Role of glutamate and its receptors in migraine with reference to amitriptyline and transcranial magnetic stimulation therapy.

Glutamate plays an important role in migraine pathogenesis but there is paucity of studies on glutamate in migraine subtypes, effect of treatment on glutamate levels and the changes in glutamate receptors. In this study we report the glutamate levels and changes in glutamate receptors following amitriptyline (AMT) or repetitive Transcranial Magnetic Stimulation (rTMS) therapy. One hundred and fifty migraine patients having more than 4 migraine attacks per month were included. Thirty patients were treated with AMT and 120 with rTMS; 24 patients received 3 sessions, 36 received single session of rTMS and 60 patients received sham stimulation. The severity of headache was assessed by VAS score, Migraine Index (MI) and frequency of headache. Good outcome was defined by 50% improvement in headache frequency; severity and MI. Plasma glutamate level were measured by enzyme linked immunosorbant assay and relative expression of NR2B and mGluR3 receptors by real time polymerase chain reaction. The changes in these parameters before and after treatment were measured and correlated with the clinical parameters. Glutamate levels (P = 0.006) and NR2B receptor expressions (P < 0.001) were significantly higher in migraine patients compared to the controls. Chronic migraine patients had higher glutamate level (P = 0.05). Glutamate and NR2B receptor declined after treatment (P < 0.001). There was a decline in glutamate levels following rTMS (P = 0.03), sham stimulation (P = 0.05) and AMT treatment (P = 0.003). NR2B receptors also declined after rTMS (P = 0.005) and AMT treatment (P = 0.01). It can be concluded that migraine is associated with high plasma glutamate and NR2B receptor which decline following AMT or rTMS therapy.

Memory and Learning Dysfunction Following Copper Toxicity: Biochemical and Immunohistochemical Basis.

The prototype disease of Cu toxicity in human is Wilson disease, and cognitive impairment is the presenting symptom of it. There is no study correlating Cu-induced excitotoxicity, apoptosis, and astrocytic reaction with memory dysfunction. We report excitotoxicity, apoptosis, and astrocytic reaction of the hippocampus and frontal cortex with memory dysfunction in rat model of Cu toxicity. Thirty-six rats were divided into group I (control) and group II (100 mg/kgBwt/day CuSO4 orally). Y-maze was performed for memory and learning at 0, 30, 60, and 90 days. Frontal and hippocampal free Cu concentration, oxidative stress markers [glutathione (GSH), total antioxidant toxicity (TAC), and malondialdehyde (MDA)], and glutamate were measured by atomic absorption spectroscopy, spectrophotometry, and ELISA, respectively. N-methyl-D-aspartate receptors (NMDARs) NR1, NR2A, and NR2B were done by real-time polymerase chain reaction. Immunohistochemistry for caspase-3 and glial fibrillary acidic protein (GFAP) were done and quantified using the ImageJ software. The glutamate level in hippocampus was increased, and NMDAR expression was decreased at 30, 60, and 90 days in group II compared to group I. In the frontal cortex, glutamate was increased at 90 days, but NMDARs were not significantly different in group II compared to group I. Caspase-3 and GFAP expressions were also higher in group II compared to group I, and these changes were more marked in hippocampus than frontal cortex. These changes correlated with respective free tissue Cu, oxidative stress, and Y-maze attention score. Cu toxicity induces apoptosis and astrocytosis of the hippocampus and frontal cortex through direct or glutamate and oxidative stress pathways, and results in impaired memory and learning.

Temporal kinetics of organ damage in copper toxicity: A histopathological correlation in rat model.

Excess of copper is toxic to different organs. We aim to study the histopathological changes of liver, kidney, and brain following oral CuSO4 exposure for different duration and doses in rat model. Fifty-four males Wistar rats (205 ± 10 g) were included and divided into control (group-I) and experimental (group-II and III) arms. An oral dose of 100 and 200 mg/kgBWt/Day CuSO4 was given to group-II and III respectively and group-I received normal saline by gavage. Six rats from each group were sacrificed on days 30, 60 and 90 for biochemical and histopathological examinations. The histopathological changes were graded on 1-5 scores and correlated with respective laboratory parameters. The organ functions were worsened in experimental group with increasing dose and time. Histopathological study revealed edema, hemorrhage, necrosis and fibrosis/gliosis in experimental group. The worst histopathological severity score ranged from 4 to 5(median 5) in liver, 3-5(median 4) in kidney and 4-5(median 5) in brain. The edema and hemorrhage were more marked at 30 days and fibrosis/gliosis at 90 days. In conclusion, high-dose Cu toxicity results in structural damage to liver, kidney, and brain that correlates with organ dysfunction, Cu, GSH, TAC, and MDA concentrations. Liver damage is more severe and occurs earlier than other organs.

Role of Oxidative Stress in the Worsening of Neurologic Wilson Disease Following Chelating Therapy.

Patients with neurologic Wilson disease (NWD) may worsen on treatment, but there is no study evaluating the role of oxidative stress. We report the role of plasma glutathione (GSH), total antioxidant capacity (TAC) and malondialdehyde (MDA) in the worsening of NWD following treatment. Fifty-one treatment-naïve NWD patients were subjected to detailed clinical evaluation. The severity of NWD was noted, and dystonia was measured by Burke-Fahn-Marsden (BFM) score. Their hematological, serum chemistry, ultrasound abdomen and cranial MRI changes were noted. Plasma GSH, TAC and MDA, serum free copper (Cu) and 24-h urinary Cu were measured at admission and at 3 and 6 months after treatment. The patients were considered worsened if there was one or more grade deterioration in severity scale, >10 % deterioration in BFM score or appearance of new neurologic signs. The median age of the patients was 11 (5-37) years, and 12 were females. Following treatment, 25 patients improved, 12 worsened, and 14 had stationary course. The worsened group at 3 months had lower GSH (1.99 ± 0.17 vs. 2.30 ± 0.30 mg/dl; P = 0.004) and TAC (1.59 ± 0.12 vs. 1.82 ± 0.17 mmol Trolox equivalent/L; P = 0.001) and higher MDA (5.24 ± 0.22 vs. 4.34 ± 0.46 nmol/ml; P < 0.001) levels compared to the improved group. These changes were associated with increased serum free Cu (41.81 ± 3.31 vs. 35.62 ± 6.40 µg/dl; P = 0.02) and 24-h urinary Cu (206.42 ± 41.61 vs. 121.99 ± 23.72 µg/24 h; P < 0.001) in the worsened compared to the improved group. All the patients having worsening were on penicillamine. Worsening following chelating treatment in NWD may be due to oxidative stress which is induced by increased serum free Cu. These results may have future therapeutic implication and needs further study.