All Articles

Conrad E. Johanson^1*, Nancy L. Johanson²

¹Department of Neurosurgery, Alpert Medical School at Brown University, Providence, RI, 02903 USA

²408 Autumn Trail, Georgetown, TX 78626, USA

The choroid plexus (CP) of the blood-cerebrospinal fluid barrier (BCSFB) impacts CSF homeostasis, brain diseases, and neuromedical translation. CP executes neuroendocrine, excretory, and neuroimmune actions. BCSFB diversely manages brain-spinal cord fluid environments, giving rise to a wide pathophysiology spectrum. Newly-discovered choroidal phenomena include integration of circadian clock signals, immune interaction with gut microbiotica, and expression of receptors to taste CSF composition. BCSFB tight junctions and transcellular mechanisms differ from blood-brain barrier (BBB) counterparts, variably regulating pathogen and leukocyte access to the CSF-brain nexus. This review highlights microbial agents, substrates and autoantigens using CP epithelial membranes to penetrate CSF and periventricular regions. Lipopolysaccharide (LPS) is analyzed as a barrier-damaging agent and neuroinflammation promoter. Transducing LPS- and toll-like receptor activity produce CP-CSF cytokines in sickness behavior and virulent sepsis-associated encephalopathy. Agents/systems that counter oxidative activity such as matrix metalloproteinase 8 inhibitors and Nrf2 activators (bile acids and isothiocyanates) show promise as neural and CP protectants. One review theme emphasizes CP’s preponderant role in initiating central diseases, and their remediation. In view of BCSFB permeability alterations and epithelial transformation, we discuss systemic lupus erythematosus, N-methyl D-aspartate-associated autoencephalitis, helicobacter disruption of BCSFB, toll-like receptor 2 stimulation in CP (neuroinflammation), the CP gateway for trypanosomes, and APOE-linked cholesterol transport into CSF. Another section treats concurrent involvement of BCSFB-BBB alterations in helminthic meningitis, forebrain ischemia, acute hyperthermia, leptin resistance/obesity, diabetes mellitus, and Alzheimer-type neurodegeneration. Barrier impairment is analyzed by injury type, time course, therapeutic strategies, and translational neuromedicine principles. The restorative power of BCSFB-transported growth factors, hormones and medicinal agents is emphasized for strengthening CP-CSF homeostatic mechanisms in seizures, stroke and Parkinsonism. A worthy therapeutic aim is to attenuate CNS disorders triggered by BCSFB malfunction, using CSF-delivered therapeutic agents for promoting neural viability.

Brian E. Engdahl^1-4, Lisa M. James^1,2,4,5, Ryan D. Miller¹, Arthur C. Leuthold^1,2, Scott M. Lewis^1,6, Adam F. Carpenter^1,6, Apostolos P. Georgopoulos^1,2,4-6*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, Minnesota, USA

³Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA

⁴Center for Cognitive Sciences, University of Minnesota, Minneapolis, Minnesota, USA

⁵Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

⁶Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA

GWI has affected a substantial number of Gulf War (GW) veterans. The disease involves several organ systems among which the brain is most prominent. Neurological, cognitive and mood-related (NCM) symptoms frequently dominate and are at the root of chronic ill-health and disability in veterans suffering from GWI. In addition, such symptoms frequently co-occur with diagnosable mental health disorders, predominantly posttraumatic stress disorder (PTSD). Here we investigated the possibility that increased GWI severity leads, above a threshold, to a diagnosable mental health disorder (excluding psychosis). For this purpose, we used, in separate analyses, symptom severity scores and resting-state brain functional connectivity patterns, as determined by magnetoencephalography (MEG). Two-hundred-thirty GW-era veterans participated in this study. They completed diagnostic interviews to establish the presence of GWI and assess mental health status. This distinguished 3 groups: healthy controls (N = 41), veterans with GWI and no mental illness (GWI group, N = 91), and veterans with both GWI and mental health disorder (GWI+MH, N = 98). For each veteran, symptom severity scores in the 6 GWI domains (fatigue, pain, NCM, skin, gastrointestinal, respiratory) were available as well as 9 summary measures of the distribution of Synchronous Neural Interactions (SNI) derived from the MEG recordings. We tested the hypothesis that, in the presence of GWI, the appearance of a diagnosable mental health disorder may depend on GWI symptom severity. For that purpose, we performed a logistic regression on the GWI population, where the presence (or absence) of the MH disorder was the dependent variable and the age- and gender-adjusted GWI severity in the 6-symptom domains were the predictors. The outcome was the probability that a participant will have MH disorder or not. Similarly, we tested the hypothesis that the presence of the MH disorder can be predicted by the SNI distribution patterns by performing a second logistic regression as above but with the 9 SNI measures as predictors. We found GWI symptom severity differed significantly across groups (GWI+MH > GWI > Control). SNI distributions of the GWI group also differed significantly from the other groups in a systematic hemispheric pattern, such that the presence of GWI involved predominantly the left hemisphere, and presence of mental health disorders involved, in addition, the right hemisphere. Both logistic regressions yielded highly significant outcomes, demonstrating that both GWI symptom severity and SNI distribution measures can predict the presence of MH disorder in GWI. Remarkably, the prediction probabilities for MH presence derived from the symptom-based and SNI-based logistic regressions were positively and highly statistically significantly correlated. Taken together, both objective (neural) and subjective (symptoms) indices suggest that GWI is distinct from healthy controls and varies in severity in a continuum that leads, at the higher end, to a diagnosable MH disorder. The positive correlation between the GWI symptom-based and brain-based predicted classifications provides a key link between GWI symptom severity and synchronous neural interactions in the context of mental illness.

Sara R. Roig¹, Irene Estadella¹, Sergi Cirera-Rocosa¹, María Navarro-Pérez¹, Antonio Felipe^1*

¹Molecular Physiology Laboratory, Dpt. de Bioquímica i Biomedicina Molecular, Institut de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal 643, E-08028 Barcelona, Spain

Microglial cells are responsible for brain immunosurveillance. These cells maintain brain homeostasis, phagocytose cellular debris, present antigens to T-lymphocytes and secrete cytokines and chemokines. Upon activation, microglia can polarize into two different phenotypes in particular environments: the classical M1 proinflammatory state and the alternative M2 anti-inflammatory state. Chronically activated M1 microglial cells are involved in neuroinflammation in various brain diseases. In multiple sclerosis, Alzheimer’s disease, Parkinson’s disease and neuropathic pain, brain inflammation is involved in initiation and pathological progression, which is partially mediated by activated microglia. Molecular studies revealed that expression of the voltage-gated potassium channel Kv1.3 is a M1 phenotypic feature. Indeed, an increase in Kv1.3 expression and function was detected in chronically activated microglial cells in patients. Therefore, recent works evaluated Kv1.3-targeted therapies for neuroimmune diseases and showed encouraging results. Inhibition of Kv1.3 activity led to amelioration of some pathology-related features in brain diseases. This review summarizes the latest findings concerning microglial function in neuroinflammatory processes, focusing on the involvement of Kv1.3 and highlighting this channel as a promising therapeutic target.

Bilal El Waly¹, Myriam Cayre¹, Pascale Durbec^1*

¹Aix Marseille University, CNRS, IBDM-UMR 7288, Case 907, Parc Scientifique de Luminy, campus de Luminy, 13288 Marseille, Cedex 09, France

Ani Amar*

Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel

Heart failure is characterized as any heart condition resulting from impairment of the heart’s ability to pump blood, with high prevalence in both aged and diseased hearts. Numerous population-based studies have shown that, in patients with impaired left ventricular systolic function, additional structural and functional cardiovascular abnormalities are often found, making it difficult to understand the underlying pathophysiological processes. Advances in experimental and modeling tools have led to the identification of many cellular mechanisms that contribute to cardiac failure. Still, the mechanism by which cardiac myofiber adaptation ultimately leads to failure remains unclear. Several human cell, tissue, and organ models are used to model heart failure. In this mini review, several available human models are summarized with a focus on the simulation of cellular remodeling: from membrane excitation at the level of the single cell to contraction of the ventricle.

Cristine Betzer^1,2, Poul Henning Jensen^1,2*

¹Danish Research Institute of Translational Neuroscience - DANDRITE, Aarhus University, Denmark

²Department of Biomedicine, Aarhus University, Denmark

Yannick Kronimus, Richard Dodel*, Sascha Neumann

Department of Geriatrics, University Duisburg-Essen, Germaniastrasse 1-3, 45356 Essen, Germany

Accumulation and aggregation of Beta-Amyloid (Aβ) and Alpha-Synuclein (α-Syn) are considered as central or even causative for the development of Alzheimer’s (AD) and Parkinson’s disease (PD). Therefore, the regulation of these proteins seems to be an essential aspect for prevention and is of central interest in current research aiming to find therapeutic approaches. The human immunological repertoire already contains such a regulatory system. Naturally occurring autoantibodies (nAbs) against the proteins Aβ (nAbs-Aβ) and α-Syn (nAbs-α-Syn) are part of the innate immune system and modulate the metabolism of their specific antigens including protein clearance and inhibition of aggregation. Thus, many researchers hypothesize that in the course of AD and PD, quantitative alterations of nAbs-Aβ and nAbs-α-Syn arise resulting in impaired proteastasis. Such alterations would represent promising, reliable biomarkers and indicate potential approaches for therapeutic strategies. Hence, it is not surprising that many studies dealing with nAbs-Aβ and nAbs-α-Syn titers in AD and PD patients in comparison to control participants are available in the literature. In this mini review, we summarize the current evidence. Furthermore, we critically discuss problems and future requirements for nAbs quantification when a clinical application is the overriding goal.

Valeria Belleudi¹, Nera Agabiti^1*, Marina Davoli¹, Danilo Fusco¹

¹Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo, 112, 00147 Rome, Italy

Kathleen Monahan, D.S.W., L.C.S.W., L.M.F.T.

Associate Professor Director, Trauma Specialization Stony Brook School of Social Welfare 101 Nicolls Road Health Sciences Center, Level 2 Stony Brook, NY, USA

Intimate Partner Violence (IPV) remains at epidemic proportions in the United States. Traumatic Brain Injury (TBI) as an outcome of IPV is now being investigated by researchers, particularly long-term sequelae. This review addresses underreporting and lack of treatment, and the physical and psychological impact for victims of IPV who have received a TBI. Recent research has begun to investigate professional sports players who experience repeated concussions and their at-risk status for Chronic Traumatic Encephalopathy (CTE). Women who are in abusive relationships for long periods of time may also incur repeated blows to the head. Researching the at-risk status for CTE is a much needed line of inquiry for this underserved population.

Gerhard Ransmayr

Dept. of Neurology 2, Kepler University Hospital, Krankenhausstr 9, A-4020 Linz, Austria

Apostolos P. Georgopoulos^1,2*, Effie-Photini C. Tsilibary^1,2, Eric P. Souto¹, Lisa M. James^1,2, Brian E. Engdahl^1,2, Angeliki Georgopoulos³

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, Minnesota

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, Minnesota

³Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota

Gulf War Illness (GWI) is a chronic debilitating disease of unknown etiology that affects the brain and has afflicted many veterans of the 1990-91 Gulf War (GW). Here we tested the hypothesis that brain damage may be caused by circulating harmful substances to which GW veterans were exposed but which could not be eliminated due to lack of specific immunity. We assessed the effects of serum from GWI patients on function and morphology of brain cultures in vitro, including cultures of embryonic mouse brain and neuroblastoma N2A line. Blood serum from GWI and healthy GW veterans was added, alone and in combination, to the culture and its effects on the function and morphology of the culture assessed. Neural network function was assessed using electrophysiological recordings from multielectrode arrays in mouse brain cultures, whereas morphological assessments (neural growth and cell apoptosis) were done in neuroblastoma cultures. In contrast to healthy serum, the addition of GWI serum disrupted neural network communication and caused reduced cell growth and increased apoptosis. All of these detrimental effects were prevented or ameliorated by the concomitant addition of serum from healthy GW veterans. These findings indicate that GWI serum contains neuropathogenic factors that can be neutralized by healthy serum. We hypothesize that these factors are persistent antigens circulating in GWI blood that can be neutralized, possibly by specific antibodies present in the healthy serum, as proposed earlier¹.

Elke Kalbe^1*, Ann-Kristin Folkerts¹

¹ Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstraße 62, 50937 Cologne, Germany

While it is undeniable that cognitive stimulation (CS) is effective in patients with dementia, there is still a lack of understanding of the underlying mechanisms of the effects, and questions like “Who benefits?” or “Which factors determine the benefits?” are not yet answered. Therefore, this commentary gives an overview of different aspects (e.g., sociodemographic factors, disease characteristics, living setting) that need to be considered while doing research on CS to understand their impact on CS effects. It is also necessary to examine the effects of CS in real-life settings (e.g., geriatric hospitals) with mixed samples (e.g., patients with different severity of dementia). Additionally, important factors for future studies on CS in dementia (e.g., reporting according to the CONSORT guidelines, more health-economics studies) are outlined.

M Mirzaei^{1,2,3 *}, V B Gupta⁴, V K Gupta²

¹Department of Molecular Sciences, Macquarie University, Sydney, NSW, Australia

²Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia

³Australian Proteome Analysis Facility, Macquarie University, Sydney, NSW, Australia

⁴School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia

Septimiu Tudor Bucurescu

Neurology at Vital-Klinik, Bad Driburg, Germany

In this paper we describe the case of a Guillain-Barré syndrome patient who was diagnosed with an active yersiniosis and past chlamydiosis. We also discuss the diagnosis, therapy and recovery prognosis of patients with Guillain-Barré syndrome.

Wolf-Dieter Heiss, MD

¹Max Planck Institute for Metabolism Research, Cologne, Germany

The diagnosis of cerebral small vessel disease (SVD) is difficult because there is no consensus on clinical criteria and therefore, imaging is important for diagnosis. Most patients undergo brain imaging by computed tomography (CT), which is able to detect ischemic strokes, hemorrhages and brain atrophy and may also indicate white matter changes. Magnetic resonance imaging (MRI) remains the key neuroimaging modality and is preferred to CT in vascular cognitive impairment (VCI) because it has higher sensitivity and specificity for detecting pathological changes. These modalities for imaging morphology permit to detect vascular lesions traditionally attributed to VCI in subcortical areas of the brain, single infarction or lacunes in strategic areas (thalamus or angular gyrus), or large cortical-subcortical lesions reaching a critical threshold of tissue loss. In SVD multiple punctuate or confluent lesions can be seen in the white matter by MRI and were called leukoaraiosis. Another major neuroimaging finding of small vessel disease in VCI are microhemorrhages. However, while CT and MRI are able to detect morphologic lesions, these modalities cannot determine functional consequences of the underlying pathological changes.

Positron emission tomography (PET) can support the clinical diagnosis by visualizing cerebral functions in typically affected brain regions. In SVD, Fluor-Deoxy-Glucose (FDG)-PET can clearly differentiate scattered areas of focal cortical and subcortical hypometabolism that differ from the typical metabolic pattern seen in Alzheimer Dementia (AD) with marked hypometabolism affecting the association areas. Additional PET tracers can further support the diagnosis of a type of dementia and also yield information on the underlying pathophysiology.

Hanna Kalamarz-Kubiak

Department of Genetics and Marine Biotechnology, Institute of Oceanology, Polish Academy of Sciences, Sopot, Poland

Lucia Mendoza-Viveros^1,2, Karl Obrietan³, Hai-Ying M. Cheng^1,2*

¹Department of Biology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada

²Department of Cell and Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada

³Department of Neuroscience, Ohio State University, Columbus, OH, 43210, USA

Daily rhythms in behavior and physiology are coordinated by an endogenous clock located in the suprachiasmatic nucleus (SCN) of the hypothalamus. This central pacemaker also relays day length information to allow for seasonal adaptation, a process for which melatonin signaling is essential. How the SCN encodes day length is not fully understood. MicroRNAs (miRNAs) are small, non-coding RNAs that regulate gene expression by directing target mRNAs for degradation or translational repression. The miR-132/212 cluster plays a key role in facilitating neuronal plasticity, and miR-132 has been shown previously to modulate resetting of the central clock. A recent study from our group showed that miR-132/212 in mice is required for optimal adaptation to seasons and non-24-hour light/dark cycles through regulation of its target gene, methyl CpG-binding protein (MeCP2), in the SCN and dendritic spine density of SCN neurons. Furthermore, in the seasonal rodent Mesocricetus auratus (Syrian hamster), adaptation to short photoperiods is accompanied by structural plasticity in the SCN independently of melatonin signaling, thus further supporting a key role for SCN structural and, in turn, functional plasticity in the coding of day length. In this commentary, we discuss our recent findings in context of what is known about day length encoding by the SCN, and propose future directions.

Gizem Yalcin

Department of Medical Biology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey

Sirtuins are highly conserved NAD+-dependent enzymes connected to an increasing set of biological processes. These enzymes have attracted major interest because of their roles in age-related diseases. Sirtuins are implicated in various biological pathways related to stress response, mitochondrial dysfunction, oxidative stress, protein aggregation and inflammatory processes that are intertwined with age-related neurodegenerative diseases.

Nathan Collins MD, Jeffrey Sager MD

Santa Barbara Cottage Hospital Department of Internal Medicine Santa Barbara, CA, USA

Acute laryngeal dystonia (ALD) is a drug-induced dystonic reaction that can lead to acute respiratory failure and is potentially life-threatening if unrecognized. It was first reported in 1978 when two individuals were noticed to develop difficulty breathing after administration of haloperidol. Multiple cases have since been reported with the use of first generation antipsychotics (FGAs) and more recently second-generation antipsychotics (SGAs). Acute dystonic reactions (ADRs) have an occurrence rate of 3%-10%, but may occur more frequently with high potency antipsychotics. Younger age and male sex appear to be the most common risk factors, although a variety of metabolic abnormalities and illnesses have also been associated with ALD as well. The diagnosis of ALD can go unrecognized as other causes of acute respiratory failure are often explored prior to ALD. The exact mechanism for ALD remains unclear, yet evidence has shown a strong correlation with extrapyramidal symptoms (EPS) and dopamine receptor blockade. Recognition and appropriate management of ALD can prevent significant morbidity and mortality.

Khan MI^1*

¹Orthopedic & Hand surgery, Beverly Hills, CA, USA

Torsak Tippairote¹, Dunyaporn Trachootham^2*

¹BBH Hospital, Bangkok, Thailand

²Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand

Zinc status is an important modifiable factor in Attention Deficit and Hyperactive Disorders (ADHD) and Autistic Spectrum Disorders (ASD), the two most common neurodevelopmental disorders. Many studies reported low serum or plasma zinc level in children with these conditions. While hair zinc level can be obtained non-invasively in young children, the reports of the hair zinc levels in ASD and ADHD children were varied. ASD children were reported to have lower than or indifferent level of hair zinc from that of healthy children. In ADHD children, hair zinc levels were reported as either lower or higher than their healthy control groups. Many factors interplayed and affected measurement of hair zinc level. Until more standardized method has been established, currently the zinc level in hair samples may be used as screening or supporting evidence. Other functional zinc markers such as serum zinc concentrations, dietary zinc intakes, and percentage of stunting rate, are still needed to assess the zinc status in susceptible children.

Zohar Barnett-Itzhaki^1,2*, Eli Marom and Eyal Schwartzberg^3,4,5

¹Public Health Services, Ministry of Health, Jerusalem, Israel

²Bioinformatics department, school of life and health science, Jerusalem College of Technology, Jerusalem, Israel

³Pharmaceutical & Enforcement Divisions, Ministry of Health, 39 Yirmiyahu St., Jerusalem, Israel

⁴Faculty of Heath Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

⁵Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, USA

Logan McCool¹, Michel Kliot², Danqing Guo³, Danzhu Guo³

There have been many advances in recent years in peripheral nerve releases and most notably those involving median nerve entrapment at the wrist. This mini-review article focuses on the advances within the past five years in minimally, percutaneous, and ultra-minimally invasive techniques for carpal tunnel release. The progress in these surgical techniques has been made in part by the improvements in real time sonographic imaging. With each surgical technique, we look at the pre-clinical and clinical data and any complications from or limitations with these procedures. It is our aim with this article to spark discussion and spur innovation regarding ultrasound guided carpal tunnel release that can be applied to other peripheral nerve entrapments.

In the past five years, the surgical techniques to perform carpal tunnel release continue to advance. Among these surgical techniques is a growing trend towards less invasive methods and increased utilization of ultrasound guidance. In the literature, the list of methods includes open release, endoscopic release, minimally invasive release, percutaneous release, and ultra-minimally invasive release. These progressively less invasive techniques take advantage of the major improvements in both ultrasound image quality and real-time definition. This mini-review examines various surgical techniques involving minimally invasive, percutaneous, and ultra-minimally carpal tunnel release with emphasis on the development of techniques that are increasingly less invasive and more reliant on high-quality ultrasound imaging.

Yumiko Watanabe¹, N.A.R. Nik-Mohd-Afizan^1,2, Ichiro Takashima^1*

Noninvasive brain stimulation methods, including repetitive transcranial magnetic stimulation and transcranial direct current stimulation (tDCS), have received considerable attention in recent years for use in the study and treatment of neurological conditions. Of these methods, tDCS is considered particularly promising due to its ease of use and ability to confer polarity-dependent effects on brain excitability, making it an excellent option for clinical treatment of neurological and psychiatric diseases. While generally regarded as safe when following standard protocols, the effects of tDCS on cerebral blood vessels and blood-brain barrier (BBB) functions remain poorly understood. Here, we provide an overview of tDCS in the context of BBB function, summarize the current literature, and discuss implications for future research. To date, no alterations or damage to the BBB have been reported after weak tDCS stimulations in human subjects; however, some animal studies have reported alterations to BBB function following increased tDCS intensity, with inconsistencies in the effective tDCS polarity used to produce these BBB disruptions between studies. Further research will be necessary to evaluate the effects of tDCS on the BBB under various conditions. Finally, we discuss the potential of tDCS for enhancing drug delivery to the central nervous system, which may become possible as we refine our understanding of the effects of tDCS on BBB permeability.

Lingyu Qiu, Huiqiang Lu*

Neuronal apoptosis is an important pathophysiological factor of Alzheimer’s disease (AD). Inhibition of endoplasmic reticulum stress (ERS)-induced neuronal apoptosis is an effective strategy to deal with AD. In this commentary, we summarize the relationship between AD and ERS injury-induced neuronal apoptosis, and highlight the protective effects and mechanism of isorhamnetin (Iso) against ERS-induced injury in N2a cells. Moreover, this commentary discusses the recent findings in the role of Iso in other diseases.