New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children

Hyponatremia is the most common electrolyte abnormality encountered in children. In the past decade, new advances have been made in understanding the pathogenesis of hyponatremic encephalopathy and in its prevention and treatment. Recent data have determined that hyponatremia is a more serious condition than previously believed. It is a major comorbidity factor for a variety of illnesses, and subtle neurological findings are common. It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2 cc/kg with a maximum of 100 cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia. In this review, we discuss how to recognize patients at risk for inadvertent overcorrection of hyponatremia and what measures should taken to prevent this, including the judicious use of 1-desamino-8d-arginine vasopressin (dDAVP)

Glutamate neurotoxicity, transport and alternate splicing of transporters

Glutamate is the major excitatory neurotransmitter in the central nervous system and its levels in the synaptic cleft are tightly controlled by high affinity glutamate transporters (also known as Excitatory Amino Acid Transporters or EAATs). The EAAT family is comprised of five members (EAAT1-5), and these transporters are subject to alternative splicing. Alternative splicing of the EAAT genes is a fundamental mechanism that can give rise to multiple distinct mRNA transcripts, producing protein isoforms with potentially altered functions. Numerous splice variants of EAATs have been identified in humans, rodents, and other mammalian species. All splice variants of EAATs cloned to date are either exon-skipping and/or intron-retaining types. These modifications may impact upon protein structure, posttranslational modification, function, cellular localization, and trafficking. Message and protein for these splice variants are detectable in the normal brain and, in many instances, have been shown to be induced by pathophysiological insults such as hypoxia. In addition, aberrant expression of EAAT splice variants has been reported in neurodegenerative conditions such as amyotrophic lateral sclerosis, Alzheimer's disease, ischemic stroke, and age- related macular degeneration. These EAAT variants may represent therapeutic targets and thus require an improved understanding of their regulation. This chapter describes recent developments in investigating the molecular heterogeneity, localization, function, structure, and regulation of the EAATs and their splice variants

Astrocyte and Glutamate Markers in the Superficial, Deep, and White Matter Layers of the Anterior Cingulate Gyrus in Schizophrenia

Most studies of the neurobiology of schizophrenia have focused on neurotransmitter systems, their receptors, and downstream effectors. Recent evidence suggests that it is no longer tenable to consider neurons and their functions independently of the glia that interact with them. Although astrocytes have been viewed as harbingers of neuronal injury and CNS stress, their principal functions include maintenance of glutamate homeostasis and recycling, mediation of saltatory conduction, and even direct neurotransmission. Results of studies of astrocytes in schizophrenia have been variable, in part because of the assessment of single and not necessarily universal markers and/or assessment of non-discrete brain regions. We used laser capture microdissection to study three distinct partitions of the anterior cingulate gyrus (layers I–III, IV–VI, and the underlying white matter) in the brains of 18 well-characterized persons with schizophrenia and 21 unaffected comparison controls. We studied the mRNA expression of nine specific markers known to be localized to astrocytes. The expression of astrocyte markers was not altered in the superficial layers or the underlying white matter of the cingulate cortex of persons with schizophrenia. However, the expression of some astrocyte markers (diodinase type II, aquaporin-4, S100β, glutaminase, excitatory amino-acid transporter 2, and thrombospondin), but not of others (aldehyde dehydrogenase 1 family member L1, glial fibrillary acidic protein, and vimentin) was significantly reduced in the deep layers of the anterior cingulate gyrus. These findings suggest that a subset of astrocytes localized to specific cortical layers is adversely affected in schizophrenia and raise the possibility of glutamatergic dyshomeostasis in selected neuronal populations