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Biomedical subjects

E Gale

Publications and source records attributed to E Gale.

16 recordsLinked to original sources

Positional apoptosis during vertebrate CNS development in the absence of endogenous retinoids.

We have previously shown that quail embryos that develop in the absence of vitamin A have severe defects in their central nervous system. One defect is a completely missing posterior hindbrain. Here we have studied how this comes about by examining cell death using a wholemount technique. In these A- embryos we observe two narrow bands of ectopic apoptosis. One is in the mesenchyme in the region of the first somite and occurs at the 4-6 somite stage, before neural tube closure. The second band follows immediately afterwards and occurs in the neuroepithelium of the presumptive posterior hindbrain at the 6-8 somite stage. Electron microscopy shows that the dying neuroepithelial cells exhibit the characteristics of apoptosis. Rescuing the embryos by injecting retinol before gastrulation completely prevents these apoptotic events. In an effort to identify some of the genes that may be involved in the apoptotic pathway we show that Msx-2 is upregulated in the apoptotic neuroepithelium and thus may be involved, whereas Bmp-4 is not altered and thus presumably not involved. Since these apoptotic event take place at the time of specification of axial identity and segmentation in the mesenchyme and neuroepithelium we conclude that these cells die because they are wrongly specified in terms of their rostrocaudal position, a novel phenomenon which we refer to as positional apoptosis.

Age Factors

Vitamin A-deficient quail embryos have half a hindbrain and other neural defects.

BACKGROUND: Retinoic acid (RA) is a morphogenetically active signalling molecule thought to be involved in the development of severely embryonic systems (based on its effect when applied in excess and the fact that it can be detected endogenously in embryos). Here, we adopt a novel approach and use the vitamin A-deficient (A-) quail embryo to ask what defects these embryos show when they develop in the absence of RA, with particular reference to the nervous system. RESULTS: We have examined the anatomy, the expression domains of a variety of genes and the immunoreactivity to several antibodies in these A- embryos. In addition to the previously documented cardiovascular abnormalities, we find that the somites are smaller in A- embryos, otic vesicle development is abnormal and the somites continue up to and underneath the otic vesicle. In the central nervous system, we find that neural crest cells need RA for normal development and survival, and the neural tube fails to extend any neurites into the periphery. Using general hindbrain morphology and the expression patterns of Hoxa-2, Hoxb-1, Hoxb-4, Krox-20 and FGF-3 as markers, we conclude that segmentation in the myelencephalon (rhombomeres 4-8) is disrupted. In contrast, the dorsoventral axis of the neural tube using Shh, islet-1 and Pax-3 as markers is normal. CONCLUSIONS: These results demonstrate at least three roles for RA in central nervous system development: neural crest survival, neurite outgrowth and hindbrain patterning.

Animals

Late effects of retinoic acid on neural crest and aspects of rhombomere.

We exposed st.10 chicks to retinoic acid (RA), both globally, and locally to individual rhombomeres, to look at its role in specification of various aspects of hindbrain derived morphology. Previous studies have looked at RA exposure at earlier stages, during axial specification. Stage 10 is the time of morphological segmentation of the hindbrain and is just prior to neural crest migration. Rhombomere 4 localised RA injections result in specific alterations of pathways some crest cells that normally migrate to sites of differentiation of neurogenic derivatives. The r4 crest cells that give rise to mesenchymal derivatives are unaffected. In addition, r4 gene expression is also partially altered by RA; within 6 hours of r4 exposure to RA, ectopic expression of Krox-20 is seen in r4 and Hoxb-1 expression is lost while Hoxa-2 expression continues normally. When we examined these RA-treated animals later in development, they showed an anterior displacement of the facial ganglion in addition to a mis-direction of the extensions of its distal axons and a dramatic decrease in the number of contralateral vestibuloacoustic neurons normally seen in r4. Only this r4-specific neuronal type is affected in r4; the motor neuron projections seem normal in experimental animals. The specificity of this result, combined with the loss of Hoxb-1 expression in r4 and the work by Krumlauf and co-workers showing gain of contralateral neurons co-localised with ectopic Hoxb-1 expression, indicates a role for Hoxb-1 and RA in the specification of this cell type in normal development. These results suggest that RA, at st.10, is able to affect some aspects of segment identity while leaving others unchanged.

Animals

Hemolytic anemia and acute renal failure associated with temafloxacin-dependent antibodies.

Quinine-ingestion has been associated with immune-mediated recurrent pancytopenia, hemolysis, and renal failure. The structure of fluoroquinolone antibiotics is similar to the structure of quinine. Over a 3 month period, three patients at our institution developed hemolysis and renal failure following ingestion of the fluoroquinolone antibiotic temafloxacin. Two of the three patients required hemodialysis. Following withdrawal from the drug, the hemolysis resolved and the renal function eventually returned to normal in all three patients. One patient also had a transient mild thrombocytopenia. Sera from all three patients were tested for drug-dependent antibodies to red blood cells, platelets, and neutrophils. Temafloxacin-dependent red cell antibodies were detected in one patient, and temafloxacin-dependent red cell and neutrophil antibodies were detected in a second patient. No temafloxacin-dependent antibodies were detected in the third patient. Sera from all three patients were also tested for quinine and quinidine-dependent antibodies to red cells, platelets, and neutrophils. Sera from the patient without temafloxacin-dependent red cell antibodies reacted with red cells in the presence of quinine. These results suggest that, at least in some patients, the toxicities associated with temafloxacin are immune mediated.

Acute Kidney Injury

Causes of hypoglycaemia.

Hypoglycaemia represents a disturbance in carbohydrate metabolism that threatens to deprive the brain of its principal fuel, and its physiological consequences are mediated almost exclusively by the CNS. Although some find the distinction pedantic, it is useful to reserve the term hypoglycaemia for this biochemical state, and neuroglycopenia for the clinical syndrome that results.

Alcoholism

Patient self-monitoring of blood glucose and refinements of conventional insulin treatment.

The compelling evidence that blood glucose control will slow or prevent microvascular complications has stimulated research to find better ways of managing insulin-dependent diabetes. The excellent results obtained with "open loop" insulin infusion systems suggest that the relative failure of conventional treatment is the result of (1) a lack of appropriate feedback to the patient and (2) the use of insulin regimens which do not mimic physiologic insulinemia, particularly in the basal state. Doctors regard blood glucose measurements as an essential part of diabetic management and extension of this technology to patients has added a new dimension, particularly in the assessment of control. Nevertheless, home blood-glucose monitoring will not necessarily improve diabetic control; the best results have been obtained when it has been offered as part of a package deal which includes more investment of time and interest by patients and doctor together with joint discussions of problems and changes in treatment. The biggest problem with conventional twice daily insulin regimens is to sustain constant basal insulin levels during the night. Attempts to obtain fasting normoglycemia with an injection before supper often result in nocturnal hyperinsulinemia and hypoglycemia. This can usually be resolved by changing to a three times daily regimen with an extra injection of NPH insulin at bedtime. Three times daily insulin injections with feedback from home blood-glucose monitoring give as good blood glucose control as infusion systems and are cheaper and more acceptable to patients.

Blood Glucose

Hypoglycaemia.

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Adenoma, Islet Cell

Brittle diabetes.

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Adolescent

A critical evaluation of methods of monitoring diabetic control.

Patients with insulin-treated diabetes need to be actively involved in their own treatment. We have found that measurement of blood rather than urinary glucose by our diabetic patients leads to greater understanding and enthusiasm as well as to better control of blood glucose. Home blood glucose monitoring is complementary to rather than a substitute for measurement of hemoglobin A1. The latter provides an objective index of long-term control that is of more use to the doctor than to the patient. The former gives the patient information that enables him to master his own disease from day to day.

Blood Glucose