RESUMO
It is proposed that the regulation of the pathways directing mammalian cell cycle progression involves several oncogenes. A summary of what is known about some of these regulatory oncogenes (fos, jun, myc, and Rb-1) and where they might function in the progression of a cell from G0 to G1 and G1 to S is presented. Data on two replication-dependent genes, those encoding histones and thymidine kinase, respectively, are also presented as models for describing transcriptional and post-transcriptional events at the G1-S border.
Assuntos
Ciclo Celular/genética , Oncogenes , Animais , Sequência de Bases , DNA , Fase G1 , Regulação da Expressão Gênica , Histonas/genética , Humanos , Dados de Sequência Molecular , Fase S , Timidina Quinase/genéticaRESUMO
The idea that excitatory amino acid transporters (EAATs) can control the activation of specific metabotropic glutamate receptors (mGluRs) was investigated in rat hippocampal slices. Using the accumulation of inositol phosphates as a measure of group I mGluR activity, we have shown that the broad spectrum, non-transportable EAAT blocker, TBOA, produces a significant shift to the left of agonist concentration-response curves. Moreover, this increase in potency did not occur if endogenous glutamate was enzymatically removed, suggesting a glutamate-dependent mechanism. This shift in potency was shown to be NMDA and group II mGlu receptor independent. Additionally, experiments with selective antagonists indicated that the group I receptor responsible for the stimulation of inositol phosphate production in this preparation is likely to be mGluR5. Inhibition of forskolin-stimulated cyclic AMP (cAMP) production was used as an index of group II/III mGluR activity. TBOA produced a rightward shift of the forskolin concentration-response curve. A group III, but not a group II, mGluR agonist also produced this effect, suggesting that the TBOA-mediated increase in glutamate activates a receptor, which appears to be a member of the group III mGluR subset. This was confirmed by the observation that an antagonist of group III mGluRs, prevented the TBOA-induced rightward shift in forskolin potency. These results provide evidence of a role for EAATs in the regulation of mGluR5 and group III mGluRs in the rat hippocampus, which may have therapeutic implications.
Assuntos
Transportador 1 de Aminoácido Excitatório/antagonistas & inibidores , Transportador 2 de Aminoácido Excitatório/antagonistas & inibidores , Glicina/análogos & derivados , Hipocampo/metabolismo , Metoxi-Hidroxifenilglicol/análogos & derivados , Receptores de Glutamato Metabotrópico/metabolismo , Animais , Ácido Aspártico/farmacologia , Benzoatos/farmacologia , Colforsina/farmacologia , AMP Cíclico/biossíntese , Antagonistas de Aminoácidos Excitatórios/farmacologia , Transportador 1 de Aminoácido Excitatório/metabolismo , Transportador 2 de Aminoácido Excitatório/metabolismo , Glicina/farmacologia , Hipocampo/efeitos dos fármacos , Técnicas In Vitro , Inositol 1,4,5-Trifosfato/metabolismo , Masculino , Metoxi-Hidroxifenilglicol/farmacologia , Piridinas/farmacologia , Ácido Quisquálico/metabolismo , Ratos , Ratos Sprague-DawleyRESUMO
In humans the regulation of cellular copper homeostasis is essential for proper organ development and function. A novel cytosolic protein, named Atox 1, was recently identified in yeast that functions in shuttling intracellular mononuclear copper [Cu(I)] to copper-requiring proteins. Atox 1 and its human homolog, hAtox1, are members of an emerging family of proteins termed copper chaperones that are involved in the maintenance of copper homeostasis. Northern blot analysis demonstrates that Atox 1 is widely expressed at varying levels in a variety of rat tissues including brain. Using in situ hybridization histochemistry, we characterized the expression profile for the rat homolog of Atox1 (rAtox1) in the normal adult rat brain. There is widespread expression within the brain that appears to be primarily neuronal. The highest levels of Atox1 message consists of distinct neuronal subtypes that are also characterized by their high levels of metals like copper, iron, and zinc, which include the pyramidal neurons of the cerebral cortex and hippocampus in addition to the neurons of the locus coeruleus. The high levels of a metal chaperone like Atox1 in subsets of neurons that also sequester metals suggests that Atox1 may be important in maintaining the functionality of metal requiring enzymes. A detailed analysis of the restricted expression profile for a novel copper chaperone, rAtox1, is described in the adult rat CNS. Further analysis shows that Atoxl expression is associated with neuronal populations that sequester copper.
Assuntos
Encéfalo/metabolismo , Proteínas de Transporte/genética , Proteínas de Transporte de Cátions , Cobre/metabolismo , Regulação da Expressão Gênica , Chaperonas Moleculares , Proteínas de Saccharomyces cerevisiae , Animais , Proteínas de Transporte/biossíntese , Proteínas de Transporte de Cobre , DNA Complementar/genética , Proteínas Fúngicas/genética , Hipocampo/metabolismo , Homeostase , Humanos , Hibridização In Situ , Ferro/metabolismo , Metalochaperonas , Camundongos , Especificidade de Órgãos , Estresse Oxidativo , Ratos , Especificidade da Espécie , Tegmento Mesencefálico/metabolismo , Zinco/metabolismoRESUMO
We generated a monoclonal antibody (MAb), designated LN-6, directed against human vimentin, which retains its immunoreactivity in B5-fixed, paraffin-embedded tissues. Like other anti-vimentin MAb, LN-6 was found to be reactive with a wide spectrum of human sarcomas and normal cells of mesenchymal derivation. However, unlike other similar reagents, LN-6 was unreactive with normal and malignant human lymphoid cells and therefore displays a more restricted immunoreactivity. Because of its ability to stain routinely processed pathological tissues and its marked reactivity with human sarcomas, LN-6 is a unique reagent for the immunohistochemical diagnosis of human cancer.
Assuntos
Anticorpos Monoclonais/imunologia , Mesoderma/citologia , Neoplasias de Tecidos Moles/patologia , Vimentina/metabolismo , Animais , Carcinoma/diagnóstico , Carcinoma/metabolismo , Carcinoma/patologia , Imunofluorescência , Formaldeído , Técnicas Histológicas , Humanos , Técnicas Imunoenzimáticas , Linfoma/diagnóstico , Linfoma/metabolismo , Linfoma/patologia , Mesoderma/metabolismo , Mesoderma/ultraestrutura , Camundongos , Camundongos Endogâmicos BALB C , Parafina , Testes de Precipitina , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/metabolismo , Vimentina/imunologiaRESUMO
Insulin-like growth factors (IGFs) are important trophic factors during development as well as in the adult or damaged nervous system. Their trophic actions are modulated by interactions with six distinct IGF binding proteins. The mRNA expression profiles of binding proteins 2, 4 and 5 in the normal developing and adult CNS are well characterized and are shown to have distinctive, non-overlapping distributions. The IGF binding protein-6 (BP6) is also expressed in the CNS, however, details regarding its mRNA expression distribution in the developing and adult nervous system is limited. BP6 has the unique property of preferentially binding the IGF-II ligand. Coupled with the fact that this ligand is the most abundantly expressed IGF in the adult CNS, this suggests that the IGF-II/BP6 complex has a unique role in modulating IGF-II function in the adult brain. In this report the anatomical distribution of BP6 messenger RNA in the developing and adult rat nervous system is presented. In the embryonic animal the CNS expression is tightly restricted to trigeminal ganglia and, relative to the rest of the embryo, this structure has the highest expression. The expression in the forebrain and cerebellum does not occur until after postnatal day 21 and then is primarily associated with GABAergic interneurons. The highest levels of expression in the adult animal are in the hindbrain, spinal cord, cranial ganglia, and dorsal root ganglia. These nuclei in the hindbrain and periphery that express BP6 are all associated with the coordination of sensorimotor function in the cerebellum, which indicates an important role for the BP6/IGF-II complex in the function and maintenance of these systems.
Assuntos
Encéfalo/metabolismo , Gânglios Sensitivos/metabolismo , Proteína 6 de Ligação a Fator de Crescimento Semelhante à Insulina/biossíntese , Sistema Nervoso/metabolismo , Medula Espinal/metabolismo , Animais , Imuno-Histoquímica , Técnicas In Vitro , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like II/metabolismo , RNA Mensageiro/biossíntese , Ratos , Distribuição Tecidual , Regulação para CimaRESUMO
Two novel murine monoclonal antibodies that bind to intracellular antigens, designated TNT-1 and TNT-2, have been generated by immunizing mice with nuclear extracts from human lymphoma cells. The monoclonal antibodies were initially identified by indirect immunofluorescence on lymphoma cell lines and subsequently were found to stain the nucleus of all cell types from several species including plants by indirect immunofluorescence techniques. Immunoblot analysis demonstrated that TNT-1 bound to a protein of 22 kD and TNT-2 bound to two proteins of 15 and 22 kD, consistent with the known molecular weight of histones. To characterize their immunoreactivity, competition radioimmunoassays were performed using purified histone fractions H1, H2a, H2b and H3. By these assays, TNT-1 was found to bind to histone fraction H1 and TNT-2 to an epitope common to histone fractions H1 and H3. Histones are found in abundance in the nucleus of the cell and are known to play a major role in chromosome structure and gene expression. Upon cell death, histones remain tightly bound to DNA and consequently provide an abundant intracellular antigen that can be exploited in targeting necrotic cells, such as those found in tumors.
Assuntos
Anticorpos Antinucleares/imunologia , Anticorpos Monoclonais/imunologia , Histonas/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Animais , Humanos , Hibridomas/imunologia , Immunoblotting , Camundongos , RadioimunoensaioAssuntos
Anticorpos Monoclonais/uso terapêutico , Linfoma de Burkitt/tratamento farmacológico , Daunorrubicina/uso terapêutico , Radiossensibilizantes/uso terapêutico , Linfoma de Burkitt/patologia , Sobrevivência Celular/efeitos dos fármacos , Portadores de Fármacos , Humanos , Técnicas In Vitro , Células Tumorais CultivadasRESUMO
Nine immunoglobulin M (IgM) monoclonal antibodies (MAbs) produced in ascites fluids or in cell culture supernatants, have been purified on a fast protein liquid chromatography (FPLC) system using anion-exchange, size-exclusion, or mixed-mode chromatography matrices. The use of a mixed-mode ABx column provided an IgM that had a purity of greater than 99% after a single purification step. Anion-exchange chromatography using a Mono Q column, provided a partial purification of the IgM which could subsequently be purified to a product of ca. 90% purity (determined from sodium dodecyl sulfate polyacrylamide gel electrophoresis) by size-exclusion chromatography on a Superose-6 column. Alternatively, the ascites containing the IgM was ammonium sulfate precipitated and chromatographed on the Superose-6 column under normal- as well as high-ionic strength conditions, which also yielded a product of ca. 90% purity. The purification of IgM from concentrated cell culture supernatants was evaluated using the Superose-6 or the ABx column. IgM purified from this source was greater than 99% pure when chromatographed on the mixed-mode column and ca. 60% pure on the size-exclusion column. MAbs from each of the procedures retained their immunoreactivity, as shown by indirect immunofluorescence staining of fixed cell preparations. A comparison of these methods revealed that mixed mode chromatography was simple, efficient, and yielded a product of high purity. The optimization of these methods facilitates the large-scale purification of mouse IgM MAbs and provides practical procedures for generating IgMs for use as diagnostic and therapeutic reagents.
Assuntos
Anticorpos Monoclonais/isolamento & purificação , Imunoglobulina G/isolamento & purificação , Resinas de Troca Aniônica , Células Cultivadas , Cromatografia de Afinidade , Cromatografia Líquida , Eletroforese em Gel de Poliacrilamida , Hibridomas , Resinas de Troca Iônica , Sefarose , Frações Subcelulares/análiseRESUMO
The hamster histone H3.2 promoter contains an AP-1-like element (referred to as site X) that contains the sequence CGAGTCA. This site differs from the Jun/AP-1 consensus sequence by one base and is also similar to the cyclic AMP response element. Similar AP-1/cyclic AMP response element-like sites have been found in the promoters of other histone H3 genes and are known to bind proteins either in vivo or in vitro. Using site directed mutagenesis, we demonstrate that a 10-base pair region which encompasses site X is a positive control element that is necessary for the S phase dependent increase in H3.2 transcription in cells synchronized by serum stimulation or aphidicolin block. DNase I footprint analysis shows that mutating site X eliminates v-Jun and hamster cellular factor(s) binding. Further in vitro analysis with gel retardation assays reveals that the flanking sequence of this site is necessary for the formation of an H3.2 specific complex that can be distinguished from complexes formed with a collagenase or SV40 AP-1 element. Antibodies specific to the different members of the Jun and Fos family of transcription factors show that, in gel retardation assays, a Jun-like factor is a component of the H3.2 specific complex. However, the H3.2 specific complex exhibits different reactivity toward the Jun and Fos specific antibodies as compared to complexes formed with a collagenase AP-1 element. We hypothesize that a unique protein complex, containing a component related to the AP-1 family of transcription factors, binds to the AP-1-like motif of the hamster H3.2 promoter and may be involved in the S phase dependent regulation of transcription.
Assuntos
Núcleo Celular/metabolismo , Histonas/genética , Regiões Promotoras Genéticas/genética , Proteínas Proto-Oncogênicas c-jun/metabolismo , Fase S/genética , Transcrição Gênica/genética , Animais , Composição de Bases/genética , Sequência de Bases , Sítios de Ligação/fisiologia , Cloranfenicol O-Acetiltransferase/genética , Cricetinae , Proteínas de Ligação a DNA/metabolismo , Dados de Sequência Molecular , Mutação/genética , Ligação ProteicaRESUMO
The hamster histone H3.2 promoter contains a protein binding site (referred to as site X) required for G1/S transcriptional activation. We report here that nuclear extracts prepared from serum synchronized cells at various stages of the cell cycle show a biphasic increase in the H3.2 specific complex, H3abp, binding to site X. An increase in binding activity occurs as cells first enter the cell cycle and later at the G1/S border. The H3.2 specific binding activity is enhanced by Mg2+ and Ca2+ in vitro, but is inhibited by Zn2+. Site X resembles a Jun/AP-1 site, but previously it has been shown that the H3abp complex is immunologically distinct from the characterized AP-1 proteins. Here, we identify the size of the hamster nuclear protein(s) that bind specifically to the H3abp site by ultra-violet crosslinking and renaturation of specific protein bands following gel electrophoresis. In addition, we purify H3abp by affinity chromatography and show that the purified H3abp has a different methylation interference profile from AP-1. Our results indicate that a protein species around 68 kDa is the major DNA binding component of the H3abp complex and it binds specifically to the histone promoter site required for G1/S regulation.
Assuntos
Ciclo Celular/fisiologia , Proteínas de Ligação a DNA/metabolismo , Histonas/metabolismo , Proteínas Nucleares/metabolismo , Regiões Promotoras Genéticas , Animais , Sequência de Bases , Cátions Bivalentes/farmacologia , Extratos Celulares/química , Cricetinae , Reagentes de Ligações Cruzadas , DNA/metabolismo , Proteínas de Ligação a DNA/química , Proteínas de Ligação a DNA/isolamento & purificação , Histonas/genética , Metilação , Dados de Sequência Molecular , Peso Molecular , Proteínas Nucleares/química , Proteínas Nucleares/isolamento & purificação , Ligação Proteica/efeitos dos fármacos , Fator de Transcrição AP-1 , Raios UltravioletaRESUMO
The cyclins are an extensive family of proteins whose cell cycle-dependent synthesis is postulated to control multiple events during the cell cycle. The synthesis of A-type cyclins begins at the start of S phase. In mammalian cells, association with the cdc-type kinases suggests that cyclin A complexes are important for DNA replication and regulating other DNA-bound substrates required for S phase. We report here that a 25-bp promoter element previously shown to be important for the G1-S activation of the human thymidine kinase (htk) promoter in growth-stimulated cells is a cellular target of cyclin A and the p33cdk2 complexes. Though the p33cdk2 and other nuclear factor complexes exhibit constitutive binding to the htk G1-S regulatory domain, the binding activity of a cyclin A/p107 protein complex is greatly enhanced when the cells enter S phase, correlating with the increase in the tk mRNA levels and the replication of DNA. The binding activity of the cyclin A complex is maintained throughout S phase. Mutation of the DNA sequences on either half of the 25-bp protein binding site results in the loss of its ability to compete efficiently in vitro for the htk complexes, including that of cyclin A-containing complex. The loss of high-affinity binding for the htk complexes also substantially reduces the S-phase regulation of the htk promoter in vivo. Our results support the hypothesis that a cyclin A complex, in association with the p33cdk2 kinase, mediates the S-phase-regulated transcription of the htk promoter in growth-stimulated cells.
Assuntos
Quinases relacionadas a CDC2 e CDC28 , Ciclo Celular/genética , Quinases Ciclina-Dependentes , Ciclinas/metabolismo , Regulação da Expressão Gênica , Regiões Promotoras Genéticas , Proteínas Quinases/metabolismo , Proteínas Serina-Treonina Quinases , Timidina Quinase/genética , Transcrição Gênica , Sequência de Bases , Ciclo Celular/fisiologia , Linhagem Celular , Cloranfenicol O-Acetiltransferase/genética , Cloranfenicol O-Acetiltransferase/metabolismo , Quinase 2 Dependente de Ciclina , Proteínas de Ligação a DNA/metabolismo , Fase G1/genética , Humanos , Cinética , Dados de Sequência Molecular , Oligodesoxirribonucleotídeos , Proteínas Recombinantes de Fusão/metabolismo , Sequências Reguladoras de Ácido Nucleico , Fase S/genética , Timidina Quinase/metabolismo , Fatores de Tempo , TransfecçãoRESUMO
Neural activity and neurotrophins induce synaptic remodeling in part by altering gene expression. A cDNA encoding a glycosylphoshatidylinositol-anchored protein was identified by screening for hippocampal genes that are induced by neural activity. This molecule, named neuritin, is expressed in postmitotic-differentiating neurons of the developing nervous system and neuronal structures associated with plasticity in the adult. Neuritin message is induced by neuronal activity and by the activity-regulated neurotrophins BDNF and NT-3. Purified recombinant neuritin promotes neurite outgrowth and arborization in primary embryonic hippocampal and cortical cultures. These data implicate neuritin as a downstream effector of activity-induced neurite outgrowth.
Assuntos
Encéfalo/metabolismo , Fatores de Crescimento Neural/farmacologia , Neuritos/fisiologia , Neurônios/metabolismo , Neuropeptídeos/biossíntese , Neuropeptídeos/farmacologia , Transcrição Gênica , Sequência de Aminoácidos , Animais , Anticorpos , Sequência de Bases , Células CHO , Córtex Cerebral/metabolismo , Cricetinae , DNA Complementar , Embrião de Mamíferos , Proteínas Ligadas por GPI , Glicosilfosfatidilinositóis/metabolismo , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Humanos , Hibridização In Situ , Dados de Sequência Molecular , Neuritos/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Neuropeptídeos/isolamento & purificação , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/imunologia , RNA Mensageiro/biossíntese , Ratos , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/farmacologia , TransfecçãoRESUMO
A monoclonal antibody, designated BM-1, which is reactive in B5 formalin-fixed, paraffin-embedded tissues, has been generated against a cytoplasmic and nuclear antigen expressed in human myeloid precursor cells and derived leukemias. Using the avidin-biotin-complex immunoperoxidase procedure, BM-1 was found to stain selectively myeloid precursor cells in normal bone marrow and mature granulocytes in the blood. In a screen of 26 normal adult and fetal human organs fixed in B5 formalin, BM-1 was negative in all nonhematopoietic tissues with the exception of tissue granulocytes and scattered cells in the peripheral cortex of the thymus. Likewise a screen of 30 solid tumor cell lines including a spectrum of carcinomas, sarcomas, and neural-derived tumors was negative. BM-1 was also negative with 21 T and B cell lymphomas and 11 Hodgkin's disease tumors. A preliminary study of tumors of the hematopoietic system revealed that BM-1 was reactive with M2 and M3 acute myelogenous leukemias (AML), chronic myelogenous leukemias (CML) and myelomonocytic leukemias, and granulocytic sarcomas. M1, M4, M5, and M6 AML clot preparations were negative in this study, indicating that BM-1 may have a role in the histopathologic diagnosis of myelogenous leukemia. Myeloid leukemic cell lines HL-60, ML-2, KG1, and TPH-1-O showed BM-1 nuclear and/or cytoplasmic reactivity in a subpopulation of cells, but erythroid and lymphoid leukemias and all lymphoma cell lines were negative. Immunoperoxidase studies of a panel of fetal tissues showed BM-1 positive cells in the peripheral cortex of the thymus and portal myelopoietic regions of the liver at 18 weeks gestation. Finally, DNA-cellulose and solid phase radioimmunoassay (RIA) techniques developed in our laboratory demonstrate that the BM-1 antigenic domain is reactive only after binding to eukaryotic but not prokaryotic single- or double-stranded DNA. Immunoblot techniques using a DNA-cellulose purified protein sample revealed that BM-1 recognizes a 183 kD protein. These studies indicate that BM-1 is recognizing a myeloid-specific antigen that, because of its DNA binding characteristics, may have an important role in the differentiation of myeloid cells at the molecular level.
Assuntos
Anticorpos Monoclonais , Medula Óssea/metabolismo , Proteínas de Ligação a DNA/metabolismo , Animais , Anticorpos Monoclonais/biossíntese , Antígenos/imunologia , Linhagem Celular , Técnicas Histológicas , Humanos , Imuno-Histoquímica , Leucemia Experimental/metabolismo , Leucemia Mieloide/metabolismo , Linfoma/metabolismo , Peso MolecularRESUMO
Ten patients with refractory B cell lymphomas were treated with weekly intravenous infusions of escalating doses of murine monoclonal antibody (MoAb) LYM-1 over four weeks. LYM-1 is a recently developed IgG2a murine MoAb that recognizes a polymorphic HLA-Dr antigen on surfaces of normal and malignant B cells but does not bind to any other normal tissues. MoAb LYM-1 has several advantages for serotherapy, since the antigen it recognizes is not shed from the cell surface and does not modulate in response to MoAb therapy. Furthermore, in vitro studies have indicated significant anti-tumour activity against lymphoma cell lines. In the current trial, dose-dependent levels of free LYM-1 were detected in the serum of all patients, but penetration of extravascular tumour tissues was poor. No significant toxicity or human anti-mouse antibody responses were observed in any patient. Clinical responses were minor and appeared to correlate with the number of infiltrating T cells seen in the initial lymphoma specimens. LYM-1 appears to be well-tolerated and has demonstrated several potential advantages as a therapeutic agent in patients with lymphoma. The mechanism of anti-tumour effect and plans for further clinical studies are discussed.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antígenos HLA-DR/imunologia , Linfoma/terapia , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/imunologia , Linfócitos B , Citotoxicidade Imunológica , Feminino , Humanos , Imunização Passiva , Imunoglobulinas/análise , Contagem de Leucócitos , Masculino , Pessoa de Meia-IdadeRESUMO
Recent evidence suggests that spinal cord glia can contribute to enhanced nociceptive responses. However, the signals that cause glial activation are unknown. Fractalkine (CX3C ligand-1; CX3CL1) is a unique chemokine expressed on the extracellular surface of spinal neurons and spinal sensory afferents. In the dorsal spinal cord, fractalkine receptors are primarily expressed by microglia. As fractalkine can be released from neurons upon strong activation, it has previously been suggested to be a neuron-to-glial signal that induces glial activation. The present series of experiments provide an initial investigation of the spinal pain modulatory effects of fractalkine. Intrathecal fractalkine produced dose-dependent mechanical allodynia and thermal hyperalgesia. In addition, a single injection of fractalkine receptor antagonist (neutralizing antibody against rat CX3C receptor-1; CX3CR1) delayed the development of mechanical allodynia and/or thermal hyperalgesia in two neuropathic pain models: chronic constriction injury (CCI) and sciatic inflammatory neuropathy. Intriguingly, anti-CX3CR1 reduced nociceptive responses when administered 5-7 days after CCI, suggesting that prolonged release of fractalkine may contribute to the maintenance of neuropathic pain. Taken together, these initial investigations of spinal fractalkine effects suggest that exogenous and endogenous fractalkine are involved in spinal sensitization, including that induced by peripheral neuropathy.