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Cortical spreading depression blocks prostaglandin E1 and endotoxin fever in rats.

We have tested the hypothesis that the cortex may play a role in the development of fever. Male Sprague-Dawley rats equipped with AM transmitters for telemetric measurement of body temperature were given intracerebroventricular prostaglandin E1 (PGE1), corticotropin-releasing hormone (CRH), or intravenous E. coli endotoxin. Application of cotton pellets soaked with 3.3 M KCl to the frontal cortex (to induce spreading depression) significantly reduced fevers to PGE1 and endotoxin when compared with fever magnitude with 0.9% NaCl application to the cortex. Neither CRH-induced hyperthermia nor normal body temperatures were altered by the spreading depression. Our results reveal a novel action of spreading depression on thermoregulatory function and indicate cortical involvement in the development of fever.

Alprostadil↗

Multiwavelength optical intrinsic signal imaging of cortical spreading depression.

Cortical spreading depression (CSD) is an important disease model for migraine and cerebral ischemia. In this study, we exploit the high temporal and spatial resolution of optical imaging to characterize perfusion-dependent and -independent changes in response to CSD and to investigate the etiology of reflectance changes during CSD. In this experiment, we characterized the optical response to CSD at wavelengths that emphasize perfusion-related changes (610 and 550 nm), and we compared these results with 850 nm and blood volume data. Blood volume changes during CSD were recorded using an intravascular fluorescent dye, Texas Red dextran. We observed triphasic optical signals at 850 and 550 nm characterized by spreading waves of increased, decreased, then increased reflectance (Fig. 1) which expanded at a rate of approximately 3-5 mm/min. The signal at 610 nm had a similar initial phase, but the phase 2 response was slightly more complex, with a parenchymal decrease in reflectance but a vascular increase in reflectance. Reflectance values decreased in phase three. Blood volume signals were delayed relative to the optical intrinsic signals and corresponded temporally to phases 2 and 3. This is the first study to characterize optical imaging of intrinsic signal responses to CSD, in vivo, at multiple wavelengths. The data presented here suggest that changes in light scattering precede perfusion responses, the blood volume increase (phase 2) is accompanied by a reduction in deoxyhemoglobin, and the blood volume decrease (phase 3) is accompanied by an increase in deoxyhemoglobin. Previous studies have suggested the oligemia of spreading depression was a result of decreased metabolic demand. This study suggests that during the oligemic period there is a greater reduction in oxygen delivery than in demand.

Animals↗

Mitochondrial and intrinsic optical signals imaged during hypoxia and spreading depression in rat hippocampal slices.

During hypoxia in the CA1 region of the rat hippocampus, spreading-depression-like depolarization (hypoxic spreading depression or HSD) is accompanied by both a negative shift of the extracellular DC potential (DeltaV(o)), and a sharp decrease in light transmittance (intrinsic optical signal or IOS). To investigate alterations in mitochondrial function during HSD and normoxic spreading depression (SD), we simultaneously imaged mitochondrial depolarization, using rhodamine-123 (R123) fluorescence, and IOS while monitoring extracellular voltage. Three major phases of the R123 signal were observed during hypoxia: a gradual, diffuse fluorescence increase, a sharp increase in fluorescence coincident with the HSD-related DeltaV(o), primarily in the CA1 region, and a plateau-like phase if reoxygenation is delayed after HSD onset, persisting until reoxygenation occurs. Two phases occurred following re-oxygenation: an abrupt and then slow decrease in fluorescence to near baseline and a slow secondary increase to slightly above baseline and a late recovery. Parallel phases of the IOS response during hypoxia were also observed though delayed compared with the R123 responses: an initial increase, a large decrease coincident with the HSD-related DeltaV(o), and a trough following HSD. After reoxygenation, there occurred a delayed increase in transmittance and then a slow decrease, returning to near baseline. When Ca(2+) was removed from the external medium, resulting in complete synaptic blockade, the mitochondrial response to hypoxia did not significantly differ from control (normal Ca(2+)) conditions. In slices maintained in low-chloride (2.4 mM) medium, a dramatic reversal in the direction of the IOS signal associated with HSD occurred, and the R123 signal during HSD was severely attenuated. Normoxic SD induced by micro-injection of KCl was also associated with a decrease in light transmittance and a sharp increase in R123 fluorescence but both responses were less pronounced than during HSD. Our results show two mitochondrial responses to hypoxia: an initial depolarization that appears to be caused by depressed electron transport due to lack of oxygen and a later, sudden, sharp depolarization linked to HSD. The depression of the second, sharp depolarization and the inversion of the IOS in low-chloride media suggest a role of Cl(-)-dependent mitochondrial swelling. Lack of effect of Ca(2+)-free medium on the R123 and IOS responses suggests that the protection against hypoxic damage by low Ca(2+) is not due to the prevention of mitochondrial depolarization.

Animals↗

Recovery of apparent diffusion coefficient after ischemia-induced spreading depression relates to cerebral perfusion gradient.

BACKGROUND AND PURPOSE: Transient decreases of the apparent diffusion coefficient (ADC) of water as measured by fast diffusion-weighted imaging (DWI) in the ischemic border zone are thought to reflect cellular swelling associated with spreading depression. DWI and dynamic contrast-enhanced MRI were applied to study the characteristics of spreading depression and the correlation between ADC recovery time and tissue perfusion in focal ischemia. METHODS: Serial DWI was performed during remote middle cerebral artery occlusion in rats (n = 5) with an echo-planar imaging technique. ADC maps were calculated and ADC values displayed as a function of time in user-defined regions of interest with a time resolution of 12 to 16 seconds. Dynamic contrast-enhanced MRI was performed for qualitative correlation of ADC changes with tissue perfusion. RESULTS: Recovery time of transient ADC decreases correlated with the degree of the perfusion deficit (r = .81, P < .001). Slowly recovering ADC declines were found close to the ischemic core and correlated with severe perfusion deficit, while short-lasting ADC declines were typically found in moderately malperfused or normal tissue. Transient ADC decreases originated in the subcortical and cortical ischemic border zones and propagated along the cortex with a velocity of 2.9 +/- 0.9 mm/min. CONCLUSIONS: The variation in the recovery time of transient ADC decreases in the ischemic periphery reflects the gradient of the tissue perfusion. Severely delayed recovery time after spreading depression is thought to represent the ischemic penumbra.

Animals↗

Spreading depression analysis of contact behaviour of rats.

Social contact behaviour induced by spreading cortical depression was studied in rats. The controls looked for and remained in contact, whereas between the rats with spreading cortical depression and their other partners there was no contact. This phenomenon is due mainly to the absence of an active urge for contact. The contact behaviour of rats is evidently controlled by the cerebral cortex or by subcortical areas of the brain which are inhibited after the elicitation of spreading depression. The experiments show that the contact behaviour of rats has at least two components - an active urge for contact and passive tolerance of contact.

Amphetamine↗

Different mechanisms promote astrocyte Ca2+ waves and spreading depression in the mouse neocortex.

Cortical spreading depression (CSD) is thought to play an important role in different pathological conditions of the human brain. Here we investigated the interaction between CSD and Ca2+ waves within the astrocyte population in slices from mouse neocortex (postnatal days 10-14). After local KCl ejection as a trigger for CSD, we recorded the propagation of Ca2+ increases within a large population of identified astrocytes in synchrony with CSD measured as intrinsic optical signal (IOS) or negative DC-potential shift. The two events spread with 39.2 +/- 3.3 mum/sec until the IOS and negative DC-potential shift decayed after approximately 1 mm. However, the astrocyte Ca2+ wave continued to propagate for up to another 500 microm but with a reduced speed of 18.3 +/- 2.5 microm/sec that is also typical for glial Ca2+ waves in white matter or culture. While blocking CSD using MK-801 (40 microm), an NMDA-receptor antagonist, the astrocyte Ca2+ wave persisted with a reduced speed (13.2 +/- 1.5 microm/sec). The specific gap junction blocker carbenoxolon (100 microm) did not prevent CSD but decelerated the speed (2.9 +/- 0.9 microm/sec) of the astrocyte Ca2+ wave in the periphery of CSD. We also found that interfering with intracellular astrocytic Ca2+ signaling by depletion of internal Ca2+ stores does not affect the spread of the IOS. We conclude that CSD determines the velocity of an accompanying astrocytic Ca2+ response, but the astrocyte Ca2+ wave penetrates a larger territory and by this represents a self-reliant phenomenon with a different mechanism of propagation.

Animals↗

Enhanced rate of cortical spreading depression due to malnutrition: prevention by dietary protein supplementation.

The enhanced propagation rate of cortical spreading depression, observed previously in rats rendered malnourished by the regional basic diet that is typical of the daily fare of many of the inhabitants of the northeastern region of Brazil, was not prevented by raising the quantity of dietary protein to the normal level without changing its quality. Dietary supplementation with casein, a protein of good quality, however, abolished the effect on spreading depression. These data indicate that the quality, and not the quantity, of the dietary protein is the critical factor in reversing the effects of regional basic diet malnutrition on spreading depression.

Animals↗

Modeling cortical spreading depression.

Cortical spreading depression is a wave of electrical silence and biochemical changes that spreads across the cerebral cortex. Recently there has been a growing recognition that it may be an important pathophysiological event in a number of neurological disorders. In this paper, we describe a reaction-diffusion model of the extracellular potassium changes that are a central part of this process. Simulations with the model show that an appropriate stimulus evokes a moving wave of increased potassium with many similarities to that seen experimentally. The resultant model is a useful computational tool for future study of the effects of spreading depression on the cortex.

Computer Simulation↗

Spreading depression: a neurohumoral reaction.

1. The main characteristics of spreading depression are a decrease of spontaneous electrical activity, slow negative potential changes, transmembrane ion translocations, and an increase in tissue lactate. This is a general phenomenon in the central nervous system. 2. Retinal spreading depression, a very useful model for this phenomenon, has been extensively studied in terms of its optical, electrical and mechanical components. Ionic changes in the extracellular microenvironment have also been assessed and chemical substances liberated from tissue have been detected. 3. The velocity of propagation has been measured and some physical and chemical factors underlying the spread of the electrophysiological depression have been identified. Hypotheses about the nature of the reaction are discussed.

Animals↗

Threshold determination of spreading depression evoking substances in the retina in vitro.

A technique for the determination of the threshold concentrations of chemical substances for elicitation of spreading depression is described. The technique minimizes the interference of mechanical stimulating effects and alterations in the susceptibility of the retina to spreading depression due to changes in unstirred layers at the liquid-tissue interphase. The following threshold concentrations were shown to elicit the wave: 8000-10000 microM KCl, 100-200 microM sodium glutamate, 5-10 microM sodium kainate, 10-20 microM sodium N-methyl-aspartate, 600-1200 microM (NH4)2SO4 and 400-600 microM BaCl2. Variations of K+ or Mg2+ concentration in the standard Ringer solution that may cause an increase or decrease of spreading depression velocity have an inverse effect on the threshold for elicitation of the reaction.

Animals↗

Biphasic effects of gap junctional uncoupling agents on the propagation of retinal spreading depression.

The spreading depression wave of Leão (SD) propagates in the nervous tissue at 3-10 mm/min and is accompanied by an increase of intracellular Ca2+ concentration and a decrease in the extracellular milieu. Recently the spread of Ca2+ waves with propagating velocities of the same order of magnitude has been detected in cultures of nerve cells. It has been suggested that these waves, which can be blocked by gap junctional agents, are related to SD. The present experiments describe some effects of heptanol and octanol (10 microM to 10 mM), well-known uncoupling agents of gap junctions, on the slow voltage changes and the velocity of propagation of Leão's phenomenon in isolated chick retina: 1) a 50 to 700 microM concentration of these alcohols in the superfusate solutions increased the velocity, whereas high concentrations (1 to 10 mM) decreased and subsequently halted the spread; 2) the recovery period of the slow voltage changes of SD was shorter in the presence of alcohol and its amplitude was larger during faster SD waves. These effects were observed in the retina during successive individual waves as well as in the course of circling SD. All of these effects were reversible, without any sign of damage to the retina. In the concentration range of 50 microM to 10 mM, methanol, ethanol, butanol and cyclo-hexanol had no effect on retinal SD. These data suggest the involvement of gap junctions in Leão's wave. This involvement is complex and its functional effects together with other factors that influence the velocity of propagation of SD are being investigated.

Animals↗

Lichenoid dermatitis in paraneoplastic pemphigus: a pathogenic trigger of epitope spreading?

BACKGROUND: In select cases, lichen planus has been observed to be a paraneoplastic condition sometimes associated with paraneoplastic pemphigus, a disease featuring autoantibodies directed against plakin proteins, desmogleins 3 and 1, and a still uncharacterized 170-kd antigen. Epitope spreading describes the phenomenon where underlying chronic inflammation leads to the sequential recognition of new epitopes on self-proteins over time. OBSERVATIONS: Five of 6 patients diagnosed as having paraneoplastic pemphigus had concomitant clinical and histological features of lichen planus. In 1 patient, results of the initial indirect immunofluorescence on rat bladder were negative and only 2 of the 5 antigens were identified by immunoprecipitation. After 1 year of worsening disease, repeated testing confirmed the presence of antibodies directed against all 6 of the implicated antigens, supportive of our hypothesis that epitope spreading may occur in paraneoplastic pemphigus. CONCLUSIONS: Lichenoid eruptions may predispose to an early evolutionary stage of paraneoplastic pemphigus. Cell-mediated autoimmunity at the dermoepidermal junction may promote the exposure of self-antigens and the development of subsequent and progressive humoral autoimmunity. As such, paraneoplastic pemphigus may demonstrate epitope spreading in a human, humoral-mediated autoimmune disease.

Adult↗

Lentigo maligna with spread onto oral mucosa.

BACKGROUND: Lentigo maligna (LM) is a form of melanoma in situ most often seen in white patients on sun-exposed areas, primarily the head and neck. Spread of LM onto the conjunctiva has been reported. There have been no reports of LM extending onto oral mucosa. OBSERVATIONS: We report 4 cases of LM in white women with contiguous spread from perioral areas to oral mucosa. The locations of the primary lesions were the vermilion of the lip, vermilion and perioral skin, cheek, and cutaneous aspect of the lip. Three cases showed focal histopathologic evidence of invasion during the course of the disease. The lesions ran a prolonged course characterized by repeated recurrences after surgery. Three of the cases required a complicated reconstruction after surgical excision. Mohs surgery with rush permanent (paraffin-embedded) sections resulted in a long remission in 2 cases, while in 1 patient, treatment with carbon dioxide laser was unsuccessful. CONCLUSIONS: In a perioral distribution, LM can spread onto oral mucosa. This clinical presentation may cause significant long-term morbidity, as indicated by a high recurrence rate and/or progression to invasive melanoma. The oral mucosa should be examined in patients with atypical pigmented perioral lesions.

Aged↗

Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium.

BACKGROUND: Carbapenem antibiotics are used to treat serious infections caused by extended-spectrum beta-lactamase-carrying pathogens. Carbapenem resistance has been unusual in isolates of Klebsiella pneumoniae. In this study, the prevalence and molecular epidemiologic characteristics of carbapenem-resistant K pneumoniae are analyzed, and the experience involving 2 hospital outbreaks is described. METHODS: A citywide surveillance study was conducted in hospitals in Brooklyn. An observational study involving subsequent outbreaks at 2 hospitals was undertaken. Isolates were genetically fingerprinted by ribotyping and were examined for the presence of KPC-type carbapenem-hydrolyzing beta-lactamases. RESULTS: Of 602 isolates of K pneumoniae collected during the citywide surveillance study, 45% had extended-spectrum beta-lactamases. Of the extended-spectrum beta-lactamase-producing isolates, 3.3% carried the carbapenem-hydrolyzing beta-lactamase KPC-2. Several isolates were reported by the clinical microbiology laboratories as being susceptible to imipenem. Although all the isolates were resistant using agar diffusion methods, minimal inhibitory concentrations of imipenem were substantially lower for several isolates using standard broth microdilution tests and were highly dependent on the inoculum used. Two hospitals experienced the rapid spread of carbapenem-resistant isolates involving 58 patients. Overall 14-day mortality for bacteremic patients was 47%. Most isolates belonged to a single ribotype. CONCLUSIONS: Carbapenem-resistant K pneumoniae isolates are rapidly emerging in New York City. The spread of a strain that possesses a carbapenem-hydrolyzing beta-lactamase has occurred in regional hospitals. Because these isolates are resistant to virtually all commonly used antibiotics, control of their spread is crucial. However, automated systems used for susceptibility testing may not accurately identify all these isolates, which will severely hamper control efforts.

Carbapenems↗

Perineural spread of cutaneous head and neck cancer. Its orbital and central neurologic complications.

The ability of cutaneous squamous cell carcinoma of the face to cause ophthalmoplegia or central nervous system dysfunction via perineural spread is not well recognized. Five patients presenting to a general neurology unit are described in whom partial or complete ophthalmoplegia developed following fifth and seventh cranial nerve involvement by cutaneous squamous cell carcinoma. Two patients subsequently developed a contralateral hemiparesis; and one, multiple cranial nerve palsies as the tumor spread centrally. Normal radiologic findings or complete healing of the primary skin lesion caused delay in the diagnosis in three of the patients. When ophthalmoplegia or central nervous system dysfunction develops as a consequence of perineural spread of cutaneous facial cancer, management is palliative.

Aged↗

Intracranial spread of squamous carcinoma along the trigeminal nerve.

Two patients with intracranial dissemination of squamous carcinoma along the trigeminal nerve had facial dysesthesias mistakenly diagnosed as tic douloureux. In one case, tumor originated in the skin of the lateral canthus and spread along an orbital nerve to involve the cavernous sinus and Gasserian ganglion. In the other, the primary site was the retromolar trigone, with preponderantly deep intraosseous growth. Perineural spread occurred along the inferior alveolar nerve to eventually involve the facial and the ocular motor nerves. Such neurotropic spread of tumors is unfamiliar to many clinicians, yet early diagnosis may be life-saving. If intracranial foramina have not been transgressed, surgery and radiotherapy have been curative; otherwise, treatment is largely palliative. Adequate initial treatment of the primary lesion would seem to be the best preventive measure. Treatment of recurrent lesions should include consideration of neural invasion.

Aged↗

Dynamics of chromosome spreading.

Consistency of optimum chromosome spreading during harvest of cytogenetic specimens remains a major concern. We have tested the idea that a precise control of the drying rate (the time with which metaphase cells dry), as fixed cell suspension is placed on a slide or an in situ culture in last fixation, may be the answer. Amniocyte and lymphocyte cultures were allowed to dry at defined combinations of relative humidity (RH) and temperature (T) in a modified Thermotron environmental control unit. We were able to demonstrate, based on 2,250 amniocytes and 1,650 lymphocytes, that the metaphase area after drying was a function of RH and T for both in situ and non-in situ culture systems. As the RH and T increase, the metaphase area increases until a threshold is reached. Also, as RH increases, the slide drying time increases. Data obtained using a response surface regression, proportional hazards regression analysis and slide drying time studies are consistent with our model of chromosome spreading. Optimum metaphase areas can be achieved at various combinations of RH and T. We propose that the use of an environmental control unit is a practical way of achieving optimum chromosome spreading routinely and in a highly consistent manner.

Chromosomes↗

Hepatitis E in South Africa: evidence for sporadic spread and increased seroprevalence in rural areas.

Hepatitis E virus (HEV) is a major cause of non-A, non-B hepatitis in developing countries. Factors influencing sporadic spread of hepatitis E are unclear. We examined anti-HEV seroprevalence and demographic data from 407 urban and 360 rural black South African adults living in formal housing, squatter camps, or mud huts. Anti-HEV sero-prevalence ranged from 5.8% to 19.1% (mean 10.7%) in the different regions. Mean urban and rural rates were 6.6% and 15.3%, respectively (P = 0.0001). Rural mud hut dwellers, using unchlorinated river water, were at greater risk (17.4%) than rural villagers (5.3%; P = 0.008). A linear relation was found between seroprevalence and age, suggesting sporadic spread. The high prevalence in mud hut dwellers suggests that contaminated water plays a major role in HEV spread in South Africa. Routine chlorination or boiling of river drinking water before consumption may reduce HEV infection.

Adult↗