Outcomes following staged bilateral pallidotomy in advanced Parkinson's disease.

The authors assessed clinical outcome for up to one year after staged bilateral pallidotomy in 14 patients with advanced PD. One year after surgery, dyskinesias were virtually abolished and there were significant reductions in "off" time (67%) and activities of daily living "off" scores (24%), as well as nonsignificant reduction in "off" motor score (39%); "on" scores were unchanged. One patient developed a visual field deficit; two had transient confusion. Staged bilateral pallidotomy improves motor function in selected patients with advanced PD.

Partial deficiency of manganese superoxide dismutase exacerbates a transgenic mouse model of amyotrophic lateral sclerosis.

The pathogenesis of neuronal cell death as a consequence of mutations in copper/zinc superoxide dismutase (SOD1) associated with familial amyotrophic lateral sclerosis may involve oxidative damage and mitochondrial dysfunction. We examined whether crossing transgenic mice with the G93A SOD1 mutation with transgenic mice with a partial depletion of manganese superoxide dismutase (SOD2) would affect the disease phenotype. Compared with G93A mice alone, the mice with partial deficiency of SOD2 and the G93A SOD1 mutation showed a significant decrease in survival and an exacerbation of motor deficits detected by rotorod testing. There was a significant exacerbation of loss of motor neurons and substantia nigra dopaminergic neurons in the G93A mice with a partial deficiency of SOD2 compared with G93A mice at 110 days. Microvesiculation of large motor neurons was more prominent in the G93A mice with a partial deficiency of SOD2 compared with G93A mice at 90 days. These findings provide further evidence that both oxidative damage and mitochondrial dysfunction may play a role in the pathogenesis of motor neuron death associated with mutations in SOD1.

Stereotactic pallidotomy performed without using microelectrode guidance in patients with Parkinson's disease: surgical technique and 2-year results.

OBJECT: Pallidotomy for the treatment of medically refractory Parkinson's disease (PD) has enjoyed renewed popularity. However, the optimal surgical technique, lesion location, and long-term effectiveness of pallidotomy remain subjects of debate. In this article the authors describe their surgical technique for performing pallidotomy without using microelectrode guidance, and the clinical and radiological results of this procedure. METHODS: Patients were evaluated preoperatively by using a battery of validated clinical rating scales and magnetic resonance (MR) imaging of the brain. Individuals with severe treatment-refractory idiopathic PD who were believed to be good candidates for surgery underwent computerized tomography scanning- and MR imaging-guided stereotactic pallidotomy. Intraoperative macrostimulation was used to optimize lesion placement and to avoid injury to nearby structures. Lesion location and size were calculated from MR imaging sequences of the brain obtained within the first 24 hours after surgery and again 3 months later. Clinical examinations were conducted at 1.5, 3, 6, 12, and 24 months after surgery. Seventy-five patients (mean age 61 years, range 38-79 years) underwent unilateral pallidotomy. Significant improvements were observed in the "off' period scores for the activities of daily living portion of the Unified Parkinson's Disease Rating Scale (UPDRS), the UPDRS motor scores, total "on" time, levodopa-induced dyskinesias, and contralateral tremor. These improvements were maintained 24 months postoperatively. The mean lesion volume measured on the immediate postoperative MR image was 73 +/- 5.4 mm3. Radiological analysis suggests that initial lesion volume does not predict outcome. The only permanent major complication was a single visual field defect. CONCLUSIONS: Pallidotomy performed without using microelectrode guidance is a safe and effective treatment for selected patients with medically refractory PD.

Age-dependent increases in oxidative damage to DNA, lipids, and proteins in human skeletal muscle.

A role for oxidative damage in normal aging is supported by studies in experimental animals, but there is limited evidence in man. We examined markers of oxidative damage to DNA, lipids, and proteins in 66 muscle biopsy specimens from humans aged 25 to 93 years. There were age-dependent increases in 8-hydroxy-2-deoxyguanosine (OH8dG), a marker of oxidative damage to DNA, in malondialdehyde (MDA), a marker of lipid peroxidation, and to a lesser extent in protein carbonyl groups, a marker of protein oxidation. The increases in OH8dG were significantly correlated with increases in MDA. These results provide evidence for a role of oxidative damage in human aging which may contribute to age-dependent losses of muscle strength and stamina.

The importance of accurate lesion placement in posteroventral pallidotomy. Report of two cases.

Pallidotomy has become a widely used treatment for medically refractory Parkinson's disease. However, the optimal lesion size and location within the pallidum have not yet been determined, and the role of repeated pallidotomy remains undefined. The authors present two patients who had unsatisfactory results after their first unilateral pallidotomy but attained dramatic and long-lasting improvement with repeated surgery. The results obtained in these cases indicate that patients who have a good clinical outcome initially but relapse rapidly after surgery should be considered for repeated pallidotomy if the initial lesion was not placed in the optimal location.

Increased 3-nitrotyrosine and oxidative damage in mice with a human copper/zinc superoxide dismutase mutation.

Mutations in copper/zinc superoxide dismutase (SOD1) cause a subset of cases of autosomal dominant familial amyotrophic lateral sclerosis (FALS). Transgenic mice that express these point mutations develop progressive paralysis and motor neuron loss thought to be caused by a gain-of-function of the enzyme. The gain-of-function may be an enhanced ability of the mutant SOD1 to generate .OH radicals or to facilitate peroxynitrite-mediated nitration of proteins. We found significant increases in concentrations of 3-nitrotyrosine, a marker of peroxynitrite-mediated nitration, in upper and lower spinal cord and in cerebral cortex of transgenic mice with the FALS-associated G93A mutation. Malondialdehyde, a marker of lipid peroxidation, was increased in cerebral cortex. 3-Nitrotyrosine-, heme oxygenase-1-, and malondialdehyde-modified protein immunoreactivities were increased throughout SOD1 transgenic mice spinal cord but particularly within motor neurons. These results suggest that the gain-of-function of at least one mutant SOD1 associated with FALS involves increased protein nitration and oxidative damage, which may play a role in neuronal degeneration.

Mutations in mitochondrial cytochrome c oxidase genes segregate with late-onset Alzheimer disease.

Mounting evidence suggests that defects in energy metabolism contribute to the pathogenesis of Alzheimer disease (AD). Cytochrome c oxidase (CO) is kinetically abnormal, and its activity is decreased in brain and peripheral tissue in late-onset AD. CO is encoded by both the mitochondrial and the nuclear genomes. Its catalytic centers, however, are encoded exclusively by two mitochondrial genes, CO1 and CO2 (encoding CO subunits I and II, respectively). We searched these genes, as well as other mitochondrial genes, for mutations that might alter CO activity and cosegregate with AD. In the present study, specific missense mutations in the mitochondrial CO1 and CO2 genes but not the CO3 gene were found to segregate at a higher frequency with AD compared with other neurodegenerative or metabolic diseases. These mutations appear together in the same mitochondrial DNA molecule and define a unique mutant mitochondrial genome. Asymptomatic offspring of AD mothers had higher levels of these mutations than offspring of AD fathers, suggesting that these mutations can be maternally inherited. Cell lines expressing these mutant mitochondrial DNA molecules exhibited a specific decrease in CO activity and increased production of reactive oxygen species. We suggest that specific point mutations in the CO1 and CO2 genes cause the CO defect in AD. A CO defect may represent a primary etiologic event, directly participating in a cascade of events that results in AD.

Evidence of increased oxidative damage in both sporadic and familial amyotrophic lateral sclerosis.

Some cases of autosomal dominant familial amyotrophic lateral sclerosis (FALS) are associated with mutations in the gene encoding Cu/Zn superoxide dismutase (SOD1), suggesting that oxidative damage may play a role in ALS pathogenesis. To further investigate the biochemical features of FALS and sporadic ALS (SALS), we examined markers of oxidative damage to protein, lipids, and DNA in motor cortex (Brodmann area 4), parietal cortex (Brodmann area 40), and cerebellum from control subjects, FALS patients with and without known SOD mutations, SALS patients, and disease controls (Pick's disease, progressive supranuclear palsy, diffuse Lewy body disease). Protein carbonyl and nuclear DNA 8-hydroxy-2'-deoxyguanosine (OH8dG) levels were increased in SALS motor cortex but not in FALS patients. Malondialdehyde levels showed no significant changes. Immunohistochemical studies showed increased neuronal staining for hemeoxygenase-1, malondialdehyde-modified protein, and OH8dG in both SALS and FALS spinal cord. These studies therefore provide further evidence that oxidative damage may play a role in the pathogenesis of neuronal degeneration in both SALS and FALS.

Manganese injection into the rat striatum produces excitotoxic lesions by impairing energy metabolism.

There is compelling evidence that excessive exposure to manganese (Mn) produces neurotoxicity, especially in the basal ganglia, resulting in a dystonic Parkinsonian disorder. Several experimental or clinical observations suggest that Mn neurotoxicity could involve impairment of energy metabolism. We examined the neurotoxic effects of Mn following local intrastriatal injection. Three hours after the injection of 2 mumol of MnCl2 into rat striatum, ATP levels were reduced to 51% of the control side and lactate level were increased by 97%, indicating an impairment of oxidative metabolism. Neurochemical analysis of the striata 1 week after Mn injection showed changes consistent with a N-methyl-D-aspartate (NMDA) excitotoxic lesion. Dopamine, gamma-aminobutyric acid, and substance P concentrations showed dose-dependent significant decreases, but concentrations of somatostatin-like immunoreactivity and neuropeptide Y-like immunoreactivity were unchanged. The lesions were blocked by prior removal of the cortico-striatal glutamatergic input or by treatment with the noncompetitive NMDA antagonist MK-801. These findings indicate that Mn neurotoxicity involves a NMDA receptor-mediated process similar to that we have previously found with two characterized mitochondrial toxins, aminooxyacetic acid, and 1-methyl-4-phenylpyridinium. Our results show that Mn may produce neuronal degeneration by an indirect excitotoxic process secondary to its ability to impair oxidative energy metabolism.

Enhancement of Ca2+-sensitive myosin ATPase activity by cadmium.

The effects of Cd2+ on Ca2+-sensitive myosin ATPase activity were examined. In the absence of Ca2+, the Ca2+-dependent myosin ATPase activity was enhanced by Cd2+ to the same extent as with Ca2+ at concentrations ranging from 10(-6) to 10(-3) M. At 10(-2) M, however, no activation was observed. Zn2+, Co2+, and Sr2+ also activated the myosin ATPase. Sr2+ and Co2+ were less effective. Hg2+, Cr3+, and Cu2+ were essentially inactive. In the presence of below 10(-3) M Ca2+, the increase in the enzyme activity observed on the addition of Cd2+ was in addition to that caused by Ca2+ alone. The ability of metal ions to activate myosin ATPase was compared with that to activate calmodulin-dependent cAMP phosphodiesterase. The activating effects of the metal ions tested were in the order of Ca2+ greater than Cd2+ greater than Zn2+ greater than Co2+ greater than Sr2+ for Ca2+-sensitive myosin ATPase and Ca2+ greater than Cd2+ greater than Sr2+ greater than Zn2+ greater than Hg2+ greater than Co2+ for cAMP phosphodiesterase. Cd2+ activated both enzyme activities most efficiently among the metal ions tested except Ca2+. These results indicate that Cd2+ is able to substitute for Ca2+ in the case of Ca2+ dependent enzymes, regardless of whether or not calmodulin participates in the activating process.

Effects of sodium N-methyl-N-dithiocarboxyglucamine on cadmium distribution and excretion.

Sodium N-methyl-N-dithiocarboxyglucamine (MDCG) was evaluated for its efficacy in mobilizing and promoting excretion of metallothionein-bound 109Cd using mice which had received 0.03 mg of CdCl2 . 2 . 5H2O along with 1.0 muCi of 109CdCl2 three weeks earlier. The MDCG-induced change in the fecal excretion of Cd ranged from a 15-fold increase over the control rate at the lowest dose level used (2.2 mmol/kg; 684 mg/kg) up to a 72-fold increase at the highest dose (8.8 mmol/kg; 2736 mg/kg) following three daily injections. The latter treatment regimen resulted in a fecal excretion of almost 30% of the administered Cd over a 3-day period of observation. Urinary Cd excretion was insignificant in both the control and treated groups. The whole body burden of Cd was reduced by over 50% following seven thrice-weekly i.p. injections of MDCG at 8.8 mmol/kg. There was a 60-65% reduction in both the liver and kidney Cd levels following the same treatment regimen. Radioassay of ten other organs and tissues revealed only modest changes. Testicular Cd was decreased slightly at the highest dose level, and heart tissue from each treated group contained slightly more Cd than controls. Results indicated a rather marked specificity of MDCG in lowering the Cd content of two organs most susceptible to Cd-induced toxicity.

Sodium N-methyl-D-glucamine dithiocarbamate and cadmium intoxication.

The sodium and ammonium salts of N-methyl-D-glucamine dithiocarbamate were prepared and their usefulness as antidotes for cadmium intoxication investigated. This chelating agent was found to be effective in both acute and repeated exposure cadmium poisoning. A single intraperitoneal injection of sodium N-methyl-D-glucamine dithiocarbamate (NaNMG-DTC), administered at a level greater than 1.1 mmol/kg body weight, protects against a normally lethal (greater than 95%) dose of cadmium chloride (10 mg CdCl2/kg body weight) and results in a subsequent dose-dependent decrease in the liver and kidney burdens of cadmium ion. In repeated exposure cadmium intoxication, repeated administration of NaNMG-DTC can result in substantial reductions in both the kidney (71%) and the liver (40%) levels of cadmium. The LD50 of the compound was not determined, but single injections of 26.6 mmol/kg body weight (injectate volume 1.0 ml) are well tolerated in mice.

Mobilization of aged cadmium deposits by dithiocarbamates.

Mice with chronic cadmium intoxication were given low levels (0.6 mm/kg) of several dithiocarbamates (parent compounds: dihydroxyethylamine, iminodiacetic acid, methylhydroxyethylamine and sarcosine) in an attempt to reduce the cadmium present in the liver and kidney. Comparing the results with those obtained with the less polar sodium diethyldithiocarbamate (NaDDTC), only ammonium di(hydroxyethyl)dithiocarbamate (NH4DHE-DTC) possessed a similar ability to reduce kidney cadmium levels. Under the experimental conditions employed, the reduction obtained with NH4DHE-DTC was less than that effected by a comparable dose of NaDDTC. A subsequent dose-dependence study showed, however, that sodium di(hydroxyethyl)dithiocarbamate (NaDHE-DTC) is quite effective at higher dosage levels (up to 5.5 mmoles/kg) where substantial reductions in both kidney (89% mobilization) and liver (38% mobilization) stores of cadmium were observed. High doses of the NaDHE-DTC are well tolerated as the LD50 of this compound in mice is greater than 19.8 mmoles/kg.

In vivo screening of potential antidotes for chronic cadmium intoxication.

Nineteen chelating agents have been screened under identical conditions of metal loading in an attempt to establish their relative ability to mobilize cadmium from the liver and kidney in mice with chronic cadmium intoxication. The compounds investigated were divided into five groups: polyaminocarboxylic acids, monothiols, dithiols, macrocycles, and a miscellaneous category. Only 2,3-dimercaptopropanol (BAL) and sodium diethyldithiocarbamate (NaDDTC) were able to produce a statistically significant (at the 95% level) reduction in the cadmium content of the kidney. The closely related dithiols sodium 2,3-dimercaptopropane-1-sulfonate and 2,3-dimercaptosuccinic acid produced statistically significant increases in the liver cadmium contents, as did N-(2-mercaptopropionyl)-glycine. The reduction in kidney cadmium levels produced by both BAL and NaDDTC was just under 40%.

Luminal and antiluminal transport of glutamine in dog kidney: effect of metabolic acidosis.

We have studied the luminal acid antiluminal transport of glutamine and glutamate with the pulse injection multiple indicator dilution technique in normal dogs and in dogs with acute and chronic acidosis. The single-pass experiments yield estimates of unidirectional influx at each nephron surface. The kidney of normal dogs extracts 57% of the arterial glutamine load; 23% of this extraction is due to luminal reabsorption and 34% to antiluminal uptake from the peritubular circulation. After the total net extraction by the kidney is determined from arteriovenous differences and blood flow measurements, in normal dogs, the net antiluminal flux is calculated to be negative, indicating that at least part of the glutamine reabsorbed is returned to the renal venous circulation across the antiluminal membrane. In acutely acidotic dogs, the situation is similar, but a 30% to 40% fall in renal hemodynamics (blood flow and GFR) is observed with secondary reduction in luminal and antiluminal uptake. In chronically acidotic dogs, the unidirectional luminal and antiluminal uptakes of glutamine are similar to that observed in normal animals, but the calculated efflux across the antiluminal membrane is drastically reduced. These findings suggest that (l) a cellular transport mechanism for glutamine exists at the antiluminal pole of the renal tubule and dominates the luminal uptake process in normal animals; (2) cellular transport of glutamine (luminal and antiluminal) does not play a role in the renal adaptation to metabolic acidosis; (3) the intrarenal utilization of glutamine acts as a metabolic sink for this amino acid, which in turn regulates its net uptake by the kidney; and (4) the total uptake of glutamine limits ammoniagenesis in this species.