Lateral rectus muscle palsy secondary to sphenoid sinusitis

Isolated sphenoid sinus disease is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurological and vascular structures nearby. Early recognition and treatment are critical to prevent the progression of the disease. We present a case of a 60-year-old woman with a history of severe left-sided headache, facial pain, diplopia and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. Magnetic resonance imaging revealed opacification in left sphenoid sinus with cavernous sinus/superior orbital fissure involvement consistent with left sphenoid sinusitis. She was then referred to the ear, nose and throat department and had endoscopic transnasal sphenoidotomy in theatre. Culture results showed Haemophilus influenza and fungal pseudohyphae. She recovered three months later after a course of antibiotics and antifungals. The onset of isolated sphenoid sinus disease is often insidious and the diagnosis of this condition remains a challenge. Magnetic resonance imaging and computed tomography remain the best diagnostic tools to recognise and manage this condition.

725 Monthly Antibiotic Use in The Sheffield Children’s Hospital ED: A Hospital-Based Clinical Audit

Aim: To evaluate guideline compliance of antibiotics prescription in Emergency Department (ED).

To improve documentation of antibiotic prescription.

To highlight the need for good antibiotic stewardship.

To optimise the use of antibiotics.

Method

A cross-sectional, retrospective patient record review was conducted regarding antibiotic prescription over 1 month in Sheffield Children’s Hospital ED. All antibiotic prescriptions over that period were collected. From the total number of prescriptions, a convenience sample of 100 prescriptions was selected to correlate their indications with local guidelines.

Results

A total of 290 prescriptions for 310 antibiotics were collected. The most frequent antibiotic prescribed was Penicillin V (26.7%), followed by Amoxicillin (21.3%), Co-amoxiclav (20.3%), and Flucloxacillin (16.5%). From the convenience sample, 12 antibiotics were prescribed inappropriately, with the most frequent being Co-amoxiclav (41.7%), followed by Penicillin V (25%), Amoxicillin and Flucloxacillin (both 16.7%). Overall, there has been good stewardship of antibiotic use with 88% of antibiotic prescribing conducted appropriately as per ED guidelines.

Conclusions

Antibiotic resistance is a growing concern, with one of the leading causes being inappropriate prescription of antibiotics. Adhering to local guidelines can help to prevent them from developing resistance. Adherence can be improved through induction and training of clinicians.

Abstract P3-12-02: Intraoperative radiotherapy outcomes in early-stage breast cancer: A study in elderly Canadian women

Objective. Breast-conserving therapy with external beam radiotherapy (EBRT) is currently the standard of care for women with early breast cancer. Our aim was to determine if early-stage breast cancers treated with lumpectomy and primary intraoperative radiotherapy (IORT) have comparable local recurrence rates. This is the first study examining the Canadian experience with IORT.

Methods. Patients who underwent breast-conserving therapy with pre-pathology IORT between 2007- 2017 were retrospectively identified. The primary outcome measure was ipsilateral breast tumor recurrence (IBRT). A time to event analysis was performed; Kaplan-Meier estimates report the fraction of patients living free of recurrence. Secondary outcomes included acute and chronic wound complications.

Results. 106 patients with a median age of 70 (IQR 65-75) were included. Median follow-up was 33 months. The majority of patients had screen-detected (94.3%), estrogen-receptor positive (96.2%), HER2neu negative (93.4%), invasive ductal carcinomas (92.5%). Only 50 (47.6%) were prescribed adjuvant endocrine blockade. IBTR occurred in 5 (4.7%) patients. Five and ten-year local recurrence-free rates were 0.95 and 0.81, respectively. The superficial skin infection rate was 9.4%. Acute symptomatic seromas occurred in 23 (21.7%), while only 10 (9.4%) persisted chronically.

Conclusion. In this cohort of Canadian post-menopausal women treated with breast-conserving surgery and IORT, the IBTR approached 5%. Despite selection of low-risk patients, the local recurrence rate is higher than what is reported in the literature with EBRT. The low rates of prescribed adjuvant systemic therapy may have contributed to this outcome.

Citation Format: Elmi M, Tigert A, Escallon J, Zagorski B, Leong W, Vranic M, Fyles A, Vitkin A, Cil T, McCready D. Intraoperative radiotherapy outcomes in early-stage breast cancer: A study in elderly Canadian women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-02.

Large-scale two-dimensional MoS₂ photodetectors by magnetron sputtering

We report on the demonstration of photodetectors based on large scale two-dimensional molybdenum disulfide (MoS2) transition metal dichalcogenides. Excellent film uniformity and precise control of the MoS2 thickness down to a monolayer (~0.75nm) were achieved by magnetron sputtering synthesis approach. In particular, the photodetectors integrated with five MoS2 monolayers exhibit a high photoresponsivity of 1.8 A/W, an external quantum efficiency exceeding 260%, and a photodetectivity of ~5 x 10(8) Jones for a wavelength of 850 nm, surpassing the performance of mechanically exfoliated based photodetectors.

Postzygotic isolation involves strong mitochondrial and sex-specific effects in Tigriopus californicus, a species lacking heteromorphic sex chromosomes

Detailed studies of the genetics of speciation have focused on a few model systems, particularly Drosophila. The copepod Tigriopus californicus offers an alternative that differs from standard animal models in that it lacks heteromorphic chromosomes (instead, sex determination is polygenic) and has reduced opportunities for sexual conflict, because females mate only once. Quantitative trait loci (QTL) mapping was conducted on reciprocal F2 hybrids between two strongly differentiated populations, using a saturated linkage map spanning all 12 autosomes and the mitochondrion. By comparing sexes, a possible sex ratio distorter was found but no sex chromosomes. Although studies of standard models often find an excess of hybrid male sterility factors, we found no QTL for sterility and multiple QTL for hybrid viability (indicated by non-Mendelian adult ratios) and other characters. Viability problems were found to be stronger in males, but the usual explanations for weaker hybrid males (sex chromosomes, sensitivity of spermatogenesis, sexual selection) cannot fully account for these male viability problems. Instead, higher metabolic rates may amplify deleterious effects in males. Although many studies of standard speciation models find the strongest genetic incompatibilities to be nuclear-nuclear (specifically X chromosome-autosome), we found the strongest deleterious interaction in this system was mito-nuclear. Consistent with the snowball theory of incompatibility accumulation, we found that trigenic interactions in this highly divergent cross were substantially more frequent (>6×) than digenic interactions. This alternative system thus allows important comparisons to studies of the genetics of reproductive isolation in more standard model systems.

Abstract PD03-05: Analysis of tumour cell signaling in response to neoadjuvant metformin in women with early stage breast cancer

Background: The anti-diabetic drug metformin, commonly used to treat type 2 diabetes due to its ability to reduce circulating glucose and insulin, has emerged as a potential anti-cancer agent. Observational studies have reported decreased cancer incidence and mortality in diabetics receiving metformin. Metformin's ability to reduce insulin may be particularly important for breast cancer (BC) because hyperinsulinemia is an adverse prognostic factor and most cells express the insulin receptor (IR). The anti-cancer effects of metformin are associated with both direct (insulin-independent) and indirect (insulin-dependent) actions. Direct effects are linked to activation of AMPK and an inhibition of mTOR signalling, while indirect effects are mediated by reductions in circulating insulin levels, leading to reduced IR-activated PI3K signalling. We conducted a neoadjuvant, single arm, “window of opportunity” trial examining the clinical and biological effects of metformin on thirty-nine locoregional BC patients awaiting definitive surgery.

Methods: Non-diabetic women with newly diagnosed, untreated BC were given metformin 500 mg tid for ≥2 weeks post diagnostic core biopsy until surgery. Fasting blood and tumour samples were collected at diagnosis and surgery. Blood glucose and insulin were assayed to assess the physiologic effects of metformin, while IHC analysis of tumours was used to characterize cellular markers before and after metformin. Specifically, IR levels and the phosphorylation status of proteins involved in AMPK and PI3K/AKT/mTOR signalling, including AMPK (T172) and AKT (S473), were examined.

Results: 39 patients with a mean age of 51 years received metformin for a median of 18 days (range 13–40) with minor GI toxicities. The clinical effects (previously reported) included significant (p < 0.05) decreases in body mass index (−0.5 kg/m2), weight (−1.2 kg), glucose (−0.14 mM) and HOMA (an estimate of insulin resistance, −0.21), and a decrease in insulin (−4.7 pmol/L) that approached significance (p = 0.0686). Ki67 staining in tumour tissue decreased significantly and TUNEL increased significantly. Levels of IR expression decreased significantly (from 4.39 to 3.82, p = 0.0375) as did the phosphorylation status of AKT (S473) and AMPK (T172) (from 9.82 to 7.08, p = <0.0001; from 6.2 to 5.1, p = 0.0034, respectively).

Conclusions: Metformin impact was consistent with beneficial anti-cancer effects. Reduced AKT phosphorylation, coupled with decreased insulin and IR levels, suggest insulin-dependent effects are important in the clinical setting. Assessment of additional factors in BC cells, including OCT1 expression (required for metformin uptake), and the phosphorylation of ACC (a marker of AMPK activation), is underway and will be reported. Integrated analysis of these factors combined with the physiological and molecular data described above will further enhance understanding of metformin action in the clinical setting.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD03-05.

Coronary artery spasm (CAS) simulating inferior ST elevation myocardial infarction (STEMI)

Coronary arteries vasospasm (CAS) is commonly seen in invasive cardiology laboratory during diagnostic catheterization or coronary intervention. Though the incidence of Printzmetal angina is uncommon, coronary vasospasm resulting in acute myocardial infarct is rare, especially if there is no significant atherosclerotic plaque within the coronary vasculature.

P2-15-07: The Need for Additional Surgeries to Adequately Excise Early Breast Cancers May Have a Negative Impact on Local Recurrence

Background: Breast conservation surgery (BCS) is considered the standard of care for the treatment of early stage breast cancer (ESBC, AJCC stage 1 and 2). 20 to 50% of patients will require further surgery for positive or close margins. There is recent data suggesting that re-operation can have a negative impact on local and distant recurrences. Our aim is to examine the effects of multiple surgeries to obtain adequate margins on breast cancer recurrence, metastatic disease and survival.

Methods: We reviewed a prospectively maintained breast cancer database at the University Health Network and included all women who had BCS for their first diagnosis of ESBC between January 2004 and December 2007. Patients with neoadjuvant chemotherapy were excluded. We collected patient demographics, surgical pathology, adjuvant therapy and follow up outcome data, which included local recurrence, distant recurrence, cancer-specific survival and overall survival. Clinical and pathologic features were compared using chi-square analyses. Patients who had one lumpectomy were compared to those who had multiple surgeries by using Kaplan-Meier survival curves and log rank test.

Results: Of a total of 744 patients (8 patients had bilateral cancer) 577 (77.6%) had one lumpectomy only (Group 1). 167 (22.4%) patients required further surgery (group 2 = LR+LM+LRM): 83 (11.1%) had a re-excision (LR), 69 (9.3%) had mastectomy (LM) and 15 (2%) had a re-excision followed by a mastectomy (LRM). Thus, a total of 85 (11.4%) patients had mastectomy to achieve adequate margins. All clinicopathologic factors and adjuvant systemic treatments were similar between the two groups except for age and use of adjuvant radiotherapy, which was related to that fact that many of those in group 2 had mastectomy. We observed a difference in disease-free survival favoring patients with lumpectomy only (group 1–3.4% vs. group 2–8.1%, p= 0.01) but there was no difference in distant metastasis (4.5% vs. 5.6%, p=0.56), cancer-specific survival (97.6% vs. 95.6%, p=0.20) and overall survival (6.9% vs 6.3%, p= 0.76) at a median follow up of 4.54 years.

Conclusion: Despite having similar stage, grade, receptor status and adjuvant systemic therapies, having multiple surgeries for primary breast cancer appeared to be associated with decreased disease-free survival but had no difference in rates of distant metastatic disease, cancer-specific survival and overall survival.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-07.

Durian induced hyperkalaemia

Hyperkalaemia is a life threatening acute medical emergency. Patients with end stage renal failure are more prone to get hyperkalaemia as potassium is normally excreted via the kidneys. Therefore, patients with end stage renal failure should avoid food with high potassium contents. Bananas are well known to have high potassium content. However, the 'king of fruits' the durian, has higher potassium content compared to bananas. We describe a case of life threatening hyperkalaemia in a lady with end stage renal failure who ate durians prior to her presentation.

Abstract P2-11-01: Molecular Profiling Identifies Differentially Expressed Genes between Normal Breast Tissue from BRCA Carriers and Women at Population Risk

Background: Women found to carry a BRCA1 or BRCA2 gene mutation are at significant risk of future breast cancer (BC). Prophylactic mastectomy (PM) remains the most effective risk reducing strategy in that setting. Thus far, there are no data available identifying changes in gene expression profiles prior to the onset of BC in these women using microarray technology.

Material and methods : In this pilot study, we prospectively collected PM specimens from BRCA1/2 mutation carriers (n=21), and reduction mammoplasty (RM) specimens from healthy controls at population risk of breast cancer (n=13). Samples were collected from all 4 quadrants (fresh frozen) and careful histological examination was conducted. Selected samples (most dense parenchymal tissue) were sent for microarray analyses (19K chip, http://www.uhnres.utoronto.ca/facilities/index.htm). We compared the molecular profiles of breast tissue obtained from these two groups using two approaches: 1) microarray analysis for a global assessment of gene expression, and 2) gene set analysis to identify differences based on cellular function and biologic themes. Results: Women in each group were of similar age (p=NS). No invasive cancer was identified. In histologically normal breast tissue, class comparison identified differential gene expression between RM and PM tissues. Gene set analysis of five collections including MSigDB C2, C4, cytobands, Stanford 5Mb chromosomal tiles and KEGG database identified 22 significant gene sets. Nine sets were overexpressed and 13 sets were underexpressed in PM tissues (FDR < 0.2; p < 0.012). We found overexpression of genes relating to proliferation and transcription specifically in the PM tissues enriched for Gene Ontology annotations. The top 200 genes ranked by SAM were also examined by pathway analysis that showed high enrichment for cancer related pathways. All three approaches implicated T cell receptor signaling and a TSG101-stathmin breast cancer related pathway as contributing to the differential molecular profiles between RM and PM tissues.

Discussion: We have shown differential expression of single genes as well as cancer related biologic pathways (using microarray and gene set analyses) between normal breast tissue from BRCA1/2 mutation carriers (at high risk of BC) and healthy controls (at population risk of BC). These differences may represent early molecular defects of genetic pathways potentially involved in the early stages of breast carcinogenesis in women at hereditary high risk or may represent the result of BRCA1/2 haploinsufficiency. These results support the hypothesis that molecular pathways leading to BC formation are unique to BRCA1/2 carriers. This information may help the development of innovative preventive strategies for BRCA carriers in the future.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-11-01.

Chronic inflammatory demyelinating polyradiculoneuropathy: MRI study of brain and spinal cord

CNS demyelinating lesions have been reported in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). There are no studies of cord atrophy in CIDP. Ten patients with CIDP underwent brain and spinal cord MRI to investigate CNS demyelination and cord atrophy. No CNS demyelination was found, but the mean cervical cord area was significantly smaller in CIDP patients vs control subjects. Spinal cord atrophy may be related to degeneration secondary to axonal loss.

Engineered antibody for treating lymphoma

One approach to improving the results of antibody treatment of posttransplant and other lymphomas is to alter the geometry of the antibody molecule so as to enhance its cytotoxicity. When antibody alights on a cell, cytotoxicity can be exerted by initiation of apoptotic signals at the cell surface, and by recruitment of effectors to specific sites on the antibody Fc region. Other routes to cytotoxicity have been described but their generality is debatable. The effectors consist of complement, and a series of potentially cytotoxic cells (macrophages, NK cells, neutrophils and others) bearing Fc-receptors (FcR). Recent evidence suggests that the FcR-bearing cells are the more important in dealing with antibody-coated autologous cells, including tumor cells. If the antibody happens to be of the host IgG class then its Fc region (Fcgamma) will contain a site for attachment of a non-cytotoxic FcR known as FcRB (the Brambell receptor): it is this receptor, present on endothelial cells, which recycles the molecule intact if it happens to be endocytosed and thus prolongs its metabolic life. Replacement of the mouse Fcgamma by human Fcgamma is expected to have three beneficial effects: better recruitment of human effector cells, better persistence of the antibody in extracellular fluid, and removal of a major source of immunogenic epitopes. Chemical manipulations of Fab'gamma and Fcgamma modules, linking them in different geometries via their hinge regions, offers constructs with further enhancements of cytotoxicity. These include Fab2Fc2, in which the presence of dual Fc regions enhances recruitment of both complement and cellular effectors; and bispecific antibody of the same modular formula in which one of the Fab arms is specific for tumor while the other is specific for, and recruits powerfully, a cellular effector.

Comparative effects of metal chelating agents on the neuronal cytotoxicity induced by copper (Cu+2), iron (Fe+3) and zinc in the hippocampus

The ability of metal chelating agents to prevent neuronal death caused by intra-hippocampal injections of cupric sulphate, ferric citrate and zinc chloride was investigated. Ammonium tetrathiomolybdate was itself toxic after injection into the hippocampus, but this toxicity was reduced by formation of a metal ion/tetrathiomolybdate complex with Cu+2. Disodium bathocuproine disulphonate (BCDS) prevented neuronal death caused by Cu+2, but not that induced by Fe+3 or Zn+2. Desferrioxamine prevented death caused by Fe+3, had no significant effect of the toxicity of Zn+2, and increased that caused by Cu+2. Even though N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN) has a higher affinity for Cu+2 than for Zn+2, TPEN had no effect on the toxicity of Cu+2 while totally preventing damage caused by Fe+3 or Zn+2. Ethylenediaminetetra-acetic acid (EDTA) prevented the toxicity of all three metal ions. Motor seizure activity occurred in most rats after injections of Fe+3; or combinations of Cu+2 plus TPEN, or 4 nmol Fe+3 plus 0.1 nmol desferrioxamine. However, apart from the low dose desferrioxamine/Fe+3 combination, only the occasional brain contained seizure-induced neuronal loss in limbic regions outside the injected hippocampus, and these brains were not used for analysis. Seizure activity was found even with very low levels of Cu+2 with a fixed amount of TPEN (a ratio of Cu+2/TPEN of 1:100), but the extent of hippocampal damage in these brains was not significantly different to that caused by injections of saline. These studies demonstrate that idiosyncratic interactions can occur between metal ions and chelating agents. Thus further investigations are needed before chelating agents can be examined for their protective properties in various neurodegenerative diseases.

In vivo, the direct and seizure-induced neuronal cytotoxicity of kainate and AMPA is modified by the non-competitive antagonist, GYKI 52466

The 2,3-benzodiazepine GYKI 52466, administered intracerebrally or systemically, was assessed for its ability to protect against the neuronal death in the brain caused by intra-hippocampal injections of the non-N-methyl-D-aspartate (NMDA) receptor agonists, kainate and L-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA). In contrast to a previous report, a low intra-hippocampal dose of GYKI 52466 (25 nmol) did not protect against kainate toxicity. In order to achieve higher doses of GYKI 52466, solubilization in 2-hydroxypropyl-beta-cyclodextrin was used, and limited protection against AMPA, but not kainate toxicity was found. There was a commensurate reduction in seizure-related neuronal loss in the limbic regions of the brain. When diazepam was used to prevent seizures, GYKI 52466 had no effect on hippocampal neuronal loss caused by the direct toxicity of AMPA and kainate on hippocampal neurons. Systemic administration of GYKI 52466 had only a minimal effect on preventing neuronal death caused by AMPA. In vivo, GYKI 52466 is only weakly effective as a neuroprotective agent.

Thioether-bonded constructs of Fab'gamma and Fc gamma modules utilizing differential reduction of interchain disulfide bonds

We describe a two-stage preparation of chemically engineered Ab constructs, employing as modules Fab'gamma from mAb or rAb, and Fc from human normal IgG1. A multivalent, optionally multispecific F(ab')(n) core is formed in stage one, and one or more Fc modules added in stage two. Examples include bispecific Fab(2)Fc(2) (for simplicity, primes and Greek letters are omitted from names of final constructs) and trivalent Fab(3)Fc(2), which are designed to kill neoplastic cells. An essential element in the construction is the availability of the Fab' in two reduced forms, Fab'(-sulfhydryl (SH))(5) and Fab'-SH. The first is obtained by full reduction of the interchain disulfide bonds (SS) in the F(ab')(2) fragment of IgG. Fab'-SH is obtained by disulfide-interchange reactions on Fab'(-SH)(5), whereby the gamma-light SS is reconstituted, an unusual intrachain SS forms in the gamma-chain hinge, and one hinge SH remains. F(ab')(2) and F(ab')(3) cores are built using partially reduced modules, being given intermodular thioether links that resist reduction. These cores are then fully reduced, making available SH groups for addition of the Fcgamma modules. In the final constructs, all intermodular links embody tandem thioether bonds arising at hinge-region cysteines. Cytotoxic activities of representative constructs, and some enhancements deriving from multiple modules, are assessed. In guinea pigs, catabolism of Fab(2)Fc(2) yielded a t(1/2) similar to that of human IgG1, although the serum Fab(2)Fc(2) revealed some proteolytic breakdown not shown by the IgG1. Immunotherapy of a guinea-pig leukemia confirmed the ability of these constructs to kill target cells in vivo.

Laboratory-supported influenza surveillance in Victorian sentinel general practices

Laboratory-supported influenza surveillance is important as part of pandemic preparedness, for identifying and isolating candidate vaccine strains, for supporting trials of anti-influenza drugs and for refining the influenza surveillance case definition in practice. This study describes the implementation of laboratory-supported influenza surveillance in Victorian sentinel general practices and provides an estimate of the proportion of patients with an influenza-like illness proven to have influenza. During 1998 and 1999, 25 sentinel general practices contributed clinical surveillance data and 16 metropolitan practices participated in laboratory surveillance. Serological, virus-antigen detection, virus culture and multiplex polymerase chain reaction procedures were used to establish the diagnosis of influenza. Two laboratories at major teaching hospitals in Melbourne provided additional data on influenza virus identification. General practice sentinel surveillance and laboratory identification of influenza provided similar data on the pattern of influenza in the community between May and September. The clinical suspicion of influenza was confirmed in 49 to 54 per cent of cases seen in general practice.

Preparation of fcgamma for addition to sulfhydryl-expressing ligands with minimal disturbance of the hinge

We described previously a scheme for linking functionally intact human normal Fcgamma1, via a thioether linkage emerging from its hinge, to any molecule expressing a free sulfhydryl group (SH). The scheme entails reducing the Fc to release four SH from the two inter-gamma disulfide bonds (SS) in the hinge, blocking one SH by a stochastic alkylation, restoring by SS-interchange the inter-gamma SS whose two SH are still available, and attaching a bismaleimide linker to the one remaining SH. One thereby obtains Fc with a single maleimide group (Fc-maleimide) for attachment to the SH-displaying partner. Restoration of the inter-gamma SS is necessary if the final chimeric construct is to be able to activate the classical complement pathway. However, during this preparation of Fc-maleimide, there is apparently some SS-formation between non-homologous SH, so that not all hinges emerge with a reconstituted inter-gamma SS. To reduce this error we have modified the preparative procedure after investigating an initial partial reduction of the hinge, and reviewing the conditions for stochastic alkylation. During partial reduction by dithiothreitol, the two hinge SS were cleaved apparently randomly: there was no evidence for one bond being more susceptible to reduction than the other, and little indication that the reduction of one bond enhanced the susceptibility of the other. By limiting reduction to an average of one SS per molecule, and alkylation to 0.8 SH per molecule, a final Fc-maleimide product is obtained in which most of the molecules have passed through the entire preparation with one of their hinge SS, and by inference much of the hinge conformation, remaining intact.

Effect of metal chelating agents on the direct and seizure-related neuronal death induced by zinc and kainic acid

The ability of metal chelating agents to affect seizure-induced neuronal death caused by intra-amygdaloid injections of kainic acid was investigated. N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN), diethyldithiocarbamate (DEDTC) and diphenylthiocarbazone (dithizone), administered simultaneously or within 30 min of a kainate injection, all failed to affect the amount of neuronal loss in the ipsilateral hippocampus. This failure was not due to an inability to complex endogenous zinc as all these chelating agents quenched staining for endogenous zinc by the Timm method. However, the period for which this quenching occurred was short for DEDTC and dithizone (a maximum of 1.5 h) although it lasted for 8 h with TPEN. TPEN, but not DEDTC or dithizone prevented the neuronal loss caused by intra-hippocampal injections of zinc chloride. In the presence of diazepam to prevent seizures, co-injection of TPEN and kainate into the hippocampus also failed to prevent the direct cytotoxicity of kainate. Endogenous zinc, released from mossy fibres in the hippocampus by seizure activity, does not appear to modify seizure activity sufficiently to alter the extent of the resulting neuronal death.

Neuronal cytotoxicity of inositol hexakisphosphate (phytate) in the rat hippocampus

D-myo-Inositol hexakisphosphate (InsP6, phytate), a normal cellular constituent, was found to be toxic to neuronal perikarya when injected into the rat hippocampus. However, the extrinsic cholinergic innervation of the hippocampus (as estimated by staining for acetylcholinesterase) was unaffected. Its potency as a toxin was approximately equal to that of the excitotoxin quinolinate. Other highly charged derivatives of inositol (inositol hexakissulphate, inositol monophosphate) were not toxic. The cytotoxicity of InsP6 was not due to a high osmolality, or to seizure-induced lesions, but was reduced by calcium. Nevertheless, the toxicity was not due to chelation of brain calcium by InsP6, as another calcium chelator with a higher affinity for calcium, 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA), produced only a very mild lesion. Thus, abnormal metabolism of InsP6 might possibly contribute to neuronal death in neurodegenerative diseases.

Interactions between excitotoxins and the Na+/K+-ATPase inhibitor ouabain in causing neuronal lesions in the rat hippocampus

A possible indirect role of glutamate in causing the neuronal death found after intracerebral administration of a low dose of ouabain (0.1 nmol) has been evaluated. This dose of ouabain produces a more extensive neuronal lesion than those caused by glutamate receptor agonists (kainate at an equimolar dose, or NMDA (N-methyl-D-aspartate) at a 50-fold higher dose). The selective glutamate receptor antagonists, dizocilpine (MK-801) and NBQX (2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(F)quinoxaline), in doses which blocked the direct toxicity of glutamate receptor agonists acting on either the NMDA and non-NMDA classes of glutamate receptor, failed to provide more than a minor protection against ouabain-induced neuronal death in the rat dorsal hippocampus. In contrast, the non-selective glutamate receptor antagonist, kynurenate (100 nmol) reduced the damage by around 70%. The difference in neuroprotection found between the glutamate receptor antagonists suggests that kynurenate may protect by a non-glutamatergic mechanism. Co-administration of ouabain and glutamate receptor agonists (kainate, NMDA or glutamate) resulted in additive rather than synergistic damage to hippocampal neurons. The results suggest that in vivo, ouabain and excitotoxins probably cause neuronal death by independent mechanisms.

The sodium-potassium ATPase inhibitor ouabain is neurotoxic in the rat substantia nigra and striatum

Injection of ouabain, a potent and selective inhibitor of Na+/K+ ATPase, into the rat striatum and substantia nigra caused a selective neuronal loss in up to 70% of the lesioned area. However, there was a glial cell/macrophage proliferation in the core of the lesion. Neuronal loss was demonstrated by staining in vivo with Trypan Blue, a marker for dead cells. Cholinesterase staining was also lost, but in the striatum this was revealed only after pre-existing enzyme was irreversibly inhibited in vivo.

Stimulation of cartilage resorption by extracellular ATP acting at P2-purinoceptors

Net loss of the cartilage extracellular matrix occurs in all forms of arthritis, and it is important to identify the factors that initiate and maintain this process. Extracellular ATP can elicit biological responses via P2-purinoceptors, and we have obtained evidence for the presence of these receptors at the surface of cultured human articular chondrocytes. We have extended this work by examining whether exogenous ATP also promotes cartilage resorption. Cultured explants of bovine nasal cartilage were used, and breakdown of proteoglycans was monitored by measuring the release of glycosaminoglycans. ATP, GTP, CTP, UTP, ITP, 2-methylthioadenosine 5'-triphosphate, and adenosine 5'-O-(3-thiotriphosphate) all promoted release of glycosaminoglycans, whereas ADP, AMP, adenosine, and adenosine 5'-(alpha,beta-methylene)triphosphate were inactive. On lowering the concentration of foetal calf serum in the tissue culture medium from 10% (v/v) to 2.5% (v/v), the response to ATP was enhanced and the minimum effective concentration was reduced. The ATP-elicited release of glycosaminoglycans was also enhanced by interleukin 1 beta, tumour necrosis factor alpha, and transforming growth factor-beta, although only high concentrations of the latter were effective. These data provide further evidence for the presence of P2-purinoceptors in cartilage, and indicate that if ATP arises extracellularly, it could have potentially deleterious effects. The enhancement of the response to ATP by interleukin 1 beta and tumour necrosis factor alpha suggests an additional mechanism whereby these cytokines can promote cartilage resorption.

NBQX prevents contralateral but not ipsilateral seizure-induced cytotoxicity of kainate but not AMPA-reversal at high doses of NBQX

The non-N-methyl-D-aspartate (NMDA) glutamate agonists are potent convulsants, and cause neuronal loss in many regions of the limbic system in the brain. Kainate or L-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) and the non-NMDA antagonist 2,3-dihydroxy-6-nitro-7-sulphamoyl-benzo(F)quinoxaline (NBQX) were concomitantly injected unilaterally into the rat dorsal hippocampus. Kainate with low doses of NBQX (12.5-25 nmol) almost completely prevented damage to the contralateral but not ipsilateral limbic areas (distal toxicity). In most animals, damage was still found in the contralateral midline thalamic nuclei. In contrast, high doses of NBQX (95-190 nmol) gave no protection to either side. AMPA showed a trend for a reduction in limbic damage to both sides with increasing dose of NBQX. At the highest doses, NBQX prevented damage to both sides.

Synergy between diazepam and NBQX in preventing neuronal death caused by non-NMDA agonists

The non-N-methyl-D-aspartate (NMDA) glutamate receptor agonists kainate and L-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA), when injected into the rat dorsal hippocampus, cause neuronal death directly by activating non-NMDA receptors and as a consequence of initiating seizure activity. Co-injection of the non-NMDA antagonist 2,3-dihydroxy-6-nitro-7-sulphamoyl-benzo(F)quinoxaline (NBQX; 12.5-95 nmol) was partially effective in preventing up to about 60% of the direct excitotoxicity. On the other hand, diazepam (6 x 5 mg kg-1, i.p.) had only a minor protective effect against the direct neuronal damage, but was effective in preventing almost all the extra-hippocampal loss of neurones caused by seizure activity. The combination of intracerebral NBQX and systemic diazepam reduced the toxicity of kainate or AMPA to a greater extent than that found in the presence of either protectant alone. At optimum doses the neuronal cytotoxicity caused by non-NMDA agonists in the hippocampus was completely prevented.

Brain lesions induced by specific and non-specific inhibitors of sodium-potassium ATPase

The cytotoxicity in the brain of potent selective and non-selective inhibitors of Na+/K+ ATPase has been assessed. Following injection of cardiac glycosides into the dorsal hippocampus of rats, the extent of neuronal loss roughly paralleled their potencies as inhibitors of the enzyme. Dihydroouabain was less potent than ouabain as a cytotoxin by an order of magnitude, similar to their relative affinities for Na+/K+ ATPase. The non-specific inhibitors, melittin, erythrosin B and zinc (chloride) were less neurocytotoxic than the selective inhibitors having equivalent potencies. The toxicity of a low dose of ouabain appeared to be selective for neuronal perikarya as staining for acetylcholinesterase (present on the nerve terminals of the afferent cholinergic innervation) was unaffected. A higher dose of ouabain caused a non-specific necrosis including damage to the neuropil and a loss of cholinesterase staining. Concurrently, there was an invasion of the tissue by cells resembling foaming macrophages. Other inhibitors of the enzyme caused a mixed pathology with both types of responses evident. It is suggested that the pathological response may depend on the relative degrees to which the glial and neuronal activities of the enzyme are affected.

Differential effects of NBQX on the distal and local toxicity of glutamate agonists administered intra-hippocampally

The ability of the non-NMDA glutamate antagonist NBQX (2,3-dihydroxy-6-nitro-7-sulphamoyl-benzo(F)quinoxaline) to protect the brain against the neuronal death caused by glutamate agonists was examined. Glutamate agonists and NBQX were co-injected into the dorsal region of the rat hippocampus and 4 days later the brain was examined histochemically for the loss of neurons. 95 nmol NBQX prevented the toxicity of glutamate agonists acting on the AMPA receptor (quisqualate and AMPA [L-alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate]), except for the higher dose of AMPA where toxicity was only partially reduced. This dose of NBQX also prevented about 50% of the toxicity of kainate, but produced a slight increase in the size of the lesions caused by NMDA (N-methyl-D-aspartate). With 190 nmol NBQX, a variable degree of non-specific damage resulted, but was mainly confined to the dentate region. Allowing for this damage, almost complete protection against the toxicity of non-NMDA glutamate agonists was obtained, with a partial protection against NMDA toxicity. Kainate, and a high dose of AMPA (2 nmol), consistently caused neuronal death in other limbic regions of the brain in addition to the hippocampal damage. About 50% of rats treated with 15 nmol quisqualate also showed damage to limbic regions. Both doses of NBQX prevented this distal damage caused by quisqualate, but not that caused by kainate. With AMPA, only the high dose of NBQX blocked the distal toxicity. Diazepam also blocked the distal toxicity of AMPA, but had only a minor effect on the hippocampal damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of enhanced responsiveness of human articular chondrocytes to extracellular ATP by tumour necrosis factor-alpha

1. We have observed previously that extracellular ATP acting at P2-purinoceptors promotes the production of prostaglandin E2 by human articular chondrocytes, and that this response is enhanced synergistically by interleukin-1 beta. Since other cytokines that influence the metabolism of articular cartilage may have a similar effect, we have investigated whether tumour necrosis factor-alpha also modulates the stimulation of the production of prostaglandin E2 in these cells by ATP. 2. Tumour necrosis factor-alpha enhanced the response of cultured human articular chrondrocytes to a maximally stimulating concentration of ATP (100 mumol/l). This effect was present when the cells were co-incubated with tumour necrosis factor-alpha and ATP for 4 h, was augmented when the cells were also preincubated with the cytokine for 24 h, and remained constant or decline on extending the preincubation period to 72 h. The enhancement of responsiveness to ATP by tumour necrosis factor-alpha was dose-dependent, and the minimum effective concentration (6 pmol/l) did not consistently increase prostaglandin E2 production when the cytokine was tested alone. The presence of tumour necrosis factor-alpha during the incubation with ATP was required for maximum enhancement of the response. Tumour necrosis factor-alpha did not alter the minimum concentration of ATP that stimulated production of prostaglandin E2. 3. Cytokines such as interleukin-1 and tumour necrosis factor-alpha are involved in the pathogenesis of some forms of arthritis, and these data provide additional evidence that their actions in articular cartilage may be modulated by other agents which originate from chondrocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-1 beta enhances the response of human articular chondrocytes to extracellular ATP

It has been observed that both interleukin-1 (IL-1) and extracellular ATP stimulate the production of prostaglandin E (PGE) by human articular chondrocytes in monolayer culture. The combined effects of recombinant human IL-1 beta and ATP were therefore studied using these cells. IL-1 beta rapidly enhanced the response to a maximally effective concentration of ATP (100 microM). On continuous exposure of the cells to the cytokine, its effect was greatest after approx. 24 h and tended to decline thereafter. The enhancement of the response to 100 microM ATP by IL-1 beta was dose-dependent. Removal of IL-1 beta prior to treating the cells with 100 microM ATP did not affect the degree of enhancement of the response. The effect of the cytokine on the response to suboptimal concentrations of extracellular ATP was also tested. IL-1 beta lowered the minimum concentration of ATP required to elicit an increase in the production of PGE by human articular chondrocytes. These findings are of interest, since they indicate a synergistic interaction between a cytokine and a purinergic agonist. Moreover, since both the sensitivity of the cells to extracellular ATP and the maximum response to this agent were enhanced, it is possible that IL-1 modulates more than one step in the process of P2-purinoceptor-mediated stimulation of PGE production. These observations may be relevant to the pathogenesis of some forms of arthritis.

The non-NMDA glutamate antagonist NBQX blocks the local hippocampal toxicity of kainic acid, but not the diffuse extrahippocampal damage

The neuronal lesion caused locally by the injection of 0.47 nmol kainic acid into the dorsal hippocampus was greatly reduced by the co-administration of 190 nmol 2,3-dihydro-6-nitro-7-sulphamoyl-benzo(F)quinoxaline (NBQX). Protection was particularly marked for the neurons present in the CA3 and dentate hilar regions which are the neurons most vulnerable to kainic acid. On the other hand, systemic administration of NBQX (3 doses of 30 mg/kg i.p.) was completely ineffective in blocking neuronal loss in the CA3 and hilar regions. Furthermore, neither hippocampal nor systemic NBQX could prevent the diffuse neuronal damage to other regions in the limbic system outside of the dorsal hippocampus.

Evidence for the presence of P2-purinoceptors at the surface of human articular chondrocytes in monolayer culture

Extracellular purines can act at purinoceptors to influence metabolic processes. Nucleotide-metabolizing ectoenzymes may modulate such purinergic effects, and their occurrence in a tissue may suggest the presence of purinoceptors. Thus, following the identification of ecto-nucleoside triphosphate pyrophosphatase in cultured human articular chondrocytes, we have studied whether these cells express P2-type purinoceptors. Release of prostaglandin E (PGE) was monitored, since articular chondrocytes synthesize and secrete PGE, and activation of P2-purinoceptors frequently results in enhanced prostaglandin production. Extracellular ATP and ADP stimulated PGE production, whereas AMP and adenosine had only limited effects. ATP concentrations as low as 5 microM were effective, and maximal responses were achieved at 50-100 microM ATP. GTP, UTP and ITP also elicited responses, but tended to be less effective than ATP at equivalent concentrations. Of the analogues of ATP that were tested, only adenosine 5'-(beta,gamma-methylene)triphosphate stimulated PGE production. The response to extracellular ATP was virtually abolished by indomethacin. Treatment of the cells with the P1-purinoceptor antagonist, 8-phenyltheophylline, or with pertussis toxin reduced both basal and ATP-stimulated PGE production, but did not substantially decrease the ratio of ATP-stimulated to basal PGE production. These results indicate the presence of P2-purinoceptors in cultured human articular chondrocytes, and suggest that extracellular ATP may have physiological and pathological effects in human articular cartilage.

Submicromolar manganese dependence of Golgi vesicular galactosyltransferase (lactose synthetase)

1. Manganese(II) buffers were set up with inorganic triphosphate, trimethylenediaminetetraacetate and tetramethylenediaminetetraacetate to study the Mn dependence of beta 1,4-galactosyltransferase (lactose synthetase) in preparations of rat mammary gland. 2. In intact particulate preparations, treated with the calcium ionophore A23187, lactose synthesis was abolished by chelators and restored by bivalent transition metal ions in a manner characteristic of activation site I of the pure enzyme. Ni(II) also activated, as did Mg at high concentration. 3. Only Mn(II) could restore endogenous rates, giving an apparent Km of 0.1-0.2 microM, and eliciting about 70% full activity without addition of a site II activator. 4. In purified Golgi membrane vesicles, Mn gave an apparent Km of 0.4 microM. This increased sharply to about 10 microM on permeabilization with filipin, lysis with detergents, solubilization with Triton X-100, or in the pure enzyme. Preparations of chemically undamaged Golgi vesicles, known to include a proportion of the enzyme on exposed membranes, exhibited both low-Km and high-Km components. 5. The response of particulate galactosyltransferase to apparently physiological concentrations of free Mn(II) ion is interpreted as either due to a sensitizing factor within the Golgi lumen, or to the accumulation of Mn at elevated concentrations. Alternatively, the high Km of the soluble enzyme may reflect proteolytic damage.

Structure of molten nitrates. V. Effect of cation change and anion symmetry on melt structure

A previous study of the effect of univalent cations on the intensity of symmetrical stretching frequency in nitrate melts has been extended. The use of divalent cations Mg2+, Ca2+, Pb2-, and Cd2+ has confirmed that for systems in which covalent bonding is not important the intensity of the symmetrical stretching frequency decreases linearly with the strength of the cationic field. In systems for which covalent interactions are important the change in intensity is probably related to the electronic structure of the cation. The low frequency vibrational modes for the melts studied also showed great variation in intensity. This has been correlated with the variation in the anisotropy of the anionic polarizability and substitution in the pseudo lattice of the melt. The effect of the anisotropy of the polarizability was further studied by replacing the nitrate ion by perchlorate, chlorate, and nitrite. The measurements showed that the greater the anisotropy the higher the intensity of the lattice modes.