Region-specific expression of vesicular glutamate and GABA transporters under various ischaemic conditions in mouse forebrain and retina.

There is accumulating evidence that glutamate and GABA release are key mechanisms of ischaemic events in the CNS. However, data on the expression of involved transporters for these mediators are inconsistent, potentially impeding further neuroprotective approaches. Here, we applied immunofluorescence labelling to characterise the expression pattern of vesicular glutamate (VGLUT) and GABA transporters (VGAT) after acute focal cerebral ischaemia and in two models of retinal ischaemia. Mice were subjected to filament-based focal cerebral ischaemia predominantly involving the middle cerebral artery territory, also leading to retinal ischaemia due to central retinal artery occlusion (CRAO). Alternatively, retinal ischaemia was induced by a transient increase of the intraocular pressure (HIOP). One day after ischaemia onset, diminished immunolabelling of neuronal nuclei and microtubule-associated protein 2-positive structures were found in the ipsilateral neocortex, subcortex and the retina, indicating neuronal degeneration. VGLUT1 expression did not change significantly in ischaemic tissues whereas VGLUT2 was down-regulated in specific areas of the brain. VGLUT3 expression was only slightly down-regulated in the ischaemia-affected neocortex, and was found to form clusters on fibrils of unknown origin in the ischaemic lateral hypothalamus. In contrast, retinae subjected to CRAO or HIOP displayed a rapid loss of VGLUT3-immunoreactivity. The expression of VGAT appears resistant to ischaemia as there was no significant alteration in all the regions analysed. In summary, these data indicate a region- and subtype-specific change of VGLUT expression in the ischaemia-affected CNS, whose consideration might help to generate specific neuroprotective strategies.

Activation of voltage-gated Na⁺ and Ca²âº channels is required for glutamate release from retinal glial cells implicated in cell volume regulation.

Gliotransmitters such as glutamate and ATP play an essential role in the prevention of the osmotic swelling of retinal glial (Müller) cells. It has been shown that vascular endothelial growth factor (VEGF) induces a Ca²âº-dependent release of glutamate from the cells [Wurm et al. (2008), J Neurochem 104:386-399]. In the present study, we investigated with cell swelling experiments on freshly isolated retinal glial cells of the rat whether activation of voltage-gated Na⁺ (Na(v)) and Ca²âº channels (VGCCs) is implicated in mediating the VEGF-induced release of glutamate. We found that the inhibitory effect of VEGF on the osmotic swelling of retinal glial cells, used as an indicator of glutamate release, is prevented in the presence of selective blockers of T-type VGCCs (kurtoxin, mibefradil, Ni²âº) and Na(v) channels (TTX, saxitoxin, phenytoin). In contrast, the swelling-inhibitory effect of glutamate, that is mediated by a downstream release of ATP, remained unaffected in the presence of the blockers. The cells displayed immunolabeling for VGLUT3, Ca(v)1.2, Ca(v)3.1, and Na(v)1.6. In addition to VEGF, various other receptor agonists including neuropeptide Y, progesterone, erythropoietin, and endothelin-1 evoked a VGCC- and Na(v) channel-dependent release of glutamate. It is concluded that activation of T-type VGCCs and Na(v) channels is implicated in mediating the ligand-induced release of glutamate from retinal glial cells of the rat. The involvement of VLGUTs might suggest that glutamate is released by vesicular exocytosis.

Erythropoietin inhibits osmotic swelling of retinal glial cells by Janus kinase- and extracellular signal-regulated kinases1/2-mediated release of vascular endothelial growth factor.

The volume homeostasis of retinal glial cells is mediated by an autocrine purinergic mechanism of ion channel opening which is activated in response to a decrease in the extracellular osmolarity. Here, we show that erythropoietin (EPO) prevents the osmotic swelling of glial somata in retinal slices and of isolated glial cells from control and diabetic rats, with a half-maximal effect at approximately 0.01 nM. The downstream signaling evoked by EPO includes a release of vascular endothelial growth factor from the cells which was blocked by Janus kinase and extracellular signal-regulated kinases (ERK)1/2 inhibitors. Transactivation of kinase insert domain-containing receptor/fms-like tyrosine kinase 1 (KDR/flk-1) evokes a calcium-dependent, exocytotic release of glutamate, followed by activation of group I/II metabotropic glutamate receptors which results in calcium-independent release of ATP and adenosine from the cells. The final step in this cascade is the activation of adenosine A(1) receptors which results in protein kinase A- and phosphoinositide 3-kinase-mediated opening of potassium and chloride channels. EPO receptor protein was immunohistochemically localized to the inner retina and photoreceptor inner segments. In isolated glial cells, EPO receptor protein is selectively localized to fibers which traverse the inner nuclear layer in situ. Inhibition of glial swelling might contribute to the neuroprotective action of EPO in the retina under pathological conditions.

[Laparoscopic Collis-Nissen operation for shortened esophagus]. / Laparoskopische Collis-Nissen-Operation bei Brachyösophagus.

Esophageal shortening as a complication of advanced gastroesophageal reflux disease is seen in 2-4 % of patients with GERD. The Collis gastroplasty with Nissen fundoplication creates an intraabdominal neoesophagus with a fundic wrap and is an effective procedure in the difficult intraoperative situation of esophageal shortening. After own experience with the open Collis gastroplasty and after reports on successful laparoscopic Collis-Nissen operation we performed 2 laparoscopic Collis-Nissen operations. The technique we used is a new modification of the laparoscopic technique described by Johnson and Hunter in 1998. The postoperative course was uncomplicated in both patients. The follow up included endoscopy and barium meal. The patients showed relief from reflux symptoms except a mild dysphagia. There was no persisting esophagitis. The laparoscopic Collis-Nissen gastroplasty is an effective minimal-invasive procedure in patients with shortened esophagus diagnosed intraoperatively.