Gene regulation by glucocorticoid in ENaC-mediated Na⁺ transport by middle ear epithelial cells.

OBJECTIVES/HYPOTHESIS: The epithelial sodium channel (ENaC) is a Na(+) transport channel located in the apical membrane of the human middle ear epithelium. Although ENaC-mediated sodium transport has been reported to be upregulated by dexamethasone in human middle ear epithelium, there has been no study of the downstream pathways for increased ENaC expression mediated by glucocorticoids in this tissue. We investigated the effect of dexamethasone on the expression of ENaC and glucocorticoid regulatory genes for ENaC expression in human middle ear epithelial cells (HMEECs). STUDY DESIGN: In vitro investigation. METHODS: Real-time RT-PCR and Western blot analysis were used to determine the expression level of ENaC and its regulatory genes in HMEECs. RESULTS: The transcript and protein expression of the α-, ß-, and γ-ENaC subunits were all upregulated by dexamethasone (100 nM) in HMEECs. Dexamethasone treatment also increased the transcript expression of serum/glucocorticoid-regulated kinase1 (SGK1) and neural precursor cell-expressed developmentally downregulated (Nedd) 4-2, and decreased the transcript expression of 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1). ENaC transcript expression was not changed after mifepristone (a glucocorticoid antagonist, 100 nM) + dexamethasone treatment when compared to the control, but increased after spironolactone (a mineralocorticoid antagonist, 100 nM) + dexamethasone treatment. CONCLUSIONS: These findings indicate that dexamethasone increases the transcript and protein expression of the α-, ß-, and γ-ENaC subunits via the GR-SGK1-Nedd4-2 pathway and provides insight into the molecular mechanism of the increased sodium transport mediated by ENaC with steroid treatment in HMEECs. LEVEL OF EVIDENCE: N/A.

Periodic alternating nystagmus of peripheral vestibular origin.

OBJECTIVES/HYPOTHESIS: Periodic alternating nystagmus (PAN) is most commonly found either in its congenital form or after cerebellar/pontomedullary lesions. However, we identified PAN in 10 patients with peripheral vestibular disorders and will try to describe their characteristics to aid in the differential diagnosis between peripheral and central etiologies. STUDY DESIGN: Observation of a case series. METHOD: Peripheral vestibular lesions were confirmed by neurological examinations, vestibular function tests, and brain magnetic resonance imaging (MRIs). Eye movements of the patients were recorded using electronystagmography or video nystagmography for a minimum of 10 minutes to confirm the nystagmus change in direction. RESULTS: The final diagnoses of the patients included Meniere's disease (n = 3), acute labyrinthitis (n = 4), sudden sensorineural hearing loss with vertigo (n = 2), and vestibular schwannoma (n = 1). Direction-changing spontaneous horizontal nystagmus with quiescent intervals was observed in all patients under dark conditions. The nystagmus was suppressed by visual fixation; and the results of oculomotor tests were normal for saccadic and smooth pursuit eye movements and optokinetic nystagmus. All patients showed mild to complete canal paresis on a bithermal caloric test. PAN progressed into unidirectional nystagmus of the contra-lesion side in all patients within 48 hours. CONCLUSION: PAN can be observed in patients with peripheral vestibular disorders, but detecting PAN in this subpopulation is difficult because of its transitory nature. The absence of central symptoms and signs, the visual suppression of PAN, normal oculomotor tests, and transient persistence are important diagnostic clues for differentiating peripheral from central PAN. LEVEL OF EVIDENCE: 4.

Design of a Pep-1 peptide-modified liposomal nanocarrier system for intracellular drug delivery: Conformational characterization and cellular uptake evaluation.

In order to facilitate the intracellular delivery of macromolecules, Pep-1 peptide-modified liposomal (Pep1-Lipo) nanocarriers were designed and examined for their in vitro cell translocation capability. Pep-1 peptides were coupled via thiol-maleimide linkage to small unilamellar vesicles composed of phosphatidylcholine, Tween 80, and N-[4-(p-maleimidophenyl)butyryl]-phosphatidylethanolamine (MPB-PE). The amount of Pep-1 peptide conjugated to the vesicle was effectively controlled by the amounts of maleimide groups on the vesicular surface, ranging from 70 to 700 molecules per vesicle. Systems were evaluated for cell uptake capacity by monitoring entrapped fluorescence-labeled bevacizumab, a model protein for poorly permeable macromolecule, using confocal microscopy. The novel carriers rapidly bound to the cell membrane and migrated into the cells within 1 h, exhibiting better translocation of macromolecules compared to that of conventional liposomes. Cellular uptake of Pep1-Lipo was proportional to the amount of Pep-1 peptide on the liposomal surface. In conclusion, we found that the Pep1-Lipo formulation was a promising nanocarrier system for intracellular delivery of macromolecules.