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Identification of a new amino acid residue capable of modulating agonist efficacy at the homomeric nicotinic acetylcholine receptor, alpha7.

Neuronal nicotinic receptors (nAChRs) have been implicated in pathology associated with neurological diseases and aberrant cognitive states such as addiction and schizophrenia. The design of subtype-specific cholinergic drugs is dependent on identification of key amino acids that play a significant role in determining subunit-specific agonist efficacy. 1,1-Dimethyl-4-phenylpiperazinium (DMPP) and a series of piperazium (PIP)-derived cholinergic agonists (1,1 dimethyl-4-acetylpiperizinium iodide, EthylPIP, PropylPIP, and ButylPIP) were used to identify a site (position 84) in homomeric neuronal nAChRs, which is a partial determinant of pharmacological specificity. In contrast to absolutely conserved amino acids within the nicotinic superfamily, the amino acid in position 84 can be polar or nonpolar. The addition of one methylene to PropylPIP to form ButylPIP eliminated channel activation of but not binding to the chick alpha7 homomeric nAChR (leucine in position 84). In rat alpha7 (glutamine in position 84), ButylPIP was an agonist. 1, 1-Dimethyl-4-phenylpiperazinium, a structural analog of ButylPIP, activates the rat alpha7 but is a weak partial agonist of the chick alpha7. Mutation of the chick alpha7 (L84Q) restored activation by ButylPIP, and the corresponding mutation in rat alpha7 (Q84L) abolished activation by ButylPIP. These mutations had moderate effects on the apparent affinity for acetylcholine, increasing its affinity for chick alpha7 and decreasing it for rat alpha7. Thus, the amino acid in position 84 (a residue on the periphery of the highly conserved loop A of the cys-loop superfamily of receptors) can potentially be exploited to produce subtype-specific drugs and can provide insights into the structure of the binding domain.

Acetylcholine↗

Familial Alzheimer's disease and cortical Lewy bodies: is there a genetic susceptibility factor?

The reason for the occurrence of Lewy body disease (LBD) in Alzheimer's disease (AD) patients is unknown. If brains from etiologically different AD groups differ in their tendency to develop cortical Lewy bodies, the concurrence of LBD in AD patients may be a manifestation of the AD process in specific AD subsets. To address this issue, we counted cortical Lewy bodies in AD patients with genetic abnormalities on chromosome 14 (n = 19), and chromosome 21 (n = 3), sporadic AD (n = 27), Down's syndrome (n = 1) and control (n = 26) patients. Cortical Lewy bodies were occasionally present in AD patients with long-duration disease in most of the above AD subgroups, but were not present in any of our age-matched control cases. We suggest that cortical Lewy body formation may be an intrinsic part of the late pathologic changes of AD regardless of etiology and that it is not specific to any of the AD subtypes studied.

Aged↗

Familial risk of ischemic and hemorrhagic stroke: a large-scale study of the Swedish population.

BACKGROUND AND PURPOSE: Previous studies of familial risks have often combined ischemic and hemorrhagic stroke even though it seems unlikely that these 2 very different pathological conditions are under the same genetic influence. This study is the first to investigate the concordant (same subtype) and disconcordant (different subtype) association between ischemic and hemorrhagic stroke. METHODS: Data of first hospitalization for stroke were obtained from the Hospital Discharge Register during the study period 1987 to 2001. All individuals born in Sweden from 1932 onwards were included and linked to their siblings. Risks were calculated as standardized incidence ratios and compared with individuals without affected siblings. Results were standardized for age, gender, geographical region and socioeconomic status. RESULTS: Ischemic stroke (n=25,630) was associated only with ischemic stroke (n=7961), which was also the case for hemorrhagic stroke. The statistically significant standardized incidence ratios were 2.14 (95% CI, 1.21 to 3.74) and 1.82 (95% CI, 1.21 to 2.75), respectively. For discordant subtypes of stroke no significant associations were found. CONCLUSIONS: The results suggest that ischemic and hemorrhagic stroke are not under the same genetic influence. However, further studies of the human genome are needed in order to identify the specific genes that play roles in the pathogenesis of common subtypes of stroke.

Adolescent↗

Osteoblastic meningioma of the fourth ventricle.

Meningiomas of the fourth ventricle are rare neoplasms. Only meningothelial and fibroblastic subtypes, purportedly arising from the tela choroidea, have been described. In this report we describe clinical, neuroradiological and pathological findings in a 52-year-old man with mild hydrocephalus produced by a large, calcified, osteoblastic meningioma of the fourth ventricle.

Cerebral Ventricles↗

Non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue.

The concept of mucosa-associated lymphoid tissue (MALT) lymphomas was introduced by Isaacson and Wright [Cancer 1983; 52:1410-1416] in 1983. After more than 20 years of clinical research MALT lymphomas are now recognized as a distinct subtype of non-Hodgkin's lymphoma (NHL) with unique pathogenic, histological, and clinical features. Although this subtype of NHL occurs frequently, optimal management remains elusive. This manuscript reviews features of the clinical presentation, diagnosis, pathology, molecular characteristics, and management of both gastric and non-gastric MALT lymphoma.

Humans↗

A clinicopathologic and immunohistochemical study of diffuse large B-cell lymphoma.

OBJECTIVE: To study the clinicopathologic and immunohistochemical features of diffuse large B-cell lymphoma (DLBCL) and the significance of immunohistochemistry in diagnosis and differential diagnosis of DLBCL. METHODS: 60 cases of DLBCL were studied and immunohistochemical staining for LCA, L26, BLA-36, CD30, bcl-6 were carried out with the EnVision 2 step method. RESULTS: The age range of 76.7% (46/60) patients was 40 - 70 years. The location of the lesion includes nodal and extranodal sites. 90.0% (54/60) were in clinical stages of II (24/54), III (21/54), IV (9/54). Histopathologic morphology presented as centroblastic (88.3%, 53/60), immunoblastic (3.3%, 2/60), anaplastic large B cell type (3.3%, 2/60) and T cell rich B cell type (5.0%, 3/60). Immunostaining showed 100% (60/60) DLBCL were positive for LCA, L26, BLA36, 3.3% (2/60) DLBCL positive for CD30, 95% (57/60) expressed bcl-6 protein. CONCLUSIONS: DLBCL is an aggressive lymphoma which shows cytologic variability from case to case. The evaluation of pathologic features and immunohistochemistry in DLBCL are useful and practical for diagnostic purposes, but cannot delineate distinctive morphologic subtypes.

Adult↗

Limbic-hypothalamic-pituitary-adrenal axis activity and ventricular-to-brain ratio studies in affective illness and schizophrenia.

Some investigators have speculated that structural brain alterations observed in some psychiatric patients might be related to increased limbic-hypothalamic-pituitary-adrenal axis (LHPA) activity. To explore this hypothesis, we prospectively studied 166 research volunteers (19 patients with research diagnostic criteria (RDC) major depression, 9 patients with RDC bipolar depression, 45 patients with RDC schizophrenia, and 94 RDC normal controls), examining the relationship between magnetic resonance image-determined ventricular-to-brain ratio (VBR) and indices of LHPA axis function (cerebrospinal fluid (CSF) corticotropin-releasing factor (CRF), CSF adrenocorticotropic hormone (ACTH), and 24-hour urinary-free cortisol secretion). We observed no significant differences in mean VBR among the three patient groups and the normal control volunteers. Of the indices of LHPA activity, only CSF CRF concentrations distinguished the four subject groups, with CSF CRF being significantly elevated in the more severely depressed major depression patients. Indices of LHPA activity were not significantly correlated with VBR in any of the three patient groups or in the normal volunteers. These preliminary results suggest that VBR is not highly associated with alterations in LHPA activity, at least as determined cross-sectionally. Further longitudinal studies with reference to diagnostic subtypes, severity, symptom profiles, and more specific neuroanatomic regions may allow the elucidation of possible relationships between LHPA pathology and structural brain alterations.

Adrenocorticotropic Hormone↗

[Lymphography in Hodgkin's lymphoma. Diagnostic value based on the current status of experience and knowledge].

Lymphography was carried out at least once in 355 patients with Hodgkin's lymphoma (HL). In 229 patients, there was a histological subclassification: 26 LP, 63 NS, 122 NC and 18 LD cases. The lymphographic manifestations could be subdivided empirically into two superordinate groups: 1. lymph nodes closely linked together in chains (LC) with dense structures as well as LC destructions, LC debris and 2. LC of varying size with pathological internal structure. Apart from in the NS type, a correlation between the lymphological appearance and the histological subtype could not be discerned in any other histological subgroup. After lymphography, 61.6% of stages I and II were assigned to stage III. The staging of the lymphography was: stage I 24.5%, stage II 47.3%, stage III 10% and stage IV 9%, and after lymphography: stage I 9.9%, stage II 17.7%, stage III 63.1% and stage IV 9.3%. From a qualitative point of view, lymphography is superior to all other methods in the diagnosis of malignant lymphomas and should hence be carried out obligatorily in suspicion of a malignant lymphoma.

Adolescent↗

[Psychosomatic aspects of psoriasis: affectivity and conflict].

With a sample of 32 patients with psoriasis--compared with 22 control-persons--possible disturbances of the development of affectivity in the childhood of the patients were investigated (cluster- and factor-analysis). By this an essential point in psychosomatic theories could be explained: the inhibition of an immediate psychic discharge of affects. Further investigation concerned the question--, of how far conflict-coping-behavior of psoriatic patients is characterized by denial of reality, excessive repression and over-adjustment. Disturbed affective development and pathological conflict-behavior together may result in a chronic overstrain of psychic structures--as a correlate of the psychosomatic illness. Our results show a pathological conflict-behavior and a disturbed development of affectivity in the genesis of psoriasis. We found two subtypes of psoriatic patients with specific character-traits--whereas a typical personality could not be found.

Adaptation, Psychological↗

[Pathological study of hepatoid gastric adenocarcinomas].

Routine examination of pathologic sections in 500 cases of primary gastric adenocarcinomas was carried out by light microscopy. Regions of hepatocellular carcinomatoid differentiation were discovered in 12 of the 500 cases. In 11 of them, histopathologic features were described in great detail and the hepatocellular carcinomatoid regions were studied by four kinds of immunohistochemistrical methods. The results indicate that positive staining for AFP was seen in 9 cases but negative in 9 controls, weakly positive for CEA in 10 cases, but strongly positive in 8 controls. Staining for alpha 1-AT and alpha 1-ACT showed no differences as compared to controls. The clinical pathological features and its relationship with AFP are discussed. It is suggested that hepatoid gastric adenocarcinoma is a subtype of gastric adenocarcinoma.

Adenocarcinoma↗

[Advances in gastrointestinal hormones: cholecystokinin].

Cholecystokinin (CCK) and gastrin are members of an important family of gastroenteropancreatic polypeptides. Distribution of CCK both in the digestive system and central and peripheral nervous structures correlates with the variety of its actions; more than a classic hormone, CCK is a peptidergic neurotransmitter. CCK plays a predominant role in multiple digestive functions: contraction and emptying of the gallbladder, stimulation of pancreatic secretion of enzymes, delay of gastric emptying, diminution of gastric acid secretion, regulation of insulin secretion, reduction of food intake, etc. Distinction between pharmacologic and physiologic effects has been difficult in all of these areas. Modern technological procedures have generated significant progresses: reliable plasmatic bioassay, understanding of molecular heterogeneity, identification and characterization of receptors and their subtypes, agonists and antagonists, some of them currently available for research studies. The integrationist perspective of normal and pathological physiology has been considerably enhanced. Therapeutic use of CCK and its derivatives in some specific problems, i.e. obesity and anorexia, remains incipient and restricted.

Cholecystokinin↗

Expression of estrogen receptor-alpha and Ki67 in relation to pathological and molecular features in early-onset infiltrating ductal carcinoma.

Estrogen causes breast cancer by triggering proliferation via an estrogen receptor (ER)-mediated mechanism. However, paradoxically, ER alpha, one of the two known ER subtypes, and the proliferation marker, Ki67, are not usually expressed in the same breast tumor. To explore whether ER alpha-positive tumors and proliferating (Ki67-positive) tumors have different tumorigenic characteristics, we performed an immunohistochemical study on 74 early-onset infiltrating ductal carcinomas of the breast. To test this hypothesis, we examined whether ER alpha-positive and Ki67-positive tumors showed differences in (i) pathological grade, (ii) three indices of tumor grade (tubule formation, nuclear pleomorphism, and mitotic number), and (iii) expression of important proteins implicated in breast tumorigenesis (cyclin D1, ErbB2, ATM, BRCA1, Rb, p53, and p21). The results of the multigenic analysis showed that ER alpha and Ki67 were the only two important markers significantly and independently associated with tumor grade, consistent with the above hypothesis. ER alpha-positive, Ki67-negative tumors frequently displayed a low tumor grade (i.e. being well differentiated), whereas Ki67-positive, ER alpha-negative tumors were more likely to exhibit a high tumor grade. In addition, positive ER alpha expression (46 of 74 cases, 62%) correlated well with positive cyclin D1 expression (p < 0.005), less nuclear pleomorphism (p < 0.001), and a low mitotic count (p < 0.005), whereas positive Ki67 expression (36 of 74 cases, 49%) correlated with reduced BRCA1 expression (p < 0.01) and high mitotic activity (p < 0.01). These findings suggest that the expressions of ER alpha and Ki67 might be involved in distinct pathological and molecular features during breast cancer development.

Age of Onset↗

Alglucerase. A review of its therapeutic use in Gaucher's disease.

Alglucerase is a mannose-terminated form of human placental glucocerebrosidase, developed to treat patients with Gaucher's disease. Functional glucocerebrosidase is deficient in Gaucher's disease, an autosomal recessive lipid storage disorder that affects people of all ethnic backgrounds, but has a higher incidence among East European Jews (Ashkenazim). Gaucher's disease manifests with hepatosplenomegaly, bleeding disorders and bone disease, with the more rare subtypes (types 2 and 3) featuring neurological dysfunction. Prior to the development of enzyme replacement therapy, treatment for Gaucher's disease was mainly symptomatic relief. Primary treatment with glucocerebrosidase focuses on removal of the lipid metabolite that causes the pathology. Because of the rarity of Gaucher's disease clinical trials are small, and much of the data investigating alglucerase therapy have been obtained from studies of patients with type 1 disease, the prevalent subtype. Nonetheless, after intravenous administration of alglucerase, improvements are evident within 6 months of therapy. Patients have increased haemoglobin levels and platelet counts, and decreased incidences of epistaxis and bruising. Spleen and liver size are reduced, and skeletal parameters improve. Children gain height and most patients receiving alglucerase therapy are able to resume work and daily activities. Alglucerase is well tolerated, with few mild adverse reactions reported. Although the pharmacokinetic and pharmacodynamic information for alglucerase is limited, its unequivocal efficacy justifies enzyme replacement therapy with this compound as first-line treatment for patients with Gaucher's disease, for whom treatment options are limited.

Bone and Bones↗

Recent advances in the histopathology and molecular pathology of carcinoma of the endometrium.

Endometrial carcinoma is the commonest malignancy of the female genital tract. The pathogenesis is complex and at least three pathogenetic subtypes exist with different prognostic implications. The molecular events involved remain poorly defined but several genes are involved and mutations of tp53, WAF1/CIP1, PTEN, bcl-2 and c-erbB-2 have been implicated. Although care is needed in interpreting the results, the majority of these mutations can be detected immunohistochemically and therefore have the potential to aid the pathologist and surgeon in assessing the prognosis of a tumour. However, for the time being, no molecular marker is as valuable in determining prognosis as conventional parameters such as tumour type, grade and vascular space involvement.

Adenocarcinoma↗

Histopathology and molecular pathology of synovial B-lymphocytes in rheumatoid arthritis.

B-cells of the rheumatoid synovial tissue are a constant part of and, in some histopathological subtypes, the dominant population of the inflammatory infiltrate, located in the region of tissue destruction. The pattern of B-cell distribution and the relationship to the corresponding antigen-presenting cells (follicular dendritic reticulum cells: FDCs) show a great variety. B-cells may exhibit (i) a follicular organization forming secondary follicles; (ii) follicle-like patterns with irregularly formed FDC networks, and (iii) a diffuse pattern of isolated FDCs. Molecular analysis of immunoglobulin VH and VL genes from human synovial B-cell hybridomas and synovial tissue demonstrates somatic mutations due to antigen activation. The FDC formations in the synovial tissue may therefore serve as an environment for B-cell maturation, which is involved in the generation of autoantibodies. An autoantibody is defined as "pathogenic" if it fulfills the Witebsky-Rose-Koch criteria for classical autoimmune diseases: definition of the autoantibody; induction of the disease by transfer of the autoantibody; and isolation of the autoantibody from the disease-specific lesion. B-cells from rheumatoid synovial tissue show specificity for FcIgG, type II collagen, COMP, sDNA, tetanus toxoid, mitochondrial antigens (M2), filaggrin and bacterial HSPs. The contributions of these antigens to the pathogenesis of RA are still hypothetical. A possible contribution could derive from crossreactivity and epitope mimicry: due to crossreaction, an antibody directed originally against a foreign infectious agent could react with epitopes from articular tissues, perpetuating the local inflammatory process. The characteristic distribution pattern, the localisation within the area of tissue destruction, the hypermutated IgVH and IgVL genes, and their exclusive function to recognize conformation-dependent antigens suggest a central role for B-cells in the inflammatory process of rheumatoid arthritis. Therefore, the analysis of synovial B-cell hybridomas and experimental expression of synovial IgVH and IgVL genes will help to characterise the antigens responsible for the pathogenesis of rheumatoid arthritis.

Animals↗

Muscarinic cholinergic receptor subtypes in hippocampus in human cognitive disorders.

Total muscarinic receptor levels, the levels of the subtypes exhibiting high and low affinity for pirenzepine, and the high- and low-affinity agonist states of the receptor were investigated in hippocampal tissue obtained at autopsy from mentally normal individuals and the following pathological groups: Alzheimer's disease, Parkinson's disease, Down's syndrome, alcoholic dementia, Huntington's chorea, and motor-neurone disease. A moderate decrease in the density of both high-affinity pirenzepine and high-affinity agonist subtypes was found in Alzheimer's disease, whereas a trend towards an increase in the overall muscarinic receptor density was apparent in the parkinsonian patients without dementia, mainly due to an increase in the low-affinity agonist state; the differences between the Alzheimer's disease and nondemented parkinsonian cases were highly significant. As previously reported, the levels of both choline acetyltransferase and acetylcholinesterase were markedly reduced in both Alzheimer's disease and Parkinson's disease--with a greater loss of both enzymes in the demented subgroup of parkinsonian patients. Activities of the cholinergic enzymes were also extensively reduced in Down's syndrome, accompanied by a loss of high-affinity pirenzepine binding. There were no significant receptor or enzyme alterations in the other groups studied. These observations suggest that in the human brain, extensive degeneration of cholinergic axons to the hippocampus, as indicated by a loss of cholinergic enzymes, is not necessarily accompanied by extensive muscarinic receptor abnormalities (as might be expected if a major subpopulation were presynaptic). Moreover, the opposite changes in muscarinic binding in Parkinson's and Alzheimer's diseases may be related to the greater severity of dementia in the latter disease.

Acetylcholinesterase↗

Pathology of neuroblastic tumors.

Histogenesis, basic histologic features, nomenclature, and criteria for diagnosis and prognostic classifications based on morphological features of neuroblastic tumors (NTs) are described. NTs that arise from neuroectodermal cells of the adrenal medulla and sympathetic ganglia recapitulate the development of sympathetic ganglion. The following three basic types of NTs are recognized: neuroblastoma (NBs) and ganglioneuroblastomas (GNBs) and ganglioneuromas (GNs). NBs can be undifferentiated, poorly differentiated or differentiating; GNBs have the following three subtypes. (1) nodular, (2) intermixed, and (3) borderline. The conventional and recommended terminology and Shimada terminology of NTs are described (Tables 1 and 2). There are three basic pathologic components of NTs, neuroblastomatous, ganglioneuromatous, and intermediate components (Figs 3, 5, and 7). There are two major prognostic classifications based on morphological features of NTs, Shimada classification and histologic grading (Tables 3 and 4).

Adrenal Gland Neoplasms↗

The clinical behavior of "mixed" small cell/large cell bronchogenic carcinoma compared to "pure" small cell subtypes.

Biopsy specimens from 19 previously untreated lung cancer patients were prospectively diagnosed as small cell carcinoma with a large cell component. The patients were thoroughly staged and received intensive combination chemotherapy. They represented 12% of all small cell carcinoma cases eligible for aggressive chemotherapy protocols during a 5.5 year period. To determine whether the clinical behavior of this "mixed" histologic variant differed from the other histologic subtypes of small cell lung cancer, we compared these 19 patients to a concurrent group of 103 patients with only small cell cancer in their diagnostic biopsies given equivalent therapy. The "mixed" histology patients were comparable to the "pure" small cell group in age, performance status, extent of disease, and frequency of bone marrow, liver, bone, and central nervous system metastases. Their complete plus partial response rare (58%) was significantly less than the response rate for the "pure" small cell patients (91%), their complete response rate was also lower (16 versus 46%), and their overall survival was significantly shorter (median, 6 versus 10.5 months) Mixed histology small cell/large cell carcinoma represents a distinct pathologic variant of small cell carcinoma of the lung, associated with lower response rates and shorter survival than the "pure" small cell subtypes. Since combination chemotherapy yields some complete responses and long-term disease-free survival in these patients, however, aggressive treatment with potentially curative intent should be considered in their management.

Adult↗