Endocrine and Growth Abnormalities in 4H Leukodystrophy Caused by Variants in POLR3A, POLR3B, and POLR1C.

CONTEXT: 4H or POLR3-related leukodystrophy is an autosomal recessive disorder typically characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism, caused by biallelic pathogenic variants in POLR3A, POLR3B, POLR1C, and POLR3K. The endocrine and growth abnormalities associated with this disorder have not been thoroughly investigated to date. OBJECTIVE: To systematically characterize endocrine abnormalities of patients with 4H leukodystrophy. DESIGN: An international cross-sectional study was performed on 150 patients with genetically confirmed 4H leukodystrophy between 2015 and 2016. Endocrine and growth abnormalities were evaluated, and neurological and other non-neurological features were reviewed. Potential genotype/phenotype associations were also investigated. SETTING: This was a multicenter retrospective study using information collected from 3 predominant centers. PATIENTS: A total of 150 patients with 4H leukodystrophy and pathogenic variants in POLR3A, POLR3B, or POLR1C were included. MAIN OUTCOME MEASURES: Variables used to evaluate endocrine and growth abnormalities included pubertal history, hormone levels (estradiol, testosterone, stimulated LH and FSH, stimulated GH, IGF-I, prolactin, ACTH, cortisol, TSH, and T4), and height and head circumference charts. RESULTS: The most common endocrine abnormalities were delayed puberty (57/74; 77% overall, 64% in males, 89% in females) and short stature (57/93; 61%), when evaluated according to physician assessment. Abnormal thyroid function was reported in 22% (13/59) of patients. CONCLUSIONS: Our results confirm pubertal abnormalities and short stature are the most common endocrine features seen in 4H leukodystrophy. However, we noted that endocrine abnormalities are typically underinvestigated in this patient population. A prospective study is required to formulate evidence-based recommendations for management of the endocrine manifestations of this disorder.

The titanium tris-anilide cation [Ti(N[(t)Bu]Ar)3](+) stabilized as its perfluoro-tetra-phenylborate salt: structural characterization and synthesis in connection with redox activity of 4,4'-bipyridine dititanium complexes.

This work explores the reduction of 4,4'-bipyridine using two equivalents of the titanium(iii) complex Ti(N[(t)Bu]Ar)3 resulting in formation of a black, crystalline complex, (4,4'-bipy){Ti(N[(t)Bu]Ar)3}2, for which an X-ray structure determination is reported. The neutral, black, 4,4'-bipyridine-bridged bimetallic was found to be redox active, with mono- and di-anions being accessible electrochemically, and with the mono- and di-cations also being accessible chemically, and isolable, at least when using the weakly coordinating anion [B(C6F5)4](-) as the counter-ion. It proved possible to crystallize the salt [(4,4'-bipy){Ti(N[(t)Bu]Ar)3}2][B(C6F5)4]2 for a single-crystal X-ray structure investigation; in this instance it was revealed that the aromaticity of the 4,4'-bipyridine ligand, that had been disrupted upon reduction, had been regained. A rare cationic d(0) metal tris-amide complex, shown by X-ray crystallography to contain an intriguing pyramidal TiN3 core geometry, namely {Ti(N[(t)Bu]Ar)3}(+), could also be isolated when using [B(C6F5)4] as the essentially non-interacting counter-ion. This highly reactive cation should be considered as a potential intermediate in the plethora of reactions wherein Ti(N[(t)Bu]Ar)3 has been shown to effect the reduction of substrates including halogenated organic molecules, carbonyl compounds, organic nitriles, and metal complexes.

Thermodynamic, kinetic, and mechanistic study of oxygen atom transfer from mesityl nitrile oxide to phosphines and to a terminal metal phosphido complex.

The enthalpies of oxygen atom transfer (OAT) from mesityl nitrile oxide (MesCNO) to Me(3)P, Cy(3)P, Ph(3)P, and the complex (Ar[(t)Bu]N)(3)MoP (Ar = 3,5-C(6)H(3)Me(2)) have been measured by solution calorimetry yielding the following P-O bond dissociation enthalpy estimates in toluene solution (±3 kcal mol(-1)): Me(3)PO [138.5], Cy(3)PO [137.6], Ph(3)PO [132.2], (Ar[(t)Bu]N)(3)MoPO [108.9]. The data for (Ar[(t)Bu]N)(3)MoPO yield an estimate of 60.2 kcal mol(-1) for dissociation of PO from (Ar[(t)Bu]N)(3)MoPO. The mechanism of OAT from MesCNO to R(3)P and (Ar[(t)Bu]N)(3)MoP has been investigated by UV-vis and FTIR kinetic studies as well as computationally. Reactivity of R(3)P and (Ar[(t)Bu]N)(3)MoP with MesCNO is proposed to occur by nucleophilic attack by the lone pair of electrons on the phosphine or phosphide to the electrophilic C atom of MesCNO forming an adduct rather than direct attack at the terminal O. This mechanism is supported by computational studies. In addition, reaction of the N-heterocyclic carbene SIPr (SIPr = 1,3-bis(diisopropyl)phenylimidazolin-2-ylidene) with MesCNO results in formation of a stable adduct in which the lone pair of the carbene attacks the C atom of MesCNO. The crystal structure of the blue SIPr·MesCNO adduct is reported, and resembles one of the computed structures for attack of the lone pair of electrons of Me(3)P on the C atom of MesCNO. Furthermore, this adduct in which the electrophilic C atom of MesCNO is blocked by coordination to the NHC does not undergo OAT with R(3)P. However, it does undergo rapid OAT with coordinatively unsaturated metal complexes such as (Ar[(t)Bu]N)(3)V since these proceed by attack of the unblocked terminal O site of the SIPr·MesCNO adduct rather than at the blocked C site. OAT from MesCNO to pyridine, tetrahydrothiophene, and (Ar[(t)Bu]N)(3)MoN was found not to proceed in spite of thermochemical favorability.

Cyclophosphates as ligands for cobalt(III) in water.

Examination of cyclotriphosphate and cyclotetraphosphate as ligands for Co(III) in aqueous solutions revealed that cyclotetraphosphate affords stable complexes as a hemilabile ligand, while cyclotriphosphate exhibits facile hydrolysis.

Appearance of anti-NMDAR antibodies after plasma exchange and total removal of malignant ovarian teratoma in a patient with paraneoplastic limbic encephalopathy.

A 29-year-old female was admitted under section 2 of the mental health act with an acute psychosis. Her condition deteriorated as she developed a fever and worsening hallucinations. Brain imaging was normal but a lumbar puncture revealed a reactive cerebrospinal fluid. A transvaginal ultrasound revealed a left ovarian mass suggestive of a teratoma. A diagnosis of anti-N-methyl-D-aspartic acid receptor (NMDAR) limbic encephalitis was made but the anti-NMDAR antibody was found to be negative. The patient proceeded to a laparoscopic oopherectomy and a 5-day course of plasma exchange. The patient has made a gradual improvement and the anti-NMDAR antibody has since become positive.

6-Coordinate tungsten(VI) tris-n-isopropylanilide complexes: products of terminal oxo and nitrido transformations effected by main group electrophiles.

The nitridotungsten(vi) complex NW(N[i-Pr]Ar)(3) (-N, Ar = 3,5-Me(2)C(6)H(3)) reacts with (CF(3)C(O))(2)O followed by ClSiMe(3) to give the isolable trifluoroacetylimido-chloride complex -(NC(O)CF(3))Cl, with oxalyl chloride to give cyanate-dichloride -(OCN)(Cl)(2), and with PCl(5) to give trichlorophosphinimide-dichloride -(NPCl(3))(Cl)(2). The oxo-chloride complex -(O)Cl, obtained from -N upon treatment with pivaloyl chloride, reacts with PCl(5) to give trichloride -(Cl)(3). Synthetic and structural details are reported for the new tungsten trisanilide derivatives.

A nitridoniobium(V) reagent that effects acid chloride to organic nitrile conversion: synthesis via heterodinuclear (Nb/Mo) dinitrogen cleavage, mechanistic insights, and recycling.

The transformation of acid chlorides (RC(O)Cl) to organic nitriles (RC[triple bond]N) by the terminal niobium nitride anion [N[triple bond]Nb(N[Np]Ar)3]- ([1a-N]-, where Np = neopentyl and Ar = 3,5-Me2C6H3) via isovalent N for O(Cl) metathetical exchange is presented. Nitrido anion [1a-N]- is obtained in a heterodinuclear N2 scission reaction employing the molybdenum trisamide system, Mo(N[R]Ar)3 (R = t-Bu, 2a; R = Np, 2b), as a reaction partner. Reductive scission of the heterodinuclear bridging N2 complexes, (Ar[R]N)3Mo-(mu-N2)Nb(N[Np]Ar)3 (R = t-Bu, 3b; R = Np, 3c) with sodium amalgam provides 1 equiv each of the salt Na[1a-N] and neutral N[triple bond]Mo(N[R]Ar)3 (R = t-Bu, 2a-N; R = Np, 2b-N). Separation of 2-N from Na[1a-N] is readily achieved. Treatment of salt Na[1a-N] with acid chloride substrates in tetrahydrofuran (THF) furnishes the corresponding organic nitriles concomitant with the formation of NaCl and the oxo niobium complex O[triple bond]Nb(N[Np]Ar)3 (1a-O). Utilization of 15N-labeled 15N2 gas in this chemistry affords a series of 15N-labeled organic nitriles establishing the utility of anion [1a-N]- as a reagent for the 15N-labeling of organic molecules. Synthetic and computational studies on model niobium systems provide evidence for the intermediacy of both a linear acylimido and niobacyclobutene species along the pathway to organic nitrile formation. High-yield recycling of oxo 1a-O to a niobium triflate complex appropriate for heterodinuclear N2 scission has been developed. Specifically, addition of triflic anhydride (Tf2O, where Tf = SO2CF3) to an Et2O solution of 1a-O provides the bistriflate complex, Nb(OTf)2(N[Np]Ar)3 (1a-(OTf)2), in near quantitative yield. One-electron reduction of 1a-(OTf)2 with either cobaltocene (Cp2Co) or Mg(THF)3(anthracene) provided the monotriflato complex, Nb(OTf)(N[Np]Ar)3 (1a-(OTf)), which efficiently regenerates complexes 3b and 3c when treated with the molybdenum dinitrogen anions [N2Mo(N[t-Bu]Ar)3]- ([2a-N2]-) or [N2Mo(N[Np]Ar)3]- ([2b-N2]-), respectively.

Solution calorimetric and stopped-flow kinetic studies of the reaction of *Cr(CO)3C5Me5 with PhSe-SePh and PhTe-TePh. Experimental and theoretical estimates of the Se-Se, Te-Te, H-Se, and H-Te bond strengths.

The kinetics of the oxidative addition of PhSeSePh and PhTeTePh to the stable 17-electron complex *Cr(CO)3C5Me5 have been studied utilizing stopped-flow techniques. The rates of reaction are first-order in each reactant, and the enthalpy of activation decreases in going from Se (deltaH(double dagger) = 7.0 +/- 0.5 kcal/mol, deltaS(double dagger) = -22 +/- 3 eu) to Te (deltaH(double dagger) = 4.0 +/- 0.5 kcal/mol, deltaS(double dagger) = -26 +/- 3 eu). The kinetics of the oxidative addition of PhSeH and *Cr(CO)3C5Me5 show a change in mechanism in going from low (overall third-order) to high (overall second-order) temperatures. The enthalpies of the oxidative addition of PhE-EPh to *Cr(CO)3C5Me5 in toluene solution have been measured and found to be -29.6, -30.8, and -28.9 kcal/mol for S, Se, and Te, respectively. These data are combined with enthalpies of activation from kinetic studies to yield estimates for the solution-phase PhE-EPh bond strengths of 46, 41, and 33 kcal/mol for E = S, Se, and Te, respectively. The corresponding Cr-EPh bond strengths are 38, 36, and 31 kcal/mol. Two methods have been used to determine the enthalpy of hydrogenation of PhSeSePh in toluene on the basis of reactions of HSPh and HSePh with either *Cr(CO)3C5Me5 or 2-pyridine thione. These data lead to a thermochemical estimate of 72 kcal/mol for the PhSe-H bond strength in toluene solution, which is in good agreement with kinetic studies of H atom transfer from HSePh at higher temperatures. The reaction of H-Cr(CO)3C5Me5 with PhSe-SePh is accelerated by the addition of a Cr radical and occurs via a rapid radical chain reaction. In contrast, the reaction of PhTe-TePh and H-Cr(CO)3C5Me5 does not occur at any appreciable rate at room temperature, even in the presence of added Cr radicals. This is in keeping with a low PhTe-H bond strength blocking the chain and implies that H-TePh < or = 63 kcal/mol. Structural data are reported for PhSe-Cr(CO)3C5Me5 and PhS-Cr(CO)3C5Me5. The two isostructural complexes do not show signs of an increase in steric strain in terms of metal-ligand bonds or angles as the Cr-EPh bond is shortened in going from Se to S. Bond strength estimates of the PhE-H and PhE-EPh derived from density functional theory calculations are in reasonable agreement with experimental data for E = Se but not for E = Te. The nature of the singly occupied molecular orbital of the *EPh radicals is calculated to show increasing localization on the chalcogenide atom in going from S to Se to Te.

Organic nitriles from acid chlorides: an isovalent N for (O)CL exchange reaction mediated by a tungsten nitride complex.

Nitride NW(N[i-Pr]Ar)3 (1, Ar = 3,5-C6H3Me2) was synthesized in two steps from known NW(O-t-Bu)3 (41% overall yield). Complex 1 is the tungsten congener of NMo(N[i-Pr]Ar)3, a known molecule that has been synthesized using N2 as the nitrido nitrogen source, but which undergoes no reaction with pivaloyl chloride. Compound 1 undergoes metathesis with pivaloyl chloride at 25 degrees C to form the corresponding nitrile in 97% yield. Another substrate examined in this work was the labeled acid chloride 1-Ad13C(O)Cl (Ad = adamantyl). The "(O)Cl" moiety is transferred to tungsten forming an oxo-chloride, (Ar[i-Pr]N)3W(O)Cl (3), as the final tungsten product; both 1 and 3 were characterized structurally by X-ray diffraction. An intermediate observed in the nitrile-forming reaction was characterized spectroscopically to be a tungsten acylimido complex. The latter assignment was substantiated by the synthesis and structural characterization of the compound (Ar[i-Pr]N)3W(NC(O)CF3)(O2CCF3) (2m). In addition, density functional theory calculations performed using ADF lent insight into the thermochemistry of the overall process.

Involving patients and the public in the NHS.

Involving patients and the public in the NHS is a new strategic initiative by the Deparment of Health. Over time it will make a significant change to how services are designed and delivered. Doctors need to be aware of this new legislation and the change in the patient/clinician dynamic it embraces. In the clinical setting a change of culture is required so that doctors move to working in partnerships with their patients. Within trusts, hospital or otherwise, structures must be in place to ensure appropriate patient/public involvement. Health service workers and the public will need to understand the skills required from both sides for a constructive partnership to emerge. It is hoped that the prioritising of health service resources in the future will be the result of a more democratic process involving patients, public and health service workers.

Interactions of aziridines with nickel complexes: oxidative-addition and reductive-elimination reactions that break and make C-N bonds.

Reaction of the N-tosylaziridines (p-CH(3)C(6)H(4)SO(2))NCH(2)CHR (1a, R = H; 1b, R = Me; 1c, R = n-Bu; 1d, R = i-Pr) with (bpy)Ni(cod) (2; bpy = 2,2'-bipyridine; cod = 1,5-cyclooctadiene) or (bpy)NiEt(2) (3) results in elimination of cod or butane from 2 and 3, respectively, and oxidative addition of an aziridine C-N bond to give the azametallacyclobutane complexes (bpy)Ni(NTosCHRCH(2)) (4a, R = H; 4b, R = Me; 4c, R = n-Bu; 4d, R = i-Pr) as maroon solids in 50-70% isolated yields. The structure of 4b exhibits a puckered four-membered azametallacycle containing a pyramidal nitrogen and with Ni-N(1) = 1.911(5) A; the tosyl group on N and the methyl substituent on the adjacent C are disposed in an anti conformation. The monodeuterated aziridine syn-(p-CH(3)C(6)H(4)SO(2))NCHDCH-n-Bu (1e) reacts with either 2 or 3 to give (bpy)Ni[NTosCH(n-Bu)CHD] (4e) in 60-65% yield, having an anti arrangement of the methine and methylene protons in the azametallacycle, and indicates that >95% inversion of stereochemistry has occurred at the methylene carbon during the oxidative-addition reaction. When the azametallacyclobutane complexes 4a-e are exposed to oxygen, oxidatively induced reductive elimination ensues, giving the free aziridines in 30-60% isolated yields. In the oxidation of 4e, the product aziridine is spectroscopically identical to its parent, 1e, indicating the elimination that forms the C-N bond also proceeds with inversion of stereochemistry (approximately 92% by (1)H NMR) at the methylene carbon.