Neurophysiological, histological and immunohistochemical characterization of bortezomib-induced neuropathy in mice

Bortezomib, a proteasome inhibitor, is an antineoplastic drug to treat multiple myeloma and mantle cell lymphoma. Its most clinically significant adverse event is peripheral sensory neuropathy. Our objective was to characterize the neuropathy induced by bortezomib in a mouse model. Two groups were used; one group received vehicle solution and another bortezomib (1 mg/kg/twice/week) for 6 weeks (total dose as human schedule). Tests were performed during treatment and for 4 weeks post dosing to evaluate electrophysiological, autonomic, pain sensibility and sensory-motor function changes. At the end of treatment and after washout, sciatic and tibial nerves, dorsal ganglia and intraepidermal innervation were analyzed. Bortezomib induced progressive significant decrease of sensory action potential amplitude, mild reduction of sensory velocities without effect in motor conductions. Moreover, it significantly increased pain threshold and sensory-motor impairment at 6 weeks. According to these data, histopathological findings shown a mild reduction of myelinated (−10%; p = 0.001) and unmyelinated fibers (−27%; p = 0.04), mostly involving large and C fibers, with abnormal vesicular inclusion body in unmyelinated axons. Neurons were also involved as shown by immunohistochemical phenotypic switch. After washout, partial recovery was observed in functional, electrophysiological and histological analyses. These results suggest that axon and myelin changes might be secondary to an initial dysfunctional neuronopathy.     

Bortezomib-induced peripheral neurotoxicity: a neurophysiological and pathological study in the rat

Bortezomib is a new proteasome inhibitor with a high antitumor activity, but also with a potentially severe peripheral neurotoxicity. To establish a preclinical model and to characterize the changes induced on the peripheral nerves, dorsal root ganglia (DRG) and spinal cord, bortezomib was administered to Wistar rats (0.08, 0.15, 0.20, 0.30 mg/kg/day twice [2q7d] or three times [3q7d] weekly for a total of 4 weeks). At baseline, on days 14, 21 and 28 after the beginning the treatment period and during a 4-week follow-up period sensory nerve conduction velocity (SNCV) was determined in the tail of each animal. Sciatic nerve, DRG and spinal cord specimens were processed for light and electron microscope observations and morphometry. At the maximum tolerated dose bortezomib induced a significant reduction in SNCV, with a complete recovery at the end of the follow-up period. Sciatic nerve examination and morphometric determinations demonstrated mild to moderate pathological changes, involving predominantly the Schwann cells and myelin, although axonal degeneration was also observed. Bortezomib-induced changes were also observed in DRG and they were represented by satellite cell intracytoplasmatic vacuolization due to mitochondrial and endoplasmic reticulum damage, closely resembling the changes observed in sciatic nerve Schwann cells. Only rarely did the cytoplasm of DRG neurons has a dark appearance and clear vacuoles occurring in the cytoplasm. Spinal cord was morphologically normal. This model is relevant to the neuropathy induced by bortezomib in the treatment of human malignancies and it could be useful in increasing our knowledge regarding the mechanisms underlying bortezomib neurotoxicity.     

Upregulation of CCL2 via ATF3/c-Jun interaction mediated the Bortezomib-induced peripheral neuropathy

Bortezomib (BTZ) is a frequently used chemotherapeutic drug for the treatment of refractory multiple myeloma and hematological neoplasms. The mechanism by which the administration of BTZ leads to painful peripheral neuropathy remains unclear. In present study, we found that application of BTZ at 0.4 mg/kg for consecutive 5 days significantly increased the expression of CCL2 in DRG, and intrathecal administration of neutralizing antibody against CCL2 inhibited the mechanical allodynia induced by BTZ. We also found an increased expression of c-Jun in DRG, and that inhibition of c-Jun signaling prevented the CCL2 upregulation and mechanical allodynia in the rats treated with BTZ. Furthermore, the results with luciferase assay in vitro and ChIP assay in vivo showed that c-Jun might be essential for BTZ-induced CCL2 upregulation via binding directly to the specific position of the ccl2 promoter. In addition, the present results showed that an upregulated expression of ATF3 was co-expressed with c-Jun in the DRG neurons, and the enhanced interaction between c-Jun and ATF3 was observed in DRG in the rats treated with BTZ. Importantly, pretreatment with ATF3 siRNA significantly inhibited the recruitment of c-Jun to the ccl2 promoter in the rats treated with BTZ. Taken together, these findings suggested that upregulation of CCL2 resulting from the enhanced interaction between c-Jun and ATF3 in DRG contributed to BTZ-induced mechanical allodynia.     

Swelling of astrocytes causes membrane potential depolarization

Rat brain astrocytes growing in primary monolayer cultures were swollen by exposing them to media of decreasing osmolality caused by removal of NaCl, and the effects of this treatment on their membrane potentials were measured by intracellular recording. Depolarizations were seen that were proportional to the degree of swelling, reaching a maximum of around 60 mV when 80-100 mM NaCl was removed from the reaction media, which had an original total osmolality of 290 mosmolal. These effects were completely reversible, since restoring the cells to iso-osmotic medium after a 2-min exposure caused an immediate repolarization back to the original membrane potentials, and depolarizations were not seen when isotonicity was maintained by replacing NaCl with sucrose. Partial repolarization was seen during an extended period (30 min) of exposure to hypo-osmotic medium, mirroring a regulatory volume decrease we have previously described in these cells under identical conditions. In ion-replacement studies depolarizations were seen when the solution was made hypo-osmotic with the large cation N-methyl-D-glucamine totally replacing Na+ in the medium. Removal of Cl- from the medium also had no effect on the initial swelling-induced depolarization. These results show that even moderate swelling of astrocytes in primary culture results in marked depolarization of their membrane potentials; possible mechanisms for this effect and the potentially profound implications for the swelling of astrocytes seen in situ under pathological conditions are discussed.     

Somatostatin release from dispersed hypothalamic cells—Effects of membrane depolarization, calcium and glucose deprivation

We have developed a new short term in vitro system to examine hypothalamic somatostatin (SRIF) release. Hypothalamic cells were obtained from normal rats after trypsin or collagenase aided dispersion and released immuno-reactive (IR) SRIF which eluted in 3 molecular weight (MW) forms on gel chromatography. The smallest MW form, which constituted the major peak, co-eluted with synthetic cyclic 1-14 SRIF on gel and reverse phase high pressure liquid chromatography (HPLC). After 24 h in culture in medium containing heat inactivated fetal calf serum, cell viability was demonstrated by two techniques, (1) vital staining with trypan blue, and (2) incorporation of 32Pi into phospholipids. SRIF release was also studied at this time which was optimal in terms of responsivity of the cells to depolarizing stimuli. SRIF release increased in a time dependent manner, over 3 h. Membrane depolarization, induced either by potassium chloride 56 mM or ouabain (the Na+, K+-ATPase inhibitor) 10(-6) M or greater, markedly stimulated SRIF release. Incubation at 4 degrees C, or in the presence of EDTA 0.05 M or verapamil, the calcium channel blocker, 50 microM abolished these stimulatory effects. Glucose deprivation was induced by the addition of 2-deoxy-D-glucose (2-DG) to the experimental medium. 2-DG, at concentrations of up to 200 mg%, had no significant effect on SRIF release during incubation periods of up to 1 h.     

Intracellular acidification induced by membrane depolarization in rat hippocampal slices: roles of intracellular Ca and glycolysis

To elucidate the mechanism of pH_i changes induced by membrane depolarization, the variations in pH_i and [Ca²⁺]_i induced by a number of depolarizing agents, including high K⁺, veratridine, N-methyl-

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-aspartate (NMDA) and ouabain, were investigated in rat hippocampal slices by the fluorophotometrical technique using BCECF or fura-2. All of these depolarizing agents elicited a decrease in pH_i and an elevation of intracellular calcium ([Ca²⁺]_i) in the CA1 pyramidal cell layer. The increases in [Ca²⁺]_i caused by the depolarizing agents almost completely disappeared in the absence of Ca²⁺ (0 mM Ca²⁺ with 1 mM EGTA). In Ca²⁺ free media, pH_i acid shifts produced by high K⁺, veratridine or NMDA were attenuated by 10–25%, and those produced by ouabain decreased by 50%. Glucose-substitution with equimolar amounts of pyruvate suppressed by two-thirds the pH_i acid shifts induced by both high K⁺ and NMDA. Furthermore, lactate contents were significantly increased in hippocampal slices by exposure to high K⁺, veratridine or NMDA but not by ouabain. These results suggest that the intracellular acidification produced by these depolarizing agents, with the exception of ouabain, is mainly due to lactate accumulation which may occur as a result of accelerated glycolysis mediated by increased Na⁺–K⁺ ATPase activity. A Ca²⁺-dependent process may also contribute to the intracellular acidification induced by membrane depolarization. Since an increase in H⁺ concentration can attenuate neuronal activity, glycolytic acid production induced by membrane depolarization may contribute to the mechanism that prevents excessive neuronal excitation.     

Neurobiochemical evidence for calcium-induced depolarization of EGTA-pretreated hippocampal synaptosomes

The neurochemical effects of calcium were determined in hippocampal cholinergic synaptosomes which had been prepared and preincubated in calcium-free medium containing 50 μM EGTA. Calcium (and barium) reversibly stimulated [³H]acetylcholine release and produced a long-lasting elevation of high-affinity [³H]choline uptake. Both effects were blocked by ω-conotoxin and substantially reduced by tetrodotoxin. Together, these data indicate that calcium causes membrane depolarization and is associated with opening of voltage-gated sodium channels in EGTA-pretreated synaptosomes.     

Membrane depolarization by isotonic or hypertonic KCl: differential effects on mRNA levels of tyrosine hydroxylase and dopamine β-hydroxylase mRNA in PC12 cells

Membrane depolarization is an important and common manipulation used to study the result of enhanced neuronal activity on adaptive changes, including alterations in gene expression. In this study, the effect of elevated KCl, under isotonic and hypertonic conditions, on the changes in mRNA levels of the catecholamine biosynthetic enzymes, tyrosine hydroxylase (TH) and dopamine β-hydroxylase (DBH) was compared. Treatment of PC12 pheochromocytoma cells for several hours with 50 mM KCl, under conditions where osmolarity was maintained, induced TH mRNA levels several fold, without changing DBH mRNA levels (Kilbourne and Sabban, 1990). In contrast, 50 mM KCl added to culture media without adjusting the osmolarity did not alter TH mRNA levels for up to 24 h. Longer continuous exposure to this hypertonic depolarization condition reduced TH mRNA levels to about 10% of control levels. DBH mRNA levels also declined when PC12 cells were treated from 12 h to 5 days with hypertonic 50 mM KCl. The effect appeared to be specific, since actin mRNA levels were elevated about 2-fold with these same hypertonic treatments. As a control for osmotic changes, 50 mM NaCl was used and did not alter TH or DBH mRNA levels. Viability of the cells was maintained and total protein synthesis was reduced somewhat after 12 h of exposure to hypertonic 50 mM KCl, and remained relatively constant for as long as 4 days. Thus, there appears to be an interaction between osmolarity and elevated KCl since very different results of the effects of membrane depolarization on the mRNA levels for the catecholamine biosynthetic enzymes were obtained depending on the osmolarity of the cultures. The extent of elevation of TH mRNA with isotonic KCl was also dependent on cell density. At high cell densities, membrane depolarization no longer induced TH mRNA levels. The results of this study indicate the experimental parameters which can be crucial in studies of membrane depolarization.     

Hypoxic neuronal damage in the absence of hypoxic depolarization in rat hippocampal slices: the role of glutamate receptors

The propensity of neurons to undergo profound and precipitous depolarization is believed to contribute to their characteristic vulnerability to hypoxic injury. The length of time a neuron spends in a depolarized state following hypoxic depolarization (HD) is a critical determinant of the extent of irreversible cell damage. It is less clear, however, what the effects of moderate hypoxia are when HD does not occur. The present study examined the effects of prolonged, moderate hypoxia which does not elicit HD in rat hippocampal slices. Extracellularly-recorded population excitatory postsynaptic potentials (pEPSPs) in stratum radiatum of CA1 were eliminated 10–15 min after initiating hypoxia. Physiological damage was related to the hypoxic duration: full, intermediate, or poor recovery of pEPSP slope was observed after 30, 60, or 120 min of hypoxia, respectively. The glutamate receptor antagonists,d,l-2-amino-5-phosphono-valeric acid (APV) or 6,7-dinitroquinoxaline-2,3-dione (DNQX), enhanced the post-hypoxic recovery of synaptic responses. These findings demonstrate that profound HD is not necessary to elicit physiological damage during moderate hypoxia; moreover, the neuroprotective actions of excitatory transmitter antagonists are not limited to their capacity to delay HD. The precise characterization of cellular responses under these conditions will be of particular importance for understanding the pathophysiology of an ischemic penumbra.     

Recurrent potentials in human peripheral sensory nerve: possible evidence of primary afferent depolarization of the spinal cord.

To study slowly conducted components of the orthodromic compound sensory action potential (CSAP), the response evoked at the lateral malleolus in the sural nerve was recorded through near-nerve needles at two to four sites along the nerve at midcalf. When 500 to 2000 responses were averaged at high gain, components with latencies of 30 to 80 ms were often recorded. In contrast to the main component and late components with latencies of less than 15 to 20 ms, the latencies of these extremely late components diminished the closer to the spinal cord that they were recorded. This suggested that the components were conducted antidromically from proximal to distal. This assumption was supported by abolishing the components by local anesthesia of the nerve proximal to the recording electrodes. These antidromic potentials therefore appear to be due to recurrent discharges in the sural nerve. Recurrent discharges were recorded from 65% of 60 subjects (18 normal subjects and 42 patients with peripheral or central nervous system disorders). The latencies of the recurrent discharges allowed conduction to and back from the spinal cord. Although the origin of these potentials remains unknown, we suggest that they are due to dorsal root reflexes within the spinal cord. In this case, the responses may be a direct expression of primary afferent depolarization (PAD) seen in presynaptic inhibition, and may be of value in further studies on the physiology and pathophysiology of presynaptic inhibition of cutaneous fibers in man.     

Axonal neuropathy,long limbs and bumpy tongue: Think of MEN2B

Introduction: Multiple endocrine neoplasia type 2 (MEN 2) is an uncommon autosomal dominant cancer syndrome which can be associated with nerve conduction abnormalities. Methods: A 14‐year‐old boy with a family history of consanguinity developed progressive gait clumsiness, pes cavus, hypotonia, and mucosal tumors of the lips and tongue since the age of 3 years. At age 11 years, he was diagnosed with an hereditary motor neuropathy (Charcot‐Marie‐Tooth syndrome). Results: Physical examination revealed a Marfanoid habitus, mucocutaneous verrucous tumors, thyroid nodules, and cervical adenopathy. Genetic testing demonstrated the p.M918T mutation in the RET gene, and blood tests showed elevated levels of calcitonin. Conclusions: Clinical suspicion in MEN2 is crucial for early diagnosis and subsequent therapy. Mucosal neuroma and a Marfanoid habitus are especially useful. Other neurologic manifestations should not disguise the endocrine disorder, because early diagnosis and treatment of medullary thyroid carcinoma determines the prognosis. Muscle Nerve, 2012     

Storage and release of endogenous and labelled GABA formed from [3H]glutamine and [14C]glucose in hippocampal slices: effect of depolarization

The emergence of the capacities for calcium uptake and calcium-regulated protein phosphorylation during the development of embryonic brain neurons in tissue culture was examined. In the maturing cells, the enhancement in 45Ca2+-uptake upon stimulation with high K+ increased by 3-4 fold during the second week in vitro, in parallel to an increase in the capacity for high K+-induced Ca2+-dependent release of prelabeled [3H]dopamine. The pattern of incorporation of [32Pi]phosphate into the major phosphoproteins in maturing cells under nonstimulating conditions also changed during cell development: the incorporation of 32Pi into two proteins of apparent molecular weights--55,000 and 43,000 dalton--increased, but decreased in a 45,000 dalton protein. Stimulation of mature cells (after 10-11 days in vitro) resulted in a Ca2+-dependent increase in the amount of 32Pi incorporated into the 43,000 dalton protein and a decrease in the amount incorporated into the 55,000 dalton protein. This calcium-regulated phosphorylation pattern was not observed until 6 days in vitro. Introduction of Ca2+ into the immature cells by means of the Ca2+ ionophore A23187 did not alter the phosphorylation pattern and did not cause neurotransmitter release. The amount of [35S]methionine incorporated into a 43,000 dalton protein which comigrated with the 43,000 dalton phosphoprotein also increased upon cell maturation. The results suggest that this phosphoprotein (which does not comigrate with nonphosphorylated actin on two-dimensional polyacrylamide gels) develops in the cells in parallel to the emerging processes of the stimulation-induced calcium entry and calcium-dependent neurosecretion.     

Metabolic and perfusion responses to recurrent peri-infarct depolarization during focal ischemia in the Spontaneously Hypertensive Rat: dominant contribution of sporadic CBF decrements to infarct expansion

Peri-infarct depolarizations (PIDs) contribute to the evolution of focal ischemic lesions. Proposed mechanisms include both increased metabolic demand under conditions of attenuated perfusion and overt vasoconstrictive responses to depolarization. The present studies investigated the relative contributions of metabolic and perfusion effects to PID-associated infarct expansion during middle cerebral artery (MCA) occlusion in the Spontaneously Hypertensive Rat. The initial distribution of ischemic depolarization (ID) was established within minutes after MCA occlusion at a cerebral blood flow threshold of ∼40 mL/100 g per minute, with expansion of the depolarized territory during 3 hours detected in half of the animals. Peri-infarct depolarizations were associated with transient metabolic responses, comparable to those observed after spreading depression, with no evidence of cumulative energy failure after multiple transient depolarizations during 1 hour. Speckle contrast imaging of PID-associated flow transients documented prominent distal hyperemic flow responses that became progressively attenuated in regions of already impaired perfusion, with modest propagated flow decreases more proximal to the ischemic core. However, sporadic PIDs were associated with persistent decrements in perfusion, increasing tissue volume below the threshold for energy failure, ID and infarction. These latter, comparatively rare, events can account for the pattern of stepwise infarct expansion in this model.     

Neuroblastoma cell as a model for a taste cell: mechanism of depolarization in response to various bitter substances

The mouse neuroblastoma cell (N-18 clone) was used as a model for a taste cell. The N-18 cell was found to be reversibly depolarized by various bitter substances. The minimum concentrations of bitter substances which induced depolarization (threshold concentration) varied greatly with the type of the substance. There was a good correlation between the threshold concentrations for various bitter substances in the N-18 cell and those in the human taste responses. The input membrane resistance was little changed during the depolarization induced by the bitter substances. Replacement of Na+ and Cl- with impermeable ions had practically no effect on the depolarization response to the bitter substances and reduction of calcium concentration from 1.8 to 0.2 mM led to a slight increase in the responses. It was suggested that the depolarization of the N-18 cell by bitter substances mainly stems from changes in the phase-boundary potential at the outer surface of the cell.     

Choline acetyltransferase activity in chick retina cultures: effect of membrane depolarizing agents

The activity of choline acetyltransferase (CAT) was investigated in primary cultures of retina from 8-day-old chick embryos. After the second day in culture, the total and specific activities of the enzyme decreased by more than 50%. Cultivation of the cell in 56 mM K⁺ or 59 μg/ml of veratrine retarded the loss of CAT activity up to days 3–5 in vitro. If the addition of 56 mM K⁺ or 59 μg/ml of veratrine was delayed until the third day of culture, these agents had no effect on the remaining CAT activity. These results suggest that the survival in culture of a part of the cholinergic retinal neurons requires membrane depolarization.     

Optical imaging of spreading depolarization waves triggered by spinal nerve stimulation in the chick embryo: possible mechanisms for large-scale coactivation of the central nervous system

Using a multiple-site optical recording technique with a voltage-sensitive dye, we found that widely spreading depolarization waves were evoked by dorsal root stimulation in embryonic chick spinal cords. Spatiotemporal maps of the depolarization waves showed that the signals were mainly distributed in the ventral half of the slice, with the highest activity in the ventrolateral area. The propagation velocity of the waves was estimated to be in the order of mm/s. Depolarization waves were evoked in the ventral root-cut preparation, but not in the dorsal root-cut preparation, suggesting that the wave was triggered by synaptic inputs from the primary afferents, and that activation of the motoneurons was not essential for wave generation. In intact spinal cord-brain preparations, the depolarization wave propagated rostrally and caudally for a distance of several spinal segments in normal Ringer's solution. In a Mg(2+)-free solution, the amplitude and extent of the signals were markedly enhanced, and the depolarization wave triggered in the cervical spinal cord propagated to the brainstem and the cerebellum. The depolarization wave demonstrated here had many similarities with the vagus nerve-evoked depolarization wave reported previously. The results suggest that functional cell-to-cell communication systems mediated by the depolarization wave are widely generated in the embryonic central nervous system, and could play a role in large-scale coactivation of the neurons in the spinal cord and brain.     

Effect of glucocorticoids on development of the membrane resting potential of chick embryo brain cells in culture

Progressive increase in membrane resting potential (MRP) values in cultured chick embryo brain neurons were recorded from days 2 to 10 of development. Application of corticosterone or prednisone in 24 hr old cultured cells caused a significant increment in MRP recorded at day 2 of culture with respect to control. When ouabain was added to the corticosterone treated cells its effect on the MRP was impaired. An increment in protein synthesis and a reduction in sodium concentration were also observed in corticosterone pretreated cells. These results show that corticoids accelerate the differentiation process in cultured cells particularly the MRP, stimulating perhaps the Na⁺-K⁺ ATPase pump.     

-Adrenergic receptor-mediated depolarization of rat neocortical astrocytes in primary culture

The membrane potentials of rat neocortical astrocytes growing in primary cultures (mean resting potential; −79 mV at [K⁺]_o = 4.5 nM) were depolarized by up to 30 mV by 10⁻⁵ M norepinephrine added to the medium, or up to 11 mV by norepinephrine or phenylephrine applied by ionophoresis. This depolarization could be inhibited by the -adrenergic receptor antagonist phentolamine (10⁻⁵ M) but not by the β-adrenergic antagonist propranolol (10⁻⁵ M). These results suggest that the norepinephrine-evoked depolarizations seen in these cells may be mediated through an -adrenergic receptor.     

Influence of various growth factors and conditions on development of resting membrane potential and its electrogenic pump component of cultured rat skeletal myotubes

The effects of different growth factors and growth conditions were studied on the development of resting membrane potential and its electrogenic—ouabain-sensitive—pump component in cultured rat myotubes. Resting potential and its electrogenic pump component were dependent on the initial plating density of the myotubes, both values increasing with increasing density. Medium from cells plated at high density, when used to replace the medium of low density cells, increased both the resting potential and its electrogenic pump component of low density myotubes. Treatment of myotubes with cytosine-arabinoside delayed the appearance of [³H]ouabain binding sites and electrogenic pump component of resting potential, but by 8 days in culture there was no difference between treated and control cells. Similarly, cells plated initially in 5% horse serum developed resting potential and its electrogenic pump component more slowly than those in 15% horse serum, but by 8–10 days in vitro, the differences were no longer apparent. Chick embryo extract was found to have little, if any, influence on development of resting potential and its electrogenic pump component. We conclude that the different growth conditions and factors to the extent that they influence membrane potential, do so by altering the time of appearance of Na-K ATPase, the activity of which contributes a considerable component to resting potential.