ZFHX3 variants cause childhood partial epilepsy and infantile spasms with favourable outcomes.

BACKGROUND: The ZFHX3 gene plays vital roles in embryonic development, cell proliferation, neuronal differentiation and neuronal death. This study aims to explore the relationship between ZFHX3 variants and epilepsy. METHODS: Whole-exome sequencing was performed in a cohort of 378 patients with partial (focal) epilepsy. A Drosophila Zfh2 knockdown model was used to validate the association between ZFHX3 and epilepsy. RESULTS: Compound heterozygous ZFHX3 variants were identified in eight unrelated cases. The burden of ZFHX3 variants was significantly higher in the case cohort, shown by multiple/specific statistical analyses. In Zfh2 knockdown flies, the incidence and duration of seizure-like behaviour were significantly greater than those in the controls. The Zfh2 knockdown flies exhibited more firing in excitatory neurons. All patients presented partial seizures. The five patients with variants in the C-terminus/N-terminus presented mild partial epilepsy. The other three patients included one who experienced frequent non-convulsive status epilepticus and two who had early spasms. These three patients had also neurodevelopmental abnormalities and were diagnosed as developmental epileptic encephalopathy (DEE), but achieved seizure-free after antiepileptic-drug treatment without adrenocorticotropic-hormone/steroids. The analyses of temporal expression (genetic dependent stages) indicated that ZFHX3 orthologous were highly expressed in the embryonic stage and decreased dramatically after birth. CONCLUSION: ZFHX3 is a novel causative gene of childhood partial epilepsy and DEE. The patients of infantile spasms achieved seizure-free after treatment without adrenocorticotropic-hormone/steroids implies a significance of genetic diagnosis in precise treatment. The genetic dependent stage provided an insight into the underlying mechanism of the evolutional course of illness.

Efficacy and safety of perampanel as the first add-on therapy for children with epilepsy: A real-world multicenter prospective observational study.

OBJECTIVE: Perampanel (PER) is a new anti-seizure medication (ASM) with a novel mechanism of action. This study aimed to determine the efficacy and safety of PER when added to monotherapy in children and adolescents (age, 4-18 years) with epilepsy. METHOD: A multicenter prospective observational study was performed on children and adolescents (age, 4-18 years) with epilepsy who did not respond to ASM monotherapy between July 2021 and October 2022. PER was used as the first add-on therapy for the enrolled patients. Seizure-free rate, response rate, inefficacy rate, and drug retention rate were the main observation indicators during the 6 months of treatment. The patients were grouped based on treatment efficacy, and factors affecting efficacy were statistically analyzed. Adverse reactions were also recorded. RESULTS: In this study, 93 patients with epilepsy were enrolled; among them, 9 patients were lost to follow-up (attrition rate, 9.7 %), and 84 were included in the analysis. Five patients with unknown efficacy discontinued taking PER early due to intolerable adverse reactions, and 79 patients (48 males, 31 females; mean age, 11.0 ± 3.9 years) finally remained. Genetic epilepsy and structural epilepsy were found in 22 patients and 36 patients, respectively. The mean duration of epilepsy history at the time of PER initiation was 4.0 ± 3.8 years, and the mean maintenance dosage of add-on PER was 4.5 ± 1.8 mg/day (equivalent to 0.14 ± 0.07 mg/kg/day). Among the 79 patients, 28 patients were diagnosed with epilepsy syndrome, including 13 patients having self-limited epilepsy with centrotemporal spikes, among whom 9 patients were seizure-free after adding PER during the 6-month follow-up (seizure-free rate, 69.2 %). For these 79 patients, the seizure-free, response, and retention rates at the end of follow-up were 45.6 %, 74.7 %, and 82.1 %, respectively. Among the 84 patients included in the analyses, adverse reactions occurred in 20 patients, mainly dizziness (8 patients), somnolence (6 patients), and irritability (4 patients), and 4 patients developed two adverse reactions simultaneously. Univariate analyses revealed statistically significant differences in efficacy between groups with structural and non-structural epilepsy and between groups with different baseline concomitant ASMs, suggesting that these factors affected the efficacy of PER as the first add-on therapy. CONCLUSION: The overall response rate of PER as the first add-on therapy for children and adolescents with epilepsy who were followed up for 6 months was 74.7 %, indicating a relatively favorable safety and tolerability profile. The group of the baseline concomitant ASM administered and the etiological classification of epilepsy as either structural or non-structural were the factors influencing the efficacy of PER as the first add-on therapy.

Dibutyl phthalate adsorbed on multi-walled carbon nanotubes can aggravate liver injury in mice via the Jak2/STAT3 pathway.

Phthalic acid esters (PAEs) and carbon nanotubes (CNTs) are common environmental pollutants and may degrade differently with different resulting biotoxicity, when present together. This study investigated the toxicological effects of singular or combined exposure to dibutyl phthalate (DBP) and multi-walled carbon nanotubes (MWCNTs) in KM mice. Results indicated that combined exposure led to slower weight gain and an increased leukocyte count in the blood, as well as liver tissue lesions and downregulation of organ coefficients. Additionally, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated in the liver, and glucose, pyruvate, triglyceride (TG), and total cholesterol (T-CHO) were significantly reduced, suggesting compromised liver function. Furthermore, mRNA levels of genes related to hepatic glucose and lipid metabolism were significantly altered. These findings suggest that combined exposure to DBP and MWCNTs can have severe impacts on liver function in mice, highlighting the importance of considering interactions between multiple contaminants in environmental risk assessments.

Combined exposure to multiwalled carbon nanotubes and dibutyl phthalates aggravated airway inflammation in rats.

Previous work has shown that mice exposed to dibutyl phthalate (DBP) adsorbed onto multi-walled carbon nanotubes (MWCNTs), via tail vein injection, displayed black lesions in their lungs. To investigate the mechanism causing this toxicity in the lung tissue, we performed an experiment with rats, exposing them to DBP adsorbed onto MWCNTs via a tail vein injection for 14 days. The results revealed pulmonary edema and greyish-black lung tissue in the MWCNTs and the MWCNTs + DBP combined exposure groups. In the combined exposure group there was evident alveolar fragmentation and adhesion, and lung tissue sections showed significant levels of black particles. Sections of the non-cartilaginous region of the trachea had significant folding of the pseudostratified ciliated columnar epithelium and marked thickening of the submucosa. In broncho alveolar lavage fluid, the number of leukocytes (WBC), lymphocytes (Lym), neutrophils (Neu), and eosinophils (Eos), as well as levels of immunoglobulin E (IgE), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin 1ß (IL-1ß) were all significantly higher. TNF-α, IL-6, signal transducer and activator of transcription 3 (STAT3), and α-smooth muscle actin (α-SMA) mRNA expression were all elevated in the lung tissue. The combined exposure group, which had considerable airway remodeling, had a greater degree of tracheal constriction and luminal narrowing, according to the results of the α-SMA immunofluorescence assay. According to these experimental findings, the exposure to both MWCNTs and DBP seemed to have a synergistic effect and exacerbated rats' impaired respiratory function that resulted from exposure to MWCNTs alone.

Dibutyl Phthalate Adsorbed on Multiwalled Carbon Nanotubes Causes Fetal Developmental Toxicity in Balb/C Mice.

This study investigated whether using multiwalled carbon nanotubes (MWCNTs) as a carrier for dibutyl phthalate (DBP) could delay the degradation rate of DBP in mice and increase its estrogen-like interference effect. Pregnant Balb/C mice were divided into four groups and exposed to different treatments via tail-vein injection every 3 days until gestational day 20. The female and male mice were then sacrificed for toxicological study. The results showed that the combination of MWCNTs and DBP resulted in a higher fetal mortality rate than if the mice were exposed to MWCNTs or DBP alone. H&E staining showed that the estrous period of the exposed mice was delayed, the development of oocytes was blocked in the combination group, the number of spermatogenic cells decreased, and the quality of sperm decreased. Our experiment showed that the expression levels of the genes involved in sex hormone synthesis in the testis and ovaries were significantly increased after combined treatment compared with the MWCNT group (p < 0.01). The study suggests that DBP degradation is delayed when absorbed on MWCNTs, which increases its estrogen-like interference and interferes with fetal development, ultimately leading to increased fetal mortality.

CELSR1 variants are associated with partial epilepsy of childhood.

CELSR1 gene, encoding cadherin EGF LAG seven-pass G-type receptor 1, is mainly expressed in neural stem cells during the embryonic period. It plays an important role in neurodevelopment. However, the relationship between CELSR1 and disease of the central nervous system has not been defined. In this study, we performed trios-based whole-exome sequencing in a cohort of 356 unrelated cases with partial epilepsy without acquired causes and identified CELSR1 variants in six unrelated cases. The variants included one de novo heterozygous nonsense variant, one de novo heterozygous missense variant, and four compound heterozygous missense variants that had one variant was located in the extracellular region and the other in the cytoplasm. The patients with biallelic variants presented severe epileptic phenotypes, whereas those with heterozygous variants were associated with a mild epileptic phenotype of benign epilepsy with centrotemporal spikes (BECTS). These variants had no or low allele frequency in the gnomAD database. The frequencies of the CELSR1 variants in this cohort were significantly higher than those in the control populations. The evidence from ClinGen Clinical-Validity Framework suggested a strong association between CELSR1 variants and epilepsy. These findings provide evidence that CELSR1 is potentially a candidate pathogenic gene of partial epilepsy of childhood.

Exposure to dibutyl phthalate adsorbed to multi-walled carbon nanotubes causes neurotoxicity in mice by inducing the release of BDNF.

Multi-walled carbon nanotubes (MWCNTs) and dibutyl phthalate (DBP) exist extensively in the environment, and they are easy to form compound pollution through π-π interactions in the environment. We investigate whether DBP, an environmental hormone disruptor, mediated by CNTs can more easily cross the blood-brain barrier, and whether DBP entering the brain has neurotoxic effects on the cells in the brain. Experimental subjects were 40 male Kunming (KM) mice randomly divided into 4 groups: the control group; the MWCNTs group; the DBP group; and the MWCNTs+DBP group. The mice were exposed via tail intravenous injection once every 3 days for 21 days, following which toxicology studies were carried out. The results of behavioral experiments showed that the mice in the combined exposure group (MWCNTs+DBP) exhibited spatial learning and memory impairment, and anxiety-like behavior. Staining of hippocampal sections of mouse brain tissue showed that, in the CA1, CA2, and DG areas, the number of neurons decreased, the nucleus was pyknotic, the cell body was atrophied, and levels of the microglia marker Iba-1 increased. By proteomic KEGG analysis, we found that the DEPs were mainly those related to neurodegenerative diseases. Immunohistochemistry in the hippocampus indicated that the level of brain-derived neurotrophic factor (BDNF) in the DG region was significantly increased. RT-PCR results revealed that the expression levels of P53, caspase3, and Bax genes related to apoptosis were up-regulated. The experimental results demonstrated that the mechanism of the combined-exposure injury to neurons in the hippocampus of mice may be that MWCNTs with adsorbed DBP can induce the release of BDNF, accelerate the apoptosis of neurons, and reduce the number of nerve cells, which activates microglia, causing neuroinflammation and nervous system toxicity.

Reproductive toxicity of dibutyl phthalate adsorbed on carbon nanotubes in male Balb/C mice.

Dibutyl phthalate (DBP) is an environmental hormone disrupter. This study was designed to investigate whether DBP adsorbed in multi-walled carbon nanotubes (MWCNTs) can easily cross the blood-testis barrier and slow down the degradation of DBP in male mice, thereby prolonging the interference effect of DBP. The results showed that: in male Balb/C mice, the sperm density of the MWCNTs group and the DBP plus MWCNTs group decreased significantly (p < 0.05); and the sperm deformity rate increased significantly (p < 0.05). Testicular tissue sections from the combined exposure group showed that most of the seminiferous tubules were atrophied, there were more large gaps between the cells in the tubules, and the number of mature-sperm decreased. The reactive oxygen species (ROS) levels increased significantly in the combined exposure group (p < 0.01). Proteomics results showed that there were 231 differentially expressed proteins in the combined exposure group compared with the MWCNTs only group, and 69 differentially expressed proteins compared with the DBP group. GO enrichment analysis showed that the differentially expressed proteins mainly include: 60 s acid ribosomal protein P1; nuclear autoantigen sperm protein; centromere protein V; and other proteins related to cell division. These results indicate that MWCNTs with adsorbed DBP can increase oxidative damage in the testis of male mice, interfere with DNA replication and cell division in testicular tissue cells, induce cell apoptosis, and destroy the normal spermatogenic function of the testis.

Children of rural-to-urban migrant workers in China are at a higher risk of contracting severe hand, foot and mouth disease and EV71 infection: a hospital-based study.

The incidence and severity of hand, foot and mouth disease have increased in mainland China since 2008. Therapies and vaccines are currently at different stages of development. This study aimed to determine the social factors associated with the outbreaks and severity of the disease in Chinese children. A multicentre, prospective, case-controlled study was conducted in Shanghai, Chongqing, Guangzhou and Shantou to identify the sociodemographic and behavioural risk factors for hand, foot and mouth disease. Children hospitalized for hand, foot and mouth disease were randomly enrolled from April to November 2011. Stool samples were collected to test for the presence of enterovirus 71 (EV71). A total of 443 children between 1.6 and 68 months of age were enrolled; 304 were uncomplicated cases and 139 were severe cases with central nervous system involvement. The overall detection rate of EV71 was 54.2%, and the positivity rate of EV71 was significantly higher in the severe group than in the uncomplicated group (82.0% versus 40.9%, odds ratio (OR): 8.35, P=0.000). The children of migrant workers (OR: 3.014, P=0.000) and children attending kindergarten (OR: 2.133, P=0.002) were significantly associated with a severe outcome of the disease (OR: 1.765, P=0.026). Our findings indicate that kindergarten attendance and migrant worker parents are the major risk factors associated with severe hand, foot and mouth disease in children <5 years of age. Future public health intervention vaccination campaigns should consider the particular difficulties of achieving high compliance with multiple-dose vaccination regimens in the children of migrant workers.

ent-Abietane and ent-kaurane diterpenoids from the roots of Suregada glomerulata.

Twelve ENT-abietane and ENT-kaurane type diterpenoids, 1- 12, including five new compounds 1- 5, were isolated from the roots of Suregada glomerulata. The structures of the new compounds were elucidated on the basis of 1D and 2D NMR and other spectroscopic studies, and the structures of 1 and 2 were confirmed by X-ray crystallography. Cytotoxic activities against five human tumor cell lines were evaluated.