Imaging characteristics of cerebrovascular arteriopathy and stroke in Hutchinson-Gilford progeria syndrome.

BACKGROUND AND PURPOSE: HGPS is a rare disorder of segmental aging, with early morbidity from cardiovascular and cerebrovascular disease. The goal of this study was to identify the neurovascular features, infarct type, topography, and natural history of stroke in the only neurovascular imaging cohort study of HGPS. MATERIALS AND METHODS: We studied 25 children with confirmed diagnoses of HGPS and neuroimaging studies available for review. Relevant clinical information was abstracted from medical records. RESULTS: We identified features suggestive of a vasculopathy unique to HGPS, including distinctive intracranial steno-occlusive arterial lesions, basal cistern collateral vessels, and slow compensatory collateral flow over the cerebral convexities. The arterial pathology in the neck consisted of distal vertebral artery stenosis with prominent collateral vessel formation as well as stenosis and calcification of both the cervical internal and common carotid arteries. Radiographic evidence of infarction was found in 60% of patients, of which half were likely clinically silent. Both large- and small-vessel disease was observed, characterized by arterial territorial, white matter, lacunar, and watershed infarcts. CONCLUSIONS: We report a unique intracranial and superior cervical arteriopathy in HGPS distinct from other vasculopathies of childhood, such as Moyamoya, and cerebrovascular disease of aging, including atherosclerosis. Arterial features of the mid and lower neck are less distinctive. For the first time, we identified early and clinically silent strokes as a prevalent disease characteristic in HGPS. Longitudinal analysis of stroke incidence and vasculopathy may provide an outcome measure for future treatment interventions for children with HGPS.

[18F]-Fluorodeoxyglucose positron emission tomography in children with neurofibromatosis type 1 and plexiform neurofibromas: correlation with malignant transformation.

The objective of this study was to investigate the predictive value of [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting malignant transformation of plexiform neurofibromas in children with neurofibromatosis type 1 (NF1). An electronic search of the medical records was performed to determine patients with NF1 who had undergone FDG-PET for plexiform neurofibroma between 2000 and 2011. All clinical, radiologic, pathology information and operative reports were reviewed. Relationship between histologic diagnosis, radiologic features and FDG-PET maximum standardized uptake value (SUV(max)) was evaluated. This study was approved by the Institutional Review Board of our institution. 1,450 individual patients were evaluated in our Multidisciplinary Neurofibromatosis Program, of whom 35 patients underwent FDG-PET for suspected MPNST based on change or progression of clinical symptoms, or MRI findings suggesting increased tumor size. Twenty patients had concurrent pathologic specimens from biopsy/excision of 27 distinct lesions (mean age 14.9 years). Pathologic interpretation of these specimens revealed plexiform and atypical plexiform neurofibromas (n = 8 each), low grade MPNST (n = 2), intermediate grade MPNST (n = 4), high grade MPNST (n = 2), GIST (n = 1) and non-ossifying fibroma (n = 1). SUV(max) of plexiform neurofibromas (including typical and atypical) was significantly different from MPNST (2.49 (SD = 1.50) vs. 7.63 (SD = 2.96), p < 0.001). A cutoff SUV(max) value of 4.0 had high sensitivity and specificity of 1.0 and 0.94 to distinguish between PN and MPNST. FDG-PET can be helpful in predicting malignant transformation in children with plexiform neurofibromas and determining the need for biopsy and/or surgical resection.

Craniofacial abnormalities in Hutchinson-Gilford progeria syndrome.

HGPS is a rare syndrome of segmental premature aging. Our goal was to expand the scope of structural bone and soft-tissue craniofacial abnormalities in HGPS through CT or MR imaging. Using The Progeria Research Foundation Medical and Research Database, 98 imaging studies on 25 patients, birth to 14.1 years of age, were comprehensively reviewed. Eight newly identified abnormalities involving the calvaria, skull base, and soft tissues of the face and orbits were present with prevalences between 43% and 100%. These included J-shaped sellas, a mottled appearance and increased vascular markings of the calvaria, abnormally configured mandibular condyles, hypoplastic articular eminences, small zygomatic arches, prominent parotid glands, and optic nerve kinking. This expanded craniofacial characterization helps link disease features and improves our ability to evaluate how underlying genetic and cellular abnormalities culminate in a disease phenotype.

Moyamoya following cranial irradiation for primary brain tumors in children.

OBJECTIVE: To study the risk factors for the development of moyamoya syndrome after cranial irradiation for primary brain tumors in children. METHODS: We reviewed neuroimaging studies and dosimetry data for 456 children who were treated with radiation for a primary brain tumor and who were prospectively evaluated with serial neuroimaging studies and neurologic evaluations. A total of 345 patients had both adequate neuroimaging and radiation dosimetry data for further analysis. We used survival analysis techniques to examine the relationship of clinically important variables as risk factors for the development of moyamoya over time. RESULTS: Overall, 12 patients (3.5%) developed evidence of moyamoya. The onset of moyamoya was more rapid for patients with neurofibromatosis type 1 (NF1) (median of 38 vs 55 months) and for patients who received >5,000 cGy of radiation (median of 42 vs 67 months). In a multiple Cox proportional hazards regression analysis controlling for age at start of radiation, each 100-cGy increase in radiation dose increased the rate of moyamoya by 7% (hazard ratio [HR] = 1.07, 95% CI: 1.02 to 1.13, p = 0.01) and the presence of NF1 increased the rate of moyamoya threefold (HR = 3.07, 95% CI: 0.90 to 10.46, p = 0.07). CONCLUSIONS: Moyamoya syndrome is a potentially serious complication of cranial irradiation in children, particularly for those patients with tumors in close proximity to the circle of Willis, such as optic pathway glioma. Patients who received higher doses of radiation to the circle of Willis and with neurofibromatosis type 1 have increased risk of the development of moyamoya syndrome.

Adipose tissue fatty acid composition in humans with lipoprotein lipase deficiency.

BACKGROUND: Lipid stores in human adipose tissue are maintained primarily by incorporating lipid from circulating chylomicrons and very low density lipoproteins. Adipose tissue lipoprotein lipase (LPL) hydrolyzes triglyceride from these lipoprotein particles to facilitate their entry into adipocytes for storage. Subjects deficient in LPL still have normal adiposity, and this may result from increased adipocyte lipogenesis or from uptake of circulating lipid through alternate mechanisms. The objective of this study was to determine whether fatty acid composition of adipose tissue from LPL-deficient subjects reflects maintenance of lipid stores through increased lipogenesis or through alternate mechanisms of lipoprotein uptake. METHODS: Adipose tissue samples from LPL-deficient subjects who consume fat-restricted diets and normal subjects were analyzed for fatty acid composition by gas-liquid chromatography. RESULTS: Compared with that of normal subjects, adipose tissue from LPL-deficient subjects showed an increase in 16:1 and decreases in 18:0, 18:2, and 18:3 fatty acids, whereas other nonessential fatty acid levels were not statistically different. CONCLUSIONS: The reduction in essential fatty acids and increase in nonessential fatty acids in adipose tissue of those with LPL deficiency, taken together with recent data from animal studies, suggest that lipid stores in these subjects are maintained primarily through enhanced adipocyte lipogenesis.

Expression of voltage-activated chloride currents in acute slices of human gliomas.

Using whole-cell patch-clamp recordings, we identified a novel voltage-activated chloride current that was selectively expressed in glioma cells from 23 patient biopsies. Chloride currents were identified in 64% of glioma cells studied in acute slices of nine patient biopsies. These derived from gliomas of various pathological grades. In addition, 98% of cells acutely isolated or in short-term culture from 23 patients diagnosed with gliomas showed chloride current expression. These currents, which we termed glioma chloride currents activated at potentials >45 mV, showed pronounced outward rectification, and were sensitive to bath application of the presumed Cl- channel specific peptide chlorotoxin (approximately 600 nM) derived from Leiurus scorpion venom. Interestingly, low grade tumours (e.g., pilocytic astrocytomas), containing more differentiated, astrocyte-like cells showed expression of glioma chloride currents in concert with voltage-activated sodium and potassium currents also seen in normal astrocytes. By contrast, high grade tumours (e.g., glioblastoma multiforme) expressed almost exclusively chloride currents, suggesting a gradual loss of Na+ currents and gain of Cl- currents with increasing pathological tumour grade. To expand on the observation that these chloride currents are glioma-specific, we introduced experimental tumours in scid mice by intracranial injection of D54MG glioma cells and subsequently recorded from tumour cells and adjacent normal glial cells in acute slices. We consistently observed expression of chlorotoxin-sensitive chloride channels in implanted glioma cells, but without evidence for expression of chloride channels in surrounding "normal" host glial cells, suggesting that these chloride channels are probably a glioma-specific feature. Finding of this novel glioma specific Cl- channel in gliomas in situ and it's selective binding of chlorotoxin may provide a way to identify or target glioma cells in the future.

Cell cycle-dependent expression of a glioma-specific chloride current: proposed link to cytoskeletal changes.

We recently demonstrated expression of a novel, glioma-specific Cl- current in glial-derived tumor cells (gliomas), including stable cell lines such as STTG1, derived from a human anaplastic astrocytoma. We used STTG1 cells to study whether glioma Cl- channel (GCC) activity is regulated during cell cycle progression. Cells were arrested in defined stages of cell cycle (G0, G1, G1/S, S, and M phases) using serum starvation, mevastatin, hydroxyurea, demecolcine, and cytosine beta-D-arabinofuranoside. Cell cycle arrest was confirmed by measuring [3H]thymidine incorporation and by DNA flow cytometry. Using whole cell patch-clamp recordings, we demonstrate differential changes in GCC activity after cell proliferation and cell cycle progression was selectively altered; specifically, channel expression was low in serum-starved, G0-arrested cells, increased significantly in early G1, decreased during S phase, and increased after arrest in M phase. Although the link between the cell cycle and GCC activity is not yet clear, we speculate that GCCs are linked to the cytoskeleton and that cytoskeletal rearrangements associated with cell division lead to the observed changes in channel activity. Consistent with this hypothesis, we demonstrate the activation of GCC by disruption of F-actin using cytochalasin D or osmotic cell swelling.

Left syringeal dominance in testosterone-treated female canaries.

Male canaries (Serinus canaria) produce most of their song syllable types on the left side of the syrinx, the two-sided vocal organ. Female canaries treated with testosterone propionate begin to sing in a male fashion, a behavior seldom seen in untreated females. To learn whether syringeal dominance occurs in testosterone-treated female canaries, we deactivated either the right or the left side of the syrinx by severing the tracheosyringeal nerve on that side. Recordings of the birds' songs were made before and after the nerve cut, and song analysis was based upon visual comparisons of sound spectrograms. Pre- and post-operative syllable types were identified by their frequency structures and repetition rates. Six of eight birds displayed clear left dominance as assessed by nerve cuts; therefore, we concluded that most, but not all, female canaries generate the majority of their syllable types with the left syrinx.

Biophysical and pharmacological characterization of chloride currents in human astrocytoma cells.

Expression of voltage-activated ion channels was studied in primary cultures from seven freshly resected human primary brain tumors and in an established human astrocytoma cell line, STTG1. Astrocytoma cells consistently expressed voltage-dependent outwardly rectifying currents. Currents activated at potentials > 45 mV and showed outward transients on termination of voltage steps. Currents reversed at the Cl equilibrium potential, suggesting that they were largely carried by Cl-. Altering extracellular K- or Na+ concentration did not alter currents; neither did replacement of intracellular K+ by Cs+ or intracellular Na+ by N-methyl-D-glucosamine. Anion-substitution experiments suggest the following permeability sequence, determined from shifts in tail current reversal potential: I- > NO3- > Br- > Cl- > acetate > isethionate > F- > glutamate. Currents were sensitive to the Cl- channel blockers chlorotoxin, 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS), and 4,4'-dinitrostilbene-2,2' disulfonic acid (DNDS), with chlorotoxin being most effective, yielding > 80% block at 590 nM. DIDS (100 microM) and DNDS (100 microM) reduced currents by 33.5 and 38.2%, respectively. Currents were also sensitive to Zn2+ (100 microM, 47% block) and Cd2- (25 microM, 42% block). Reducing extracellular Ca2+ concentration decreased outward currents by 58% and almost completely eliminated transients, suggesting that Cl- currents are Ca2+ dependent. Cl channel block resulted in altered cell proliferation as determined by [3H]thymidine incorporation, suggesting that these channels may be involved in astrocytoma growth control.

Human astrocytoma cells express a unique chloride current.

Human astrocytoma cells were studied using whole-cell patch-clamp recording. Voltage-dependent outwardly-rectifying anion currents were identified in primary cultures of six freshly resected human brain tumors and in seven established anaplastic astrocytoma/glioblastoma cell lines (U251MG, CH235MG, U373MG, U105MG, D54MG, SK-MG-1, and STTG1). Anion currents were not observed in normal, non-neoplastic glial cells, nor in human tumor-derived cells of non-glial origin (melanoma, breast cancer, neuroblastoma, rhabdomyosarcoma). Currents activated at potentials > 50 mV and showed large transients upon termination of voltage steps. Currents reversed at the predicted equilibrium potential for chloride ions and could also be recorded when Cl- was replaced by F-, Br- or I-. Currents were inhibited by the Cl- channel blockers chlorotoxin, DIDS, and DNDS. These Cl- currents may play a role in the growth control of astrocytoma cells.

Human astrocytoma cells express a unique chloride current.

Human astrocytoma cells were studied using whole-cell patch-clamp recording. Voltage-dependent outwardly-rectifying anion currents were identified in primary cultures of six freshly resected human brain tumors and in seven established anaplastic astrocytoma/glioblastoma cell lines (U251MG, CH235MG, U373MG, U105MG, D54MG, SK-MG-1, and STTG1). Anion currents were not observed in normal, non-neoplastic glial cells, nor in human tumor-derived cells of non-glial origin (melanoma, breast cancer, neuroblastoma, rhabdomyosarcoma). Currents activated at potentials > 50 mV and showed large transients upon termination of voltage steps. Currents reversed at the predicted equilibrium potential for chloride ions and could also be recorded when Cl- was replaced by F-, Br- or I-. Currents were inhibited by the Cl- channel blockers chlorotoxin, DIDS, and DNDS. These Cl- currents may play a role in the growth control of astrocytoma cells.

Reduction of glial proliferation by K+ channel blockers is mediated by changes in pHi.

Astrocyte proliferation was studied in primary cultures of rat spinal cord by [3H]thymidine uptake and was significantly reduced by culturing cells for 24 h in the presence of agents known to block astrocytic K+ channels: Cs+, Ba2+, 4-AP and tetraethylammonium (TEA). To determine whether effects were mediated by changes in Vm or pHi, these parameters were studied electrophysiologically or ratiometrically, using BCECF. Of the four K+ channel blockers, only Ba2+ depolarized astrocytes significantly. However, all four K+ channel blockers resulted in an alkaline shift in pHi. Under culture conditions that altered pHi in a defined way, proliferation strongly depended on pHi, with highest rates at pH approximately 6.7 and growth inhibition at more acidic or alkaline conditions. These observations suggest that astrocyte proliferation is sensitive to changes in pHi and that K+ channel blockers may exhibit their antiproliferative effects through changes in pHi.

Astrocyte Na+ channels are required for maintenance of Na+/K(+)-ATPase activity.

Astrocytes in vitro and in situ have been shown to express voltage-activated ion channels previously thought to be restricted to excitable cells, including voltage-activated Na+, Ca2+, and K+ channels. However, unlike neurons, astrocytes do not generate action potentials, and the functional role of voltage-activated channels in astrocytes has been an enigma. In order to study the function of Na+ channels in glial cells, we carried out ion flux measurements, patch-clamp recordings, and ratiometric imaging of [Na+]i during blockade of Na+ channels on rat spinal cord astrocytes cultured for 7-10 d. Acute blockade of astrocyte Na+ channels by TTX had multiple effects: (1) TTX reduced, in a dose-dependent manner, Na+/K(+)-ATPase activity measured as unidirectional influx of 86Rb+; (2) TTX depolarized astrocyte membrane potential at a rate of approximately 1 mV/min; (3) TTX (100 microM) reduced [Na+]i; and (4) prolonged exposure to micromolar TTX induced astrocyte death. All these effects of TTX could be mimicked by ouabain or strophanthidin, specific blockers of the Na+/K(+)-ATPase. The effects of TTX and ouabain (or strophanthidin) were not additive. These results suggest that TTX-blockable Na+ channels in glial cells serve functions that do not require their participation in action potential electrogenesis; in particular, we propose that glial Na+ channels constitute a "return" pathway for Na+/K(+)-ATPase function, which permits Na+ ions to enter the cells to maintain [Na+]i at concentrations necessary for activity of the Na+/K(+)-ATPase. Since astrocyte Na+/K(+)-ATPase is believed to participate in [K+]o homeostasis in the CNS, the coupling of Na+ flux through voltage-activated Na+ channels to ATPase activity may provide a feedback loop that participates in the regulation of K+ ion levels in the extracellular space.