Corticobasal and ataxia syndromes widen the spectrum of C9ORF72 hexanucleotide expansion disease.

Recently, a hexanucleotide (GGGGCC) repeat expansion in the first intron of C9ORF72 was reported as the cause of chromosome 9p21-linked frontotemporal dementia-amyotrophic lateral sclerosis (FTD-ALS). We here report the prevalence of the expansion in a hospital-based cohort and associated clinical features indicating a wider clinical spectrum of C9ORF72 disease than previously described. We studied 280 patients previously screened for mutations in genes involved in early onset autosomal dominant inherited dementia disorders. A repeat-primed polymerase chain reaction amplification assay was used to identify pathogenic GGGGCC expansions. As a potential modifier, confirmed cases were further investigated for abnormal CAG expansions in ATXN2. A pathogenic GGGGCC expansion was identified in a total of 14 probands. Three of these presented with atypical clinical features and were previously diagnosed with clinical olivopontocerebellar degeneration (OPCD), atypical Parkinsonian syndrome (APS) and a corticobasal syndrome (CBS). Further, the pathogenic expansion was identified in six FTD patients, four patients with FTD-ALS and one ALS patient. All confirmed cases had normal ATXN2 repeat sizes. Our study widens the clinical spectrum of C9ORF72 related disease and confirms the hexanucleotide expansion as a prevalent cause of FTD-ALS disorders. There was no indication of a modifying effect of the ATXN2 gene.

Genetic alterations of the BRI2 gene: familial British and Danish dementias.

Classic arguments sustaining the importance of amyloid in the pathogenesis of dementia are usually centered on amyloid beta (Abeta) and its role in neuronal loss characteristic of Alzheimer disease, the most common form of human cerebral amyloidosis. Two non-Abeta cerebral amyloidoses, familial British and Danish dementias, share many aspects of Alzheimer disease, including the presence of neurofibrillary tangles, parenchymal pre-amyloid and amyloid deposits, cerebral amyloid angiopathy, and a widespread inflammatory response. Both early-onset conditions are linked to specific mutations in the BRI2 gene, causing the generation of longer-than-normal protein products and the release of 2 de novo created peptides ABri and ADan, the main components of amyloid fibrils in these inherited dementias. Although the molecular mechanisms and signal transduction pathways elicited by the amyloid deposits and their relation to cognitive impairment remain to be clarified, new evidence indicates that, independent of the differences in their primary structures, Abeta, ABri, and ADan subunits are able to form morphologically compatible ion-channel-like structures and elicit single ion-channel currents in reconstituted lipid membranes. These findings reaffirm the notion that non-Abeta amyloidosis constitute suitable alternative models to study the role of amyloid deposition in the mechanism of neuronal cell death.

Diabetes decreases Na+-K+ pump concentration in skeletal muscles, heart ventricular muscle, and peripheral nerves of rat.

Na+-K+-ATPase or the Na+-K+ pump is essential for some specific properties of muscle and nerve tissue such as contractility and excitability. Previous studies have shown conflicting variations in Na+-K+-ATPase activity or Na+-K+ pump concentration of muscle cells in experimental diabetes. Our study demonstrates that early untreated diabetes in rats induced by injection of streptozocin is associated with decreases in [3H]ouabain binding-site concentration of 24-48% in various skeletal muscles and 16% in peripheral nerves as well as a decrease in K+-dependent 3-O-methylfluorescein phosphatase activity of 21% in the heart ventricle. These effects could be prevented by insulin treatment. They probably represent a decrease in the concentration of Na+-K+ pumps. There was no evidence for more than one population of Na+-K+ pumps in intact samples of skeletal muscle and nerves from normal, diabetic, and insulin-treated animals. The decrease in Na+-K+ pump concentration in nerve cells may be due to atrophy of the axons. In skeletal muscles, myocardium, and peripheral nerves, the observed decrease in Na+-K+ pump concentration may be important for the pathophysiology of diabetes. We emphasize that quantification of Na+-K+-ATPase or the Na+-K+ pump in muscle and nerve tissue from diabetic animals should preferably be performed with either intact samples or crude homogenates of whole tissue.

Effect of chronic lithium treatment with or without haloperidol on number and sizes of neurons in rat neocortex.

The present study used stereological methods to determine whether long-term administration of lithium, with or without haloperidol, affects the number and average volume of neocortical neurons. Twenty-five rats were divided into three groups and given no treatment, lithium, or lithium combined with haloperidol. Serum lithium levels ranged from 0.5 to 0.8 mmol/l. Haloperidol was injected intraperitoneally at a daily dose of 1 mg/kg. After 30 weeks of treatment, the animals were killed and the brains were prepared. Neocortical volume, density of neurons, total number of neurons and mean volume of neurons were estimated. As no differences were found between the groups, the present study provides no evidence for quantitative morphological changes in the cerebral cortex due to long-term 'therapeutic' levels of lithium, with or without haloperidol.

Chromosome 13 dementia syndromes as models of neurodegeneration.

Two hereditary conditions, familial British dementia (FBD) and familial Danish dementia (FDD), are associated with amyloid deposition in the central nervous system and neurodegeneration. The two amyloid proteins, ABri and ADan, are degradation products of the same precursor molecule BriPP bearing different genetic defects, namely a Stop-to-Arg mutation in FBD and a ten-nucleotide duplication-insertion immediately before the stop codon in FDD. Both de novo created amyloid peptides have the same length (34 amino acids) and the same post-translational modification (pyroglutamate) at their N-terminus. Neurofibrillary tangles containing the classical paired helical filaments as well as neuritic components in many instances co-localize with the amyloid deposits. In both disorders, the pattern of hyperphosphorylated tau immunoreactivity is almost indistinguishable from that seen in Alzheimer's disease. These issues argue for the primary importance of the amyloid deposits in the mechanism(s) of neuronal cell loss. We propose FBD and FDD, the chromosome 13 dementia syndromes, as models to study the molecular basis of neurofibrillary degeneration, cell death and amyloid formation in the brain.

The impact of recent stereological advances on quantitative studies of the nervous system.

The usefulness of a number of new stereological principles for unbiased estimation of particle number and sizes and sampling of particles is illustrated together with a novel principle for unbiased estimation of anisotropic surfaces. The examples include descriptions of estimators of neurone and synapse number and sizes, synapse gradients, neurone point patterns in three-dimensional space, capillary surface area, and perikarya volumes. A major advantage of the methods is the possibility to carry out the estimation procedures in specified, well-characterized regions or layers of the brain. Some general statistical and stereological problems are briefly discussed.

The retrograde fast component of axonal transport in motor and sensory nerves of the rat during administration of 2,5-hexanedione.

The retrograde and anterograde fast component of axonal transport (rFC and aFC) were examined in rats following intoxication with 2,5-hexanedione (1 g/kg/week) for 2, 4, 6 and 8 weeks. rFC and aFC were measured as accumulations distal and proximal to a double ligature after labeling of protein by injection of [35S]methionine into L5 spinal cord or L5 dorsal root ganglion. Clinical symptoms appeared after an accumulated dose of 6 g/kg of the toxin and was dominated by motor deficiencies. Abnormalities in retrograde build-up appeared earliest in motor nerves after an accumulated dose of 4 g/kg, while the sensory nerves showed a decreased retrograde build-up only after 6 g/kg. In motor nerves retrograde build-up for the short and the long accumulation interval (11.5-17.5 h and 11.5-25.5 h, respectively) was equally depressed, while in sensory nerves the retrograde build-up for the early accumulation interval (10-16 h) was less severely depressed as compared to the late collection interval (10-24 h). These findings point to a decreased amount of rFC, rather than a delay in turn-around. Furthermore, build-up was inversely correlated with the dose of 2,5-hexanedione and was most pronounced in motor nerves (82% vs 52% in motor and sensory nerves, respectively) at the final dose of 8 g/kg. When intoxication was stopped, rats improved in muscle-strength, but still showed atrophy of leg muscles. Coincidently, retrograde transport in motor nerves was normalized for the short accumulation interval, and improved for the longer collection interval, though not completely normalized.

The effect of chronic lithium treatment on the calibre of axons and nerve fibres in the rat sural nerve.

Cases of peripheral neuropathy have been reported in humans receiving lithium therapy. However, no previous studies have addressed the question of whether chronic lithium treatment causes morphological changes in the peripheral nervous system in experimental animals. The present study used stereological methods to determine whether long-term administration of lithium affected the calibre of the axons or of the nerve fibres in the rat sural nerve. Twenty-two rats were divided into 2 groups and given either no treatment or lithium, with serum levels averaging from 0.5 to 0.7 mmol/l. After 30 weeks of treatment, the animals were killed and the sural nerve was isolated at the level of the knee and was removed. The cross-sectional area of axons and of nerve fibres was estimated by point counting. Compared with the controls, a strong tendency towards a reduced nerve fibre area in the lithium-treated animals was found, with a between-group difference of 1.79 microns 2 (P = 0.06). For the axon area, the difference was 0.73 micron 2 (P = 0.20).

Chronic lithium treatment with or without haloperidol fails to affect the morphology of the rat cerebellum.

We used unbiased stereological principles to determine whether long-term administration of lithium at human therapeutic levels, with or without haloperidol, affects the number or sizes of cerebellar Purkinje cells or the volume of histological layers in the rat cerebellum. Twenty-eight rats were randomly divided into three groups, receiving either no treatment, lithium, or lithium combined with haloperidol. The serum lithium levels ranged from 0.50 to 0.77 mmol/l. Haloperidol was given at a daily dose of 1 mg/kg. After 30 weeks of treatment, the animals were killed and the cerebelli were histologically prepared. No statistically significant differences were observed between the groups with respect to the cerebellar measures.

No effect of growth hormone treatment on axonal transport of slow component a in diabetic and nondiabetic rats.

A decreased axonal transport of slow component a (SCa), i.e., neurofilaments, is an early event in experimental diabetes as well as hypothyroidism, and common to these metabolic derangements are decreased levels of serum insulin-like growth factor I (IGF-I). To evaluate the possible connection between these facts, we investigated the effect of growth hormone (GH), which stimulates IGF-I production, on axonal transport of SCa in diabetic and nondiabetic rats. Serum concentrations of IGF-I fell from about 1500 micrograms/L in controls to about 600 micrograms/L in diabetics. GH treatment (100 mu/rat twice daily) normalized IGF-I for the first week of diabetes, after which the level decreased to the level of the untreated diabetics. The SCa transport velocity was found to be decreased in the diabetic nerves as previously reported [0.91 +/- 0.07 = mm/day, n = 9; (mean +/- SD) versus 1.01 +/- 0.09 mm/day, n = 8, in controls, 2 p less than 0.05). No changes were seen for the GH-treated groups (1.03 +/- 0.06 mm/day, (n = 11) in GH-treated controls). The lack of effect of GH treatment can be due to blockage of IGF-I synthesis or the decreased level of thyroid hormone, triiodothyronine (T3), in the diabetic rats.

Molecular chaperons, amyloid and preamyloid lesions in the BRI2 gene-related dementias: a morphological study.

Molecular chaperons or amyloid-associated proteins (AAPs) are deposited in vascular and parenchymal amyloid lesions in Alzheimer's disease (AD) and other amyloidoses. AAPs, such as apolipoprotein E (ApoE) or apolipoprotein J (ApoJ) have been strongly implicated in the pathogenesis of AD in vitro and in vivo. Furthermore the possession of the ApoE in4 allele is a well-studied risk factor for AD. In view of the similarities between AD and both familial British dementia (FBD) and familial Danish dementia (FDD), we investigated the presence of AAPs in these two diseases to understand better their role in the general process of amyloidogenesis. Immunohistochemistry for ApoE, ApoJ, serum amyloid P (SAP), alpha-1-antichymotrypsin, cystatin C, heparan sulphate proteoglycans, such as agrin, perlecan, syndecans, glypican-1 and for heparan sulphate glycosaminoglycan (HS GAG) side chains was carried out together with immunohistochemical preparations specific to the amyloid subunits. Significant or extensive staining for ApoE, ApoJ, agrin, glypican-1 and HS GAG side chains was found in both amyloid (fibrillar) and preamyloid (nonfibrillar) deposits in FBD and FDD. The remaining AAPs, including SAP, were predominantly found in amyloid lesions. Only very weak staining was present in a small proportion of the amyloid lesions using perlecan immunohistochemistry. These findings suggest that the deposition patterns of AAPs in FBD and FDD are mostly similar to those in AD. The presence of AAPs in the preamyloid lesions supports the notion that chaperon molecules may play a role in the early steps of fibrillogenesis.

Number and volume of rat dorsal root ganglion cells in acrylamide intoxication.

Acrylamide intoxication induces a filamentous neuropathy with breakdown of distal axons and chromatolytic reaction of dorsal root ganglion cells. To obtain quantitative information about the perikaryal alterations neurons of the fifth lumbar dorsal root ganglion of rats were examined with stereological techniques following intoxication with a total dose of 500 mg acrylamide. Number, mean volume and distribution of neuron volume were estimated for each of the two cell subpopulations using optical disectors, the four-way-nucleator and systematic sampling techniques. In intoxicated rats perikaryal volume of A-cells was significantly reduced by 28%, from 63,200 micron3 (CV = 0.16) to 45,500 micron3 (CV = 0.19), whereas the volume of B-cells was unchanged. Numbers of A- and B-cells were preserved. The finding of a selective atrophy of A-cell perikaryal volume is in accordance with previous observations of predominant alterations of large myelinated sensory fibres and most likely reflects an attack on the perikaryal neurofilaments abundant in this cell type.

Anterograde components of axonal transport in motor and sensory nerves in experimental 2,5-hexanedione neuropathy.

Anterograde slow and fast axonal transport was examined in rats intoxicated with 2,5-hexanedione (1 g/kg/week) for 8 weeks. Distribution of radioactivity was measured in 3-mm segments of the sciatic nerve after labelling of proteins with [35S]methionine or [3H]leucine and glycoproteins with [3H]fucose. The axonal transport of the anterograde slow components was examined after 25 (SCa) and 10 days (SCb), in motor and sensory nerves. SCa showed an increased transport velocity in motor (1.25 +/- 0.08 mm/day versus 1.01 +/- 0.05 mm/day) and in sensory nerves (1.21 +/- 0.13 mm/day versus 1.06 +/- 0.07 mm/day). The relative amount of labelled protein in the SCa wave in both fiber systems was also increased. SCb showed unchanged transport velocity in motor as well as in sensory nerves, whereas the amount of label was decreased in the motor system. Anterograde fast transport in motor nerves was examined after intervals of 3 and 5 h, whereas intervals of 2 and 4 h were used for sensory nerves. Velocities and amounts of labelled proteins of the anterograde fast component remained normal. We suggest that the increase in protein transport in SCa reflects axonal regeneration.

The number and mean volume of neurons in the cerebral cortex of rats intoxicated with acrylamide.

Acrylamide was given in an accumulated dose of 500 mg/kg to rats by intraperitoneal injection in two different dosing schedules: 50 mg/kg twice a week for 5 weeks and 33.3 mg/kg twice a week for 7.5 weeks. The effect of acrylamide intoxication on the neurons in the cerebral cortex of the rat was studied using unbiased stereological methods. A reduction of brain weight of 8% was seen in both the intoxicated groups. The volume of neocortex was significantly decreased in the experimental groups, but the density of neurons was increased resulting in an unchanged total number of neurons. The mean volume of neurons in neocortex was significantly decreased in both acrylamide intoxicated groups. There was no difference between the two different intoxication schedules. The possibility that acrylamide causes neuronal death and the effect of eventual differential cellular sensitivity is discussed.

Structural preservation of cerebellar granule cells following neurointoxication with methyl mercury: a stereological study of the rat cerebellum.

Methyl mercury intoxication causes ataxia. Structural changes of cerebellar and peripheral nerve tissues have been described. However, it is still unclear whether the ataxia is of cerebellar or peripheral origin. To clarify this question further, the effects of methyl mercury intoxication on the numbers of granule and Purkinje cells and the volume of Purkinje cell perikarya have been evaluated with stereological methods. Rats were intoxicated with methyl mercury, at a dose of 2 mg/kg per day for 19 successive days, and the analysis was carried out 2.5 or 4.5 weeks later. The total numbers of cerebellar granule cells and Purkinje cells were estimated using an optical fractionator and the mean volume of the Purkinje cells was estimated by the vertical rotator technique. The volumes of the granular cell layer, the molecular layer and the white matter were estimated using the Cavalieri principle. The intoxicated animals developed hindlimb incoordination when held by the tail. Although pronounced axonal degeneration occurred in the peripheral nervous system, no changes were found in cerebellar cell numbers or cell sizes in either of the test groups. The absence of detectable light microscopic changes in the cerebellum indicates that the peripheral nervous system is affected prior to the cerebellum in rats intoxicated with organic mercury.

A proposal for a classification of neuropathies according to their axonal transport abnormalities.

Recent studies on axonal transport in experimental neuropathy are reviewed and the following combinations of pathological changes and underlying axonal transport abnormalities are proposed for a classification of polyneuropathies. Alterations of the anterograde transport of slow component a(SCa) leads to changes of the dimensions of the axon calibre without the occurrence either of overt neuropathy or fibre loss. Thus damming of SCa in beta,beta'-iminodiproprionitrile (IDPN) intoxication results in axonal swelling in nerve roots whereas decrease of SCa leads to atrophy distal to the swellings in IDPN intoxication and in streptozotocin induced diabetes as well. Decrease in the amount of material conveyed within the anterograde fast component (aFC) leads to acute axonal degeneration including break down of axons and fibre loss. This state occurs in acute hypoglycaemia and in doxorubicin intoxication. The most frequent type of polyneuropathy, namely distal axonopathy with accumulation of axon organelles leading to distal fibre loss, is associated with decrease in amount of the retrograde fast component (rFC). The transport is impaired before the appearance of symptoms and electrophysiological signs of neuropathy develop in the intoxications induced by parabromophenylacetylurea, acrylamide and 2.5 hexanedione, and the severity of neuropathy is proportional to the rFC impairment.

Progabide in the treatment of hyperkinetic extrapyramidal movement disorders.

The ability of the selective GABA-receptor agonist, progabide, to suppress abnormal involuntary movements was evaluated in a preliminary open pilot study. 17 patients, 10 males and 7 females, aged 10-78 years, with hyperkinetic movement disorders were included in the study. Daily doses of progabide ranged from 900 to 3600 mg (median 2400 mg) corresponding to 14-45 mg/kg (median 45 mg/kg), while the duration of treatment varied from 2 to 52 weeks. Improvement, with a reduction of involuntary movements exceeding 25%, occurred in two of four patients with Gilles de la Tourette's syndrome, and in two of three patients with postanoxic intention myoclonus, while no consistent beneficial effects were registered in ten patients with Huntington's chorea, postanoxic choreoathetosis, torsion dystonia, tardive dyskinesia, action tremor, essential myoclonus, or oro-branchio-respiratory myoclonus.

Increased thermal stability of collagen after 2,5-hexanedione intoxication in rats.

The present study examined the ability of 2,5-hexanedione (2,5-HD) to cross-link the fibrillary protein, collagen, in vivo. The thermal stability of collagen measured as the isometric contraction-relaxation force was studied in tail tendons from rats, receiving 2,5-HD intraperitoneally for 2 or 6 weeks (1 g/kg/week, divided into 3 doses). The maximum contraction force was significantly increased after 6 weeks of intoxication as compared to controls, indicating an increase in covalent cross-linking between collagen molecules. Likewise, in vitro incubation of rat tail tendons in 2,5-HD for 24 hr induced an increase in thermal isometric contraction force.

The volume of Purkinje cells decreases in the cerebellum of acrylamide-intoxicated rats, but no cells are lost.

The effects of acrylamide intoxication on the numbers of granule and Purkinje cells and the volume of Purkinje cell perikarya have been evaluated with stereological methods. The analysis was carried out in the cerebella of rats that had received a dose of 33.3 mg/kg acrylamide, twice a week, for 7.5 weeks. The total numbers of cerebellar granule and Purkinje cells were estimated using the optical fractionator and the mean volume of the Purkinje cell perikarya was estimated with the vertical rotator technique. The volumes of the molecular layer, the granular cell layer and the white matter were estimated using the Cavalieri principle. The mean weight of the cerebellum of the intoxicated rats was 7% lower than that of the control rats (2P = 0.001). The numbers of the Purkinje cells and granule cells were the same in both groups, but the mean volume of the perikarya of the Purkinje cells in the intoxicated rats was 10.5% less than that of the control group (2P = 0.004). The volume of the granular cell layer was reduced by 15% (2P = 0.006) but there were no differences in the volumes of the molecular layer and the white matter in the intoxicated and control animals.

Redistribution of axoplasm in the motor root in experimental diabetes.

Early experimental diabetes is associated with a reduction in axonal caliber. To elucidate the changes of nerve caliber further, we investigated the proximal and distal regions of the anterior root of rats after 5 weeks of streptozocin-induced diabetes. After vascular perfusion fixation, the fifth lumbar motor root was excised and two 3-mm segments were isolated, one at the level of the spinal cord and one at the dorsal root ganglion. The areas of myelinated fibers and their axons were measured by point counting. Axons from diabetic mice were enlarged proximally as compared to the controls, and reduced distally. It has been hypothesized that the reduction in axonal caliber is caused by an impairment of axonal transport of structural proteins rather than by osmotic shrinkage. Our findings indicate a redistribution of axoplasm in the nerves of the diabetic mice and support the hypothesis that changes in the axonal transport of neurofilaments are responsible for the structural changes seen in early diabetes. Similar changes could also play a role in the development of neuropathy in man.