In situ postmortem ethanol quantification in the cerebrospinal fluid by non-water-suppressed proton MRS.

Determination of the ethanol concentration in corpses with MRS would allow a reproducible forensic assessment by which evidence is collected in a noninvasive manner. However, although MRS has been successfully used to detect ethanol in vivo, it has not been applied to postmortem ethanol quantification in situ. The present study examined the feasibility of the noninvasive measurement of the ethanol concentration in human corpses with MRS. A total of 15 corpses with suspected alcohol consumption before demise underwent examination in a 3 T whole body scanner. To address the partial overlap of the ethanol and lactate signal in the postmortem spectrum, non-water-suppressed single voxel spectra were recorded in the cerebrospinal fluid (CSF) of the left lateral ventricle via the metabolite cycling technique. The ethanol signals were quantified using the internal water as reference standard, as well as based on a reference signal acquired in a phantom. The measured values were compared with biochemically determined concentrations in the blood (BAC) and CSF (CSFAC). In 8 of the 15 corpses a BAC above zero was determined (range 0.03-1.68 g/kg). In all of these 8 corpses, ethanol was measured in CSF with the proposed MRS protocol. The two applied MRS calibration strategies resulted in similar concentrations. However, the MRS measurements generally overestimated the ethanol concentration by 0.09 g/kg (4%) to 0.72 g/kg (45%) as compared with the CSFAC value. The presented MRS protocol allows the measurement of ethanol in the CSF in human corpses and provides an estimation of the ethanol concentration prior to autopsy. Observed deviations from biochemically determined concentrations are mainly explained by the approximate correction of the relaxation attenuation of the ethanol signal.

The longitudinal cerebrospinal fluid metabolomic profile of amyotrophic lateral sclerosis.

Neurochemical biomarkers are urgently sought in ALS. Metabolomic analysis of cerebrospinal fluid (CSF) using proton nuclear magnetic resonance ((1)H-NMR) spectroscopy is a highly sensitive method capable of revealing nervous system cellular pathology. The (1)H-NMR CSF metabolomic signature of ALS was sought in a longitudinal cohort. Six-monthly serial collection was performed in ALS patients across a range of clinical sub-types (n = 41) for up to two years, and in healthy controls at a single time-point (n = 14). A multivariate statistical approach, partial least squares discriminant analysis, was used to determine differences between the NMR spectra from patients and controls. Significantly predictive models were found using those patients with at least one year's interval between recruitment and the second sample. Glucose, lactate, citric acid and, unexpectedly, ethanol were the discriminating metabolites elevated in ALS. It is concluded that (1)H-NMR captured the CSF metabolomic signature associated with derangements in cellular energy utilization connected with ALS, and was most prominent in comparisons using patients with longer disease duration. The specific metabolites identified support the concept of a hypercatabolic state, possibly involving mitochondrial dysfunction specifically. Endogenous ethanol in the CSF may be an unrecognized novel marker of neuronal tissue injury in ALS.

Revisiting the controversial role of salsolinol in the neurobiological effects of ethanol: old and new vistas.

The possible involvement of salsolinol (Sal), an endogenous condensation product of ACD (the first metabolite of ethanol) and dopamine, in the neurochemical basis underlying ethanol action has been repeatedly suggested although it has not been unequivocally established, still being a controversial matter of debate. The main goal of this review is to evaluate the presumed contribution of Sal to ethanol effects summarizing the reported data since the discovery in the 1970s of Sal formation in vitro during ethanol metabolism until the more recent studies characterizing its behavioral and neurochemical effects. Towards this end, we first analyze the production and detection of Sal, in different brain areas, in basal conditions and after alcohol consumption, highlighting its presence in regions especially relevant in regulating ethanol-drinking behaviour and the importance of the newly developed methods to differentiate both enantiomers of Sal which could help to explain some previous negative findings. Afterwards, we review the behavioral and neurochemical studies. Finally, we present and discuss the previous and current enunciated mechanisms of action of Sal in the CNS.

Ethanol inhibits the sensory responses of cerebellar granule cells in anesthetized cats.

BACKGROUND: Granule cells occupy a strategic position in the transmission of afferent information to the cerebellar cortex. They are also the most abundant type of neurons in the cerebellum. The functions of the cerebellum are thought to be sensitive to acute alcohol intoxication. The effects of acute alcohol intoxication on the in vivo physiology of cerebellar granule cells are, however, not completely known. METHODS: We studied chloralose-anesthetized cats at ethanol doses relevant to human drinking (0.3-1.2 g/kg). We recorded the electrophysiological responses of granule cell clusters to auditory and visual stimulation, and simultaneously monitored the concentration of ethanol in the cerebrospinal fluid (CSF). RESULTS: At an intravenous ethanol dose of 0.3 g/kg, CSF ethanol concentration peaked in 10 minutes at 17 mM, equivalent to a blood alcohol concentration (BAC) of about 0.08 g/dL. Ethanol quickly and almost completely abolished both auditory and visual responses from granule cells. Complete or near-complete inhibition lasted 15 to 20 minutes; approximately 50% recovery required an additional 15 minutes, and a full recovery yet another 15 minutes. A higher ethanol dose at 1.2 g/kg resulted in a more severe inhibition and required longer time for recovery. The relationship between ethanol dose, CSF ethanol concentration, and granule cell responses was dynamic and nonlinear, critically depending upon the elapsed time. CONCLUSIONS: Cerebellar granule cell sensory responses are highly sensitive to ethanol inhibition. A rapid development of acute tolerance appears to be a major factor contributing to the dynamic and nonlinear relationship among ethanol dosage, CSF ethanol concentration, and granule cell responses. It is likely that a generalized de-afferentation of the cerebellum from its mossy fiber afferents, followed by the subsequent development of acute tolerance may play major roles by which alcohol intoxication affects cerebellar functions.

1H-NMR studies of cerebrospinal fluid: endogenous ethanol in patients with cervical myelopathy.

Endogenous ethanol was observed by nuclear magnetic resonance spectroscopy in the course of screening for cerebrospinal fluid of the patients with cervical myelopathy. Ethanol was detected in 10 out of 20 patients. It seems likely that the presence of endogenous ethanol is related to the severity of myelopathy. Also, the concentration of ethanol was correlated with that of lactate in the cerebrospinal fluid. This implies that ethanol may be formed as the end product of glycolysis or in an unknown pathway in the case of severely insulted myelonic tissues.

CSF monoamine metabolite and beta endorphin levels in recently detoxified alcoholics and healthy controls: prediction of alcohol cue-induced craving?

BACKGROUND: Abnormalities in central neurotransmitter systems have been described in alcohol-dependent individuals and may contribute to alcohol craving. This study compared cerebrospinal fluid (CSF) levels of monoamine metabolites and beta endorphin levels in samples from early-onset alcohol-dependent patients (n = 20), late-onset alcohol-dependent patients (n = 14), and healthy controls (n = 23). It also evaluated whether these CSF measures levels predicted the degree of craving experienced in response to an alcohol cue. METHODS: Individuals meeting DSM-III and -IV R-criteria for alcohol dependence, 1 to 3 months postdetoxification, and healthy controls underwent a lumbar puncture. Patients also completed a cue exposure test day between 3 and 15 days later. RESULTS: Alcohol-dependent patients had lower CSF levels of the norepinephrine metabolite MHPG compared with the healthy subjects, but this difference disappeared when differences in age between the groups were accounted for. No other group comparisons between patients and healthy subjects reached significance. CSF levels of the dopamine metabolite HVA were significantly higher in the early-onset patients compared with the late-onset patients and controls. The CSF measures did not predict the precue levels of craving, or the increase in craving after alcohol cue exposure. CONCLUSIONS: These results are inconclusive about the role of monoaminergic dysregulation in recovering alcoholics. They also question the utility of these CSF measures to predict alcohol cue reactivity in patients who have been sober at least 1 month.

Acute ethanol decreases NMR relaxation times of water hydrogen protons in fish brain.

The traditional belief about ethanol's mechanism of action is based on ethanol's lipophilicity and capability to penetrate and disorder lipid bilayers. This traditional belief is now being supplanted by growing evidence that ethanol has relatively selective actions on certain synaptic receptors, such as those for NMDA, serotonin, and GABA. It was recently argued that these receptor specificities are secondary to a preferential ability of ethanol to displace membrane bound water in the domains of certain receptors. The data obtained in this study are consistent with the original hypothesis: any disorganization of cellular water by ethanol will be detectable by proton nuclear magnetic resonance (NMR) spectroscopy. In particular, the relaxation times of water hydrogen protons reflect how constrained water molecules are by the macromolecules within cells. The relaxation time of "bulk" water is lengthened relative to water molecules that are under the influence of electromagnetic fields of macromolecular surfaces within cells. Here, we tested this hypothesis in living fish, which dosed themselves by swimming in water that had added ethanol. Estimates of brain alcohol at 5 min after initial exposure revealed that the brain concentration was only about 1/3 that of the water in which they were swimming. The average value of the NMR relaxation time T1, but not T2, was decreased at 5 min (when brain concentrations were on the order 100 mM) and reached statistical significance at 10 and 30 min after initial exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinetics of drug action in disease states. XLIII: Potentiating effect of L-tryptophan on the hypnotic action of phenobarbital and ethanol in rats.

The essential amino acid L-tryptophan has been widely used as a sleeping aid because it can produce drowsiness and decrease sleep latency. Its concentrations in plasma and brain and its binding to plasma protein are markedly altered in hepatic encephalopathy and renal failure. The purpose of this investigation was to determine if L-tryptophan can enhance the sensitivity of the central nervous system to the hypnotic actions of a barbiturate and an alcohol. Female rats weighing approximately 200 g received an intravenous infusion of L-tryptophan (0.8 or 0.08 mg/min) for 30 min and then an infusion of phenobarbital (0.824 mg/min) with L-tryptophan (0.8 or 0.08 mg min-1) until the onset of loss of righting reflex (LRR). Control animals received an infusion of saline solution for 30 min and then phenobarbital without the amino acid. Similar experiments were performed with ethanol (16.3 mg/min), with and without L-tryptophan (0.8 mg/min). L-Tryptophan infused alone at a rate of 3.8 mg/min for 84 min did not cause LRR. Administration of L-tryptophan at a rate of 0.8 mg/min with phenobarbital was associated with statistically significant reductions in the total dose and concentrations of phenobarbital in serum, serum water, brain, and cerebrospinal fluid (CSF) at onset of LRR. The 0.08 mg/min infusion of L-tryptophan had a less pronounced effect, with statistically significant reductions of phenobarbital concentrations at onset of LRR in brain and CSF. L-Tryptophan also significantly reduced the total dose and the concentrations of ethanol in serum, brain, and CSF required to produce LRR.(ABSTRACT TRUNCATED AT 250 WORDS)

Ionic composition of cisternal CSF in acute respiratory acidosis: lack of effect of large dose bumetanide.

Sodium/chloride cotransport carrier is known to be involved in transepithelial fluid absorption and secretion in various tissues. Recent studies indicate that Na,K,2Cl cotransport carrier also exists in the choroid plexus cells and inhibition of the carrier alters ionic composition of the choroidal tissue. In this study, we report the effects of large dose intravenous bumetanide, a potent inhibitor of Na,K,2Cl carrier, on cisternal CSF ionic composition in acute respiratory acidosis in pentobarbital-anesthetized mechanically ventilated dogs. Renal pedicles were ligated to prevent bumetanide-induced diuresis. The experimental group (Group II, n = 7) received 50 mg/kg of bumetanide intravenously and Group I (the control group, n = 7) received the vehicle. Analysis of serum and choroidal plexus tissue revealed bumetanide concentration of approximately 10(-5) mol/L in Group II. During 5 h of acute respiratory acidosis in both groups, the mean PaCO2 increased approximately 25 mm Hg, with comparable changes in CSF PCO2. In both groups, CSF [HCO3-] and [H+] increased approximately 3 mEq/L and 20 nEq/L, respectively. Furthermore, changes in CSF [Na+], [K+], [Ca2+], [Mg2+], [Cl-], and [Na(+)-Cl-] were also similar and were not significantly different from each other. These data show that bumetanide, at the dose that inhibits NaCl cotransport carrier, does not significantly affect ionic composition of cisternal CSF.

Alcohol levels in cerebrospinal fluid and blood samples from patients under pathological conditions.

We measured alcohol levels by the Cordebard method in 148 CSF samples from individuals who had abstained from alcohol for at least 7 days prior to the beginning of the study. Each blood sample was accompanied by a CSF sample from the same patient. CSF samples found to be normal after analysis were used as controls. Mean alcohol concentration in blood did not differ significantly between the control group and the groups with altered CSF. The group with altered CSF had statistically higher alcohol levels in CSF than in blood. CSF lactate, glucose and protein levels were not correlated with alcohol level. The results suggest the presence of endogenous alcohol in the CSF, with levels increasing in the presence of pathological processes involving the nervous system.

Alcohol in cerebrospinal fluid (CSF) and alcoholism.

Alcohol levels were measured in 15 cerebrospinal fluid (CSF) samples and 14 blood samples from grade III and IV male alcoholic patients with signs of nervous system involvement, and compared with levels detected in 11 CSF samples and 11 blood samples from abstemious patients or patients with grade I or II alcoholism whose CSF had been found to be normal by routine analysis (controls). Among the alcoholic patients, alcohol levels were lower in the CSF than in blood, whereas the opposite was true for the controls. The possible mechanisms underlying this difference are discussed and the need for further study of this topic is emphasized.

Environment-dependent tolerance to ethanol produced by intracerebroventricular injections in mice.

In comparison to other routes of drug administration, an intracerebroventricular (ICV) injection requires the use of a very small amount of ethanol in mice to produce a brief but substantial hypothermic response. By avoiding the longer duration of drug action, use of ICV injections may facilitate the demonstration of the contribution of certain aspects of learning in the expression of tolerance. Therefore, tolerance to ethanol was developed in mice in a Pavlovian conditioning paradigm with eight ICV injections of ethanol delivered at 2-h intervals so that the animals received four injections per day for 2 days. The effect of ethanol in a different environment was tested on the following day. Environment-dependent tolerance to the hypothermic effect of ethanol and a robust conditioned compensatory response were demonstrated when the mice were trained and tested with ICV injections of 2.0 mg ethanol. The environment-dependent tolerance was also evident when the mice were trained with ICV injections and tested with intraperitoneal injections of ethanol. These results demonstrate that ICV injections are a beneficial means of clarifying the role of learning phenomena in the development of tolerance.

Kinetics of drug action in disease states. VII. Effect of experimental renal dysfunction on the pharmacodynamics of ethanol in rats.

This investigation was designed to determine if renal dysfunction is associated with an increased sensitivity to the CNS depressant effect of ethanol. Adult female Lewis rats were given injections of either 2 or 5 mg/kg of uranyl nitrate (saline for controls) or had both ureters ligated (sham operation for controls) to provide different experimental models of renal dysfunction. Normal and renal dysfunction (ureter-ligated) rats were infused i.v. with ethanol at rates of 8.1, 16.3 or 32.6 mg/min; concentrations of ethanol in cerebrospinal fluid, serum and brain at onset of loss of righting reflex were independent of infusion rate in both groups, indicating rapid equilibration of ethanol between the sampling sites and the biophase. Ethanol concentrations in cerebrospinal fluid at onset and offset (after approximately 110 min of sleep) of loss of righting reflex were not significantly different, reflecting negligible acute tolerance development under the experimental conditions. Ethanol concentrations at onset of loss of righting reflex in cerebrospinal fluid, serum and brain of rats with severe renal dysfunction (5 mg/kg of uranyl nitrate-treated and ureterligated groups) were slightly but statistically significantly lower than in normal controls. This difference was relatively much smaller than the difference in phenobarbital concentrations observed in a similar preceding study, which is consistent with the different mechanisms of action of alcohols and barbiturates.

[Evaluation of alcohol in the cerebrospinal fluid]. / Problematika vyhodnocení alkoholu v mozkomísním moku.

Authors studied alcohol in cerebrospinal fluid as well as in blood and showed that the blood alcohol level cannot be commonly estimated from the examination of alcohol level in cerebrospinal fluid.

Acute tolerance to ethanol on the release of acetylcholine from the cat cerebral cortex.

Ethanol (1 g/kg, iv) produced a peak depression of acetylcholine release from the cat sensorimotor cortices within 30 min of the ethanol administration but recovery to control levels occurred in the following 30 min. However, the concentrations of ethanol in the blood and in the solution bathing the cortex remained stable during this recovery period. This example of acute tolerance to ethanol is possibly related to the well-known acute tolerance that develops to the behavioural effects of ethanol.

The influence of acute ethanol intoxication on intracranial physical dynamics.

The influence of acute ethanolic intoxication on intracranial physical dynamics was assessed in 42 adult cats. Acute ethanolism significantly alters intracranial tissue compliance as determined by the intracranial volume-pressure response. Cerebral vasodilatation, secondary to ethanol administration, appears to be an underlying mechanism, possibly augmented by secondary cerebral edema. Studies of CSF production and absorption as well as osmolar ratio show no changes under conditions of acute ethanol intoxication. The observed decrease in cerebral compliance may well relate to the poor prognosis, in general, of the alcoholic brain that is subjected to trauma.