Case report: Isolated brainstem-cerebellar symptoms in a patient with anti-NMDA receptor encephalitis.

Cerebellar ataxia is an uncommon and atypical manifestation of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, often accompanied by seizures, psychiatric symptoms, and cognitive deficits. Previous cases of isolated brainstem-cerebellar symptoms in patients with anti-NMDAR encephalitis have not been documented. This report presents a case of anti-NMDAR encephalitis in which the patient exhibited cerebellar ataxia, nystagmus, diplopia, positive bilateral pathological signs, and hemiparesthesia with no other accompanying symptoms or signs. The presence of positive CSF anti-NMDAR antibodies further supports the diagnosis. Other autoantibodies were excluded through the use of cell-based assays. Immunotherapy was subsequently administered, leading to a gradual recovery of the patient.

Inflammatory markers of hemogram parameters as predictive factors for disease severity in anti-N-methyl-D-aspartate receptor encephalitis.

OBJECTIVE: This study aimed to investigate the utility of inflammatory markers of hemogram parameters as objective indicators of disease severity in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. METHODS: A total of 98 patients were retrospectively reviewed. Inflammatory markers of hemogram parameters, including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio, were acquired within 24 h of admission. We then analyzed their utility as predictive factors for disease severity at different time points assessing with the modified Rankin Scale (mRS). RESULTS: There were 49 patients in the mild group (mRS ≤ 2) and 49 patients in the moderate-to-severe (mRS > 2) group at admission. The moderate-to-severe group presented more frequently with psychiatric symptoms and central hypoventilation, as well as a lower lymphocyte count, a higher neutrophil count, a higher NLR and a higher MLR (all p < 0.05) when compared with the mild group. NLR and MLR showed similar positive correlations with mRS scores (r = 0.40, r = 0.40, both p < 0.001). Further multivariate logistic regression analyses indicated that NLR > 4.232 was an independent risk factor for moderate-to-severe status at admission. Meanwhile, NLR and MLR were associated with disease severity at different stages of follow-up but showed no independent predictive value. CONCLUSION: Our findings suggested that NLR was an independent risk factor for moderate-to-severe status in the initial stage of anti-NMDAR encephalitis with a cut-off value of > 4.232.

Early-Onset Parkinson's Disease and Brain Iron Accumulation Caused by a Novel Homozygous DJ-1 Mutation.

DJ-1 mutations are rare causes of autosomal recessive early-onset Parkinson's disease (AR-EOPD) and relatively rarely reported in the Chinese population. Here, we used the whole-exome sequencing and Sanger sequencing to investigate DJ-1 mutations in the Chinese population and confirmed the pathogenicity of the mutation using primary fibroblasts established from skin biopsies. We identified a novel homozygous mutation (c.390delA, p.D131Tfs*3) in DJ-1 in a consanguineous Chinese family. The proband in this family had parkinsonism at the age of 22. His brain MRI indicated brain iron accumulation in the basal ganglia and cerebellum. The novel mutation caused DJ-1 protein deficiency, led to mitochondrial dysfunction, inhibited cell proliferation, and anti-oxidant defense.

Morvan syndrome associated with LGI1 antibody: a case report.

BACKGROUND: Morvan syndrome (MoS) is a rare autoimmune syndrome associated with antibodies against two kinds of potassium channel proteins, contactin associated protein-like 2 (CASPR2) and leucine-rich glioma inactivated protein 1 (LGI1). MoS patients with only LGI1-antibody seropositivity have rarely been reported. Here, we describe a 64-year-old male MoS patient with only LGI1-antibody seropositivity. CASE PRESENTATION: A 64-year-old male patient was referred to our hospital due to limb pain, widespread myokymia, insomnia, constipation, and hyperhidrosis for 1 month. The patient was diagnosed with MoS based on the clinical symptoms and positive LGI1-antibody in serum. He was treated with intravenous immunoglobulin (IVIG), intravenous methylprednisolone followed by oral prednisone, and other drugs for symptomatic relief. Several days later, myokymia and insomnia symptoms improved. After 60 days of follow-up, all the drugs had been stopped for 2 weeks, and the patient achieved complete remission without any medical side effects. CONCLUSION: We report the clinical characteristics of a Chinese MoS patient with only LGI1-antibody seropositivity, and further support the view that non-neoplasm MoS patients respond well to immunotherapy.

Aerobic Oil-Phase Cyclic Magnetic Adsorption to Synthesize 1D Fe2O3@TiO2 Nanotube Composites for Enhanced Visible-Light Photocatalytic Degradation.

In this work, Fe2O3@TiO2 nanostructures with staggered band alignment were newly designed by an aerobic oil-phase cyclic magnetic adsorption method. XRD and TEM analyses were performed to verify the uniform deposition of Fe2O3 nanoparticles on the nanotube inner walls of TiO2. The steady-state degradation experiments exhibited that 1FeTi possessed the most superior performance, which might be ascribable to the satisfying dark adsorption capacity, efficient photocatalytic activity, ease of magnetic separation, and economic efficiency. These results indicated that the deposition of Fe2O3 into TiO2 nanotubes significantly enhanced the activity of Fe2O3, which was mainly ascribed to the Fe2O3-induced formation of staggered iron oxides@TiO2 band alignment and thus efficient separation of h+ and e-. Furthermore, the PL intensity and lifetime of the decay curve were considered as key criterions for the activity's evaluation. Finally, the leaching tests and regeneration experiments were also performed, which illustrated the inhibited photodissolution compared with TiO2/Fe3O4 and stable cycling ability, enabling 1FeTi to be a promising magnetic material for photocatalytic water remediation.

Novel ATP13A2 and PINK1 variants identified in Chinese patients with Parkinson's disease by whole-exome sequencing.

Genetic factors are considered to play a critical role in patients with early-onset Parkinson's disease (EOPD). The genetic spectrum of EOPD patients has been extensively investigated in Caucasian populations but rarely in the Chinese population. In this study, a total of 21 unrelated Chinese EOPD patients were enrolled. Multiplex ligation-dependent probe amplification assay and whole-exome sequencing were performed, followed by Sanger sequencing. Detailed clinical features were presented. Two novel likely pathogenic variants (p.Q648X in ATP13A2 and p.N521fs in PINK1) and 10 previously reported Parkin pathogenic variations (exon 2 deletion, exon 3-4 deletion, exon 4 deletion, exon 6-7 deletion, exon 7 deletion; p.G284R, p.G329 V, p.R366W, p.N428fs, p.M458 L) were identified in 9 out of 21 (42.86%) patients. The frequency (33.33%) of Parkin variations is much higher in our cohort than that in the East Asian population. The patient carrying the ATP13A2 variant showed no response to levodopa treatment. Our findings broaden the genetic spectrum and clinical features of EOPD patients.

Clinical and genetic characteristics of Chinese patients with cerebrotendinous xanthomatosis.

BACKGROUND: Cerebrotendinous xanthomatosis (CTX) is a rare inborn lipid-storage disease caused by mutations in the sterol 27-hydroxylase (CYP27A1) gene with an autosomal recessive pattern of inheritance. To date, only 19 CTX patients from 16 families have been reported in the Chinese population. RESULTS: Three novel likely pathogenic mutations (c.368_374delCCAGTAC, c.389 T > A and c.571C > T) and 7 previously reported pathogenic mutations (c.379C > T, c.435G > T, c.1016C > T, c.1214G > A, c.1263 + 1G > A, c.1420C > T and c.1435C > T) were identified. In addition, we summarized the genotypes and phenotypes of reported Chinese CTX patients. The most predominant mutations in CYP27A1 were c.410G > A and c.379C > T, and the most common clinical manifestations were pyramidal signs, xanthomatosis, cerebellar ataxia, and cognitive impairment. CONCLUSION: Our study broadens the genetic and clinical spectrum of CTX and provides insightful information to help better diagnose and understand the disease.

Common variants at Bin1 are associated with sporadic Alzheimer's disease in the Han Chinese population.

OBJECTIVES: Recent genome-wide association studies identified bridging integrator 1 (Bin1) to be associated with sporadic Alzheimer's disease (SAD). To clarify the relevance of Bin1 as a genetic determinant of AD, we analyzed its association in a Han Chinese population from the South East part of mainland China. METHODS: This study investigated 427 SAD patients and 451 unrelated age-matched and sex-matched healthy controls. Two single nucleotide polymorphisms (rs7561528 and rs744373) adjacent to Bin1 that emerged from previous genome-wide association studies were genotyped using the MassARRAY Analyzer 4 Sequenom platform. RESULTS: As expected, the genotype distribution of rs7561528 was significantly different between the SAD group and the controls, with more AG in controls [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.429-0.854, P=0.004], and the difference increased using an additive genetic model (OR 0.593, 95% CI 0.425-0.828, P=0.002). However, we did not observe a difference in the genotype distribution of the rs744373 between the SAD and the control group (OR 1.189, 95% CI 0.809-1.747, P=0.378). CONCLUSIONS: To the best of our knowledge, our study is the first to confirm the association of the variant rs7561528 adjacent to Bin1 with SAD in a Han Chinese Population.

A variant within FGF1 is associated with Alzheimer's disease in the Han Chinese population.

Alzheimer's disease (AD) is the most common neurodegenerative disorder characterized by the accumulation of amyloid beta (Aß) plaques and Tau-containing neurofibrillary tangles in vulnerable brain areas. The progression of AD is well correlated with hippocampal neuron loss which highly suggests genes associated with neuron survival would be important for AD pathogenesis. According to the recent results of genome-wide association studies (GWAS) and other reported studies, we selected two single nucleotide polymorphisms (SNPs), rs3765728 within tumor protein p73 (P73), and rs34011 within fibroblast growth factor 1 (FGF1), both genes were related to neuron survival. We analyzed the distribution of rs3765728 and rs34011 in 1,083 Chinese subjects including 429 unrelated sporadic AD patients and 654 unrelated age and gender-matched control subjects. We found that the genotype distribution of rs34011 was significantly different between AD and control group (χ(2) = 9.048, df = 2, P = 0.011). Logistic regression manifested the risk of AD increased in TT genotype carriers in total subjects (Wald = 8.892, df = 1, P = 0.003, odds ratio [OR]:2.009, 95% confidence interval [95%CI]: 1.270-3.178). This effect was also found in APOE ϵ4 carrier group (Wald = 7.844, df = 1, P = 0.005, OR: 4.201, 95%CI: 1.539-11.472), suggesting the rs34011 has a synergetic effect of APOE on AD risk. However, no association was observed between rs3765728 and AD in the Han Chinese population (χ(2) = 0.431, df = 2, P = 0.806).

Adeno-associated virus type 2 vector-mediated glial cell line-derived neurotrophic factor gene transfer induces neuroprotection and neuroregeneration in a ubiquitin-proteasome system impairment animal model of Parkinson's disease.

BACKGROUND: The impairment of the ubiquitin-proteasome system (UPS) is a cellular mechanism underlying the neurodegenerative process in Parkinson's disease (PD). A mouse model induced by the selective proteasome inhibitor lactacystin targeting on substantia nigra has been demonstrated to be valuable in investigating etiopathogenesis and neuroprotection for PD. OBJECTIVE: In the present study, we used adeno-associated virus type 2 vector (AAV2) encoding glial cell line-derived neurotrophic factor (GDNF) injected into the striatum of this animal model to test the effectiveness and possible mechanisms of GDNF gene therapy. RESULTS: Our results showed that AAV2-mediated GDNF gene therapy significantly attenuated lactacystin-induced loss of nigral dopamine (DA) neurons and striatal DA levels. Furthermore, we found that GDNF protein is mostly expressed in astrocytes in the subventricular zone (SVZ) and dentate gyrus (DG). AAV2-mediated GDNF therapy can induce neurogenesis in the SVZ and DG, and increase the number of nigral newborn DA neurons. CONCLUSION: These data indicate that AAV2-mediated GDNF gene therapy can protect the nigral DA neurons from the UPS impairment-induced degeneration, which may partly result from the nigral DA neuron regeneration in the brain, and such experimental results may have implications for the treatment of PD.

Gender segregation in gene expression and vulnerability to oxidative stress induced injury in ventral mesencephalic cultures of dopamine neurons.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by loss of dopamine (DA) neurons in the substantia nigra pars compacta (SNC). Most epidemiologic studies have demonstrated that PD has a higher prevalence in males than in females. Both hormones and genetic factors have been considered to be contributors to this phenomenon. In the present study, we used primary cultures of ventral mesencephalic (VM) neurons from E13.5 Balb/C mice to investigate whether there were any gender differences in gene expression and cell sensitivity to oxidative stress in sex segregated cultures. We also investigated the role of SRY, the sex-determining region on the Y chromosome, and the female hormone estrogen in the gender dimorphism. We measured the expression levels of genes that previously were thought to be related to PD or DA neuron development and functions by real-time PCR, and found six of them, ATP13A2, ERß, MAO-A, D2, DAT, and Pitx3, showing significantly differential expression between males and females in the normal physiological state or under stress conditions. Furthermore, we demonstrated that male VM neurons are more vulnerable than female neurons to rotenone-induced cytotoxicity and that 17ß-estrogen has a moderate protective effect in both male and female VM neurons. Moreover, we document that SRY can upregulate monoamine oxidase A and downregulate estrogen receptor-ß, and SRY-overexpressing N2A cells enhance the resistance to oxidative stress-induced cell injury. Our results suggest that gender indeed influences several PD-related gene expressions in VM neurons, and SRY and estrogen are involved in the different responses to oxidative stress in culture.