Circulating senescent myeloid cells infiltrate the brain and cause neurodegeneration in histiocytic disorders

Neurodegenerative diseases (ND) are characterized by progressive loss of neuronal function. Mechanisms of ND pathogenesis are incompletely understood, hampering the development of effective therapies. Langerhans cell histiocytosis (LCH) is an inflammatory neoplastic disorder caused by hematopoietic progenitors expressing mitogen-activated protein kinase (MAPK)-activating mutations that differentiate into senescent myeloid cells that drive lesion formation. Some individuals with LCH subsequently develop progressive and incurable neurodegeneration (LCH-ND). Here, we showed that LCH-ND was caused by myeloid cells that were clonal with peripheral LCH cells. Circulating BRAFV600E+ myeloid cells caused the breakdown of the blood-brain barrier (BBB), enhancing migration into the brain parenchyma where they differentiated into senescent, inflammatory CD11a+ macrophages that accumulated in the brainstem and cerebellum. Blocking MAPK activity and senescence programs reduced peripheral inflammation, brain parenchymal infiltration, neuroinflammation, neuronal damage and improved neurological outcome in preclinical LCH-ND. MAPK activation and senescence programs in circulating myeloid cells represent targetable mechanisms of LCH-ND.

Circulating senescent myeloid cells drive blood brain barrier breakdown and neurodegeneration

Neurodegenerative diseases (ND) are characterized by progressive loss of neuronal function. Mechanisms of ND pathogenesis are incompletely understood, hampering the development of effective therapies. Langerhans cell histiocytosis (LCH) is an inflammatory neoplastic disorder caused by hematopoietic progenitors expressing MAPK activating mutations that differentiate into senescent myeloid cells that drive lesion formation. Some patients with LCH subsequently develop progressive and incurable neurodegeneration (LCH-ND). Here, we show that LCH-ND is caused by myeloid cells that are clonal with peripheral LCH cells. We discovered that circulating BRAF V600E + myeloid cells cause the breakdown of the blood-brain barrier (BBB), enhancing migration into the brain parenchyma where they differentiate into senescent, inflammatory CD11a + macrophages that accumulate in the brainstem and cerebellum. Blocking MAPK activity and senescence programs reduced parenchymal infiltration, neuroinflammation, neuronal damage and improved neurological outcome in preclinical LCH-ND. MAPK activation and senescence programs in circulating myeloid cells represent novel and targetable mechanisms of ND.

Molecular Diagnostic Challenges and Complex Management of Consecutive Twin Pregnancies in a Family with CD40 Ligand Deficiency

X-linked hyper-IgM syndrome (XHIGM) is a primary immunodeficiency disorder (PID) caused by mutation in the gene encoding the CD40 ligand (CD40L) expressed on activated T cells. Prenatal genotyping in carriers with twin pregnancies is more challenging than in women with singleton pregnancies. In addition, women with twin pregnancies may decide on selective termination for which the risk of loss of the healthy foetus may exceed 7%. We report here on a family affected by XHIGM. Diagnosis of the disease was made in a male patient as late as 33 years of age. After family screening, the sister of the proband conceived male twins in two consecutive pregnancies. In the first pregnancy, one of the male foetuses was hemizygous for the c.521A>G (Q174R) mutation in the CD40L gene. In the second pregnancy, ultrasound scan showed one foetus to have exencephaly and karyotyping revealed this foetus to have trisomy 18. Several options were discussed, but the parents decided on selective termination in both pregnancies. The interventions were successful in both cases, and the mother now has two healthy sons. This report demonstrates the way in which advanced technologies in molecular medicine and obstetric interventions may assist families with decisions about possible selective termination in case of life-threatening molecular or chromosomal disorders. Diagnosis of CD40L deficiency at the age of 33 years in the proband was striking and indicated that PIDs are still neglected as disease entities in the evaluation of patients with recurrent severe infectious diseases.

Mutational spectrum of smith-lemli-opitz syndrome patients in hungary

Smith-Lemli-Opitz (SLO) syndrome is an autosomal recessive disorder characterized by multiple congenital abnormalities and mental retardation. The condition is caused by the deficiency of 7-dehydrocholesterol reductase (DHCR7) which catalyzes the final step in cholesterol biosynthesis. Biochemical diagnosis is based on increased concentration of 7-dehydrocholesterol (7-DHC) in the patient serum. Both life expectancy and quality of life are severely affected by the disease. The estimated prevalence of SLO syndrome ranges between 1:20,000 and 1:40,000 among Caucasians. Although the mutational spectrum of the disease is wide, approximately 10 mutations are responsible for more than 80% of the cases. These mutations show a large interethnic variability. There are no mutation distribution data from Hungary to date. Thirteen patients were diagnosed with SLO syndrome in our laboratory. As first-line tests, serum 7-DHC and total cholesterol were measured and, in positive cases, molecular genetic analysis of the DHCR7 gene was performed. Complete genetic background of the disease could be identified in 12 cases. In 1 case only 1 mutation was detected in a heterozygote form. One patient was homozygous for the common splice site mutation c.964-1G>C, while all other patients were compound heterozygotes. One novel missense mutation, c.374A>G (p.Tyr125Cys) was identified.

Role of Aspergilli and Penicillia in mycotoxin contamination of maize in Hungary

Aspergillus and Penicillium species and their mycotoxins, including aflatoxins, ochratoxins, fumonisins and patulin, are frequently encountered on cereal products. The occurrence of these species and their mycotoxins on maize was investigated in Hungary after harvest in two consecutive years. Surface-sterilized cereal seeds were placed on selective media, and the isolated fungal strains were identified using morphological methods. In 2010 and 2011, 81.94% and 14.33%, respectively, of the samples were found to be contaminated with potentially toxigenic isolates. The species identification of selected isolates was carried out using sequence-based methods. Several Aspergillus flavus isolates were identified, which are potential aflatoxin producers. Other mycotoxinproducing species were also isolated, including black Aspergilli, which potentially produce ochratoxins and fumonisins, and A. clavatus, which produces patulin. In 2010 a large number of Penicillium species occurred in the samples, producing a wide range of mycotoxins. The mycotoxin content of the samples was analysed using the ELISA and HPLC techniques. Aflatoxins were not detected in any of the samples, while ochratoxins and fumonisins were successfully identified in some of the maize seeds.

Quality assurance in obstetric and gynecologic ultrasound. The Hungarian model

The majority of physicians performing obstetric scans are radiologists and obstetricians. The radiologist is well trained in imaging but lacks the obstetric background required to interpret information obtained from the scan. The obstetrician is qualified in obstetric knowledge but often lacks the formal imaging training necessary to optimize the pictures. In Hungary, nearly 100% of the physicians who perform obstetric and gynecologic scans are obstetricians. In order to create a standard and to hold together the practitioners in obstetrics and gynecology, as well as to eliminate the serious consequences of clinical malpractice, we organized the Hungarian Society of Ultrasound in Obstetrics and Gynecology in 1992. The Society was established according to the standards of the most skilled obstetricians and gynecologists. In addition to working out the conditions and the standards, the Society provides for its members continuous education, postgraduate training, and monitors the knowledge and level of practitioners. We have established three levels of qualification. Each level requires a medical undergraduate degree. The levels range from basic (A), intermediate (B), to specialist (C). To receive the certificate every user and ultrasound laboratory have to fulfill requirements based on skill as well as equipment and circumstances. The certificates are valid for one year. Every year the practitioner must pass a special examination at the appropriate level. By doing so, the Society provides its members with not only professional support, but ethical and legal security as well.

[Biochemical and ultrasonic screening of chromosomal aneuploidies in the second trimester of pregnancy]

For prenatal screening of chromosomal aneuploidies (primarily the most frequent Down syndrome) maternal serum AFP screening in the second trimester of pregnancy has been supplemented by the determination of hCG in Hajdú-Bihar county. In pregnancies at risk on the basis of biochemical tests, a thorough, aimed ultrasound examination for the detection of minor and major anomalies characteristic for chromosomal abnormalities was carried out. If both biochemical and ultrasound examinations were suggestive of high risk prenatal karyotyping was offered. During a two-years prospective study 14328 pregnancies were screened. Authors could detect 38% of Down-syndrome cases prenatally, 5 cases in pregnant women at age under 35 years and at the same time the number of amniocenteses increased only by 70. It was concluded that 66% of all Down syndrome cases could have been prenatally diagnosed if prenatal chromosome test were performed in all cases at high risk on the basis of screening tests and maternal age.

Risk of recurrence of craniospinal anomalies

The authors analyzed 1,655 situations from their Genetic Counseling Service over a 15 year period where the reason for counseling was craniospinal anomaly (neural tube defects and/or hydrocephalus) in the family. Excluding the obviously monogenically inherited cases, they investigated pregnancies undertaken after 1,285 isolated and 177 multiple forms of craniospinal abnormalities. The recurrence rate of craniospinal defects was found to be 3.66%, which is about ten times higher than the general population risk, supporting the theory of the multifactorial threshold model in the inheritance of these anomalies. The recurrence risks of neural tube defects and of hydrocephalus were 3.47% and 2.95%, respectively. The authors concluded that recurrence risk is mainly influenced by the pathoanatomic severity of the involved anomaly, the degree of relationship, and the number of affected relatives in the family. There is a positive correlation between the pathoanatomic severity of the anomaly in the proband and the offspring. At least in one-half of the cases the same type of anomaly was observed again in the offspring as in the proband. Attention is drawn to the fact that hydrocephalus (ventriculomegaly) is often manifested only in the second half of gestation. Therefore, performing ultrasound examination is strongly recommended not only at the 18th but at the 24th week of gestation, as well in pregnancies with a positive history of neural tube defects and/or hydrocephalus.

Impact of prenatal mid-trimester screening on the prevalence of fetal structural anomalies: a prospective epidemiological study

The objective of this study was to evaluate the effectiveness of the measurement of maternal serum alpha-fetoprotein (MSAFP) at 16 weeks and a subsequent routine ultrasound screening at 18-20 weeks' gestation and the impact on the birth prevalence of congenital structural anomalies in an unselected pregnant population of Hungary in a prospective epidemiological study. A total of 63,794 pregnant women (representing one-sixth of the population of Hungary) were offered this screening program over 3 years (1988-90). Of the pregnant population, 75.7% (48,312) received MSAFP screening and in 81.0% (51,675), at least one ultrasound scan was performed. In the screened pregnancies, 496 craniospinal, thoraco-abdominal, urogenital and other severe major anomalies occurred; 317 were detected at 18-20 weeks (sensitivity 63.1%; specificity 100.0%; positive predictive value 100.0%). The sensitivity of ultrasound scanning was significantly higher (p < 0.05) than that of the MSAFP screening. (At the time of ultrasound scanning the MSAFP value was known.) In this study, the less serious anomalies such as hydrocele, hypospadias and undescended testicle were not systematically searched for, but the birth prevalences were calculated. The overall mid-trimester prevalence of severe plus less severe major anomalies was 2.26%. The birth prevalences of severe major anomalies were 0.57 (craniospinal), 4.36 (thoracoabdominal and urogenital) and 1.21 (other severe) per 1000. These values were lower than the mid-trimester prevalences which were 2.94, 5.20 and 2.06 per 1000, respectively. The prevalence values at the age of 1 year were also calculated (0.36, 2.21, 0.54 per 1000, respectively). We conclude that our screening program with availability of termination of pregnancy could significantly (p < 0.05) reduce the prevalence of severe major abnormalities at birth. Training programs in cardiac scanning are required.

[Screening for congenital anomalies in mid-term pregnancy. Prospective epidemiologic study. Fetal trisomy]

The authors have presented their experiences on prenatal screening of fetal trisomies in this second part of a prospective study between 1988 and 1990. They gained their conclusions by processing 63,496 pregnancies during three years. The results show that maternal age plays the most important role in the prenatal screening of fetal trisomies in Hungary. They recommend fetal karyotyping for every pregnant woman aged 35 years or more. They emphasized that using of a combined screening method (i.e. maternal age, serum alpha-fetoprotein, human chorionic gonadotropin, oestriol) is only permissible if the hormonal and cytogenetic laboratory background are provided under standard circumstances. Since these are not available for the vast majority of pregnant women in Hungary they concluded that, at least for the time being, the main criteria for prenatal screening of fetal trisomies is the maternal age. By applying this recommendation 25-30 percentage of Down syndrome fetuses can be detected.

[Screening of congenital anomalies in the mid-trimester of pregnancy. Prospective epidemiologic study. Developmental anomalies]

Authors report about the data of 60,000 pregnant women from three district counties of Eastern-Hungary between 1988 and 1990, on whom both ultrasound and alfa-fetoprotein screenings were performed. They demonstrate the value of this screening for the detection of fetal malformations and for the birth prevalence rate as well. This effective screening-protocol is proposed for a nation-wide application.

Influence of gonadotropin (FSH + LH) and thyrotropin (TSH) on the multiplication of Chinese hamster ovary (CHO) cells. Impact of the age of the culture

CHO cells repeatedly treated with gonadotropin showed peak division rates after their third exposure and a decrease in the mitotic rate after their fourth exposure. Thyrotropin induced a considerable decrease in the mitotic rate following the first exposure, a significant increase after the second and a further decrease following the third and fourth exposures. The pattern did not differ between the two hormones when the cells were exposed further. The age (density of the cell cultures) had an appreciable influence on hormone-provoked changes in the mitotic rate, this differing only in intensity and never in the response following the initial re-exposure.

[Selective termination of the development of the defective fetus in discordant twin pregnancies]

Selective termination of the affected fetus in twin pregnancies was performed in the second trimester of seven pregnancies. The malformations included anencephaly/exencephaly (2 cases), hydrocephalus (1 case), thoracoabdominopagus of "B" and "C" cotwins (1 case), urethral obstruction sequence (1 case) and hygroma colli (2 cases). Intrauterine intervention on the affected fetus was done by transabdominal intracardial injection of 20% NaCl solution in the 15--24 weeks of gestation. All cases had dichorionic placentation. Unaffected co-twin infants were delivered at term with normal weight in 4 cases. In 2 cases the affected fetus was found in the lower gestational sac and both pregnancies, as well as the triplet pregnancy were lost 1--6 weeks and 3 weeks after the intervention, respectively. In the other cases, neither the mother, nor the survived fetus showed any complications. We believe that using hypertonic saline is lethal for the affected fetus but carries little or no risk either the other fetus or the mother, even if small amounts of the solution might inadvertently enter their circulation.

[Experience with chorionic villi sampling]

The authors discuss their experiences from 412 chorion villus samplings, (CVS), which they have done under four and a half years since 1985. They used eight types of instruments in performing their examinations and each instrument proved to be satisfactory in the gaining of chorion villus samples, suitable for further tests. They also discuss the bacteria found most frequently in the vagina on the basis of the examination and culturing of both vaginal and cervical fluid done prior to 151 CVS examinations and the effective method with which ascending infection can be prevented. They discuss a distributional pattern of their results based on the different indications for the CVS examinations, and the outcome of each of the pregnancies after CVS. In 377 cases they did direct karyotyping, in 30 cases DNA examination and in five cases enzyme determination also occurred.

[Possibilities of prenatal diagnosis in hemophilia A based on DNA analysis]

Haemophilia-A is the most common bleeding disorder in man, resulting from a deficiency of the coagulant protein, factor VIII. The factor VIII gene is located at Xq28 and the disease is inherited as an X-linked recessive disorder. There is a possibility using DNA probes closely linked to the gene factor VIII to determine the genotype. The availability of factor VIII DNA probes has led to the detection of carrier females and first trimester prenatal diagnosis of haemophilia-A. The authors give a short account on their experiences with four DNA probes. Their studies were carried out in nine families who have affected individuals and plan another pregnancies in the near future. DNA analysis can allow first trimester prenatal diagnosis from chorionic villi taken at 8-10th weeks of gestation. In the case of a male fetus it is possible to determine whether the mutant gene is inherited or not. Till now seven prenatal diagnoses have been performed based on the chorionic DNA.

[Prenatal diagnosis of Hunter's disease]

The authors give a short report about the first-trimester prenatal detection of Hunter's disease (MPS II) inherited as X-linked disorder. There is written about a family having one affected child with Hunter's syndrome. Chorionic villus sample was taken at 10th weeks of gestation in the new pregnancy of the mother. The sex of the fetus was a male determined by DNA analysis. The activity of sulphoiduronate sulphatase was very low. The enzyme activity was also extremely low in the cultured cells from amniotic fluid taken at 16th weeks of gestation. On the basis of these results the pregnancy was terminated at parents's request. The diagnosis of Hunter's disease was confirmed by measuring the enzyme activity of the cultured fibroblasts from the male fetus.

Cytoplasmic manifestation of the nuclear membrane's hormone binding capacity during cell division

Binding of insulin and thyrotropic hormone (TSH) to the nuclear membrane of Chang liver cells was demonstrated by qualitative and quantitative cytofluorimetry, which failed to substantiate a similar binding affinity for BSA. It appears that in the dividing cell the binding structures (receptors) of the nuclear membrane migrate in the cytoplasm together with the chromosomes by the end of the prophase and become reorganized in the nucleus around the telophase. The fluorescence which indicated binding also appeared in the midbody region during division of the two daughter cells. These experimental observations strongly suggest that, after cell division, only part of the nuclear membrane's receptor complement has to be resynthesized in the daughter cells, because the receptor number required by a single cell is conserved in cytoplasmic membrane details of nuclear membrane origin.

[Ruling out fetal Sanfilippo's syndrome (mucopolysaccharidosis IIIA) in the first trimester of pregnancy]

The defect of the enzyme heparan sulfamidase is the cause of Sanfilippo A syndrome (mucopolysaccharidosis IIIA) which is an autosomal recessive inherited disease. Three children of a marriage couple who attended our genetical counselling died of this disease which at the moment is incurable. At the 10th week of the following pregnancy chorion villi analysis was carried out and normal values of the enzyme heparan sulfamidase were obtained. In view of this it was decided that pregnancy should continue. At the moment the child is one year old and clinical and laboratory findings also show that she is not affected.

Heterogeneity and recurrence risk for congenital hydrocephalus (ventriculomegaly): a prospective study

We report on 261 prospectively ascertained pregnancies studied to determine the recurrence risk of congenital hydrocephalus. Our results suggest that couples who have had one previous child with hydrocephalus have a recurrence risk of 4%. Such couples should be offered prenatal diagnosis in the second trimester of all subsequent pregnancies. It is suggested that, apart from the X-linked recessive cases, ventriculomegaly is mostly multifactorially determined.

Changes in the patching and capping of insulin receptors under the influence of hormonal imprinting

Binding of fluorescein-isothiocyanate-(FITC)-labeled insulin was followed up in the function of time in Chang liver cells pretreated and not pretreated with insulin. The not pretreated cells showed patching, but no capping of the receptors during the period of study (60 min), whereas the insulin-pretreated cells showed indications of capping already after 10 min. Patching of the insulin receptors was particularly conspicuous at the sites of cell-cell contact (at the intercellular junctions). Supra-nuclear patching occurred earlier in the control cultures, and on it followed the fluorescence of the nuclear chromatin.

Prenatal diagnosis policy without routine amniocentesis in pregnancies with a positive family history for neural tube defects

The recurrence risk for neural tube defects in pregnancies of women with a family history of neural tube defects greatly exceeds the general population risk. In these high risk pregnancies, we used a prenatal diagnostic method differing from that usually employed, relying mainly on the results of maternal serum alpha-fetoprotein (MSAFP) and ultrasound examination, without routine amniocentesis. During the 6 years reviewed in this study, this method was applied in 539 pregnancies. Of a total of 20 neural tube defects, 19 were detected using this combination of MSAFP, ultrasound, and selective amniocentesis, and the authors estimate that about 8-10 spontaneous abortions were avoided because only 28 amniocenteses were carried out instead of 539. The risk of recurrence was found to be lower than that experienced earlier.

Adaptation of the ASTRIN staining technique for quantitative determination of the functional state of the cellular nucleus. Experiments on the nucleoli of CHO cells

Cytophotometric determination between 516 less than or equal to lambda less than or equal to 745 nm of the nucleolar spectra of cells stained with the ASTRIN technique has enabled the quantitative assessment of stain binding affinity and its changes. The hormone-like active molecule gamma-L-glutamyl-taurine, which acts at the nuclear level, gave rise to nucleolar activation, which could be precisely followed up by ASTRIN staining. It appears that the ASTRIN staining technique is suitable for the quantitative determination of changes in the functional state of the nucleus and nucleolus.

Suitability of oligopeptides for induction of hormonal imprinting--implications on receptor and hormone evolution

Hormonal imprinting induced in Tetrahymena and in Chang liver cells with di-, tri-, tetra- and pentapeptides (synthetic opioids and their fragments) has shown that both cell types are able to differentiate the related molecules from one another. The dipeptide phenylalanine + proline induced a measurable imprinting in the liver cells, and chain length increase, especially terminal coupling with tyrosine enhanced the imprinting potential enormously. Intra-chain changes in the amino acid sequence had a measurable effect on the intensity of imprinting. The molecules showing the relatively strongest physiological action accounted for the most intensive imprinting in both cell types; this indicates that, in all probability, induction of binding site formation plays a key role in the development of signal molecules, and thereby in hormone evolution.

A peculiar phenomenon: increased polypeptide hormone binding (receptor accumulation) in the midbody region

Fluorescein-labeled polypeptide hormones, hormone analogons and fragments were selectively bound by the midbody, which bound neither con-A, nor the fluorescent stain in itself. This experimental observation suggests an accumulation in the midbody region of non-glycosilated hormone receptors, apparently to present a receptor pool for the separating daughter cells.

Prenatal diagnosis of cystic fibrosis by trehalase enzyme assay in amniotic fluid

Amniocentesis and amniotic fluid trehalase enzyme assay were offered to 14 pregnant women at a 1 in 4 risk for a child with cystic fibrosis. Twelve of these pregnancies were screened at the 18th week of gestation; ten proceeded to term, seven following the finding of a normal trehalase activity and three despite the low enzyme level in amniotic fluid. In all ten cases prenatal diagnosis proved to be correct. In two cases with low enzyme activity parents opted for termination at the 19th week, and with PAS-Alcian Blue staining some slight histochemical lesions characteristic of cystic fibrosis were seen in the exocrine glands, including the pancreas and intestinal mucosa, of both fetuses. The total protein content in the meconium of these fetuses was significantly higher than in the controls. Results suggest that trehalase assay in the amniotic fluid is a potential prenatal test for cystic fibrosis and it appears that in fetuses with cystic fibrosis some histochemical and biochemical abnormalities can be observed as early as the 19th week of gestation. The role of ultrasound examination as an additional procedure for the prenatal diagnosis of cystic fibrosis is also discussed.

[Studies on the differentiation of chondrocytes in connection with poly ADP ribose synthesis]

Cell differentiation and the behaviour of poly-(ADP-ribose)-synthesis after treatment with methoxybenzamide and procaine was examined in chondrocytes of cell cultures from albino rats. In this study an increase in cell differentiation was connected with a higher level of poly(ADP-ribose)-synthesis. On the basis of an increase in poly(ADP-ribose)-synthesis in chondrocytes an improved scheme of treatment of some rheumatic diseases could be developed.

Hormonal imprinting in cell culture II. Evidence of hormonal imprinting and thyrotropin (TSH) -gonadotropin (FSH) overlap in a Chinese hamster ovary (CHO) cell line

Reexposure of cultures of the Chinese hamster ovarian cell line CHO K1 to FITC-labeled hormone 48 h after the first 24-h exposure to FSH or TSH showed that hormonal imprinting, accounting for a greater binding capacity on reexposure, also took place in in vitro conditions. TSH amplified the receptors of FSH to a greater degree than FSH itself, although the reverse effect failed to happen. TSH was able to bind the ovarian cells at first exposure, and to amplify the receptors for itself and--remarkably--to a considerably greater degree for FSH, exactly as observed earlier in in vivo systems.

Observations of age and environmental influences on the thymus kept in tissue culture

In tissue cultures of thymus of rats of various ages only the cells of Gomori- and PAS-positivity showed iodine incorporation as demonstrated by radioautography. Above other cells of the migration zone no grains indicating iodine accumulation were observable. The capacity of iodine accumulation depends on the age of the animal, namely it decreases with the ageing.