Denosumab for the treatment of giant cell tumor (GCT) of bone: Final results from a proof-of-concept, phase II study

10510

Background: GCT of bone is a primary osteolytic bone tumor with low metastatic potential that is associated with significant skeletal morbidity. GCT is rich in stromal cells that express RANKL, a key mediator of osteoclast activation. In this open-label, study, we investigated whether denosumab, a fully human monoclonal antibody against RANKL, could have a potential therapeutic effect on giant cell histology for patients with GCT. Methods: In this single-arm study, 37 patients with measurable or unresectable GCT received denosumab 120 mg subcutaneously once monthly with loading doses on days 8 and 15 of month 1. The primary endpoint was the proportion of patients with a tumor response (≥90% elimination of giant cells or no radiographic progression of the target lesion) at week 25 as assessed by histology and CT or MRI. A sample size of 35 patients was planned. All 37 enrolled patients were evaluated for safety; 35 were eligible for efficacy evaluation (2 had insufficient histology or radiology data). Results: Thirty of 35 patients (86%; 95% CI 70%-95%) had a tumor response: 20 of 20 by histology and 10 of 15 by radiology. Of 31 patients with data for assessments of clinical benefit, 26 (84%%; 95% CI 66%-95%) reported reduced pain or improvement in functional status. Bone repair was reported in 9 patients (29%; 95% CI 14%-48%). Suppression of the bone turnover markers urinary N-telopeptide and serum C-telopeptide was seen as early as 28 days after the first dose and sustained for the duration of the study. Adverse events (AEs) were reported in 33 patients (89%). One death due to surgical complications (not treatment-related) occurred on-study. No patient experienced treatment-related serious AEs or developed anti-denosumab antibodies. Conclusions: In this study, 86% of patients with measurable or unresectable GCT experienced a tumor response with denosumab. Further clinical trials of denosumab as a new therapy for GCT are warranted.

[Table: see text]

Targeted expression of csCSF-1 in op/op mice ameliorates tooth defects

OBJECTIVE

The aim of this study was to characterize the tooth phenotype of CSF-1-deficient op/op mice and determine whether expression of csCSF-1 in these mice has a role in primary tooth matrix formation.

DESIGN

Ameloblasts and odontoblasts, isolated from wt/wt frozen sections using laser capture microdissection, were analysed for csCSF-1, sCSF-1 and CSF-1R mRNA by RT-PCR. Mandibles, excised from 8 days op/op and wt/wt littermates, were examined for tooth morphology as well as amelogenin and DMP1 expression using in situ hybridisation. op/opCS transgenic mice, expressing csCSF-1 in teeth and bone using the osteocalcin promoter, were generated. Skeletal X-rays and histomorphometry were performed; teeth were analysed for morphology and matrix proteins.

RESULTS

Normal dental cells in vivo express both CSF-1 isoforms and CSF-1R. Compared to wt/wt, op/op teeth prior to eruption showed altered dental cell morphology and dramatic reduction in DMP1 transcripts. op/opCS mice showed marked resolution of osteopetrosis, tooth eruption and teeth that resembled amelogenesis imperfecta-like phenotype. At 3 weeks, op/op teeth showed severe enamel and dentin defects and barely detectable amelogenin and DMP1. In op/opCS mice, DMP1 in odontoblasts increased to near normal and dentin morphology was restored; amelogenin also increased. Enamel integrity improved in op/opCS, although it was thinner than wt enamel.

CONCLUSIONS

Results demonstrate that ameloblasts and odontoblasts are a source and potential target of CSF-1 isoforms in vivo. Expression of csCSF-1 within the tooth microenvironment is essential for normal tooth morphogenesis and may provide a mechanism for coordinating the process of tooth eruption with endogenous matrix formation.

[Squamous cell carcinoma on a leg ulcer in the West Indies]

INTRODUCTION

The epidemiology of carcinoma developing on a leg ulcer is poorly, although high incidence rates are reported in Africa.

PATIENTS AND METHODS

Retrospective study of cases reported in Guadeloupe, a tropical country with a large population from African descent and with high quality health care level.

RESULTS

Sixteen cases, mean age 71, were diagnosed over a 10-Year period in the only referral hospital. The annual incidence was an estimated 0.4/100,000. Preceding ulcers had a long course (mean of 27 Years) and had various causes. Social distress was the rule (14/16 patients). One third of the clearly differentiated (15/16) squamous cell-type tumors exhibited metastatic extension on presentation. At Year 3, the mortality rate was of 40 p. cent. The best survival rate (6 remissions/8 cases) was associated with primary limb amputation.

DISCUSSION

Malignant ulcers appeared more frequent in Guadeloupe than in the influent countries of the North, but with an instance 4-fold lower than in Africa. Like many other tropical diseases, socio-behavioral factors may play a major role.

Analyse en composantes principales de la grille AGGIR chez les patients âgés déments

AGGIR grid is the national standardized instrument determining aimed at the dependency of old people in France living in institutions as well as in the community. Attribution of the governmental financial assistance APA (Allocation Personnalisée d'Autonomie) depends essentially on the classification of frail old people in 6 degrees of dependency (GIR1 to GIR6). The aim of the present study was to test the reliability of this grid to evaluate the degree of dependency in demented elderly people. Mild, moderate or severe demented patients were included in the study (n= 120). A factorial validation of the A GGIR grid was performed by principal components analysis (PCA). This analysis showed a 5-factor solution: factor 1 named the property factor (27 percent of the variance), factor 2 named the dynamic factor (21 percent),factor 3 named the cognitive factor (20 percent), factor 4 named the external mobility factor (11 percent) and factor 5 named the communication factor (11 percent). The result showed that the AGGIR grid takes physical dependency more into account than psychological and behavioral dependency. This result suggests a need for readjustment of the AGGIR grid for demented patients by adding new variables taking into account psychosocial and behavioral disorders.

Factorial validation of the Severe Impairment Battery for patients with Alzheimer's disease. A pilot study

The Severe Impairment Battery (SIB) estimates the cognitive aptitudes and other skills of severely impaired dementia patients. The main objective of this pilot study was to clearly identify the number of factors present in the SIB and to analyze the relationships between the different cognitive domains explored by the SIB and loss of autonomy. We administered the SIB, the Mini Mental State Examination (MMSE) and two scales of dependency to 48 patients with Alzheimer's disease in its late stages. A factorial analysis (Principal Components Analysis) showed a 4-factor solution for the SIB: a cognitive factor, a praxis and visuospatial functions factor, the reactivity to external stimuli factor and the social aptitudes factor. A factorial analysis involving the dependency scales showed a cognitive factor, a dependency and constructional praxis factor, the reactivity to external stimuli factor and the social aptitudes factor. Reactivity to external stimuli and social aptitudes were not significantly correlated to cognitive aspects nor to dependency. The finding of dependency as a factor different from cognitive deterioration suggests that, in setting a treatment strategy for demented patients, attempts should be made to treat dependency in its own right. In addition, since reactivity to external stimuli and social aptitudes are not related to cognitive aspects nor to dependency, these functions should also be encouraged and stimulated.

Tissue reaction against a self-setting calcium phosphate cement set in bone or outside the organism

Calcium phosphate cements are able to set in situ when injected into bone tissue. We evaluated the tissue reaction occurring when a DCPD-based calcium phosphate cement was either set within the bone or implanted when already set. The samples were implanted in rabbit condyles and examined histologically after 8 and 16 weeks. The relative bone surface, the fibrous capsule around the implants and the implant section surface were measured. Solid material seemed to be better tolerated than paste implants. More bone was found at the solid implant contact whatever the implantation time and the solid material degraded much less rapidly. In conclusion, the physico-chemical modification of the biological environment occurring during setting increases the foreign body reaction against the material.

[Cysticercosis in Guadeloupe]

We report two cases of cysticercosis proved by histology, one in the brain, the other in the orbit. The first case was observed in a traveller, heavy smoker, serologically negative to cysticercosis in whom an isolated cerebral tumoral metastasis was suspected and resected. The lesion was centered by a typical cysticercus of Taenia solium. The second was a periorbital intramuscular nodule observed in a child who had never left our island. The fibroinflammatory nodule was centered by a cysticercus with a scolex without rostellum and without suckers. Its histological aspect led us to the diagnosis of cysticercosis. Three species of Taenia are discussed : T. solium, T. crassiceps and T. bovis. This case shows that the human transmission of the disease may exist in Guadeloupe.

[Cutaneo-mucous manifestations of dengue]

OBJECTIVES

To describe muco-cutaneous manifestations of dengue fever, assessing their incidence and histopathological aspects.

PATIENTS AND METHODS

During a dengue 2 epidemic, occurring in Guadeloupe in 1994, all patients admitted with a confirmed diagnostic of dengue fever were assessed for dermatological changes by 2 clinicians; 5 patients underwent skin biopsy with immuno-fluorescence staining.

RESULTS

Among 39 adult inpatients (Sex ratio 1.1, medium age 41 years) none presented a severe form of the disease, whereas 18/39 (46 p. 100) had some muco-cutaneous changes, associating rash (13 cases (33 p. 100)), mucous membranes involvement (7 cases (18 p. 100)), or minor haemorrhages (6 cases (15 p. 100)). The rash appeared macular, discrete, itching, troncular with peripheral extension, rather than maculo-papular (morbiliform) as usually described. Apart from cases which minor haemorrhagic changes, significatively associated with marked thrombocytopenia (medium 37 x 10(9)/1), dengue cases either with or without muco-cutaneous changes had similar clinical (duration, severity) or biological (neutro-lympho-thrombocytopenia, transaminases) features, and evolution. Histological changes appeared non specific (minor lymphocytic dermal vasculitis, non contributive immuno-fluorescence).

DISCUSSION

Clinical and histological features of the rash are unspecific and inconstant: they do not allow an easy and accurate diagnosis. Complete clinical, epidemiological (very recent travel in endemic areas) or biological data should be collected, and early virological or later serological confirmation is needed. As well as travel facilities are growing, the dengue area is extending: dengue fever should therefore be considered in every traveller with fever and rash.

Biomedical applications of maghemite ferrofluid

The use of cell-targeted ferrofluid in the characterization of modifications of cell membranes is reviewed. Maghemite ferrofluid was synthesized by the Massart method, complexed with dimercaptosuccinic acid (FF). Cell targeting by FF was developed by coupling FF to various biological effectors such as antibodies, lectins, etc, which enabled magnetic cell sorting. Modifications in erythrocyte membranes were studied using FF bound to recombinant human annexin V (AnxFF) which is very sensitive, compared to other Anx-based reagents, in the early detection of phosphatidylserine (PS) exposition on the outer leaflet of the plasma membrane. Thus PS exposition on mouse RBC was detected already after a 24-h storage at 4 degrees C and, transiently, 24 h after their infection by Plasmodium parasites, at which time the parasites are still confined to the liver, thus leading to the recruitment of young RBC and the accumulation of a species, intermediate between reticulocytes and erythrocytes, and the actual RBC target of plasmodial invasion. AnxFF revealed PS exposition on RBC from sickle cell anemia patients, following various inflammations and already after 20 days of human blood storage under blood bank conditions. Such a sensitive detection should be similar to that of macrophages which recognize exposed PS on cells and bring about the latter's elimination from the circulation. AnxFF binding determination was combined with that of cell electrophoretic mobility, glycerol resistance and filterability to characterize RBC membrane modifications in Alzheimer's disease patients which suggested a continuous damage and regeneration in RBC of these patients. A logistic analysis suggested that several three-parameter combinations could permit diagnosis of Alzheimer's disease with up to 95% accuracy. THP1 cells and macrophages, derived themselves by incubation with retinoic acid, were bound to FF and placed in a radio frequency alternating magnetic field. Magnetocytolysis was associated with FF attachment to the cells without damage to non-bound cells and without heating of the surrounding solution.

Increased total 7 alpha-hydroxy-dehydroepiandrosterone in serum of patients with Alzheimer's disease

Evidence has indicated that circulating adrenal steroid quantitites were significantly changed in patients with Alzheimer's disease (AD). Aside of 3 beta-sulfatation and 3 beta-acylations, levels of dehydroepiandrosterone (DHEA) result from production and metabolic transformation yields. 7 alpha-Hydroxylation of DHEA has been described in humans, and 7 alpha-hydroxy-DHEA may be responsible for the known antiglucocorticoid effects of DHEA. Using a negative ion fragmentometry method with gas chromatography/mass spectrometry on trifluoroacetate derivatives, we measured levels of free 7 alpha-hydroxy-DHEA as well as its sulfated conjugate and its fatty acid esters in serum of 10 female patients with AD and of 8 age-matched healthy control women. Free 7 alpha-hydroxy-DHEA levels in AD and controls were not significantly different (240.2 +/- 37.2 pg/ml and 206.8 +/- 21.6 pg/ml, respectively), but sulfate conjugate levels were significantly increased in AD (p = .01) (262 +/- 28.4 and 145.4 +/- 27.6, respectively) as well as fatty acid esters (p = .041) (65.7 +/- 6.9 and 40.7 +/- 9.2, respectively). These results indicated that the total 7 alpha-hydroxy-DHEA produced was significantly increased in AD (p = .024) and may contribute to the disease-related disturbances of DHEA production and metabolism.

Discrimination of facial identity and of emotions in Alzheimer's disease

OBJECTIVE

To investigate processing of human faces identity and of emotional expressions in patients with Alzheimer's Disease (AD).

BACKGROUND

Mechanisms responsible for discriminating facial identity may be dissociated from those involved in discriminating facial expressions. Patients with prosopagnosia often have preserved capacities for processing emotional facial expressions and occasionally, patients with focal lesions may recognize human faces without being able to recognize their facial expression. Such a dissociation has not been clearly shown in groups of AD patients.

METHODS

Thirty-one probable AD patients and 14 control subjects were administered tasks of discrimination of faces and of emotions.

RESULTS

AD patients were significantly impaired in discriminating facial identities and in naming and pointing to named emotions, but were comparable to controls in discriminating facial expressions of emotion. The deficits of facial discrimination and of identification of emotions were, on the whole, correlated with the MMS and Raven scores. Discrimination of emotions was not correlated to either test, suggesting that this ability is based on cognitive processes different from those underlying the MMS and the PM47.

CONCLUSIONS

This dissociation implies two separate systems, one dedicated to discrimination of facial identities and the other to discrimination of emotions. This is compatible with the modular organization of cognitive deficits in AD and may explain the well known experience that nonverbal communication often remains effective even in patients with severe dementia.

Membrane modifications of red blood cells in Alzheimer's disease

Red blood cells (RBC) from 24 Alzheimer's disease (AD) patients, 18 age- and sex-matched nondemented (ND) patients, hospitalized in the same facility for orthopedic problems, and 18 healthy volunteers aged 30-52 years were studied in order to gain insight into the nature of RBC membrane modifications in AD. Significant differences were found between RBC from AD and ND patients or young controls respectively for annexin V-binding (45.5 +/- 18.0% vs 27.1 +/- 14.7 and 2.7 +/- 1.9, p = .003), fraction of glycerol resistant cells (30.8 +/- 11.1% vs 19.6 +/- 6.4 and 10.2 +/- 3.1, p = .026), cell electrophoretic mobility in polymer (1.028 +/- 0.022 microns sec-1 V-1 cm vs 1.046 +/- 0.022 and 1.053 +/- 0.021, p = .02) and only limited significance for the filterability (1.46 +/- 0.12 msec vs 1.58 +/- 0.11 and 1.54 +/- 0.11, p = 0.1). A logistic analysis, using simultaneously several features as independent variables, suggested the combined use of annexinV- binding, glycerol resistance, and cell filterability which allowed the assignment of 95% of patients from this cohort to the right group. A prospective analysis of a larger cohort is required for the estimation of the diagnostic value of this test battery. In addition, the high level of annexin binding is characteristic of a disruption of the phospholipid asymmetry in aged or damaged cells, while the high glycerol resistance combined with low electrophoretic mobility an rigidity characterize young RBC, thus indicating an enhanced turnover of RBC in Alzheimer's disease.

Influence of the structure of three corals on their resorption kinetics

The aim of this study was to investigate the influence of the structure of corals on their resorption kinetics after implantation in subcutaneous areas. Three types of coral (Porites astreoides, Montastrea annularis and Dichocoenia stokesi) identical in composition but different in structure were implanted for periods of 1 and 2 months in subcutaneous sites in OF1 mice. The resorption of the implants was studied by means of qualitative (histology, scanning electron microscopy, fluorochrome labelling method) and quantitative approaches (gravimetric method). The results of the qualitative study revealed a process of irregular deterioration of the coral, linked to the detachment of crystals at the surface of the implant. The results of the quantitative study showed that the speed of resorption increases with the implantation time and the open porosity of the coral. These reactions are explained by the increase of the surface exchange area in contact with factors responsible for resorption: biological medium and cells. When considering the choice of coral as a bone substitute, these factors must be taken into account to allow the in situ maintenance of the implant over a sufficiently long period of time according to the clinical situation.

The resorption of bone-implanted corals varies with porosity but also with the host reaction

Three different exoskeletons of coral species Porites asteroides (P), Montastrea annularis (M), and Dichocoenia stokesi (D) were implanted for 2-20 weeks in rabbits. At 2, 4, 8, or 20 weeks, the exoskeletons presented variations in their resorptions depending on the species. To understand the variations in the decreasing speed of the implants despite their similar chemical composition, a study of the surface and architecture of the coral was carried out using scanning electronic microscopy, porosity was evaluated, and growth and differentiation of osteogenic cells cultured in vitro were observed for more than 1 month. At the cellular level, the surface of the implants was identical. Three-dimensional structures of the implants were variable, but the porosity values [P = 42.7%, M = 40.7%, and D = 17.4%] could not completely account for the differences in the resorbing process of the species. Standard histologic studies performed at 2, 4, 8, and 20 weeks after implantation produced the same pattern with P or M, showing aspects of rapid resorption; however, with D there were images resembling those of a foreign-body reaction. It seems that when resorption is not quick enough, a foreign body reaction develops which further slows down the process. This work focuses on the importance of porosity when using coral as bone substitute.

[Genital Schistosoma mansoni bilharziasis in women: apropos of 2 cases in Guadeloupe]

Schistosoma mansoni is the only cause of bilharziasis in Guadeloupe (French West Indies). Ectopic ovarian and endometrial involvement is rare with only one case of bilharziasis of the endometrium having previously been described in the literature. This report describes two cases of Schistosoma mansoni bilharziasis revealed by genital tract involvement. In one case involvement was endometrial and led to metrorrhagia. Histological examination of the biopsy sample obtained by curettage of the endometrium demonstrated the presence of eggs with lateral spurs. In the other case ovarian involvement was detected during assessment for associated infertility and chronic pelvic pain. Celioscopic examination showed pelvic and perihepatic adhesions secondary to sexually transmissible infection. Histologic examination of an ovarian growth demonstrated the presence of Bilharzia eggs. Both patients underwent antiparasitic treatment using oxamniquine (Vansil) which led to the resolution of metrorrhagia in the first case.

Severe impairment battery. A neuropsychological test for severely demented patients

OBJECTIVE

Patients with progressive dementia invariably evolve to a stage where they can no longer be tested by standard neuropsychological tests. We studied the use of the Severe Impairment Battery (SIB) in such patients.

DESIGN

Case series.

SETTING

Geriatric long-term facility.

PATIENTS

Sixty-nine patients who met the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Revised Third Edition, for dementia were selected. The diagnosis of probable Alzheimer's disease was established according to the guidelines suggested by the National Institute of Neurologic and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association. There were 18 men and 51 women. The mean age of the population was 82.99 +/- 5.66 years. The mean Mini-Mental State Examination (MMSE) score was 10.71 +/- 6.14.

MAIN OUTCOME MEASURE

To characterize the cognitive profile and evolution of severely demented patients by means of the SIB.

RESULTS

The mean score on the SIB was 92.52 +/- 31.92, with a possible maximum of 133 points. Subgroups of patients with the most severe degree of dementia (MMSE scores of 0 to 5 and 6 to 11) showed significant differences in their scores on the SIB. In contrast, no differences were found between subgroups with MMSE scores of 6 to 11, 12 to 17, and greater than 17. Fifteen patients who had MMSE scores of less than 6 had SIB scores ranging from 7 to 81. All cognitive domains showed a deterioration across the four severity groups as determined by the MMSE scores and also during a longitudinal study performed on 26 patients.

CONCLUSION

Our study indicates that the SIB is useful for the neuropsychological evaluation of severely demented patients and for their follow-up.

Principal component analysis of language performances in Alzheimer's disease

This report analyzes the performances of a group of 104 mildly to moderately impaired probable Alzheimer's disease patients (Mini Mental Examination 10 to 23) on linguistic tasks exploring written and oral language. A principal component analysis showed a two-factor solution including 14 out of the 15 linguistic tasks. Each factor is characterized by a type of operation required to process language material: "operativeness factor," where verbal material receives a transformation; "transcoding factor," where verbal material is processed without any structural modification. Oral verbal repetition remained isolated from the solution.

[A battery of neuropsychological tests for severe dementia. An evaluation study]

All patients with Alzheimer's disease progress, more or less rapidly, to a stage where they can no longer be tested with the standard neuropsychological tools. The Severe Impairment Battery (SIB) is a neuropsychological tool used to evaluate patients with severe dementia. Its maximum score is 133. The purpose of this study was to assess the reliability of a French version of SIB. Fifty-four patients with Alzheimer's disease (mean Mini Mental State examination [MMS] 10.11 +/- 6.38) entered the study. Their mean SIB score was 88.4 +/- 33.3. The patients who were most affected (MMS below 5) were distributed by SIB from 7 to 80 points. An inter-examinator study of 36 patients yielded a correlation coefficient r = 0.9957 (P = 0.0001). In an inter-test study of 17 patients the correlation coefficient was also very high (r = 0.874, P = 0.0001). Thus, SIB seems to be a reliable tool to evaluate cognitive functions in cases of severe dementia. The distribution of scores obtained by SIB in patients with an MMS below 10 demonstrates that even within groups of subjects with severe dementia distinctions can be made between their remaining capabilities. Using SIB in these patients should improve our knowledge of the natural course of the disease and give better correlation between clinical data and neuropathological and neurobiochemical tests on the one hand, and enable us to adjust to their condition the departments where these patients are treated on the other hand.

Reduced protein kinase C activity in sporadic Alzheimer's disease fibroblasts

A decrease in the protein kinase C immunoreactivity and an altered protein phosphorylation have been reported in patients with Alzheimer's disease, but discordant results have been obtained from determinations of protein kinase C activity. By assaying the calcium- and phospholipid-dependent phosphorylation of a lysine-rich histone after detergent extraction, we have determined the total protein kinase C activity in fibroblasts from patients with sporadic Alzheimer's disease, age-matched controls and young subjects. The activity was not significantly different between young and aged controls, whereas it was significantly lower (0.70 +/- 0.12 vs 1.16 +/- 0.23 nmol/min/mg protein, P less than 0.01) in the patients. The total amount of protein kinase C estimated from the binding of phorbol dibutyrate to intact cells was also significantly lower (1.70 +/- 0.41 vs 2.48 +/- 0.54 pmol/mg protein, P less than 0.01). This decrease in protein kinase C activity suggests that abnormal protein phosphorylation might play a role in the pathogenesis of the disease.

Senile dementia of the Alzheimer type: is there a correlation between entorhinal cortex and dentate gyrus lesions?

Senile plaques (SP) are one of the neuropathological hallmarks of senile dementia of the Alzheimer type (SDAT). In 14 patients affected with SDAT (over 74 years of age), thioflavine S, Tau and acetylcholinesterase (AChE) stainings demonstrated an increased density of SP in the outer two thirds of the dentate gyrus molecular layer. However, a wide range of SP density was observed among the cases. The molecular layer of the dentate gyrus is one of the termination site of the perforant pathway that originates in layers II and III of the entorhinal cortex. We have found that the number of AChE-, thioflavine S- and Tau-positive SP that accumulate in the dentate gyrus is positively correlated with the density of thioflavine S-stained neurofibrillary tangles in layers II and III of the entorhinal cortex. In contrast, a similar correlation is not found when using Tau immunolabeling of the entorhinal tangles. These observations show an association between the accumulation of AChE-positive SP in the dentate molecular layer and the lesions of the perforant pathway. Furthermore, they suggest that the density of SP in the dentate gyrus correlates with the late stages of neurofibrillary tangles formation (thioflavine S positive), but not with the early stages (Tau positive).

[Neuropathologic validation of clinical diagnosis of senile dementia of the Alzheimer type]

The purpose of this work was to establish a neuropathological confirmation of the clinical diagnosis of senile dementia of the Alzheimer type (SDAT) in a group of patients prospectively studied in a geriatric hospital since 1984 (Charles Richet Study). The sample consisted of 45 cases, 35 of which had received a clinical diagnosis of SDAT and 10 others a diagnosis of either vascular or mixed dementia. The mean age at death was 85 +/- 6.9 years (range 64-97). The neuropathological diagnosis was established independently of the clinical findings. Senile lesions typical of SDAT were found in 32/35 cases, giving a 91.4% rate of clinico-pathologic agreement. However, vascular lesions were present in 10 cases (28.5%) and the final pathologic diagnosis was mixed dementia, lowering the score of agreement for SDAT to 63%. Considering that the pathological criteria for the diagnosis of SDAT are not uniform, we independently applied 3 inclusion (senile lesions) and 3 exclusion (vascular lesions) criteria for the diagnosis of SDAT to each of the 45 cases. This permitted a comparison of nine combinations of neuropathological criteria with the clinical diagnosis. The sensitivity values ranged from 37 to 80% and the specificity values ranged from 55 to 100%. The highest agreement rate with the clinical diagnosis was achieved when were associated the criterion which specified that plaques and tangles must be present in the hippocampus regardless of neocortical findings and the criterion which excluded cases with vascular lesions of any site if their volume was 50 ml or more.(ABSTRACT TRUNCATED AT 250 WORDS)

[Standardized neurologic study in senile dementia of Alzheimer's type]

Seventy five patients affected by senile dementia of the Alzheimer type (mean age 82) have been submitted to a standardized neurological examination of 88 items. Gait abnormalities were present in 57% of the cases. Extrapyramidal symptoms (akinesia or rigidity or tremor) were noticed in 64% of the cases but they were rarely associated with a typical parkinsonian syndrome. Myoclonus was observed in only 4 patients. The gait abnormalities were significantly associated with the presence of rigidity and grasp reflex but not with other primitive reflexes. The only symptoms to be correlated with dementia severity as assessed by the Mini Mental State were rigidity and optokinetic nystagmus abolition. Tremor and amyotrophy of the hands appeared to be negatively correlated to dementia severity.

[Quantified neuropsychological study in senile dementia of Alzheimer's type]

Forty six patients affected by senile dementia of the Alzheimer type and 20 control subjects of similar age, sex and educational level have been studied, using a quantified neuropsychological battery (Wechsler memory scale, Raven progressive matrices and quantified tests for aphasia, apraxia and agnosia). There was a significant correlation between the scores of all cognitive functions with one another and with the Mini Mental State. The results show a rather global impairment of cognitive functions in these patients and suggest that intellectual impairment progresses as a continuum in senile dementia of the Alzheimer type.

Platelet [3H]-imipramine binding is not modified in Alzheimer's disease

Platelet [3H]-imipramine binding was studied in patients with Alzheimer's disease and control subjects matched to the patients for age and sex. There were no differences in the binding parameters of [3H]-imipramine on platelet membranes from patients with Alzheimer's disease, when compared with the control group. These results suggest that [3H]-imipramine binding could be a useful tool to discriminate between demented and depressive patients in elderly populations.

Serum neuron-specific enolase in senile dementia of the Alzheimer type

The level of neuron-specific enolase (NSE), a glycolytic enzyme localized in neurons, was measured in the serum of patients with senile dementia of the Alzheimer type (SDAT). No difference was observed between NSE levels in SDAT and in healthy elderly controls of the same age range. No correlation was found between NSE levels and severity of the cognitive deficits. There was a marginally significant negative correlation between age and NSE, younger patients having higher NSE levels. The present results suggest that serum NSE is not a useful biological marker in the senile form of the dementia of the Alzheimer type.

Pharmacological modulation of cortisol secretion and dexamethasone suppression in Alzheimer's disease

We have investigated the dexamethasone suppression of cortisol release in a group of 28 patients with senile dementia of the Alzheimer type (SDAT) after stimulation by physostigmine and clonidine, as compared with basal conditions. All patients but one had previously been evaluated with a depression symptom checklist and had submitted to a standard Dexamethasone Suppression Test (DST). SDAT patients showed normal baseline cortisol values measured at 4:00 PM. DST was reproducible, but nonsuppression did not appear to be a feature of the disease, nor of the dementia syndrome, although a majority of the most demented patients were found to be nonsuppressors. Physostigmine stimulated cortisol secretion in 20 of 24 cases, irrespective of the severity of dementia. Clonidine induced a secretion in 12 of 15 cases, but this was less than that observed after cholinergic stimulation. Physostigmine made cortisol release significantly less sensitive to the suppressive effect of dexamethasone than clonidine in SDAT. This double response should be tested as a possible predictor of a cholinergic therapeutic effect.

The Hoffmann reflex (H-reflex) in senile dementia of the Alzheimer's type--preliminary results

The Hoffmann reflex (H-reflex) and direct motor response (M) were investigated (latency, amplitude and excitability curves were analyzed) in patients with senile dementia of the Alzheimer's type (SDAT). M responses had similar latencies in SDAT patients and old control subjects. H reflex latencies were similar in SDAT patients and old control subjects but longer than in younger controls. The H max/M max ratio was also lower in SDAT patients and old control subjects than in younger controls. The excitability curve of the H-reflex (using a double shock procedure) in SDAT patients was lower than in non-demented old controls for all values of the interstimulus intervals.

Plasma corticosterone during perinatal period in postmature rats

In the fetal rat, plasma corticosterone concentration (PCC) decreases dramatically on the 20th day of gestation and remains low until birth even if the parturition is delayed until 23.5 days postcoitus. In the normal term newborn, there is an increase of PCC in the 1st h after birth. In postmature newborn rats this increase is not present but PCC can be increased towards normal term values if the adrenal cortex is stimulated with cosyntropin or lysine-vasopressin. This suggests that the lack of elevation of PCC in the postmature newborn is not due to the lack of responsiveness of the adrenal cortex but rather an impairment of the hypophyseal stimulation. The absence of PCC elevation at birth could contribute to the metabolic disorders observed in the postmature newborn rat.

Glucocorticoid-induced recovery from streptozotocin diabetes in the adult rat

The effect of a large dose of cortisol (5 mg/kg), injected 24h and 3h before or 3h and 24h after streptozotocin (SZ), on the course of SZ-induced diabetes has been studied in the rat. Glucose tolerance tests, performed 1 or 2, 8, and 30 days after the SZ injection (35 mg/kg), gave the same results in cortisol-treated rats regardless of the time of cortisol injection [before SZ (C.SZ) or after it (SZ.C)]. During the first test, elevated plasma glucose, decreased glucose tolerance, and decreased glucose-induced insulin secretion were present in SZ, C.SZ, and SZ.C rats. During the second and the third tests, glucose tolerance and insulin secretion were significantly improved in both groups of cortisol-treated rats. On the contrary, rats receiving only SZ showed a worsening of the diabetic state. It should be noted that cortisol-induced recovery of diabetes was not obtained with larger doses of SZ (50 mg/kg).

These findings indicate that an improvement of diabetes can be obtained by cortisol treatment after the onset of chemically induced diabetes. Whether this effect is obtained through an effect on pancreatic regeneration and/or through the anti-inflammatory properties of glucocorticoids is unknown at the present time.