In vivo electroretinographic studies of the role of GABAC receptors in retinal signal processing.

All three classes of receptors for the inhibitory neurotransmitter GABA (GABAR) are expressed in the retina. This study investigated roles of GABAR, especially GABACR (GABA(A)-ρ), in retinal signaling in vivo by studying effects on the mouse electroretinogram (ERG) of genetic deletion of GABACR versus pharmacological blockade using receptor antagonists. Brief full-field flash ERGs were recorded from anesthetized GABACR(-/-) mice, and WT C57BL/6 (B6) mice, before and after intravitreal injection of GABACR antagonists, TPMPA, 3-APMPA, or the more recently developed 2-AEMP; GABAAR antagonist, SR95531; GABABR antagonist, CGP, and agonist, baclofen. Intravitreal injections of TPMPA and SR95531 were also made in Brown Norway rats. The effect of 2-AEMP on GABA-induced current was tested directly in isolated rat rod bipolar cells, and 2-AEMP was found to preferentially block GABACR in those cells. Maximum amplitudes of dark (DA) and light-adapted (LA) ERG b-waves were reduced in GABACR(-/-) mice, compared to B6 mice, by 30-60%; a-waves were unaltered and oscillatory potential amplitudes were increased. In B6 mice, after injection of TPMPA (also in rats), 3-APMPA or 2-AEMP, ERGs became similar to ERGs of GABACR(-/-) mice. Blockade of GABAARs and GABABRs, or agonism of GABABRs did not alter B6 DA b-wave amplitude. The negative scotopic threshold response (nSTR) was slightly less sensitive in GABACR(-/-) than in B6 mice, and unaltered by 2-AEMP. However, amplitudes of nSTR and photopic negative response (PhNR), both of which originate from inner retina, were enhanced by TPMPA and 3-APMPA, each of which has GABAB agonist properties, and further increased by baclofen. The finding that genetic deletion of GABACR, the GABACR antagonist 2-AEMP, and other antagonists all reduced ERG b-wave amplitude, supports a role for GABACR in determining the maximum response amplitude of bipolar cells contributing to the b-wave. GABACR antagonists differed in their effects on nSTR and PhNR; antagonists with GABAB agonist properties enhanced light-driven responses whereas 2-AEMP did not.

Pupil to limbus ratio: Introducing a simple objective measure using two-box method for measuring early anisocoria and progress of pupillary change in the ICU.

INTRODUCTION: Measurement of static pupillary size in the ICU is of importance in cases of acutely expanding intracranial mass lesions. The inaccuracies with subjective assessment of pupillary size by medical personnel preclude its use in emergent neurological situations. OBJECTIVE: To determine if the ratio of pupil to limbus diameter (PLD ratio) measured by a two-box method is a reliable measure of pupil size for detecting early anisocoria and measuring pupillary changes. MATERIALS AND METHODS: The PLD ratio was defined as the ratio of the pupillary diameter measured at a para-horizontal axial plane with the limbus diameter measured at the same or parallel axial plane. A two-box method was used to estimate the diameters of imaged pupils. Eyes were imaged using an iPhone 4S cellphone camera. Background illumination was measured and kept constant. The pupils of a 78-year-old woman, who presented with a large intra-axial parenchymal hemorrhage, were imaged. The patient had left pupillary miosis in dark but not in bright light. After presenting this case along with the images of the pupillary examination, a group of 21 medical staff were asked several questions on the pupillary examination. Reliability of PLD ratio were assessed via standard error of mean (S.E.M) of PLD ratios for 3 different subjects each imaged under constant illumination and fixation but from different angles to the optical axis. RESULTS: Analysis of questionnaire data together with PLD ratios revealed that ~ 14% and 10% of participants could estimate the pupillary size in darkness and bright light respectively but none were simultaneously accurate indicating that subjective assessment of pupillary size was unreliable. The approach towards a systematic pupillary examination was inconsistent among the participants. The PLD ratio was found to be a reliable measure of pupillary size with standard error of mean below 0.1 mm for the three subjects tested. CONCLUSION: Static pupillary sizes can be objectively and consistently evaluated using PLD ratios using a two-box method. PLD ratios are resistant, within limits, to changes in imaging angle or choice of para-horizontal axes for measurement.

Is initial preservation of deep tendon reflexes in West Nile Virus paralysis a good prognostic sign?

Typical West Nile virus paralysis is characterized by muscle weakness, decreased tone, and loss of deep tendon reflexes attributed to destruction of anterior horn cells. Two cases in which deep tendon reflexes were initially preserved in the presence of profound and persistent muscle weakness are presented here. In both cases, deep tendon reflexes were later severely attenuated or lost, while weakness of the involved muscles remained profound and unchanged. Both patients showed good motor recovery at 6 months. Initial preservation of deep tendon reflexes in the presence of persistent muscle weakness indicates that in the early stages of disease, the muscle weakness in these two cases was not caused by destruction of anterior horn cells. Pathology involving anterior horns preceding AHC destruction could potentially disrupt upper motor neuron pathways to anterior horn cells, causing weakness with initial preserved deep tendon reflexes.

Differential ammonia decay kinetics indicates more than one concurrent etiological mechanism for symptomatic hyperammonemia caused by valproate overdose.

Valproic acid (VPA) has successfully been used in the therapy of a number of conditions including absence seizures, partial seizures, tonic-clonic seizures, bipolar disorder, schizoaffective disorder, social phobias, neuropathic pain and migraine headaches. There is a high rise in number of cases of toxicity due to overdose of VPA. Hyperammonemia, a common side-effect of VPA, is caused by several proposed etiologies, reported as having uncertain correlation with VPA dose or concentration. We present here a case of a 25-year-old female patient with a past history of psychiatric complaints, presented with elevated serum VPA levels associated with elevated venous ammonia levels subsequent to VPA overdose. Later in the presence of sub-therapeutic serum VPA levels her venous ammonia levels remained raised and slowly down-trending. VPA levels and ammonia levels were found to be normal after 14 days. Patient was treated with levocarnitine. Her liver enzymes were never elevated. Different decay kinetics of venous ammonia in presence of high and low concentrations of VPA indicates that VPA can cause symptomatic hyperammonemia via more than one concurrent etiological mechanism. In this patient, the mechanisms causing hyperammonia secondary to VPA use were not related to hepatic damage or carnitine deficiency.

Hyperdense large artery sign in meningitis: A marker of ominous thrombogenic potential of pneumococcus?

Hyperdensity in the middle cerebral artery (MCA) or posterior cerebral artery (PCA) on non-contrast head CT, suggests the presence of a thrombus inside these vessels, often referred to as the "MCA sign" or "PCA sign" respectively. These two signs are classically associated with strokes secondary to cardiovascular etiologies and are only infrequently reported with other types of stroke. Whereas stroke is a recognized complication of pneumococcal meningitis hyperdense large vessel sign (in this case a combination of MCA and PCA) has not been previously reported. We report a case of rapidly progressive pneumococcal meningitis that presented as acute stroke involving large vessels in the vicinity of the circle of Willis in a patient with a history of non-Hodgkin lymphoma (NHL) in remission for 6 years. This patient had received a week of high dose steroids before admission. Head CT scan on admission showed the presence of hyperdense MCA and PCA signs. The patient rapidly deteriorated and a follow-up head CT revealed diffuse brain edema and increased density in the basal cisterns without evidence of sub arachnoid hemorrhage. Tc99m exametazime brain flow scan showed no intracerebral blood flow both supra and infratentorially. Steptococcus pneumoniae, NHL cells and high-dose steroid use can upregulate tissue factor synthesis and may have led to a hypercoagulable state via activation of the extrinsic pathway in the large intracerbral arteries.

Muscarinic receptor antagonist and an alpha-adrenergic agonist are required in combination to provide stable mydriasis following intravitreal injection in mice.

Tropicamide (muscarinic receptor antagonist) and phenylephrine (α-adrenergic receptor agonist) are commonly used to dilate the pupils by topical application. These two eye drops are often used, singly or in combination, to dilate the pupil and perform acute light-evoked physiological experiments (electroretinography, for example), before and after intravitreal injections of pharmacological agents, as an assay for their affect on retinal activity. This study wanted to determine whether treatment with one of these drugs, or with both, is most effective in maintaining mydriasis after intravitreal injections. Changes in pupillary dilation before and after intravitreal injection of balanced salt solution (0.5 µl) were recorded. Phenylephrine (α-adrenergic agonist) and tropicamide (muscarinic agonist) when combined, but not singly, produced full and stable pupillary dilation following intravitreal injections. Re-instillation of topical mydriatics after intravitreal injections was required for maximal pupillary dilation. A combination of a muscarinic receptor antagonist and an alpha-adrenergic agonist is required for stable mydriasis following intravitreal injection.

Topical mydriatics affect light-evoked retinal responses in anesthetized mice.

PURPOSE: To characterize effects of the muscarinic antagonist atropine (A) and the alpha-adrenergic agonist, phenylephrine (P), on mydriasis and light-evoked signaling in mice anesthetized by ketamine and xylazine (K+X). METHODS: Pupillary areas of anesthetized C57BL/6 mice were measured, with or without topical application of A or A+P. Dark-adapted ERGs were recorded from 2- to 4-month-old C57BL/6 and 7.5-month-old albino hrhoG/hrhoG mice after application of A or P singly or in combination, before or after induction of K+X anesthesia. Effects of GABA were tested in the hrhoG/hrhoG mice. RESULTS: K+X anesthesia resulted in maximum mydriasis that was not enhanced by A or A+P. Dark-adapted b-wave amplitudes (-1.3 log sc td s) after K+X anesthesia were similar with or without A or P. A+P in the presence of K+X produced a slow growth in b-wave amplitude, reaching a plateau of twofold enhancement in 1 hour. Recordings of responses to varying flash energies revealed that the effects of A+P were on the maximum amplitude of the a- and b-waves and not on their sensitivity. Scotopic threshold responses were augmented as well. In photoreceptor-degenerated mice (hrhoG/hrhoG), an electronegative ERG wave recorded with K+X+A, was converted to a gamma-aminobutyric acid (GABA)-sensitive response with two electropositive components with A+P after K+X. CONCLUSIONS: Topical administration of A and P together, but not separately, in the presence of K+X, leads to a slow, dramatic enhancement of a- and b-waves by an unknown mechanism independent of pupil dilation.

Two R7 regulator of G-protein signaling proteins shape retinal bipolar cell signaling.

RGS7, RGS11, and their binding partner Gbeta5 are localized to the dendritic tips of retinal ON bipolar cells (ON-BPC), where mGluR6 responds to glutamate released from photoreceptor terminals by activation of the RGS7/RGS11 substrate, Galphao. To determine their functions in retinal signaling, we investigated cell-specific expression patterns of RGS7 and RGS11 by immunostaining, and measured light responses by electroretinography in mice with targeted disruptions of the genes encoding them. RGS7 staining is present in dendritic tips of all rod ON-BPC, but missing in those for subsets of cone ON-BPC, whereas the converse was true for RGS11 staining. Genetic disruption of either RGS7 or RGS11 produced delays in the ON-BPC-derived electroretinogram b-wave, but no changes in the photoreceptor-derived a-wave. Homozygous RGS7 mutant mice had delays in rod-driven b-waves, whereas RGS11 mutant mice had delays in rod-driven, and especially in cone-driven b-waves. The b-wave delays were further enhanced in mice homozygous for both RGS7 and RGS11 gene disruptions. Thus, RGS7 and RGS11 act in parallel to regulate the kinetics of ON bipolar cell responses, with differential impacts on the rod and cone pathways.

Subcellular compartmentalization of two calcium binding proteins, calretinin and calbindin-28 kDa, in ganglion and amacrine cells of the rat retina.

PURPOSE: Intracellular free calcium ions (Ca(2+)) are an important element in retinal ganglion cell response. Two major EF-hand (E-helix-loop-F-helix-hand) calcium binding proteins in the retina, calretinin and calbindin-28 kDa, are important buffers of intracellular free Ca(2+) in neurons, and may also serve as Ca(2+)-dependent regulators of enzymes and ion channels. METHODS: This study used immunohistochemistry to investigate the subcellular expression patterns of calretinin and calbindin-28 kDa, in the soma, dendrites, and the axonal compartment of rat retinal ganglion cells. RESULTS: Antibodies for calretinin and calbindin-28 kDa labeled different cell populations in the retinal ganglion cell layer. In this layer, calretinin labeled a larger number of cells compared to calbindin-28 kDa, many, but not all, of which were displaced amacrine cells. The calbindin-28 kDa immunopositive neurons were distinct in that their somata were peripherally encircled by microtubule associated protein 1 (MAP-1) or neurofilament-200 kDa subunit (NF-200 kDa) immunofluorescence. Although somata of retinal ganglion cells contained these calcium binding proteins, neither protein was found in the dendrites or initial segments of the axons. However, both were expressed in the ganglion cell axons in nerve fiber layer. Calretinin and calbindin-28 kDa staining overlapped in some fibers and not in others. Calretinin immunofluorescence was concentrated in discrete axonal regions, which showed limited staining for calbindin-28 kDa or for NF200 kDa, suggesting its close proximity to the plasma membrane. CONCLUSIONS: There is a clear compartmentalization of calbindin-28 kDa and calretinin distribution in retinal ganglion cells. This suggests that the two calcium binding proteins perform distinct functions in localized calcium signaling. It also indicates that rather than freely diffusing through the cytoplasm to attain a homogeneous distribution, calbindin-28 kDa and calretinin must be bound to cellular structures through interactions that are likely important for their functions.

Contribution of voltage-gated sodium channels to the b-wave of the mammalian flash electroretinogram.

Voltage-gated sodium channels (Na(v) channels) in retinal neurons are known to contribute to the mammalian flash electroretinogram (ERG) via activity of third-order retinal neurons, i.e. amacrine and ganglion cells. This study investigated the effects of tetrodotoxin (TTX) blockade of Na(v) channels on the b-wave, an ERG wave that originates mainly from activity of second-order retinal neurons. ERGs were recorded from anaesthetized Brown Norway rats in response to brief full-field flashes presented over a range of stimulus energies, under dark-adapted conditions and in the presence of steady mesopic and photopic backgrounds. Recordings were made before and after intravitreal injection of TTX (approximately 3 microm) alone, 3-6 weeks after optic nerve transection (ONTx) to induce ganglion cell degeneration, or in combination with an ionotropic glutamate receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX, 200 microm) to block light-evoked activity of inner retinal, horizontal and OFF bipolar cells, or with the glutamate agonist N-methyl-D-aspartate (NMDA, 100-200 microm) to reduce light-evoked inner retinal activity. TTX reduced ERG amplitudes measured at fixed times corresponding to b-wave time to peak. Effects of TTX were seen under all background conditions, but were greatest for mesopic backgrounds. In dark-adapted retina, b-wave amplitudes were reduced only when very low stimulus energies affecting the inner retina, or very high stimulus energies were used. Loss of ganglion cells following ONTx did not affect b-wave amplitudes, and injection of TTX in eyes with ONTx reduced b-wave amplitudes by the same amount for each background condition as occurred when ganglion cells were intact, thereby eliminating a ganglion cell role in the TTX effects. Isolation of cone-driven responses by presenting test flashes after cessation of a rod-saturating conditioning flash indicated that the TTX effects were primarily on cone circuits contributing to the mixed rod-cone ERG. NMDA significantly reduced only the additional effects of TTX on the mixed rod-cone ERG observed under mesopic conditions, implicating inner retinal involvement in those effects. After pharmacological blockade with CNQX, TTX still reduced b-wave amplitudes in cone-isolated ERGs indicating Na(v) channels in ON cone bipolar cells themselves augment b-wave amplitude and sensitivity. This augmentation was largest under dark-adapted conditions, and decreased with increasing background illumination, indicating effects of background illumination on Na(v) channel function. These findings indicate that activation of Na(v) channels in ON cone bipolar cells affects the b-wave of the rat ERG and must be considered when analysing results of ERG studies of retinal function.

Capillary-contacting horizontal cells in the rodent retina.

Horizontal cells, the interneurons in the distal retina, provide feedback control of the photoreceptor synaptic output at the first synapse in the visual pathway. This article, using immunohistological and confocal microscopy techniques, presents anatomical evidence that in rat and mouse retina, the horizontal cell processes are in contact with retinal capillaries as are retinal glial cells. This glia-like property of horizontal cells in these two species, also previously reported in tree shrews by Knabe and Ochs (1999), appear to be a more common theme for these neurons than previously appreciated.