Primary Lateral Sclerosis: Clinical,radiological and molecular features

Primary Lateral Sclerosis (PLS) is an uncommon motor neuron disorder. Despite the well-recognisable constellation of clinical manifestations, the initial diagnosis can be challenging and therapeutic options are currently limited. There have been no recent clinical trials of disease-modifying therapies dedicated to this patient cohort and awareness of recent research developments is limited. The recent consensus diagnostic criteria introduced the category ‘probable’ PLS which is likely to curtail the diagnostic journey of patients. Extra-motor clinical manifestations are increasingly recognised, challenging the view of PLS as a 'pure' upper motor neuron condition. The post mortem literature of PLS has been expanded by seminal TDP-43 reports and recent PLS studies increasingly avail of meticulous genetic profiling. Research in PLS has gained unprecedented momentum in recent years generating novel academic insights, which may have important clinical ramifications.     

风湿性心脏病心房颤动患者左、右心房肌Cx40、Cx43表达的对比研究

通过对伴或不伴心房颤动 (简称房颤 )的风湿性心脏病 (简称风心病 )二尖瓣病变患者左、右心房肌细胞缝隙连接蛋白 (Connexin ,Cx)Cx4 0、Cx4 3表达进行对比研究 ,探讨房颤对Cx表达的影响。选择 31例接受心脏瓣膜置换术的风心病患者为研究对象并分为三组 :实验Ⅰ组 11例 ,为阵发性房颤或房颤持续时间≤ 6个月者 ;实验Ⅱ组12例 ,房颤持续时间 >6个月 ;对照组 8例 ,为窦性心律。分别于手术中切取左、右心房肌标本。用免疫印迹法检测Cx4 0、Cx4 3的表达量。结果 :每例患者自身左、右心房肌比较 ,其Cx4 0及Cx4 3的表达量无显著差异 (P均 >0 .0 5 ) ;而每组中左、右心房肌Cx4 0、Cx4 3表达量均值也无显著性差异 ;其中实验Ⅰ、Ⅱ组与对照组比较 ,Cx4 0表达量明显降低 (左心房 :5 94 9.2± 832 .9,4 16 9.0± 95 5 .9Int×mm2 vs 86 74 .8± 10 0 8.3Int×mm2 ;P <0 .0 5和 <0 .0 1;右心房 :5 992 .1± 80 6 .5 ,4 12 0 .2± 95 4 .9Int×mm2 vs 86 17.4± 10 0 4 .7Int×mm2 ;P <0 .0 5和 <0 .0 1) ;Cx4 3的表达量在三组间无显著差异 (P >0 .0 5 )。结论 :Cx4 0表达下调可能参与了房颤的发生与维持。     

Tumor-promoting activity and cytotoxicity of 3,4,3′,4′-tetrachlorobiphenyl on N-nitrosomorpholine-induced murine liver foci

Summary Effects of 3,4,3,4-tetrachlorobiphenyl (TCB) on glucose-6-phosphatase (G6Pase)-altered hepatic foci of N-nitrosomorpholine (NNM)-treated B6C3F1 mice were investigated. TCB was chosen as a selective 3-methylcholanthrene-type inducer and tumor promoter. To initiate hepatocarcinogenesis, mice were treated with NNM (160 mg/l, in drinking water for 7 weeks), as in previous studies with the rat model. After a treatment-free interval of 22 weeks, TCB was administered (5×50 mg/kg, every 3 days), and liver foci were analysed 10 weeks after the start of TCB treatment. Unexpectedly, the number of G6Pase-negative and-positive foci per liver was markedly diminished following TCB treatment (to 32% and 57%, respectively). On the other hand, the mean volume of the remaining G6Pase-altered foci was enhanced, owing to an increase in the percentage of foci of large size (>0.5mm²). Throughout the experimental period of 39 weeks prolonged liver injury due to NNM and TCB treatment was demonstrated by histology and by elevated serum levels of glutamate-oxaloacetate transaminase. The results suggest that (in contrast to the rat system) TCB exhibited opposing effects on liver foci in the mouse model: (a) moderate tumor-promoting effects and (b) cytotoxic effects in NNM-injured liver, leading to decreased numbers of liver foci.Abbreviations used G6Pase glucose-6-phosphatase - NNM N-nitrosomorpholine - TCB 3,4,3,4-tetrachlorobiphenyl     

卡维地洛对缺氧、再供氧心肌细胞缝隙连接通道蛋白43表达的影响

目的:检测卡维地洛(Cavedilol,CVD)对缺氧再供氧时心肌细胞缝隙连接通道蛋白43(Conexin43,CX43)的基因表达和CX43通道蛋白变化的影响。方法:原代培养心肌细胞,随机分为2组:未用药组,CVD组。建立缺氧、再供氧模型,分别于正常、缺氧30min、再供氧1h、2h、3h、6h搜集细胞。逆转录聚合酶链式反应(RT-PCR)检测CX43 mRNA表达、蛋白免役印迹法(Western blot)检测CX43蛋白的含量。结果:未用药组的心肌细胞缺氧30min时CX43 mRNA表达与蛋白含量和正常相比无显著差异(P>0.05)。再供氧1h、2h、3h、6h则分别减少了39.16%、45.00%、46.67%、51.67%,和正常时相比差异显著(P<0.01)。其中再供氧1h下降幅度最大。用CVD干预后再供氧1h、2h、3h、6h则分别减少了22.95%、27.87%、30.33%、35.25%(P<0.01)。再供氧1h、6h的下降幅较未用药组分别减少了41.39%、31.78%,差异显著(P<0.01)。结论:心肌细胞缺氧再供氧时,其CX43基因表达和蛋白含量明显减少,卡维地洛可抑制CX43降解。     

细胞间隙连接通讯及其通路蛋白与大肠癌发生关系的研究进展

细胞间隙连接通讯(gap junctional intercellular communication,GJIC)是多细胞生物体内普遍存在的一种通讯方式,他参与离子和其他小分子信号物质的转运.GJIC对细胞的生长、增殖和分化起重要的调控作用,他的改变与肿瘤的发生密切相关.大肠癌是人类常见的恶性肿瘤之一,目前研究表明,大肠癌的发生是一个多步骤、多基因、多阶段的过程,包括癌基因激活、抑癌基因失活、DNA转录表达失控、DNA损伤等.不论何种原因的细胞转化,其最终表现为细胞周期失控、细胞无限增殖.本文就GJIC及其通路蛋白、细胞因子与大肠癌的发生的研究进展作一综述.     

Deprescribing guidelines: An international symposium on development,implementation, research and health professional education

Deprescribing is a clinically important and feasible innovation that ensures medication efficacy, reduces harms, and mitigates polypharmacy. It involves reducing doses or stopping medications that are not useful, no longer needed, or which may be causing harm. It may also involve changing to a safer agent or using non-pharmacological approaches for care instead. Clinical guidelines combined with behaviour changes (of health care providers (HCPs), the public, and health care decision-makers) are needed to integrate deprescribing into routine practice. Using rigorous international standards, the Bruyère Research Institute Deprescribing Guidelines research team validated a ground-breaking deprescribing guideline methodology and developed or co-developed 5 evidence-based deprescribing guidelines. In March 2018, the team hosted an international symposium convening HCPs, researchers, public agencies, policymakers, and patient advocates in Ottawa, Ontario, Canada. This 3-day symposium aimed to facilitate knowledge exchange amongst guideline developers, users, and the public; initiate partnerships and collaborations for new deprescribing guideline recommendations and effectiveness research; and to continue work on HCP deprescribing education activities. An interprofessional planning committee developed an overall agenda, and small groups worked on session objectives and formats for different components: methods for rigorous deprescribing guideline development, implementation experiences, research/evaluation experiences and educational needs. Through a series of keynote speakers, panel discussions, and small working groups, the symposium provided a forum for participants to meet one another, learn about their different experiences with deprescribing guidelines, and develop collaborations for future initiatives. One hundred thirty participants, from 10 countries and representing over 100 institutions and organizations took part. Symposium proceedings are presented in this issue of RSAP for sharing with the wider community engaged in the care of patients with problematic polypharmacy.     

In vitro and in vivo characteristics of connexin 43-modified human skeletal myoblasts as candidates for prospective stem cell therapy for the failing heart

Background

Previously, connexin 43-modified skeletal myoblasts (MbCx) were shown to reduce the pro-arrhythmic effect during the regeneration of heart tissue in an animal model of infarction. To increase the relevance to clinical implementation, in this study, we introduced connexin 43 into human myoblasts using a highly safe non-viral vector and demonstrated that their transplantation had a positive effect on the function of the injured heart.

Methods and results

Myoblasts were efficiently transfected with a pCiNeo-GJA1 plasmid (65.72%). qPCR analysis revealed over 32-fold higher expression of the connexin 43 gene in the MbCx cell population compared to ‘native’ controls. The susceptibility of the myoblasts to oxidative stress conditions (p < 0.001) and the fusion index (p < 0.01) were increased in the MbCx cells. Additionally, we observed changes in the MYOG and MYH2 gene expression levels in the GJA1-modified myoblasts. Finally, we observed a significant improvement in the post-infarction echocardiographic parameters after intervention using MbCx cells compared with non-transfected myoblasts (MbWt) and the control (0.9% NaCl), wherein a significant decrease in the left ventricular area change in the short axis (SAX AC%) was observed at the two-month follow-up (p < 0.05 and p < 0.01, respectively).

Conclusions

We demonstrated the positive effect of connexin 43 overexpression on the biology and function of human skeletal myoblasts in the context of their potential clinical applications. Our preclinical studies using a mouse infarction model indicated the positive effect of MbCx implantation on the function of the injured heart.     

七氟醚预处理对大鼠心肌缺血再灌注时缝隙连接蛋白43的影响

目的 评价七氟醚预处理对大鼠心肌缺血再灌注时缝隙连接蛋白43的影响.方法 健康成年雄性Wistar大鼠,体重220 ～ 250 g,采用改良Langendorff灌注装置制备离体心脏灌注模型.取离体心脏模型16个,采用随机数字表法,将其随机分为2组(n=8):缺血再灌注组(I/R组)和七氟醚预处理组(SP组).平衡灌注30 min时,I/R组继续灌注K-H液20 min;SP组将2.4％七氟醚持续吹入K-H液中,用预充2.4％七氟醚的K-H液持续灌注15 min,然后用K-H液洗脱5 min.之后两组均行全心缺血40 min,再灌注60 min.分别于平衡灌注末、缺血前即刻、再灌注30和60 min时,记录HR、左室发展压(LVDP)、左心室内压最大上升速率(+dp/dtmax)及左心室内压最大下降速率(- dp/dtmax).于再灌注60 min时,取部分心尖组织,观察心肌病理学改变;取左室部分心肌,观察缝隙连接蛋白43的分布情况,测定缝隙连接蛋白43的表达.结果 与平衡灌注末比较,I/R组和SP组缺血前即刻+ dp/dtmax和- dp/dtmax降低,再灌注30和60 min时HR、LVDP、+dp/dtmax和- dp/dtmax降低(P＜0.01);与缺血前即刻比较,I/R组和SP组再灌注30和60 min时HR、LVDP、+dp/dtmax和- dp/dtmax降低(P ＜0.05或0.01);与I/R组比较,SP组缺血前即刻HR、LVDP、+dp/dtmax和- dp/dtmax降低,再灌注30和60 min时HR、LVDP、+dp/dtmax和- dp/dtmax升高(P＜0.01),病理学损伤减轻.缝隙连接蛋白43 I/R组分布不均,闰盘处少见;SP组分布规律呈条带状,主要位于闰盘处.两组缝隙连接蛋白43表达比较差异无统计学意义(P＞0.05).结论 七氟醚预处理减轻大鼠心肌缺血再灌注损伤的机制可能与抑制缝隙连接蛋白43的再分布有关,而与缝隙连接蛋白43的表达无关.     

Cell autonomous requirement of connexin 43 for osteocyte survival: consequences for endocortical resorption and periosteal bone formation

Connexin 43 (Cx43) mediates osteocyte communication with other cells and with the extracellular milieu and regulates osteoblastic cell signaling and gene expression. We now report that mice lacking Cx43 in osteoblasts/osteocytes or only in osteocytes (Cx43(ΔOt) mice) exhibit increased osteocyte apoptosis, endocortical resorption, and periosteal bone formation, resulting in higher marrow cavity and total tissue areas measured at the femoral mid-diaphysis. Blockade of resorption reversed the increased marrow cavity but not total tissue area, demonstrating that endocortical resorption and periosteal apposition are independently regulated. Anatomical mapping of apoptotic osteocytes, osteocytic protein expression, and resorption and formation suggests that Cx43 controls osteoclast and osteoblast activity by regulating osteoprotegerin and sclerostin levels, respectively, in osteocytes located in specific areas of the cortex. Whereas empty lacunae and living osteocytes lacking osteoprotegerin were distributed throughout cortical bone in Cx43(ΔOt) mice, apoptotic osteocytes were preferentially located in areas containing osteoclasts, suggesting that osteoclast recruitment requires active signaling from dying osteocytes. Furthermore, Cx43 deletion in cultured osteocytic cells resulted in increased apoptosis and decreased osteoprotegerin expression. Thus, Cx43 is essential in a cell-autonomous fashion in vivo and in vitro for osteocyte survival and for controlling the expression of osteocytic genes that affect osteoclast and osteoblast function.