Estradiol- and progesterone-associated changes in microRNA-induced silencing and reduced anti-seizure efficacy of an antagomir in female mice

About one third of individuals living with epilepsy have treatment-resistant seizures. Alternative therapeutic strategies are thus urgently needed. One potential novel treatment target is microRNA-induced silencing, which is differentially regulated in epilepsy. Inhibitors (antagomirs) of specific microRNAs have shown therapeutic promise in preclinical epilepsy studies; however, these studies were mainly conducted in male rodent models, and research into microRNA regulation in females and by female hormones in epilepsy is scarce. This is problematic because female sex and the menstrual cycle can affect the disease course of epilepsy and may, therefore, also alter the efficacy of potential microRNA-targeted treatments. Here, we used the proconvulsant microRNA miR-324-5p and its target, the potassium channel Kv4.2, as an example to test how microRNA-induced silencing and the efficacy of antagomirs in epilepsy are altered in female mice. We showed that Kv4.2 protein is reduced after seizures in female mice similar to male mice; however, in contrast to male mice, microRNA-induced silencing of Kv4.2 is unchanged, and miR-324-5p activity, as measured by the association with the RNA-induced silencing complex, is reduced in females after seizure. Moreover, a miR-324-5p antagomir does not consistently reduce seizure frequency or increase Kv4.2 in female mice. As a possible underlying mechanism, we found that miR-324-5p activity and silencing of Kv4.2 in the brain were differentially correlated with plasma levels of 17β-estradiol and progesterone. Our results suggest that hormonal fluctuations in sexually mature female mice influence microRNA-induced silencing and could alter the efficacy of potential future microRNA-based treatments for epilepsy in females.Significance StatementMicroRNA-induced silencing is currently investigated in preclinical studies as a potential novel class of treatment target for epilepsy; however, surprisingly little is known about if and how microRNA-induced silencing is regulated by biological sex and if microRNA therapeutics are as effective in females as they are in males. This study shows that microRNA silencing of the potassium channel Kv4.2 and the functional activity of its targeting microRNA, miR-324-5p, change with plasma levels of estrogens and progesterone and that an inhibitor of miR-324-5p is less effective in female mice to suppress seizures. These findings are significant as they suggest microRNA-induced silencing as a novel molecular mechanism contributing to sex differences in epilepsy that could impact future therapy development.

Health care, public policy and the courts: black health status as a civil rights issue

In the U.S.A. serious differences in the health status between black and white citizens continue to exist. Black Americans are less healthy and receive less health care than while Americans. The discrimination is examined as a civil rights issue with focus on both the policy and judicial perspectives of the application of Title VI of the Civil Rights Act of 1964 and the implementative effects of the Hill-Burton Act of 1946. The application, and compliance and enforcement, of civil rights to health care is complicated by a captivity process involving Federal agencies, by corporate medical rights emphasizing a business approach to health care, and by a liberal pluralistic political arena in which certain influential groups prevail over others. In order for black health status and care to improve in the U.S.A., blacks must continue to utilize the judicial system to seek redress of health care inequities. Second, they must utilize their demonstrated political power to demand better treatment from the medical establishment.

Scoring reliability of the multiple sleep latency test in a clinical population

STUDY OBJECTIVES

To determine intrarater and interrater scoring reliability of the multiple sleep latency test (MSLT) in a population of sleep clinic patients.

DESIGN

N/A.

SETTING

Urban sleep center.

PATIENTS

200 consecutive sleep center patients (diagnoses included: obstructive sleep apnea, narcolepsy, periodic-limb-movement, and individuals with no diagnosis).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

MSLTs were recorded and scored according to standard clinical procedures. One of four clinical polysomnographers and one of seven polysomnographic technologists scored each MSLT. All MSLTs were then rescored by the same polysomnographer. The intrarater reliability coefficient for mean MSLT score was .87 and interrater reliability was .90. Coefficients for the mean number of REM onsets during the MSLT were .81 for intrarater and .88 for interrater reliability. Intrarater and interrater agreement (kappa coefficients) for the presence of at least one REM onset during the MSLT was .78 and .86, respectively. For the presence of greater than one REM onset, a kappa of .78 was obtained for intrarater agreement and .91 for interrater agreement.

CONCLUSIONS

The clinical MSLT displays excellent interrater and intrarater reliability estimates for both sleep latency and REM onset scores in a sleep-disordered population.

Health care reform, managed competition, and the urban medically underserved: some preliminary questions about structure, equity, and quality care

The purpose of this article is to provide some preliminary observations and discussion on several questions relating to managed competition in health and the urban medically underserved. The shift to managed competition in health care financing and delivery from an unmanaged fee-for-service system raises several critical transitional questions for those groups in the urban arena that have been traditionally medically underserved. After an overview discussion of cost dynamics in the American health care system and selected characteristics of the health care system and the urban medically underserved, the article explores several critical transitional questions relating to structure, equity and quality care considerations in managed competition and the urban medically underserved.

The uninsured and patient dumping: recent policy responses in indigent care

This article discusses the uninsured population and the phenomenon known as "patient dumping"--the transfer of a patient from one hospital (typically a private hospital) to a public hospital because of the patient's lack of insurance or inability to pay. The uninsured are the most vulnerable to patient dumping. The growth of patient dumping, a profile of the uninsured who are most likely to be a minority, and an analysis of federal and state policy responses to patient dumping are all discussed. The need for reform of the American health care system is highlighted and the Canadian health system is suggested as an alternative model.

Black health care in America: a political perspective

Despite recent improvements in the health status of blacks, significant disparities continue to exist between blacks and whites in nearly every health status index. Contributing to these disparities are biases in the health system; economic bias being the most significant. This article assesses the competitive market strategy, the most recent federal initiative to promote equity in the access to health services in terms of the consequences for black health. Several policy actions are recommended to improve the health status of the black population.

Medical indigency and inner city hospital care: patient dumping, emergency care and public policy

This paper discusses the growing lack of private for-profit hospital care for the medically indigent. The issues of patient dumping and emergency care are examined from both judicial and public policy perspectives. The paper concludes by noting that dumping may be viewed as a most serious form of neglect and more comprehensive laws and court decisions are needed to require all hospitals, regardless of ownership, to treat all patients who arrive at their doors if they have the appropriate medical staff and facilities.

Inner-city hospital closures/relocations: race, income status, and legal issues

Hospital closures/relocations are occurring with increasing frequency in the United States and these actions are alleged to have adverse consequences for racial-minorities and low-income individuals. This paper through an examination and review of the literature discusses the reasons why hospitals close/relocate, examines the legal issues and questions that have arisen over decisions leading to hospital closures/relocations and discusses the implications of hospital closures/relocations on the health care of inner-city minorities and low-income individuals. The conclusion suggests that for inner-city indigents hospital closure/relocations means only one thing--a decline in hospital care. If the present trend in hospital closures/relocations continues, a few for-profit hospital chains may have the responsibility for determining community health needs based on what services are most profitable and who will be the recipient of these services.

Black health inequities and the American health care system

This paper examines the health care status of blacks in the American health care system and points out that blacks are burdened by a number of health inequities when compared to their white counterparts. The paper's central theme is that the degree of governmental commitment in a liberal, pluralistic society is at the foundation of inadequate health care for black Americans. Blacks lack input in the health care politics and decision/policy-making processes. This lack of input has resulted in a health care system that appears to be unresponsive to the health care needs of black Americans. This is most acute in the areas of health manpower planning and health planning. The conclusion suggests that an increase in the number of blacks in the health professions along with more black participation in health decision/policy-making could lead to a substantial improvement in the overall health care of blacks.