Predictors of whole exome sequencing in dystonic cerebral palsy and cerebral palsy-like disorders

INTRODUCTION

Cerebral palsy (CP) is a group of permanent disorders attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Cerebral palsy-like (CP-like) disorders may clinically resemble CP but do not fulfill CP criteria and have often a progressive course and/or neurodevelopmental regression. To assess which patients with dystonic CP and dystonic CP-like disorder should undergo Whole Exome Sequencing (WES), we compared the rate of likely causative variants in individuals regarding their clinical picture, co-morbidities, and environmental risk factors.

METHOD

Individuals with early onset neurodevelopmental disorder (ND) manifesting with dystonia as a core feature were divided into CP or CP-like cohorts based on their clinical picture and disease course. Detailed clinical picture, co-morbidities, and environmental risk factors including prematurity, asphyxia, SIRS, IRDS, and cerebral bleeding were evaluated.

RESULTS

A total of 122 patients were included and divided into the CP group with 70 subjects (30 males; mean age 18y5m±16y6m, mean GMFCS score 3.3 ± 1.4), and the CP-like group with 52 subjects (29 males; mean age 17y7m±1y,6 m, mean GMFCS score 2,6 ± 1,5). The WES-based diagnosis was present in 19 (27.1%) CP patients and 30 CP-like patients (57.7%) with genetic conditions overlap in both groups. We found significant differences in diagnostic rate in CP individuals with vs. without risk factors (13.9% vs. 43.3%); Fisher's exact p = 0.0065. We did not observe the same tendency in CP-like (45.5% vs 58.5%); Fisher's exact p = 0.5.

CONCLUSION

WES is a useful diagnostic method for patients with dystonic ND, regardless of their presentation as a CP or CP-like phenotype.

A case of novel DYT6 dystonia variant with serious complications after deep brain stimulation therapy: a case report

Background

DYT6 dystonia belongs to a group of isolated, genetically determined, generalized dystonia associated with mutations in the THAP1 gene.

Case presentation

We present the case of a young patient with DYT6 dystonia associated with a newly discovered c14G>A (p.Cys5Tyr) mutation in the THAP1 gene. We describe the clinical phenotype of this new mutation, effect of pallidal deep brain stimulation (DBS), which was accompanied by two rare postimplantation complications: an early intracerebral hemorrhage and delayed epileptic seizures. Among the published case reports of patients with DYT6 dystonia, the mentioned complications have not been described so far.

Conclusions

DBS in the case of DYT6 dystonia is a challenge to thoroughly consider possible therapeutic benefits and potential risks associated with surgery. Genetic heterogeneity of the disease may also play an important role in predicting the development of the clinical phenotype as well as the effect of treatment including DBS. Therefore, it is beneficial to analyze the genetic and clinical relationships of DYT6 dystonia.

Atypical presentations of DYT1 dystonia with acute craniocervical onset

DYT1 gene mutations lead to early-onset dystonia that begins with focal limb onset and spreads to other body regions within 5 years, with typical sparing of the oromandibular muscles. In the present study, we describe two patients with an unusual presentation of the disease.

The potential of δ2Hn-alkanes and δ18Osugar for paleoclimate reconstruction - A regional calibration study for South Africa

The hydrogen isotopic composition of leaf wax-derived n-alkanes (δ²H_n-alkanes) is a widely applied proxy for (paleo)climatic changes. It has been suggested that the coupling with the oxygen isotopic composition of hemicellulose-derived sugars (δ¹⁸O_sugar) - an approach dubbed 'paleohygrometer' - might allow more robust and quantitative (paleo)hydrological reconstructions. However, the paleohygrometer remains to be evaluated and tested regionally. In this study, topsoil samples from South Africa, covering extensive environmental gradients, are analysed. δ²H_n-alkanes correlates significantly with the isotopic composition of precipitation (δ²H_p), whereas no significant correlation exists between δ¹⁸O_sugar and δ¹⁸O_p. The apparent fractionation (ε_app) is the difference between δ²H_n-alkanes and δ²H_p (ε_{app 2H}) and δ¹⁸O_sugar and δ¹⁸O_p (ε_{app 18O}), respectively, and integrates i) isotopic enrichment due to soil water evaporation, ii) leaf (and xylem) water transpiration and iii) biosynthetic fractionation. We find no correlation of ε_{app 18O} nor for ε_{app 2H} with temperature, and no correlation of ε_{app 2H} with potential evapotranspiration and an aridity index. By contrast, ε_{app 18O} correlates significantly with both potential evapotranspiration and the aridity index. This highlights the strong effect of evapotranspirative enrichment on δ¹⁸O_sugar. In study areas without plant predominance using Crassulacean Acid Metabolism (CAM), coupling δ¹⁸O_sugar and δ²H_n-alkanes enables to reconstruct δ²H_p and δ¹⁸O_p with an offset of Δδ²H = 6 ± 27‰ and Δδ¹⁸O = 0.8 ± 3.7‰, respectively, as well as relative humidity (RH) with an offset of ΔRH = 6 ± 17%. The paleohygrometer does, however, not work well for our study areas where CAM plants prevail (reconstructed δ¹⁸O_p, δ²H_p and RH are off by 3.1‰, 27.2‰ and 31.7%). This probably reflects plant-specific (phenological) adaptations and/or post-photosynthetic exchange reactions related to CAM metabolism. Overall, our findings corroborate that δ²H_n-alkanes and δ¹⁸O_sugar are valuable proxies, and the paleohygrometer is a promising approach for paleoclimate reconstructions in southern Africa.

Redirection to the bone marrow improves T cell persistence and antitumor functions

A key predictor for the success of gene-modified T cell therapies for cancer is the persistence of transferred cells in the patient. The propensity of less differentiated memory T cells to expand and survive efficiently has therefore made them attractive candidates for clinical application. We hypothesized that redirecting T cells to specialized niches in the BM that support memory differentiation would confer increased therapeutic efficacy. We show that overexpression of chemokine receptor CXCR4 in CD8+ T cells (TCXCR4) enhanced their migration toward vascular-associated CXCL12+ cells in the BM and increased their local engraftment. Increased access of TCXCR4 to the BM microenvironment induced IL-15-dependent homeostatic expansion and promoted the differentiation of memory precursor-like cells with low expression of programmed death-1, resistance to apoptosis, and a heightened capacity to generate polyfunctional cytokine-producing effector cells. Following transfer to lymphoma-bearing mice, TCXCR4 showed a greater capacity for effector expansion and better tumor protection, the latter being independent of changes in trafficking to the tumor bed or local out-competition of regulatory T cells. Thus, redirected homing of T cells to the BM confers increased memory differentiation and antitumor immunity, suggesting an innovative solution to increase the persistence and functions of therapeutic T cells.

Treatment of the Anemia of Hemodialysis Patients with Recombinant Human Erythropoietin

Fifteen long-term hemodialysis patients suffering from stable anemia received recombinant human erytheropoietin (r-huEPO). The hormone was given intravenously at the end of each dialysis session starting with a dose of 24 IU/kg. This dose was doubled when hemoglobin levels did not rise within 2 weeks. The number of reticulocytes started to increase after 14 days of treatment. The hematocrit rose from baseline values of 23.7 ± 1.2% to 32.4 ± 1.3% after 24 weeks of treatment. In parallel, hemoglobin values increased from 7.3 ± 0.3 g/100 ml to 10.1 ± 0.4 g/100 ml. As for side effects, 3 patients developed hypertension and 2 patients suffered from occlusions of their arterio-venous fistulas. There was no evidence of major organ dysfunctions, toxic effects, allergic reactions, or antibody formation. These data show that rHuEPO is able to correct the anemia of patients undergoing hemodialysis treatment.

Expression of a dominant T-cell receptor can reduce toxicity and enhance tumor protection of allogeneic T-cell therapy

Due to the lack of specificity for tumor antigens, allogeneic T-cell therapy is associated with graft-versus-host disease. Enhancing the anti-tumor specificity while reducing the graft-versus-host disease risk of allogeneic T cells has remained a research focus. In this study, we demonstrate that the introduction of 'dominant' T-cell receptors into primary murine T cells can suppress the expression of endogenous T-cell receptors in a large proportion of the gene-modified T cells. Adoptive transfer of allogeneic T cells expressing a 'dominant' T-cell receptor significantly reduced the graft-versus-host toxicity in recipient mice. Using two bone marrow transplant models, enhanced anti-tumor activity was observed in the presence of reduced graft-versus-host disease. However, although transfer of T-cell receptor gene-modified allogeneic T cells resulted in the elimination of antigen-positive tumor cells and improved the survival of treated mice, it was associated with accumulation of T cells expressing endogenous T-cell receptors and the development of delayed graft-versus-host disease. The in-vivo deletion of the engineered T cells, mediated by endogenous mouse mammary tumor virus MTV8 and MTV9, abolished graft-versus-host disease while retaining significant anti-tumor activity of adoptively transferred T cells. Together, this study shows that the in-vitro selection of allogeneic T cells expressing high levels of a 'dominant' T-cell receptor can lower acute graft-versus-host disease and enhance anti-tumor activity of adoptive cell therapy, while the in-vivo outgrowth of T cells expressing endogenous T-cell receptors remains a risk factor for the delayed onset of graft-versus-host disease.

Genetic Regulation of Fate Decisions in Therapeutic T Cells to Enhance Tumor Protection and Memory Formation

A key challenge in the field of T-cell immunotherapy for cancer is creating a suitable platform for promoting differentiation of effector cells while at the same time enabling self-renewal needed for long-term memory. Although transfer of less differentiated memory T cells increases efficacy through greater expansion and persistence in vivo, the capacity of such cells to sustain effector functions within immunosuppressive tumor microenvironments may still be limiting. We have therefore directly compared the impact of effector versus memory differentiation of therapeutic T cells in tumor-bearing mice by introducing molecular switches that regulate cell fate decisions via mTOR. Ectopic expression of RAS homolog enriched in brain (RHEB) increased mTORC1 signaling, promoted a switch to aerobic glycolysis, and increased expansion of effector T cells. By rapidly infiltrating tumors, RHEB-transduced T cells significantly reduced the emergence of immunoedited escape variants. In contrast, expression of proline-rich Akt substrate of 40 kDa (PRAS40) inhibited mTORC1, promoted quiescence, and blocked tumor infiltration. Fate mapping studies following transient expression of PRAS40 demonstrated that mTORC1(low) T cells made no contribution to initial tumor control but instead survived to become memory cells proficient in generating recall immunity. Our data support the design of translational strategies for generating heterogeneous T-cell immunity against cancer, with the appropriate balance between promoting effector differentiation and self-renewal. Unlike pharmacologic inhibitors, the genetic approach described here allows for upregulation as well as inhibition of the mTORC1 pathway and is highly selective for the therapeutic T cells without affecting systemic mTORC1 functions.

Ovarian stimulation in ART - Unwinding pressing issues

Conventional controlled ovarian stimulation (cCOS) can cause significant discomfort, including ovarian hyperstimulation syndrome (OHSS). Clearly, management of OHSS and poor responder patients requires new strategies to overcome these problems and facilitate the birth of a healthy child with the fewest stimulation cycles. Several alternative methods have been developed. Non-conventional controlled ovarian stimulation (non-cCOS) is based on low-dose stimulation regimens and is often termed "light", "soft", "mini", "minimal", "mild", "low cost", or "low dose IVF". Non-controlled ovarian stimulation therapies (non-COS) include natural cycle IVF or a mixture between non-controlled and non-cCOS, termed "modified natural IVF" or "antiestrogen/aromatase inhibitor/low dose FSH-cycles", in which cycles are monitored but not controlled. These approaches promise to reduce the physical, emotional, and financial burden of IVF therapy while maintaining acceptable pregnancy rates. Such approaches might reduce the risk of OHSS. However, the overall cost per baby increases due to the higher number of stimulation cycles required, and the inconvenience of ovum pick-up still remains. The primary focus should be to obtain several good quality blastocysts after a single cCOS cycle. Thus, adequate numbers of mature oocytes are mandatory. What is more difficult and expensive for patients: several non-COS/non-cCOS cycles to obtain a baby or a single cCOS cycle with a high probability to obtain more than one child? Classic cCOS using the GnRH agonist long protocol followed by single embryo transfer (SET) at the blastocyst stage and aseptic vitrification of surplus embryos optimizes the IVF outcome. This strategy, combined with outpatient management in the case of OHSS, minimizes inconvenience and risks of OHSS. Accumulation cycles (AC) by repeated COS with subsequent freezing of blastocysts, combined with preimplantation genetic screening (PGS), is a promising new approach for low responders, especially in cases of advanced maternal age (AMA).

CD8 T cell tolerance to a tumor-associated self-antigen is reversed by CD4 T cells engineered to express the same T cell receptor

Ag receptors used for cancer immunotherapy are often directed against tumor-associated Ags also expressed in normal tissues. Targeting of such Ags can result in unwanted autoimmune attack of normal tissues or induction of tolerance in therapeutic T cells. We used a murine model to study the phenotype and function of T cells redirected against the murine double minute protein 2 (MDM2), a tumor-associated Ag that shows low expression in many normal tissues. Transfer of MDM2-TCR–engineered T cells into bone marrow chimeric mice revealed that Ag recognition in hematopoietic tissues maintained T cell function, whereas presentation of MDM2 in nonhematopoietic tissues caused reduced effector function. TCR-engineered CD8⁺ T cells underwent rapid turnover, downmodulated CD8 expression, and lost cytotoxic function. We found that MDM2-TCR–engineered CD4⁺ T cells provided help and restored cytotoxic function of CD8⁺ T cells bearing the same TCR. Although the introduction of the CD8 coreceptor enhanced the ability of CD4⁺ T cells to recognize MDM2 in vitro, the improved self-antigen recognition abolished their ability to provide helper function in vivo. The data indicate that the same class I–restricted TCR responsible for Ag recognition and tolerance induction in CD8⁺ T cells can, in the absence of the CD8 coreceptor, elicit CD4 T cell help and partially reverse tolerance. Thus MHC class I–restricted CD4⁺ T cells may enhance the efficacy of therapeutic TCR-engineered CD8⁺ T cells and can be readily generated with the same TCR.

[Vitrification and the use of high concentrations of cryoprotectants: is it a justified argument to prefer slow freezing?]

The use of high levels of cryoprotectants (CPs) in solutions applied to vitrify oocytes or embryos is an argument to still prefer slow freezing procedure. Is it a justified argument? Out of three studies using mice zygotes we may assume that (i) the intracellular concentration of CPs is far lower than the one in the vitrification solutions, (ii) the intracellular concentration of CPs in the vitrified zygote is in contrary to the common beliefs even lower than the one observed after a slow freezing procedure, (iii) survival after slow freezing reflects the presence of an intracellular vitrified state in these cells.

Scanning tunneling spectroscopy and vortex imaging in the iron pnictide superconductor BaFe1.8Co0.2As2

We present an atomic resolution scanning tunneling spectroscopy study of superconducting BaFe1.8Co0.2As2 single crystals in magnetic fields up to 9 T. At zero field, a single gap with coherence peaks at Delta=6.25 meV is observed in the density of states. At 9 and 6 T, we image a disordered vortex lattice, consistent with isotropic, single flux quantum vortices. Vortex locations are uncorrelated with strong-scattering surface impurities, demonstrating bulk pinning. The vortex-induced subgap density of states fits an exponential decay from the vortex center, from which we extract a coherence length xi=27.6+/-2.9 A, corresponding to an upper critical field Hc2=43 T.

Normalization of serum prolactin levels in hemodialysis patients on recombinant human erythropoietin

Correction of anemia in long-term hemodialysis patients by recombinant human erythropoietin (r-HuEPO) has been reported to improve sexual function. As elevated serum prolactin levels are believed to contribute to altered sexual function in uremia, we followed serum prolactin and testosterone levels during four months of r-HuEPO therapy. Within these four months, hematocrit values rose from 23.7 +/- 1.2 to 35.7 +/- 0.2% and hemoglobin from 7.3 +/- 0.3 to 11.3 +/- 0.4 g/100 ml. In parallel, serum prolactin values decreased significantly, from 66.9 +/- 9.3 to 9.6 +/- 2.6 ng/ml in females and from 39.5 +/- 10.5 to 10.3 +/- 1.0 ng/ml in male dialysis patients. Testosterone concentrations were in the lower normal range in male patients and remained unchanged during r-HuEPO therapy. Sexual function improved in four out of seven males, and five out of nine female patients started to have regular menstruations again. It appears that treatment of anemia in end-stage renal disease by r-HuEPO may improve sexual function by lowering elevated serum prolactin concentrations.

Phospholipase A activities in ascites, serum, lymph, and urine in acute pancreatitis following pancreas stimulation with secretin-ceruletid

As a result of pancreas stimulation with secretin-ceruletid we were able to measure the release of phospholipase A in ascites, serum, lymph, and urine in acute experimental pancreatitis in the dog. After induction of acute pancreatitis we found no increase over the normal range in serum, lymph, and urine phospholipase A activities. In addition, the stimulation of the exocrine pancreas did not show a significant change in phospholipase A activity. The excessively high phospholipase A activity in ascites following induction of acute pancreatitis fell significantly after pancreas stimulation with secretin-ceruletid.

Treatment of the anemia of hemodialysis patients with recombinant human erythropoietin

Fifteen long-term hemodialysis patients suffering from stable anemia received recombinant human erythropoietin (r-huEPO). The hormone was given intravenously at the end of each dialysis session starting with a dose of 24 IU/kg. This dose was doubled when hemoglobin levels did not rise within 2 weeks. The number of reticulocytes started to increase after 14 days of treatment. The hematocrit rose from baseline values of 23.7 +/- 1.2% to 32.4 +/- 1.3% after 24 weeks of treatment. In parallel, hemoglobin values increased from 7.3 +/- 0.3 g/100 ml to 10.1 +/- 0.4 g/100 ml. As for side effects, 3 patients developed hypertension and 2 patients suffered from occlusions of their arterio-venous fistulas. There was no evidence of major organ dysfunctions, toxic effects, allergic reactions, or antibody formation. These data show that r-HuEPO is able to correct the anemia of patients undergoing hemodialysis treatment.

[Therapy of renal anemia with recombinant human erythropoietin]

The effectiveness of recombinant human erythropoietin (r-HEPO) was tested in 15 haemodialysis patients. The dosage was started at 24 IU/kg three times weekly, as an intravenous bolus at the end of the dialysis session, and then doubled every two weeks as long as the rise in haemoglobin was less than 2 g/dl. During treatment the reticulocyte count rose from 31 +/- 5 x 10(3)/microliters to 152 +/- 11 x 10(3)/microliters after 16 weeks. The haematocrit rose from 0.24 +/- 0.01 to 0.36 +/- 0.002. At the beginning of treatment the haemoglobin level was 7.3 +/- 0.3 g/dl and rose during treatment to 11.3 +/- 0.2 g/dl. Three patients developed hypertension and in two their Cimino shunt closed. but there were no toxic side effects, organ damage, allergic reactions or antibodies against the hormone. The results show that the anaemia of patients on chronic dialysis can be treated effectively and without serious side effects with r-HEPO.

Gliosis in schizophrenia: a survey

Increased gliosis has been previously described in schizophrenic brain. In this study, the degree of gliosis in schizophrenic and control brains was assessed quantitatively using an antibody to glial fibrillary acidic protein, immunocytochemical techniques, and a computed image analysis system. Twenty separate brain areas were assessed, and no significant differences were found between the schizophrenic and control groups. It seems unlikely that a specific pattern of pathologically significant gliosis is present in schizophrenic brains. These negative findings are of note because of previously reported structural differences in the temporal lobe in the schizophrenic group in this series.

Neuropeptides in the amygdala of controls, schizophrenics and patients suffering from Huntington's chorea: an immunohistochemical study

The location of the neuropeptides methionine-enkephalin (ME), neurotensin (NT), neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) within the amygdaloid complex of healthy human individuals, schizophrenics and patients suffering from Huntington's chorea was studied qualitatively by means of immunohistochemistry. VIP-like immunoreactivity (IR) was present predominantly in a dense cluster of fibers and terminals in the central amygdaloid nucleus. ME-IR was observed in fibers, terminals and cell bodies in the same subnucleus, exhibiting a characteristical distribution pattern. NT-positive cell bodies were situated within the center of the central amygdaloid nucleus, fibers and terminals being encountered mainly at the periphery. NPY-IR was found to be evenly distributed throughout the amygdala. Distribution and staining intensity of ME, NPY and NT in the amygdala showed no qualitatively recognizable difference between the normal and schizophrenic specimens, whereas VIP-IR appeared to be slightly increased in the central amygdaloid nucleus of schizophrenics. In the choreic cases, the considerably shrunken amygdala exhibited only very low staining intensity of the four investigated neuropeptides.

[A serological criterion for Bechterew's disease. Demonstration of a new antibody specificity with polytene chromosomes]

A new antibody reacting with an antigen from polytene chromosomes of Drosophila melanogaster has been found in serum of patients with Bechterew's disease. This antigen-antibody system differs from other nuclear antibodies (anti-RNP, anti-Sm, anti-Ha/SS-B) in that it is not detectable by counter-immunoelectrophoresis. The antibody could be detected in 24 out of 62 Morbus Bechterew sera in which the antibody did not strictly correlate with the appearance of HLA-B27 antigen. The new antibody specificity is a specific serological finding in patients with Bechterew's disease and is therefore suitable for use as a diagnostic, and perhaps also as a prognostic test for this type of spondylarthritis till now assumed to be seronegative.

Methionine-enkephalin and substance P in the basal ganglia of normals, Parkinson patients, Huntington patients, and schizophrenics. A qualitative immunohistochemical study

The distribution of methionine-enkephalin (ME)-like and substance P (SP)-like immunoreactivity in the basal ganglia of untreated schizophrenics as compared with normal control cases, and untreated Huntington and Parkinson patients was studied using the unlabeled peroxidase-antiperoxidase (PAP) method. ME but not SP was reduced in the pallidum of one of six schizophrenics. The remaining five cases showed no differences to the controls. In contrast, no or only very faint homogeneously distributed ME and SP was found in any part of the basal ganglia in Huntington's disease. In Parkinson's disease, SP immunoreactivity was within normal range.

A new serologic marker in ankylosing spondylitis

Sera of patients with ankylosing spondylitis (AS) were screened for the presence of antibodies by indirect immunofluorescence staining of polytene chromosomes of Drosophila melanogaster. Thirty-nine percent of the sera tested contained antibodies which selectively reacted with an antigen(s) present at the chromosomal locus 93D after heat shock treatment. This indicates a novel antibody specificity in a subgroup of AS patients and may provide a new aid in the diagnosis of AS.

[Biomechanics of human tendons: connection between stress relaxation and stress recovery (author's transl)]

108 tendons of the m. extensor hallucis longus were examined with a tensile testing machine within 36 h after death. The specimen were kept at a resting length of 20 mm. After the "steady state" was reached by cyclic loading, the tendons were stretched up to a maximum load of 18 kp, then deloaded to a certain level and after that the elongation was kept constant. At high loading level the tension of the tendon decreases with time (relaxation). At medium and low loading level the tension increases slightly (mechanical recovery). Between that two regions there is a certain load, where the tension will not change with time (isorheological point). The position of the isorheological point depends on the velocity of the elongation. At low velocity (2 mm/min) the isorheological point is situated at 70%, at high velocity (12 mm/min) at 60% of the maximum load. One will find the maximum relaxation, when no deloading occurs. The mechanical recovery, however, has its maximum at 5--25% of the maximum load. But when the tendon is totally deloaded, there seems to occur no recovery. The maximum relaxation is 5 to 6 times larger than the maximum recovery. Supposingly the relaxation- and recovery-processses will happen at the same time but with different intensity depending on the loading level. At least the relaxation-process consists of different relaxation components with different relaxation times. This will explain the phenomenon of a "secondary relaxation": After a long time of registration the recovery will turn into a slight relaxation.