Stiripentol efficacy against status epilepticus and associated mortality in mice.

Stiripentol (STP, Diacomit©) is an antiseizure medication indicated for Dravet syndrome, a rare developmental and epileptic encephalopathy characterized by drug-resistant seizures, including status epilepticus (SE). SE is a life-threatening event that may lead to increased risk of morbidity and mortality. Here, we evaluated the effect of STP on SE and SE-associated mortality using a CBA mouse model induced by systemic administration of methionine sulfoximine (MSO), an irreversible inhibitor of glutamine synthetase. MSO induces convulsions, prolonged seizure (SE) and death, with an increase of blood ammonia level. A single acute intraperitoneal pretreatment with 200-300-400 mg/kg of STP significantly inhibited the number of seizures, SE occurrence and death in MSO-treated animals in a dose-dependent manner. Regarding blood ammonia level, STP significantly reduced by 41 % the hyperammonemia induced by MSO. In conclusion, our results show protective effects of STP to reduce and or suppress the occurrence of SE as well as its associated mortality in mice.

Protective effects of Saccharomyces boulardii CNCM I-745 in an experimental model of NSAID-induced enteropathy.

Nonsteroidal anti-inflammatory drugs (NSAIDs) induce a broad spectrum of gastro-intestinal adverse effects, including ulceration and bleeding. The pathophysiology of NSAID enteropathy is complex and incompletely understood, but some evidence showed that NSAIDs impair the intestinal barrier and cause a gut dysbiosis. Identifying new treatments aiming to reverse or attenuate NSAID-induced adverse effects would have a significant impact on a high number of patients. The aim of this work is to assess the effects of the probiotic yeast Saccharomyces boulardii CNCM I-745 (Sb) on a model of NSAID-induced enteropathy. Four groups of mice were tested: Control, Indomethacin, Sb, and Sb + Indomethacin. A clinical score was evaluated throughout the experiment. Faecal calprotectin, microbiota and haemoglobin analyses were performed. At the end of the treatments, the small intestine, colon, and caecum lengths, and intestinal permeability were measured. Sections of ileum and jejunum were observed to assess a histological score and ileal cytokines were measured by immunoassay. Indomethacin-treated animals showed an increase in their clinical scores, reflecting a worsening of their general state. Mice co-treated with Sb and indomethacin displayed an improvement of their clinical score in comparison with mice treated with indomethacin alone. Sb prevented the indomethacin-induced shortening of the small intestine and caecum, and significantly attenuated the severity of intestinal lesions. Sb also prevented the increase in faecal calprotectin, reduced faecal haemoglobin, and prevented the increase of intestinal permeability in mice treated with indomethacin. Sb also counteracted the increase of faecal bacteria associated with the pathogenesis of NSAID-enteropathy. In conclusion, our results show a protective effect of Sb in a model of indomethacin-induced enteropathy. Sb improved the intestinal barrier function and exerted a positive action on gut microbiota composition.

Feasibility of cetuximab given with a simplified schedule every 2 weeks in advanced colorectal cancer: a multicenter, retrospective analysis.

Cetuximab was approved using a weekly schedule, alone or in combination with chemotherapy (CT). However, many CT regimens in metastatic colorectal cancer (CRC) are delivered every 2 weeks (q2wks). Preliminary data suggested that a simplified schedule using cetuximab q2wks, 500 mg/m² would be equivalent to the standard weekly administration. Medical data of all patients with advanced CRC who received cetuximab q2wks were retrospectively collected and checked for consistency by an independent monitor in 4 European centers. Ninety-one patients were treated between 2005 and 2007 when the K-RAS mutational status of tumors was not determined routinely. They received a median of 4 (0-5) previous drugs, including previous weekly cetuximab in 38.5% of patients. Cetuximab q2wks was associated with an irinotecan-based regimen in 85.7% of patients. The median number of cetuximab administrations was 6 (1-23). Skin toxicity was observed in 68.2% of evaluable patients (grade 3 in 15%). Only one grade 1 allergy was reported. In the 84 patients beyond first-line therapy, response rate was 29.3%. The median progression-free survival was 3.0 months (range 2.2-3.8), and median overall survival was 9.0 months (range 6.2-11.8). Cetuximab q2wks appears safe and effective in heavily pretreated patients and convenient in combination with q2wks CT schedules.

D-JNKi, a peptide inhibitor of c-Jun N-terminal kinase, promotes functional recovery after transient focal cerebral ischemia in rats.

The c-Jun-N-terminal kinase (JNK) pathway has been shown to play an important role in excitotoxic neuronal death and several studies have demonstrated a neuroprotective effect of D-JNKi, a peptide inhibitor of JNK, in various models of cerebral ischemia. We have now investigated the effect of D-JNKi in a model of transient focal cerebral ischemia (90 min) induced by middle cerebral artery occlusion (MCAo) in adult male rats. D-JNKi (0.1 mg/kg), significantly decreased the volume of infarct, 3 days after cerebral ischemia. Sensorimotor and cognitive deficits were then evaluated over a period of 6 or 10 days after ischemia and infarct volumes were measured after behavioral testing. In behavioral studies, D-JNKi improved the general state of the animals as demonstrated by the attenuation of body weight loss and improvement in neurological score, as compared with animals receiving the vehicle. Moreover, D-JNKi decreased sensorimotor deficits in the adhesive removal test and improved cognitive function in the object recognition test. In contrast, D-JNKi did not significantly affect the infarct volume at day 6 and at day 10. This study shows that D-JNKi can improve functional recovery after transient focal cerebral ischemia in the rat and therefore supports the use of this molecule as a potential therapy for stroke.

An animal model with relevance to schizophrenia: sex-dependent cognitive deficits in osteogenic disorder-Shionogi rats induced by glutathione synthesis and dopamine uptake inhibition during development.

Low glutathione levels have been observed in the prefrontal cortex and the cerebrospinal fluid of schizophrenic patients, possibly enhancing the cerebral susceptibility to oxidative stress. We used osteogenic disorder Shionogi mutant rats, which constitute an adequate model of the human redox regulation because both are unable to synthesize ascorbic acid. To study the long-term consequences of a glutathione deficit, we treated developing rats with L-buthionine-(S,R)-sulfoximine (BSO), an inhibitor of glutathione synthesis, and later investigated their behavior until adulthood. Moreover, some rats were treated with the dopamine uptake inhibitor GBR 12909 in order to elevate dopamine extracellular levels, thereby mimicking the dopamine hyperactivity proposed to be involved in schizophrenia. BSO and GBR 12909 alone or in combination minimally affected the development of spontaneous alternation or basic sensory and motor skills. A major effect of BSO alone or in combination with GBR 12909 was the induction of cataracts in both sexes, whereas GBR 12909 induced an elevation of body weight in females only. Sex and age-dependent effects of the treatments were observed in a test of object recognition. At postnatal day 65, whereas male rats treated with both BSO and GBR 12909 failed to discriminate between familiar and novel objects, females were not affected. At postnatal day 94, male object recognition capacity was diminished by BSO and GBR 12909 alone or in combination, whereas females were only affected by the combination of both drugs. Inhibition of brain glutathione synthesis and dopamine uptake in developing rats induce long-term cognitive deficits occurring in adulthood. Males are affected earlier and more intensively than females, at least concerning object recognition. The present study suggests that the low glutathione levels observed in schizophrenic patients may participate in the development of some of their cognitive deficits.

Dual role of the NF-kappaB transcription factor in the death of immature neurons.

We have previously shown that the extent of axotomy-induced death of retinal ganglion cells is reduced by cycloheximide, an inhibitor of protein synthesis, and that an earlier sublethal oxidative insult induced by buthionine sulfoximine, a glutathione synthesis inhibitor, enhances the protective effects of cycloheximide. Thus, axotomy-induced ganglion cell death seems to involve an interaction between the redox status and genetic expression. The redox-sensitive transcription factor nuclear factor-kappaB (NF-kappaB) is a logical candidate for providing this interaction. In the present study, we injected intraocularly selective inhibitors of NF-kappaB in chick embryos either unlesioned, or after a unilateral tectal lesion, which axotomizes ganglion cells. The number of dying cells in the retina contralateral to the lesion was reduced in embryos receiving NF-kappaB inhibitors as compared with vehicle-injected controls. In contrast, the same NF-kappaB inhibitors administered as pretreatment before intraocular injection of buthionine sulfoximine and cycloheximide drastically raised neuronal death and induced fulgurant degenerative changes in the retina. The most parsimonious interpretation of our results is that in axotomized retinal ganglion cells of chick embryos NF-kappaB may have either death-promoting or death-inhibiting effects. We propose a theoretical model to explain these dual effects assuming the existence of parallel death pathways differently affected by NF-kappaB. These results may have implications for future redox-based therapeutic strategies for neuroprotection.

Neuroprotective effects of a new glutathione peroxidase mimetic on neurons of the chick embryo's retina.

During their period of naturally occurring neuronal death, retinal ganglion cells are particularly vulnerable to axotomy. The resulting cell death requires protein synthesis and is redox-regulated, since antioxidants protect axotomized-ganglion cells when given in doses that maintain the redox status near an optimal set-point. Here we report the effects of BXT-51072, a new glutathione peroxidase mimetic, on ganglion cell death induced in various ways in the retinas of chick embryos. The intraocular injection of BXT-51072 protected axotomized neurons at doses in a narrow (tenfold) range. It also reduced the deleterious effects of intraocular tert-butyl hydroperoxide, an inducer of lipid peroxidation, and diminished the excitotoxic degeneration induced by N-methyl-D-aspartate. However, BXT-51072 did not noticeably reduce naturally occurring cell death. Globally, our results show that BXT-51072 has numerous protective effects in the retina. In accordance with published data, the present report indicates that glutathione peroxidase mimetics may have potential applications for neurologic or degenerative diseases.

Inhibitors of mitogen-activated protein kinases protect axotomized developing neurons.

Axotomy kills developing neurons by mechanisms dependent on protein synthesis and influenced by the redox status. Amongst the redox-regulated transduction systems regulating gene expression are the mitogen-activated protein kinases (MAPKs). In the chick embryo, inhibitors of two different MAPK pathways, including notably the p38 kinase pathway, reduce the number of dying axotomized retinal ganglion cells. The regulation of the genetic events associated to axotomy-induced death thus seems to involve MAPKs.

Protection of axotomized ganglion cells by salicylic acid.

Neuronal survival is influenced by the redox environment, and it has been shown that antioxidants protect developing neurons from the effects of axotomy. Here, we show that the intraocular injection of salicylic acid (SA) reduces the number of dying axotomized ganglion cells in the chick embryo. The antioxidant properties of SA are probably responsible for its protective effects, whose U-shaped dose-dependency matches that of several other antioxidants. We conclude that SA protects axotomized neurons by maintaining the redox status near an optimal set-point.

Relationships between neuronal death and the cellular redox status. Focus on the developing nervous system.

During the development of the nervous system, a large number of neurons are eliminated through naturally occurring neuronal death. Many morphological and biochemical properties of such dying neurons are reminiscent of apoptosis, a type of death involving the action of genetically-programmed events but also epigenetic phenomena including oxidative stress. The following review contains three parts focusing respectively on basic knowledge of neuronal death and redox regulation, the mechanisms involved in neuronal death which are ordered in three sequential phases, and on the complex relations between neuronal fate and the redox status. Finally, we point out that oxidants are not always detrimental for neuronal survival. On the one hand, dying neurons often display signs of oxidative stress, including an elevation of their intracellular concentration of free radicals. Antioxidants may reduce the extent of neuronal death, suggesting a causal implication of free radicals in the death-process. On the other hand, at high concentrations antioxidants may lose their protective effects on developing neurons, and a non-lethal oxidative stress may potentiate the protective effects of other agents. These data suggest that free radicals, perhaps through their effects on cellular signalling pathways, may have positive effects on neuronal survival, provided that their intraneuronal concentrations are maintained at low levels. Much evidence suggests that the neuronal redox status must be maintained within a narrow range of values compatible with survival. Antioxidants may protect neurons subjected to an oxidative stress following axotomy or trophic factor-deprivation; but excessive reduction may become equally detrimental for neurons.

An optimal redox status for the survival of axotomized ganglion cells in the developing retina.

The neuronal redox status influences the expression of genes involved in neuronal survival. We previously showed that antioxidants may reduce the number of dying ganglion cells following axotomy in chick embryos. In the present study, we show that various antioxidants, including the new spin trap azulenyl nitrone and 1,3-dimethyl-2-thiourea, protect axotomized ganglion cells, confirming that neuronal death involves an imbalance of the cellular redox status towards oxidation. However, high concentrations of antioxidants did not protect ganglion cells, suggesting that excessive reduction is detrimental for neurons. Simultaneous injections of two different antioxidants gave results only partly supporting this view. Combinations of azulenyl nitrone and N-acetyl cysteine in fact gave greater protection than either antioxidant alone, whereas N-acetyl cysteine lost its neuroprotective effects and diminished those of alpha-phenyl-N-tert-butyl nitrone when the two compounds were injected simultaneously. The results of the combined treatments suggest that azulenyl nitrone and alpha-phenyl-N-tert-butyl nitrone do not have the same chemical effects within the ganglion cells. Moreover, N-acetyl cysteine's own antioxidant properties enhance the spin trapping effects of azulenyl nitrone but potentiate the toxicity of alpha-phenyl-N-tert-butyl nitrone. Our main conclusion is that neuronal survival requires the maintenance of the redox status near an optimal set-point. "Reductive stress" may be as dangerous as oxidative stress.

Neuronal death in the central nervous system during development.

About half the neurons in the brain die at the time when their connections are being formed. This neuronal death is regulated by anterograde and retrograde signals that reflect both electrical activity and the uptake of trophic factors. Our recent data on the isthmo-optic projection indicate that there are in fact two different retrograde signals: a slow-acting survival signal mediated by a neurotrophin, and a fast-acting death signal mediated by calcium entry due to electrical activity in the presynaptic terminals. The developmental roles of the cell death are not well understood, but they appear to include the elimination of aberrant connections. The intracellular mechanisms of the cell death may not always correspond to the apoptotic ones so thoroughly investigated in vitro, because only one of the three morphological types occurring regularly in vivo resembles apoptosis. However, our experiments on retinal ganglion cells indicate that several apoptotic mechanisms apply in this particular in vivo situation: these include an involvement of oxygenated free radicals and glutathione, cell cycle-related events, and probably the synthesis of proteins promoting neuroprotection or cell death.

Cooperation between glutathione depletion and protein synthesis inhibition against naturally occurring neuronal death.

It is generally agreed that naturally-occurring neuronal death in developing animals is dependent on the synthesis of proteins. Oxidative stress, as when intracellular concentrations of free radicals are raised or when cell constituents such as membrane lipids or protein thiols are oxidized, is also involved in various types of neuronal death. In the present report, we show that the number of naturally dying retinal cells in the chick embryo can be reduced by intraocular injections of cycloheximide, an inhibitor of protein synthesis. L-buthionine-[S,R]-sulfoximine, an inhibitor of glutathione synthesis, can either enhance or diminish the cell death, depending on the conditions of treatment. Moreover, when the two inhibitors are combined, L-buthionine-[S,R]-sulfoximine potentiates the neuroprotective effects of cycloheximide. Measurements of retinal glutathione concentration and protein synthesis show the specificity of the treatments: buthionine-sulfoximine diminishes glutathione concentrations but not protein synthesis whereas cycloheximide inhibits protein synthesis without decreasing glutathione concentrations. Naturally-occurring neuronal death thus seems to involve the synthesis of proteins, and is also influenced by oxidative phenomena. Our results extend previous data in tectal-lesioned embryos, and suggest that a moderate, non-lethal oxidative stress can enhance the resistance of ganglion cells that might otherwise have died (spontaneously or following axotomy) owing to insufficient retrograde trophic support.

Inhibition of glutathione synthesis can enhance cycloheximide-induced protection of developing neurons against axotomy.

Developing neurons depend for survival on target-derived trophic substances. These are thought to block the expression of a genetic program of cell death. Nevertheless, it is known that less orderly events such as oxidative stress are involved in neuron death. In vivo, retinal ganglion cell death induced by axotomy can be reduced by antioxidants. In this study, we investigated the effects of inhibiting glutathione synthesis by means of buthionine sulfoximine to characterize the influence of endogenous glutathione-dependent antioxidant systems on ganglion cell death. Moreover, since protein synthesis inhibition by cycloheximide has been shown to enhance glutathione synthesis in vitro, we studied the effects on cell death of intraocular injections of buthionine sulfoximine, cycloheximide and combinations of the two inhibitors. Cycloheximide's protective action did not seem to involve an increase in glutathione synthesis. Surprisingly, buthionine sulfoximine injected before cycloheximide enhanced its protective effects, whereas it inhibited them when injected later. We interpret our results as an interaction between death-promoting effects of glutathione depletion through an elevation of free radical concentrations and cycloheximide-sensitive effects of oxidative stress through the synthesis of both death-inhibiting and death-promoting proteins.

Neurotoxicology and amino acid intake during development: the case of threonine.

The development of the central nervous system is highly dependent on an adequate supply of nutrients. In particular, protein and amino acid availability is of major concern during gestation and in early postnatal life. Numerous data have been published on some amino acids directly involved in brain functions as neurotransmitters or indirectly as precursors of neurotransmitters, but scant information is available on the possible consequences of hyperthreoninemia, a phenomenon repeatedly noted in clinical reports. The results of neurochemical and behavioral studies in the developing rat suggest that despite numerous possible effects of threonine on brain constituents, moderate hyperthreoninemia does not impair markedly the development of the central nervous system.

Axotomy-induced retinal ganglion cell death in development: its time-course and its diminution by antioxidants.

Developing neurons die when deprived of trophic support from their axonal target. Although this is generally attributed to the programmed expression of suicide proteins, recent data suggest that a less orderly mechanism involving oxidative stress may also be involved. We have studied retinal ganglion cell death in the chick embryo after a contralateral tectal lesion. The kinetics of cell death, as judged from counts of pyknotic cells, are described. In addition, we show that the pyknotic counts are reduced following intraocular injections of the protein synthesis inhibitor cycloheximide or the antioxidants N-t-butyl-alpha-phenylnitrone and N-acetyl cysteine. Our results suggest that target deprivation-induced ganglion cell death involves oxidative stress.

Effect of threonine on the behavioural development of the rat.

Rats received different levels of threonine (Thr), one, 1.7 and four times the normal dietary intake, from conception to adulthood. The mothers were fed the experimental diets before and during pregnancy. Their offspring received a daily oral load of Thr or placebo until weaning. Thereafter, the juveniles were fed the same diet as their mothers. Morphologic development, ingestive behaviour, homing, and locomotion were observed before weaning. Exploration and spontaneous alternation were studied thereafter. Animals exposed during gestation to 1.7 times the normal Thr intake consumed more food during the test of independent ingestion. Grooming showed inconsistent variations between days 12 and 29 in pups fed 1.7 times the normal Thr intake. Rats performed equally well on the other behavioural tasks independently of the dietary treatment. We conclude that Thr intake as much as four times higher than the levels found in normal diets does not impair the behavioural ontogenesis of the rat.

Effects of diet-induced hyperthreoninemia. II). Tissue and extracellular amino acid levels in the brain.

Growing rats were fed graded levels of threonine (Thr, 0.4, 0.8, and 3.3 g/100 g diet). Free amino acid content was measured in plasma and brain. Extracellular amino acid levels were measured by microdialysis in brain slices. Large quantities of dietary Thr (3.3 g/100 g) raised plasma and brain Thr and glycine (Gly) levels. Brain and spinal cord extracellular levels of Thr were also raised, whereas the other amino acid levels remained unchanged. A moderate level of dietary Thr (0.8 g/100 g) raised plasma Thr and Gly levels and brain Thr but not Gly level. The diet raised cortical Thr extracellular levels but did not modify the levels of the other amino acids, including glutamate (Glu) and aspartate (Asp). These data suggest that brain neurochemical processes involving Gly, Glu, and Asp are safeguarded in rats fed high Thr levels.

Effects of diet-induced hyperthreoninemia. I). Amino acid levels in the central nervous system and peripheral tissues.

Rats were fed four levels of threonine (Thr, 0.4, 0.6, 0.8, and 5.8 g/100 g diet). After two weeks, Thr, serine (Ser), and glycine (Gly) levels were measured in plasma, liver, muscle, and central nervous system. The diet containing 5.8 g/100 g of Thr elevated Thr and Gly concentrations in plasma and nervous tissue in comparison with a standard diet. In muscle and liver, Thr concentrations were also raised but Gly levels did not change. The hepatic Thr dehydratase activity was enhanced. Diets containing moderate Thr quantities (0.6 and 0.8 g/100 g) induced slight elevations of Thr levels in all tissues. Gly concentrations were not modified. The activity of hepatic Thr dehydratase was diminished. Our results show that a high dietary content of Thr (15 times the normal levels) elevates Gly levels in various tissues, including the brain. On the contrary, diets containing 2 to 4 times the normal levels of Thr induce a weak hyperthreoninemia insufficient to modify brain Gly.

Central and peripheral effects of repeated stress and high NaCl diet on neuropeptide Y.

This study was performed to investigate the influence of repeated psychological stress alone or combined with high NaCl intake on the function of the sympathetic nervous system. In addition, NPY levels have been measured in brain regions of potential importance in the central regulation of stress responses (ventrolateral and dorsomedial medulla, paraventricular and arcuate nucleus of the hypothalamus, and frontal cortex). Normotensive Wistar rats received a standard diet alone or supplemented with NaCl. To accentuate differences in sodium balance, rats on the high NaCl diet (HNa) were uninephrectomized. Half the animals on each diet were subjected to chronic stress using daily sessions (1 h) of immobilization stress. After 12 days, plasma levels of neuropeptide Y (NPY), norepinephrine (NE), and epinephrine (E) were measured basally and in response to acute footshock stress. HNa intake or chronic stress alone did not significantly alter either basal or stimulated plasma levels of NPY. However, combining the treatments produced a significant interaction, increasing the NPY response to footshock by 31% compared to HNa alone (p = 0.039) and by 98% compared to stress alone (p less than 0.001). Chronic stress increased basal levels of NE and enhanced the response to subsequent acute stress: combining the treatments did not yield further increases. Plasma levels of E were not significantly affected by the treatments. In the brain, stress alone had no effect on the NPY levels in the structures studied. HNa intake induced a significant increase in NPY levels of the arcuate nucleus, and produced a significant interaction with stress in the dorsomedial medulla. In a supplementary experiment, to evaluate the role of the autonomic nervous system in plasma NPY responses, treatment with the ganglion blocker hexamethonium was shown to significantly attenuate stress-induced changes in NPY, NE, and E.