DAMPs/PAMPs induce monocytic TLR activation and tolerance in COVID-19 patients; nucleic acid binding scavengers can counteract such TLR agonists

Millions of COVID-19 patients have succumbed to respiratory and systemic inflammation. Hyperstimulation of toll-like receptor (TLR) signaling is a key driver of immunopathology following infection by viruses. We found that severely ill COVID-19 patients in the Intensive Care Unit (ICU) display hallmarks of such hyper-stimulation with abundant agonists of nucleic acid-sensing TLRs present in their blood and lungs. These nucleic acid-containing Damage and Pathogen Associated Molecular Patterns (DAMPs/PAMPs) can be depleted using nucleic acid-binding microfibers to limit the patient samples' ability to hyperactivate such innate immune receptors. Single-cell RNA-sequencing revealed that CD16+ monocytes from deceased but not recovered ICU patients exhibit a TLR-tolerant phenotype and a deficient anti-viral response after ex vivo TLR stimulation. Plasma proteomics confirmed such myeloid hyperactivation and revealed DAMP/PAMP carrier consumption in deceased patients. Treatment of these COVID-19 patient samples with MnO nanoparticles effectively neutralizes TLR activation by the abundant nucleic acid-containing DAMPs/PAMPs present in their lungs and blood. Finally, MnO nanoscavenger treatment limits the ability of DAMPs/PAMPs to induce TLR tolerance in monocytes. Thus, treatment with microfiber- or nanoparticle-based DAMP/PAMP scavengers may prove useful for limiting SARS-CoV-2 induced hyperinflammation, preventing monocytic TLR tolerance, and improving outcomes in severely ill COVID-19 patients.

Generation of an anticoagulant aptamer that targets factor V/Va and disrupts the FVa-membrane interaction in normal and COVID-19 patient samples

Coagulation cofactors profoundly regulate hemostasis and are appealing targets for anticoagulants. However, targeting such proteins has been challenging because they lack an active site. To address this, we isolate an RNA aptamer termed T18.3 that binds to both factor V (FV) and FVa with nanomolar affinity and demonstrates clinically relevant anticoagulant activity in both plasma and whole blood. The aptamer also shows synergy with low molecular weight heparin and delivers potent anticoagulation in plasma collected from patients with coronavirus disease 2019 (COVID-19). Moreover, the aptamer's anticoagulant activity can be rapidly and efficiently reversed using protamine sulfate, which potentially allows fine-tuning of aptamer's activity post-administration. We further show that the aptamer achieves its anticoagulant activity by abrogating FV/FVa interactions with phospholipid membranes. Our success in generating an anticoagulant aptamer targeting FV/Va demonstrates the feasibility of using cofactor-binding aptamers as therapeutic protein inhibitors and reveals an unconventional working mechanism of an aptamer by interrupting protein-membrane interactions.

Admission screening and cohort care decrease carbapenem resistant enterobacteriaceae in Vietnamese pediatric ICU's

Objectives

To assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU’s) at the Vietnamese National Children’s Hospital.

Method

CRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status.

Results

CRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR − 3.2, p < 0.005) from 90% in period 2 (highest) to 48% in period 8 (last period). Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI, n = 20 (14%) vs. n = 2 (2%), longer hospital stays, 3.26 vs. 2.37 weeks, and higher total treatment costs, 2852 vs. 2295 USD.

Conclusion

Admission CRE screening and cohort care in pediatric ICU’s significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.

COVID-19 related muscle denervation atrophy

COVID-19 has presented with a variety of manifestations including peripheral neurological symptoms. The most commonly associated peripheral neuropathies described with COVID-19 are Guillain-Barre syndrome and its variants as well as critical illness polyneuropathy. We report in this paper the distinct MRI findings of an unusual case of peripheral neuropathy associated with COVID-19. These findings are similar to those seen in Guillain-Barre syndrome or one of its variants, although differing from the classic condition in certain key clinical and radiological features.

Remote TELEmonitoring and Health Coaching for patients with acute heart failure: results of the TELE-HC randomized trial

Introduction

Patients discharged after acute decompensated heart failure (ADHF) have elevated risk for readmission due to multiple factors including suboptimal behavioral and social support. Telemonitoring interventions have shown inconsistent effectiveness in reducing HF readmissions. Patient-centered health coaching, when combined with telemonitoring, may be a viable model to engage patients in self-care behaviors and enhance patient experiences following acute hospitalization.

Purpose

This multicenter randomized trial evaluates whether remote telemonitoring combined with health coaching decreases 60 day readmission rates for patients with ADHF when compared to standard of care.

Methods

Patients with primary or secondary diagnosis of ADHF were consented and randomized prior to hospital discharge to either standard care or intervention of remote telemonitoring and health coaching. Within 2 days of hospital dismissal, intervention patients were onboarded to the remote monitoring platform, which links personal health sensors which collect on-body physiologic measures (ECG, heart rate, respiration rate, and activity via 3-axis accelerometer) with providers through secure mobile communication. A registered nurse was designated as the primary health coach focusing on disease management - including symptom recognition, adherence to treatment strategies, care coordination, medication matters, and problem solving. A social worker and nutritionist were also assigned. The primary outcome was all-cause mortality or readmission within 60 days of hospital dismissal. Statistical analysis included stratified log-rank tests and stratified Cochran-Mantel-Haenszel Chi-square test to account for site-stratified randomization.

Results

The study was halted due to low rate of subject accrual. Of planned 304 subjects, 143 were randomized between 2015 and 2019 at 6 sites in the United States. Dropout and withdrawal after randomization of 32 subjects (22%) left 112 analyzable for the primary endpoint. Many subject withdrawals after unblinded disclosure of arm allocation were related to treatment assignment. Immediate withdrawal without follow up in these subjects precluded an intention-to-treat analysis. Mean age was 69 years and subjects were more often male (56%) and non-Hispanic white (70%). In per-protocol analysis, using subjects adherent to protocol specified visits (n=112), we observe no difference in the primary outcome (26% among intervention vs 28% among standard care, Figure, p=0.77). There were also no differences among secondary outcomes of overall mortality (2% vs 7%, p=0.20) or composite emergency department visit, hospital admission, or death (35% vs 34%, p=0.85).

Conclusions

Among patients with heart failure, an intervention of remote telemonitoring and health coaching did not reduce all-cause readmission or mortality. Significant withdrawal rates suggest future studies may need to improve screening and study retention.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Aging

Complexation by cysteine and iron mineral adsorption limit cadmium mobility during metabolic activity of Geobacter sulfurreducens

Cadmium (Cd) adversely affects human health by entering the food chain via anthropogenic activity. In order to mitigate risk, a better understanding of the biogeochemical mechanisms limiting Cd mobility in the environment is needed. While Cd is not redox-active, Cd speciation varies (i.e., aqueous, complexed, adsorbed), and influences mobility. Here, the cycling of Cd in relation to initial speciation during the growth of Geobacter sulfurreducens was studied. Either fumarate or ferrihydrite (Fh) was provided as an electron acceptor and Cd was present as: (1) an aqueous cation, (2) an aqueous complex with cysteine, which is often present in metal stressed soil environments, or (3) adsorbed to Fh. During microbial Fe(iii) reduction, the removal of Cd was substantial (∼80% removal), despite extensive Fe(ii) production (ratio Fe(ii)total : Fetotal = 0.8). When fumarate was the electron acceptor, there was higher removal from solution when Cd was complexed with cysteine (97-100% removal) compared to aqueous Cd (34-50%) removal. Confocal laser scanning microscopy (CLSM) demonstrated the formation of exopolymeric substances (EPS) in all conditions and that Cd was correlated with EPS in the absence of Fe minerals (r = 0.51-0.56). Most notable is that aqueous Cd was more strongly correlated with Geobacter cells (r = 0.72) compared to Cd-cysteine complexes (r = 0.51). This work demonstrates that Cd interactions with cell surfaces and EPS, and Cd solubility during metabolic activity are dependent upon initial speciation. These processes may be especially important in soil environments where sulfur is limited and Fe and organic carbon are abundant.

Determination of Oxytetracycline/Oxytetracycline Hydrochloride in Animal Feed, Fish Feed, and Veterinary Medicinal Products by Liquid Chromatography with Fluorescence Detection: Collaborative Study

A method for determining oxytetracycline (OTC) in animal feed, fish feed, and veterinary medicinal products at medicated use and contamination levels was collaboratively studied. The method is applicable to the analysis of animal feeds and mineral premixes containing levels 2 mg/kg, and fish feed containing levels 10 mg/kg. Oxytetracycline hydrochloride (OTC.HCl) is extracted from ground feed material in acidmethanol solution using mechanical agitation. After centrifugation for 5 min at 1230 g, an aliquot of the extract is diluted with water and/or acidmethanol so that the concentration of OTC.HCl is approximately the same as that in the working standard, and the solutions contain at least 50 water. Injectable veterinary medicinal materials (also called animal remedy materials) are diluted with water and/or extractant to reach the target concentration. The extracts are filtered and analyzed by reversed-phase liquid chromatography with fluorescence detection with excitation at 390 nm and emission at 512 nm. Twenty-eight test samples of medicated feeds, supplements, and drug premixes, including 4 test samples for trace-level analysis, were sent to 17 collaborators in Canada, The Netherlands, and the United States. Results were received from 11 laboratories. The RSDr values (within-laboratory repeatability) ranged from 1.26 to 9.21; RSDR values (among-laboratory reproducibility) ranged from 2.14 to 12.9, and HorRat values ranged from 0.54 to 3.02. It is recommended that this method be adopted AOAC Official First Action.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Hiv-Exposed but Uninfected Infants: Identifying Developmental Delay and the challenges faced in Accessing Developmental Services from a Canadian Tertiary Centre

BACKGROUND: Children born to HIV-positive mothers but are HIV uninfected (HEU) are at increased risk for adverse developmental outcomes. The literature suggests that the increased risk is more related to social determinants of health rather than effects of perinatal exposures to HIV and antiretrovirals. Developmental screening and early referral do result in improved outcomes and so HEUs should benefit from anticipatory guidance and early specialist referral.

OBJECTIVES: We aimed to identify the rate of development screening, identification and referral of developmental concern, and referral completion in a provincial family-centered HIV clinic caring for 20-30 HIV exposed newborns per year and secondarily identify barriers to referral completion.

DESIGN/METHODS: We conducted a retrospective review of all of the HEU cared for at this outpatient clinic born between January 1, 2008 and June 30, 2013 to examine the frequency of developmental concerns, referral rates for children with documented concerns, and referral outcomes.

RESULTS: We reviewed 112 subjects: 64 (57%) male; 87 (77%) born at term (&gt;37 weeks). 78 (66%) of the families had one or more social vulnerabilities (parental ill health apart from HIV, poverty, limited literacy, limited English language skills, etc), including 43 (38%) who had some involvement with child protection services. 104 (92.8%) had at least one documented developmental assessment using standardized tools. Among these 104, 46 (44.2%) were noted to have a developmental concern and of those, 40 (87.0%) were referred to at least one developmental service provider or general pediatrician. There were a total of 43 referrals to developmental service providers; 58.1% occurred at time of study completion, and 60.0% for which recommendations were formally communicated. Of 36 referrals to general pediatricians, 69.4% had occurred, 92.0% of which recommendations communicated back to the clinic. Barriers to referral completion included inability to contact caregivers (7.3%), patient no-show (13.0%), waiting lists (23.2%), and other (56.5%).

CONCLUSION: The large majority of patients were screened and referred when indicated, but a significant number of patients either were not assessed by the secondary provider, or no information was communicated back to the clinic. Multiple barriers at the clinic, patient, and referral centre level were identified. The discrepancy in referral completion between developmental service provider referrals and general pediatrician referrals, may further highlight the difficulty HEU families have navigating our provincial developmental services. Future work will examine how to overcome these barriers in a vulnerable population.

Improved recovery from spinal cord injury in rats with chronic parvovirus serotype-1a infection

OBJECTIVES

A vendor informed us that rats shipped to us and used by us in a spinal cord contusion injury experiment were infected by rat parvovirus type 1a (RPV-1a). Our aim was therefore to determine whether this infection may have altered locomotor recovery or tissue pathology.

SETTING

Stockholm, Sweden.

METHODS

We induced a moderate contusion injury of the spinal cord in rats received from an (unknown to us) RPV-1a-contaminated facility. We compared the hind limb locomotor function between RPV-1a-infected rats and non-infected controls with the same spinal cord lesions, obtained before (historical control), as well as after infection (future controls). Histologically, we assessed spinal tissue sparing, astrocyte reactivity and the amount of macrophages/activated microglia.

RESULTS

RPV-1a-infected rats had significantly better hind limb locomotor recovery compared with both 'historical' and 'future' controls. We also observed significantly better tissue sparing and axonal sparing around the injury site, as well as significant reductions in macrophages/activated microglia and astrocyte reactivity in the spinal cords of RPV-1a-infected rats.

CONCLUSION

The results stress the importance of knowing the health status of animals used to study central nervous system trauma and support the notion that acquired infections, even if asymptomatic, may alter response to injury in mammals. Furthermore, the results demonstrate that virus infections may have positive effects on functional recovery after spinal cord injury and indicate that RPV-1a infection may be neuroprotective by dampening secondary damage.

Abstract P2-18-16: Patients’ impression of the expected appearance of breasts in 2013

Background: Concern exists about the increasing rate of bilateral mastectomy for patients with unilateral breast cancer. Patient concern for second primary, use of breast MRI, and increased genetic cancer risk assessment all may influence choice of operation. In recent years, cosmetic breast augmentation has also become more common. This study was performed to evaluate women's perception of the current expected appearance of breasts.

Methods: From April 2012 to May 2013, all patients seen at a Breast Clinic were shown two pictures (A “natural” and B “augmented”) and asked “What is the expected appearance of breasts in 2012(2013)?” Sociodemographic, clinical, and treatment variables were collected. Univariate analysis was performed to identify variables which were associated with picture choice. All of the variables with a p-value &lt;0.10 were included in the multivariate analysis.

Results: 1,177 consecutive patients were seen with mean age 45 years. 93% of the patients were insured with Medicaid or uninsured and 19% were non-Hispanic White (NHW). The mean monthly income was only $1104. Overall 70% of patients felt that the augmented appearance is “expected in 2013.” Age was strongly associated with augmented appearance as younger patients were significantly more likely to choose picture B: age less than 40 years (85%), age 40-49 years (67%), age 50-59 years (65%), and age 60+ years (51%). Patients of all race/ethnic groups felt that the augmented appearance was expected. NHW 65%, AA 67%, and Hispanic 71%. Multivariate analysis found that more years of education (p = 0.001), younger age and lower BMI were strongly associated (p &lt; 0.0001) with choosing the augmented appearance as “expected in 2013.”

Of the 1177 patients, 337 breast cancer patients were seen. Overall 62% felt that the augmented appearance was expected. Of those who underwent an operation, 178 (58%) patients underwent breast conservation and 62% felt the augmented appearance was expected. Of 128 patients who underwent mastectomy, 36 (28%) underwent reconstruction. 23 patients underwent bilateral mastectomy. Of those who underwent mastectomy alone (41/83 = 49%) only about half felt the augmented appearance was expected. By contrast those who underwent reconstruction (33/36 = 92%; p &lt; 0.001) or bilateral mastectomy (17/23 = 74%; p = 0.057), were significantly more likely than those who underwent mastectomy alone to feel the augmented appearance was expected.

Conclusions: The current study suggests women's perception of the expected appearance of breasts is changing. Younger age was strongly associated with the perception that the “augmented” appearance is expected. This change may affect patients’ choice in surgical operations with more mastectomies and reconstructions in the future. In October 2012 from a common women's periodical, when asked about her choice of operation for a small area of unilateral DCIS, one woman responded, “Just take them off and give me implants. Everybody has implants; it's no big deal.”

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-16.

Long-term beneficial effects of adrenal medullary autografts supported by nerve growth factor in Parkinson's disease

Parkinson's disease has been the object of several therapeutic strategies based upon replacement of the degenerating dopaminergic neurons. Adrenal medullary transplants were tried initially, because of the biochemical relationship between chromaffin cells of the medulla and dopaminergic neurons of the substantia nigra. Compared to transplant of fetal neurons, autologous grafts of adrenal medullary tissue has the advantage of using a readily available source of tissue without the problems of immunosuppression. However, these cells have not proven to be as effective as fetal neurons, probably because they do not fully differentiate into neurons. In animal models, brief treatment with nerve growth factor can facilitate such differentiation. This study is a clinical evaluation of the efficacy of adrenal medullary cell transplantation, combined with nerve growth factor infusion. Two patients were selected who were moderately to severely affected (Hoehn-Yahr stage 2 in on-phase and stage 4 in off-phase). After adrenalectomy, small pieces of medulla were prepared and implanted stereotactically into the dorsal putamen on one side of the brain. A catheter filled with mouse beta-nerve growth factor (NGF) was placed close to the grafts. Infusion of NGF was continued for one month. Despite a progressively deteriorating course prior to surgery, both patients showed improvement on the rating scales postoperatively. There was also significant improvement in timed motor tests. Motor readiness evoked potentials showed increased voltage over the operated hemisphere. The study points to methods and feasibility of supplying nerve growth factor intraparenchymally to the human brain. Possible implications with respect to other growth factors, particularly Glial cell-line Derived Neurotrophic factor (GDNF) are discussed.

Inactivation of the Dlc1 gene cooperates with downregulation of p15INK4b and p16Ink4a, leading to neoplastic transformation and poor prognosis in human cancer

The tumor suppressor gene deleted in liver cancer-1 (DLC1), which encodes a protein with strong RhoGAP (GTPase activating protein) activity and weak Cdc42GAP activity, is inactivated in various human malignancies. Following Dlc1 inactivation, mouse embryo fibroblasts (MEF) with a conditional Dlc1 knockout allele reproducibly underwent neoplastic transformation. In addition to inactivation of Dlc1 and increased activity of Rho and Cdc42, transformation depended on the subsequent decreased expression of the Cdk4/6 inhibitors p15(Ink4b) and p16(Ink4a) together with increased expression and activation of Cdk4/6. The level of expression of these cell-cycle regulatory genes was relevant to human tumors with low DLC1 expression. Analysis of publicly available annotated datasets of lung and colon cancer with gene expression microarray profiles indicated that, in pairwise comparisons, low DLC1 expression occurred frequently together (P < 0.01) with downregulation of p15(Ink4b) or p16(Ink4a) or upregulation of CDK4 or CDK6. In addition, an unfavorable prognosis (P < 0.05) was associated with low DLC1 and low p15(Ink4b) in lung cancer and colon cancer, low DLC1 and low p16(Ink4a) in lung cancer, low DLC1 and high CDK4 in lung cancer, and low DLC1 and high CDK6 in colon cancer. Thus, several genes and biochemical activities collaborate with the inactivation of DLC1 to give rise to cell transformation in MEFs, and the identified genes are relevant to human tumors with low DLC1 expression.

Cholinergic denervation attenuates phencyclidine-induced c-fos responses in rat cortical neurons

The cortical cholinergic innervation, which is important for memory and cognition, has been implicated in schizophrenia. To experimentally analyze such a possible role of the cholinergic system, we have used the dissociative drug phencyclidine (PCP), known to produce schizophrenia-like psychosis in humans, to model aspects of schizophrenia in rats. We previously showed that induced cortical cholinergic hypofunction leads to enhanced PCP-induced locomotor activity and attenuated social interaction. After PCP, rats lacking cortical cholinergic innervation also show impaired declarative memory. To directly study the role of the basalo-cortical cholinergic projections for PCP-induced neural activation in different cortical areas, we have now monitored the rapid (30 and 60 min) effects of low doses of PCP (2 and 3mg/kg) on neural activation as reflected by transcriptional activation of c-fos in cortical areas, using quantitative in situ hybridization. We find an almost pan-cortical neural induction of c-fos mRNA with doses of PCP low enough not to alter levels of either BDNF or Nogo receptor mRNA levels. Specific unilateral lesioning of the uncrossed cholinergic projections to the cortical mantle by 192-IgG-saporin immunotoxin delivery to nc basalis (NBM) caused a striking ipsilateral decrease of the PCP-induced cortical c-fos mRNA induction, restricted to areas which had become effectively denervated. Because PCP at low doses is unlikely to directly influence cortical neurons, we suggest that it acts by activation of the cholinergic input, which in turn leads to cortical c-fos mRNA increases. Our results are compatible with a role for the cholinergic system in symptoms of schizophrenia, by showing that the basalo-cortical cholinergic projections are needed in order for PCP to have full activating effects on cortical neurons.

Quality of induced sputum using a human-powered nebuliser in a mobile human immunodeficiency virus testing service in South Africa

OBJECTIVES

To investigate the quality of induced sputum samples using a human-powered (HPN) and an electric-powered nebuliser (EPN).

METHODS

For each participant two sputum samples were induced using the HPN and the EPN. The sequence of the two nebulisers was allocated at random. The proportion of good quality sputum according to different assessment criteria was compared using an exact McNemar test. The difference in time to expectoration was compared using the Wilcoxon matched-pairs signed-rank test.

RESULTS

A total of 123 individuals were eligible for the study. Nine individuals refused to participate and five were unable to produce a sputum sample. The proportion of good quality sputum was higher among sputum samples induced by the HPN compared to those obtained using the EPN. The median time to produce a sputum sample was 2.2 min (IQR 1.13-4.1) for the HPN and 2.5 min (IQR 1.4-4.1) for the EPN.

CONCLUSION

The HPN induced good quality sputum within 3 min. The device operates without electricity and is suitable not only for remote clinics with unreliable electricity, but also for mobile services and community-based intensified tuberculosis (TB) case finding. Further research needs to investigate the yield of TB in sputum samples induced by the HPN.

MitoPark mice mirror the slow progression of key symptoms and L-DOPA response in Parkinson's disease

The MitoPark mouse, in which the mitochondrial transcription factor Tfam is selectively removed in midbrain dopamine (DA) neurons, is a genetic model for Parkinson's disease (PD) that replicates the slow and progressive development of key symptoms. To further validate this model, we have extended both behavioral and biochemical analyses in these animals. We found that vertical movements decline earlier and faster than horizontal movements, possibly modeling the early occurrence of axial, postural instability in PD. L-DOPA induces different locomotor responses depending on the age: in young MitoPark mice the L-DOPA-induced motor activation is small; middle-aged MitoPark mice respond in a dose-dependent manner to L-DOPA, whereas aged MitoPark mice display a double-peaked locomotor response to a high dose of L-DOPA that includes an intermittent period of very low motor activity, similar to the 'on-off' phenomenon in PD. To correlate behavior with biochemical data, we analyzed monoamine levels in three different brain areas that are highly innervated by the DA system: striatum, anterior cortex and olfactory bulb. DA levels declined earlier and faster in striatum than in cortex; only at the latest time-point analyzed, DA levels were found to be significantly lower than control levels in the olfactory bulb. Interestingly, the ratio between homovanillic acid (HVA) and DA differed between regions over time. In striatum and olfactory bulb, the ratio increased steeply indicating increased DA turnover. In contrast, the ratio decreased over time in cortex, revealing important differences between DA cells in substantia nigra and the ventral tegmental area.

Therapeutic hypothermia can be induced and maintained using either commercial water bottles or a "phase changing material" mattress in a newborn piglet model

BACKGROUND

Therapeutic hypothermia, a safe and effective treatment for neonatal encephalopathy in an intensive care setting, is not available in low-resource settings. Aims/

METHODS

To assess two low-tech, low-cost cooling devices for use in low-resource settings: (i) commercially available water bottles filled with tepid water (25 degrees C); (ii) a mattress made of phase changing material (PCM) with a melting point of 32 degrees C (PCM works as a heat buffer at this temperature). Eleven anaesthetised newborn piglets were studied following transient hypoxia-ischaemia. The cooling device was applied 2-26 h after hypoxia-ischaemia with a target rectal temperature (T(rectal)) of 33-34 degrees C. T(rectal) undershoot was adjusted using cotton blankets; the cooling device was renewed when T(rectal) rose above 35 degrees C. T(rectal) data during cooling were dichotomised (within or without target) to assess: (a) the total period within the target T(rectal) range; (b) the stability and fluctuation of T(rectal) during cooling.

RESULTS

Therapeutic hypothermia was achieved with both water bottles (n = 5) and the PCM mattress (n = 6). The mean (SD) time to reach target T(rectal) was 1.8 (0.5) h with water bottles and 1.9 (0.3) h with PCM. PCM cooling led to a longer period within the target T(rectal) range (p<0.01) and more stable cooling (p<0.05). Water bottle cooling required device renewal (in four out of five piglets).

CONCLUSION

Simple, low-tech cooling devices can induce and maintain therapeutic hypothermia effectively in a porcine model of neonatal encephalopathy, although frequent fine tuning by adjusting the number of blankets insulating the piglet was required to maintain a stable temperature. PCM may induce more stable cooling compared with water bottles.

Cytochrome P450 2E1 gene polymorphisms/haplotypes and Parkinson's disease in a Swedish population

Cytochrome P450 2E1 (CYP2E1), which inter alia is located in dopamine containing neurons in the substantia nigra, has been hypothesized to be of importance for the pathophysiology of Parkinson's disease (PD), either by its production of reactive oxygen species (ROS) or by its capability to detoxify putative neurotoxins. Numerous polymorphisms in the coding and non-coding regions of the gene for this enzyme have been reported. Different variants may account for inter-individual differences in the activity of the enzyme or production of ROS. In this study, the CYP2E1 gene was examined in a control population (n = 272) and a population with PD (n = 347), using a tag-single nucleotide polymorphism (tSNP) approach founded on HapMap Data. Six tSNPs were used in the analysis and haplotype block data were obtained. In case of significance, the SNP was further examined regarding early/late age of disease onset and presence of relatives with PD. We found an association between allele and genotype frequencies of the C/G polymorphism at intron 7 (rs2070676) of this gene and PD (P value of 0.026 and 0.027, respectively). Furthermore, analysis of the rs2070676 polymorphism in subgroups of patients with age of disease onset higher than 50 years and those not having a relative with PD also demonstrated a significant difference with controls. This was seen in both genotype (corresponding to P value = 0.039 and 0.032) and allele (P = 0.027 and 0.017 respectively) frequency. As a representative of many polymorphisms or in possible linkage disequilibrium with other functional variants, it is possible that rs2070676 could influence the regulation of the enzyme. In conclusion, our results display an association between the rs2070676 polymorphism and PD. Additional investigations are needed to elucidate the importance of this polymorphism for the activity of CYP2E1 and PD susceptibility.

Factors regulating growth of catecholamine-containing nerves, as revealed by transplantation and explantation studies

Intraocular grafting of various types of neuron and target tissue shows that peripheral and central noradrenergic neurons may substitute morphologically and functionally for each other in certain, but not all, target tissues. The morphology of growing adrenergic nerve terminals, their patterning, and the number of fibres are completely determined by the target tissues. Thus, the sympathetic adrenergic neuron of an adult organism is a highly plastic unit which may, for instance, double or even triple its terminal field in response to new demands from the environment. Several differences exist between central and peripheral adrenergic nerves: locus coeruleus will not innervate heart grafts; sympathetic fibres will not innervate the spinal cord; and central adrenergic neurons are not sensitive to nerve growth factor (NGF). Chromaffin cells can be made to innervate peripheral and central targets. No NGF is detected in normal adult iris. The iris responds to grafting, explantation, and to sensory or sympathetic denervation with rapid production of NGF as shown by bioassays on chick embryonic ganglia. This iris also contains a potent stimulatory factor for the ciliary ganglion. Trauma to the iris or to the anterior eye chamber may cause it to become hyperinnervated. Heavy metals have characteristic and different effects on the sympathetic nerves of the iris: lead and manganese causes hyperinnervation; cadmium does not change the number of nerves; while mercury causes severe terminal degeneration followed by regeneration.

Novel design of interactive multimodal biofeedback system for neurorehabilitation

A previous design of a biofeedback system for Neurorehabilitation in an interactive multimodal environment has demonstrated the potential of engaging stroke patients in task-oriented neuromotor rehabilitation. This report explores the new concept and alternative designs of multimedia based biofeedback systems. In this system, the new interactive multimodal environment was constructed with abstract presentation of movement parameters. Scenery images or pictures and their clarity and orientation are used to reflect the arm movement and relative position to the target instead of the animated arm. The multiple biofeedback parameters were classified into different hierarchical levels w.r.t. importance of each movement parameter to performance. A new quantified measurement for these parameters were developed to assess the patient's performance both real-time and offline. These parameters were represented by combined visual and auditory presentations with various distinct music instruments. Overall, the objective of newly designed system is to explore what information and how to feedback information in interactive virtual environment could enhance the sensorimotor integration that may facilitate the efficient design and application of virtual environment based therapeutic intervention.

Developmental regulation of leucine-rich repeat kinase 1 and 2 expression in the brain and other rodent and human organs: Implications for Parkinson's disease

Mutations in leucine-rich repeat kinase 2 (LRRK2) constitute the most common known cause of Parkinson's disease (PD), accounting for both familial and sporadic forms of the disease. We analyzed the tempo-spatial activity of leucine-rich repeat kinase 1 (LRRK1) and LRRK2 at the cellular level in human and rat tissues including development and aging. Lrrk2 mRNA is expressed in adult rat striatum, hippocampus, cerebral cortex, sensory and sympathetic ganglia, lung, spleen and kidney. In the developing rat striatum, Lrrk2 transcription is first observed at postnatal day (P) 8 followed by increasing mRNA levels during the following 3 weeks, as revealed by quantitative in situ hybridization, after which levels remain up to 24 months of age. The time-course of postnatal development of Lrrk2 activity in striatum thus closely mirrors the postnatal development of the dopamine innervation of striatum. Lrrk2 mRNA is seen in P1 rat lung, heart, and kidney, whereas Lrrk1 is found in many areas of the P1 rat. Lrrk1 is present in adult rat brain, adrenal gland, liver, lung, spleen and kidney and also in embryonic brain, with declining gene activity after birth. LRRK1 and LRRK2 are active in the adult human cortex cerebri, hippocampus and LRRK2, but not LRRK1, in striatum. Transcription of both genes is also seen in the young human thymus and LRRK2 is active in tubular parts of the adult human kidney. Our findings suggest that the two paralogous genes have partly complementary expression patterns in the brain, as well as in certain peripheral organs including lymphatic tissues. While the strong presence of Lrrk2 message in striatum is intriguing in relation to PD, the many other neuronal and non-neuronal sites of Lrrk2 activity also needs to be taken into account in deciphering possible pathogenic pathways.