Differences in globus pallidus neuronal firing rates and patterns relate to different disease biology in children with dystonia.

BACKGROUND: The pathophysiology underlying different types of dystonia is not yet understood. We report microelectrode data from the globus pallidus interna (GPi) and globus pallidus externa (GPe) in children undergoing deep brain stimulation (DBS) for dystonia and investigate whether GPi and GPe firing rates differ between dystonia types. METHODS: Single pass microelectrode data were obtained to guide electrode position in 44 children (3.3-18.1 years, median 10.7) with the following dystonia types: 14 primary, 22 secondary Static and 8 progressive secondary to neuronal brain iron accumulation (NBIA). Preoperative stereotactic MRI determined coordinates for the GPi target. Digitised spike trains were analysed offline, blind to clinical data. Electrode placement was confirmed by a postoperative stereotactic CT scan. FINDINGS: We identified 263 GPi and 87 GPe cells. Both GPi and GPe firing frequencies differed significantly with dystonia aetiology. The median GPi firing frequency was higher in the primary group than in the secondary static group (13.5 Hz vs 9.6 Hz; p=0.002) and higher in the NBIA group than in either the primary (25 Hz vs 13.5 Hz; p=0.006) or the secondary static group (25 Hz vs 9.6 Hz; p=0.00004). The median GPe firing frequency was higher in the NBIA group than in the secondary static group (15.9 Hz vs 7 Hz; p=0.013). The NBIA group also showed a higher proportion of regularly firing GPi cells compared with the other groups (p<0.001). A higher proportion of regular GPi cells was also seen in patients with fixed/tonic dystonia compared with a phasic/dynamic dystonia phenotype (p<0.001). The GPi firing frequency showed a positive correlation with 1-year outcome from DBS measured by improvement in the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-m) score (p=0.030). This association was stronger for the non-progressive patients (p=0.006). INTERPRETATION: Pallidal firing rates and patterns differ significantly with dystonia aetiology and phenotype. Identification of specific firing patterns may help determine targets and patient-specific protocols for neuromodulation therapy. FUNDING: National Institute of Health Research, Guy's and St. Thomas' Charity, Dystonia Society UK, Action Medical Research, German National Academic Foundation.

Hypothalamic Na(+)-K(+)-ATPase inhibitor characterized in two-sided liposomes containing pure renal Na(+)-K(+)-ATPase.

The functional characterization of putative endogenous inhibitors of the Na(+)-K(+)-ATPase has been greatly hindered by spare amounts extractable from biological sources. We therefore used a miniaturized, two-sided test system consisting of ATP-filled liposomes containing dispersed, randomly oriented renal Na(+)-K(+)-ATPase molecules to study effects of a low-molecular-weight, nonpeptidic Na(+)-K(+)-ATPase inhibitor extracted from bovine hypothalamus. With this test system, Na(+)-K(+)-ATPase inhibition produced by a single dose of 0.1 U (congruent to 75 fmol) of the hypothalamic inhibitory factor (HIF) as well as the membrane permeation of a single unit (approximately equal to 750 fmol) became measurable, and an estimation of the minimal number of HIF molecules per unit could be made. By a molecular mechanism involving positive cooperativity, HIF potently and completely blocked active 86Rb+ transport catalyzed by the right-side-out-oriented pump population, with an average 50% inhibitory concentration of 3.5 x 10(-8) M, indicating a roughly 30-fold higher apparent affinity than ouabain. By studying inhibition of the inside-out-oriented pump population, comparison of the membrane permeability of HIF to that of various cardiac glycosides of known hydrophobicity further indicated that HIF is not entirely ouabain-like as HIF penetrates the liposomal membrane, whereas ouabain does not. Besides the cardiac glycosides, HIF is the only compound tested thus far in the purified system that displays such striking transport inhibition. Other known or proposed endogenous Na(+)-K(+)-ATPase inhibitors, including unsaturated fatty acids, palytoxin, dehydroepiandrosterone, and vanadate, produce only partial transport inhibition even at high concentration.

[Digitalis receptor]. / Le récepteur digitalique.

It has been well established that the Na+,K+-ATPase is the pharmacological receptor of cardiac glycosides. One or several endogenous analogues of these digitalis compounds have been shown to interfere with radioimmunoassays (RIA). Given the low therapeutic range of the steroid cardiotonics, such interference must be taken into consideration. The present review briefly describes the digitalis receptor and discusses monitoring by RIA of patients treated with cardiac glycosides. Finally, the putative origin and chemical nature of this (these) endogenous digoxin-like factor(s) are presented in detail.

Characterization of (Na+ + K+)-ATPase-liposomes. III. Controlled activation and inhibition of symmetric pumps by timed asymmetric ATP, RbCl, and cardiac glycoside addition.

Inside-out as well as right-side-out oriented (Na+ + K+)-ATPase molecules reconstituted in liposomes are activated successively by timed asymmetric addition of ATP to the internal and external liposome compartment; this presents the first functional confirmation of the symmetric pump-orientation in cholate-dialysed preparations revealed previously by the equal distribution of intramembrane particles on the concave and convex surface of freeze-fractured (Na+ + K+)-ATPase-liposomes. The initial transport rates of the symmetrically oriented pump populations are regulated by varying the bilateral K or Rb ion concentrations; ATP, ouabain, digoxin or vanadate are used to activate or block selectively the right-side-out, inside-out or both (Na+ + K+)-ATPase populations. Finally, these liposomes of the second generation present a new tool to evaluate the membrane-permeability as well as the effects of receptor-ligands or other probes in a single preparation.