measurements for beam characterization are reported. The system can produce beams with satisfactory characteristics for this specific problem. Moreover, its use may greatly reduce administrative radioprotection problems.

Urology and the Work Environment (I): Traumatic Lesions in Work Accidents

In the introduction the authors define violent and accidental work accidents and injuries and review urologic traumatic case histories, including lesions observed both immediately and some time after the traumatic event. These cases were all reported as work accidents: patients’ age, cause and seat of injury, concomitant lesions, immediate therapy, consequences and any further treatment are given in this study. In conclusion, the authors underline the frequency of organic traumatic pathology and indicate relative complications.

Comparison of Patients with Symptomatic and Occasional Renal Neoplasms: Review of Case Histories

A review of case histories from 1988 to 1990 shows an increase in the incidence of renal neoplasms compared to previous years. Analysing the symptomatology and signs that led to diagnosis of a renal tumor in 105 patients, the classical triad (hematuria, pain, swelling) was less evident while “accidental” discovery was clearly more frequent. Taking the paraneoplastic, clinical and laboratory signs into consideration, a significant incidence of anemia, high sedimentation rate and a change in the immunoglobulin (in 30% of cases) emerged, without specificity of monoclonal peaks.

Personal experience in removal of kidney for transplant from a corpse

The authors report their experience in the removal of organs from corpses. 120 donors with brain death supplied 199 kidneys, 80 corneas, 20 hearts, 11 livers, 4 pancreases. In 30 cases more than one organ was removed. The difference in technique for removing single kidneys and for removing several organs is described. The incidence of vascular anomalies and malformations (arterial and venous) is discussed, concluding that the technique of removal en bloc with aortocaval patch is best for preserving the vascularisation and consequently for a successful transplant.

Renal oncocytoma: Personal experience

The Authors report their experience on kidney oncocytomas. They found 6 cases of kidney oncocytoma in 140 cases of kidney tumors. In all cases histological slides of neoplastic masses were made with traditional stains, PAS and PAS diastase and with immunohistochemical reaction for keratins (BDK) and vimentin (DAKO clone V9). They describe one of the six cases in which the diagnosis of oncocitary G3 type carcinoma was made, and another of oncocytomatosis with borderline aspects versus oncocytomal renal cell carcinoma.

Quantitative analysis of the Hopf bifurcation in the Goodwin n-dimensional metabolic control system

We study, from a quantitative point of view, the Hopf bifurcation in an ODE model of feedback control type introduced by Goodwin (1963) to describe the dynamics of end-product inhibition of gene activity. We formally prove that the exchange of linear stability of the positive equilibrium in the n-dimensional Goodwin system with equal reaction constants coexists with a Hopf bifurcation of nontrivial periodic solutions emanating from this equilibrium, without any further restriction on the dimension n greater than or equal to 3 or on the Hill coefficient. The direction of the bifurcation and the stability and the period of the bifurcating orbits are estimated by means of the algorithm proposed by Hassard et al. (1981).

[Limitations and complications of the use of the basket]

During the last 15 years the Dormia stone dislodger has been used in 352 cases (80%) out of 435 of ureteral stones: 318 were at ileo pelvic, 34 at lumbar level. 303 ileo pelvic and 21 lumbar stones have been successfully removed (92%). Considering that the probability of stone removal is directly proportional to the ureteral expansibility and indirectly proportional to the volume of the stone, the Basket technique isn't indicated: When the stone is more than 1 cm.; When the ureter is widely stiff (as in Ormond d. or post-radiotherapy stiffness); When stenosis is present. The impossibility of bypassing the stone, the insufficient expansion of the Basket, the stone irremovability and the difficult extraction through the meatus, my limit the successes of this technique while iperating. The immediate complications have been: 4 sectoral rips of the mucosa surrounding the ureteral end, cured by catheterisation without aftereffects (1.2%); 1 sliding of the ureter through the trigone up to urethral meatus (in a woman), which has been repaired, without aftereffects, by direct catheterisation of the ureter, out of the urethra, after removal of the Basket and stone from the ureteral extremity. (0.3%) Strictures occurred in 5 cases (1.5%) and vescicoureteral reflux in 6 (1.8%). These results of the sole Basket technique (performed according to the well-known directions) seem to be much better than those (which have been illustrated) obtained with the endoscopic lithotripsy.