The effects of prehospital TXA on mortality and neurologic outcomes in patients with traumatic intracranial hemorrhage: a subgroup analysis from the prehospital TXA for TBI trial

BACKGROUND

In the Prehospital Tranexamic Acid (TXA) for TBI Trial, TXA administered within two hours of injury in the out-of-hospital setting did not reduce mortality in all patients with moderate/severe traumatic brain injury (TBI). We examined the association between TXA dosing arms, neurologic outcome, and mortality in patients with intracranial hemorrhage (ICH) on computed tomography (CT).

METHODS

This was a secondary analysis of the Prehospital Tranexamic Acid for TBI Trial (ClinicalTrials.gov [NCT01990768]) that randomized adults with moderate/severe TBI (Glasgow Coma Scale<13) and systolic blood pressure > =90 mmHg within two hours of injury to a 2-gram out-of-hospital TXA bolus followed by an in-hospital saline infusion, a 1-gram out-of-hospital TXA bolus/1-gram in-hospital TXA infusion, or an out-of-hospital saline bolus/in-hospital saline infusion (placebo). This analysis included the subgroup with ICH on initial CT. Primary outcomes included 28-day mortality, 6-month Glasgow Outcome Scale-Extended (GOSE) < = 4, and 6-month Disability Rating Scale (DRS). Outcomes were modeled using linear regression with robust standard errors.

RESULTS

The primary trial included 966 patients. Among 541 participants with ICH, 28-day mortality was lower in the 2-gram TXA bolus group (17%) compared to the other two groups (1-gram bolus/1-gram infusion 26%, placebo 27%). The estimated adjusted difference between the 2-gram bolus and placebo groups was -8·5 percentage points (95% CI, -15.9 to -1.0) and between the 2-gram bolus and 1-gram bolus/1-gram infusion groups was -10.2 percentage points (95% CI, -17.6 to -2.9). DRS at 6 months was lower in the 2-gram TXA bolus group than the 1-gram bolus/1-gram infusion (estimated difference -2.1 [95% CI, -4.2 to -0.02]) and placebo groups (-2.2 [95% CI, -4.3, -0.2]). Six-month GOSE did not differ among groups.

CONCLUSIONS

A 2-gram out-of-hospital TXA bolus in patients with moderate/severe TBI and ICH resulted in lower 28-day mortality and lower 6-month DRS than placebo and standard TXA dosing.

LEVEL OF EVIDENCE

Therapeutic/Care Management, Level II.

Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury

IMPORTANCE

Traumatic brain injury (TBI) is the leading cause of death and disability due to trauma. Early administration of tranexamic acid may benefit patients with TBI.

OBJECTIVE

To determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI.

DESIGN, SETTING, AND PARTICIPANTS

Multicenter, double-blinded, randomized clinical trial at 20 trauma centers and 39 emergency medical services agencies in the US and Canada from May 2015 to November 2017. Eligible participants (N = 1280) included out-of-hospital patients with TBI aged 15 years or older with Glasgow Coma Scale score of 12 or less and systolic blood pressure of 90 mm Hg or higher.

INTERVENTIONS

Three interventions were evaluated, with treatment initiated within 2 hours of TBI: out-of-hospital tranexamic acid (1 g) bolus and in-hospital tranexamic acid (1 g) 8-hour infusion (bolus maintenance group; n = 312), out-of-hospital tranexamic acid (2 g) bolus and in-hospital placebo 8-hour infusion (bolus only group; n = 345), and out-of-hospital placebo bolus and in-hospital placebo 8-hour infusion (placebo group; n = 309).

MAIN OUTCOMES AND MEASURES

The primary outcome was favorable neurologic function at 6 months (Glasgow Outcome Scale-Extended score >4 [moderate disability or good recovery]) in the combined tranexamic acid group vs the placebo group. Asymmetric significance thresholds were set at 0.1 for benefit and 0.025 for harm. There were 18 secondary end points, of which 5 are reported in this article: 28-day mortality, 6-month Disability Rating Scale score (range, 0 [no disability] to 30 [death]), progression of intracranial hemorrhage, incidence of seizures, and incidence of thromboembolic events.

RESULTS

Among 1063 participants, a study drug was not administered to 96 randomized participants and 1 participant was excluded, resulting in 966 participants in the analysis population (mean age, 42 years; 255 [74%] male participants; mean Glasgow Coma Scale score, 8). Of these participants, 819 (84.8%) were available for primary outcome analysis at 6-month follow-up. The primary outcome occurred in 65% of patients in the tranexamic acid groups vs 62% in the placebo group (difference, 3.5%; [90% 1-sided confidence limit for benefit, -0.9%]; P = .16; [97.5% 1-sided confidence limit for harm, 10.2%]; P = .84). There was no statistically significant difference in 28-day mortality between the tranexamic acid groups vs the placebo group (14% vs 17%; difference, -2.9% [95% CI, -7.9% to 2.1%]; P = .26), 6-month Disability Rating Scale score (6.8 vs 7.6; difference, -0.9 [95% CI, -2.5 to 0.7]; P = .29), or progression of intracranial hemorrhage (16% vs 20%; difference, -5.4% [95% CI, -12.8% to 2.1%]; P = .16).

CONCLUSIONS AND RELEVANCE

Among patients with moderate to severe TBI, out-of-hospital tranexamic acid administration within 2 hours of injury compared with placebo did not significantly improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01990768.

Spectrum and frequency of critical procedures performed at a Level I adult and pediatric trauma center

OBJECTIVES

The primary objective of this study was to provide physician-level data about the frequency of critical procedures at a combined adult and pediatric Level I trauma center, high-acuity, high-volume academic ED. The inspiration for this study question came from a previous study by Mittiga et al. (2013) describing pediatric critical procedure data at a similar high-acuity, high-volume, pediatric-only academic ED. Our secondary objective is to compare our pediatric level procedural spectrum and frequency with those published by Mittiga et al. (2013).

METHODS

This prospective observational study occurred over eleven consecutive months at an urban, Level I combined adult/pediatric trauma center with 96,000 annual visits (8500 pediatric). We recorded only procedures performed in the resuscitation bays. All data analysis is descriptive.

RESULTS

Over eleven months, data on 3891 resuscitations were collected (3686 adults and 205 children); 38 faculty physicians supervised 1838 total critical procedures, 64 on children. The mean number of critical procedures per physician per month was 4.42 (0.15 on children). Additionally, ultrasound for intravenous access, extended focused assessment with sonography for trauma (e-FAST), or cardiac ultrasound were performed in 3862 resuscitations (178 pediatric).

CONCLUSIONS

Emergency medicine faculty physicians at a combined Level I adult and pediatric trauma center performed and/or supervised 4.4 total (0.15 pediatric) critical procedures per month per faculty which is nearly 6 times more critical procedures monthly than faculty at a similar volume pediatric-only trauma center. However, fewer critical procedures were performed on children at the combined facility.

The temporal profile of retinal cell genesis in the marmoset monkey

The New World marmoset monkey (Callithrix jacchus) has a relatively short gestational period compared with other primates but possesses a retina at a similar stage of maturation by birth. Previous studies have highlighted that the complex fovea of the marmoset undergoes a more rapid postnatal development in comparison with the Macaca monkey, reaching a mature stage earlier than these species. In this current study, we examined the prenatal proliferation profile of cells in the entire retina employing the thymidine analogs and also determined their phenotype by double-label immunocytochemistry using type-specific markers. Akin to other primate species, we demonstrate a centroperipheral gradient in the emergence of both neurons and Müller glia with cones, ganglion cells, and horizontal cells generated first in the fovea at fetal day (Fd)70-74 and with the last generated at the retinal edge at Fd115. Rods, bipolar cells, amacrine cells, displaced amacrine cells, and Müller glia were generated between Fd76 and Fd135 along the same gradient. Similar to foveal development, marmoset neuronal generation was rapid, only taking 51% of gestation whereas in Macaca this takes 81%.

Extension study of participants from the trial of early aggressive therapy in juvenile idiopathic arthritis

OBJECTIVE

To follow children with juvenile idiopathic arthritis (JIA) who had completed at least 6 months of the TRial of Early Aggressive Therapy (TREAT) clinical study for an additional 2 years, describing safety of early aggressive treatment, disease activity, function, and duration of clinical inactive disease (CID) during followup.

METHODS

Children were treated as per provider's discretion. Physician, patient/parent, and laboratory measures of disease status as well as safety information were collected at clinic visits every 3 months for up to 2 years.

RESULTS

Forty-eight children were followed for a mean of 28 months (range 12-42) beyond the end of the TREAT study. Half of patients were in CID for > 50% of their followup time. Overall, 88% of patients achieved CID at > 1 study visit and 54% achieved clinical remission while taking medication. Six patients were in CID for the duration of the study, and, of those, 2 achieved a full year of clinical remission while not taking medication. Active disease was mild: mean physician's global assessment 2.4, active joint count 3.5, parent global evaluation 2.4, Childhood Health Assessment Questionnaire 0.32, erythrocyte sedimentation rate 19 mm/h, and morning stiffness 23 min. There were no serious adverse events or adverse events reported at grade 3 or higher of Common Terminology Criteria for Adverse Events.

CONCLUSION

Early aggressive therapy in this cohort of patients with polyarticular JIA who had high initial disease activity was associated with prolonged periods of CID in the majority of patients during followup. Those not in CID had low levels of disease activity.

Prevalence of narcolepsy in King County, Washington, USA

BACKGROUND

Relatively few epidemiologic studies have focused on narcolepsy, a disabling sleep disorder with a strong association with HLA-DQB1 *0602.

METHODS

We sought to estimate the prevalence of narcolepsy using multiple overlapping techniques to identify residents of King County, WA who were 18 years or older with physician-diagnosed narcolepsy. Patients were entered into a registry and recruited into an epidemiologic study entailing interview and buccal scrapings to determine HLA-DQB1 *0602 status. Missing values were imputed to allow prevalence to be estimated based on all 425 patients entered into the registry between 2001 and 2005, whether they were recruited into the epidemiologic study (n=279) or not (n=146).

RESULTS

As of July 01, 2001, estimated prevalence per 100,000 of physician-diagnosed narcolepsy with cataplexy was 21.8 (95% confidence interval (CI): 18.8-24.8), similar to prior studies. The median age of onset was 14 (interquartile range: 10-18). For narcolepsy with HLA-DQB1 *0602, prevalence was 15.3 (95% CI: 12.8-17.9). Estimated prevalence was higher in women than men and in African-Americans than other racial groups.

CONCLUSIONS

These differences could reflect problems in identification and recruitment or may provide etiologic clues about narcolepsy. This study illustrates the challenges in performing population-based studies of narcolepsy.

Expression patterns of calretinin, calbindin and parvalbumin and their colocalization in neurons during development of Macaca monkey retina

The developmental expression of calbindin (CalB), calretinin (CaR) and parvalbumin (PV) was followed in Macaca monkey retina using single and double immunolabeling to identify which proteins provide distinctive labels for specific cell types and to clarify the role of these proteins during development. Ganglion cells (GC) expressed PV at fetal day (Fd)55 and CaR and CalB by Fd85. CaR was downregulated after birth. Separate subsets of amacrine (AM) cells expressed CaR and CalB at Fd65-70. After Fd115, many CaR+ AM coexpressed CalB. After Fd120 a few AM expressed PV and these added CaR and CalB after birth. A subset of horizontal cells (HZ) expressed CaR and CalB at Fd70. Slightly later all HZ express PV and CaR while the early subset is CalB+/PV+/CaR+. CaR downregulates in all HZ after birth. The DB3 cone bipolar cells (BP) under the HZ label for CalB by Fd90-110 while a probable OFF BP cell body just above the AM layer becomes CaR+ near birth with labeling increasing after birth. All cones outside of the fovea label for CalB by Fd125. Foveal cones, rods, most BP and Müller glia do not label for these proteins at any age. The complex patterns of up- and down-regulation found in Macaca retina are similar to previous reports of expression in human retina, but in many instances are quite different than earlier reports of CaR, CalB and PV expression patterns in monkey central visual centers. This makes it highly likely that each protein plays a specific but undetermined role(s) in each visual center, and that its expression is controlled at a given stage of retinal development by multiple intrinsic and extrinsic factors.

Co-localization of glycine and gaba immunoreactivity in interneurons in Macaca monkey cerebellar cortex

Previous work demonstrates that the cerebellum uses glycine as a fast inhibitory neurotransmitter [Ottersen OP, Davanger S, Storm-Mathisen J (1987) Glycine-like immunoreactivity in the cerebellum of rat and Senegalese baboon, Papio papio: a comparison with the distribution of GABA-like immunoreactivity and with [3H]glycine and [3H]GABA uptake. Exp Brain Res 66(1):211-221; Ottersen OP, Storm-Mathisen J, Somogyi P (1988) Colocalization of glycine-like and GABA-like immunoreactivities in Golgi cell terminals in the rat cerebellum: a postembedding light and electron microscopic study. Brain Res 450(1-2):342-353; Dieudonne S (1995) Glycinergic synaptic currents in Golgi cells of the rat cerebellum. Proc Natl Acad Sci U S A 92:1441-1445; Dumoulin A, Triller A, Dieudonne S (2001) IPSC kinetics at identified GABAergic and mixed GABAergic and glycinergic synapses onto cerebellar Golgi cells. J Neurosci 21(16):6045-6057; Dugue GP, Dumoulin A, Triller A, Dieudonne S (2005) Target-dependent use of coreleased inhibitory transmitters at central synapses. J Neurosci 25(28):6490-6498; Zeilhofer HU, Studler B, Arabadzisz D, Schweizer C, Ahmadi S, Layh B, Bosl MR, Fritschy JM (2005) Glycinergic neurons expressing enhanced green fluorescent protein in bacterial artificial chromosome transgenic mice. J Comp Neurol 482(2):123-141]. In the rat cerebellum glycine is not released by itself but is released together with GABA by Lugaro cells onto Golgi cells [Dumoulin A, Triller A, Dieudonne S (2001) IPSC kinetics at identified GABAergic and mixed GABAergic and glycinergic synapses onto cerebellar Golgi cells. J Neurosci 21(16):6045-6057] and by Golgi cells onto unipolar brush and granule cells [Dugue GP, Dumoulin A, Triller A, Dieudonne S (2005) Target-dependent use of coreleased inhibitory transmitters at central synapses. J Neurosci 25(28):6490-6498]. Here we report, from immunolabeling evidence in Macaca cerebellum, that interneurons in the granular cell layer are glycine+ at a density of 120 cells/linear mm. Their morphology indicates that they include Golgi and Lugaro cell types with the majority containing both glycine and GABA or glutamic acid decarboxylase. These data are consistent with the proposal that, as in the rat cerebellum, these granular cell layer interneurons corelease glycine and GABA in the primate cerebellum. The patterns of labeling for glycine and GABA within Golgi and Lugaro cells also indicate that there are biochemical sub-types which are morphologically similar. Further, we find that glycine, GABA and glutamic acid decarboxylase identified candelabrum cells adjacent to the Purkinje cells which is the first time that this interneuron has been reported in primate cerebellar cortex. We propose that candelabrum cells, like the majority of Golgi and Lugaro cells, release both glycine and GABA.

Ex vivo measures of LDL oxidative susceptibility predict carotid artery disease

AIM

The purpose of the study was to assess whether ex vivo measures of low-density lipoprotein (LDL) oxidation improved prediction of carotid artery disease (CAAD) case-control status compared to standard lipid and smoking measures.

METHODS

One hundred and forty cases with a high degree of carotid artery stenosis aged 40-83 years and an equal number of controls without stenosis or other vascular disease were matched by censored age within 2 years. Matched logistic regression evaluated the significance of copper-induced oxidative measures with and without covariates. The relationship of LDL oxidation measures with statin use and current smoking was also evaluated.

RESULTS

Logistic regression demonstrated a significant effect of the three correlated measures of oxidative susceptibility (lag time, oxidation rate and maximal rate of oxidation) separately on disease prediction (all p<0.05). These oxidative measures remained significant predictors of case-control status when other cardiovascular disease predictors (age; LDL-C, HDL-C and ApoAI levels; current smoking, ever smoking and pack-years smoked) were jointly considered. This relationship was not attributable to the effects of statin use on LDL oxidation.

CONCLUSIONS

Ex vivo measures of oxidation improved the prediction of carotid artery disease status, suggesting that this is an important determinant of atherosclerotic risk in this older population.

Immunocytochemical characterization of cysts in the peripheral retina and pars plana of the adult primate

PURPOSE

To better characterize the cellular constituents of cysts in the peripheral retina and pars plana of the adult monkey.

METHODS

Frozen sections of the peripheral retinal margin and pars plana from monkeys (Macaca nemestrina) between 1 and 15 years of age were stained with toluidine blue or immunolabeled with a variety of glia- and neuron-specific antibodies.

RESULTS

In animals 1 to 2 years of age, the nonpigmented inner layer of the pars plana is a pseudostratified columnar epithelium. In these young animals, the peripheral retina had distinct layers and did not contain cysts. In animals 6 years of age or older, there were numerous cysts in the pars plana and in the peripheral retina. In the peripheral retina, neurons were randomly distributed and did not have a laminar organization. Cells surrounding cysts were immunoreactive for different types of markers for retinal neurons. Some of the cells surrounding cysts in the pars plana were also unexpectedly immunoreactive for antigens normally expressed only in retinal neurons and glia.

CONCLUSIONS

Cysts form in the peripheral retina and pars plana in adult monkeys. The peripheral retinal cysts disrupt the normal lamination of the cells, but all types of retinal neurons are still present in the cysts. In an unexpected finding, cysts in the pars plana also contained cells immunoreactive for a few of the markers of retinal cells, suggesting that neurogenesis may occur in the pars plana of the adult primate.

Multiple phosphorylated isoforms of NRL are expressed in rod photoreceptors

NRL, a bZIP transcription factor of the Maf subfamily, interacts with the homeodomain protein CRX and synergistically regulates rhodopsin expression. Here we report that six isoforms of NRL (29-35 kDa) are generated by phosphorylation and expressed specifically in the mammalian retina. The anti-NRL antibody also cross-reacts with a cytosolic 45-kDa protein, which is detected in neuronal tissues but is not encoded by the NRL gene. In both human retinal cell cultures and sections of fetal and adult human retina, NRL is present in the nuclei of developing and mature rods but not cones. We propose that NRL regulates rod photoreceptor-specific gene expression and is involved in rod differentiation.

Localization of pigment epithelium derived factor (PEDF) in developing and adult human ocular tissues

PURPOSE

To localize pigment epithelium-derived factor (PEDF) in developing and adult human ocular tissues.

METHODS

PEDF was localized in fetal and adult eyes by immunofluorescence with a polyclonal antibody (pAb) against amino acids 327-343 of PEDF, or a monoclonal antibody (mAb) against the C-terminal 155 amino acids of PEDF. Specificity of the antibodies was documented by Western blotting. PEDF mRNA was localized in adult retina by in situ hybridization.

RESULTS

In developing retinas (7.4 to 21.5 fetal weeks, Fwks), pAb anti-PEDF labeled retinal pigment epithelium (RPE) granules, developing cones, some neuroblasts and many cells in the ganglion cell layer (GCL). In adult retinas, pAb anti-PEDF labeled rod and cone cytoplasm and nuclei of rods but not cones. Cells in the INL and GCL, choroid, corneal epithelium and endothelium, and ciliary body were also pAb PEDF-positive. Preadsorption of pAb anti-PEDF with the immunizing peptide blocked specific labeling in retina and other tissues, except for photoreceptor outer segments. In agreement with the immunolocalization with pAb anti-PEDF, in situ hybridization revealed PEDF mRNA in the RPE, photoreceptors, inner nuclear layer cells and ganglion cells in adult retina. In developing retinas 18 Fwks and older, and in adult retinas, mAb anti-PEDF labeled the interphotoreceptor matrix (IPM). Western blots of retina, cornea, and ciliary body/iris with pAb anti-PEDF produced several bands at about 46 kDa. With mAb anti-PEDF, retina produced one band at about 46 kDa; cornea and ciliary body/iris had several bands at about 46 kDa.

CONCLUSIONS

PEDF, originally reported as a product of RPE cells, is present in photoreceptors and inner retinal cell types in developing and adult human eyes. Photoreceptors and RPE may secrete PEDF into the IPM.

Regulation of retinal capillary cells by basic fibroblast growth factor, vascular endothelial growth factor, and hypoxia

Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) feature prominently in retinal neovascular diseases. Although the role of VEGF in retinal angiogenesis is well established, the importance of bFGF in this process requires further clarification. This study was undertaken to investigate the responses of retinal capillary cells (endothelial cells and pericytes) to bFGF under hypoxic conditions, as well as the potentially synergistic effects of bFGF and VEGF on the proliferation and cord formation of retinal endothelial cells. Cell proliferation was determined by cell number and by 3H-thymidine incorporation. Cord formation was assessed in three-dimensional gels of collagen type I. VEGF and bFGF increased 3H-thymidine incorporation by both cell types, an effect that was more pronounced in a hypoxic environment. Moreover, the proliferation of pericytes was stimulated to a greater extent by bFGF relative to VEGF. Endothelial migration in collagen gels, however, was induced more effectively by VEGF than by bFGF. A synergistic effect of VEGF and bFGF on cell invasion was observed in the collagen gel assay. VEGF and bFGF each augment proliferation of these cells, especially under hypoxia. We thus propose that these two cytokines have a synergistic effect at several stages of angiogenesis in the retina.

Spatial and temporal expression of short, long/medium, or both opsins in human fetal cones

Human cone photoreceptors are characterized by long (L), medium (M), or short (S) wavelength-specific opsin. No reports have described the developmental pattern of human cone opsin expression, nor has the existence of human cones containing more than one opsin been tested. Single-and double-label immunocytochemistry and in situ hybridization have been used to determine the developmental pattern of opsin appearance and to investigate the presence of double-labeled cones in sections and wholemounts of human fetal, neonatal, infant, and adult retina. S opsin protein appears in and around the fovea at fetal week (Fwk) 10.9, whereas L/M opsin first appears in the fovea at Fwk 14-15. S opsin mRNA and protein are consistently detected much farther into peripheral retina than L/M opsin, indicating that S appears before L/M opsin. S cones cover 90% of the retina by Fwk 19. L/M cones appear outside the central retina by Fwk 21.5 and reach the retinal edge by Fwk 34-37. The spatial pattern of mRNA expression closely matches that for protein, but mRNA appears slightly earlier than protein at a given retinal point, indicating that only short delays occur between mRNA expression and translation into protein. Cones containing both S and L/M opsin (S+L/M) appear around the fovea shortly after L/M opsin is expressed, are found in more peripheral retina at older ages, and decrease in number after birth. Some S+L/M cones are still detected in adult retina. Both S opsin protein and mRNA appear significantly earlier than L/M mRNA or protein across the human retina, suggesting that the two cone types differentiate under independent controlling factors. However, the presence of single cones containing both S and L/M opsin during development suggests that human cones can respond to the factors controlling expression of each opsin.

Nocturnal tarsier retina has both short and long/medium-wavelength cones in an unusual topography

The evolutionary position of tarsiers with respect to primates is still debated. The type of photoreceptors in the nocturnal Tarsius spectrum retina has been compared with the nocturnal New World monkey Aotus trivulgaris and the Old World monkey Macaca nemestrina by using immunocytochemical labeling for antisera known to be specific for primate cone and rod proteins. In all three species, antisera to long/medium (L/M) -wavelength specific cone opsin and cone-specific alpha-transducin detected a single row of cones. Only Macaca and tarsier retina contained cones labeled by antiserum to short (S) -wavelength specific cone opsin. Tarsier rod cell bodies were 6-12 deep, depending on retinal eccentricity. Tarsier central cones had 2-microm-wide outer (OS) and inner segments, which came straight off the cell body. Cone morphology differed little from rods except OS were shorter. Macaca cones labeled for 7G6 and calbindin, Aotus cones did not label for calbindin, and Tarsius cones did not label for 7G6 or calbindin. In tarsier retinal whole-mounts, peak cone density ranged from 11,600-14,200/cones mm(2). The 11- to 12-mm-wide peak region centered roughly on the optic disc, although foveal counts remain to be completed. Density decreased symmetrically to a far peripheral band of 4,200-7, 000/cones mm(2). In contrast, S cone density was very low in central retina (0-300/mm(2)), rose symmetrically with eccentricity, and peaked at 1,100-1,600/mm(2) in a 2- to 3-mm-wide zone in the far periphery. In this zone, S cones were 9-14% of all cones. L/M cones were regularly spaced, whereas S cones showed no regular distribution pattern. Although the functional characteristics of the tarsier S and L/M cone systems are yet to be determined, tarsier cone proteins and distribution have some similarities to both New and Old World monkey retinas.

The spatial and temporal expression of outer segment proteins during development of Macaca monkey cones

PURPOSE

To characterize the spatial and temporal expression of key structural and phototransduction cascade proteins in the monkey cone outer segment (OS).

METHODS

Retinas from Macaca monkeys from ages fetal day (Fd) 89 through adulthood were double labeled using immunofluorescence for short (S) or long/medium (L/M) wavelength-sensitive cone opsin and either a structural protein (peripherin) or a phototransduction cascade protein (alpha-transducin [alpha-T], phosphodiesterase [PDE], or rhodopsin kinase [RK]). The spatial and temporal patterns of expression for each protein at each age were determined and graphed as a percentage of retinal coverage.

RESULTS

In both cone types, opsins and phototransduction proteins appear first in the fovea and last at the retinal edge. Peripherin appears concomitantly with opsin in both S and L/M cones, but S cones express peripherin and opsin 1 to 3 weeks before neighboring L/M cones. Alpha-T, PDE, and RK are expressed together in the L/M cone OS shortly after L/M opsin appears. Phototransduction proteins are not expressed in S cones until 1 to 3 weeks after the appearance of S opsin and at the same time that neighboring cones are expressing both L/M opsin and phototransduction proteins.

CONCLUSIONS

The concomitant appearance of opsin and peripherin strongly suggests roles in promoting the structural integrity of the developing OS. Phototransduction cascade proteins appear in the developing OS at the same time as one another, but after opsin. The significant lag between their expression and that of S cone opsin indicates that phototransduction proteins are not essential for OS formation, nor does opsin expression trigger their expression. The different temporal but similar spatial expression patterns of phototransduction proteins within S and L/M cones suggests that some local signal(s) coordinates their appearance.

Flavor-cued modulation of intake in rats: role of familiarity and impact on 24-h intake

Following training with distinctively flavored nutritive solutions that differ in concentration and thus in caloric value, rats demonstrate flavor-postingestive consequence learning by preferentially consuming one of the flavors in two-bottle tests (both flavors in nutrient-identical solutions.) Experiment 1 investigated whether the relative familiarity of the flavor-nutrient combinations encountered in two-bottle tests contributes to the observed preference. One of the training concentrations (rather than the customary intermediate concentration) was used to present the flavors in testing; thus, one of the flavors was in a familiar context while the other was in an unfamiliar context. The results of two independent trials (rats trained with 1 and 5% sucrose; rats trained with 5 and 40% sucrose) confirmed that two-bottle test preference was not a preference for the familiar flavor-nutrient combination. Experiment 2 examined whether caloric expectancies based upon a previously learned flavor-postingestive consequence association would affect total daily intake. On alternating days, rats consumed 30 mL of dilute (5%) and concentrated (40%) sucrose, each distinctively flavored. When given 30 mL of 22.5% sucrose containing each of the flavors on separate test days, they ate less chow and thus fewer total calories over 24 h when given the flavor previously paired with concentrated sucrose. Experiment 3 replicated the design of Experiment 2 except that fat calories were used instead of sucrose; no significant adjustment of chow intake in extinction tests was noted, even when the number of fat calories used in training was increased (Experiment 4). Thus, rats did not exhibit flavor-cued modulation of chow intake when trained with fat, in contrast to responsivity to flavor cues when trained with sucrose. This differential responding to fat versus carbohydrate calories is consistent with previous observations, in a variety of paradigms, that modulation of caloric intake is less energetically appropriate when ingested foods are high in fat relative to high-carbohydrate foods.

Analysis of chicken Wnt-13 expression demonstrates coincidence with cell division in the developing eye and is consistent with a role in induction

We used a degenerate polymerase chain reaction (PCR) strategy to search for Wnt RNA in developing ocular tissues. We isolated a Macaca monkey Wnt-13 PCR fragment, orthologous to the human and murine Wnt-13 and Xenopus Wnt-2b, and a chick Wnt13 cDNA. Wnt-13 is a member of the Wnt-1 class of transforming Wnt molecules. In situ RNA hybridization revealed a dynamic Wnt-13 expression pattern in numerous developing tissues. Within the eye, Wnt-13 is expressed in the proliferative epithelium of the lens and both pigmented and non-pigmented layers of the ciliary margin. In vitro BrdU incorporation studies coupled with in situ hybridization showed that cWnt-13 expression domains in the lens were coincident with cell division. In addition to the eye, cWnt-13 was expressed in head ectoderm, prospective forelimb mesenchyme, lung bud, pharyngeal arches, the brain, as well as the otic vesicle. Our data are consistent with previous observations linking transforming Wnts with cell division and implicate a cascade of events involving cWnt-13 first in dorsoventral patterning and later in cell proliferation regulation associated with lens development. Dev Dyn 1999;215:215-224.

Distribution and development of short-wavelength cones differ between Macaca monkey and human fovea

Macaca monkey and humans have three cone types containing either long-wavelength (L), medium-wavelength (M), or short-wavelength (S)-specific opsin. The highest cone density is found in the fovea, which mediates high visual acuity. Most studies agree that the adult human fovea has a small S cone-free area, but data are conflicting concerning S-cone numbers in the adult Macaca monkey fovea, and little evidence exists for how either primate fovea develops its characteristic cone pattern. Single- and double-label in situ hybridization and immunocytochemistry have been used to determine the pattern of foveal S cones in both the fetal and adult Macaca and human. Both labels find a clear difference at all ages between monkey and human. Adult humans have a distinct but variable central zone about 100 microm wide that lacks S cones and is surrounded by a ring in which the S-cone density is 8%. This S cone-free zone is detectable at fetal week 15.5 (Fwk15.5), shortly after S opsin is expressed, and is similar to the adult by Fwk20.5. Adult monkey foveas have an overall S-cone foveal density of 10%, with several areas lacking a few S cones that are not coincident with the area of highest cone density. A surrounding zone at 200-microm eccentricity has an S-cone density averaging 25%, but, by 800 microm, this has decreased to 11%. Fetal day 77-135 monkeys all have a distribution and density of foveal S cones similar to adults, although the high-density ring is not obvious in fetal retinas. Estimates of the numbers of S cones missing in the fetal human fovea range from 234 to 328, whereas no more than 40 are missing in the fetal monkey. These results show that, in these two trichromatic primates, S-cone distribution and the developmental mechanisms determining S-cone topography are markedly different from the time that S cones are first detected.

Spatial and temporal expression of cone opsins during monkey retinal development

The primate retina requires a coordinated series of developmental events to form its specialized photoreceptor topography. In this study, the temporal expression of cone photoreceptor opsin was determined in Macaca monkey retina. Markers for mRNA and protein that recognize short wavelength (S) and long/medium wavelength (L/M) opsin were used to determine (1) the temporal and spatial patterns of opsin expression, (2) the spatial relationship between S and L/M cones at the time of initial opsin expression, and (3) the relative time of cone and rod opsin expression (Dorn et al. [1995] Invest. Ophthalmol. Vis. Sci. 36:2634-2651). Adult cone outer segments were recognized by either L/M or S opsin antiserum. Of all adult cone inner segments, 88-90% contained L/M opsin mRNA, whereas 10-12% contained S opsin mRNA. Fetal cones initially showed cell membrane as well as outer segment labeling for opsin protein, but cell membrane labeling disappeared by birth. No cones at any age contained markers for both S and L/M opsin mRNA or protein. S and L/M opsin protein appeared in the fovea at fetal day 75. Once opsin expression progressed beyond the fovea, both mRNA and protein for S opsin were consistently detected more peripherally than L/M opsin. Cones at the peripheral edge of S opsin expression had basal telodendria that appeared to reach toward neighboring cones. Because interactions between cone populations could organize the cone mosaic, the spatial relationship between S cones and the first cones to express L/M protein was analyzed quantitatively by using double-label immunocytochemistry. No consistent relationship was found between these two cone populations. Cones are generated at least 1 week before rods across monkey retina. However, rod opsin protein appears in and around the fovea at fetal day 66, 1 week before cone opsin protein. This suggests that independent local factors control differentiation in these two photoreceptor populations.

Parvalbumin, calbindin, and calretinin mark distinct pathways during development of monkey dorsal lateral geniculate nucleus

Immunocyochemical labeling was applied to follow the developmental changes in the calcium-binding proteins parvalbumin (PV), calbindin D28k (CaB), and calretinin (CaR) during fetal and infant development of Macaca monkey dorsal lateral geniculate nucleus (LGN). For all three proteins, LGN cell body and retinal ganglion cell (RGC) axon labeling patterns changed temporally and spatially over development, and many of these were LGN laminar specific. CaR+ and CaB+ cells were present at the youngest age studied, fetal day 55 (F55). After lamination of the LGN occurred between F90 and F115, CaR+ and CaB+ neurons were specific markers for the S, intercalated, and interlaminar layers. Double label immunocytochemistry showed that all CaR+ cells contained CaB, and none contained GABA. CaR+ cell bodies decreased in number soon after birth so that adult LGN contained only a very small number of CaR+ cells. These patterns and cell counts indicated that a downregulation of CaR had occurred in the CaB+ population. Although CaB+ cell density in S and interlaminar zones declined in the adult, cell counts indicated that this is due to dilution of a stable population into a much larger nucleus during development. PV+ cells appeared at F85 only within the putative magnocellular (M) and parvocellular (P) layers, and PV remained a marker for these layers throughout development. Fetal PV cells also contained GABA, indicating that they were LGN interneurons. After birth, GABA-/PV+ cell numbers increased dramatically throughout the whole nucleus so that by the end of the first year, P and M layers were filled with PV+ cells. Their number and size indicated that these were the LGN projection neurons. Beginning at F66, bundles of PV+ axons occupied the anterior-middle LGN and filled the optic tract. Up to F101, PV+ synaptic terminals were restricted to Players, but after F132 labeling in M layers was heavier than in P layers. Axonal labeling for CaR began at F125. Prenatally CaR+ terminals were present mainly in P layers, whereas by postnatal 9 weeks labeling in M layers much exceeded P layers. Axonal labeling for CaB was present at F132, but CaB+ terminals were observed only after birth with labeling always heavier in M than P layers. By postnatal 9 weeks, PV, CaR, and CaB were colocalized in the same axons and terminals. These experiments indicated that during development and in the adult LGN, both CaR and CaB were markers for the LGN neurons in the S and intercalated pathway. CaR was present transiently while CaB persisted into adulthood. PV was a M and P layer marker first for interneurons and later for projection cells. The complex temporal developmental patterns found in this study suggested that viewing PV, CaB, and CaR simply as calcium-buffering proteins severely underestimates their functional roles during visual system maturation.

Detection of MAO-A and MAO-B mRNAs in monkey brainstem by cross-hybridization with human oligonucleotide probes

The distribution of mRNAs encoding the isoenzymes monoamine oxidase A and B (MAO-A and MAO-B) in monkey locus coeruleus and dorsal raphe nucleus was studied by in situ hybridization histochemistry using 35S-labelled oligodeoxynucleotide probes complementary to cloned human sequences. MAO-A mRNA was highly expressed in noradrenergic neurons of the locus coeruleus while MAO-B mRNA was abundantly and exclusively localized in serotoninergic neurons of the raphe. However, upon emulsion radioautography raphe neurons showed a level of MAO-A mRNA signal noticeably above the background. Our results indicate the utility of human MAO oligodeoxynucleotide probes to identify homologous species of transcripts in the brain of a non-human primate. They also suggest the coexistence of the isoenzymes in raphe neurons as well as the potential role of MAO-A in metabolizing serotonin in vivo.

Shifting relationships between photoreceptors and pigment epithelial cells in monkey retina: implications for the development of retinal topography

This study examines the spatiotemporal relationships between retinal pigment epithelium (RPE) and photoreceptors (PR) during development of Macaca nemestrina retina. Our aim was to learn more about the developmental dynamics of these two important cell populations, particularly whether development changes in RPE cell densities mimic those of PR at selected retinal points. Twelve eyes ranging in age from 100 fetal days (Fd) to adulthood were flatmounted; the retinal perimeters were traced; and then sample punches were taken of the RPE and neural retina at the fovea, optic disc, mid- and far-nasal periphery, and far temporal, inferior and superior periphery. The two tissues were gently separated and the RPE cells and photoreceptors from the same region of the punch were counted using Nomarski contrast interference optics. We found that the total number of cones remains stable around 4 million between Fd100 and adulthood, but RPE number increases from 1.6 million at Fd100 to 2.56 million in adulthood. At the fovea, the core:RPE ratio increases from 5.4:1 at Fd100 to 28:1 by adulthood. In the temporal periphery by contrast, the cone:RPE ratio declines from 2.2:1 at Fd100-110 to less than 1:1 in the adult. In the vicinity of the optic disc, the ratio of (cones+rods); RPE remains around 35:1 throughout development, but in the retinal periphery it decreases to the adult value of 22:1. These changing ratios indicate that photoreceptors and RPE cells are redistributed independently during development, and that these two cellular sheets slide over one another to achieve their final distribution. This situation suggests that the forces or factors causing foveation are intrinsic to the neural retina.

Coincidental appearance of the alpha 1 subunit of the GABA-A receptor and the type I benzodiazepine receptor near birth in macaque monkey visual cortex

The expression of subtypes of the GABA-A/benzodiazepine receptor complex has been studied during pre- and postnatal development of Macaca monkey visual cortex using complementary radioligand and immunocytochemical labeling. Type I benzodiazepine receptors were labeled directly by [3H]zolpidem. Type II receptors were determined by the amount of binding for [3H]flunitrazepam (FZ) persisting in the presence of the type I-specific ligand CL218872. Monoclonal antibody bd24 was used to label alpha 1 subunits and bd17 to label beta 2 and beta 3 subunits of the GABA-A receptor. Radioligand binding data and bd17 immunoreactivity indicated that type II benzodiazepine receptors were present by fetal day (Fd) 74 (44% of gestation). Immunoreactivity for the beta 2/beta 3 subunits increased until 3-6 weeks after birth, and then declined somewhat into adulthood. Neither radioligand labeling for type I receptors nor immunocytochemical staining for the alpha 1 subunit were apparent until mid-gestation. Both markers appeared shortly before birth in layer 4C, and then in other cortical layers after birth. Immunoreactivity for the alpha 1 subunit increased steadily after birth until it became more intense than that for beta 2/3 subunits in the adult. Quantitative densitometry of CL218872 competition for [3H]FZ binding showed that type I/II distribution was 22%/78% at Fd103; 42%/58% at Fd131; 67%/33% at 9 months; and 61%/39% in adult visual cortex. This "switch" between benzodiazepine receptor subtypes overlaps the postnatal critical period for geniculostriate development, suggesting that the change from type II to type I receptors and the appearance of alpha 1 subunits may play a decisive role in the maturation of geniculocortical axon terminations and cortical response properties. It remains to be shown whether this "switch" is dependent on functional visual input.

Light and electron microscopic analysis of synaptic development in Macaca monkey retina as detected by immunocytochemical labeling for the synaptic vesicle protein, SV2

The development of synapses has been followed in Macaca monkey fetal and infant retina using immunocytochemical labeling for the transmembrane synaptic vesicle glycoprotein, SV2. Electron microscopy (EM) was used to verify the presence of morphological synapses at selected ages. EM immunocytochemical labeling in adult retina showed that all synaptic types contained SV2 in inner (IPL) and outer (OPL) plexiform layers. In fetal retina, SV2 expression and the appearance of morphological synapses were closely related in time, demonstrating that SV2 is a reliable marker for synaptogenesis. SV2 expression appears along a foveal to peripheral gradient. Both SV2 and synapses appear in the foveal IPL at Fd50-55, and reach the retinal edge by Fd90-103. Cone ribbon synapses and SV2 labeling are not present in the foveal OPL until Fd60. Photoreceptors in the far periphery contain SV2 by Fd119-125. This pattern demonstrates an "inner to outer" direction of synaptogenesis. Cones show SV2 labeling before rods at the same retinal eccentricity. In the cone-dominated fovea, SV2 labeling and bipolar cell ribbon-containing terminals are present at Fd55 when amacrine cell conventional terminals are very scarce, indicating that bipolar synapses precede amacrine synapses in monkey foveal IPL. SV2 labeling and bipolar terminals appear first in the outer IPL which contains "OFF" ganglion and bipolar processes in the adult, suggesting that "OFF" midget bipolar cells may form the first synapses. Both SV2 immunocytochemical labeling and EM morphology find that monkey retina follows a generalized inner before outer, and cone before rod synaptic developmental pattern, similar to that in other mammals. The cone-dominated fovea initiates synaptogenesis, and shows a different synaptic sequence from rod-dominated peripheral retina.

The development of parafoveal and mid-peripheral human retina

The morphological development of parafoveal retina (1-1.5 mm from the foveal center) and the mid-peripheral (4 mm from the foveal center) human retina has been studied from fetal (F) 26 weeks to adulthood. At both retinal points, all layers and neuronal types are present at F26 weeks. In parafovea at F26 weeks photoreceptors have only a rudimentary inner segment and no outer segments. Short outer segments are present on both rods and cones at F36 weeks. By postnatal (P) 5-8 days the inner retina is relatively mature. Photoreceptors have elongated basal axons which cause the photoreceptor layer to become much thicker than in prenatal retina. At birth cone inner segments are untapered, but rod inner segments have already reached their adult width of 2 microns. Both rod and cone inner and outer segments are 30-50% of adult length. By 13 months both inner and outer retina are mature appearing, with the photoreceptors accounting for half the retinal thickness due to the elongation of the fibers of Henle. Cone outer segments elongate up to P5 years and rod outer segments to P13 years. At mid-peripheral or rod-ring retina outer segments are present on rods at F26 weeks and on cones at F36 weeks. At birth the inner retina is adultlike. The outer plexiform layer becomes thicker up to P45 months due to the elongation of fibers of Henle. At birth both rod and cone mid-peripheral inner segments are slightly longer and outer segments are 50% longer than in parafoveal retina. By P5 years mid-peripheral rod outer segments are slightly longer than in parafoveal retina, and this changes little thereafter. This anatomical study has found that the photoreceptors in peripheral rod-ring retina develop earlier than those in more central retina, and in turn parafoveal photoreceptors develop well in advance of foveal cones. This suggests that human neonates may utilize more peripheral retinal regions for some aspects of visual function before foveal cone vision becomes dominant.

A morphological comparison of foveal development in man and monkey

The fovea can first be identified in both monkey and human retina at 26-30% gestation as a region containing all adult retinal layers and only cone photoreceptors. A shallow foveal pit and cone outer segments appear by 63-65% gestation in both species. Prenatal development continues rapidly in the monkey, so that by birth a single layer of inner retinal neurons are present in the fovea, cones are three cells deep, inner segments are elongated, and outer segments are up to 50% of inner segment length. In contrast, human fovea does not reach a similar stage until several months after birth. The fovea is adult-like in monkey at 12 weeks and in human at 11-15 months, although human will mature further up to four to five years. This study shows that human fovea is less mature at birth than monkey but develops rapidly in infancy, suggesting that it may be even more susceptible to postnatal environmental influences than the commonly-used monkey model.

Pre- and postnatal development of GABA receptors in Macaca monkey visual cortex

GABA is a putative inhibitory neurotransmitter in adult mammalian visual cortex but also has been implicated as playing a crucial role in cortical information processing during development. In order to understand better the role of GABA during primate visual cortex development, we have examined the time course of GABAA and GABAB receptor ontogenesis in 18 Macaca nemestrina monkeys ranging from fetal day 61 (F61d) to adulthood. The GABA and benzodiazepine binding sites of the GABAA receptor were detected by 3H-muscimol (3H-MS) and 3H-flunitrazepam (3H-FZ), respectively. GABAB receptors were detected by 3H-baclofen (3H-BA). All ligands were visualized by in vitro autoradiography. Quantitative analysis of film density was done to compare laminar changes during pre- and postnatal development. Saturation binding experiments were done for MS and FZ binding sites to determine receptor number (Bmax) and affinity (Kd) at selected pre- and postnatal ages. Both MS and FZ binding sites were present at F61d-72d throughout the cortical plate and marginal zone. FZ binding sites were more dense than MS binding sites over the cortical plate at young ages and were especially dense over the marginal zone. FZ binding sites also were present in lesser amounts over the subplate and intermediate zone, but not over the subventricular zone. By F119d-126d, layer 4 could be distinguished by its higher density for both ligands. The basic adult laminar pattern was established for both MS and BZ binding sites by birth (birth = F165d-170d). After birth, MS density increases dramatically in all layers, but layer 4C remains most dense to adulthood. FZ labeling is heavy in both layers 4 and 3 at birth but after 4 weeks after birth (P4 wk) it declines somewhat in the supragranular layers so that layer 4C now predominates. Labeling in layers 5/6 virtually disappears after birth. BA binding sites were present at F126d, at which time layer 4 was slightly lighter than the remainder of striate cortex; this laminar pattern remained basically the same throughout our series to adulthood. Competitive binding of agonist and antagonists for the GABAA receptor showed that MS binding characteristics were similar at F126d and P8.5 years (yr). MS binding site Bmax was about 8% of adult values at F72d, 24% by F126d, and 56% at F152d. Bmax then rose rapidly after birth to peak at P18wk at 169% of adult values, and then declined to P1yr. A second peak of 143% was found around P3.5yr, with adult values reached by P8.5yr.(ABSTRACT TRUNCATED AT 400 WORDS)

Characterization of Vicia villosa agglutinin-labeled GABAergic interneurons in the hippocampal formation and in acutely dissociated hippocampus

The distribution, morphology, and ionic conductances of Vicia villosa agglutinin (VVA)-labeled cells were examined in the rat hippocampal formation. The heaviest labeling and highest density of labeled neurons were found in the subicular complex. Lighter VVA-labeling and fewer labeled cells were found in hippocampal strata pyramidale, oriens, and alveus. VVA-labeled cells were found to be heterogeneous morphologically, including multipolar, bipolar, and basket-like shapes. The majority of VVA-labeled cells contained GABA and parvalbumin immunoreactivity; thus VVA-labeled cells in the hippocampal formation resemble previously described VVA-labeled neurons in cerebral cortex. Electrophysiological properties of subicular VVA-labeled cells were studied in an acutely dissociated neuron preparation. Dissociated cells were labeled in vitro with VVA coupled either to a fluorescent marker or to small beads. The viability of labeled dissociated cells was confirmed, and identified cells were partially characterized electrophysiologically using whole-cell voltage clamp recording. VVA-labeled cells were electrophysiologically similar to pyramidal cells from the same region, except that the VVA-labeled cells showed only small transient outward currents.

Selective effects of experimental glaucoma on axonal transport by retinal ganglion cells to the dorsal lateral geniculate nucleus

Rapid-phase axonal transport to the dorsal lateral geniculate nucleus (dLGN) was determined autoradiographically in seven macaque monkey eyes with chronic intraocular pressure (IOP) elevation, in four eyes with an acute IOP elevation, and in three eyes with normal IOP. The monkeys with chronic IOP elevation showed a greater decrease in radioactive labeling of the magnocellular layers of the dLGN than the parvocellular layers by qualitative examination. Grain counts in selected specimens confirmed that transport to the magnocellular layers was less than to the parvocellular layers in monkeys with chronic IOP elevation. This selectivity was present in mildly damaged specimens and increased with greater ganglion cell loss. In monkeys with acute IOP elevation, qualitative evaluation suggested no consistent difference in transport among the dLGN layers; one animal in this group had less transport to the parvocellular than to the magnocellular layers by grain counts. Starting in early stages of the disease, chronic experimental glaucoma causes preferential damage to the ganglion cells that project to the magnocellular layers of the dLGN.

High-dose melphalan and granulocyte-macrophage colony-stimulating factor for refractory multiple myeloma

High-dose melphalan has induced remissions in about 40% of patients with refractory myeloma, but the mortality has been high, at about 20%, due to complications of prolonged granulocytopenia. In an attempt to stimulate earlier granulocyte recovery, recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) was administered subcutaneously to 23 patients with refractory myeloma who had been treated with melphalan at a high dose of 100 mg/m2. Thirty-nine percent of patients achieved marked tumor cytoreduction by at least 75%, 2 died within 2 months from infectious complications during severe neutropenia; and median durations of relapse-free and overall survival were 7 and 10+ months, respectively. The nine patients presenting with both advanced age over 50 years and a long history of prior therapy of over 1 year required significantly longer median times of 31 days for granulocytes and of 63 days for platelets to reach safe levels of at least 500/microL and 50,000/microL, respectively, than the 14 remaining patients who had none or only one of these adverse features (21 and 26 days, respectively). In a historic control of 43 patients treated previously with high-dose melphalan but without GM-CSF, hematologic recovery to the aforementioned levels of granulocytes and platelets proceeded over almost 5 weeks, regardless of age and prior treatment exposure. Thus GM-CSF seems to hasten marrow recovery, especially in patients with adequate normal marrow stem-cell reserve as defined by younger age or less prior therapy. While not shortening the duration of neutropenia, GM-CSF dose increments (from 0.25 to 0.5 to 0.75 mg/m2) increased the incidence of severe toxicity from 0% to almost 40%, especially among older patients. These results support the usefulness of low-dose GM-CSF (0.25 mg/m2) in stimulating marrow recovery in selected patients with adequate marrow reserve treated with high-dose melphalan for refractory multiple myeloma.

A qualitative and quantitative analysis of the human fovea during development

The anatomical development of the human fovea has been sampled from 22 weeks gestation to adulthood, using both qualitative and quantitative methods. The foveal depression continues to deepen after birth until 15 months, due to the migration of the cells of the inner retina toward the periphery. Before birth the rod-free zone or foveola is over 1000 microns in diameter, but it becomes progressively narrower after birth because of a centralward migration of cones. It reaches the adult diameter of 650-700 microns by 45 months of age. Postnatally, foveolar cone development is characterized by maturation, elongation, and an increase in packing density. Foveolar cone diameter changes markedly after birth, going from 7.5 microns at 5 days postnatal to 2 microns by 45 months. During this time the foveolar cone develops both its outer segment and basal axon process (fiber of Henle). This combination of elongation and centralward migration results in an increase of foveolar cone density from 18 cones/100 microns at 1 week postnatal to 42 cones/100 microns in the adult. Measures of foveola width and cone diameter reach the adult stage of development at 45 months of age, but the two important visual factors of outer segment length and cone packing density still are only half the adult values at 45 months of age.

Indoleamine-accumulating horizontal cells in the squirrel monkey retina

Horizontal cells capable of selectively accumulating indoleamines have been found in the retina of Saimiri sciureus, the New World squirrel monkey. The uptake of 3H-serotonin (5HT) in vivo and in vitro has been localized by light and electron microscopic (EM) autoradiography only to horizontal cells. In the central retina up to 50% and in the periphery 15-20% of the somas lying at the scleral border of the inner nuclear layer are labeled. In EM autoradiographs, labeled processes occur as lateral elements in both cone and rod synaptic invaginations, but grain counts show four times as many rods as cones are labeled. The light-dark adaptational state of the retina has no apparent effect on 3H-5HT uptake, but it is temperature dependent, and is saturable as indicated by its inhibition in the presence of an excess of nonradioactive 5HT. The indoleamine-accumulating capacity of this population of horizontal cells also was demonstrated by histofluorescence microscopy. A single row of fluorescent cells with a round soma was found lying at the outer edge of the inner nuclear layer. These cells send fluorescent processes only into the outer plexiform layer. The authors suggest that 5HT is not the native transmitter of these squirrel monkey horizontal cells because they lack intrinsic fluorescence and only could be visualized after uptake of extrinsically applied indoleamines. The true transmitter is likely to be a closely related but nonfluorescent indole.

Overlap of retinal and prestriate cortical pathways in the primate pretectum

Connections between the pretectum and prestriate visual cortex were examined following injection of HRP into area V4 of Macaca nemestrina monkeys. Orthograde label was found in nucleus olivarius (NO) and the sublenticular (SL) regions while retrogradely labeled neurons were present in the nucleus of the optic tract (NOT). Following injection of [3H]proline into one eye, 3 pretectal zones of retinal input were seen: NO, SL and the posterior pretectal region (PPR). These results indicate that NO and SL may be sites for retinal and cortical pathway interaction in primate pretectum.

Alterations of retinal inputs following striate cortex removal in adult monkey

The morphology of the retina and central retino-recipient nuclei was studied in two monkeys that had undergone total bilateral striate cortex removal as adults. These animals had been behaviorally tested for two years after lesioning and had demonstrated significant recovery of pattern vision. Light and electron microscopy and autoradiography were done on the central retino-recipient nuclei following a monocular intravitreal injection of 3H-proline. Light microscopic analysis of retinal ganglion cell number showed a 30% loss in the parafoveal retina due to retrograde trans-synaptic degeneration. The most striking central change in retinal axon distribution was in the dorsal lateral geniculate nucleus (dLGN) where the parvocellular but not the magnocellular region showed a marked reduction in retinal input. Despite the loss of almost all dLGN neurons through retrograde degeneration, at the EM level both parvocellular and magnocellular regions contained islands of neuropil made up of retinal and several other types of synaptic terminals as well as small dendrites and pale unidentified processes. Approximately equal numbers of retinal terminals were identified by EM autoradiography in both regions of dLGN, which did not explain the apparent differences in labeling between the two regions seen in the light microscope. A second change in central retinal pathways was found in the olivary pretectal nucleus where a significant loss of retinal input also occurred. A third change, but in the opposite direction, was found in the pregeniculate nucleus (PGN) where the area of retinal terminals appeared enlarged. The remaining central retino-recipient nuclei had the same distribution of retinal input as the control animals.

Localization of substance P-like immunoreactivity within the monkey retina

Substance P (SP)--like immunoreactivity has been localized to distinct retinal cell populations in the primate Macaca nemestrina by means of immunohistochemical techniques with a well-characterized monoclonal antiserum directed to SP. The specificity of the immunoreactive staining was established by absorption of the antiserum with 10 micro M synthetic SP. Specific SP-like immunoreactivity was observed within varicose processes located in the outer plexiform layer, inner nuclear layer (INL), and in three bands within the inner plexiform layer (IPL). SP-immunoreactive somata were located in the proximal INL, IPL, and ganglion cell layer. These studies have thus identified SP-containing amacrine cells, interstitial amacrine cells, and displayed amacrine cells. In addition, these studies suggest the existence of SP-containing interplexiform cells and perhaps ganglion cells.

The retina of the newborn human infant

We have examined a pair of eyes from a normal, full-term infant who died at 8 days as a result of accidental injury. Eyes were obtained immediately after death, fixed, and sectioned for light microscopy. Results from both eyes were substantially the same. The macular region was still drastically immature at 1 week. Even though a foveal depression existed, all cell layers were still present across it. Furthermore, the inner nuclear layer was divided into two separate layers. The receptor layer was reduced to one or two cells thick; receptors had both inner and outer segments, but they were very short and stumpy. The region of immaturity covered about 5 degrees of the retina. These findings suggest that the central region of a human infant's retina is probably not fully functional at birth.

Hypertrophy of neurons in dorsal lateral geniculate nucleus following striate cortex lesions in infant monkeys

Monkeys whose left striate cortex had been removed in infancy received bilateral injections of horseradish peroxidase (HRP) into the prelunate gyrus (PLG) prestriate cortex. Scattered large neurons in the dorsal lateral geniculate nucleus were retrogradely labeled in both hemispheres. On the lesioned side, the HRP-labeled cell bodies were 58% larger in area, showing an overall increase in soma size and complexity of dendritic field, suggesting a hypertrophy of the geniculate-PLG pathway following a neonatal striate cortex lesion.

Anisometropic amblyopia in Macaca nemestrina monkeys produced by atropinization of one eye during development

Two macaque monkeys were reared with daily administration of the cycloplegic drug, atropine, to one eye until 8 months after birth. Behavioral testing of contrast sensitivity functions in the atropinized eyes during the rearing period demonstrated that this rearing procedure caused the treated eyes to be chronically defocused. Measurement at the age of 6 or 8 months of contrast sensitivity while optically correcting the defocus demonstrated that an amblyopia had developed in the treated eyes. Furthermore, the relative magnitude of the amblyopia across spatial frequencies was similar to the relative magnitude of the defocus. Subsequently testing at 1 year of age demonstrated that the deficits persisted for several months after termination of the defocus rearing. This rearing procedure appears to provide a reasonable primate model with which to study anisometropic amblyopia in monkeys.