Hereditary transthyretin amyloidosis: a comprehensive review with a focus on peripheral neuropathy

Amyloidoses represent a group of diseases characterized by the pathological accumulation in the extracellular area of insoluble misfolded protein material called “amyloid”. The damage to the tissue organization and the direct toxicity of the amyloidogenic substrates induce progressive dysfunctions in the organs involved. They are usually multisystem diseases involving several vital organs, such as the peripheral nerves, heart, kidneys, gastrointestinal tract, liver, skin, and eyes. Transthyretin amyloidosis (ATTR) is related to abnormalities of transthyretin (TTR), a protein that acts as a transporter of thyroxine and retinol and is produced predominantly in the liver. ATTR is classified as hereditary (ATTRv) and wild type (ATTRwt). ATTRv is a severe systemic disease of adults caused by mutations in the TTR gene and transmitted in an autosomal dominant manner with incomplete penetrance. Some pathogenic variants in TTR are preferentially associated with a neurological phenotype (progressive peripheral sensorimotor polyneuropathy); others are more frequently associated with restrictive heart failure. However, many mutations express a mixed phenotype with neurological and cardiological involvement. ATTRv is now a treatable disease. A timely and definite diagnosis is essential in view of the availability of effective therapies that have revolutionized the management of affected patients. The purpose of this review is to familiarize the clinician with the disease and with the correct diagnostic pathways in order to obtain an early diagnosis and, consequently, the possibility of an adequate treatment

Being Ready to Treat Ebola Virus Disease Patients

As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD

Acquisition of isotopic composition for surface snow in East Antarctica and the links to climatic parameters

The isotopic compositions of oxygen and hydrogen in ice cores are invaluable tools for the reconstruction of past climate variations. Used alone, they give insights into the variations of the local temperature, whereas taken together they can provide information on the climatic conditions at the point of origin of the moisture. However, recent analyses of snow from shallow pits indicate that the climatic signal can become erased in very low accumulation regions, due to local processes of snow reworking. The signal-to-noise ratio decreases and the climatic signal can then only be retrieved using stacks of several snow pits. Obviously, the signal is not completely lost at this stage, otherwise it would be impossible to extract valuable climate information from ice cores as has been done, for instance, for the last glaciation. To better understand how the climatic signal is passed from the precipitation to the snow, we present here results from varied snow samples from East Antarctica. First, we look at the relationship between isotopes and temperature from a geographical point of view, using results from three traverses across Antarctica, to see how the relationship is built up through the distillation process. We also take advantage of these measures to see how second-order parameters (d-excess and O-17-excess) are related to delta O-18 and how they are controlled. d-excess increases in the interior of the continent (i.e., when delta O-18 decreases), due to the distillation process, whereas O-17-excess decreases in remote areas, due to kinetic fractionation at low temperature. In both cases, these changes are associated with the loss of original information regarding the source. Then, we look at the same relationships in precipitation samples collected over 1 year at Dome C and Vostok, as well as in surface snow at Dome C. We note that the slope of the delta O-18 vs. temperature (T) relationship decreases in these samples compared to those from the traverses, and thus caution is advocated when using spatial slopes for past climate reconstruction. The second-order parameters behave in the same way in the precipitation as in the surface snow from traverses, indicating that similar processes are active and that their interpretation in terms of source climatic parameters is strongly complicated by local temperature effects in East Antarctica. Finally we check if the same relationships between delta O-18 and second-order parameters are also found in the snow from four snow pits. While the d-excess remains opposed to delta O-18 in most snow pits, the O-17-excess is no longer positively correlated to delta O-18 and even shows anti-correlation to delta O-18 at Vostok. This may be due to a stratospheric influence at this site and/or to post-deposition processes

The global distribution of natural tritium in precipitation simulated with an Atmospheric General Circulation Model and comparison with observations

The description of the hydrological cycle in Atmospheric General Circulation Models (GCMs) can be validated using water isotopes as tracers. Many GCMs now simulate the movement of the stable isotopes of water, but here we present the first GCM simulations modelling the content of natural tritium in water. These simulations were obtained using a version of the LMDZ General Circulation Model enhanced by water isotopes diagnostics, LMDZ-iso. To avoid tritium generated by nuclear bomb testing, the simulations have been evaluated against a compilation of published tritium datasets dating from before 1950, or measured recently. LMDZ-iso correctly captures the observed tritium enrichment in precipitation as oceanic air moves inland (the so-called continental effect) and the observed north-south variations due to the latitudinal dependency of the cosmogenic tritium production rate. The seasonal variability, linked to the stratospheric intrusions of air masses with higher tritium content into the troposphere, is correctly reproduced for Antarctica with a maximum in winter. LMDZ-iso reproduces the spring maximum of tritium over Europe, but underestimates it and produces a peak in winter that is not apparent in the data. This implementation of tritium in a GCM promises to provide a better constraint on: (1) the intrusions and transport of air masses from the stratosphere, and (2) the dynamics of the modelled water cycle. The method complements the existing approach of using stable water isotopes. (C) 2015 Elsevier B.V. All rights reserved

Molecular Weights of Bovine and Porcine Heparin Samples: Comparison of Chromatographic Methods and Results of a Collaborative Survey

In a collaborative study involving six laboratories in the USA, Europe, and India the molecular weight distributions of a panel of heparin sodium samples were determined, in order to compare heparin sodium of bovine intestinal origin with that of bovine lung and porcine intestinal origin. Porcine samples met the current criteria as laid out in the USP Heparin Sodium monograph. Bovine lung heparin samples had consistently lower average molecular weights. Bovine intestinal heparin was variable in molecular weight; some samples fell below the USP limits, some fell within these limits and others fell above the upper limits. These data will inform the establishment of pharmacopeial acceptance criteria for heparin sodium derived from bovine intestinal mucosa. The method for MW determination as described in the USP monograph uses a single, broad standard calibrant to characterize the chromatographic profile of heparin sodium on high-resolution silica-based GPC columns. These columns may be short-lived in some laboratories. Using the panel of samples described above, methods based on the use of robust polymer-based columns have been developed. In addition to the use of the USP’s broad standard calibrant for heparin sodium with these columns, a set of conditions have been devised that allow light-scattering detected molecular weight characterization of heparin sodium, giving results that agree well with the monograph method. These findings may facilitate the validation of variant chromatographic methods with some practical advantages over the USP monograph method

A Comprehensive Update on Late-Onset Pompe Disease

Pompe disease (PD) is an autosomal recessive disorder caused by mutations in the GAA gene that lead to a deficiency in the acid alpha-glucosidase enzyme. Two clinical presentations are usually considered, named infantile-onset Pompe disease (IOPD) and late-onset Pompe disease (LOPD), which differ in age of onset, organ involvement, and severity of disease. Assessment of acid alpha-glucosidase activity on a dried blood spot is the first-line screening test, which needs to be confirmed by genetic analysis in case of suspected deficiency. LOPD is a multi-system disease, thus requiring a multidisciplinary approach for efficacious management. Enzyme replacement therapy (ERT), which was introduced over 15 years ago, changes the natural progression of the disease. However, it has limitations, including a reduction in efficacy over time and heterogeneous therapeutic responses among patients. Novel therapeutic approaches, such as gene therapy, are currently under study. We provide a comprehensive review of diagnostic advances in LOPD and a critical discussion about the advantages and limitations of current and future treatments

Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study

The extent of nerve involvement in leprosy is highly variable in distribution and clinical presentation. Mononeuropathies, multiple mononeuropathies, and polyneuropathies can present both in the context of a cutaneous and/or systemic picture and in the form of pure neuritic leprosy (PNL). The differential diagnosis of leprosy neuropathy remains challenging because it is a very rare condition and, especially in Western countries, is often overlooked. We report one case of the polyneuropathic form of PNL (P-PNL) and one case of multiple mononeuropathy in paucibacillary leprosy. In both cases, the diagnosis was achieved by performing a sural nerve biopsy, which showed subverted structure, severe infiltration of inflammatory cells in nerve fascicles, granulomatous abnormalities, and the presence of alcohol-acid-resistant, Ziehl–Neelsen-positive bacilli inside the nerve bundles. Leprosy remains an endemic disease in many areas of the world, and globalization has led to the spread of cases in previously disease-free countries. In this perspective, our report emphasizes that the diagnostic possibility of leprosy neuropathy should always be taken into account, even in Western countries, in the differential diagnostic process of an acquired sensory polyneuropathy or multineuropathy and confirms that nerve biopsy remains a useful procedure in working up neuropathies with unknown etiology

Motor learning and metaplasticity in striatal neurons: Relevance for Parkinson's disease

Nigro-striatal dopamine transmission is central to a wide range of neuronal functions, including skill learning, which is disrupted in several pathologies such as Parkinson's disease. The synaptic plasticity mechanisms, by which initial motor learning is stored for long time periods in striatal neurons, to then be gradually optimized upon subsequent training, remain unexplored. Addressing this issue is crucial to identify the synaptic and molecular mechanisms involved in striatal-dependent learning impairment in Parkinson's disease. In this study, we took advantage of interindividual differences between outbred rodents in reaching plateau performance in the rotarod incremental motor learning protocol, to study striatal synaptic plasticity ex vivo. We then assessed how this process is modulated by dopamine receptors and the dopamine active transporter, and whether it is impaired by overexpression of human \u3b1-synuclein in the mesencephalon; the latter is a progressive animal model of Parkinson's disease. We found that the initial acquisition of motor learning induced a dopamine active transporter and D1 receptors mediated long-Term potentiation, under a protocol of long-Term depression in striatal medium spiny neurons. This effect disappeared in animals reaching performance plateau. Overexpression of human \u3b1-synuclein reduced striatal dopamine active transporter levels, impaired motor learning, and prevented the learning-induced long-Term potentiation, before the appearance of dopamine neuronal loss. Our findings provide evidence of a reorganization of cellular plasticity within the dorsolateral striatum that is mediated by dopamine receptors and dopamine active transporter during the acquisition of a skill. This newly identified mechanism of cellular memory is a form of metaplasticity that is disrupted in the early stage of synucleinopathies, such as Parkinson's disease, and that might be relevant for other striatal pathologies, such as drug abuse

Is amyloid involved in acute neuroinflammation? A CSF analysis in encephalitis

INTRODUCTION: Several investigations have argued for a strong relationship between neuroinflammation and amyloid metabolism but it is still unclear whether inflammation exerts a pro-amyloidogenic effect, amplifies the neurotoxic effect of amyloid, or is protective. METHODS: Forty-two patients with acute encephalitis (ENC) and 18 controls underwent an extended cerebrospinal fluid (CSF) panel of inflammatory, amyloid (Aβ40, 42, and 38, sAPP-α, sAPP-β), glial, and neuronal biomarkers. Linear and non-linear correlations between CSF biomarkers were evaluated studying conditional independence relationships. RESULTS: CSF levels of inflammatory cytokines and neuronal/glial markers were higher in ENC compared to controls, whereas the levels of amyloid-related markers did not differ. Inflammatory markers were not associated with amyloid markers but exhibited a correlation with glial and neuronal markers in conditional independence analysis. DISCUSSION: By an extensive CSF biomarkers analysis, this study showed that an acute neuroinflammation state, which is associated with glial activation and neuronal damage, does not influence amyloid homeostasis