Somatostatin Receptor PET/MR Imaging of Inflammation in Patients With Large Vessel Vasculitis and Atherosclerosis

BACKGROUND

Assessing inflammatory disease activity in large vessel vasculitis (LVV) can be challenging by conventional measures.

OBJECTIVES

We aimed to investigate somatostatin receptor 2 (SST2) as a novel inflammation-specific molecular imaging target in LVV.

METHODS

In a prospective, observational cohort study, in vivo arterial SST2 expression was assessed by positron emission tomography/magnetic resonance imaging (PET/MRI) using 68Ga-DOTATATE and 18F-FET-βAG-TOCA. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy; imaging mass cytometry; and bulk, single-cell, and single-nucleus RNA sequencing.

RESULTS

Sixty-one participants (LVV: n = 27; recent atherosclerotic myocardial infarction of ≤2 weeks: n = 25; control subjects with an oncologic indication for imaging: n = 9) were included. Index vessel SST2 maximum tissue-to-blood ratio was 61.8% (P < 0.0001) higher in active/grumbling LVV than inactive LVV and 34.6% (P = 0.0002) higher than myocardial infarction, with good diagnostic accuracy (area under the curve: ≥0.86; P < 0.001 for both). Arterial SST2 signal was not elevated in any of the control subjects. SST2 PET/MRI was generally consistent with 18F-fluorodeoxyglucose PET/computed tomography imaging in LVV patients with contemporaneous clinical scans but with very low background signal in the brain and heart, allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. Clinically effective treatment for LVV was associated with a 0.49 ± 0.24 (standard error of the mean [SEM]) (P = 0.04; 22.3%) reduction in the SST2 maximum tissue-to-blood ratio after 9.3 ± 3.2 months. SST2 expression was localized to macrophages, pericytes, and perivascular adipocytes in vasculitis specimens, with specific receptor binding confirmed by autoradiography. SSTR2-expressing macrophages coexpressed proinflammatory markers.

CONCLUSIONS

SST2 PET/MRI holds major promise for diagnosis and therapeutic monitoring in LVV. (PET Imaging of Giant Cell and Takayasu Arteritis [PITA], NCT04071691; Residual Inflammation and Plaque Progression Long-Term Evaluation [RIPPLE], NCT04073810).

Post-mortem confirmation of fetal brain abnormalities: challenges highlighted by the MERIDIAN cohort study

OBJECTIVES

To assess and analyse the concordance between post-mortem findings and in utero magnetic resonance imaging (iuMRI) in the MERIDIAN (MRI to enhance the diagnosis of fetal developmental brain abnormalities in utero) cohort.

DESIGN

Prospective cohort study.

SETTING

Fetal medicine units in the UK.

POPULATION

Pregnant women with a diagnosis of fetal brain abnormality identified on ultrasound at 18 weeks of gestation or later.

METHODS

All pregnancies from the MERIDIAN study that resulted in a abortion were included and the rate of uptake and success of post-mortem examinations were calculated. In the cases in which diagnostic information about the fetal brain was obtained by post-mortem, the results were compared with the diagnoses from iuMRI.

MAIN OUTCOME MEASURE

Outcome reference diagnosis from post-mortem examination.

RESULTS

A total of 155 from 823 pregnancies (19%) ended in a termination of pregnancy and 71 (46%) had post-mortem brain examinations, 62 of which were diagnostically adequate. Hence, the overall rate of successful post-mortem investigation was 40%, and for those cases there was a concordance rate of 84% between iuMRI and post-mortem examination. Detailed information is provided when the results of the post-mortem examination and the iuMRI study differed.

CONCLUSIONS

We have shown tissue-validation of radiological diagnosis is hampered by a low rate of post-mortem studies in fetuses aborted with brain abnormalities, a situation further compounded by a 12% rate of autopsy being technically unsuccessful. The agreement between iuMRI and post-mortem findings is high, but our analysis of the discrepant cases provides valuable clues for improving how we provide information for parents. TWEETABLE ABSTRACT: iuMRI should be considered a reliable indicator of fetal brain abnormalities when post-mortem is not performed.

The genome of the sparganosis tapeworm Spirometra erinaceieuropaei isolated from the biopsy of a migrating brain lesion

BACKGROUND

Sparganosis is an infection with a larval Diphyllobothriidea tapeworm. From a rare cerebral case presented at a clinic in the UK, DNA was recovered from a biopsy sample and used to determine the causative species as Spirometra erinaceieuropaei through sequencing of the cox1 gene. From the same DNA, we have produced a draft genome, the first of its kind for this species, and used it to perform a comparative genomics analysis and to investigate known and potential tapeworm drug targets in this tapeworm.

RESULTS

The 1.26 Gb draft genome of S. erinaceieuropaei is currently the largest reported for any flatworm. Through investigation of β-tubulin genes, we predict that S. erinaceieuropaei larvae are insensitive to the tapeworm drug albendazole. We find that many putative tapeworm drug targets are also present in S. erinaceieuropaei, allowing possible cross application of new drugs. In comparison to other sequenced tapeworm species we observe expansion of protease classes, and of Kuntiz-type protease inhibitors. Expanded gene families in this tapeworm also include those that are involved in processes that add post-translational diversity to the protein landscape, intracellular transport, transcriptional regulation and detoxification.

CONCLUSIONS

The S. erinaceieuropaei genome begins to give us insight into an order of tapeworms previously uncharacterized at the genome-wide level. From a single clinical case we have begun to sketch a picture of the characteristics of these organisms. Finally, our work represents a significant technological achievement as we present a draft genome sequence of a rare tapeworm, and from a small amount of starting material.

The genome of the sparganosis tapeworm Spirometra erinaceieuropaei isolated from the biopsy of a migrating brain lesion

BACKGROUND

Sparganosis is an infection with a larval Diphyllobothriidea tapeworm. From a rare cerebral case presented at a clinic in the UK, DNA was recovered from a biopsy sample and used to determine the causative species as Spirometra erinaceieuropaei through sequencing of the cox1 gene. From the same DNA, we have produced a draft genome, the first of its kind for this species, and used it to perform a comparative genomics analysis and to investigate known and potential tapeworm drug targets in this tapeworm.

RESULTS

The 1.26 Gb draft genome of S. erinaceieuropaei is currently the largest reported for any flatworm. Through investigation of β-tubulin genes, we predict that S. erinaceieuropaei larvae are insensitive to the tapeworm drug albendazole. We find that many putative tapeworm drug targets are also present in S. erinaceieuropaei, allowing possible cross application of new drugs. In comparison to other sequenced tapeworm species we observe expansion of protease classes, and of Kuntiz-type protease inhibitors. Expanded gene families in this tapeworm also include those that are involved in processes that add post-translational diversity to the protein landscape, intracellular transport, transcriptional regulation and detoxification.

CONCLUSIONS

The S. erinaceieuropaei genome begins to give us insight into an order of tapeworms previously uncharacterized at the genome-wide level. From a single clinical case we have begun to sketch a picture of the characteristics of these organisms. Finally, our work represents a significant technological achievement as we present a draft genome sequence of a rare tapeworm, and from a small amount of starting material.

Temozolomide responsiveness in aggressive corticotroph tumours: a case report and review of the literature

Pituitary carcinoma occurs in ~0.2% of resected pituitary tumours and carries a poor prognosis (mean survival <4 years), with standard chemotherapy regimens showing limited efficacy. Recent evidence suggests that temozolomide (TMZ), an orally-active alkylating agent used principally in the management of glioblastoma, may also be effective in controlling aggressive/invasive pituitary adenomas/carcinomas. A low level of expression of the DNA-repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) predicts TMZ responsiveness in glioblastomas, and a similar correlation has been observed in the majority of aggressive pituitary adenomas/carcinomas reported to date. Here, we report a case of a silent pituitary corticotroph adenoma, which subsequently re-presented with Cushing's syndrome due to functioning hepatic metastases. The tumour exhibited low immunohistochemical MGMT expression in both primary (pituitary) and secondary (hepatic) lesions. Initial TMZ therapy (200 mg/m² for 5 days every 28 days-seven cycles) resulted in marked clinical, biochemical [>50% fall in adrenocorticotrophic hormone (ACTH)] and radiological [partial RECIST (response evaluation criteria in solid tumors) response] improvements. The patient then underwent bilateral adrenalectomy. However, despite reintroduction of TMZ therapy (further eight cycles) ACTH levels plateaued and no further radiological regression was observed. We review the existing literature reporting TMZ efficacy in pituitary corticotroph tumours, and highlight the pointers/lessons for treating aggressive pituitary neoplasia that can be drawn from experience of susceptibility and evolving resistance to TMZ therapy in glioblastoma. Possible strategies for mitigating resistance developing during TMZ treatment of pituitary adenomas/carcinomas are also considered.

Mechanisms and genetic determinants regulating sterol absorption, circulating LDL levels, and sterol elimination: implications for classification and disease risk

This review integrates historical biochemical and modern genetic findings that underpin our understanding of the low-density lipoprotein (LDL) dyslipidemias that bear on human disease. These range from life-threatening conditions of infancy through severe coronary heart disease of young adulthood, to indolent disorders of middle- and old-age. We particularly focus on the biological aspects of those gene mutations and variants that impact on sterol absorption and hepatobiliary excretion via specific membrane transporter systems (NPC1L1, ABCG5/8); the incorporation of dietary sterols (MTP) and of de novo synthesized lipids (HMGCR, TRIB1) into apoB-containing lipoproteins (APOB) and their release into the circulation (ANGPTL3, SARA2, SORT1); and receptor-mediated uptake of LDL and of intestinal and hepatic-derived lipoprotein remnants (LDLR, APOB, APOE, LDLRAP1, PCSK9, IDOL). The insights gained from integrating the wealth of genetic data with biological processes have important implications for the classification of clinical and presymptomatic diagnoses of traditional LDL dyslipidemias, sitosterolemia, and newly emerging phenotypes, as well as their management through both nutritional and pharmaceutical means.

Correlation of MR relative cerebral blood volume measurements with cellular density and proliferation in high-grade gliomas: an image-guided biopsy study

BACKGROUND AND PURPOSE

As newer MR imaging techniques are used to assist with tumor grading, biopsy planning, and therapeutic response assessment, there is a need to relate the imaging characteristics to underlying pathologic processes. The aim of this study was to see how rCBV, a known marker of tumor vascularity, relates to cellular packing attenuation and cellular proliferation.

MATERIALS AND METHODS

Nine patients with histologically proved high-grade gliomas and 1 with a supratentorial PNET requiring an image-guided biopsy were recruited. Patients underwent a DSC study. The rCBV at the intended biopsy sites was determined by using a histogram measure to derive the mean, maximum, and 75th centile and 90th centile values. This measure was correlated with histologic markers of the MIB-1 labeling index (as a marker of glioma cell proliferation) and the total number of neoplastic cells in a high-power field (cellular packing attenuation).

RESULTS

There was a good correlation between rCBV and MIB-1 by using all the measures of rCBV. The mean rCBV provided the best results (r = 0.66, P < .001). The only correlation with cellular packing attenuation was with the 90% centile (rCBV(90%), r = 0.36, P = .03). The increase in rCBV could be seen over 1 cm from the edge of enhancement in 4/10 cases, and at 2 cm in 1/10.

CONCLUSIONS

rCBV correlated with cellular proliferation in high-grade gliomas but not with cellular packing attenuation. The increase in rCBV extended beyond the contrast-enhancing region in 50% of our patients.

Internal auditory canal metastasis mimicking a vestibular schwannoma at presentation - a case report and review of the literature

Metastasis to the internal auditory canal from breast carcinoma is extremely rare and difficult to diagnose. It radiologically mimics vestibular schwannoma and can occur as a first manifestation of systemic relapse after a long disease-free interval in patients previously treated for early breast cancer. The diagnosis is usually made retrospectively and the optimal management of such metastasis following complete resection remains undefined.

Amyotrophic lateral sclerosis with sensory neuropathy: part of a multisystem disorder?

Sensory involvement is thought not to be a feature of amyotrophic lateral sclerosis (ALS). However, in the setting of a specialist motor neuron disease clinic, we have identified five patients with sporadic ALS and a sensory neuropathy for which an alternative cause could not be identified. In three individuals, sensory nerve biopsy was performed, demonstrating axonal loss without features of an alternative aetiology. These findings support the hypothesis that ALS is a multisystem neurodegenerative disorder that may occasionally include sensory neuropathy among its non-motor features.

Abnormal prion protein in the pituitary in sporadic and variant Creutzfeldt-Jakob disease

By using high-sensitivity Western blotting and immunohistochemistry, pituitary glands from patients with sporadic and variant Creutzfeldt-Jakob disease (sCJD and vCJD, respectively) were analysed for the presence of the protease-resistant form of the prion protein (PrPres). PrPres was detected in a greater proportion of vCJD pituitaries than sCJD pituitaries and was localized predominantly in the neurohypophysis. PrPres was also detected in a recurrent pituitary adenoma from an sCJD patient. Immunohistochemical analysis showed sparse positive labelling, predominantly in folliculostellate cells, in vCJD and sCJD adenohypophyses. The PrPres glycosylation pattern in the vCJD neurohypophyses showed a predominance of the unglycosylated band, which differed markedly from patterns found in all other vCJD tissues. The presence of PrPres in the pituitary of CJD patients at autopsy suggests that human growth hormone-related iatrogenic CJD may have indeed resulted from infectivity in collected pituitaries rather than necessarily from contamination of pituitary pools by adjacent brain tissue.

Reversible parkinsonism in a patient with progressive multifocal leucoencephalopathy

A case of pathologically confirmed progressive multifocal leucoencephalopathy presenting with unilateral parkinsonism and cognitive decline that significantly improved over a 12-month period without any treatment is described. The patient had a background of chronic lymphocytic leukaemia, but had been in complete remission for 4 years at the time of diagnosis. This case is highly unusual not only in terms of the mode of clinical presentation in an apparently immunocompetent patient but also in that the patient spontaneously improved without any intervention. Progressive multifocal leucoencephalopathy should therefore be considered in the differential diagnosis of movement disorders developing in patients with a history of lymphoproliferative disease, even if they are in remission. Furthermore, such cases may not always require treatment, as the patient's immune system may overcome the viral disease process with spontaneous resolution of their neurological disorder.

Improved delineation of glioma margins and regions of infiltration with the use of diffusion tensor imaging: an image-guided biopsy study

BACKGROUND AND PURPOSE

The efficacy of radiation therapy, the mainstay of treatment for malignant gliomas, is limited by our inability to accurately determine tumor margins. As a result, despite recent advances, the prognosis remains appalling. Because gliomas preferentially infiltrate along white matter tracks, methods that show white matter disruption should improve this delineation. In this study, results of histologic examination from samples obtained from image-guided brain biopsies were correlated with diffusion tensor images.

METHODS

Twenty patients requiring image-guided biopsies for presumed gliomas were imaged preoperatively. Patients underwent image-guided biopsies with multiple biopsies taken along a single track that went into normal-appearing brain. Regions of interest were determined from the sites of the biopsies, and diffusion tensor imaging findings were compared with glioma histology.

RESULTS

Using diffusion tissue signatures, it was possible to differentiate gross tumor (reduction of the anisotropic component, q > 12% from contralateral region), from tumor infiltration (increase in the isotropic component, p > 10% from contralateral region). This technique has a sensitivity of 98% and specificity of 81%. T2-weighted abnormalities failed to identify the margin in half of all specimens.

CONCLUSION

Diffusion tensor imaging can better delineate the tumor margin in gliomas. Such techniques can improve the delineation of the radiation therapy target volume for gliomas and potentially can direct local therapies for tumor infiltration.

Measures of folding applied to the development of the human fetal brain

Previous work has suggested the existence of differences between the cerebral cortex of normal individuals, and those of patients with diseases such as epilepsy and schizophrenia. These shape abnormalities may be of developmental origin. Improved shape measures could provide useful tools for neuroscience research and patient diagnosis. We consider the theoretically desirable properties of measures of brain shape. We have implemented seven measures, three from the neuroscience literature, and four new to this field. Three of the measures are zero-order and four are second-order with respect to the surface. We validate the measures using simple geometrical shapes, and a collection of magnetic resonance scans of ten histologically normal ex vivo fetal brains with gestational ages from 19-42 weeks. We then apply the measures to MR scans from two histologically abnormal ex vivo brains. We demonstrate that our implementation of the measures is sensitive to anatomical variability rather than to the discreteness of the image data. All the measures were sensitive to changes in shape during fetal development. Several of the measures could distinguish between the normal and abnormal fetal brains. We propose a multivariate approach to studying the shape of the cerebral cortex, in which both zero-order and second-order measures are used to quantify folding.

Rasmussen's encephalitis followed by lupus erythematosus

A 6-year-old female presented with right hemichorea, initially thought to be post-streptococcal, which subsequently progressed to a right dystonic hemiplegia. At 7 1/2 years she developed right focal and secondary generalized tonic-clonic seizures. These became intractable. A brain biopsy was consistent with Rasmussen's encephalitis (RE). At 9 1/2 years the child underwent a left hemispherectomy making a good recovery with resolution of seizures. At 12 years she presented with recurrent episodes of abdominal pain, fever, and malar rash with serological evidence of systemic lupus erythematosus (SLE). A possible link between RE and SLE is discussed.

Chromosomal imbalances in meningeal solitary fibrous tumors

We present the results of a comparative genomic hybridization (CGH) analysis of three meningeal solitary fibrous tumors (SFT). One case showed loss of chromosome 3 and two tumors had deletions of the region 3p21-p26. Other chromosomal losses included 4p15, 8q22-q24, 10, 11q14-q25, 17q11- q23, 20, and 21 in one case each. In addition, there were gains of 18p11-p13 in one case, and 1p11-p36 and 20q11-q13 in another. To our knowledge, there are no previous CGH or cytogenetic data on meningeal SFT, and loss of material on chromosome 3 has not been described in SFT at other sites. Our findings are discussed in relation to published molecular genetic and cytogenetic data on meningioma and hemangiopericytoma, the two lesions with which meningeal SFT are most likely to be confused.

Solitary fibrous tumours of the meninges: case series and literature review

We report four new cases of meningeal Solitary Fibrous Tumour (SFT). Two patients presented with raised intracranial pressure from posterior fossa SFT, and the third developed hemiparesis and dysphasia due to a large lesion that originated in the left middle cranial fossa. These were successfully excised and the patients remain well at follow-up of between 1 and 3 years. The fourth patient, a 71-year-old man, suffered an intracerebral haemorrhage and later died from a malignant SFT that had invaded the falx cerebri, superior sagittal sinus, and brain. This is the first description of a locally aggressive meningeal SFT with multiple atypical histological features. The 31 previously reported cases of meningeal SFT are reviewed. They occur at all ages and may be relatively more common in the posterior fossa and spine. Intracranial SFT originate from the dura and are probably indistinguishable from meningiomas on imaging and at surgery. In contrast, approximately two-thirds of spinal SFT have no dural attachment. Histologically, SFT are spindle-cell neoplasms with a characteristic immunohistochemical profile of CD34, vimentin, and bcl-2 positivity. Data on outcome for patients with meningeal SFT are limited. At other sites, however, extent of resection is the most important prognostic factor, and invasion or metastasis can occur with histologically benign SFT. Meningeal SFT should, therefore, be excised as completely as possible and followed carefully in the long-term.

Chronic encephalitis and temporal lobe epilepsy: a variant of Rasmussen's syndrome?

The authors report two adult patients with chronic temporal lobe epilepsy and pathologic features consistent with Rasmussen's encephalitis. Although seizures persisted after temporal lobe surgery no progressive cognitive or neurologic deficit has emerged. Prominent auditory auras in each suggested a persisting epileptogenic focus in the superior temporal gyrus. The current findings expand the clinical spectrum of Rasmussen's encephalitis and suggest that chronic nonprogressive encephalitis may serve as the pathologic substrate of medically intractable temporal lobe epilepsy.

Extracellular matrix-modulated differential invasion of human meningioma cell lines in vitro

The in vitro invasive behaviour of six meningioma cell lines of various histological sub-type and grade was assessed using Boyden chemotaxis chambers ('Transwell' units) precoated with various extracellular matrix proteins. The cell lines included a benign meningothelial (IPGS), two benign transitional (IPCBR and IPGC), one atypical (IPIH) and two malignant (IPSE and IPIR) meningiomas. IPGC was a recurrent tumour. The results showed that IPCBR was most invasive through laminin and vitronectin. IPIH was moderately invasive through collagen type IV, laminin, vitronectin and fibronectin. However, both IPSE and IPIR were less invasive than IPIH whereas, IPGS was least invasive of all. Moreover, laminin was the most permissive extracellular matrix protein for most cell lines and collagen type IV, the least permissive. These results show that there is a differential in vitro invasive behaviour of cell lines derived from different histological types of meningiomas according to extracellular matrix substrate and suggests that invasion and migration of meningiomas in situ might be modulated by various extracellular components.

Progressive dendritic pathology in cynomolgus macaques infected with simian immunodeficiency virus

Neuronal pathology in acquired immunodeficiency syndrome (AIDS) is of interest in relation to cognitive impairment in AIDS patients and from the broader perspective of the pathogenesis of neurodegeneration. Cortical dendritic spine loss has been described in patients with AIDS and the aim of this study was to test the hypothesis that similar pathology is present in cynomolgus macaques infected with simian immunodeficiency virus (SIV). These animals develop an AIDS-like illness, but multinucleated giant cell encephalitis is not a feature and CNS virus load is found to be very low. Four animals infected for 2.5-3 months and four infected for 2-3 years were compared with four controls. The Golgi-Cox technique was employed to demonstrate dendritic morphology in the frontal cortex and the diameter of apical dendrites, dendritic spine density and dendritic spine lengths were measured in layer V pyramidal cells. Immunohistochemistry for microtubule-associated protein-2 (MAP-2), MHC class II and glial fibrillary acidic protein (GFAP) was also performed. In infected animals there was progressive spine loss and atrophy of remaining spines with loss of MAP-2 immunoreactivity at late time points. No parallel increase in GFAP immunostaining or MHC-class II expression in microglial cells was seen. We conclude that progressive neuronal dendritic pathology is a feature of SIVmac251 infection of cynomolgus macaques and is apparent relatively early in disease. Furthermore, dendritic abnormalities occur in the absence of either multinucleated giant cell pathology or substantial CNS virus load.

Clinicopathological study of seven cases of spinal cord teratoma: a possible germ cell origin

AIMS

To establish the clinical and pathological aspects of teratoma affecting the spinal cord.

METHOD AND RESULTS

We reviewed our neurosurgical records for the last 15 years and found seven cases of teratoma of the spinal cord. The cases were reviewed clinically, radiologically and pathologically using immunohistochemical markers to identify various tissue components. We found that spinal cord teratoma is an extremely rare tumour of spinal cord affecting patients aged 23-47 years and of approximately equal male to female distribution. The terminal portions of spinal cord and intradural location of the tumour are common. Three cases were associated with vertebral anomaly. Most tumours showed benign (mature) components derived from more than one germ cell layer; one showed malignant adenocarcinomatous component. All cases were treated by surgical resection and two recurred at 6 and 10 year intervals without malignant transformation.

CONCLUSION

Spinal cord teratoma is a rare, mainly benign tumour, which could be associated with vertebral anomaly. The pathogenesis of this tumour is controversial, possibly due to germinal cell aberration.

Histologic, molecular, and radiologic characterization of resolving cerebral posttransplant lymphoproliferative disorder

Lymphoproliferative disorders (LPDs) are commoner in pediatric versus adult immunosuppressed transplant recipients, and frequently involve the central nervous system. In these circumstances, the justification for biopsy is heavily influenced by the likely diagnostic yield. The present study centers on a 12-y-old renal transplant patient who developed multifocal cerebral LPD and had serial magnetic resonance (MR) examinations during the course of her illness from which she has completely recovered upon reduction of immunosuppression. She underwent stereotaxic biopsy, which was analyzed by both immunocytochemistry and polymerase chain reaction to examine the general question of how to release the maximum amount of information contained within, as well as to obtain a tissue diagnosis in this particular case. We show that a combination of these methods permits identification of the immunophenotype, lineage, clonality, viral involvement, and origin of abnormal cellular infiltrates. The biopsy also showed a novel histologic pattern of LPD, comprising numerous benign T cells obscuring a tiny clone of B cells. The MR examinations documented, for the first time, the differences in signal that accompany clinical resolution at both biopsied and nonbiopsied sites, showing that the latter may be associated with reduction, but not elimination, of MR signal abnormality. We conclude: 1) a combination of conventional and polymerase chain reaction analysis offers the greatest diagnostic yield from stereotaxic biopsies, even when the available tissue is minimal; 2) a focal polyclonal T cell infiltrate should prompt further investigation to exclude an underlying B cell lesion.

Hippocampal neuronal atrophy occurs in rhesus macaques following infection with simian immunodeficiency virus

There is strong evidence that patients with AIDS have loss of cortical neurons. In this study we have examined the hippocampus of rhesus monkeys infected with simian immunodeficiency virus (SIV) to determine whether neuronal damage occurs in this model of human AIDS and to investigate its time course. Twenty-eight infected monkeys (23 young [< 9 years] and five elderly [> 16 years]) were compared with 11 controls (six young and five elderly). Numbers of nucleolated neurons per unit area of section and mean pyramidal cell diameters were measured in each CA sub-field of each animal. There was neuronal atrophy in all regions examined, as early as 3 months following inoculation. An initial apparent increase in neuronal density at 3 months did not reach statistical significance. In younger animals, however, there was a later, significant association between the reduction in neuronal density and duration of infection. Elderly animals were only examined at a single, early time point. These results show that there is neuronal pathology following infection with SIV and that there is probably subsequent neuronal death.

Different patterns of neuropathological disease in rhesus monkeys infected by simian immunodeficiency virus, and their relation to the humoral immune response

The brains of 21 rhesus monkeys inoculated with SIVMAC251 were examined after intervals ranging from 3 to 27 months and compared with five uninoculated controls. Eighteen animals became infected and individually exhibited several distinct patterns of disease. Nine (50%) had largely intramural leptomeningeal venous infiltrates (LMVI) without multinucleate giant cells (MGC) or foamy macrophages. Three (17%) had only MGC lesions, involving the cerebral parenchyma. One had both patterns and five (33%) neither. The controls had sparse and tiny LMVI only, similar to three inoculated animals that did not become infected. Immunohistochemistry showed the predominance of T and B lymphocytes in LMVI and choroid plexus mononuclear lesions but a predominance of macrophages over lymphocytes in the MGC lesions. Specific disease patterns differed in their association with the humoral immune response. Animals with LMVI were all hypergammaglobulinaemic when killed compared to pre-inoculation levels, and the size of the change in serum immunoglobulin concentration was positively correlated with a quantitative index of LMVI density. Furthermore, their post-mortem lymph node histology was hyperplastic. In contrast, animals found at autopsy to have MGC brain lesions were hypogammaglobulinaemic compared to preinoculation. The results are consistent with two phases in SIV-associated disease: one characterized by LMVI and hypergammaglobulinaemia and another featuring MGC and hypogammaglobulinaemia.

Cerebral aspergilloma in a child with autosomal recessive chronic granulomatous disease

A 2 year old girl presented with epilepsy 16 months after being diagnosed as having autosomal recessive chronic granulomatous disease. Computed tomography showed a cerebral mass which was surgically removed and proved histologically to be an aspergilloma. This case illustrates the application of molecular diagnostic techniques to the diagnosis of chronic granulomatous disease. The occurrence of, and unusual reaction to, cerebral aspergillus infection indicates the need to consider this possibility in the differential diagnosis of mass lesions in chronic granulomatous disease. Furthermore, it is clear that autosomal recessive chronic granulomatous disease cannot be considered to be a clinically mild form that is exempt from major neurological complications.

Evaluation of a linear model of directional selectivity in simple cells of the cat's striate cortex

We have compared the responses of simple cells to laterally moving sinusoidal gratings and to stationary temporally-modulated gratings. From the amplitudes and temporal phases of the responses to stationary gratings of different spatial phases, it should be possible to predict the preferred direction of movement, the amplitudes of the responses to gratings moving in the preferred and nonpreferred directions and, thence, the degree of directional preference (Reid et al., 1987). The preferred direction can be predicted reliably. However, the magnitude of the directional preference cannot be predicted, since the measured amplitude of the response in the nonpreferred direction of movement is very much less than that predicted by a linear theory. Nonlinearities in the relationship between response amplitude and contrast may contribute to the failure of the predictions, but this contribution is small. We conclude that the magnitude of the directional preference seems to be determined predominantly by nonlinear suppression of the response in the nonpreferred direction of movement.

The effects of contrast on the linearity of spatial summation of simple cells in the cat's striate cortex

Non-linearities of spatial summation were examined in simple cells in the cat's striate cortex. The degree of non-linearity was assessed from an examination of the waveforms of the responses to moving sinusoidal gratings and was quantified by a measure called relative modulation. Relative modulation was affected little by changes in contrast at either optimal or non-optimal spatial frequencies. The non-linearities of spatial summation exhibited by some simple cells are, therefore, essential. Those simple cells which exhibit linear spatial summation are no less linear at high stimulus contrasts. These results support a 'push-pull' model of simple cell receptive field organization in which ON and OFF centre l.g.n. input is combined both additively and subtractively.

Spatial summation by simple cells in the striate cortex of the cat

Spatial summation has been studied in simple cells of the cat's visual cortex by examining the responses of pairs of lines. One line was placed in an ON region of the receptive field; the other was placed in an OFF region. When the luminances of the lines were modulated in anti-phase, the excitatory responses to the individual lines were almost synchronous. A simple cell's overt response to the composite stimulus was usually greater than the sum of the overt responses to the two components. The result could be explained by supposing that the underlying response was the linear sum of the excitatory signals but that an overt response occurred only when the underlying response exceeded a fixed threshold value. This was true even of simple cells which exhibited non-linearities of spatial summation, as judged from the waveforms of their responses to moving sinusoidal gratings. When the two lines were modulated in phase, the excitatory responses occurred in different halves of the temporal cycle. Some cells summed antagonistic signals linearly. The waveforms of their responses to moving sinusoidal gratings also implied linear spatial summation. However, other cells whose responses to moving gratings implied linearity of summation did not, in fact, sum antagonistic signals linearly. The excitatory responses evoked in a receptive field region were weaker than the inhibitory responses that could be evoked in the same region. The remaining cells did not sum antagonistic signals linearly. There was imperfect cancellation, resulting in the generation of ON-OFF response components. The excitatory responses evoked in a receptive field region were stronger than the inhibitory responses that could be evoked in the same region. These cells gave responses to sinusoidal gratings that did imply nonlinear spatial summation.

Factors influencing the temporal phase of response to bar and grating stimuli for simple cells in the cat striate cortex

We have characterized the speed of response of simple cells in cat striate cortex by the temporal phase of the response to bar and grating stimuli. Stimulation of the most responsive subregion (either ON or OFF) in the receptive field with a 1 Hz temporally modulated bar elicited responses whose phase led the excitatory phase of the stimulus by about 25 degrees. The response to stationary gratings whose contrast was sinusoidally modulated at 2 Hz also showed a phase lead. The differences in the phase of response of ON and OFF sub-regions exhibited a marked scatter about the expected value of 180 degrees. The phase of response to both temporally modulated bars and laterally moving gratings advanced by 20-35 degrees as the stimulus contrast was raised by a factor of 5.

On the distinctness of simple and complex cells in the visual cortex of the cat

The behaviour of neurones in cat striate cortex was examined in response to moving sinusoidal gratings and flashed bright and dark lines. The responses were summarized by three indices: discreteness was a measure of the degree of separation of inhibitory and excitatory regions in the receptive field; spatial summation ratio showed the degree of spatial summation within each region; relative modulation was a measure of the degree of modulation in the response to a moving grating. Some neurones had receptive fields with completely discrete excitatory and inhibitory regions; others responded equally to stimulus onset and offset throughout their receptive fields; however, some had overlapping excitatory and inhibitory regions. The degree of overlap varied continuously from complete separation to complete overlap. For neurones with discrete receptive fields, the widths of the regions were compared with the width of the bars in a grating of optimum spatial frequency to assess the degree of spatial summation within the regions. Most neurones with discrete receptive fields showed roughly predictable spatial summation, in that the two width measures agreed; but about 10% of them had receptive field regions that were too large by a factor of over two. The neurones which showed incomplete spatial summation also had considerable overlap of their excitatory and inhibitory regions. The waveforms of the responses to moving gratings of optimal spatial frequency were examined. The degree of modulation in the response was continuously distributed between low values typical of complex cells and high values typical of simple cells; the distribution was not bimodal. The degree of response modulation was closely correlated with the degree to which the excitatory and inhibitory regions in the receptive field were discrete. Both the degree of spatial summation and the degree of response modulation have been previously proposed as means for distinguishing simple and complex cells. In the present study, the continuity of the distributions of both indices ensured that neither index alone could be used to class all neurones unequivocally. However, a criterion based on two indices did allow classification. Simple and complex cells showed distinctive behaviour. However, complex cells with distinguishable excitatory and inhibitory regions in their receptive fields were not distinctly different from other complex cells.

The statistical reliability of signals in single neurons in cat and monkey visual cortex

The variability of the discharge of visual cortical neurons in cats and macaque monkeys limits the reliability with which such neurons can relay signals about weak visual stimuli. In general, the variance of a neuron's firing rate is directly proportional to its mean firing rate. The probability that a neuron will fire a criterion number of impulses on a stimulus trial grows monotonically with the contrast of a sinusoidal grating stimulus. Neural probability functions prepared either by computing the probability of criterion response or by integrating receiver operating characteristics to yield the probability of correct choice in a two-alternative forced-choice situation resemble psychometric functions obtained in psychophysical and behavioral experiments on humans and animals, but are shallower in slope. The slopes of neuronal probability functions are slightly higher when they are estimated over short time periods, but even so do not equal the slopes measured psychophysically in human and monkey observers. This discrepancy in slope could be explained if the whole observer responded only when about four neurons were active together.

Adaptation-induced alteration of the relation between response amplitude and contrast in cat striate cortical neurones

The activity of neurones in cat striate cortex in response to laterally moving sinusoidal gratings has been examined. The effect of prolonged visual stimulation with a high contrast moving grating stimulus of optimal orientation and spatial frequency was investigated in terms of the changes wrought in the relationship between response amplitude and stimulus contrast. The adaptation which resulted was characterized by an elevation of contrast threshold by about 0.4 log units and a reduction in the steepness of the relation between response and contrast by about 0.36 log units. Both simple and complex cells exhibited this behaviour. The similarity of these values to the size of contrast threshold elevations demonstrated psychophysically suggests a possible physiological basis for the perceptual phenomenon.

Non-linear temporal summation by simple cells in cat striate cortex demonstrated by failure of superposition

Simple cells in area 17 of the anaesthetized, paralysed cat were stimulated with stationary sinusoidal gratings whose contrast was temporally modulated in different ways. The response to a temporal waveform which was the sum of two sinusoids (1.25 Hz and 7.75 Hz) was compared with the response elicited by each component when presented alone. The responses to the high temporal frequency in the compound stimulus were relatively enhanced by the addition of the low temporal frequency; those to the low frequency were relatively depressed.

The distribution of acetylcholinesterase in the lateral geniculate nucleus of the cat and monkey

The distribution of acetylcholinesterase (AChe) has been examined histochemically in the lateral geniculate nucleus (LGN) of the cat and the monkey, and in the cat visual cortex. It was found that in the cat, AChE is most concentrated in laminae A and A1. Lamina C-proper possessed a weak band of AChE in its ventral part. Only restricted patches of activity were observed in the medial interlaminar nucleus. Laminae C1-3 and the central interlaminar nucleus possessed very little AChE. This pattern of enzyme distribution suggests that in the cat LGN, AChe activity coincides with the sites of neurophysiologically recorded X-cells, which are predominantly found in laminae A and A1 and are scarce in the C laminae and the medial interlaminar nucleus. The presence of AChE over neurones in layer VI of both areas 17 and 18 of the cerebral cortex in the cat suggests the corticothalamic pathway as one possible source of geniculate AChE activity. In the monkey LGN, AChE activity was observed in the parvocellular and magnocellular layers. The activity was greatest in the magnocellular layers, which are believed to contain neurones driven predominantly by retinal Y-cells. Thus, for this species the correlation between AChE activity and X-cells does not seem to hold.

The variability of discharge of simple cells in the cat striate cortex

The relationship between the variance and mean rate of discharges of simple cells in the cat striate cortex has been examined when mean rate was varied by changing either stimulus spatial frequency or contrast. In both cases, the variance was related to the mean discharge rate by an exponent of about 1.15; the relation was thus roughly linear. The discharge variance was on average 1.7 times the mean rate for data obtained from measurements of the neurones' spatial frequency tuning curves, and 1.48 times the mean for data from the response-contrast determination. However, this difference was not statistically significant.

Preferred direction of movement as an element in the organization of cat visual cortex

Neurones recorded close together in the cat's striate cortex prefer not only the same orientation of elongated visual stimulus but also the same direction of stimulus movement. The degree of similarity in both preferred orientation and preferred direction is greater in electrode penetrations made perpendicular to the cortical surface than in oblique penetrations. This suggests that preferred direction is organized in columnar fashion, just as is orientation.

The relationship between response amplitude and contrast for cat striate cortical neurones

1. The activity of forty-three neurones in the cat's striate cortex in response to laterally moving sinusoidal gratings of various contrasts was recorded, in order to examine the relationship between response amplitude and contrast. 2. Neurones seemed to exhibit contrast thresholds: stimuli of very low contrast failed to evoke a change in the response amplitude from the concurrent levels of spontaneous activity. 3. The suprathreshold portion of the response-contrast relation was found to be monotonic. Typically, the relation was adequately described as linear up to contrasts of about 0.3, above which, varying degrees of saturation were evident. 4. The response-contrast relation had a higher threshold and a shallower slope when the spatial frequency was not optimal for the neurone. 5. The slope, or gain, of the response-contrast relation for a stimulus of optimal orientation and spatial frequency varied considerably from neurone to neurone. The gains of special complex cells were significantly greater than those of either standard complex cells or simple cells. 6. The distributions of contrast threshold and contrast gain were examined for their dependence on optimal spatial frequency. Contrast threshold was significantly positively correlated with optimal spatial frequency, while contrast gain was significantly negatively correlated with optimal spatial frequency. This behaviour is consistent with an optical contribution to the measured response properties of striate cortical neurones.

Non-linearities of temporal summation in neurones in area 17 of the cat

Sinusoidal temporal modulation of the contrast of sinusoidal gratings has been used to provide one description of the temporal properties of neurones in area 17 of the cat's visual cortex. Concurrently, the waveforms of the neurones' responses to 2 s flashes of identical gratings were examined. In most neurones, the response to the long flash was much more transient than would be expected from the shape of the temporal-frequency tuning curve. Temporal summation in cortical neurones is non-linear.