An unusual cause of abdominal pain: spontaneous bilateral adrenal hemorrhage.

Bilateral adrenal hemorrhage (BAH) is a rare condition that can lead to acute adrenal insufficiency and death if not recognized and treated promptly. We report the case of a 30-year-old male who presented to the emergency department with acute abdominal pain, nausea, and vomiting. On emergency room admission, the first abdominal CT revealed normal adrenal glands without enlargement, but with the development of hypotension and hypoglycemia, a second CT performed four days later showed enlargement due to hemorrhage in both adrenals. The diagnosis of BAH associated with acute adrenal insufficiency was retained. Prompt treatment with intravenous and oral corticosteroids resulted in successful conservative management. We describe the clinical, biological, radiological and etiological features of this condition based on a review of the literature.

Altered balance of glutamatergic/GABAergic synaptic input and associated changes in dendrite morphology after BDNF expression in BDNF-deficient hippocampal neurons.

Cultured neurons from bdnf-/- mice display reduced densities of synaptic terminals, although in vivo these deficits are small or absent. Here we aimed at clarifying the local responses to postsynaptic brain-derived neurotrophic factor (BDNF). To this end, solitary enhanced green fluorescent protein (EGFP)-labeled hippocampal neurons from bdnf-/- mice were compared with bdnf-/- neurons after transfection with BDNF, bdnf-/- neurons after transient exposure to exogenous BDNF, and bdnf+/+ neurons in wild-type cultures. Synapse development was evaluated on the basis of presynaptic immunofluorescence and whole-cell patch-clamp recording of miniature postsynaptic currents. It was found that neurons expressing BDNF::EGFP for at least 16 h attracted a larger number of synaptic terminals than BDNF-deficient control neurons. Transfected BDNF formed clusters in the vicinity of glutamatergic terminals and produced a stronger upregulation of synaptic terminal numbers than high levels of ambient BDNF. Glutamatergic and GABAergic synapses reacted differently to postsynaptic BDNF: glutamatergic input increased, whereas GABAergic input decreased. BDNF::EGFP-expressing neurons also differed from BDNF-deficient neurons in their dendrite morphology: they exhibited weaker dendrite elongation and stronger dendrite initiation. The upregulation of glutamatergic synaptic input and the BDNF-induced downregulation of GABAergic synaptic terminal numbers by postsynaptic BDNF depended on tyrosine receptor kinase B activity, as deduced from the blocking effects of K252a. The suppression of dendrite elongation was also prevented by block of tyrosine receptor kinase B but required, in addition, glutamate receptor activity. Dendritic length decreased with the number of glutamatergic contacts. These results illuminate the role of BDNF as a retrograde synaptic regulator of synapse development and the dependence of dendrite elongation on glutamatergic input.

The autoregulation of retinal ganglion cell number.

The development of the nervous system is dependent on a complex set of signals whose precise co-ordination ensures that the correct number of neurones are generated. This regulation is achieved through a variety of cues that influence both the generation and the maintenance of neurones during development. We show that in the chick embryo, stratified retinal ganglion cells (RGCs) are themselves responsible for providing the signals that control the number of RGCs that are generated, both by inhibiting the generation of new ganglion cells and by killing incoming migratory ganglion cells. Selective toxicological ablation of RGCs in the chick embryo resulted in the achronic generation of ganglion cells, which eventually led to the repopulation of the ganglion cell layer and a large decrease in the physiological cell death affecting postmitotic migratory neurones. Interestingly, the application of exogenous NGF reversed the effects of ganglion cell ablation on ganglion cell death. Because the only source of NGF in the retina is that produced by the stratified ganglion cells, we infer that these differentiated neurones regulate their own cell number by secreting NGF, a neurotrophin that has previously been shown to be responsible for the death of migrating ganglion cells.

Programmed cell death in the developing somites is promoted by nerve growth factor via its p75(NTR) receptor.

Neurotrophins control neuron number during development by promoting the generation and survival of neurons and by regulating programmed neuronal death. In the latter case, the cell death induced by nerve growth factor (NGF) in the developing chick retina is mediated by p75(NTR), the common neurotrophin receptor (J. M. Frade, A. Rodriguez-Tebar, and Y.-A. Barde, 1996, Nature 383, 166-168). Here we show that NGF also induces the programmed death of paraxial mesoderm cells in the developing somites. Both NGF and p75(NTR) are expressed in the somites of chick embryos at the time and the place of programmed cell death. Moreover, neutralizing the activity of endogenous NGF with a specific blocking antibody, or antagonizing NGF binding to p75(NTR) by the application of human NT-4/5, reduces the levels of apoptotic cell death in both the sclerotome and the dermamyotome by about 50 and 70%, respectively. Previous data have shown that Sonic hedgehog is necessary for the survival of differentiated somite cells. Consistent with this, Sonic hedgehog induces a decrease of NGF mRNA in somite explant cultures, thus showing the antagonistic effect of NGF and Sonic hedgehog with respect to somite cell survival. The regulation of programmed cell death by NGF/p75(NTR) in a mesoderm-derived tissue demonstrates the capacity of neurotrophins and their receptors to influence critical developmental processes both within and outside of the nervous system.

An abnormal response of retinoblastoma cells (Y-79) to neurotrophins.

PURPOSE: To clarify the expression of neurotrophins and their receptors in retinoblastoma (Rb) cells, to elucidate their potential role in the proliferation of neuroectodermal tumor cells, and to establish conditions for Rb cell differentiation. METHODS: The Rb-derived cell line Y-79 was grown in serum-free suspension or monolayer culture. Proliferating and differentiated cells were isolated and submitted to semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) analysis, immunostaining, and flow cytometry. The proliferation rate of the cells was estimated by 5-bromo-2'-deoxyuridine (BrdU) incorporation, and the effects of neurotrophins and laminin on BrdU-incorporation, process outgrowth, or immunostaining were determined. RESULTS: In contrast to previously studied normal retinal precursor cells, Y-79 cells not only express nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and p75, but also the corresponding high affinity receptors TrkA, TrkB, and TrkC. Proliferation was stimulated by exogenous and endogenous neurotrophin receptor ligands. Inhibition of protein kinase phosphorylation with K252a blocked proliferation and promoted differentiation. The effect of K252a on differentiation was enhanced by the addition of soluble laminin. After 9 days of combined treatment, the fraction of differentiated cells amounted to 30%, differentiation being characterized by improved attachment, neurite outgrowth, expression of NF-68, and a loss of glial fibrillary acidic protein (GFAP) and parvalbumin immunoreactivity. These changes were accompanied by a downregulation of TrkB and TrkC, but not TrkA or p75. Differentiated cells were isolated and further grown in the absence of K252a. However, despite the high level of TrkA expression in differentiated cells, the addition of NGF had no effect on their survival. CONCLUSIONS: A mitogenic action of neurotrophins could contribute to retinal tumor growth.

Neurotrophins and other growth factors in the generation of retinal neurons.

The generation of neurons in the vertebrate retina, as in other areas of the developing nervous system, largely depends on extracellular signals. Of the known signaling molecules, neurotrophins play decisive, defined, and distinct roles. The three neurotrophins identified in the chick, namely, neurotrophin-3 (NT-3), brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF), are expressed in either the pigment epithelium (NT-3 and BDNF) or in the neural retina (NGF) at the onset of neuron birth. In addition, trkC and trkB, receptors for NT-3 and BDNF, respectively, together with p75, the low-affinity neurotrophin receptor, are expressed in the retina at the same developmental period. The role of these three neurotrophins in the differentiation of neurons in the chick retina has been elucidated by a combination of in vitro and in vivo experiments. Thus, NT-3 promotes the conversion of neuroepithelial cells into neurons, whereas BDNF and NGF control the programmed cell death (apoptosis) that affects early postmitotic neuroblasts. BDNF, acting via its trkB receptor, is a survival factor for these cells, whereas NGF, binding to p75 receptor, acts as a killing factor, thereby controlling the provisional number of newly generated neurons.

Vitronectin is expressed in the ventral region of the neural tube and promotes the differentiation of motor neurons.

The extracellular matrix protein vitronectin and its mRNA are present in the embryonic chick notochord, floor plate and in the ventral neural tube at the time position of motor neuron generation. When added to cultures of neural tube explants of developmental stage 9, vitronectin promotes the generation of motor neurons in the absence of either notochord or exogenously added Sonic hedgehog. Conversely, the neutralisation of endogenous vitronectin with antibodies inhibits over 90% motor neuron differentiation in co-cultured neural tube/notochord explants, neural tube explants cultured in the presence of Sonic hedgehog, and in committed (stage 13) neural tube explants. Furthermore, treatment of embryos with anti-vitronectin antibodies results in a substantial and specific reduction in the number of motor neurons generated in vivo. These results demonstrate that vitronectin stimulates the differentiation of motor neurons in vitro and in vivo. Since the treatment of stage 9 neural tube explants with Sonic hedgehog resulted in induction of vitronectin mRNA expression before the expression of floor plate markers, we conclude that vitronectin may act either as a downstream effector in the signalling cascade induced by Sonic hedgehog, or as a synergistic factor that increases Shh-induced motor neuron differentiation.

Control of early cell death by BDNF in the chick retina.

The developing chick retina undergoes at least two discrete periods of programmed cell death. The earlier period coincides with the main onset of neuron birth and migration (embryonic day 5-7), whereas the latter one corresponds to the well-documented process of retinal ganglion cell death following tectal innervation (embryonic day 10-14; Rager, G. H. (1980) Adv. Anat. Embryol. Cell Biol. 63, 1-92). In the early period, apoptosis is induced by nerve growth factor (NGF) acting via its p75 receptor (Frade, J. M., Rodríguez-Tébar, A. and Barde, Y.-A. (1996) Nature 383, 166-168). Here, we show that the application of brain-derived neurotrophic factor (BDNF) to chick embryos in ovo prevented retinal cell death in the early period, whereas exogenously applied NGF and neurotrophin-3 had no such effect. The addition of BDNF to embryos resulted in about 70% increase in the number of retinal ganglion cells in both E6 and E9 retinas relative to controls. BDNF is first expressed in both the pigment epithelium and neural retina of embryonic day 4 embryos, and at the same stage of development, its TrkB receptor is expressed in the neural retina. Our data indicate that early cell death is an important process in the neurogenesis of retinal ganglion cells and is regulated by locally produced BDNF.

Induction of cell death by endogenous nerve growth factor through its p75 receptor.

During development, neuronal survival is regulated by the limited availability of neurotrophins, which are proteins of the nerve growth factor (NGF) family. Activation of specific trk tyrosine kinase receptors by the neurotrophins blocks programmed cell death. The trkA-specific ligand NGF has also been shown to activate the non-tyrosine kinase receptor p75, a member of the tumour necrosis factor (TNF) receptor and Fas (APO-1/CD95) family. Here we report that, early in development, endogenous NGF causes the death of retinal neurons that express p75 but not trkA. These results indicate that, as with cells of the immune system, the death of neurons in the central nervous system can also be induced by ligands, and that the effect of NGF on cell fate depends on the type of receptor expressed by developing neurons.

Insulin-like growth factor-I stimulates neurogenesis in chick retina by regulating expression of the alpha 6 integrin subunit.

Insulin-like growth factor I (IGF-I) strongly stimulates the generation of differentiated neurons in cultures of neuroepithelial cells of the embryonic chick neural retina in the presence of a laminin-1 tissue culture substrate. Treatment of cultured neuroepithelial cells with IGF-I rapidly up-regulated the mRNA coding for the alpha 6 integrin subunit whereas specific reduction of alpha 6 subunit levels by treatment with an alpha 6 integrin antisense oligonucleotide resulted in reduced neuronal differentiation in vitro. Although IGF-I immunoreactivity is seen throughout the neural retina, expression of IGF-I mRNA is confined to the pigment epithelium during the period of neurogenesis in vivo. Neutralization of the endogenous IGF-I with a blocking antibody down-regulated levels of alpha 6 integrin mRNA and reduced the production of differentiated retinal neurons in vivo. These data indicate a role for IGF-I in the generation of retinal neurons mediated by the interaction of laminin with its alpha 6 integrin subunit-containing receptor.

Neurotrophin-3 antibodies disrupt the normal development of the chick retina.

When chick embryos are treated with a monoclonal antibody specifically blocking the activity of neurotrophin-3 (NT-3), the development of the retina is profoundly affected. Fewer axons are found in the optic nerve, and the retina shows abnormalities in all layers. Early during retinogenesis, the proportion of dividing cells is higher in NT-3-deprived embryos compared with age-matched controls and that of differentiated neurons is smaller. The NT-3 receptor trkC is expressed early by a majority of retinal cells, and NT-3 is present in the retina at the earliest stage studied. Initially, it is located mainly in the pigmented epithelium, with a shift toward the neural retina as development proceeds. Thus, NT-3 seems to be an essential intrinsic signal acting early in development to promote the differentiation and survival of many retinal neurons.

Laminin-1 selectively stimulates neuron generation from cultured retinal neuroepithelial cells.

Signals derived from the extracellular matrix (ECM) largely influence neuron differentiation and development. However, the action of specific ECM components in these processes is poorly understood. This had led us to investigate the role of different laminins in the survival, proliferation, and neuron differentiation of cultured neuroepithelial cells from the developing chicken retina. Dissociated retinal neuroepithelial cells from 5-day-old chicken embryos, cultured on laminin-1, survived, proliferated, and differentiated into neurons, as assessed by both [3H]-thymidine uptake and acquisition of neuronal markers. Nevertheless, these effects took place only in the presence of cell-cell contact. In contrast, RN22 Schwannoma-derived laminin (devoid of alpha 1 chain) and merosin (bearing an alpha 2 chain), which also promoted proliferation when cell-cell contact occurred, led to reduced cell survival and failed to foster neuron differentiation. Furthermore, the laminin-1 P1 fragment (containing the rod-like portions of the short arms of the molecule) also failed to support neuron generation. In contrast, the laminin-1 E8 fragment (containing the long arm of the molecule) supported such a process to the same extent as the whole laminin-1 molecule, although a similar activity cannot be ruled out in other globular domains of the short arms. However, these results stress the importance of the carboxy-terminal part of alpha 1 chain in neuronal development. A cDNA fragment of a chicken alpha 1 chain was cloned and semiquantitative PCR amplification revealed that its mRNA is expressed in retinal neuroepithelial cells at the time of neuron differentiation. Our data strongly suggest that an alpha 1-like chain-containing laminin is needed for differentiation of neuron precursor cells.

Developmentally regulated vitronectin influences cell differentiation, neuron survival and process outgrowth in the developing chicken retina.

Vitronectin is a multifunctional protein involved in the regulation of the immune system and blood coagulation. Here we report that the expression of vitronectin is developmentally regulated in the embryonic retina of the chicken. Vitronectin immunoreactivity was detected in chicken retinas from embryonic day 5, encompassing the cell bodies of most neuroepithelial cells. At this developmental stage, alpha v integrin subunit expression was distributed across the retina, suggesting a ligand/receptor interaction. Expression of both vitronectin and alpha v increased during development and reached a maximum at embryonic day 9, a time when most differentiated neurons grow processes and initiate synapse formation. At this age, vitronectin immunoreactivity appeared to be located predominantly in the fiber and inner plexiform layers of the differentiated stratified retina. alpha v immunoreactivity and mRNA expression was seen associated with all layers formed by differentiated neurons, being most abundant in the ganglion cell and inner nuclear layers. Later in development, levels of vitronectin decreased and immunoreactivity appeared exclusively associated with the fiber layer. In accordance with this pattern of expression, vitronectin as a substrate sustained both proliferation and differentiation of cultured neuroepithelial cells from embryonic day 5 retinas. At later stages, vitronectin supported survival and neurite outgrowth of most differentiated neurons. Our data suggest that vitronectin is a ubiquitous component of the retinal extracellular matrix, serving as a substrate for developmental processes such as proliferation, differentiation of neuron progenitors, cell survival, and axonal and dendritic growth of differentiated neurons.

Retinoic acid-mediated increase in TrkA expression is sufficient to elicit NGF-dependent survival of sympathetic neurons.

Sympathetic neurons depend on the classical neurotrophin NGF for survival by the time they innervate their targets, but the mechanisms controlling the onset of NGF responsiveness in developing neuroblasts have not been defined. Immature chick sympathetic neurons are unresponsive to NGF, but express low mRNA levels of the high-affinity NGF receptor trkA. Treatment with retinoic acid (RA) leads to increased levels of both trkA mRNA and protein, a response mediated through retinoic acid receptor alpha (RAR alpha). Ectopic expression of trkA in these cells results in the ability to survive with NGF, suggesting that RA-induced trkA expression is sufficient to elicit NGF-dependent survival. Our data establish a mechanism controlling NGF responsiveness and implicate a function for RA at defined late stages of neuron development.

Neurotrophin receptors.

The neurotrophins are members of a family of four related proteins that allow the survival and differentiation of specific sub-sets of embryonic vertebrate neurons. On neurons, two types of neurotrophin receptors can be distinguished on the basis of their dissociation constants: low affinity receptors (Kd 10(-9) M) and high affinity receptors (Kd 10(-11) M). Several genes coding for neurotrophin receptors have been cloned and the expression in fibroblasts of the recombinant membrane proteins allows comparisons to be made between the binding properties of the neurotrophins on such cell lines and neurons. As a result, it appears that much of the low affinity binding sites detected on neurons for all neurotrophins can be attributed to a single molecular entity, the low affinity neurotrophin (or NGF) receptor. This receptor binds all known neurotrophins with similar affinity but different binding kinetics. Its role in neurotrophic signal transduction remains to be established. In addition to this receptor, three members of the trk-subfamily of tyrosine kinase receptors have recently been identified as receptors for the neurotrophins. These receptors (whose intrinsic tyrosine kinase activity can be stimulated by the various neurotrophins) bind the neurotrophins with higher affinity and higher ligand specificity when compared with the low affinity receptor. However, the observation has been made that some of the recombinant trk-receptors on cell lines bind more than one neurotrophin (though typically with lower affinity than their own ligands).(ABSTRACT TRUNCATED AT 250 WORDS)

Role of neurotrophins in the control of neural development: neurotrophin-3 promotes both neuron differentiation and survival of cultured chick retinal cells.

The effects of neurotrophins brain-derived neurotrophic factor and neurotrophin-3 on cultured dissociated cells from chick retina were studied at several embryonic ages from day 4 to day 13. Precursor cells from days 4-7 retinas proliferated in vitro and, after 20 h in culture, a proportion of them underwent spontaneous differentiation, as judged by both [3H]thymidine uptake and acquisition of neuronal morphology and neuron-specific markers. Brain-derived neurotrophic factor did not affect neuronal differentiation, although this factor supports survival of differentiated retinal ganglion cells [Rodríguez-Tébar et al. (1989) Devl Biol. 136, 296-303]. However, in cultures from young undifferentiated retinas, neurotrophin-3 produced up to a 2.5-fold increase in the number of [3H]thymidine-positive neurons, i.e. those that in vitro replicated their DNA. Moreover, in older retinas, neurotrophin-3, like brain-derived neurotrophic factor, supported the survival of differentiated retinal ganglion cells over a short developmental period. This effect was negligible at embryonic day 5, maximal at day 9, decreased at day 11 and was absent at embryonic day 13. Neurotrophin-3 also supported the survival of a population of amacrine neurons. This effect was modest at embryonic day 9, and increased at days 11 and 13. Our results show that, whereas the action of brain-derived neurotrophic factor is restricted to differentiated neurons, neurotrophin-3 exerts two distinct successive actions on retinal cells in vitro: first, this factor promotes either differentiation of neuroepithelial cells or maturation of recently differentiated neurons, and later in development, this factor supports the survival of differentiated retinal ganglion and amacrine cells but only during a discrete post-differentiation period.

Specific high-affinity receptors for neurotrophin-3 on sympathetic neurons.

When used at concentrations allowing interactions only with its high-affinity receptors, neurotrophin-3 (NT-3) promotes the survival of sensory neurons isolated from embryonic day 8 (E8) chicks, but not the survival of E11 sympathetic neurons. These sympathetic neurons (which can be rescued by the addition of NGF) display high-affinity receptors for NT-3 (Kd of 1.6 x 10(-11) M) that cannot be distinguished from the high-affinity NT-3 receptors on sensory neurons using equilibrium binding or kinetic criteria. This represents the first example of embryonic neurons that cannot be rescued by the in vitro addition of a neurotrophin in spite of the presence of corresponding neurotrophin high-affinity receptors. At elevated concentrations, beyond the saturation of its high-affinity receptors, NT-3 supports the survival of some E11 sympathetic neurons, an effect that might be mediated by the high-affinity NGF receptor. Using E7 sympathetic neurons, about 40% of the cells initially plated can be rescued in vitro by the addition of low concentrations of NT-3 (but not of NGF) and produce profuse neurites. This indicates that NT-3 may play a role in the early development of some sympathetic neurons.

Neurotrophin-3 receptors in the developing chicken retina.

Neurotrophin 3 (NT-3) had specific high-affinity receptors (HNT-3R) in the developing chick retina at all ages between embryonic day (E) 4 and E14. The affinity of HNT-3R for 125I-NT-3 did not change with the developmental state. A dissociation constant (kd) of 13 pM was obtained. However, the amount of HNT-3R appeared to be developmentally regulated; the number of receptors/cell increased from E4 up to E6-7 (coinciding with the main onset of neuronal differentiation), then decreased until E9 and increased again by E12, when all retinal cells were differentiated. Kinetic and cross-linking experiments showed that HNT-3R from two prototypical developmental ages, E7 and E14, were different. E7 and E14 HNT-3R could be distinguished from each other on the basis of different inhibition patterns of 125I-NT-3 binding in the presence of nerve growth factor or brain-derived neurotrophic factor. Chemical cross-linking of increasing concentrations of 125I-NT-3 to its receptors showed (a) one 100-kDa band corresponding to neurotrophin low-affinity receptors in both E7 and E14 cells; (b) one 130-kDa band also present in both E7 and E14 cells. Densitometric measurements showed that this 130-kDa band behaved as HNT-3R in E14 cells (kd approximately 10 pM) but not in E7 cells (kd > or = 0.2 nM). Furthermore, the 130-kDa band in both E7 and E14 retinal cells displayed a trk-like immunoreactivity. Our data show that, in neurons, one particular neurotrophin may induce different actions mediated through distinct and specific receptors.

Binding of neurotrophin-3 to its neuronal receptors and interactions with nerve growth factor and brain-derived neurotrophic factor.

Neurotrophin-3 (NT-3) has low-affinity (Kd = 8 x 10(-10) M), as well as high-affinity receptors (Kd = 1.8 x 10(-11) M) on embryonic chick sensory neurons, the latter in surprisingly high numbers. Like the structurally related proteins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), NT-3 also binds to the low-affinity NGF receptor, a molecule that we suggest to designate low-affinity neurotrophin receptor (LANR). NT-3 dissociates from the LANR much more rapidly than BDNF, and more slowly than NGF. The binding of labelled NT-3 to the LANR can be reduced by half using a concentration of BDNF corresponding to the Kd of BDNF to the LANR. In contrast, the binding of NT-3 to its high-affinity neuronal receptors can only be prevented by BDNF or NGF when used at concentrations several thousand-fold higher than those corresponding to their Kd to their high-affinity neuronal receptors. Thus, specific high-affinity NT-3 receptors exist on sensory neurons that can readily discriminate between three structurally related ligands. These findings, including the remarkable property of the LANR to bind three related ligands with similar affinity, but different rate constants, are discussed.

Retinoic acid induces NGF-dependent survival response and high-affinity NGF receptors in immature chick sympathetic neurons.

An important step in the development of peripheral sensory and sympathetic neurons is the onset of the survival response and dependence on the presence of nerve growth factor (NGF) or other neurotrophic factors. We have recently observed that immature sympathetic neurons from 7-day-old chick embryos are unable to become NGF-responsive in vitro and we have now used these cells to identify molecules that induce NGF-dependent neuronal survival. We found that retinoic acid (RA) induces the ability of these cells to survive in the presence of NGF. At RA concentrations of 10(-9)-10(-8)M virtually all neurons survived in the presence of NGF. RA was found to also induce the biologically active, high-affinity NGF receptor: high-affinity receptors were undetectable on dissociated E7 sympathetic neurons and were observed in vitro only in RA-treated neurons. These findings suggest that the induction of high-affinity NGF receptors may be sufficient to activate the survival response in sympathetic neurons and imply an important role for RA during neuron differentiation in the peripheral nervous system.