The use of antibody engineering to create novel drugs that target N-methyl-D-aspartate receptors.

According to a recent World Health Organization survey, there are over four hundred million people worldwide suffering from mental and neurological disorders; schizophrenia affects some forty-five million people, and unipolar major depression ranked fifth in major causes of disability and death. Clearly it is of the utmost importance to develop new, effective, and safe neuro-pharmaceuticals with this increasing "global burden of disease". To this end, we have developed a strategy of generating monoclonal antibodies that act as modulators of the cell-surface central nervous system receptor-ion channel complexes. In this review we will focus on the generation and characterization of a monoclonal antibody that acts as a partial agonist to the N-methyl-D-aspartate receptor. The creation of peptide mimetics, derived from this monoclonal antibody, that may be useful as cognitive enhancers and protect neurons hypoxic and ischemic insults caused by stroke, will also be discussed.

The identification of novel therapeutic targets for the treatment of malignant brain tumors.

A two-step strategy was developed consisting of differential display reverse transcriptase polymerase chain reaction (DDRT-PCR) with cultured normal human fetal astrocytes and U-373MG glioma cells followed by reverse Northern analysis of normal brain and primary tumor tissues. hu-dek, alpha-NAC, ribosomal proteins L7a and L35a, and five novel genes were identified. Since none of these genes has been previously shown to be associated with malignant brain tumor formation, this approach may be useful to identify novel targets for the diagnosis and treatment of brain tumors.

Changing patterns of coronary heart disease in the hunter region of New South Wales, Australia.

A population-based observational study of men and women aged 35-69 years in the Hunter Region of New South Wales, Australia, was conducted to assess the impact of risk-factor modification and increased drug therapy on the trends in major coronary events and case fatality. From 1985 to 1993, there were 3006 coronary deaths and 6450 nonfatal major coronary events. Rates of death and nonfatal myocardial infarction declined, but there was an increase in hospital admissions for prolonged chest pain. Reductions in cigarette smoking, diastolic blood pressure, total cholesterol, and increased use of aspirin can fully explain the 3.3% (95% confidence interval [CI] 2.4, 4.2) average annual reduction in rates of major coronary events for men and the 4.1% (95% CI 2.7, 5.5) reduction for women. In contrast, increased use of aspirin, beta-blockers, fibrinolytic therapy, and angiotensin-converting enzyme inhibitors explain less than half of the 8.9% (95% CI 5.9, 11.8) and 6.9% (95% CI 2.7, 10.9) average annual reduction in case fatality in hospital for men and women, respectively. These trends suggest a decline in severity of coronary heart disease consistent with reductions in risk-factor levels and improved acute medical treatment.

Propofol versus isoflurane for endoscopic sinus surgery.

PURPOSE: A previous retrospective study reported that propofol anesthesia decreased bleeding during endoscopic sinus surgery compared with isoflurane. We performed a prospective study to compare the effects of propofol versus isoflurane on measured blood loss and the surgeon's subjective assessment of operating conditions during endoscopic sinus surgery. PATIENTS AND METHODS: After receiving institutional review board approval and written informed consent, 56 patients undergoing endoscopic sinus surgery were randomly assigned to receive propofol (n = 30) or isoflurane (n = 26) supplemented with nitrous oxide-oxygen and alfentanil. Blood loss was calculated from the hemoglobin concentration in suction canisters. One surgeon, who was blinded to the anesthetic agent, performed every procedure and assessed bleeding as follows: 1, no bleeding; 2, modest bleeding; 3, bleeding interfering with operating conditions and cause for an agent switch; and 4, intolerable bleeding requiring a change in surgical plan. Results were compared in the two anesthetic groups using chi-squared test, unpaired t-test, Mann-Whitney Utest, and a permutation test. A P of .05 was considered significant. RESULTS: Mean bleeding scores were less over time (P = .02) with propofol anesthesia, particularly in surgery in the ethmoid and sphenoid sinuses (P = .03), and the proportion of patients with a mean score >2 was less in the propofol group (30% v 54%; P = .033). Time until discharge to home or to a limited stay in a hospital bed was also less in the propofol group (183 v 243 minutes; P = .019). CONCLUSION: In our study, surgical blood loss was the same for both anesthetic agents overall, but propofol appeared to offer an advantage in terms of subjective improvement in operating conditions, particularly in the ethmoid and sphenoid sinuses.

Metabotropic glutamate receptor mediated long-term depression in developing hippocampus.

The effects of bath application of the metabotropic glutamate receptor (mGluR) agonist 1S,3R-1-aminocyclopentane-1,3-dicarboxylic acid (ACPD, 10 microM) were studied at the Schaffer collateral-CA1 synapse in hippocampal slices from rats of 8-33 days postnatal age. In immature animals (8-12 days) ACPD induced a biphasic response characterized by an acute decrease in field EPSP slope (approximately 50-60% of baseline) in the presence of the agonist, followed by long-term depression (LTD, approximately 75-80% of baseline) after washout. In animals older than 20 days, ACPD induced a slow onset potentiation or minimal change. Both the acute depression and LTD were blocked by the mGluR antagonist alpha-methyl-4-carboxyphenyl glycine (MCPG). ACPD-induced LTD was blocked by the N-methyl-D-aspartate receptor (NMDAR) antagonists D(-)-2-amino-5 phosphopentanoic acid (AP5) and dizocilpine maleate (MK-801), and by ethanol. Glutamic pyruvic transaminase, an enzyme that selectively metabolizes endogenous extracellular glutamate, also blocked LTD suggesting that the requisite NMDA currents were tonically activated by extracellular rather than synaptically released glutamate. ACPD-induced LTD was blocked by staurosporine, indicating a requirement for serinethreonine kinase activation, and was unaffected by the L-type voltage sensitive calcium channel blocker nitrendipine and the A1 adenosine receptor antagonist 8-cyclopentyl-1,3-dimethylxanthine (CPT). Because mGluR-mediated LTD was observed only in immature CA1, mGluRs may play a role in hippocampal development, perhaps by contributing to synapse pruning in a temporally restricted fashion.

Velo-cardio-facial and partial DiGeorge phenotype in a child with interstitial deletion at 10p13--implications for cytogenetics and molecular biology.

We report on a female with a interstitial deletion of 10p13 and a phenotype similar to that seen with the 22q deletion syndromes (DiGeorge/velo-cardio-facial). She had a posterior cleft palate, perimembranous ventricular septal defect, dyscoordinate swallowing, T-cell subset abnormalities, small ears, maxillary and mandibular hypoplasia, broad nasal bridge, deficient alae nasi, contractures of fingers and developmental delay. This could indicate homology of some developmental genes at 22q and 10p so that patients with the velocardiofacial phenotype who do not prove to be deleted on 22q are candidates for a 10p deletion.

Genotype of the cystic fibrosis population of the Hunter Region of New South Wales.

OBJECTIVE: To determine the genotype of patients attending the cystic fibrosis clinic at John Hunter Hospital, Newcastle, Australia. METHODOLOGY: Seventy-five of the 76 patients attending the clinic over a 6 month period had blood collected for genetic analysis of 17 of the cystic fibrosis (CF) gene mutations. RESULTS: Sixty-one per cent of the patients were homozygous for the delta F508 mutation and all except one child had at least one delta F508 mutation. DISCUSSION: Nearly 80% of the CF genes were the delta F508 mutation. This prevalence suggests that the obligatory false negative rate of a newborn screening programme for CF based on a combination of immunoreactive trypsin and the delta F508 gene may be as low as 4-5%.

Cystic fibrosis carrier screening in two New South Wales country towns.

OBJECTIVE: To assess the feasibility of offering community testing for carrier status of delta F508, a gene mutation associated with cystic fibrosis (CF). DESIGN: Prospective pilot survey. SETTING: General practice, the two main high schools and workplaces in the country towns of Young and Harden (combined population, 14,940; with 7707 people aged 16-55 years) in New South Wales (NSW). PARTICIPANTS: Individuals aged 16 years and over. MAIN OUTCOME MEASURES: Number of delta F508 carriers, test uptake rates, mode of learning about the testing, motivation for testing, retention of knowledge about CF, and test results and emotional effects of knowledge about carrier status. RESULTS: We tested 610 people (8% of the population aged 16-55 years) and identified 47 carriers (20% of the expected number in the 7707 people aged 16-55 years). Testing in schools had the highest uptake. Retention of knowledge was high; all delta F508-positive individuals recalled their carrier status accurately. Anxiety was transient among carriers; over 90% of all respondents felt they had made the right decision to be tested. CONCLUSIONS: We recommend community testing for carrier detection and suggest targeting those with a family history of CF and girls aged over 16 in high schools.

AP5 blocks LTP in developing rat dentate gyrus and unmasks LTD.

The hippocampal dentate gyrus undergoes active neuronogenesis as well as growth and regression of neuronal elements and connections during the early postnatal period. In some brain regions, most notably in the visual system, both activity-dependent synaptic plasticity and NMDA receptor activation are candidate mechanisms by which neuronal architecture may be refined during brain maturation. To investigate whether similar mechanisms might obtain in developing dentate, we studied the effects of tetanic stimulation before and after NMDA receptor blockade in hippocampal slices from rats at 7-33 days. Field potentials were recorded in the suprapyramidal granule cell layer in response to stimulation of the medial perforant path. Robust long-term potentiation (LTP) of population spike amplitude (approximately 200% of baseline) was produced by a single tetanus (100 Hz, 2 s, 200 microseconds) at all ages studied. Application of 10 microM AP5 depressed population spike amplitude only in the younger slices (approximately 81% of baseline at 8-15 days; approximately 86% of baseline at 16-24 days), suggesting that the NMDA receptor-mediated component of normal synaptic transmission is higher in early development and decreases with maturation. AP5 prevented or significantly diminished LTP at all ages, establishing the NMDA dependence of LTP induction in the medial perforant path throughout development. AP5 also unmasked tetanus-induced homosynaptic long-term depression (62-75% of baseline) in the younger slices (8-24 days). Thus, prominent NMDA receptor-mediated activity and the capacity for bidirectional synaptic plasticity are characteristic of immature dentate. These processes may influence dentate morphogenesis by contributing to the growth, regression, and stabilization of neuronal elements.

Clinical and linkage study of a large family with simple ectopia lentis linked to FBN1.

Simple ectopia lentis (EL) was studied in a large family, by clinical examination and analysis of linkage to markers in the region of FBN1, the gene for fibrillin which causes Marfan syndrome on chromosome 15. No patient had clinical or echocardiographic evidence of Marfan syndrome, although there was a trend towards relatively longer measurements of height; lower segment; arm span; middle finger, hand, and foot length in the affected members of the family, compared with unaffected sibs of the same sex. Analysis of linkage to intragenic FBN1 markers was inconclusive because they were relatively uniformative. Construction of a multipoint background map from the CEPH reference families identified microsatellite markers linked closely to FBN1 which could demonstrate linkage of EL in this family to the FBN1 region. LINKMAP analysis detected a multipoint lod score of 5.68 at D15S119, a marker approximately 6 cM distal to FBN1, and a multipoint lod score of 5.04 at FBN1. The EL gene in this family is likely to be allelic to Marfan syndrome, and molecular characterization of the FBN1 mutation should now be possible.

Perforant path kindling alters dentate gyrus field potentials and paired pulse depression in an age-dependent manner.

The effects of rapid perforant path kindling on field potentials and paired pulse depression were studied in the dentate gyrus of rats at four developmental stages: 14-16 days, 20-22 days, 27-29 days and 40-60 days (adult). In rats 14-29 days kindling was associated with sustained potentiation of population spike amplitude and population EPSP slope; in adults a progressive decline was seen in both measures. Inhibitory circuitry as assessed by paired pulse depression was intact at all ages studied. Kindling produced no lasting changes in this measure at 14-22 days; in the older age groups a significant increase in paired pulse depression was seen. Thus immature animals differed from adults in that they manifested persistent facilitation of excitatory transmission as a result of kindling and failed to mount a compensatory inhibitory response. These results suggest that the balance between excitation and inhibition is more readily shifted toward excitation in immature animals in a manner that may contribute to their unique vulnerability to epileptogenesis.

Cascade testing for carrier status in cystic fibrosis in a large family.

The offer to determine carrier status for cystic fibrosis (CF) was made to the 230 descendants of a couple who were presumed to carry the delta F508 mutation. "Cascade testing" was employed, in which the mutation is followed from the oldest generation down. Compliance was over 75% and family members were relieved of the anxiety engendered by uncertainty. In one couple considering having a family, both partners were found to be carriers.

Long-term potentiation as synaptic dialogue.

We have proposed a testable model of the physiological and biochemical events underlying LTP that offers the following novel features. (1) The focus is not on a single mechanism or synaptic site, but rather on the integration and interaction of mechanisms occurring on both sides of the synapse, (2) beta PKC plays a critical presynaptic role in LTP, while gamma PKC functions postsynaptically. (3) These stages can be ordered in a time-delimited sequence of post- then presynaptic molecular events based on the period of effectiveness of inhibitor compounds. (4) The distinction is made between the time when kinase activation occurs and the time when the potentiated response requiring this kinase activation is observed.

Use of propofol (Diprivan) for awake craniotomies: technical note.

We describe the use of propofol (Diprivan) to provide patient comfort during the initial stages of awake craniotomies.

Postsynaptic then presynaptic protein kinase C activity may be necessary for long-term potentiation.

Protein kinase C inhibitor was injected intracellularly by iontophoresis into CA1 somata either before or after long-term potentiation in the hippocampal slice preparation. Two different protein kinase C inhibitors, polymyxin B (PMXB) or 1-(5-isoquinolinesulfonyl)-2-methylpiperazine (H-7), injected 10 min before long-term potentiation induction caused potentiated responses to return to baseline 15-35 min after induction without significantly affecting the initial magnitude of potentiation. There was no effect on long-term potentiation persistence when H-7 or PMXB was injected intracellularly 5 min after long-term potentiation induction. In contrast, focal extracellular micro-pressure ejection of protein kinase C inhibitor in the stratum radiatum, 15 or 30 min, but not 60 min after long-term potentiation induction caused decay of long-term potentiation to baseline. This is probably a presynaptic action since intracellular inhibitors injected postsynaptically were ineffective 5 min after long-term potentiation induction. Focal application to stratum pyramidale produced a weaker decay than to stratum radiatum suggesting a Schaffer collateral presynaptic terminal site of action. We propose that activation of postsynaptic protein kinase C activity is necessary for long-term potentiation persistence but this activity persists for less than 5 min after induction. Presynaptic protein kinase C activity is also necessary for persistence and is time-limited to less than 60 min. It is attractive to think that these two events are sequentially activated and employ different protein kinase C subtypes differentially localized to presynaptic or postsynaptic elements.