Amino acid turnover by human oocytes is influenced by gamete developmental competence, patient characteristics and gonadotrophin treatment.

STUDY QUESTION: Can amino acid profiling differentiate between human oocytes with differing competence to mature to metaphase II (MII) in vitro? SUMMARY ANSWER: Oocytes which remained arrested at the germinal vesicle (GV) stage after 24 h of in vitro maturation (IVM) displayed differences in the depletion/appearance of amino acids compared with oocytes which progressed to MII and patient age, infertile diagnosis and ovarian stimulation regime significantly affected oocyte amino acid turnover during IVM. WHAT IS KNOWN ALREADY: Amino acid profiling has been proposed as a technique which can distinguish between human pronucleate zygotes and cleavage stage embryos with the potential to develop to the blastocyst stage and implant to produce a pregnancy and those that arrest. Most recently, the amino acid turnover by individual bovine oocytes has been shown to be predictive of oocyte developmental competence as indicated by the gamete's capacity to undergo fertilization and early cleavage divisions in vitro. STUDY DESIGN, SIZE, DURATION: The study was conducted between March 2005 and March 2010. A total of 216 oocytes which were at the GV or metaphase I (MI) stages at the time of ICSI were donated by 67 patients. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: The research was conducted in university research laboratories affiliated to a hospital-based infertility clinic. Oocytes were cultured for 24 h and the depletion/appearance of amino acids was measured during the final 6 h of IVM. Amino acid turnover was analysed in relation to oocyte meiotic progression, patient age, disease aetiology and controlled ovarian stimulation regime. MAIN RESULTS AND THE ROLE OF CHANCE: The depletion/appearance of key amino acids was linked to the maturation potential of human oocytes in vitro. Oocytes which arrested at the GV stage (n = 9) depleted significantly more valine and isoleucine than those which progressed to MI (n = 32) or MII (n = 107) (P < 0.05). Glutamate, glutamine, arginine and valine depletion or appearance differed in MII versus degenerating oocytes (n = 20) (P < 0.05). Glutamine, arginine, methionine, phenylalanine, total depletion and total turnover all differed in oocytes from patients aged < 35 years versus patients ≥35 years (P < 0.05). MII oocytes obtained following ovarian stimulation with recombinant FSH depleted more isoleucine (P < 0.05) and more alanine and lysine (P < 0.05) appeared than oocytes from hMG-stimulated cycles. MII oocytes from patients with a polycystic ovary (PCO) morphology (n = 33) depleted more serine (P < 0.05) than oocytes from women with normal ovaries (n = 61). LIMITATIONS, REASONS FOR CAUTION: Immature oocytes collected at the time of ICSI were used as the model for human oocyte maturation. These oocytes have therefore failed to respond to the ovulatory hCG trigger in vivo (they are meiotically incompetent), and have limited capacity to support embryo development in vitro. The lack of cumulus cells and stress of the conditions in vitro may have influenced turnover of amino acids, and owing to the small sample sizes further studies are required to confirm these findings. WIDER IMPLICATIONS OF THE FINDINGS: The findings provide support for the hypothesis that oocyte metabolism reflects oocyte quality. Longitudinal studies are required to link these functional metabolic indices of human oocyte quality with embryo developmental competence. Oocyte amino acid profiling may be a useful tool to quantify the impact of new assisted reproduction technologies (ART) on oocyte quality. STUDY FUNDING/COMPETING INTERESTS: This project was funded by the UK Biology and Biotechnology Research Council (BB/C007395/1) and the Medical Research Council (G 0800250). K.E.H was in receipt of a British Fertility Society/Merck Serono studentship. H.J.L. is a shareholder in Novocellus Ltd, a company which seeks to devise a non-invasive biochemical test of embryo health.

Paralysis of divergence in an adult with aqueductal stenosis: case report.

Paralysis of divergence was observed in an adult with membranous aqueductal stenosis. This association has not previously been reported, although the clinical syndrome of divergence paralysis has been described in several other neurologic disorders, which are reviewed. Recognition of the clinical syndrome of paralysis of divergence is important, since it may occur as an early sign of increased intracranial pressure and since it has been observed in several conditions that are amenable to treatment.

Competitive and glycine/NMDA receptor antagonists attenuate withdrawal-induced behaviours and increased hippocampal acetylcholine efflux in morphine-dependent rats.

The present study has examined the glycine/N-methyl-D-aspartate (NMDA) receptor antagonist, R-(+)-3-amino-1-hydroxypyrrolid-2-one (R-(+)-HA-966) and the competitive NMDA receptor antagonist, cis-4-(phosphonomethyl)piperidine-2-carboxylic acid (CGS 19755) on the behavioural syndrome and increased hipppocampal acetylcholine efflux induced during morphine-withdrawal in the rat. Subcutaneous naltrexone (1 mg/kg) injection, 48 hr after implantation of a 75 mg morphine pellet, induced a robust withdrawal syndrome consisting of wet dog shakes, ejaculations, mouth movement, ptosis, irritability to touch and diarrhoea. Pretreatment with the alpha2-adrenoceptor agonist, clonidine (0.1-0.4 mg/kg), R-(+)-HA-966 (10-60 mg/kg) or CGS 19755 (5 or 10 mg/kg) significantly reduced the incidence of withdrawal behaviours. In addition, all three compounds significantly attenuated the increase in hippocampal acetylcholine efflux induced following naltrexone (1 mg/kg, s.c.) injection in morphine-dependent rats. These results provide further evidence demonstrating that NMDA receptor antagonists attenuate both the behavioural and neurochemical effects observed during morphine withdrawal in the rat.

The effects of GR127935, a putative 5-HT1D receptor antagonist, on brain 5-HT metabolism, extracellular 5-HT concentration and behaviour in the guinea pig.

Studies of neurotransmitter release in guinea pig and human brain indicate that the 5-HT terminal autoreceptor is the 5-HT1D subtype and that it regulates the depolarization evoked release of 5-HT. Thus, blockade of the terminal 5-HT autoreceptor should enhance 5-HT release in vivo. In the present study, we have used the recently described, selective and potent 5-HT1D receptor antagonist, GR127935, to determine if blockade of the terminal 5-HT autoreceptor enhanced 5-HT neurotransmission in the guinea pig. Neurochemical studies showed that GR127935 (0.1, 0.3 and 1.0 mg/kg i.p.) significantly increased 5-HT metabolism in forebrain regions but not in the raphe nucleus of the guinea pig. However, using in vivo dialysis, GR127935 did not significantly increase cortical 5-HT efflux when given either systemically (1 and 5 mg/kg i.p.) or by infusion via the probe directly into the cortex (10, 33 and 100 microM). Fast cyclic voltammetry studies in the guinea pig dorsal raphe slice in vitro failed to observe any significant effects of GR127935 (0.01-1 microM) on electrically evoked 5-HT release. Behavioural studies in the guinea pig were also unable to demonstrate any effects of GR127935 (0.1-3.0 mg/kg i.p.) per se or in combination with the 5-HT precursor 5-hydroxytryptophan. Taken together, results from the present neurochemical and behavioral studies in the guinea pig provide little substantial evidence that blockade of the terminal 5-HT autoreceptor following the acute administration of GR127935 increased brain 5-HT neurotransmission in vivo.

Effects of and interactions between antagonists for different sites on the NMDA receptor complex on hippocampal and striatal acetylcholine efflux in vivo.

Intraperitoneal administration of the non-competitive NMDA receptor antagonists (5R,10S)-(+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d] cyclohepten-5,10-imine (MK-801, 0.25 and 0.5 mg/kg) and 1-(1-phenylcyclohexyl)piperidine (PCP, 5 and 10 mg/kg) increased the extracellular concentration of acetylcholine in rat hippocampus but not striatum. In contrast, R-(+)-3-amino-1-hydroxypyrrolid-2-one (R(+)-HA-966, 30 and 60 mg/kg), an antagonist at the glycine modulatory site of the NMDA receptor, did not affect acetylcholine efflux in either region. (+/-)-3-[2-Carboxypiperazin-4-yl]-propyl-1-phosphonic acid ((+/-)CPP, 10 mg/kg) and cis-4-(phosphonomethyl)piperidine-2-carboxylic acid (CGS19755, 5 mg/kg), competitive antagonists at the glutamate agonist site of the NMDA receptor, marginally increased hippocampal acetylcholine efflux. Pretreatment with R(+)-HA-966 (60 mg/kg) or (+/-)CPP (10 mg/kg) attenuated the increase of hippocampal acetylcholine efflux by MK-801 (0.5 mg/kg). However, prior administration of CGS19755 (5 mg/kg) prolonged the MK-801-induced increase of hippocampal acetylcholine efflux. Results demonstrate differential effects on hippocampal and striatal acetylcholine efflux of antagonists at different sites on the NMDA receptor complex and are discussed in relation to previously described effects of these drugs on mesolimbic dopamine function.

The human neuroblastoma cell line, IMR-32, expresses functional corticotropin-releasing factor receptors.

Corticotropin-releasing factor (CRF) receptors in IMR-32 human neuroblastoma cells were characterized after differentiation with 2.5 microM 5'-bromo-2'-deoxyuridine for 10 days. Scatchard analysis of [125I-Tyr0]ovine CRF binding revealed a high affinity binding site with a dissociation constant of 0.59 nM and a maximum binding capacity of 142 fmol/mg, the affinity of which was decreased by guanosine 5'-o-(3-thiotriphosphate). This binding was displaced in the following order of potency: human/rat CRF > ovine CRF > urotensin I > sauvagine > bovine CRF > [D-Phe12, Nle21,38, C alpha-MeLeu37]human/rat CRF-(12-41) > alpha-helical CRF-(9-41), indicative of the CRF1 receptor subtype. Functional coupling of this receptor was confirmed by CRF-induced increases in cyclic AMP, which were antagonised by alpha-helical CRF-(9-41) and [D-Phe12,Nle21,38,C alpha-MeLeu37] human/rat CRF-(12-41).

Effects of two truncated forms of human calcitonin-gene related peptide: implications for receptor classification.

We investigated the possibility that human alpha-calcitonin-gene related peptide (CGRP)-(8-37) and human beta CGRP-(8-37) show some selectivity as antagonists of CGRP1 and CGRP2 receptor-mediated responses. Bindings assays showed that human alpha CGRP, human alpha CGRP-(8-37) and human beta CGRP-(8-37) showed high affinity (in the nanomolar concentration range) for CGRP receptors expressed in SK-N-MC cells and also in rat brain membrane preparations. Both human alpha CGRP-(8-37) and human beta CGRP-(8-37) were potent antagonists of human alpha CGRP-stimulated cAMP accumulation in SK-N-MC cells. However, both human alpha CGRP-(8-37) and human beta CGRP-(8-37) were weakly effective in antagonizing human alpha CGRP-stimulated responses in guinea-pig atria and rat vas deferens. In rat vas deferens, but not guinea-pig atria, the effects of human alpha CGRP and human alpha CGRP-(8-37) (but not human beta CGRP-(8-37)) were potentiated by thiorphan. Neither human alpha- nor human beta CGRP-(8-37) showed selectivity for supposedly CGRP1 and CGRP2 receptor-mediated responses. Furthermore, differences in the effects of the truncated CGRP analogues may reflect differences in enzyme distribution rather than the existence of CGRP receptor subtypes.

Neurologic complications of acute and chronic renal failure.

It is obvious from the preceding discussion that neurologic complications contribute significantly to morbidity and mortality in patients with chronic and acute renal failure and that dysfunction of the nervous system continues to occur even in those patients receiving successful renal transplants. In an effort to find the causes of these disorders, a large cooperative study of patients with renal failure will be needed to supply valid and statistically significant data that can be used to test the hypotheses suggested by this and other review papers. At the present time, the data are limited, because in almost all instances small and biased series of patients have been used, and basic criteria of disease have not been standardized. It will be a large task to correct these deficiencies, but it is definitely one that should be undertaken in the near future.

Hypertonic nasogastric tube feedings: do they cause diarrhea?

Hypertonic NG tube feeding in hospitalized patients, whether on the hospital ward or in the ICU, is considered a common etiology of diarrhea. To evaluate the accuracy of this assumption, five normal volunteers, ten hospitalized postoperative patients with head and neck cancer, and 24 ICU patients were given hypertonic (690 mosm), low residue, lactose-free tube feedings starting at 30 kcal/kg.day. There was no prior history of diarrhea in any of the groups studied. There was a significant difference in albumin levels between the three groups, with an average albumin of 2.8 g/dl in the ICU patient group; different from 4.5 g/dl present in both the normal volunteer and non-ICU hospitalized patient groups (general linear models procedure from SAS, p less than .05) (Duncan test). Diarrhea was not present in the normal volunteers or non-ICU patients during the feedings, but did occur in 3/24 ICU patients. This difference was not significant. The three patients with diarrhea had an average albumin level of 3.0 g/dl, while the other ICU patients had an average albumin of 2.7 g/dl. We conclude that hypertonic NG tube feedings do not cause diarrhea in normal volunteers or postoperative head and neck cancer patients. However, in a small statistically insignificant percent of mechanically ventilated ICU patients, this regimen may cause diarrhea although no risk factors can be identified.

Candida albicans meningitis in a parenteral drug abuser.

We have described a patient with meningitis due to Candida albicans, in whom the only identifiable risk factor was a history of intravenous amphetamine abuse. Despite intravenous therapy with 2 gm of amphotericin B and concurrent 5-fluorocytosine, symptoms, CSF pleocytosis, and hypoglycorrhachia persisted. After a brief course of intrathecal amphotericin B therapy, the patient improved clinically and the CSF returned to normal.

Isotonic nasogastric tube feedings: do they cause diarrhea?

NG tube feedings in hospitalized patients, whether in a ward or ICU, are considered a common etiology of diarrhea. To evaluate the accuracy of this assumption, 13 hospitalized postoperative patients with head and neck cancer, 11 ICU patients, and five healthy volunteers were given isotonic, low-residue, lactose-free tube feedings starting at 30 kcal/kg.day. There was no prior history of diarrhea in any patient studied. There was a significant difference in both albumin levels and diarrhea incidence in the three groups (analysis of variance, p less than .05). Diarrhea occurred in four of 11 ICU patients while receiving feedings, but not in the healthy volunteers or non-ICU patients. The four patients with diarrhea had an average albumin level of 2.8 g/dl, while the other ICU patients had an average albumin of 2.6 g/dl. We conclude that isotonic NG tube feedings do not cause diarrhea in healthy volunteers or postoperative head and neck cancer patients. However, in some mechanically ventilated ICU patients, this regimen may cause diarrhea even though no risk factors can be clearly identified.