The carboxy-terminal fragment of α1A calcium channel preferentially aggregates in the cytoplasm of human spinocerebellar ataxia type 6 Purkinje cells

Spinocerebellar ataxia type 6 (SCA6) is an autosomal dominant neurodegenerative disease caused by a small polyglutamine (polyQ) expansion (control: 4–20Q; SCA6: 20–33Q) in the carboxyl(C)-terminal cytoplasmic domain of the α1A voltage-dependent calcium channel (Cav2.1). Although a 75–85-kDa Cav2.1 C-terminal fragment (CTF) is toxic in cultured cells, its existence in human brains and its role in SCA6 pathogenesis remains unknown. Here, we investigated whether the small polyQ expansion alters the expression pattern and intracellular distribution of Cav2.1 in human SCA6 brains. New antibodies against the Cav2.1 C-terminus were used in immunoblotting and immunohistochemistry. In the cerebella of six control individuals, the CTF was detected in sucrose- and SDS-soluble cytosolic fractions; in the cerebella of two SCA6 patients, it was additionally detected in SDS-insoluble cytosolic and sucrose-soluble nuclear fractions. In contrast, however, the CTF was not detected either in the nuclear fraction or in the SDS-insoluble cytosolic fraction of SCA6 extracerebellar tissues, indicating that the CTF being insoluble in the cytoplasm or mislocalized to the nucleus only in the SCA6 cerebellum. Immunohistochemistry revealed abundant aggregates in cell bodies and dendrites of SCA6 Purkinje cells (seven patients) but not in controls (n = 6). Recombinant CTF with a small polyQ expansion (rCTF-Q28) aggregated in cultured PC12 cells, but neither rCTF-Q13 (normal-length polyQ) nor full-length Cav2.1 with Q28 did. We conclude that SCA6 pathogenesis may be associated with the CTF, normally found in the cytoplasm, being aggregated in the cytoplasm and additionally distributed in the nucleus

Supplementary Material for: Nutritional Status and Changes in Body Weight in Patients with Multiple System Atrophy

<i>Introduction:</i> The importance of nutritional management in neurodegenerative diseases is increasingly recognized in the clinical setting. However, few reports have examined the nutritional intake in patients with multiple system atrophy (MSA). Here, we investigated changes in daily caloric intake, body mass index (BMI) and nutritional status during the disease course of MSA. <i>Methods:</i> We performed a single-hospital study of 82 consecutive patients with probable MSA according to the consensus criteria. We determined daily caloric intake, the level of activities of daily living (ADL; independent, wheelchair-bound or bedridden) and BMI at the time of admission. Nutritional status was also evaluated using biochemical nutritional markers including serum albumin, total cholesterol and lymphocyte count. <i>Results:</i> Although daily caloric intake decreased with ADL level deterioration (p < 0.01), no significant differences were observed in BMI among ADL levels. Serum albumin also decreased with ADL deterioration (p < 0.01); however, no significant differences were observed for serum total cholesterol or lymphocyte count with respect to ADL level. <i>Conclusion:</i> We demonstrated that patients with advanced stage MSA may develop malnutrition in the absence of a decrease in BMI. Moreover, serum albumin level may be useful for evaluating nutritional changes in MSA patients

Reversible brain atrophy and cognitive impairment in an adolescent Japanese patient with primary adrenal Cushing&rsquo;s syndrome

Nobumasa Ohara,1 Hiroshi Suzuki,1 Akiko Suzuki,1 Masanori Kaneko,1 Masahiro Ishizawa,1 Kazuo Furukawa,1 Takahiro Abe,1 Yasuhiro Matsubayashi,1 Takaho Yamada,1 Osamu Hanyu,1 Takayoshi Shimohata,2 Hirohito Sone1 1Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan; 2Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan Abstract: Endogenous Cushing&rsquo;s syndrome is an endocrine disease resulting from chronic exposure to excessive glucocorticoids produced in the adrenal cortex. Although the ultimate outcome remains uncertain, functional and morphological brain changes are not uncommon in patients with this syndrome, and generally persist even after resolution of hypercortisolemia. We present an adolescent patient with Cushing&rsquo;s syndrome who exhibited cognitive impairment with brain atrophy. A 19-year-old Japanese male visited a local hospital following 5 days of behavioral abnormalities, such as money wasting or nighttime wandering. He had hypertension and a 1-year history of a rounded face. Magnetic resonance imaging (MRI) revealed apparently diffuse brain atrophy. Because of high random plasma cortisol levels (28.7 &micro;g/dL) at 10 AM, he was referred to our hospital in August 2011. Endocrinological testing showed adrenocorticotropic hormone-independent hypercortisolemia, and abdominal computed tomography demonstrated a 2.7 cm tumor in the left adrenal gland. The patient underwent left adrenalectomy in September 2011, and the diagnosis of cortisol-secreting adenoma was confirmed histologically. His hypertension and Cushingoid features regressed. Behavioral abnormalities were no longer observed, and he was classified as cured of his cognitive disturbance caused by Cushing&rsquo;s syndrome in February 2012. MRI performed 8 months after surgery revealed reversal of brain atrophy, and his subsequent course has been uneventful. In summary, the young age at onset and the short duration of Cushing&rsquo;s syndrome probably contributed to the rapid recovery of both cognitive dysfunction and brain atrophy in our patient. Cushing&rsquo;s syndrome should be considered as a possible etiological factor in patients with cognitive impairment and brain atrophy that is atypical for their age. Keywords: Cushing&rsquo;s syndrome, brain atrophy, cognitive impairment, adrenalectomy, adolescent&nbsp

Serum levels of the soluble haemoglobin scavenger receptor CD163 in MPO-ANCA-associated renal vasculitis

<p><b>Objectives</b>: The contribution of infections to the mortality of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is important, and early and careful infection control is necessary. We investigated the usefulness of the serum-soluble haemoglobin scavenger receptor CD163 for detecting the presence of infectious complications regardless of disease activity.</p> <p><b>Method</b>: Soluble CD163 in serum obtained from 45 Japanese patients with myeloperoxidase (MPO)-AAV was measured by an enzyme-linked immunosorbent assay (ELISA). We evaluated 36 samples from active-vasculitis patients, 36 samples from inactive-vasculitis patients without infection, and 19 samples from inactive-vasculitis patients with infectious complications. Serum-soluble CD163 was also measured in 15 infectious patients without vasculitis and in 30 normal controls.</p> <p><b>Results</b>: The mean serum-soluble CD163 level was higher in the patients with infectious complications than in the active-vasculitis patients, inactive-vasculitis patients, and normal controls. There were significant positive correlations between serum-soluble CD163 levels and white blood cell (WBC) count, serum C-reactive protein (CRP) levels, and serum albumin levels, but only serum CRP levels were correlated with serum-soluble CD163 levels in a multiple regression analysis. On the receiver-operating characteristic (ROC) curve, serum-soluble CD163 levels had 80.6% sensitivity and 86.7% specificity for differentiating patients with infection from those without infection. Among the active-vasculitis patients, the mean serum-soluble CD163 level of the patients with alveolar haemorrhage was significantly lower than that of the patients with interstitial lung diseases and that of the patients without pulmonary lesions.</p> <p><b>Conclusions</b>: The serum-soluble CD163 level may be a useful marker for the detection of infectious complications in MPO-AAV patients.</p