Influence of BDNF Val66Met genetic polymorphism in Major Depressive Disorder and Body Mass Index: Evidence from a meta-analysis of 6481 individuals

BACKGROUND

Major depressive disorder (MDD) and obesity are global health problems that frequently co-occur. Among shared etiological factors, genetic variation at the brain-derived neurotrophic factor (BDNF) gene is interesting since its implication in energy balance regulation, food intake and synaptic function. Thus, the aim of this study was to investigate the influence of the BDNF Val66Met polymorphism in relation to MDD and body mass index (BMI) in two large independent cohorts.

METHODS

The sample consisted of 2646 individuals with MDD and 3835 controls from the PISMA-ep and Radiant studies. Linear regressions were performed to test the association between the polymorphism and BMI and the interaction between the polymorphism and MDD on BMI. A meta-analysis across cohorts was conducted.

RESULTS

No association was found between the polymorphism and BMI. However, we found an association with MDD, showing these individuals higher BMI than controls in both cohorts. No differences were found in BMI depending on Val66Met genotype and no interaction between this polymorphism and MDD in relation to BMI was found. Although a tendency towards an interaction was found in the Radiant sample, the results of the meta-analysis did not support this finding.

LIMITATIONS

The use of self-reported height and weight measures to calculate BMI values.

CONCLUSIONS

We provide evidence for an association between BMI and MDD confirming previous results. Our meta-analysis including two large cohorts showed no interaction between BDNF, BMI and MDD. Future studies will be needed to confirm the role of this polymorphism in the relationship between BMI and MDD.

Myths and realities about knowledge, attitudes and practices of household contacts of tuberculosis patients

SETTING

Five Colombian cities: Villavicencio, Pereira, Cucuta, Bucaramanga and Bosa.

OBJECTIVE

To describe the knowledge, attitudes and practices related to tuberculosis (TB) in household contacts (HHCs) of TB patients.

METHODS

A cross-sectional study was conducted. The estimated sample size required was 855. The World Health Organization guide 'Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys' was translated into Spanish and adapted to the dialect of each city. HHCs were invited to participate in the study and included if they agreed.

RESULTS

We interviewed 878 HHCs. Most of them knew that TB was transmitted by airborne droplets; however, 52.2% also said that TB could be transferred from one person to another by sharing plates or clothes or shaking hands. Fifty-five per cent of HHCs acquired TB-related information from health care workers, and 44% from family members and friends. Fear was the main reaction reported by HHCs when they were informed of a TB diagnosis (60%). Eighty-five per cent of HHCs answered that the community rejects or avoids TB cases.

CONCLUSION

There are significant gaps in the knowledge about TB and the stigmatisation associated with it. Educational strategies should be designed together with the community to demystify many misconceptions about TB.

Netrin-1 and multiple sclerosis: a new biomarker for neuroinflammation?

BACKGROUND AND PURPOSE

Netrin-1, an axon guidance protein, reduces serum levels of pro-inflammatory mediators and stabilizes the blood-brain barrier limiting the entrance of immune cells into the central nervous system. The aim was to investigate its presence in the experimental autoimmune encephalomyelitis (EAE) model and in multiple sclerosis (MS) patients with and without clinical activity.

METHODS

Netrin-1 levels were evaluated in EAE mouse tissues. Afterwards, serum netrin-1 was cross-sectionally quantified in 90 patients with different MS phenotypes and 30 control subjects. An additional group of 10 relapsing-remitting MS (RRMS) patients was longitudinally evaluated throughout a relapse (RRMSr) with an interval of 60 days. Tumour necrosis factor α (TNFα), a reference inflammatory cytokine, and netrin-1 were quantified by enzyme-linked immunosorbent assay.

RESULTS

Experimental autoimmune encephalomyelitis mice showed significantly lower netrin-1 levels and higher TNFα amounts in sera, spinal cord and cerebella than healthy control mice. MS patients showed significantly lower serum netrin-1 levels than controls (511.62 ± 209.30 and 748.32 ± 103.24 pg/ml, respectively; P ≤ 0.005). The lowest protein levels were found in RRMSr, remaining significantly lower throughout the relapse. TNFα serum concentrations were higher in MS patients compared to controls, and negatively correlated with netrin-1 levels (r = -0.3734, P ≤ 0.0001).

CONCLUSIONS

Netrin-1 decreased in EAE and in MS patients, mainly during relapse, suggesting an anti-inflammatory role of netrin-1. Further research should be performed in a larger cohort of patients to validate netrin-1 as a biomarker of MS inflammatory activity.

Uncovered secret of a Vasseur-Tramond wax model

The technique of anatomical wax modelling reached its heyday in Italy during the 18th century, through a fruitful collaboration between sculptors and anatomists. It soon spread to other countries, and prestigious schools were created in England, France, Spain and Austria. Paris subsequently replaced Italy as the major centre of manufacture, and anatomical waxes were created there from the mid-19th century in workshops such as that of Vasseur-Tramond. This workshop began to sell waxes to European Faculties of Medicine and Schools of Surgery around 1880. Little is known of the technique employed in the creation of such artefacts as this was deemed a professional secret. To gain some insight into the methods of construction, we have studied a Vasseur-Tramond wax model in the Valladolid University Anatomy Museum, Spain, by means of multi-slice computerised tomography and X-ray analysis by means of environmental scanning electron microscopy. Scanning electron microscopy was used to examine the hair. These results have revealed some of the methods used to make these anatomical models and the materials employed.

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain

BACKGROUND

The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care.

METHOD

A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI).

RESULTS

Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain.

CONCLUSIONS

The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

The risk for depression conferred by stressful life events is modified by variation at the serotonin transporter 5HTTLPR genotype: evidence from the Spanish PREDICT-Gene cohort

We report results from the PREDICT-Gene case-control study nested in a prospective cohort designed to identify predictors of the onset of depression among adult primary-care attendees. We tested the potential gene-by-environment interaction between 5HTTLPR genotype at the serotonin transporter gene and previous exposure to threatening life events (TLEs) in depression. A total of 737 consecutively recruited participants were genotyped. Additional information was gathered on exposure to TLEs over a 6-month period, socio-demographic data and family history of psychological problems among first-degree relatives. Diagnoses of depression were ascertained using the Composite International Diagnostic Interview (CIDI) by trained interviewers. Two different depressive outcomes were used (ICD-10 depressive episode and ICD-10 severe depressive episode). Both the s/s genotype and exposure to increasing number of TLEs were significantly associated with depression. Moreover, the 5HTTLPR s/s genotype significantly modified the risk conferred by TLEs for both depressive outcomes. Thus, s/s homozygous participants required minimal exposure to TLE (1 TLE) to acquire a level of risk for depression that was only found among l/s or l/l individuals after significantly higher exposure to TLEs (two or more TLEs). The interaction was more apparent when applied to the diagnosis of ICD-10 severe depressive episode and after adjusting for gender, age and family history of psychological problems. Likelihood ratios tests for the interaction were statistically significant for both depressive outcomes (ICD-10 depressive episode: LR X(2)=4.7, P=0.09 (crude), LR-X(2)=6.4, P=0.04 (adjusted); ICD-10 severe depressive episode: LR X(2)=6.9, P=0.032 (crude), LR-X(2)=8.1, P=0.017 (adjusted)).

Dermatoglyphic profile in 22q deletion syndrome

A genetic subtype of schizophrenia has been described in 22q11 Deletion syndrome. Previous studies have described an excess of dermatoglyphic alterations in schizophrenia, such as low a-b ridge counts (ABRCs), a high frequency of ridge dissociations, and increased dermatoglyphic fluctuating asymmetry. Little is known however, about the dermatoglyphic profile of 22qDS subjects showing psychotic symptoms and its similarity to the previously reported anomalies in schizophrenia. We studied the palmar dermatoglyphics of 22 subjects with 22qDS of predominantly Caucasian origin, 15 of whom had psychotic illness, and in 84 healthy controls of similar ethnicity. We observed higher values for total ATD angle in cases than in controls (P = 0.04). In addition, there was an excess of radial figures in the hypothenar area in cases, especially in the left hand. Interestingly, greater fluctuating asymmetry, determined by the absolute difference between right and left ABRC, was observed in 22qDS subjects compared to controls (P = 0.05). However, no differences were found for ABRCs and frequency of dissociations. Despite the small sample size, the palmprints analyzed suggest the existence of an altered dermatoglyphic profile in 22qDS, involving: (i) ATD angle amplitude, (ii) presence of radial loops in the hypothenar area, and (iii) an increment of fluctuating asymmetry. The first two features are similar to those found in other genetic syndromes associated with low IQ, while high levels of fluctuating asymmetry have often been reported in schizophrenia.

The 5-HT(2A) receptor gene 102T/C polymorphism is associated with suicidal behavior in depressed patients

Several lines of evidence suggest that genetic factors constitute an important determinant of suicidal behavior. A significant association between the 5-HT(2A)-C allele and suicidality has recently been reported. The aim of this study was to investigate whether the proposed association between 5-HT(2A)-102T/C polymorphism and suicidality could be replicated in a larger and independent sample of Spanish patients with major depression. The 102T/C polymorphism of the 5-HT(2A) receptor gene was analyzed in 159 patients with major depression (DSM-IV criteria) and 164 unrelated and healthy controls using a case control design. All individuals were subjects of Spanish origin. Significant differences in allele (chi-square = 4.13, df = 1, P = 0.04) and genotype (chi-square = 6.19, df = 2, P = 0.04) distributions were found between non-suicide attempters and suicide attempters. Moreover, those patients carrying 5-HT(2A)-C allele had more than five times the risk for attempting suicide than noncarriers (OR = 5.50, 95% CI = 1.18-35.20, P = 0.01). Our results replicate the proposed association between 5HT(2A)-C allele and suicidality in major depression. Moreover, no overall associations are detected when patients with major depression and controls are compared for 102T/C frequencies, suggesting that the increased risk for suicidality conferred by 5-HT(2A)-C allele is primarily associated with suicidal behavior and not with the diagnosis of major depression itself.

Dermatoglyphics and abnormal palmar flexion creases as markers of early prenatal stress in children with idiopathic intellectual disability

A number of studies have shown the importance of dermatoglyphics as markers of prenatal disturbance in developmental disorders of unknown origin. Genetic and non-genetic factors are involved in the aetiology of intellectual disability (ID), although the cause remains unknown in up to 50% of cases. The aim of the present study was to analyse dermatoglyphic traits and abnormal palmar flexion creases as markers of environmental prenatal stress in children with idiopathic ID (IID) using a case-control study design. Three dermatoglyphic variables, which have been reported as altered in other congenital disorders, were considered were studied in a sample of 62 children with IID (IQ < 70) and 75 healthy controls (IQ > 70): (1) fingerprint patterns; (2) total a-b ridge count (TABRC); and (3) abnormal palmar flexion creases (APFCs). More arches, the simplest fingerprint pattern, and more radial loops, an unusual pattern, were found in IID cases in comparison to controls (chi23 = 9.26; P = 0.02), with especially marked differences in boys (chi23 = 6.5; P = 0.0008). A significant increase of APFCs was also found in the affected children (chi24 = 28.52; P < 0.00; odds ration = 3.86, 95% confidence interval = 1.77-8.47). For TABRC, the differences between IID cases and controls failed to reach the conventional level of significance. These findings suggest that environmental factors acting early in development, or mechanisms involving an interaction of genotype and environment could be involved in the aetiology of some cases of ID.

Association study between novel promoter variants at the 5-HT2C receptor gene and human patients with bipolar affective disorder

Two recently described adjacent DNA polymorphisms [(GT)12-18 and (CT)4-5] in the 5'-regulatory region of 5-HT2C receptor gene were analysed in a sample of 88 bipolar patients and 162 controls, all of Spanish origin. Statistical analyses revealed no overall allele or genotype associations with the disease. A haplotype analyses between the (GT)12-18/(CT)4-5 motif and a Cys23Ser variant of the 5-HT2C gene (which had previously been genotyped in the same sample) showed similar distributions between cases and controls. Only a slight increase of s-Ser23 haplotype was found in the subgroup of bipolar women with family history of psychiatric illness (OR=1.24 [95%CI: 1.12-1.38]).

Genetic variation in the 5-HT5A receptor gene in patients with bipolar disorder and major depression

In the present study, genetic variation of the 5-HT5A receptor was analyzed in patients affected by affective disorders and healthy controls. The sample consisted of 181 patients with major depression, 88 patients with bipolar affective disorder (BP) and 157 unrelated controls (C), all of Spanish origin. Two polymorphisms (-19G/C and 12A/T) in the 5-HT5A receptor gene were analyzed by polymerase chain reaction amplification and subsequent enzyme digestion. No genotype, allele or haplotype differences were found when we compared patients and controls. When clinical variables were considered as possible tools for detecting genetic heterogeneity, no differences were found. Our results suggest that the polymorphisms analyzed in the 5-HT5A receptor gene do not play a major role in the pathogenesis of affective disorders.

Variability in the 5-HT(2A) receptor gene is associated with seasonal pattern in major depression

The 102-T/C polymorphism of the 5-HT(2A) receptor gene was analysed in 159 patients with major depression and 164 unrelated and healthy controls using a case-control design. Allele and genotype frequencies did not differ between cases and controls. No differences according to sex, age of onset, melancholia, suicidal behaviour or family history of psychiatric illness were found. However, genotype distributions significantly differed between patients with seasonal pattern in their episodes (MDS) and patients with no seasonal pattern (N-MDS) (chi(2) = 10.63; P = 0.004). A seasonal pattern was 7.57 times more frequent in 102C-allele carriers than in 102T homozygous (95.1% of patients MDS carried 102C-allele vs 72% of patients N-MDS (chi(2) = 9.45, df=1, P = 0.002; OR = 7.57 (95% CI: 1.65--48.08)). These results suggest that variation in the 5-HT2A receptor gene may play a role in the development of major depression with seasonal pattern and support the existence of a genetic and etiological heterogeneity underlying the diagnosis of major depression.

The ubiquitin-proteasome pathway plays an essential role in proteolysis during Trypanosoma cruzi remodeling

Here, we document for the first time the presence of the 26S proteasome and the ubiquitin pathway in a protozoan parasite that is in an early branch in the eukaryotic lineage. The 26S proteasome of Trypanosoma cruzi epimastigotes was identified as a high molecular weight complex (1400 kDa) with an ATP-dependent chymotrypsin-like activity against the substrate Suc-LLVY-Amc. This activity was inhibited by proteasome inhibitors and showed same electrophorectic migration pattern as yeast 26S proteasome in nondenaturating gels. About 30 proteins in a range of 25-110 kDa were detected in the purified T. cruzi 26S proteasome. Antibodies raised against the AAA family of ATPases from eukaryotic 26S proteasome and the T. cruzi 20S core specifically recognized components of T. cruzi 26S. To confirm the biological role of 26S in this primitive eukaryotic parasite, we analyzed the participation of the ubiquitin (Ub)-proteasome system in protein degradation during the time of parasite remodeling. Protein turnover in trypomastigotes was proteasome and ATP-dependent and was enhanced during the transformation of the parasites into amastigotes. If 20S proteasome activity is inhibited, ubiquitinated proteins accumulate in the parasites. As expected from the profound morphological changes that occur during transformation, cytoskeletal proteins associated with the flagellum are targets of the ubiquitin-proteasome pathway.

Developmental instability and schizotypy

INTRODUCTION

It has been suggested that evidence of developmental disturbance of cognition and lateralisation in schizophrenia can be best understood from the perspective of developmental stability (DS), an indicator of the extent to which an individual develops according to a specified ontogenic programme in the presence of environmental noise. Higher levels of fluctuating asymmetry (FA; the difference between right and left side of a quantitative morphological trait such as dermatoglyphics) are thought to reflect less DS. We examined this issue for dimensions of schizotypy.

METHODS

Associations between FA, measures of laterality and cognitive function on the one hand, and negative and positive dimensions of schizotypy on the other, were examined in a sample of 260 healthy adolescents aged 11.9-15.6years. FA was measured as a-b ridge count right-left differences. Neuropsychological measures yielded a general cognitive ability score and a frontal function score. Laterality was assessed with the Annett scale.

RESULTS

Measures of psychosis proneness were normally distributed. Negative schizotypy was associated with more FA and lower general cognitive ability in a dose-response fashion. The association with FA was more apparent in boys. No associations existed with laterality or frontal function.

CONCLUSION

The negative dimension of schizotypy may be associated with early developmental instability, resembling the pattern seen in the negative symptom dimension of schizophrenia. Measures of fluctuating asymmetry may be more sensitive with regard to the schizotypy phenotype than measures of laterality.

Pharmacology of cizolirtine: a new analgesic agent

Cizolirtine citrate (E-4018) is a new analgesic agent with antinociceptive activity against phenylquinone (ED50 33.7 mg/kg) and acetic acid (ED50 24.4 mg/kg) in mice, against acetic acid in rats (ED50 21.3 mg/kg) and in the plantar test (ED50 26.8 mg/kg). It demonstrated antinociceptive activity in the tail-pinch and tail-flick tests (ED50s of 68.0 and 46.0 mg/kg, respectively), in both phases of the formalin test (ED50 13.8 and 2.31 mg/kg), and in the capsaicin test (ED50 7.14 mg/kg). Cizolirtine does not inhibit prostaglandin biosynthesis, it is not a ligand for opioid receptors, it does not have antiinflammatory or ulcerogenic activity, it has some antipyretic activity and shows no affinity for alpha 2-adrenergic receptors, but its analgesic effect was modified by idazoxan and by desipramine. Recent studies have shown that the analgesic effect of cizolirtine could be related, at least partially, to an inhibition of spinal substance P release.

Increased morbid risk for schizophrenia in families of in-patients with bipolar illness

BACKGROUND

It has been reported that relatives of probands with severe, psychotic forms of bipolar illness have increased rates of schizophrenia but not the relatives of individuals with milder, non-psychotic forms of disorder. In this study, we examined the prevalence of psychiatric disorders in the first degree relatives of a sample of 103 inpatients with bipolar disorder and in a matched control sample of 84 healthy individuals.

METHOD

Relatives of cases and controls were interviewed using the FH-RDC to determine familial morbid risk for schizophrenia and bipolar disorder. Age- and sex-adjusted morbidity risks were calculated in both samples according to the method of Strömgren.

RESULTS

The morbid risks for both bipolar disorder (4.9%) and schizophrenia (2.8%) were higher in relatives of patients than in relatives of controls (0.3% and 0.6% respectively). The relative risks were 14.2 [95% confidence interval (CI)=3.1-64.2] for bipolar disorder and 4.9 (95% CI=1.3-18.8) for schizophrenia. Relatives of women with early onset of bipolar illness had the highest morbid risks for both bipolar illness and schizophrenia. The presence of more than one patient with bipolar disorder in a family increased the risk for schizophrenia nearly fourfold (RR=3.5, 95% CI=1.2-10.2). There was no additional effect of presence of psychotic features.

CONCLUSION

Our results suggest that the transmission of psychosis is not disorder-specific. Bipolar illness characterised by a high familial loading is associated with increased risk of schizophrenia in the relatives.

An integrated approach to the quantification of aortic regurgitation by Doppler echocardiography

BACKGROUND

Although different Doppler methods have been proposed for the quantification of aortic regurgitation, no study has prospectively compared these methods with each other and their correlation with angiography. The aim of this study was to prospectively analyze the usefulness of different Doppler echocardiography parameters by testing all such parameters in each patient.

METHODS

Fifty-one patients with aortic regurgitation underwent 2-dimensional and Doppler echocardiographic studies and catheterization. The following Doppler indexes were analyzed and compared with aortography. Color Doppler: (1) jet color height/left ventricular outflow tract height in parasternal long-axis view, and (2) jet color area/left ventricular outflow tract area in short-axis view. Continuous Doppler: (3) regurgitant flow pressure half-time, (4) regurgitant flow time velocity integral (in centimeters), and (5) regurgitant flow time velocity integral (in centimeters)/diastolic period (in milliseconds). Pulsed Doppler in thoracic and abdominal aorta: (6) time velocity integral of diastolic reverse flow (in centimeters), (7) time velocity integral of systolic anterograde flow/integral of diastolic reverse flow, (8) (time velocity integral of diastolic reverse flow/diastolic period) x 100, and (9) diastolic reverse flow duration/diastolic period (as a percentage). We compared these parameters with severity of regurgitation measured by angiography and classified as mild, moderate, or severe.

RESULTS

The most useful parameters were (1) jet color height/left ventricular outflow tract height (correctly classified 42 of 49 patients), (2) (time velocity integral of diastolic reverse flow/diastolic period) x 100 in the thoracic aorta (correctly classified 41 of 46 patients), and (3) (time velocity integral of diastolic reverse flow/diastolic period) x 100 in the abdominal aorta (correctly classified 42 of 49 patients). Sequential integration of these 3 parameters correctly classified 96% of patients (44 of 46 patients) and was achieved in 90% of cases.

CONCLUSION

An integrated combination of several Doppler parameters can quickly and accurately classify the degree of aortic regurgitation as determined by angiography.

Variability in the serotonin transporter gene and increased risk for major depression with melancholia

The serotonin transporter (SERT) gene is a particularly interesting candidate for genetic involvement in affective disorders owing to its role in both the regulation of serotonergic neurotransmission and the mechanism of action of many antidepressant drugs. In this study, variability in the SERT gene was analyzed for the first time in a sample of patients with major depression with melancholia (MDDM) in the context of a genetic association study. Two different polymorphisms of the SERT gene (17q11.1-17q12) were analyzed: a variable number of tandem repeats (VNTR) polymorphism in intron 2, and a deletion/insertion polymorphism (5-HTTLPR) in the promoter region of the gene, the short variant of which (allele 484) reduces the transcriptional efficiency of the SERT gene. Our sample consisted of 74 unrelated subjects who strictly met DSM-IV criteria for MDDM and 84 healthy controls, all of Spanish origin. The analysis of haplotype distribution for both polymorphisms showed significant differences between cases and controls (log-likelihood ratio chi2=11.15, df=4, P=0.025). Moreover, when the frequencies of the 484-STin2.10 haplotype were considered in comparison with any other haplotype combination, a significant increase in this haplotype was found in patients with MDDM [z=2.53 (95% CI, 1.21-5.34), P=0.007]. According to these results, variability in the SERT gene has a small effect on liability to MDDM. Our findings are compatible with an additive effect of both the 484 low-activity allele and a mutation elsewhere within the transporter gene or a susceptibility locus nearby in linkage disequilibrium with the VNTR marker.

Serotonin transporter gene and risk for bipolar affective disorder: an association study in Spanish population

BACKGROUND

The serotonin transporter (5-HTT) is an important candidate gene for the genetic transmission of manic depressive illness. Many studies of patients with affective disorders have found abnormalities in serotonin metabolism and dysregulation of the transporter itself. In the present study, we hypothesize that genetic variation in the 5-HTT gene (17q11.1-17q12) may have an effect in the etiology of manic depression.

METHODS

To test this hypothesis, we analyzed allele, genotype, and haplotype frequencies of two polymorphisms recently described in the 5-HTT gene (a variable number of tandem repeats in intron 2 and a deletion/insertion polymorphism in the transcriptional control region) in a sample of 88 patients with manic-depressive illness and 113 controls. Cases and controls were matched for ethnic and geographic origin.

RESULTS

No associations were found between any of these polymorphisms, tested individually or as haplotypes, and manic depression. Moreover, the genetic analysis by sex, presence/absence of psychiatric family history, and age of onset did not reveal significant differences in allele or genotype distributions.

CONCLUSIONS

Our results suggest that the genetic variability of the 5-HTT gene is not a major risk factor for manic depression.

Congenital dermatoglyphic malformations in severe bipolar disorder

Dermatoglyphic alterations may be the result of early prenatal disturbances thought to be implicated in the aetiology of psychiatric illness. In order to test this hypothesis in the particular case of bipolar disorder, we assessed two congenital dermatoglyphic malformations (ridge dissociation (RD) and abnormal features (AF)) and two metric dermatoglyphic traits (total finger ridge count (TFRC) and total a-b ridge count (TABRC)) in a sample of 118 patients with chronic DSM-III-R bipolar illness, and 216 healthy controls. Bipolar cases showed a significant excess of RD and AF (OR = 2.80; 95% CI: 2.31-3.38) when compared with controls. In the cases, the presence of anomalies was associated with earlier age of onset. No differences were found for TFRC and TABRC. No associations were found with sex or familial morbid risk of psychiatric disorders. Our findings add further weight to the suggestion that early developmental disruption is a risk factor for later bipolar disorder.

General pharmacological profile and effects of E-4716, a novel histamine receptor blocker, on the central nervous system

The general pharmacological profile and effects of E-4716 on the CNS have been investigated in comparison with other histamine receptor blockers. In in vitro studies with isolated organs and in binding studies on numerous receptors, E-4716 had no activity even at high concentrations, except for the selective blockade of H1 receptors. No activity was observed in pharmacological trials in vivo, such as the Irwin test or analgesia induced by phenylbenzoquinone or electroshock, suggesting a depressant activity on the CNS. In tests potentiating hypnosis induced by barbiturates, benzodiazepines and ethanol in mice, E-4716 always showed milder potentiating effects than the other reference drugs. In monkeys, no sedating effects were observed at 200 mg/kg, p.o. These results suggest that E-4716 exhibits good clinical efficacy without any secondary effects.

Genetic variation of the 5-HT2A receptor gene and bipolar affective disorder

Abnormalities of the serotonergic system have classically been associated with the origin of affective disorders through the biochemical action of therapeutic agents and their role in affective and perceptual states. In the present study, we hypothesized that genetic variation in the 5-hydroxytryptamine (serotonin) type 2A (5-HT2A) receptor gene (HTR2A) might have an effect on the aetiology of bipolar affective disorder. Four different polymorphisms in the HTR2A gene were studied in 88 patients with bipolar affective disorder and 113 healthy controls, all of Spanish origin. No significant association was observed between any of the four polymorphisms at the HTR2A locus, whether tested individually or as haplotypes, and bipolar affective disorder. The lack of association suggests that HTR2A is not a major risk factor for bipolar affective disorder.

Haptoglobin phenotypes and gene frequencies in bipolar disorder: an association study in family-history subgroups

Several studies have shown that major depression is accompanied by significantly increased plasma levels of positive acute-phase proteins such as haptoglobin (Hp). A significant higher frequency of the HP*1 allele has recently been detected in patients with unipolar major depression. Pursuing the hypothesis that certain unipolar and bipolar disorders may be genetically related, this study analyzed Hp genotype and allele frequencies in bipolar patients, taking into account their family history of major affective disorders. An increase of HP*1 allele frequency was found in the subgroup of patients with family history of exclusively unipolar disorder (70% in patients vs. 38% in controls, chi2 = 8.34, p = 0.004). The relative risk for the HP*1 carriers in this subgroup was 3.8 (chi2 = 7.29, p = 0.007). These results suggest a genetic and etiological heterogeneity in the bipolar disorder.

Association analysis of the catechol O-methyltransferase gene and bipolar affective disorder

OBJECTIVE

Catechol O-methyltransferase (COMT) is an enzyme that inactivates catecholamines. Two common COMT alleles determine high and low activity of the enzyme. Previous studies using biochemical methods found lower enzyme activity in patients with major depression and bipolar disorder in comparison with control values, suggesting that a dysfunction in catecholamine metabolism may be related to the etiology of depression.

METHOD

The authors studied two recently described DNA polymorphisms at the COMT gene (a silent C256G mutation and a structural mutation, Val-108-Met) in 88 patients with bipolar disorder and in 113 healthy comparison subjects, all of Spanish origin.

RESULTS

The frequency of the C256 allele was 0.58 in the patients and 0.54 in the comparison subjects. The frequency of the Val108 variant was 0.57 for both the patients and the comparison subjects. No allelic or genotypic associations were observed.

CONCLUSIONS

The lack of association suggests that the COMT gene is not a major risk factor for bipolar disorder.

Allelic association analysis of the 5-HT2C receptor gene in bipolar affective disorder

We have examined a structural variant of the 5-HT2C receptor (Cys23Ser) for allelic association with bipolar affective disorder in 88 cases and 113 controls. Overall, there was no significant difference in allele frequencies between the two groups, indicating that the 5-HT2C gene is not a major risk factor for bipolar affective disorder. However, when the subjects were analysed according to sex, there was a small excess of the serine ser23 allele in female cases (P = 0.04) and this effect was also seen if the ser23 allele was considered recessive (P = 0.03). A small increase in significance was found if only female cases with a known family history were included (P = 0.01). These results suggest that the ser23 allele may increase susceptibility to bipolar affective disorder in women.

Effects of E-4716, a new antihistaminic with antiallergic properties, on chemical mediators induction of immunologic reactions

The effects of E-4716 on chemical mediators were compared with those of classical antihistaminics and other second generation (nonsedating) drugs normally used in the therapy of allergic reactions, such as astemizole, terfenadine and ebastine, in a series of in vitro and in vivo tests. In vitro, antihistaminic activity was demonstrated in a test on isolated organs and a binding test on histamine receptors, with no anticholinergic activity observed. A high antihistaminic activity was also shown in in vivo tests on chemical mediators release by compound 48/80, histamine-induced bronchospasm in anesthetized guinea pigs and histamine-induced cutaneous reaction in beagle dogs. The antiallergic activity was studied in passive cutaneous anaphylaxis test using ovalbumin antibodies. Astemizole and E-4716 had similar activities with ED50 values of 0.8 and 0.5 mg/kg, respectively, whereas terfenadine (ED50 = 4.5) was less active. E-4716 also inhibited the vascular permeability response in histamine-stimulated conjunctivitis model after topical ocular administration (ED50 = 0.002, 0.0002, 0.015 and 1.2% at 30 min and 6, 12 and 24 h, respectively). E-4716 had a high and selective antihistaminic and antiallergic activity by all routes of administration (oral, i.v., i.p., topical ocular and inhalation). These results, combined with its low toxicity and lack of central effects, indicate that E-4716 has excellent potential for therapeutic use.

Serum antibodies to Trypanosoma cruzi antigens in Atacameños patients from highland of northern Chile

In the present work we have investigated the serum antibody spectrum to parasite antigens involved in human T. cruzi infection. Analysis was performed by conventional serology (IHA, IFAT and ELISA), complement-mediated lysis, anti-gal antibody assay and reactivity against recombinant and synthetic peptides and metacyclic antigens by immunowestern-blotting. All the sera showed a significant reactivity in IHA, IFAT and ELISA. We found that 84.2% of the sera showed lytic activity and thirty serum samples (78.9%) which showed a lytic activity higher than 50%, also showed anti-gal antibodies at serum dilutions higher than 1:1,600. Ninety-four percent of sera reacted with one or more of the recombinant DNA clones and 97.3% reacted with one or more of the synthetic peptides. A pool of serum samples with a lytic activity higher than 75% were able to produce 60% to 78% inhibition of cell invasion. Thirty-six of the serum samples (94.7%) were able to react by immunowestern blotting with a T. cruzi metacyclic antigen with molecular size of 70 kDa. The results obtained give preliminary information about the humoral immune response and the possible role of antibodies in protection against T. cruzi infection of chronic patients from the highlands of Chile.

Balloon mitral commissurotomy in patients with previous annuloplasty. Our experience

Balloon mitral commissurotomy is an alternative to surgical commissurotomy in the treatment of mitral stenosis and different studies have shown its usefulness for restenosis following surgical commissurotomy. We describe our experience in balloon mitral commissurotomy in five patients with previous commissurotomy and annuloplasty. Among 360 balloon commissurotomies performed in our hospital up to December 1993, 29 procedures were performed on patients with restenosis after surgical commissurotomy, five of whom also had an annuloplasty (flexible ring in four and rigid in one). The balloon commissurotomy was performed without complications using the Inoue single balloon technique. Mitral valve area increased from 0.9 +/- 0.1 cm2 to 1.0 +/- 0.1 cm2 by pressure half-time, and from 1.0 +/- 0.2 cm2 to 1.3 +/- 0.1 cm2 by Gorlin formula. Two patients in functional class III underwent mitral valve replacement, 32 and 11 months later; the other three patients were in class II 38, 10 and 7 months later. The presence of a mitral ring should not constitute a contraindication to balloon commissurotomy. However, the haemodynamic results are not favourable in our patients, probably due to the practical absence of commissural fusion and the ring's restrictive effect on valvular stretching.

[Levels of anti-Gal antibodies in persons infected and non-infected with Trypanosoma cruzi. Probably induced by bacteria and by the parasite]

Antibodies levels against Gal alpha 1,3 Gal epitopes were studied in 407 human sera (92 chagasic and 315 non-chagasic), by means of hemagglutination with rabbit erytrocytes reactivity of serum having high titres of anti-Gal antibodies in presence of Escherichia coli and Serratia marcescens antigen was studied by immunoelectrotransference. Finally, using a purified anti-Gal antibody, Gal alpha 1,3 Gal epitopes were identified in metacyclic forms from 12 high Andean Chilean strains of Trypanosoma cruzi. Among the chagasic sera, it was demonstrated that in 63 (68.5%) were detected antibodies anti-Gal at the same or higher titer than 1:1,600; while i the non chagasic sera only 49 (15.6%) showed and anti-Gal response at similar titers. Immunoelectrotransference showed that the sera of people infected with T. cruzi recognize antibodies present in E. coli and S. marcescens, which reinforces the idea that at least in part, these bacterias would be capable of stimulating these responses. The autoradiographic analysis using purified anti-Gal antibodies, showed differences in the Gal alpha 1,3 Gal epitopes expressed in the different strains of T. cruzi. These results suggest that anti-Gal antibodies could have a real significance on the natural immunity mechanisms and protection of human infection with T. cruzi.

Total anomalous pulmonary venous connection in adults. Long-term follow-up

Between 1961 and 1989, 19 patients with total anomalous pulmonary venous connection underwent surgical correction. Ages ranged from 18 to 38 years (mean 26.2 +/- 6.5 years). The anatomic variants included 10 patients with total anomalous pulmonary venous connection to the vertical vein, 6 patients with total anomalous pulmonary venous connection to the coronary sinus, and 2 with total anomalous pulmonary venous connection directly to the right atrium. The last patient had mixed connection to the coronary sinus and left vertical vein. Two patients died, one because of left atrial rupture and another of low cardiac output. Long-term follow-up after surgical repair ranged from 2 to 24 years (mean 7 +/- 6.2 standard deviation). Preoperative disability, assessed according to New York Heart Association criteria, showed 12 patients in functional class II and seven in class III. After treatment, 16 patients were in class I and one in class II (p less than 0.001). Echocardiographic evaluation of six patients revealed in all a normal left ventricular ejection fraction; the diastolic function was also normal except in one patient. The postoperative evaluation of the pulmonary arterial systolic pressure performed by both Doppler echocardiography and right cardiac catheterization in 14 patients showed a significant reduction of the mean pulmonary arterial systolic pressure from 51.1 +/- 3.4 to 37.4 +/- 14.4 mm Hg (p less than 0.01). The remaining three patients evaluated in the follow-up period only by clinical examination are in New York Heart Association functional class I. The anatomic characteristics of our patients were responsible for the long-term outcome without correction. Surgical treatment of older patients can be performed with satisfactory results and excellent long-term survival.

[Partial pericardial tamponade immediately after cardiac surgery]

Partial pericardial tamponade is a critical situation frequently misdiagnosed. We describe five patients with this entity during an urgent surgical reintervention performed few hours after the initial one. We found clots compressing cardiac cavities in all, usually in the right atrium. In one of them we found also a clot compressing the left atrium. None of the patients studied had the classical clinical features of cardiac tamponade (Kussmaul's sign: pulsus paradoxus) and we found no difference in blood pressure, quantity of bleeding or pulmonary capillary pressure, considering the reinterventional moment in comparison to the values taken immediately after the initial surgery and the ones registered during the surgical reintervention. There was significative increase in the central venous pressure value, decreased urine output and drop in the cardiac index. Based on this observation, we believe it is possible to have a presumptive diagnosis of partial pericardial tamponade by bidimensional echocardiographic studies just before the surgical reintervention.

Maximum tolerated temperature in the rat tail: a broadly sensitive test of analgesic activity

The methods most frequently employed for the study of analgesic activity of opiates are those based on thermal stimuli (hot-plate, tail-flick, TWR). These tests, however, are only sensitive for opiates which are pure agonists. In this work, we propose a modification of the TWR method capable of detecting analgesic activity in both agonist and agonist-antagonist opiates. In addition, non-opiate analgesics also show activity in this test. The ED50 (mg/kg, i.p.) of the substances studied, administered 30 min before commencement of the test, were as follows: buprenorphine: 0.02; methadone: 0.08; morphine: 1.9; pentazocine: 4.5; d-propoxyphene: 5.5; codeine: 7.6; pethidine: 9.2; zomepirac: 20.1; suprofen: 138.0; acetylsalicylic acid: 453.4. There was a statistically significant linear correlation between the results obtained by the proposed method (MTT) and those of some of the most frequently used methods for the study of analgesic agents (writhing induced by phenylbenzoquinone, acetic acid, acetylcholine bromide, hot-plate test and rat tail withdrawal test). The simplicity of the method makes it suitable for use in the battery of screening tests for analgesic activity of both narcotic and non-narcotic substances.

Inhibition of aconitine-induced mortality in the conscious rat: a screening test for antiarrhythmic drugs

A test for inhibition of mortality induced by intravenous injection of aconitine in rats is proposed as a particularly valid method, owing to its simplicity and degree of specificity, for inclusion among the preliminary screening tests for antiarrhythmic activity. LD50 (63.5 micrograms/kg, i.v.) and LD99 (118.9 micrograms/kg, i.v.) values of aconitine were determined. The dose employed for screening was 100 micrograms/kg i.v., which in control animals produced a death rate of 97.7% (293 deaths/300 treated animals). The protection produced by various drugs belonging to different groups of antiarrhythmics was studied. ED50s, expressed in mg/kg i.p., were as follows: Class I antiarrhythmics: flecainide, 5.5; E-4017, 30.0; lorcainide, 30.9; quinidine, 41.1; diphenylhydantoin, 42.3; lidocaine, 48.5; ajmaline: 53.9; procainamide, 61.3. Class II antiarrhythmics: pindolol 22.8; propranolol, 24.9; oxprenolol, 38.0; labetalol, 60.7; atenolol, 100.0; metoprolol, approximately 160; acebutalol, greater than 160; timolol, greater than 160. Class III antiarrhythmics: amiodarone, greater than 160. Class IV antiarrhythmics: verapamil, diltiazem and nifedipine were inactive up to 40 mg/kg. The test would appear to be selective for membrane-stabilizing agents (class I) and beta-blockers (class II), but in view of the magnitudes of activity found, it should be used in combination with other antiarrhythmic tests.

Pharmacological properties of droxicam, a new non-steroidal anti-inflammatory agent

Droxicam showed high antiinflammatory activity in carrageenin-induced edema in rat. At doses of 0.25 and 0.5 mg/kg, droxicam was as active as piroxicam and more active than phenylbutazone given at 2.5 and 5 mg/kg. Against nystatin-induced edema, droxicam (ED50, p.o., 5, 6, 7, 8 h: 7.5, 12.9, 4.8, 8.4 mg/kg) was 4-11 times more active than phenylbutazone and more than 12 times more active than isoxicam. In cotton pellet-induced granuloma in rats, title compound was as active as suprofen. In U.V. light-induced erythema in guinea pigs, droxicam (ED50, p.o., 1, 2, 3, 4 h: 0.51, 0.94, 1.56, 4.88 mg/kg) was 5-9 times more active than phenylbutazone. At doses of 0.1, 0.33 and 1.0 mg/kg/day, droxicam, similar to piroxicam, showed good antiarthritic activity in rats injected with Mycobacterium butyricum against primary and secondary lesions. Droxicam demonstrated strong analgesic activity in protecting against writhings: induced by phenylbenzoquinone in mice: ED50: droxicam = 5.3, phenylbutazone = 61.5, acetylsalicylic acid = 90.7, dipyrone = 83.6, isoxicam = 88.3 mg/kg, p.o.; induced by acetylcholine bromide in mice: ED50: droxicam = 1.1, phenylbutazone = 32.1, acetylsalicylic acid = 32.2, isoxicam = 32.7 mg/kg, p.o.; induced by acetic acid in rat: ED50: droxicam = 0.94, acetylsalicylic acid = 8.72, isoxicam = 4.70 mg/kg, p.o. Antipyretic activity of title compound was demonstrated in rats with pyresis induced by brewer's yeast, being 4-13 times more active than dipyrone. In pyresis induced by Salmonella typhi, droxicam was more active than acetylsalicylic acid and 4-aminoantipyrine at all times and doses. In a study of protection against diarrhea induced by castor oil in rats, droxicam and piroxicam showed equal activity (ED50 = 0.081 and 0.079 mg/kg, p.o., respectively) and were 3.9 and 15.6 times more active than isoxicam and phenylbutazone, respectively. Droxicam significantly inhibited peritoneal capillary permeability in mice at a dose of 5 mg/kg, p.o., while isoxicam and phenylbutazone required 100 and 200 mg/kg, p.o., respectively. Droxicam did not exhibit uricosuric activity in rats. It did not show cardiovascular or respiratory effects in anesthetized cats, nor modify their response to administration of acetylcholine, norepinephrine and histamine. In the Irwin's test, droxicam did not alter rat behavior (80 mg/kg, i.p.) nor that of mice (160 mg/kg, p.o.). Induction of gastrointestinal injuries in rats by droxicam was 10 times less than by piroxicam (UD50: droxicam, 57 mg/kg, p.o.; piroxicam, 5.6 mg/kg, p.o.). The potentiation of gastric injuries induced by stress through cold in rats was also studied.(ABSTRACT TRUNCATED AT 400 WORDS)