T cells, natural killer cells, and γδT cells in a large patient cohort with rheumatoid arthritis: influence of age and anti-rheumatic therapy.

Objective: The aim of this cohort study was to evaluate the distribution of natural killer (NK) cells and T-cell subsets, including γδT cells, in the peripheral blood of patients with rheumatoid arthritis (RA) in a large real-life patient cohort, taking into account the patients' demographics, disease characteristics, and anti-rheumatic therapy.Method: The study recruited 508 RA patients between November 2013 and August 2015. Lymphocyte differentiation using eight-colour flow cytometry (fluorescence-activated cell sorting) of the peripheral blood was performed for all patients. Clinical data, including age, gender, disease duration, serostatus, disease activity, antibody status, immunosuppressive therapy including use of different biological disease-modifying anti-rheumatic drugs (bDMARDs) and conventional synthetic DMARDs, were retrospectively assessed using electronic patient files. Multivariate regression analysis was performed to assess the effect of these variables on T-cell, NK-cell, and γδT-cell counts.Results: The median patient age was 61.0 years and 74.1% were female. The median disease duration of RA was 12.0 years. Median Disease Activity Score based on 28-joint count was 2.8 and 56.3% were treated with bDMARDs. There were no differences in immunosuppressive therapy between different age groups. While rituximab, abatacept, and tocilizumab had no influence on lymphocyte subdifferentiation, tumour necrosis factor (TNF) inhibitors and age significantly influenced the numbers of T cells, T-helper cells, T-NK cells, NK cells, and γδT cells.Conclusion: Age and TNF-inhibition therapy influence lymphocyte subdifferentiation in patients with RA. It may be prudent to use age- and therapy-adjusted standard values for lymphocyte subsets during clinical trials and treatment of RA.

Proconvulsant actions of intrahippocampal botulinum neurotoxin B in the rat.

Botulinum neurotoxins (BoNTs) may affect the excitability of brain circuits by inhibiting neurotransmitter release at central synapses. There is evidence that local delivery of BoNT serotypes A and E, which target SNAP-25, a component of the release machinery specific to excitatory synapses, can inhibit seizure generation. BoNT serotype B (BoNT/B) targets VAMP2, which is expressed in both excitatory and inhibitory terminals. Here we assessed the effects of unilateral intrahippocampal infusion of BoNT/B in the rat on intravenous pentylenetetrazol (PTZ) seizure thresholds, and on the expression of spontaneous behavioral and electrographic seizures. Infusion of BoNT/B (500 and 1,000 unit) by convection-enhanced delivery caused a reduction in myoclonic twitch and clonic seizure thresholds in response to intravenous PTZ beginning about 6 days after the infusion. Handling-evoked and spontaneous convulsive seizures were observed in many BoNT/B-treated animals but not in vehicle-treated controls. Spontaneous electrographic seizure discharges were recorded in the dentate gyrus of animals that received local BoNT/B infusion. In addition, there was an increased frequency of interictal epileptiform spikes and sharp waves at the same recording site. BoNT/B-treated animals also exhibited tactile hyperresponsivity in comparison with vehicle-treated controls. This is the first demonstration that BoNT/B causes a delayed proconvulsant action when infused into the hippocampus. Local infusion of BoNT/B could be useful as a focal epilepsy model.

Altered spontaneous discharge rate and pattern of basal ganglia output neurons in the circling (ci2) rat mutant.

The circling rat is an autosomal recessive mutant (homozygous ci2/ci2) characterized by lateralized rotational behavior, locomotor hyperactivity, ataxia, stereotypic head movements, and deafness. Previous neurochemical investigations showed that ci2 rats of both genders have a lower tissue content of dopamine in the striatum ipsilateral to the preferred direction of circling. For further evaluation as to whether this striatal imbalance has functional consequences within basal ganglia structures, the spontaneous extracellular single unit activity of GABAergic neurons located in the striatum and, downstream to the dopaminergic nigrostriatal system, the substantia nigra pars reticulata (SNr) was recorded bilaterally in anesthetized ci2 rats. Heterozygous (ci2/+) littermates that display normal behavior, and rats from the background strain (LEW/Ztm) served as controls. No significant hemispheric imbalances in striatal discharge rate and firing pattern were evident in ci2 rats. Furthermore, there were no significant intergroup differences in striatal activity. However, the mean spontaneous discharge rate of SNr neurons was significantly increased in both brain sides, and there was a significant shift toward rhythmic burst-like firing in ci2 mutants. Again, no hemispheric differences were detected. The data substantiate previous findings of altered basal ganglia function in ci2 rats. The abnormal basal ganglia output activity, i.e. of the SNr, is likely to contribute to the complex behavioral disturbances seen in ci2 rats.

Lack of robust anticonvulsant effects of muscimol microinfusions in the anterior substantia nigra of kindled rats.

The substantia nigra pars reticulata is thought to control the spread of seizures in various seizure models. Potentiation of gamma-aminobutyrate (GABA)-mediated transmission in this region by intranigral administration of drugs such as muscimol has been shown to inhibit seizure propagation in such models, including the kindling model of epilepsy. More recent studies have shown that the effects on seizures are site-specific within the substantia nigra pars reticulata. Using flurothyl to induce clonic seizures, it was reported that bilateral microinfusions of muscimol into the anterior substantia nigra pars reticulata were anticonvulsant, while similar infusions into the posterior pars reticulata were proconvulsant. This prompted us to reevaluate the effects of intranigral muscimol in the kindling model with particular emphasis on the anterior substantia nigra pars reticulata. In amygdala kindled rats, muscimol was bilaterally infused into the anterior pars reticulata at doses of either 60 or 120 ng. Thirty minutes later, the threshold for induction of afterdischarges in the amygdala and the threshold for generalized seizures were determined in each rat. Furthermore, severity and duration of seizures at threshold currents were recorded. Unexpectedly, muscimol failed to increase seizure thresholds or to significantly reduce seizure severity or duration of motor seizures, although there was a moderate reduction in motor seizure duration in several rats. The data indicate that, in contrast to flurothyl seizures, in kindled rats the anterior pars reticulata of the substantia nigra is not a site at which muscimol causes robust anticonvulsant effects.

Spontaneous remission of paroxysmal dystonia coincides with normalization of entopeduncular activity in dt(SZ) mutants.

Recent studies have shown a dramatically decreased spontaneous discharge rate of entopeduncular neurons in a unique animal model of idiopathic paroxysmal dystonia, the dt(sz) mutant hamster. These changes were found in animals at the age at which the most marked expression of dystonia is usually observed. In this rodent model, the age-dependent disappearance of stress-inducible dystonic attacks at an age of approximately 10 weeks allows investigations of the relevance of pathophysiological changes for the occurrence of dystonia by ontogenetic studies. Therefore, we examined the entopeduncular activity by extracellular single unit recordings in groups of dt(sz) mutants and nondystonic control hamsters at 17-22 weeks of age. In contrast to recent findings, after the complete remission of dystonia, the mean discharge rate of entopeduncular neurons in dt(sz) mutants (28.1 +/- 1.2 spikes/sec) was similar to that of age-matched nondystonic control hamsters (30.8 +/- 0.9 spikes/sec). Thus, the disappearance of paroxysmal dystonia is accompanied by a normalization of the entopeduncular activity in dt(sz) mutants. The present data clearly demonstrate the fundamental importance of a decreased basal ganglia output for the expression of paroxysmal dystonia.

Deficit of striatal parvalbumin-reactive GABAergic interneurons and decreased basal ganglia output in a genetic rodent model of idiopathic paroxysmal dystonia.

The underlying mechanisms of various types of hereditary dystonia, a common movement disorder, are still unknown. Recent findings in a genetic model of a type of paroxysmal dystonia, the dt(sz) mutant hamster, pointed to striatal dysfunctions. In the present study, immunhistochemical experiments demonstrated a marked decrease in the number and density of parvalbumin-immunoreactive GABAergic interneurons in all striatal subregions of mutant hamsters. To examine the functional relevance of the reduction of these inhibitory interneurons, the effects of the GABA(A) receptor agonist muscimol on severity of dystonia were examined after microinjections into the striatum and after systemic administrations. Muscimol improved the dystonic syndrome after striatal injections to a similar extent as after systemic treatment, supporting the importance of the deficiency of striatal GABAergic interneurons for the occurrence of the motor disturbances. The disinhibition of striatal GABAergic projection neurons, as suggested by recent extracellular single-unit recordings in dt(sz) hamsters, should lead to an abnormal neuronal activity in the basal ganglia output nuclei. Indeed, a significantly decreased basal discharge rate of entopeduncular neurons was found in dt(sz) hamsters. We conclude that a deficit of striatal GABAergic interneurons leads by disinhibition of striatal GABAergic projection neurons to a reduced activity in the entopeduncular nucleus, i.e., to a decreased basal ganglia output. This finding is in line with the current hypothesis about the pathophysiology of hyperkinesias. The results indicate that striatal interneurons deserve attention in basic and clinical research of those movement disorders.

Kindling causes persistent in vivo changes in firing rates and glutamate sensitivity of central piriform cortex neurons in rats.

The present experiments were undertaken to study whether amygdala kindling induces persistent alterations in the functional status of neurons of the central piriform cortex, a subregion of the piriform cortex identified previously as a site involved in the kindling process. Extracellular, single-unit recordings of piriform cortex neurons were made in anesthetized fully kindled rats at an interval of at least five weeks after the last seizure. Electrode implanted but not kindled rats served as sham controls. An additional group of non-implanted rats was used as naive controls. Spontaneously firing piriform cortex neurons were characterized in all groups by smooth, sharp, biphasic (i.e. positive/negative) action potentials with a duration of 0.8-1.8 ms, and were primarily located at the border between piriform cortex layers II and III. In kindled rats, neurons in the central piriform cortex exhibited a significantly higher firing rate compared to controls. Based on median group values, the increase in basal activity in kindled rats averaged about 90%. The responsiveness of piriform cortex neurons to neurotransmitters was tested by microiontophoretic application of glutamate, N-methyl-D-aspartate and GABA. Piriform cortex neurons of kindled rats exhibited a significantly lower responsiveness to the excitatory effect of glutamate than naive controls. A lowered glutamate responsiveness was also seen in sham controls. No significantly altered transmitter sensitivities of piriform cortex neurons from kindled rats were seen with N-methyl-D-aspartate or GABA. The data indicate that amygdala kindling causes persistent interictal changes in both basal activity and glutamate responsiveness of central piriform cortex neurons which could contribute to the abnormal hyperexcitability characteristic of kindling.

In vivo extracellular electrophysiology of pallidal neurons in dystonic and nondystonic hamsters.

In the dt(sz) hamster, a model of idiopathic paroxysmal dystonia, recent findings indicated a decreased neuronal activity within the globus pallidus (GP) and an impaired gamma aminobutyric acid (GABA)ergic function when compared to nondystonic controls. Therefore, in the present study, extracellular single-unit recordings combined with systemical application of a subconvulsant prodystonic dose of pentylenetetrazole (PTZ) were used to compare the electrophysiological properties of GP neurons in anesthetized dt(sz) hamsters and nondystonic controls. The spontaneous discharge rate of GP neurons was not decreased but a trend towards a wide-ranged distribution was found in mutants compared to controls. Since the single-unit activity of striatal neurons was recently shown to be significantly increased in dt(sz) hamsters, the lack of significant changes in GP discharge rates was unpredicted. We suggest that this is due to antagonistic convergent striatal and subthalamic inputs and to lateral monosynaptic inhibition known for striatum and GP. While no significant changes of the discharge rate of GP neurons could be detected, the spike morphology was significantly altered in dt(sz) hamsters, suggesting subtle impaired information processing in the GP. The lack of marked changes in basal firing pattern may be related to the anesthesia. Administration of PTZ (25 mg/kg i.p.) at a subconvulsant dose, which aggravates dystonia in awake dt(sz) hamsters, seemed to induce more marked changes in spike morphology and firing pattern in mutants than in controls, although the discharge rate did not differ significantly between both animal groups in response to PTZ. In view of recent findings, we assume that GABAergic dysfunctions in dystonic hamsters are of regionally different extent.

Tyrosine hydroxylase immunoreactivity and [3H]WIN 35,428 binding to the dopamine transporter in a hamster model of idiopathic paroxysmal dystonia.

Recent pharmacological studies and receptor analyses have suggested that dopamine neurotransmission is enhanced in mutant dystonic hamsters (dt(sz)), a model of idiopathic paroxysmal dystonia which displays attacks of generalized dystonia in response to mild stress. In order to further characterize the nature of dopamine alterations, the present study investigated possible changes in the number of dopaminergic neurons, as defined by tyrosine hydroxylase immunohistochemistry, as well as binding to the dopamine transporter labelled with [3H]WIN 35,428 in dystonic hamsters. No differences in the number of tyrosine hydroxylase-immunoreactive neurons were found within the substantia nigra and ventral tegmental area of mutant hamsters compared to non-dystonic control hamsters. Similarly, under basal conditions, i.e. in the absence of a dystonic episode, no significant changes in [3H]WIN 35,428 binding were detected in dystonic brains. However, in animals killed during the expression of severe dystonia, significant decreases in dopamine transporter binding became evident in the nucleus accumbens and ventral tegmental area in comparison to controls exposed to the same external stimulation. Since stimulation tended to increase [3H]WIN 35,428 binding in control brains, the observed decrease in the ventral tegmental area appeared to be due primarily to the fact that binding was increased less in dystonic brains than in similarly stimulated control animals. This finding could reflect a diminished ability of the dopamine transporter to undergo adaptive changes in response to external stressful stimulation in mutant hamsters. The selective dopamine uptake inhibitor GBR 12909 (20 mg/kg) aggravated dystonia in mutant hamsters, further suggesting that acute alterations in dopamine transporter function during stimulation may be an important component of dystonia in this model.

Subconvulsive dose of pentylenetetrazole increases the firing rate of substantia nigra pars reticulata neurons in dystonic but not in nondystonic hamsters.

Dystonic attacks, including twisting movements, can be initiated by mild stress in mutant (gene symbol dt(sz)) Syrian golden hamsters, an animal model of idiopathic paroxysmal dystonia. Previous studies suggested that dysfunctions in basal ganglia, which are not restricted to periods of attacks, are involved in the dystonic syndrome in mutant hamsters. Therefore, in the present study in anesthetized animals, we examined whether the spontaneous firing rate of extracellularly recorded neurons of the substantia nigra pars reticulata (SNr) differs between dt(sz) and age-matched nondystonic control hamsters. Furthermore, we investigated the responsiveness of these nondopaminergic, presumably GABAergic neurons to a subconvulsive dose (25mg/kg i.p.) of systemically applied pentylenetetrazole (PTZ), which exerts prodystonic effects in mutant hamsters. The mean basal (spontaneous) firing rate of SNr neurons was not altered in mutant hamsters. However, within 5 min after i.p. injection of PTZ, the mean firing rate of SNr neurons significantly increased to about 160% of predrug control values in dt(sz) but not in control hamsters. Although the present study failed to reveal changes in the basal firing rate of SNr neurons in mutant hamsters, the abnormal response to PTZ is in line with previous pharmacological and biochemical data indicating disturbed function of the GABAergic system.

Extracellular single-unit recordings of piriform cortex neurons in rats: influence of different types of anesthesia and characterization of neurons by pharmacological manipulation of serotonin receptors.

In epilepsy research, there is a growing interest in the role of the piriform cortex (PC) in the development and maintenance of limbic kindling and other types of limbic epileptogenesis leading to complex partial seizures. Neurophysiological studies on PC or amygdala-PC slice preparations from kindled rats showed that kindling of the amygdala induces long-lasting changes in synaptic efficacy in the ipsilateral PC, including spontaneous discharges and enhanced susceptibility of PC neurons to evoked burst responses. These long-lasting electrophysiological changes in the PC during kindling appear to be due, at least in part, to impaired function of gamma-aminobutyric acid (GABA)ergic interneurons. The aim of the present study was to develop an anesthetic protocol allowing electrophysiological single-unit recordings from inhibitory, presumably GABAergic PC interneurons in vivo. In addition to recording of spontaneously active PC neurons, microiontophoretic application of glutamate was used to activate silent neurons. Anesthesia of rats with ketamine/xylazine was not suited for single-unit recordings in the PC because of marked cardiovascular depression. Anesthesia with chloral hydrate allowed recording of spontaneous or glutamate-driven single-unit activity in approximately 40% of all animals. A similar percentage was obtained when recordings were done with the narcotic opioid fentanyl (plus gallamine), after all surgical preparations were performed under anesthesia with repeated administration of the barbiturate methohexital. To avoid brain accumulation of methohexital by repeated applications, we modified the anesthetic protocol in that methohexital was only injected once for initiation of surgical anesthesia, followed by the short-acting anesthetic propofol which does not accumulate upon repeated application. Again, after surgical preparation, electrophysiological recordings were done under fentanyl (plus gallamine). By this procedure, spontaneous or glutamate-driven single-unit activity could be measured in all rats in either layer II or III of the PC. Based on shape and frequency of action potentials, two types of neurons were recorded. The predominant type was similar in its firing characteristics to GABAergic neurons in other brain regions, was mainly located in layer III, and could be suppressed by the serotonin2A receptor antagonist MDL 100,907, suggesting that this type of PC neuron represents inhibitory, putative GABAergic interneurons. This new in vivo preparation may be useful for evaluation of PC neurons in kindled rats.

Alterations in spontaneous single unit activity of striatal subdivisions during ontogenesis in mutant dystonic hamsters.

The pathophysiology of idiopathic dystonia, characterized by sustained twisting movements and postures, is still unknown. Clinically, however, the basal ganglia are thought to be the main causative origin of idiopathic dystonia. In the dtsz hamster, a genetic animal model for idiopathic paroxysmal dystonia, the attacks occur in response to mild stress and the severity of dystonia is age-dependent. Previous autoradiographic studies in the dtsz hamster revealed a decreased dopamine D1 and D2 receptor binding and an increased [3H]-2-deoxyglucose uptake in the dorsomedial caudate-putamen (CPu), a region supposed to be critically involved in dystonia. Therefore, we were interested whether the spontaneous firing rate of dorsomedial striatal neurons is age-dependently altered in comparison to age-matched non-dystonic control hamsters. Extracellular recordings of spontaneous single unit activity of dorsomedial and ventromedial Type II striatal neurons, i.e., biphasic positive-negative action potentials, from fentanyl anesthetized animals revealed a drastically increased firing rate in the dorsomedial CPu of mutants during age of maximum severity of dystonia. In post-dystonic dtsz hamsters, i.e., after remission of stress-inducible dystonia, no significant differences regarding the dorsomedial CPu could be obtained. We conclude that the dorsomedial subregion of the CPu seems to be critically involved in the dystonic syndrome of dtsz hamsters and that a transiently reduced inhibitory control over excitatory cortico-striatal processes, possibly due to an altered development of GABAergic inhibition, occurs during ontogenesis in dtsz hamsters.

Quantitative EEG analysis of depth electrode recordings from several brain regions of mutant hamsters with paroxysmal dystonia discloses frequency changes in the basal ganglia.

Computerized EEG spectral analyses of depth electrode recordings from striatum (caudate/putamen; CPu), globus pallidus (GP), and parietal cortex (pCtx) were performed before and after dystonic attacks in freely moving mutant dt(sz) hamsters with paroxysmal dystonia. In these hamsters, sustained attacks of abnormal movements and postures can be reproducibly induced by stress, such as placing the animals in a new environment. Data recorded from mutant hamsters were compared with recordings from age-matched nondystonic control hamsters. The predominant EEG changes in CPu and GP of dystonic hamsters were significant decreases in the high-frequency beta2 range and there was a tendency to increase in delta and theta activities. These changes were seen both before and after onset of dystonic attacks, indicating a permanent disturbance of neural activities in the basal ganglia of dystonic animals. No such changes were seen in the pCtx. Furthermore, no epileptic or epileptiform activity was seen in any of the recordings, substantiating a previous notion from cortical and hippocampal recordings that paroxysmal dystonia in these mutant hamsters has no epileptogenic basis. The present finding of abnormal synchronization of neural activity in the CPu and GP of dystonic hamsters adds to the belief that the striatopallidal-thalamocortical circuit is the most likely site in which to search for the unknown defect in primary (idiopathic) dystonia. As suggested by this study, quantitative EEG analysis can increase the likelihood of detecting subtle EEG abnormalities in different types of idiopathic dystonia and thereby improves our understanding of the pathogenetic mechanisms of this movement disorder.

Prodystonic effects of riluzole in an animal model of idiopathic dystonia related to decreased total power in the red nucleus?

The effects of riluzole (2-amino-6-trifluoromethoxy benzothiazole) on the severity of dystonia were examined in mutant hamsters (dtsz), an animal model of idiopathic dystonia in which dystonic attacks can be age dependently induced by mild stress. Previous studies in hamsters have shown antidystonic activity of various glutamate receptor antagonists whereas lamotrigine, considered as an inhibitor of glutamate release, exerted prodystonic effects. The latter, unexpected, finding prompted us to investigate riluzole which is thought to possess antiglutamatergic properties with mechanisms similar to those of lamotrigine. Riluzole (2, 5, 10 or 20 mg/kg i.p.) dose dependently decreased the latency to onset of dystonic attacks. A dose of 10 or 20 mg/kg significantly increased the severity of dystonia. Even in dtsz hamsters older than 70 days, i.e., after spontaneous remission of age-dependent dystonia, riluzole (10 or 20 mg/kg) provoked severe long-lasting (> 4 h) dystonic attacks. At a dose of 20 mg/kg, riluzole provoked short-lasting (< 1 h) dystonic disturbances also in non-dystonic control hamsters. Electroencephalographic recordings from depth electrodes in the red nucleus, where recent studies have shown abnormal neural activity before and during dystonic attacks in dtsz hamsters, revealed that riluzole (10 mg/kg) tended to cause a further decrease of the total power in dtsz hamsters and significantly reduced the total power in control animals. This finding may indicate that the prodystonic effects of riluzole are related to alterations of rubrospinal activity. With regard to antidystonic effects of glutamate receptor antagonists demonstrated in previous studies, the prodystonic effects of riluzole and, as shown by recent experiments, of lamotrigine also, may be due to the lack of selectivity of these drugs to inhibit glutamate release.

The electrical activity is impaired in the red nucleus of dt(sz) mutant hamsters with paroxysmal dystonia: an EEG power spectrum analysis of depth electrode recordings.

The genetically dystonic (dt(sz)) hamster is an animal model of paroxysmal dystonia that displays attacks of sustained abnormal movements and postures in response to mild stress. Dysfunctions within the basal ganglia may be critically involved in the pathophysiology of dystonia in mutant hamsters. Furthermore, previous observations from autoradiographic studies pointed to an altered neural activity in the red nucleus (RN). In the present study, computerized EEG spectral analysis of depth electrode recordings from the RN was performed before and after dystonic attacks in freely moving dt(sz) hamsters and compared to age-matched non-dystonic controls. No epileptic activity was seen in any of the recordings, substantiating previous notions that paroxysmal dystonia in these mutants has no epileptogenic basis. The predominant EEG changes in RN of dystonic hamsters were a decrease in total power over the range of 1.25-42.00 Hz, a decrease in maximum power and a shift of frequency at maximum power to lower frequencies. With regard to selected frequency bands, there was a decrease in the alpha, beta and gamma band. Although the observed changes of neural activity in the RN are probably based on a primary dysfunction in related structures, the present data demonstrate its importance in the expression of dystonic movements.

Abnormal c-fos expression in the lateral habenula during dystonic attacks in a hamster model of idiopathic dystonia.

The genetically dystonic hamster (dtsz), an animal model of idiopathic dystonia, displays sustained twisting movements and postures either spontaneously or in response to mild stress. In the present study the expression of c-fos immunoreactive neurons (Fos-ir), used as an indicator of neuronal activity, was investigated within various brain regions in dtsz hamsters and non-dystonic control hamsters. Under baseline condition, i.e. in the absence of dystonia, the expression of Fos-ir did not reveal any differences between dtsz hamsters and controls. However, in response to mild stress several brain regions, particularly the lateral habenula (LHb), exhibited differences in c-fos induction in dtsz hamsters and controls. Whereas in the LHb the expression of Fos-ir was markedly enhanced in controls, it showed almost no increase in dystonic hamsters, indicating impaired neuronal activity. Since the lateral habenula receives major input from the basal ganglia via the entopeduncular nucleus, the present data might indicate that basal ganglia are involved in the dystonic syndrome in mutant hamsters.