Charcot-Marie-Tooth-Erkrankungen

Die Gruppe der hereditären Neuropathien (Charcot-Marie-Tooth-Erkrankungen, CMT) ist eine klinisch und genetisch heterogene Gruppe von peripheren Neuropathien. Die Prävalenz beträgt 1:2 500, womit die CMT zu den seltenen Erkrankungen zählen. In der klinischen Neurologie stellen sie die häufigste neurogenetische Erkrankung dar. Die CMTFormen mit sensiblen und motorischen Symptomen sind am häufigsten. Neben diesen Formen gibt es rein sensible Formen, mit oder ohne autonome Symptome (HSAN), rein motorische Neuropathien (dHMN) und die besondere Form der hereditären Neuropathie mit Neigung zu Druckparesen (HNPP). Die molekulargenetische Diagnostik wurde zunehmend weiterentwickelt. Die Gendiagnostik ist integraler Bestandteil der Diagnostik für Patienten mit dem klinischen Verdacht auf das Vorliegen einer hereditären Neuropathie. Die klinische und genetische Zuordnung ist durch die große Heterogenität des Phänotyps bei über 80 potenziell krankheitsverursachenden Genen oft sehr erschwert. Trotzdem werden über 90% aller genetisch gesicherten CMT durch Mutationen in vier Genen (PMP22, Cx32, MPZ und MFN2) geklärt. Diese stellen die klinisch relevanten Kandidatengene im klinischen Alltag dar.

Language lateralization in young children assessed by functional transcranial Doppler sonography

Compared to adults, children show superior recovery of language function after damage to the dominant brain hemisphere. Possible explanations are that children have different patterns of language representation or display different patterns of reorganization. Information about language lateralization in children could provide insights into the repair mechanisms of the young brain. While functional magnetic resonance imaging (fMRI) is usually difficult to perform in children younger than 5 years, functional transcranial Doppler sonography (fTCD) is nonfrightening and readily applicable in young and very young children. However, for serial examinations, sufficient validity and reliability are required. To this end, we designed a picture-description language task (PDLT) for fTCD examinations in children, compared the outcome to established protocols and determined the 1 month retest-reliability of the measurement in 16 children aged 2-9 years. The dependent variable was the task-related hemispheric perfusion difference based on averaged relative cerebral blood flow velocity (CBFV) increases in the middle cerebral arteries. This picture-description language lateralization index was compared to language lateralization by a phonetic word generation task (PWGT) in adults revealing good intermethod validity (r=0.70; P <or= 0.05). The 1 month retest-reliability of the PDLT in the children was r=0.87 (P <or= 0.05). With this degree of reliability, fTCD seems a promising tool for the assessment of changes in hemispheric involvement in language in young and very young children.

How does the brain accommodate to increased task difficulty in word finding? A functional MRI study

In functional imaging of the brain, the difficulty of a task may be critical for the pattern of activation. Increased task difficulty could lead to increased activation in task-specific regions or to activation of additional, "compensatory" regions. A previous study with functional transcranial Doppler sonography (fTCD) showed no evidence that increased difficulty in word retrieval leads to a recruitment of areas homologous to language-related regions. The question remains how the brain accommodates increasing task difficulty. Because of limitations of fTCD method, we used functional magnetic resonance imaging (fMRI) in this study. We manipulated word retrieval difficulty in healthy subjects (n = 14) to determine whether the classical language-related brain regions are activated with increasing difficulty in word retrieval. fMRI demonstrated that with increased task difficulty (I) the lateralization of language-associated brain activation remained constant, (II) no additional activation of language-related regions of the dominant hemisphere, nor of homologous regions of the subdominant hemisphere, was evident, (III) additional activation was found in right posterior parietal cortex--typically associated with sustained attention and executive control. Thus, increased difficulty in word retrieval leads to coactivation of distinct brain areas, working together in a large cognitive network, rather than to increased activation of typically language-related areas.

Familial aggregation of strong hemispheric language lateralization

The most conspicuous aspect of the neural basis of language is the uneven involvement of the cerebral hemispheres. The familial distribution of variable degrees of left-hemispheric language lateralization was investigated. A significant familial aggregation of strong left-hemispheric language lateralization and a positive association of the degree of language lateralization between parents and their children were found. These data strongly suggest a genetic determination of the degree of language lateralization.

Calystegines in Calystegia sepium do not inhibit fungal growth and invertase activity but interact with plant invertase

Calystegines are alkaloidal glycosidase inhibitors. They accumulate predominantly in young and meristemic parts of Calystegia sepium (Convolvulaceae). C. sepium, bindweed, infests meadows and cereal fields and is difficult to control chemically. Fungal pathogens against C. sepium are established as mycoherbicides. Stagonospora convolvuli LA39 attacks C. sepium and does not affect crop plants, but young plants of C. sepium are less susceptible to the fungus. The interaction of Stagonospora convolvuli with calystegines was investigated. Further, endophytic fungi of several classes were isolated from wild-grown Calystegia sepium leaves, and selected strains were tested for interaction with calystegines. Fungal growth on agar containing calystegines was not affected considerably. Plants in climate chambers were infected with an endophyte, Phomopsis, and with the fungal pathogen, Stagonospora convolvuli. Calystegine levels were measured in infected and non-infected plant tissues. Accumulation depended on developmental stage of the plant tissue and was not influenced by infection. Acid invertase was measured from fungal mycelia and from infected and non-infected plant tissues. Fungal acid invertase activity was not inhibited by 10 mM calystegine B (2), while invertase from C. sepium leaves was inhibited. It is concluded that calystegines do not inhibit fungal development and sucrose consumption under the conditions of the present investigation, but may act by redirection of plant carbohydrate metabolism.

When finding words becomes difficult: is there activation of the subdominant hemisphere?

Language-related activation has been observed in the right cerebral hemisphere by functional imaging in dysphasic patients who had partially recovered from a left hemispheric ischemic stroke with aphasia. It has been cautioned that, because dysphasic patients have difficulties in retrieving words, a right-hemisphere activation could be the result of an unspecific increase in global brain activation because of an increased effort. To test this hypothesis, we increased the difficulty of finding words in a word completion task in healthy subjects (n = 14) and measured hemispheric activation by functional transcranial Doppler sonography (fTCD). The sensitivity of fTCD for this approach was validated with an established motor paradigm by detecting a steady increase in bilateral cerebral perfusion in parallel to increasing the speed of finger tapping. Conversely, in the linguistic task, increasing the difficulty of word completion did not change task related perfusion of the dominant or subdominant hemisphere (repeated measurement ANOVA: P = 0.8). These results demonstrate that difficult to perform word searches do not lead to an additional involvement of the subdominant hemisphere. This suggests that after stroke, language-related activation of the subdominant hemisphere is not simply an effort-related effect.

Degree of language lateralization determines susceptibility to unilateral brain lesions

Language is considered a function of either the left or, in exceptional cases, the right side of the brain. Functional imaging studies show, however, that in the general population a graded continuum from left hemispheric to right hemispheric language lateralization exists. To determine the functional relevance of lateralization differences, we suppressed language regions using transcranial magnetic stimulation (TMS) in healthy human subjects who differed in lateralization of language-related brain activation. Language disruption correlated with both the degree and side of lateralization. Subjects with weak lateralization (more bilaterality) were less affected by either left- or right-side TMS than were subjects with strong lateralization to one hemisphere. Thus in some people, language processing seems to be distributed evenly between the hemispheres, allowing for ready compensation after a unilateral lesion.

Calystegines in Calystegia sepium derive from the tropane alkaloid pathway

Calystegines were measured in roots and aerial parts of Calystegia sepium. The accumulation appears developmentally regulated. Calystegine accumulation in hairy root cultures follows growth and reaches maximal values of 1,5 mg/g dry mass. 15N-Labelled tropinone was fed to root cultures and the incorporation of label into calystegines and further metabolites of the tropane alkaloid pathway was measured after 2, 4 and 6 days. Pseudotropine was completely labelled after 2 days, and calystegine A(3) was labelled faster than the calystegines of the B-group. 2,7-Dihydroxynortropane also incorporated 15N from tropinone and is suggested to be a by-product of the tropane alkaloid pathway leading to calystegines.

Language and spatial attention can lateralize to the same hemisphere in healthy humans

BACKGROUND

Disorders of language classically occur after left brain lesions, and disorders of spatial attention after right brain lesions. It is unclear whether the hemispheric dissociation of functions is a fixed pattern of brain organization.

OBJECTIVE

The authors determined whether lateralization of language and lateralization of spatial attention also dissociate in people with atypical (i.e., right hemispheric) language dominance.

METHODS

The authors selected 10 subjects with typical, i.e., left hemispheric, and 10 with atypical, i.e., right hemispheric, language representation on a random basis from a sample of 326 healthy volunteers examined with functional transcranial Doppler sonography (fTCD) for language dominance. In these subjects, hemispheric lateralization of cerebral perfusion during a line bisection task was determined with fTCD.

RESULTS

The authors found a dissociation between dominance for language and spatial attention in all but four subjects. In the latter subjects, there was a significant lateralization to the right hemisphere for both tasks. The four subjects showed normal intellectual, linguistic, and spatial performance, with normal EEG and MRI scans of the brain.

CONCLUSION

Even in the absence of brain pathology, the same hemisphere can be dominant in control of both language and spatial attention.

Automated multiple development thin layer chromatography for calystegines and their biosynthetic precursors

Automated multiple development thin layer chromatography (AMD-TLC) was used for separation of calystegines, a class of nortropane alkaloids, and of precursors of their biosynthesis. The calystegines differ in the number of hydroxyl groups at the nortropane ring system and in the substitution pattern. A combination of TLC methods allows the separation of the individual calystegines and separation of possible precursors of the biosynthesis. Solvent combination, development time, the number of development steps, the drying time between each run and the preconditioning parameters of the silica gel TLC plates were optimised. Limits of detection were evaluated for several detection reagents.

Pulsed amperometric detection of calystegines separated by capillary electrophoresis

Calystegines are polyhydroxyalkaloids with a nortropane skeleton. They are oxidized by pulsed amperometry at a gold electrode due to their vicinal hydroxyl groups similar to monosaccharides, but at a slightly higher potential. Compared to carbohydrates, calystegines exhibit lower acidity, thus the effective electrophoretic mobility as anions in 0.1 M NaOH is lower, independent of their molecular mass. The acidity and mobility of calystegines increase with the number of hydroxyl groups. The influence of temperature and power dissipation in the capillary and changes of the inner surface on the migration times was eliminated by cooling and subtraction of the electroosmotic flow velocity. The high resolving power of capillary zone electrophoresis allows the separation of calystegines with the same number of hydroxyl groups. Detection is linear from 2 to 200 mg L(-1) with a 1 nL injection volume. Calystegines were determined in crude plant sap after filtration without further sample purification.

Behavioural relevance of atypical language lateralization in healthy subjects

In most humans, language is lateralized to the left side of the brain. It has been speculated that this hemispheric specialization is a prerequisite for the full realization of linguistic potential. Using standardized questionnaires and performance measures, we attempted to determine if there are behavioural correlates of atypical, i.e. right-hemispheric and bilateral, language lateralization. The side and degree of language lateralization were determined by measuring the hemispheric perfusion differences by functional transcranial Doppler ultrasonography during a word generation task in healthy volunteers. Subjects with left (n = 264), bilateral (n = 31) or right (n = 31) hemisphere language representation did not differ significantly with respect to mastery of foreign languages, academic achievement, artistic talents, verbal fluency or (as assessed in a representative subgroup) in intelligence or speed of linguistic processing. These findings suggest that atypical hemispheric specialization for language, i.e. right-hemisphere or bilateral specialization, is not associated with major impairments of linguistic faculties in otherwise healthy subjects.

Dihydroxynortropane alkaloids from calystegine-producing plants

Three dihydroxynortropanes, 2alpha,7beta-dihydroxynortropane, 2alpha,3beta-dihydroxynortropane, and 3alpha,7beta-dihydroxynortropane, were isolated from calystegine-producing plants in the families Convolvulaceae and Solanaceae. 2alpha,7beta-Dihydroxynortropane was isolated from six species in the Convolvulaceae whereas only Calystegia soldanella contained it and 2alpha,3beta-dihydroxynortropane. Although neither of these were detectable in three species tested in the Solanaceae, 3alpha,7beta-dihydroxynortropane was, however, isolated from Duboisia leichhardtii.

Calystegines in root cultures of Atropa belladonna respond to sucrose, not to elicitation

Calystegines are norpseudotropine alkaloids accumulating in root cultures of Atropa belladonna, together with tropine derivatives, e.g. hyoscyamine. Both alkaloid groups are derived from the tropane alkaloid pathway. For the investigation of the regulation and individual steps of tropane biosynthesis, methods for the induction of the pathway were tested. Elicitation by chitosan, or defence responses to ABA and methyl jasmonate did not enhance calystegine accumulation, but led to a more or less pronounced decrease. By blocking one arm of the diverged tropane pathway, calystegine accumulation can be increased, but total tropane alkaloid formation does not increase considerably. By elevation of sucrose supply, both, total alkaloids and calystegines in particular were increased approximately threefold. The mechanism of the induction of the biosynthesis by sucrose is not known and needs further experiments.

Handedness and hemispheric language dominance in healthy humans

In most people the left hemisphere of the brain is dominant for language. Because of the increased incidence of atypical right-hemispheric language in left-handed neurological patients, a systematic association between handedness and dominance has long been suspected. To clarify the relationship between handedness and language dominance in healthy subjects, we measured lateralization directly by functional transcranial Doppler sonography in 326 healthy individuals using a word-generation task. The incidence of right-hemisphere language dominance was found to increase linearly with the degree of left-handedness, from 4% in strong right-handers (handedness = 100) to 15% in ambidextrous individuals and 27% in strong left-handers (handedness = -100). The relationship could be approximated by the formula: f1.gif" BORDER="0">. These results clearly demonstrate that the relationship between handedness and language dominance is not an artefact of cerebral pathology but a natural phenomenon.

Language lateralization in healthy right-handers

Our knowledge about the variability of cerebral language lateralization is derived from studies of patients with brain lesions and thus possible secondary reorganization of cerebral functions. In healthy right-handed subjects 'atypical', i.e. right hemisphere language dominance, has generally been assumed to be exceedingly rare. To test this assumption we measured language lateralization in 188 healthy subjects with moderate and strong right-handedness (59% females) by a new non-invasive, quantitative technique previously validated by direct comparison with the intracarotid amobarbital procedure. During a word generation task the averaged hemispheric perfusion differences within the territories of the middle cerebral arteries were determined. (i) The natural distribution of language lateralization was found to occur along a bimodal continuum. (ii) Lateralization was equivalent in men and women. (iii) Right hemisphere dominance was found in 7.5% of subjects. These findings indicate that atypical language dominance in healthy right-handed subjects of either sex is considerably more common than previously suspected.

Specificities of the enzymes of N-alkyltropane biosynthesis in Brugmansia and Datura

The enzymes N-methylputrescine oxidase (MPO), the tropine-forming tropinone reductase (TRI), the pseudotropine-forming tropinone reductase (TRII), the tropine:acyl-CoA transferase (TAT) and the pseudotropine:acyl-CoA transferase (PAT) extracted from transformed root cultures of Datura stramonium and a Brugmansia candida x aurea hybrid were tested for their ability to accept a range of alternative substrates. MPO activity was tested with N-alkylputrescines and N-alkylcadaverines as substrates. TRI and TRII reduction was tested against a series of N-alkylnortropinones, N-alkylnorpelletierines and structurally related ketones as substrates. TAT and PAT esterification tests used a series of N-substituted tropines, pseudotropines, pelletierinols and pseudopelletierinols as substrates to assess the formation of their respective acetyl and tigloyl esters. The results generally show that these enzymes will accept alien substrates to varying degrees. Such studies may shed some light on the overall topology of the active sites of the enzymes concerned.

Reproducibility of functional transcranial Doppler sonography in determining hemispheric language lateralization

BACKGROUND AND PURPOSE

Since functional transcranial Doppler ultrasonography (fTCD) allows convenient and fully automated quantification of language lateralization, it seems ideal for longitudinal studies of perfusion changes during deterioration as well as recovery of language functions. However, during serial examinations, the technical, stochastic, and physiological variabilities of cerebral blood flow velocities (CBFV) have to be considered. Therefore, before fTCD is accepted as a tool for evaluation of changes in lateralization in the diseased state, its reliability in healthy subjects needs to be determined.

METHODS

We performed fTCD during a word generation task based on a previously validated technique with automated calculation of the averaged CBFV differences in the middle cerebral arteries providing an index of lateralization (LI).

RESULTS

(1) The accuracy of the LI as assessed by the confidence interval was better than 1% of the mean hemispheric difference. (2) On repeated examination, LIs obtained from 10 subjects showed a high test-retest reproducibility (Pearson product moment correlation coefficient r = 0.95, P < 0.0001). (3) On 10 repeated assessments of LI in the same subject, no practice effects were detected.

CONCLUSIONS

Functional TCD is a suitable and very robust tool for the longitudinal quantitative measurement of cerebral language lateralization.

Characterization of transgenic plants derived from hairy roots ofHyoscyamus muticus

Mature plants were regenerated via protoplasts fromAgrobacterium rhizogenes-transformed root cultures ofHyoscyamus muticus L., and chemical analyses were performed on 34 individual plants. The regenerated plants showed strong phenotypic differences from clone to clone as well as from the control plants. Polymerase chain reaction studies revealed that the plants exhibiting the strongest phenotypic alterations contained therol (A, B and C) genes, whereas the plants with fewer alterations had lost them. The plants produced hyoscyamine, scopolamine and a range of different calystegins, and considerable somaclonal variation was observed. Alkaloid production in the plants transgenic for therol genes was clearly reduced. The pattern of calystegins was similar within all the regenerated plants lackingrol genes. Among the plants withrol genes, the calystegin B₁ was not detectable. It seems clear that the presence ofrol genes is detrimental to the alkaloid accumulation in the transgenic plants in contrast to hairy root cultures.

Distribution of calystegines in several solanaceae

Calystegines are nortropane alkaloids with glycosidase inhibitor activity. They were found in different plant organs vary remarkably.

The reduction of tropinone in Datura stramonium root cultures by two specific reductases

In tropane-alkaloid producing plants and root cultures, the reduction of tropinone is a branch-point in secondary metabolism. Two different reductases stereospecifically form the isomeric alcohols tropine (tropan-3 alpha-ol) and pseudotropine (tropan-3 beta-ol). We describe here the purification and characterization of both reductases from transformed root cultures of Datura stramonium. The tropine-forming reductase (TR I, EC 1.1.1.206) was purified 108-fold, the pseudotropine-forming enzyme (TR II, EC 1.1.1.236) was purified 3410-fold to homogeneity. The native molecular weights, both determined by gel chromatography, were 50,700 (TR I) and 77,700 (TR II). In SDS gel electrophoresis a subunit with an M(r) of 27,700 could be identified for TR II. Isoelectric points are at 5.2 (TR I) and 5.7 (TR II). Km values for the physiological substrate tropinone are 1.30 mM (TR I) and 0.11 mM (TR II). NADPH as a cosubstrate shows Km values of 58 microM (TR I) and 16 microM (TR II). NADH is not accepted by either enzyme. The reverse reaction (i.e. oxidation of the alcohol to tropinone) was found only for TR I with a Km of 180 microM. From a detailed analysis of the catalytic activities of TR I and TR II with a range of substrate analogues some key features of the mechanism of reaction can be proposed. The catalytic properties of TR I and TR II are compared with each other and with TR I and TR II activities from other solanaceous species from which these enzymes have been described.

Levels of tropinone-reductase activities influence the spectrum of tropane esters found in transformed root cultures of Datura stramonium L

The nortropane sulphur analogues 8-thiabicyclo[3.2.1] octan-3-one, 8-thiabicyclo[3.2.1]octan-3a-ol and 8-thiabicyclo[3.2.1]octan-3β-ol have been found to have differential effects in vitro on the activities of tropinone reductase I and tropinone reductase II from Datura stramonium L. It has been demonstrated that only tropinone reductase I is able to metabolise 8-thiabicyclo[3.2.1]octan-3-one and that only this enzyme is inhibited by 8-thiabicyclo[3.2.1]octan-3α-ol and 8-thiabicyclo[3.2.1]octan-3β-ol. A K m of 0.035 mM was determined for 8-thiabicyclo[3.2.1]octan-3-one and I50 values of 0.081 mM and 0.021 mM for 8-thiabicyclo[3.2.1]octan-3α-ol and 8-thiabicyclo[3.2.1]octan-3β-ol, respectively. The influence that these differential interactions might have on metabolism was investigated in transformed root cultures of D. stramonium. It was found that when these cultures were grown in the presence of either 8-thiabicyclo[3.2.1]octan-3-one or 8-thiabicyclo[3.2.1]octan-3β-ol the spectrum of alkaloids that accumulated was altered from that found in control roots in the manner predicted from the observed effects of these inhibitors on the isolated reductases. The effect could be mimicked by feeding pseudotropine, the product of tropinone reductase II. It is concluded that the relative levels of activity of the two tropinone reductases might play an important role in regulating the balance of tropan-3α-ols to tropan-3β-ols seen in the spectrum of tropane-alkaloid-producing plants.

[Emergency Cesarean section--analysis of 143 emergency sections]

Since compromises must be accepted in emergency Caesarean sections in respect of preparation, anaesthesia and hygienic standards, 143 emergency caesarean sections out of a total number of 37,583 deliveries were analysed during 1981-1990 from four different obstetrical departments as well as risks, complications, maternal and foetal morbidity and mortality were studied. In connection with these operations, which are not influenced only by medical factors but also by logistics, two mothers died (1.4%). Perinatal mortality was 3.3% (unpurified perinatal mortality: 8.5%). Neither the influence of time, when the Caesarean section was performed, nor the place of operation (theatre or labor bed), nor the indication for the operation on foetal outcome and maternal morbidity were found. Maternal morbidity was mainly contributed to pre- and intraoperative bleeding. Intraoperatively 12.6% and postoperatively 10.5% of the patients had to be given heterologous blood conserves. In more than a third of the newborn, which had been delivered by emergency Caesarean section, because of a pathological cardiotocogram, the pH values showed no pathological findings. The benefit of an antibiotic prophylaxis in emergency Caesarean sections could be significantly demonstrated, showing the different rates of secondary healing complications. A particular problem exists in emergency Caesarean sections for the delivery of the second twin following spontaneous delivery of the first one (2.8%).