A missense mutation in the Hspa8 gene encoding heat shock cognate protein 70 causes neuroaxonal dystrophy in rats

Neuroaxonal dystrophy (NAD) is a neurodegenerative disease characterized by spheroid (swollen axon) formation in the nervous system. In the present study, we focused on a newly established autosomal recessive mutant strain of F344-kk/kk rats with hind limb gait abnormalities and ataxia from a young age. Histopathologically, a number of axonal spheroids were observed throughout the central nervous system, including the spinal cord (mainly in the dorsal cord), brain stem, and cerebellum in F344-kk/kk rats. Transmission electron microscopic observation of the spinal cord revealed accumulation of electron-dense bodies, degenerated abnormal mitochondria, as well as membranous or tubular structures in the axonal spheroids. Based on these neuropathological findings, F344-kk/kk rats were diagnosed with NAD. By a positional cloning approach, we identified a missense mutation (V95E) in the Hspa8 (heat shock protein family A (Hsp70) member 8) gene located on chromosome 8 of the F344-kk/kk rat genome. Furthermore, we developed the Hspa8 knock-in (KI) rats with the V95E mutation using the CRISPR-Cas system. Homozygous Hspa8-KI rats exhibited ataxia and axonal spheroids similar to those of F344-kk/kk rats. The V95E mutant HSC70 protein exhibited the significant but modest decrease in the maximum hydrolysis rate of ATPase when stimulated by co-chaperons DnaJB4 and BAG1 in vitro, which suggests the functional deficit in the V95E HSC70. Together, our findings provide the first evidence that the genetic alteration of the Hspa8 gene caused NAD in mammals.

Patient with bipolar I disorder who presented with low blood lithium levels after receiving crushed tablets via a nasogastric tube: A case report

In clinical psychiatric cases, the placement of a nasogastric tube is occasionally considered. If a patient who presents with mania or other psychiatric conditions refuses to take drugs, they are administered via the nasogastric tube. The tablet is crushed, suspended, passed via the nasogastric line, and reaches the stomach directly. However, the effects of these processes on blood drug concentrations remain unclear. Herein, we report a patient with bipolar I disorder who presented with low blood lithium carbonate (Li) concentrations after receiving the drug via the nasogastric tube.

CASE

A 26-year-old woman developed manic symptoms with grandeur delusion. She was admitted to a psychiatric hospital three times after diagnosis. Her manic symptoms with delusion improved with Li and aripiprazole (ARP). Her condition stabilized with Li 800 mg/day and ARP 9 mg/day. After the Li dose was reduced to 600 mg/day, she maintained remission, with the blood level range of Li being 0.31 ∼ 0.42 mEq/L. After 1 year, she was admitted to our hospital due to a jaw deformity. During the perioperative period, treatment with oral Li was discontinued by the surgeons, and her manic symptoms recurred. During therapy with olanzapine 20 mg and Li 800 mg, her blood Li concentration was 0.67 mEq/L. The symptoms remained. Hence, the Li dose increased to 1,000 mg/day. However, she refused to take the medication. Thus, a nasogastric tube was used to administer medicines. Thereafter, the blood Li concentration decreased to 0.43 mEq/L, which was lesser than 800 mg/day. Each blood sample was collected approximately 18 h after the administration. Her symptoms remained. Thereafter, she agreed to take the medication, and the Li concentration reached 0.78 mEq/L. Then, the symptoms partly improved.

CONCLUSION

After the administration of Li via the nasogastric tube, the Li concentration decreased, which was lower than expected. This phenomenon could be attributed to the fact that the medication was crushed, suspended, and administered via the nasogastric tube. Therefore, pulverizing and administering Li tablets via the nasogastric tube can be applied for the management of mania, however, caution should be observed because of the risk of fluctuations in blood Li levels, as in this case.

Beneficial effects of manually assisted chiropractic adjusting instrument in a rabbit model of osteoarthritis

Osteoarthritis (OA) is a degenerative disease characterized by injury of all joint tissues. Our previous study showed that in experimental osteoporosis, chiropractic manipulation (CM) exerts protective effects on bone. We here assessed whether CM might ameliorate OA by improving subchondral bone sclerosis, cartilage integrity and synovitis. Male New-Zealand rabbits underwent knee surgery to induce OA by anterior cruciate ligament injury. CM was performed using the chiropractic instrument ActivatorV 3 times/week for 8 weeks as follows: force 2 setting was applied to the tibial tubercle of the rabbit right hind limb (TM-OA), whereas the corresponding left hind limb received a false manipulation (FM-OA) consisting of ActivatorV firing in the air and slightly touching the tibial tubercle. After sacrifice, subchondral bone integrity was assessed in the tibiae by microCT and histology. Cartilage damage and synovitis were estimated by Mankin's and Krenn's scores, respectively, and histological techniques. Bone mineral density and content in both cortical and trabecular compartments of subchondral bone decreased in OA rabbits compared to controls, but partially reversed in the TM-OA group. Trabecular bone parameters in the latter group also showed a significant improvement compared to FM-OA group. Moreover RANKL, OPG, ALP and TRAP protein expression in subchondral bone significantly decreased in TM-OA rabbits with respect to FM-OA group. CM was associated with lower Mankin's and Krenn's scores and macrophage infiltrate together with a decreased protein expression of pro-inflammatory, fibrotic and angiogenic factors, in TM-OA rabbits with respect to FM-OA. Our results suggest that CM may mitigate OA progression by improving subchondral bone as well as cartilage and synovial membrane status.

CS-11 PITUITARY EPENDYMOMA: A CASE REPORT

INTRODUCTION

Neoplasms of the sellar region generally includes pituitary adenoma, craniopharyngioma, meningioma. We report a case of pituitary ependymoma.

CASE

A 39 years-old man. He experienced the sense of discomfort of the inside upper part field of vision of the left eye for a few months since May, 201X. Ophthalmological examination showed right homonymous hemianopia of right upper 1/4. He was introduced to the department of neurosurgery of nearby hospital. MRI showed intrasellar tumor and the lesion was partially removed because of solidness by endoscopic transsphenoidal surgery on July, 201X. Postoperative pathological diagnosis was pituitary adenoma. The residual tumor was followed up, but the compression to the left optic nerve was not resolved. So he was introduced to our hospital in January, 201X+1 and endoscopic transsphenoidal surgery was performed on May, 201X+1.

OPERATION

Supposing the change to extended transsphenoidal surgery, we prepared rescue flap. Enlarging the window of sellar floor and removing the tuberculum sellae, the tumor was totally removed. The boundary between the tumor and the normal pituitary gland was obscure. We inserted fat piece to the intrasellar space, and reconstructed the sellar floor with the absorbable plate following fixation with a polyglycolic acid sheet, fibrin glue, and sinus balloon.

PATHOLOGY

Fusiform cells having an oval or a short spindle shape nucleus multiplied in strand and palisading pattern through capillary vessels were the main findings, and ependymal rosettes were confirmed. Immunohistchemical study showed chromograninA(focally+), synaptophysin (-), EMA (+, dot and ring pattern), CAM5.2(+), bcl-2(+), TTF-1(-), S100(focally+), GFAP(-). Final diagnosis was pituitary ependymoma. Mild diabetes insipidus was occurred postoperatively but it was controlled medically. Now he is followed up in outpatient department.

DISCUSSION

Pituitary ependymoma was reported only eight cases in the past literatures. Though it is extremely rare, pituitary ependymoma should be included as a differential diagnosis of the sellar tumors.

Impact of Chiropractic Manipulation on Bone and Skeletal Muscle of Ovariectomized Rats

Evidence suggests that chiropractic manipulation might exert positive effects in osteoporotic patients. The aim of this study was to evaluate the effects of chiropractic manipulation on bone structure and skeletal muscle in rats with bone loss caused by ovariectomy (OVX). The 6-month old Sprague-Dawley rats at 10 weeks following OVX or sham operation (Sh) did not suffer chiropractic manipulation (NM group) or were submitted to true chiropractic manipulation using the chiropractic adjusting instrument Activator V^® three times/week for 6 weeks as follows: Force 1 setting was applied onto the tibial tubercle of the rat right hind limb (TM group), whereas the corresponding left hind limb received a false manipulation (FM group) consisting of ActivatorV^® firing in the air and slightly touching the tibial tubercle. Bone mineral density (BMD) and bone mineral content (BMC) were determined in long bones and L3-L4 vertebrae in all rats. Femora and tibia were analyzed by μCT. Mechano growth factor (MGF) was detected in long bones and soleus, quadriceps and tibial muscles by immunohistochemistry and Western blot. The decrease of BMD and BMC as well as trabecular bone impairment in the long bones of OVX rats vs Sh controls was partially reversed in the TM group versus FM or NM rats. This bone improvement by chiropractic manipulation was associated with an increased MGF expression in the quadriceps and the anterior tibial muscle in OVX rats. These findings support the notion that chiropractic manipulation can ameliorate osteoporotic bone at least partly by targeting skeletal muscle.

Beta(3)-adrenergic receptor gene variant is associated with upper body obesity only in obese Japanese-American men but not in women

We investigated gender differences in the relationships between the Trp64Arg variant of the beta(3)-adrenergic receptor (AR) gene in obesity and insulin resistance in nondiabetic subjects. In 476 nondiabetic Japanese-Americans (M/F=204/272), the Trp64Arg variant of the beta(3)-AR gene was examined. The presence or absence of the Trp64Arg mutation was examined in DNA separated from leukocytes in peripheral blood using the PCR-RFLP method. The frequency of abnormal allele of the beta(3)-AR gene was 0.18 for males and 0.17 for females, almost the same as the reported values in Japanese. There was no difference in the frequency of the beta(3)-AR gene variant between obese and non obese subjects for each gender. However, among obese males (body mass index > or =24.2 kg/m(2)), with the beta(3)-AR gene mutation, the waist-to-hip ratio, fasting insulin, 2-h insulin, total insulin, and HOMA, an index of insulin resistance, were all significantly higher than obese males without the mutation. In females, the index of obesity, insulin resistance, or lipid metabolism did not differ significantly between the subjects with or without the beta(3)-AR gene variant either in the obese and non-obese group. We suggest that the beta(3)-AR gene variant is not important as an obesity-inducing factor in Japanese. However, in males, when obesity becomes obvious, the beta(3)-AR gene variant is considered to influence the enhancement of insulin resistance, in association with visceral obesity.

Insulin resistance precedes the appearance of albuminuria in non-diabetic subjects: 6 years follow up study

Microalbuminuria is a marker of increased risk of cardiovascular mortality in type 1 and type 2 diabetes, and in non-diabetic subjects. Little is known about the association between prospective changes of microalbuminuria and the risk factors of atherosclerosis, or gene polymorphism in non-diabetic subjects. We conducted a 6-year prospective study of risk factors for progression of albuminuria in non-diabetic subjects. The participants were 116 non-diabetic subjects who consecutively underwent medical examinations for Japanese-Americans living in Hawaii. In the baseline examination in 1992, normoalbuminuria was found in all subjects. After 6 years, 101 subjects remained normoalbuminuria (non-progressors), 15 subjects changing from normoalbuminuria to microalbuminuria or proteinuria and were defined as progressors. In progressors, compared with non-progressors, the fasting insulin level and HOMA-R were significantly higher at 3 years follow-up, and the systolic and diastolic pressure and Sigma insulin level were significantly higher at 6 years follow-up. Insulin resistance appeared earlier than the appearance of hypertension and albuminuria. In progressors, there was no significant correlation with angiotensin-converting enzyme (ACE) genotype or angiotensinogen (AGT) genotype compared with non-progressors. Therefore, the appearance of insulin resistance should be regarded as a remarkable mediator of albuminuria.

Regression of both pituitary and ovarian cysts after administration of thyroid hormone in a case of primary hypothyroidism

We report a 19-year-old woman who was diagnosed as polycystic ovary. Hypothyroidism with a markedly elevated TSH level and an enlarged pituitary gland on MRI were noted. The 123I uptake was decreased to 6.5%. After treatment with thyroid hormone, regression of the enlarged pituitary and the ovarian cysts was observed. In the present case, hypothyroidism was considered to have caused a reversible enlargement of the pituitary gland and concomitant polycystic ovary. We concluded that the polycystic ovary might have resulted from the effects of an excessive amount of TSH on immature ovaries.

Gln27Glu variant of the beta2-adrenergic receptor gene is not associated with obesity and diabetes in Japanese-Americans

The beta(3)-adrenergic receptor (AR) gene variant (Trp64Arg) has been reported to be associated with obesity and insulin resistance in humans. However, this association remains controversial. We investigated the relationships between the beta(2)-AR gene variant (Gln27Glu) and obesity, insulin resistance, and serum lipids in Japanese-Americans. The frequency of an abnormal Gln27Glu allele in the beta(2)-AR gene in 652 subjects was 0.092 in males, 0.077 in females, and 0.084 overall, markedly lower than the previously reported value of 0.4 in Caucasian men and women. In both males and females, there were no differences in the indices of obesity, insulin resistance, and serum lipid levels between the subjects with and without the beta(2)-AR gene (Gln27Glu) variant in patients with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes (DM). The frequency of the beta(2)-AR gene (Gln27Glu) variant tended to increase with worsening of glucose tolerance, but the differences were not statistically significant. Furthermore, there were no differences in the frequency of the beta(2)-AR gene variant in either males or females with obesity (body mass index [BMI], > or = 25.2). Even in Japanese-Americans, who have a more westernized life style than Japanese, the association of the beta(2)-AR gene (Gln27Glu) variant with the parameters of obesity, insulin resistance, and serum lipid level has yet to be clarified. We conclude that the beta(2)-AR gene (Gln27Glu) variant might not be an important factor for obesity or IGT in Japanese subjects.

DiGeorge syndrome with Graves' disease: A case report

DiGeorge syndrome (DGS) is characterized by aplasia or hypoplasia of the thymus and parathyroid glands, cardiac defects and anomaly face. This syndrome is usually associated with hypocalcemia resulting from hypoparathyroidism. In most cases the initial symptom is tetany caused by hypocalcemia within 24-48 hours after birth, with symptoms by immune abnormality appearing later. We report a woman who passed with no symptoms before age 18 and was diagnosed DiGeorge syndrome by tetany with developing auto-immune thyroid disease (Graves' disease). She had surgery for intraventricular septal defect at age 3, hypoparathyroidism, decrease of T cells in peripheral blood and the deletion of the 22nd chromosome long arm (22q11.2). It is supposed that abnormalities of immune function of this case are not complete as indicated by complicating of Graves' disease, and contributing to her long-term survival.

Reduced prevalence of diabetes according to 1997 American Diabetes Association criteria

AIMS/HYPOTHESIS

We examined the prevalence of diabetes and investigated the characteristics of subjects diagnosed by the American Diabetes Association and the World Health Organization criteria.

METHODS

A total of 1235 Japanese-Americans living in Hawaii and Los Angeles was studied. Of the subjects 114 were classified as previously diagnosed as having diabetes. A 75-g glucose tolerance test was given to the rest of the subjects.

RESULTS

When abnormal glucose tolerance was diagnosed by the American Diabetes Association criteria, it was possible to identify only 40 % of diabetic subjects who had not been previously diagnosed compared with the current World Health Organization criteria based on a glucose tolerance test. In addition, the subjects identified by the American Diabetes Association criteria had higher glucose concentrations and had less insulin secretory capacity and they were in need of intensive treatment for diabetes. On the other hand, the subjects not diagnosed by the American Diabetes Association criteria alone were those whose glucose tolerance would be more likely to improve with lifestyle modification.

CONCLUSION/INTERPRETATION

It might be better to use the fasting plasma glucose criterion advocated by the American Diabetes Association in combination with a glucose tolerance test after taking a detailed medical history. To reduce the number of subjects requiring the glucose tolerance test, priority should be given to subjects with impaired fasting glucose (6.1 </= fasting plasma glucose < 7.0 mmol/l). [Diabetologia (1999) 42: 1168-1170]

Bradycardia induced by irinotecan: a case report

Irinotecan chloride (CPT-11) is a new semi-synthetic camptothecin analogue which has encouraging antitumor activity against various malignancies. The major and unique toxicity of CPT-11 is diarrhea. Cardiovascular toxicity is rare and has not been found in clinical trials performed in Japan except for a very few cases of insignificant tachycardiac arrhythmia. We report a case of a 69-year-old man with recurrent colon cancer who suffered from bradycardia induced by infusion of CPT-11. Other toxicities including hematological toxicity and diarrhea were mild. Pharmacokinetic analysis using a limited sampling model revealed that the occurrence of bradycardia did not correlate with the excess of drug exposure. Although all of the cholinergic actions reported in the literature were mild, cardiotoxicity may come to be a clinically significant problem. If the events were examined more thoroughly, the cholinergic effect may be discovered more frequently. To administer CPT-11 safely needs meticulous monitoring not only for hematological toxicity and diarrhea but also for other cholinergic actions including bradycardia.