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24 janvier 2013 4 24 /01 /janvier /2013 07:40
Les parodontopathies sont fréquentes, touchant jusqu'à 35 % des plus de 30 ans. Elles correspondent à une prolifération bactérienne locale, conduisant à une destruction progressive du support de la dent, et éventuellement, à terme, à son déchaussage. Mais ces parodontopathies peuvent aussi être considérées comme une maladie systémique, avec élévation des marqueurs de l'inflammation. Et elles pourraient favoriser diverses pathologies telles que maladies cardiovasculaires, cancers, et rhumatismes inflammatoires. Par exemple, les sujets souffrant d'une polyarthrite rhumatoïde (PR) ont 2 à 8 fois plus de parodontopathies que les sujets sains. Le lien entre parodontopathies et d'autres rhumatismes inflammatoires reste cependant à préciser. Des auteurs ont donc réalisé une étude cas-témoins chez 6 821 patients présentant une spondylarthrite, appariés à 34 105 sujets contrôles. Tous les participants, âgés de 27,2 ± 19,4 ans (60 % ont plus de 40 ans) sont issus d'une cohorte taïwanaise. Les spondylarthrites ont été repérées à partir du codage effectué par les professionnels de santé. Tous les sujets inclus bénéficiaient, grâce à leur couverture sociale, d'une surveillance dentaire systématique tous les 6 mois, ce qui permettait le diagnostic de parodontopathie. Les patients atteints de spondylarthrite avaient plus fréquemment une parodontopathie que les sujets contrôles (41,5 % versus 25,9 % ; p<0,001) après ajustement sur leur statut socio-économique. Par contre, il faut noter qu'il n'y a pas eu d'ajustement possible pour le tabagisme car cette information n'était pas disponible dans la base de données de cette cohorte. Ainsi, les malades souffrant de spondylarthrite avaient presque 2 fois plus de parodontopathies que les sujets sains (odds ratio [OR] : 1,84 ; intervalle de confiance à 95 % [IC95 %] : 1,74-1,98). Enfin les auteurs ont retrouvé, sans surprise, davantage d'interventions pour parodontopathie (gingivectomie ou gingivoplastie) (OR : 1,70 ; IC95 % : 1,56-1,89) dans les 5 ans précédant l'étude, parmi les sujets atteints de spondylarthrite. Au total, tout comme dans la PR, cette étude suggère que les parodontopathies sont plus fréquentes dans la spondylarthrite. Il est cependant possible que ce lien soit en partie expliqué par un tabagisme accru, facteur de risque de parodontopathie, et aussi de spondylarthrite. Keller JJ et coll : Association between ankylosing spondylitis and chronic periodontitis. A population-based study. Arthritis and Rheumatism. 2013; 65: 167-173 23/01/13 Dr Laurent Laloux
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22 janvier 2013 2 22 /01 /janvier /2013 08:21
Minerals, trace elements, Vit. D and bone health European Journal of Clinical Nutrition (2012) 66, 1323–1328; doi:10.1038/ejcn.2012.169; published online 24 October 2012 Minerals, trace elements, Vit. D and bone health Serum 25-hydroxyvitamin D and markers of insulin resistance in a Japanese working population N M Pham1, S Akter1, K Kurotani1, A Nanri1, M Sato2, H Hayabuchi3, K Yasuda4 and T Mizoue1 1Department of Epidemiology and Prevention, Clinical Research Center, National Center for Global Health and Medicine, Tokyo, Japan 2Department of Applied Biological Chemistry, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka, Japan 3Faculty of Human Environmental Science, Fukuoka Women’s University, Fukuoka, Japan 4Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan Correspondence: Dr NM Pham, Department of Epidemiology and Prevention, Clinical Research Center, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail: pham@ri.ncgm.go.jp Received 12 March 2012; Revised 17 August 2012; Accepted 28 September 2012 Advance online publication 24 October 2012 Background/Objectives: The association between vitamin D status and insulin resistance (IR) has been less studied among Asians, and it remains elusive whether calcium could modify such an association. We examined the association of serum 25-hydroxyvitamin D (25(OH)D) concentrations with IR markers and the potential effect modification by calcium intake among a Japanese population. Subjects/Methods: The authors analyzed data (n=494) from a cross-sectional survey conducted in 2009 among a Japanese working population aged 20–68 years. Fasting serum 25(OH)D and insulin, as well as fasting plasma glucose were determined, and homeostatic model assessment of IR (HOMA-IR) was calculated. Calcium intake was assessed using a validated diet history questionnaire. Multiple linear regression was done with adjustment of potential confounding variables. Results: Fasting insulin and HOMA-IR were significantly inversely associated with 25(OH)D concentration across quartiles of 25(OH)D after fully adjusting for covariates (Ptrend=0.04 and 0.02, respectively). Across clinically relevant categories of 25(OH)D, compared with participants in the vitamin D sufficiency group, those in the vitamin D insufficiency group had a 5% higher HOMA-IR score, and those in the hypovitaminosis D group had an 18% higher HOMA-IR score (Ptrend=0.01). In an analysis by calcium intake, the HOMA-IR score was highest among participants with both a low calcium intake and lowest 25(OH)D concentrations, with significant inverse trend being observed in the group with lower calcium intake (Ptrend=0.02). Conclusions: Our findings suggest that low vitamin D status is associated with IR among Japanese adults. Keywords: 25-hydroxyvitamin D; insulin; glucose; insulin resistance
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22 janvier 2013 2 22 /01 /janvier /2013 08:18
« Génériques : la crise de confiance » Le Parisien , L'Express C’est ce que titre Le Parisien sur sa Une, relevant que « selon un sondage, la confiance dans les génériques s’érode. Les Français sont d’autant plus sceptiques que ces médicaments sont pour l’essentiel fabriqués à l’autre bout du monde dans des conditions difficilement contrôlables ». Le journal relate ainsi les résultats de l’enquête Ifop pour le groupement de pharmaciens PHR, selon laquelle « 61% des Français affirment que les génériques sont aussi sûrs que les médicaments d’origine, contre 71% en 2011 ». Le quotidien ajoute que « près de 4 Français sur 10 (39%) sont sceptiques sur le fait qu’ils soient aussi efficaces que les originaux. Une personne sur deux (46%) critique la nouvelle disposition qui oblige à avancer l’argent si on refuse un générique au profit d’un princeps ». Lucien Bennatan, président du groupe PHR, précise que « ces résultats ne doivent pas faire oublier que le générique est un produit sûr ». Le Parisien relève cependant que « les éléments recueillis au cours de cette enquête auprès de différents professionnels de santé montrent que le problème est plus profond. Du fait de la mondialisation, la production de matières premières […] s’est complètement recentrée sur l’Asie ». David Simonnet, directeur général du groupe Axyntis, industriel fabriquant des principes actifs en France, remarque ainsi : « On estime que 80% des principes actifs des génériques sont maintenant faits en Chine et en Inde, contre 50% pour les princeps ». Le journal continue : « Le problème, détaillent les sources contactées, c’est que les milliers de sites de production chinois et indiens sont très peu contrôlés. La Direction européenne de la qualité du médicament n’a mené en 2011 que 18 inspections en Asie, qui ont abouti à la suspension d’autorisation de 29 sites. Or, des médecins en France sont confrontés en ce moment à une moindre efficacité des traitements de leurs patients, notamment de l’antibiotique vancomycine, produit dont la matière première est partiellement fabriquée en Chine, sur des sites non inspectés ». Le Parisien ajoute qu’« aussi étonnant que cela puisse paraître, le grand public n’a pas les moyens de savoir d’où viennent les matières premières qui ont servi à fabriquer son médicament. Seul le nom du «titulaire et exploitant» figure sur l’emballage. C’est pour cela que la présidente d’une grande association de malades demande que la règle change et qu’une étiquette mentionne dorénavant d’où viennent les principales matières premières entrant dans la composition des médicaments. Une vraie révolution ». Claude Rambaud, présidente du Lien, déclare ainsi que « l’équivalence entre un médicament générique et le princeps, dont il est pourtant censé être la copie, n’est pas toujours réelle. […] On ne connaît pas assez l’origine des médicaments génériques. Le made in China ou le made in India doit apparaître sur les boîtes de médicaments ». La responsable indique en outre : « Nous avons envoyé, au nom du CISS, une lettre à la ministre de la Santé […] en lui demandant davantage de contrôles et de transparence dans le domaine du générique. Nous souhaiterions également qu’un rapport de l’Igas sur la politique française en matière de génériques, qui lui a été remis, soit rendu public ». train vers Amsterdam Zuid et Rai station
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22 janvier 2013 2 22 /01 /janvier /2013 08:17
Le test HPV dépiste plus de lésions précancéreuses que le frottis De précédents travaux ont montré que la recherche d'une infection à papillomavirus (HPV) par la recherche de l'ADN viral permettait de dépister plus de lésions cervicales pré-invasives que la cytologie. Un nouvel essai randomisé a été publié récemment, réalisé par une équipe finlandaise et incluant 2 cohortes de plus de 100 000 patientes. Elles bénéficiaient d'un dépistage par HPV test en première intention et cytologie en cas de positivité, ou par cytologie seule. Le suivi durera le temps d'un « round » de dépistage, soit 5 ans dans cette étude. Pendant la durée du suivi, 1 010 lésions précancéreuses ou cancéreuses ont été dépistées dans le groupe bénéficiant du HPV test en première intention, et 701 dans le groupe cytologie. Pour les lésions CIN 1, le hazard ratio est de 1,53 (intervalle de confiance à 95 % de 1,33 à 1,78). Il est de 1,54 (1,33 à 1,78) pour les CIN 2, 1,32 (1,09 à 1,59) pour les CIN 3 ou les adénocarcinomes in situ (AIS), et enfin, de 0,81 (0,48 à 1,37) pour les cancers cervicaux. Le taux cumulé de détection est de 0,0057 chez les 25-34 ans dépistées par le test HPV et de 0,0046 pour le sous-groupe du même âge dépisté par cytologie classique. Pour les patientes de 35 ans et plus, ces taux cumulés sont de 0,0022 et de 0,0017 respectivement. Le HPV test confirme donc de meilleures performances que le frottis classique en première intention pour le dépistage des lésions cervicales précancéreuses. Les auteurs nuancent toutefois cette affirmation. Ils déplorent en effet de nombreux dépistages « opportunistes », réalisés avant le délai des 5 ans prévus par le protocole. Car malgré la mise en place d'un dépistage organisé, seulement un tiers des CIN diagnostiqués en Finlande le sont par ce programme national, les autres étant la conséquence de dépistages « opportunistes ». Les auteurs estiment qu'avant de remplacer le frottis par un test HPV pour le dépistage organisé, il sera nécessaire de réduire l'incidence de ces dépistages opportunistes qui augmentent les coûts, notamment chez les jeunes femmes chez qui les dysplasies moyennes sont fréquentes et le plus souvent spontanément résolutives. Le test HPV permettant de diagnostiquer des lésions à un stade plus précoce, augmente aussi la détection de lésions à moindre risque de progression. De nouvelles stratégies pourraient sans doute être envisagées et validées pour la prise en charge des lésions ainsi dépistées. Par exemple, au lieu de traiter immédiatement les CIN 2, il serait peut-être possible d'en assurer la surveillance. Leinonen M.K. et coll. : Detection rates of precancerous and cancerous cervical lesions within one screening round of primary human papillomavirus DNA testing: prospective randomised trial in Finland. BMJ 2012;345:e7789 doi: 10.1136/bmj.e7789 http://www.bmj.com/content/345/bmj.e7789.pdf%2Bhtml 10/12/12 (JIM) Dr Roseline Péluchon
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22 janvier 2013 2 22 /01 /janvier /2013 08:16
Des plaques amyloïdes visualisées in vivo par TEP avec traceur fluoré chez la moitié des sujets âgés fragiles Plusieurs études suggèrent que l'existence d'une fragilité peut être associée à un déclin cognitif ultérieur et à un risque de démence, et une relation entre fragilité et MA a déjà été démontrée. Une étude ancillaire de MAPT ( Multi-domain Alzheimer Preventive Trial) avait pour but d'examiner la relation entre les dépôts d'amyloïdes et la fragilité des personnes âgées sans démence. Un sous groupe de 138 volontaires âgés fragiles, recrutés auprès de maisons de retraite, d'hôpitaux et de centres de soins, a été inclus sur la présence d'un au moins des critères suivants : plainte cognitive (mémoire) exprimée au médecin généraliste, limitation dans au moins une activité de la vie quotidienne et faible vitesse de marche (</= 0,8 m/s). Les plaques amyloïdes cérébrales étaient visualisées par imagerie TEP avec un traceur fluoré et les images étaient traitées et analysées à l'aide de méthodes normalisées et de seuils de positivité. L'analyse visuelle révèle des données considérées comme pathologiques dans près de 50 % des cas, positifs pour la pathologie amyloïde. La région la plus concernée était le cortex antérieur cingulaire et les sujets positifs pour les plaques amyloïdes étaient plus jeunes que ceux négatifs (77,2 +/- 4,43 ans contre 75,6 +/- 4,19). L'imagerie permet donc d'identifier une pathologie amyloïde dans le cerveau du vivant des personnes. Des études complémentaires sont nécessaires pour évaluer l'intérêt de cette technique d'imagerie chez les sujets atteints de fragilité. Adel D et coll. : High Prévalence of Amyloid Positive PET in Frailty Subjects. A Multicenter Study. 5th Conference Clinical Trials on Alzheimer's Disease (Monte Carlo) : 29-31 octobre 2012. Dominique Monnier (10/12/2012)
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22 janvier 2013 2 22 /01 /janvier /2013 08:15
Prenatal Mercury Exposure Linked to ADHD Fish is one of the healthiest forms of lean protein you can eat, but you need to make sure the fish you are eating is wild caught high quality fish that is contaminant free. Pregnant women need to be especially careful because eating fish that contain even low levels of mercury can increase the risk for attention-deficit/hyperactivity disorder (ADHD) in offspring. This can be confusing for mothers to be because there are also several other types of fish during pregnancy may protect against the disorder. A cohort study of almost 400 children showed that the risk for inattention and impulsivity at the age of 8 years was significantly associated with maternal mercury levels and as the mercury levels increased, so did risk. The study was conducted between 1993 and 1998. 788 infants from Massachusetts were enrolled in the study which was designed to assess a possible link between exposure to polychlorinated biphenyls (PCBs) and neurodevelopment. Soon after birth, hair samples were collected from the mothers and analyzed for mercury levels. The mothers also filled out a questionnaire regarding fish consumption during pregnancy. At 8-year follow-up, 421 of these children were assessed for possible ADHD behaviors and the results showed that not only was mercury exposure associated with inattention and impulsivity/hyperactivity, but the risk for these behaviors increased with maternal hair mercury levels. The threshold for first association with ADHD symptoms appeared to be at least 1 μg/g or more of mercury. In addition, these associations were more notable in boys than girls. This research does not mean that pregnant women should avoid eating all types of fish because the study also found offspring of mothers who consumed at least 2 servings of fish a week (which is currently more than the current recommended amounts from the FDA and EPA) had a decrease in ADHD-related behaviors — especially in impulsivity/hyperactivity. “These findings underscore the difficulties of balancing the benefits of fish intake with the detriments of low-level mercury exposure in developing dietary recommendations in pregnancy,” write the investigators. Although the researchers did not assess which fish are worst and best to consume while pregnant, they noted in a release that previous studies have shown that shark, fresh tuna, and swordfish should be avoided by pregnant women, whereas fish such as haddock, salmon, and flounder are good because of their low levels of mercury and their nutritional value. The investigators suggest that more research is needed, because they did not assess a clinical diagnosis of ADHD in their study, nor did they examine types of fish consumed. “Women need to know that nutrients in fish are good for the brain of a developing fetus, but women also need to be aware that high mercury levels in some fish pose a risk,” said lead author Sharon Sagiv, PhD, MPH, from Boston University School of Public Health in Massachusetts. In addition, Dr. Lanphear writes that the findings show that the time is now right to form a national scientific advisory panel to examine ADHD environmental risk factors, including known factors such as lead and tobacco. Both this and recent studies “reinforce the urgency of revising the regulatory framework for environmental contaminants and toxicants,” he writes. The FDA provides three recommendations for young children, pregnant women, and women of child-bearing age: Do not eat shark, swordfish, king mackerel, or tilefish because they might contain high levels of mercury. Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury. Five of the most commonly eaten fish and shellfish that are low in mercury are: shrimp, canned light tuna, salmon, pollock, and catfish. Another commonly eaten fish, albacore or big eye (“white”) tuna depending on its origin might have more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, it is recommended that you should not eat more than up to 6 ounces (one average meal) of albacore tuna per week. Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but consume no other fish during that week. Fish can be packed with brain boosting nutrition, but we also recognize how important it is to make sure the fish you consume comes from high quality wild caught sources. That’s why we’ve teamed up with the good folks at Vital Choice to offer the highest quality home delivery seafood on the market. We even created a Dr. Amen Brain Health Gift Box packed full of the most nutritious and tasty treats from Vital Choice Wild Seafood & Organics, rich with brain and heart healthy omega-3 fatty acids and brain boosting antioxidants… And of course, chocolates for your pleasure centers. Source: http://www.medscape.com/viewarticle/772495?src=nl_crb ONE RESPONSE TO PRENATAL MERCURY EXPOSURE LINKED TO ADHD Michele Lambotte says: December 11, 2012 at 3:30 pm This study is very interesting. Our older son who is now 34 years old was diagnosed with ADHD when he was 6 years old. I didn’t have a diet high in fish contaminated with mercury. But 5 years go, diagnosed with Chronic Fatigue Syndrome, I tested my level of heavy metals and my level of mercury and lead was extremely high and I also had some arsenic. I was raised and lived in a mining area in Belgium until I was 35 years old, when we moved to San Diego. I am ADD myself. Why did I have such a high level of heavy metals? Apparently, I don’t have the genes in my immune system that code to detoxify toxic substances, like heavy metals, toxin from Borrelia (Lyme disease, which I have) or mold toxins. The test that was used to check this was a HLA-RA test. I absolutely agree with the fact that studies should be done about the influence of our environment and problems like ADHD or autism. Michele Lambotte
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22 janvier 2013 2 22 /01 /janvier /2013 08:13
Breath profiles by electronic nose correlate with systemic markers but not ozone response. AuthorsBiller H, et al. Show all Journal Respir Med. 2011 Sep;105(9):1352-63. doi: 10.1016/j.rmed.2011.03.002. Epub 2011 Mar 24. Affiliation Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Nikolai-Fuchs-Str. 1, 30625 Hannover, Germany. Abstract BACKGROUND: The evaluation of exhaled breath profiles by electronic nose (eNose) is considered as a promising non-invasive diagnostic tool, and the discrimination of breathprints between patients with COPD and asthma has been reported. The aim of this study was to assess, whether exhaled breath profile analysis can detect the inflammatory airway response induced by ozone inhalation. METHODS: In a randomized double-blind, cross-over study 14 healthy ozone-responsive subjects were exposed to 250 ppb ozone and filtered room air for 3h with intermittent exercise. Blood biomarkers, exhaled NO, exhaled CO, and breathprints (Cyranose 320(®)) were assessed prior and at 3 time points up to 24h post exposure. Induced sputum was collected at baseline and 3h post exposure. Multivariate analysis of eNose data was performed using transformed and normalized datasets. RESULTS: Significantly increased numbers of sputum and blood neutrophils were observed after ozone, whereas the eNose signals showed no differences between exposures and no correlation with neutrophilic airway inflammation. However, independent of ozone exposure, sensor data correlated with serum SP-D levels and to a smaller extent with blood neutrophil numbers. CONCLUSIONS: Exhaled breath profiles as measured by the Cyranose 320(®) did not reflect airway responses to ozone. This suggests that exhaled volatiles did not change with ozone challenges or that the changes were below the detection limits. Conversely, the correlation of eNose signals with blood neutrophils and serum SP-D, i.e. markers of systemic inflammation and lung permeability, suggested that the Cyranose 320(®) can detect volatile organic compounds of systemic origin. Copyright © 2011 Elsevier Ltd. All rights reserved.
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22 janvier 2013 2 22 /01 /janvier /2013 08:10
Benzodiazépines : l’ANSM invite à maintenir la vigilance 19/12/2012 Paris, le mercredi 19 décembre 2012 – La donnée est répétée à l’envi, jusqu’à en perdre parfois sa juste signification : les Français compteraient parmi les plus importants consommateurs de psychotropes. En réalité, les faits sont plus nuancés, comme l’ont mis en évidence plusieurs enquêtes récentes. Les psychostimulants et les médicaments de substitution aux opiacés sont ainsi bien moins répandus en France que dans d’autres pays. A contrario, en matière d’hypnotiques et d’anxiolytiques, notre pays détient souvent des records. Or, aujourd’hui, une très grande partie des anxiolytiques et hypnotiques prescrits en France sont des benzodiazépines (respectivement 83,3 et 76,3 %). Des traitements beaucoup trop longs Ce phénomène n’est pas sans conséquence en terme de santé publique. En effet, très fréquent, l’usage des benzodiazépines s’accompagne souvent d’un mésusage. Ainsi, en janvier, l’Agence nationale de sécurité du médicament (ANSM) déplorait dans un rapport consacré à ces médicaments que « le temps de traitement médian est de sept mois pour une benzodiazépine anxiolytique et hypnotique », tandis qu’environ « la moitié des sujets traités le sont depuis plus de deux ans » alors que la durée maximale de prescription est limitée à 12 semaines pour les premiers et à quatre semaines pour les seconds rappelle-t-elle. Ces prescriptions prolongées apparaissent fortement problématiques en raison des effets secondaires connus de ces traitements : risques d’abus, de dépendance, de chutes ou encore de troubles de la mémoire et du comportement. C’est dément ! En outre, récemment, la possibilité d’un risque accru de démence chez les patients exposés aux benzodiazépines a été évoquée. Le professeur Bernard Bégaud (INSERM Bordeaux) a ainsi confirmé dans une étude prospective publiée en septembre dans le British Medical Journal (Benzodem) une association entre une prescription de benzodiazépine et le risque de développer une démence. Face à ces résultats, l’ANSM souligne « Même s’il est important de rappeler (…) que ces études épidémiologiques observationnelles ne peuvent pas mettre en évidence avec une certitude suffisante un lien de causalité entre la prise des benzodiazépines et la survenue d’une démence, cette association, bien que de faible intensité, vient s’ajouter aux autres risques déjà identifiés ». Des traitements efficaces à conditions que l’on respecte les règles Ces différents éléments incitent donc aujourd’hui une nouvelle fois l’ANSM à procéder à un rappel des « règles de bon usage ». Quatre recommandations sont notamment martelées : pas de systématisation de la prescription, initiation des traitements pour une courte durée, réévaluation régulière de la prescription et information précise des patients quant aux risques liés aux médicaments reçus. Le suivi de ces différentes règles devrait permettre de bénéficier de l’efficacité et de l’utilité thérapeutique des anxiolytiques et des hypnotiques, dûment démontrées, lorsqu’ils sont pris correctement. Ordonnance sécurisée ou pas ? Cette mise au point s’inscrit dans un programme de surveillance plus vaste de l’ANSM qui a multiplié cette année les interventions au sujet des benzodiazépines. On sait notamment que la possibilité d’un élargissement de l’obligation de prescription sur ordonnances sécurisées à toutes les benzodiazépines est à l’étude. Ce n’est cependant que début 2013 que l’ANSM disposera des résultats de l’enquête qu’elle a initiée sur ce point, afin de se prononcer sur la pertinence d’un tel dispositif. Aurélie Haroche
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Une cible prometteuse pour une vaccination contre la maladie d’Alzheimer 29/12/2012 Le cerveau des malades d’Alzheimer se caractérise notamment par l’accumulation extracellulaire de formes insolubles des peptides amyloïdes β. On sait qu’il existe naturellement chez ces malades et chez les sujets sains des anticorps anti-amyloïde β qui ont des rôles possibles dans la neurodégénérescence, ce qui a suggéré la possibilité de stratégies d’immunothérapie contre la maladie. L’ankyrine G (ankG) est une protéine du cytosquelette qui restreint la diffusion des canaux ioniques et d’autres protéines au segment initial de l’axone. Des données récentes lui accordent un rôle indispensable à la neurogenèse, et le polymorphisme de son gène ANK3 a été associé à la forme la plus fréquente de la maladie d’Alzheimer (MA), d’apparition tardive. Dans cette nouvelle étude, une équipe suisse explore tout le spectre des anticorps sériques dirigés contre des antigènes cérébraux chez des malades d’Alzheimer d’au moins 65 ans. Les chercheurs observent chez ces patients des taux élevés d’anticorps dirigés contre l’ankG [présence d’IgGs contre ankG chez 54,84 % des patients Alzheimer (n = 31) vs 24,24 % des contrôles sains (n= 33) ; p = 0,001]. Leurs données suggèrent que la présence de ces anticorps chez les patients représente un mécanisme protecteur qui ralentit la progression de la maladie. En effet, les malades immuno-positifs pour ces IgGs présentent des fonctions cognitives stables, voire même améliorées sur une période de 2 ans (test MMSE) par rapport à des patients immuno-négatifs, et le nombre de patients stables ou améliorés est plus élevé dans le groupe immunopositif (p = 0,03 par rapport aux patients immunonégatifs). L’étude de la distribution de l’ankG par immunohistochimie, chez les malades d’Alzheimer et dans un modèle murin de la maladie (souris arcAβ doublement mutées pour la protéine précurseur de l’amyloïde APP humaine), suggère que les concentrations cérébrales en ankG augmentent avec le développement de la pathologie amyloïde. On observe une redistribution de la protéine ankG cytosolique des neurones vers l’espace extracellulaire via un processus impliquant les exosomes, et une accumulation dans les plaques de β-amyloïde. Dans le modèle animal, une immunisation active par une protéine ankG recombinante, une fois par mois pendant 3 mois, augmente progressivement le taux d’IgGs contre ankG. Elle réduit la taille et le nombre des plaques amyloïdes cérébrales chez les souris arcAβ et augmente les concentrations en peptide Aβ42 soluble. L’efficacité de cette vaccination est aussi vérifiée dans un second modèle murin porteur d’une seule mutation de APP. Selon le mécanisme proposé par les auteurs, les anticorps cibleraient préférentiellement l’ankG extracellulaire dont celle liée aux plaques amyloïdes permettant ainsi leur interaction avec la microglie qui favoriserait l’élimination des peptides Aβ. De façon très intéressante, ex vivo sur des coupes d’hippocampe de souris arcAβ, les anticorps anti ankG atténuent la perte des épines dendritiques, bourgeonnements sur les dendrites des neurones qui forment la partie post-synaptique de la synapse. Ce qui prend un relief particulier à un moment où de plus en plus d’études sont en faveur d’un modèle explicatif de l’Alzheimer basé sur une hypothèse synaptique bêta amyloïde où l’on considère comme centrale la toxicité synaptique des oligomères bêta-amyloïdes. La dégénérescence des épines dendritiques liée à des anomalies de la plasticité synaptique et donc de la mémoire est une des étapes très précoce de la MA (1). L’ankG devient une cible d’avenir pour une vaccination contre la MA, et d’autres pathologies neurodégénératives. La présence d’anticorps cérébraux serait liée chez les patients à un ralentissement de l’évolution de la maladie. Ils présentent les avantages de favoriser l’élimination des plaques amyloïdes cérébrales in vivo dans des modèles murins de la maladie et de quasi réverser la disparition des épines dendritiques ex vivo chez la souris. (1) Wendou Yu et Bingwei Lu : Synapses and Dendritic Spines as Pathogenic Targets in Alzheimer’s Disease. Neural Plasticity 2012 (2012).doi:10.1155/2012/247150 http://www.hindawi.com/journals/np/2012/247150/ Dominique Monnier Santuccione AC et coll. : Active vaccination with ankyrin G reduces β-amyloid pathology in APP transgenic mice. Mol Psychiatry 2012. Publication avancée en ligne le 12 juin 2012. doi: 10.1038/mp.2012.70.
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22 janvier 2013 2 22 /01 /janvier /2013 08:06
Cytochrome c Is Released from Mitochondria in a Reactive Oxygen Species (ROS)-dependent Fashion and Can Operate as a ROS Scavenger and as a Respiratory Substrate in Cerebellar Neurons Undergoing Excitotoxic Death* Anna Atlante, Pietro Calissano‡, Antonella Bobba, Amalia Azzariti§, Ersilia Marra and Salvatore Passarella¶‖ + Author Affiliations From the Centro di Studio sui Mitocondri e Metabolismo Energetico, Consiglio Nazionale delle Ricerche (CNR), via G. Amendola, 165/A-70126 Bari, ‡Istituto di Neurobiologia, CNR, Viale K. Marx, 15-00137 Roma, §Dipartimento di Biochimica e Biologia Molecolare, Università di Bari, via Orabona, 4-70126 Bari, and ¶Dipartimento di Scienze Animali, Vegetali e dell'Ambiente, Università del Molise, via De Sanctis, 86100 Campobasso, Italy Abstract In rat cerebellar granule cells both reactive oxygen species production and release of cytochrome c take place during glutamate toxicity. This investigation was aimed (i) to ascertain whether and how these two processes are related and (ii) to gain insight into the role played by the released cytochrome c in the onset of neurotoxicity. Cytochrome c release takes place owing to the generation of reactive oxygen species both in glutamate-treated cerebellar granule cells and in sister control cultures incubated in the presence of the reactive oxygen species-generating system consisting of xanthine plus xanthine oxidase. In the early phase of neurotoxicity (30-min glutamate exposure) about 40% of the maximum (as measured at 3 h of glutamate exposure) cytochrome c release was found to occur in cerebellar granule cells from mitochondria that were essentially coupled and intact and that had a negligible production of oxygen free radicals. Contrarily, mitochondria from cells treated with glutamate for 3 h were mostly uncoupled and produced reactive oxygen species at a high rate. The cytosolic fraction containing the released cytochrome c was able to transfer electrons from superoxide anion to molecular oxygen via the respiratory chain and was found to partially prevent glutamate toxicity when added externally to cerebellar neurons undergoing necrosis. In the light of these findings, we propose that in the early phase of neurotoxicity, cytochromec release can be part of a cellular and mitochondrial defense mechanism against oxidative stress. An excessive and prolonged glutamate release has been found to play a major role in the death of neurons in many forms of acute and chronic diseases (1, 2). Moreover in vitro cultured cerebellar granule neurons undergo death via necrosis when exposed to excessive glutamate (1, 2). However the events that underlie necrosis as well as the participation of the different cell components to the biochemical processes that lead the cell to death have not been yet established in detail. As far as mitochondria are concerned, their major role in the glutamate-dependent necrosis is now commonly accepted as follows. Dying neurons have been shown to lose their mitochondrial membrane potential and energy charge (3), and a key role in Ca2+ homeostasis (4-6) was proposed for mitochondria that were also shown to undergo Ca2+-dependent uncoupling (7). An early and progressive mitochondrial dysfunction (5, 8) and oxidative stress (9-11) have been shown to occur under glutamate neurotoxicity (GNT).1 Consistently, an increase of glucose uptake by cerebellar granule cells (CGCs) was shown accounting for the higher rate of anaerobic glycolysis (12). We have recently reported that during necrotic death caused by GNT, cytochromec (cyt c) release from mitochondria of CGCs occurs. This release was found to not impair mitochondrial respiration as measured in cell homogenate, at least in the early phase of glutamate exposure, but it was suggested to allow for cell defense against the onset of glucose uptake deficiency (13). On the other hand, it should be noted that cyt c release has been already reported to occur during apoptosis (14-19); cyt c release was found to be associated with permeability transition pore opening (20, 21) or occurring via the voltage dependent anion channel (22). Cyt c release has also been found to occur before mitochondrial membrane potential collapse (14) and to actively participate in the cascade of events leading to caspase activation (15,23). During GNT, how cyt c release occurs as well as its function (see 13) outside the mitochondria remain to be established. Since reactive oxygen species (ROS) production, mostly due to xanthine oxidase (XOD) activity (11), occurs together with cyt crelease during GNT (13), we carried out experimental work aimed at ascertaining whether and how ROS could cause the release of cytc and whether this cyt c could take part in the mitochondrial defense mechanism against cell oxidative stress. Previous Section Next Section EXPERIMENTAL PROCEDURES Reagents Tissue culture medium (basal medium Eagle's) and fetal calf serum were purchased from Life Technologies, Inc., tissue culture dishes were purchased from NUNC (Denmark), and enzymes and biochemicals were purchased from Sigma. Anti-cytochrome c antibodies (7H8.2C12) were purchased from Pharmingen (San Diego, CA). Anti-glutamate dehydrogenase antibodies were kindly supplied by Dr. F. Rothe (Institut fuer Medizinische Neurobiologie, University of Magdeburg, Germany). Anti-cytochromec oxidase (subunit IV) antibodies (20E8-C12) were purchased from Molecular Probes (Eugene, OR). Peroxidase-conjugated anti-mouse and anti-rabbit antibodies and Enhanced Chemiluminescence Western blotting reagents were purchased from Amersham Pharmacia Biotech. Cell Cultures Primary cultures of cerebellar granule neurons were obtained as described in Levi et al. (24). Before each experiment, the culture medium was removed, and the plated cerebellar granule cells were washed with phosphate-buffered saline medium (PBS), pH 7.4, containing NaCl (138 mM), KCl (2.7 mM), Na2HPO4 (8 mM), and KH2PO4 (15 mM) and then collected by gentle scraping in a final volume of 4 ml of PBS/9-cm dish. Suspended granule cells showed full viability, even though they lacked the morphological organization present in culture dishes such as cell-cell and cell-substrate contacts as well as neuritis. Cell integrity, which remains rather constant for 3–5 h, was quantitatively assessed by checking the inability of cells to oxidize externally added succinate, which cannot enter intact cells (25), by checking the ability of ouabain to block glucose transport in cells (8), and by counting dead cells, identified as large phase-bright cell bodies, as in Volontè et al. (26). The final cell suspension contained routinely 85–95% intact cells and was prepared after 7–8 days in vitro. Cell Toxicity Studies Glutamate exposure was performed 7 days after plating. Primary cultures were exposed usually for 30 min to 100 μM glutamate at 25 °C in Locke's solution (154 mM NaCl, 5.6 mM KCl, 3.6 mMNaHCO3, 2.3 mM CaCl2, 5.6 mM glucose, 10 mM Hepes, pH 7.4) in the presence of 1 μM glycine, added to fully activateN-methyl-D-aspartate-sensitive glutamate receptors (27). Cells were then replenished with basal medium Eagle's containing 25 mM KCl, 2 mMglutamine, and gentamicin (100 μg/ml) and put in the incubator. For the quantitative assessment of GNT, cell integrity and count were measured as described above after 12–24 h. Neurotoxicity was expressed as the percentage of intact cells with respect to control cells kept under the same experimental conditions without the glutamate addition. In control experiments 95–97% integrity was found in 24 h. Cell Homogenate, Mitochondria, and Cytosolic Fraction Preparation Cell homogenate from a cell suspension was obtained by 10 strokes with a Dounce potter at room temperature. With this procedure, lactate dehydrogenase was released, and subsequent treatment with Triton X-100 did not cause further release. Mitochondria were isolated from cell homogenates, essentially as reported in Almeida and Medina (28). Briefly: the homogenate was centrifuged at 1500 × g for 10 min at 4 °C, and the supernatant was kept on ice. The pellet was re-homogenized with a further 3 ml of isolation buffer consisting of 320 mMsucrose, 1 mM K+-EDTA, 10 mMTris-HCl, pH 7.4, and the homogenate was centrifuged at 1500 ×g for 5 min at 4 °C. The two supernatants were pooled and centrifuged at 1500 × g for 10 min at 4 °C. Supernatant was further centrifuged at 17,000 × g for 11 min at 4 °C. The pellet, i.e. the mitochondrial fraction, was then resuspended in 200 μl of isolation buffer to obtain about 4 mg of mitochondrial protein/ml. These mitochondria, incubated in PBS, were checked for their intactness and coupling by measuring the activities of both adenylate kinase (EC 2.7.4.3) and glutamate dehydrogenase (EC 1.4.1.3) (see below), which are marker enzymes of the mitochondrial intermembrane space and matrix, respectively. The percentage of damaged mitochondria ranged between 0.5 and 1.5%. Mitochondrial coupling was checked by measuring the respiratory control ratio, i.e. (oxygen uptake rate after ADP addition)/(oxygen uptake rate before ADP addition), which reflects the ability of mitochondria to produce ATP; in both cases succinate was used as a respiratory substrate. As expected, both the inhibitors of electron flow and atractyloside, a powerful inhibitor of the ADP/ATP translocator (29), blocked ADP-stimulated oxygen uptake. Inhibition was also caused by oligomycin, which can inhibit ATP synthase (30) and is rapidly reversed by the uncoupler carbonyl cyanidep-trifluoromethoxyphenylhydrazone, which stimulates the rate of oxygen consumption. Cytosolic fractions of both control CGCs (C-CGCs) and glutamate-treated CGCs (GLU-CGCs) (about 30 × 106 cells in 1 ml) were obtained after homogenization in PBS and centrifugation at 15,000 × g for 15 min. The supernatant was concentrated to 0.2 ml by using the Savant Speed Vac concentrator and indicated as cytosolic fraction containing cyt c (CCCF). Both the protein assay of cell and mitochondria were determined according to Waddel and Hill (31), with bovine serum albumin used as a standard. Oxygen Uptake Studies O2 consumption was measured polarographically by means of a Gilson 5/6 oxygraph using a Clark electrode, as in Atlante et al. (8). Either the cell homogenate or mitochondria suspension in PBS (about 0.2 mg of protein) was incubated in a thermostatted (25 °C) water-jacketed glass vessel (final volume equal to 1.5 ml). Instrument sensitivity was set to a value that allowed the monitoring of rates of O2 uptake as low as 0.5 nanoatoms min− 1mg− 1 of protein. Immunoblot Analysis Immunoblot analysis was performed on cytosolic extracts from control and glutamate-treated cultures essentially as in Bobba et al. (18). In both cases cells were washed once with PBS and collected by centrifugation at 2000 × g for 5 min at 4 °C. The cell pellet was resuspended in 500 μl of extraction buffer containing 250 mM sucrose, 50 mM Tris-HCl, 1 mM EGTA, 1 mMEDTA, 1 mM dithiothreitol, 1 mM1,10-phenantroline, 0.1 mM phenylmethylsulfonyl fluoride, pH 7.4. The cells were homogenized in a Teflon glass homogenizer (10 strokes), and after 5 min on ice, the suspension was centrifuged at 15,000 × g for 15 min. The supernatants,i.e. cytosolic fractions, were removed and stored at −80 °C until analyzed by gel electrophoresis. 10 μg of cytosolic proteins were loaded onto a 15% SDS-polyacrylamide gel, separated, and transferred to a polyvinylidene difluoride membrane with immunoblot analysis performed as described in Bobba et al. (18). Relative optical densities and areas of bands were quantified using the GS-700 imaging densitometer implemented with the Molecular Analyst Software (Bio-Rad). Cytochrome c Assay Cyt c was assayed as in Errede et al. (32) by using the Shimadzu double-wavelength (548 minus 540 nm) spectrophotometer model UV3000. Either the cell homogenate or the resulting supernatant (obtained by centrifuging homogenate at 15,000 × g for 15 min), in the presence of 3 μM rotenone plus 0.8 μM antimycin A and 6 μM myxothiazole, were first incubated with potassium ferricyanide (0.1 mM) to oxidize the reduced cytc, then potassium cyanide (1 mM) was added to inhibit cyt c oxidase. The reduction of cytochromec (ε550 = 21 mM − 1cm− 1) was then obtained by adding a few grains of sodium dithionite as in Atlante et al. (13) and measured as an increase of absorbance. Superoxide Anion Detection in CGCs O⨪2 was detected as in Atlante et al. (11) and Atlante and Passarella (33), according to either the Fe3+-cyt c (34) or the adrenochrom assay (35). The newly formed O⨪2 gives an increase of absorbance at 550 and 480 nm for Fe2+-cyt cand adrenochrom formation, respectively, measured using a PerkinElmer lambda-5 spectrophotometer equipped with a thermostatted holder. A calibration curve is made by using an O⨪2-producing system,i.e. XX + XOD, and an O⨪2 detection system,i.e. epinephrine/Fe3+-cyt c that, in the presence of O⨪2, gives adrenochrom/Fe2+-cytc with a 1:1 stoichiometry. Detection of Superoxide Anion Produced by Mitochondria To detect mitochondrial superoxide anion production, mitochondria (about 0.2 mg of protein) were incubated in 2 ml of PBS in the presence of Fe3+-cyt c (10 μM). The reduction of Fe3+-cyt c that is a result of superoxide formation was then obtained by adding a mitochondrial respiratory substrate such as succinate (5 mM). The increase of absorbance at 550 nm, i.e. Fe2+-cyt cformation (ε550 = 31.7 mM − 1cm− 1), is a measure of O⨪2production by mitochondria. Previous Section Next Section RESULTS In Situ Generated ROS Can Cause Cyt c Release in Cerebellar Granule Cells To assess whether cyt c release takes place due to reactive oxygen species, produced either during GNT or in the presence of a ROS-generating system, two cell culture systems were employed: 1) GLU-CGCs and 2) CGCs, incubated in the presence of the ROS-producing system consisting of xanthine plus xanthine oxidase (ROS-CGCs), previously reported to cause about 60% ROS production under neurotoxicity (11). In both cases cyt c release was measured by two independent procedures: namely, Western blot analysis and polarographic measurement of the activation of cyt c-dependent ascorbate oxidation in cell homogenate (13, 18). This last measurement, at variance with Western blot assessments, allows for the evaluation of whether the released cyt c is still functionally active, a prerequisite for any hypothesis about the possible functional significance of its cytoplasmic location. In the same experiment, the ongoing O⨪2 production was also monitored (Figs.1 and2). View larger version: In this page In a new window Download as PowerPoint Slide Figure 1 Cytochrome crelease from mitochondria and ROS production under glutamate neurotoxicity. Rat CGCs, cultured for 7 days in vitro, were incubated in Locke's solution in the presence of 100 μM glutamate (GLU) or the same volume of Locke's solution alone (C) for 30 min in the absence or presence of either 10 μM allopurinol (Allo) or 1 μM leupeptin (Leu). A, Western blot analysis of cytochrome c. Cytosolic fractions from either control or glutamate-treated cells were analyzed by Western blotting as described under “Experimental Procedures.” The cytosolic content of cytochrome c was measured by densitometric scanning of the film and expressed as a percentage of control cells (C), to which a value of 100 has been given.B, superoxide anion production. Control as well as glutamate treatment were made in the presence of 10 μMFe3+-cyt c. Aliquots (1 ml) of sister culture solutions were taken, and the absorbance of Fe2+-cyt c was measured at 550 nm (for details, see “Experimental Procedures.”). The experimental data are reported as nmol of O⨪2formed/106 cells ± S.E. values. C, oxygen consumption caused by externally added ascorbate. Homogenates (about 0.2 mg of protein) from either control (a) or GLU-CGCs (b) were incubated at 25 °C in 1.5 ml of PBS in the presence of rotenone (3 μM), antimycin (0.8 μM), and myxothiazole (6 μM). Oxygen consumption was started by adding 5 mM ascorbate (ASC). Numbers along the traces are rates of oxygen uptake expressed as nanoatoms of O2min− 1 mg−1 cell of protein. Inc and d glutamate treatment was made in the presence of allopurinol and leupeptin, respectively. In A,B, and C, results are the means ± S.E. of triplicate measurements and are representative of at least six different experiments carried out with different cell preparations obtained from different groups of animals. View larger version: In this page In a new window Download as PowerPoint Slide Figure 2 ROS production due to externally added xanthine/xanthine oxidase system causes cytochrome crelease from mitochondria of control cells. Rat CGCs cultured for 7 days in vitro were incubated in Locke's solution in the absence (C) or presence of 10 μM xanthine plus 1 e.u./ml xanthine oxidase (C+XX/XOD) for 30 min. 5 e.u./ml SOD was present where indicated. A, Western blot analysis of cytochromec. The analysis was carried out as reported in the legend of Fig. 1 A. B, superoxide anion production. The measurements were carried out as reported in the legend of Fig.1 B. C, oxygen consumption caused by externally added ascorbate. The measurements were carried out as described in the legend of Fig. 1 C except that neither allopurinol or leupeptin was used. Numbers along the traces are rates of oxygen uptake expressed as nanoatoms of O2min− 1 mg−1 of cell protein. Inb, ROS treatment was made in the presence of SOD. InA, B, and C, results are the means ± S.E. of triplicate measurements and are representative of at least five different experiments carried out with different cell preparations prepared from different groups of animals. Variations up to 5% were found. As a result of 30-min incubation of CGCs with 100 μMglutamate, a marked increase of cyt c released in the extramitochondrial phase was found with respect to the control, 210 ± 10% as evaluated by Western blot analysis (Fig.1 A), and with respect to the cell homogenate capability to oxidize externally added ascorbate at more than 6-fold increase in the rate of oxygen uptake was measured in GLU-CGC homogenate (Fig.1 C, trace b) as compared with C-CGCs (Fig.1 C, trace a). These data confirm the marked release of cyt c in the extramitochondrial phase (see Ref.13) and that such a pool is functionally active. Under the same experimental conditions, GLU-CGCs had a superoxide anion production, as detected with the ferricytochrome c method, 5–6-fold higher than controls (Fig. 1 B). As expected, the specific inhibitor of XOD activity allopurinol (36) was found to reduce cyt c levels (Fig. 1 A), ROS production (Fig. 1 B), and oxygen consumption rate (Fig.1 C, trace c). Consistently, leupeptin, which is known to specifically inhibit Ca2+-dependent proteases (37, 38) and, consequently, XOD formation (11), strongly prevented both O⨪2 production and cyt c release (Fig. 1, A, B, and C, trace d). Cyt c release was fully prevented by (5R, 10S)-(+)-5-methyl-10,11-dihydro[a,d]cyclohepten-5,10-imine hydrogen maleate (MK801), a specificN-methyl-D-aspartate receptor antagonist, and largely prevented by externally added superoxide dismutase (SOD) (not shown). Controls confirmed that all the compounds failed to influence the assay conditions as shown in an in vitro system in the absence of CGCs. Interestingly, artificial ROS generation with the xanthine (XX) plus XOD system (Fig. 2 B) stimulated cyt c release in C-CGCs, as detected by both Western analysis (254 ± 5%) in the extramitochondrial phase (Fig. 2 A) and polarographic measurement (Fig. 2 C), in good agreement with the results reported in Fig. 1. In both the assays, externally added SOD largely prevented both cyt c release and ROS production (Fig. 2,A, B, C, trace b). It should be noted that in the experiments reported in the Figs. 1 and2 and in the following experiments, the presence of mitochondria in the cytosolic fraction as well as mitochondrial damage due to cell manipulations must be carefully controlled. This was done on the basis of controls performed with filters probed with a monoclonal antibody against cyt c oxidase (subunit IV) and a polyclonal antibody against glutamate dehydrogenase. Moreover, the intactness of the mitochondrial membranes was checked by assaying both adenylate kinase and glutamate dehydrogenase, marker enzymes of the intermembrane and matrix space, respectively, in supernatants of control, ROS, and GLU-CGC homogenates at different times after glutamate exposure. In all cases the activity was negligible (0.5–1%) with respect to that measured in the whole homogenates treated with 0.5% Triton X-100 used to dissolve mitochondria and was always of the same extent within the time of cell harvesting after the glutamate pulse (0–300 min). On the other hand, the possibility that mitochondria can swell in the incubation medium due to the occurrence of Na+/H+ exchange (39), with cyt crelease caused by ROS in only swollen organelles, was also considered. Therefore, in another experiment, the Na+-containing medium was substituted with mannitol medium (consisting of 210 mMmannitol, 60 mM sucrose, 10 mM KCl, 10 mM Hepes, pH 7.5) with no significant change in the experimental findings (not shown). ROS Generation and Cyt c Release Do Not Affect Mitochondrial Coupling We have previously shown that in the early phase of neurotoxicity, mitochondrial coupling in control and GLU-CGCs do not significantly differ from each other when measured in cell homogenates in which cyt c release has already occurred (13). Another set of experiments was carried out to rule out that the ROS-dependent cyt c release is accompanied by mitochondrial uncoupling, as measured with isolated organelles, and, more importantly, to ascertain whether mitochondria can produce ROS under conditions in which cyt c is released. In a typical experiment, mitochondria isolated from both control cells (C-CGC-M) (Fig. 3 A) and 30-min glutamate-treated cells (GLU-CGC-M) (Fig. 3 B) and 3-h glutamate-treated cells (Fig. 3 C) were found to oxidize succinate at a rate equal to 26, 24, and 20 nanoatoms of O2/min × mg of mitochondrial protein, respectively. The addition of 1 mM ADP increased these rates to 56, 48, and 28 nanoatoms of O2/min × mg of mitochondrial protein with a respiratory control ratio equal to 2.2, 2.0, and 1.4, respectively. It is worth noting that no significant difference in mitochondrial coupling was found between control and 30-min glutamate-treated mitochondria (n = 4). That these two treatments do not differ from each other was also shown by the capability of oligomycin (0.1 μg/mg), which inhibits ATP synthase, to decrease with the same efficiency the rate of oxygen uptake in a way reversed by adding the uncoupler carbonyl cyanidep-trifluoromethoxyphenylhydrazone (1 μM). The same mitochondria were analyzed for their capability to produce ROS (Fig. 3, D–E), as detected by the Fe3+-cytc method. Negligible ROS production was found in the control (C-CGC-M), whereas in mitochondria from 30 min glutamate-treated cells, ROS production increased to 3 nmol of O⨪2 formed/min × mg of protein (Fig. 3 D) and further increased to 12 nmol of O⨪2 formed/min × mg of protein in organelles isolated from cells exposed to glutamate for 3 h (Fig. 3 E). In this latter case, large uncoupling and a dramatic decrease in the rate of oxygen uptake takes place (Fig. 3 C) (see also Ref. 8). Control for the release of cyt c was made in the postmitochondrial supernatants and in parallel cell preparations; a significant release of cyt c was found only in the extramitochondrial phase of GLU-CGC organelles. View larger version: In this page In a new window Download as PowerPoint Slide Figure 3 The oxygen uptake and ROS production by either C-CGC-M and GLU-CGC-M added with succinate. Mitochondria (0.2 mg of protein) isolated from rat CGCs cultured for 7 days in vitro and incubated in Locke's solution in the presence of 100 μM glutamate (GLU-CGC-M) or the same volume of Locke's solution alone (C-CGC-M) for either 30 min or 3 h were incubated in 1.5 ml of PBS. A–C, oxygen consumption due to succinate addition to mitochondria. At thearrows, the following additions were made: 5 mMsuccinate (SUCC), 1 mM ADP, 0.1 μg/mg oligomycin (OLIGO), 1 μM carbonyl cyanidep-trifluoromethoxyphenylhydrazone (FCCP), 1 mM cyanide (CN−). The rate of oxygen uptake is expressed as nanoatoms of O2/min × mg of protein.D–E, ROS production due to succinate addition to mitochondria. 5 mM succinate (SUCC) was added to mitochondria incubated with 10 μM Fe3+-cytc. The rate of Fe2+-cyt c production,i.e. superoxide anion formation, was measured as the absorbance increase at 550 nm and expressed as nmol of O⨪2formed/min × mg of protein. The Fraction Containing the Released Cyt c Can Function as a ROS Scavenger and Electron Donor to Oxygen via the Respiratory Chain A set of experiments was carried out to gain some insights into the possible role played by the cyt c released in the extramitochondrial phase. To achieve this, GLU-CGC homogenate was centrifuged, and the capability of the obtained cytosolic fraction (see “Experimental Procedures”), containing cyt c, to function as an electron acceptor from ROS, i.e. as a ROS scavenger, and as an electron donor in the respiratory chain, was determined. The capability of the cytosolic fractions containing cyt c(CCCF) to oxidize the superoxide anion to oxygen was analyzed by monitoring cyt c reduction photometrically as an increase of absorbance at 550 nm (Fig. 4). First, to check the existence of oxidized cyt c in the extract, cytc reduction via dithionite, consistent with Atlante et al. (13), was also verified (see Fig, 4, inset). CCCF preparations, obtained by CGCs treated with glutamate for times ranging from 2 to 300 min, were added to the ROS-producing system, XX + XOD. Cyt c reduction increased with increasing time of exposure of CGCs to glutamate. The CCCF can, therefore, operate as an electron acceptor from the superoxide anion. In another control, the cytosolic fraction obtained from GLU-CGCs incubated in the presence of either SOD or MK801 gave no absorbance increase (not shown). View larger version: In this page In a new window Download as PowerPoint Slide Figure 4 The released cyt c can work as a ROS scavenger. CCCF (200 μl) (prepared as described under “Experimental Procedures”) from either control or GLU-CGCs with different treatment times was incubated in 1.5 ml of PBS in the presence of xanthine oxidase (1 e.u./ml). The CCCF reduction at 550 nm was started with 10 μM XX addition. Triplicate measurements, representative of at least five different experiments, were carried out with different cell preparations prepared from different groups of animals. Variations up to 5% were found. In theinset, the increase of absorbance at 548–540 nm due to the dithionite (Na2S2O4)-dependent reduction of oxidized c-cyt c is reported. XANT, xanthine. To ascertain whether cyt c reduced as a consequence of superoxide anion formation can function as an electron donor to molecular oxygen, mitochondria were added with XX plus XOD (Fig.5), and oxygen consumption was measured at a rate equal to 22 nanoatoms of O2/min × mg of cell protein (Fig. 5 A). As a result of CCCF addition, an increase of the rate of oxygen uptake was found to occur (46 nanoatoms of O2/min × mg of cell protein). The separate addition of either cyanide or allopurinol only partially inhibited the rate of oxygen uptake, which was completely blocked only in the presence of both the inhibitors. In the experiment shown in Fig.5 B, no change in oxygen level occurred after CCCF addition to mitochondria; however, as soon as the ROS-producing system was added, oxygen consumption started with a rate equal to 47 nanoatoms of O2/min × mg of cell protein. Externally added allopurinol was found to decrease this rate of oxygen uptake to 17 nanoatoms of O2/min × mg of protein, with a complete inhibition of oxygen uptake when cyanide (CN−) was added. These findings suggest that the XX + XOD-dependent oxygen consumption is dependent both on the O2 consumption due to superoxide formation (see the scheme in Fig. 4) and on the presence of cyt c released as a result of ROS formation. Consistent with this hypothesis, when CN− was added to block cytc oxidase, the rate of oxygen uptake was found to decrease from 22 ± 1.4 to 18 ± 0.8 nanoatoms of O2/min × mg of cell protein, i.e. about 20% of oxygen consumption is due to cytochrome c oxidase activity (not shown). Thus, as far as CCCF is concerned, the findings reported in Fig. 5 are consistent, as will be discussed, with a two-phase process characterized first by reduction of cyt cpresent in the cytosolic fraction followed by the oxidation of the reduced cyt c acting as an electron donor for cytc oxidase. View larger version: In this page In a new window Download as PowerPoint Slide Figure 5 The released cyt c can work as a respiratory substrate. Mitochondria (0.2 mg of protein) isolated from rat CGCs cultured for 7 days in vitro were incubated in a polarographic vessel at 25 °C in 1.5 ml of PBS. At the arrows, the following addition were made: 10 μM XX plus 1 e.u./ml XOD, 200 μl of CCCF, 10 μM allopurinol (ALLO), 1 mMcyanide (CN−). The rate of oxygen uptake is expressed as nanoatoms (natoms) of O2/min × mg of mitochondrial protein. In the inset, commercial cytc amount versus oxygen consumption rate is reported: A, the rate of O2 consumption due to cyt c added to XX + XOD system; B, the rate of O2 consumption due to cyt c added to the XX + XOD system, from which the rates due only to XX + XOD before and after CN− addition have been subtracted (see “Results”). The experiment reported is representative of at least five experiments carried out with different cell preparations obtained from different groups of animals. Variations up to 5–10% were found. In another experiment, commercial cyt c was added to the C-CGC-M in the presence of XX plus XOD, and the rate of oxygen uptake was measured in the absence or presence of increasing cyt camount (see inset Fig. 5). Oxygen uptake rate was found to depend on the added cyt c in a roughly linear manner. Comparison made between this experiment and Fig. 5 A indicates that CCCF-stimulated rate of oxygen uptake is similar to that found in the presence of 1.5 ± 0.1 μM cyt c(n = 3). It should be noted that the intercept to the ordinate axis of the line fitted on the measurements carried out in the presence of added cyt c coincides with the control experiment in which oxygen uptake is measured in the absence of externally added cyt c. The Fraction Containing the Released Cyt c Can Scavenge Both ROS Production and Prevent Glutamate Neurotoxicity The capability of CCCF to be a ROS scavenger in glutamate-treated CGCs raises the question as to whether the released cyt c could play a role in the cell defense against necrosis. This was investigated by checking ROS production in these cells plus or minus added CCCF (Fig.6 A). In fairly good agreement with Atlante et al. (11), the cultured cells produced O⨪2 at a rate of 4.6 ± 0.51 nmol/106 cells measured in a medium used to monitor superoxide anion production that contains epinephrine (1 mM) (35); externally added CCCF caused partial prevention of epinephrine reduction. This prevention depended on the time of glutamate treatment before CCCF preparation: 26, 33, and 42% prevention was found after 30-, 90-, and 180-min glutamate treatment, respectively. ROS production did not occur in control cultures and was strongly reduced in CGCs that were exposed to glutamate in the presence of SOD (5 e.u./ml) (50%), leupeptin (1 μM) (55%), or allopurinol (10 μM) (60%), in good accordance with Fig. 1 and Atlante et al. (11). Glutamate treatment in the presence of MK801, a classical inhibitor of glutamate receptor N-methyl-D-aspartate, was found to reduce the extent of O⨪2 after glutamate pulse (97%) to control levels. View larger version: In this page In a new window Download as PowerPoint Slide Figure 6 The CCCF effect on both ROS production and cell necrosis. Rat CGCs cultured for 7 days in vitrowere incubated in Locke's solution added with 100 μMglutamate (GLU) for 30 min in the absence or presence of CCCF (200 μl) (prepared as described under “Experimental Procedures”) from GLU-CGCs at different treatment times. MK801 (1 μM), SOD (5 e.u./ml), allopurinol (ALLO, 10 μM), and leupeptin (LEU, 1 μM) separately added. A, superoxide anion production. Control as well as glutamate treatment was made in the presence of 1 mM epinephrine. Aliquots (1 ml) of sister culture solutions were taken, and the absorbance of adrenochrom was measured at 480 nm (for details, see “Experimental Procedures”). The experimental data are reported as nmol of O⨪2 formed/106cells ± S.E. values. B, cell necrosis. The extent of cell death was evaluated by counting viable neurons and is expressed as the percentage of necrotic cells versus total viable cells 24 h after the exposure for 30 min to 100 μMglutamate. Obtained values are within 10% variations in three different experiments. Since CCCF can prevent ROS production in GLU-CGCs, its capability to exert an anti-toxic action comparable with that of antioxidants added to neurons undergoing excitotoxic death (11) is expected. Thus, we analyzed the possibility that CCCF could prevent cell death. Cytosolic fractions (obtained at different times of glutamate treatment), were added to sister cultures of CGCs. These cultures were then subjected to 30-min glutamate pulse, and 24 h later, the extent of cell death was measured (Fig. 6 B). As can be seen, the extent of cell death decreased significantly from 95% to 70, 58, and 40 in cells incubated with fractions prepared after 30-, 90-, and 180-min glutamate exposure, respectively. In the presence of MK801, cell death was almost completely abolished. In another set of experiments, we compared the CCCF antitoxic action with SOD, leupeptin, or allopurinol and found that these substances prevent cell death by 55, 50, and 40%, respectively, in agreement with Atlante et al. (11). Previous Section Next Section DISCUSSION In previous papers dealing with glutamate neurotoxicity in rat CGCs, we have shown partial inhibition of both cell death and the parallel production of reactive oxygen species by incubation with allopurinol, leupeptin, antioxidants, reducing agents, and superoxide dismutase (11) as well as cyt c release (see 13) under conditions in which mitochondrial coupling was not significantly impaired (8, 13). This prompted us to investigate the possible interrelationship between ROS production and cyt c release and the role of the released cyt c in the cytosol. In this paper, we show that ROS generated outside mitochondria can cause cytc release from intact and respiring mitochondria and that the fraction containing the released cyt c can transfer electrons from superoxide anion to molecular oxygen via the respiratory chain. Furthermore, CCCF proved to reduce ROS production in GGCs and to play a significant role in protecting CGCs from glutamate-dependent neurotoxicity, thus suggesting a role for the released cyt c (either alone or together with other cytosolic components) in those processes that occur in glutamate-treated CGCs in the early phase of neurotoxicity. In this respect, cyt c is assumed to play two roles, namely to contribute to energy supply as already reported (13) and to function as a ROS scavenger. Experiments reported in Figs. 1 and 2 demonstrate that cyt crelease is driven by ROS produced by glutamate exposure or by exogenous production via the XX + XOD system. This conclusion was supported by the partial prevention of cyt c release found after SOD addition, which removes superoxide anion, and by specific XOD inhibitors, which prevent ROS formation by impairing XOD activity. The identity of the reactive oxygen species responsible for the observed cyt c release remains to be fully clarified. Indeed, externally added SOD was found to only partially prevent cyt c release (Fig. 2) as well as death necrosis (Fig. 6). It should be noted that SOD has been reported to block cyt c release during apoptosis (40). Since SOD removed superoxide anion while still permitting H2O2 formation that produces OH·, the possibility that this OH· formation can contribute to the cell/mitochondria damage must be taken into consideration. These results together with those showing a low mitochondrial ROS production during cytochrome c release demonstrate that cytc release is mostly dependent on cytosolic ROS production rather than from the mitochondrial impairment that is accompanied by ROS generation (Fig. 3, C and D). Consistent with this hypothesis, mitochondrial function measured in both cell homogenates (see Ref. 8) and in isolated mitochondria (Fig. 3) was not significantly affected in the time intervals in which cyt crelease had already occurred. One of the most critical points to be taken in consideration when discussing in vitro experiments regards the assumption that the observed findings depend on biological processes and are not a result of cell manipulation. Therefore, when discussing the results shown in Figs. 1 and 2, where we show ROS-dependent cytc release, one could argue that cyt c release takes place due to mitochondrial outer membrane damage perhaps enhanced by its greater susceptibility to mechanical disruption during homogenization and centrifugation rather than being due to whatever ROS was produced. Our findings rule out such a possibility, since cytc release occurred under conditions in which neither glutamate dehydrogenase nor, more importantly, adenylate kinase were significantly released. Thus, mitochondria damage as a cause of cytc release must be excluded, at least at the beginning of neurotoxicity. On the other hand, the constantly low levels of leaked adenylate kinase and glutamate dehydrogenase in CCCF observed after different glutamate exposure times (ranging between 0–2 h) and the finding that mitochondria, both isolated and when studied in cell homogenate, are coupled and can synthesize ATP under conditions in which cyt c is already mostly released, definitely confirms that cyt c release is a physiological occurrence and not the result of laboratory manipulation. We further rule out that the cytc release is caused by the interaction of swollen mitochondria with ROS given that cyt c release occurs also in a Na+-free medium in which no mitochondrial swelling takes place. Differently from apoptosis, in GNT the involvement of the mitochondrial transition pore (41, 42) in the release of cytc can be ruled out in light of the lack of adenylate kinase leakage that is expected to occur if cyt c release was dependent on the pore. Although at present the exact amount of cyt c release cannot be evaluated with certainty, the calibration curve made with commercial cyt c, added to isolated C-CGC-M in the presence of XX + XOD, suggests CCCF contained about 1.5 μM cytc (see Fig. 5). This is in a fairly good agreement with measurements already reported (13) of the mitochondrial cytc variation in neurotoxicity. The results of Fig. 4, in which the capability of CCCF to work as a ROS scavenger is directly shown, raises the question as to its mechanism. Indeed, we observed a large prevention in the ROS production when CCCF was added outside the CGCs, whereas in vivo the scavenger role of the released cyt c should occur in the cytosol with higher efficiency. Whether other compound(s) different from cytc are also present in the extract as a potential ROS scavenger(s) must be taken into consideration. Nonetheless, although we cannot exclude the presence of another electron carrier(s) in the cytosolic fraction released from mitochondria, there is no doubt that cyt c is at least one of them. However, since externally added cyt c is reduced similarly in extracts from control cells, we are in favor of the possibility of a direct, unique electron transfer from superoxide anion to cyt c. Such a proposal is consistent with the calibration curve reported in the inset of Fig. 5in which the coincidence of the intercept with the experimental point obtained in the absence of externally added cyt c could rule out the involvement of other unknown electron carriers. Future studies by immunodepletion experiments could shed light on this problem. Interestingly, while this work was in progress, the antioxidant function of cyt c was shown in the light of the capability of externally added cyt c to prevent ROS production in rat heart mitochondria (43). We demonstrate in this paper that the reduced cyt c released from mitochondria causes oxygen consumption in isolated mitochondria (Fig. 5), i.e. it functions as a respiratory substrate. The CN− inhibition demonstrates that this O2 reduction takes place via cyt c oxidase; thus, we are forced to conclude that CCCF can be oxidized via this enzyme. How this occurs remains to be established in detail, since the direct oxidation via cyt c oxidase at mitochondrial contact sites, as suggested (44), is difficult to explain considering both the structure of the cytochrome oxidase complex and its apparent inability to span the two mitochondrial membranes. The capability of the cytosolic fraction containing cyt c to partially prevent both ROS formation and cell death (Fig. 6) is consistent with the above discussed results. Indeed, we found a high efficiency in prevention of both ROS detection and death by adding the cytosolic fraction obtained by neurons exposed to glutamate to cell cultures ongoing neurotoxicity. Surprisingly, even though the cytc assayed in the cytosolic fractions obtained from 1- and 3-h-treated neurons is more than 2-fold greater than controls (see Ref.13 and Figs. 1 and 2), the death prevention was not consistently higher. At present, this point must be only a matter of speculation; we suggest the possibility that during neurotoxicity other processes at present unknown are evoked that contribute to cell death, thus reducing the ability of cyt c to protect. Nonetheless, we propose that the cyt c release from mitochondria owing to ROS production in a feedback-like process can protect mitochondria both from mitochondrial ROS as well as from ROS generated by other cellular constituents, including the XX plus XOD system, as previously suggested (13, 33). On the other hand, long glutamate treatment results in a permanent damage of mitochondria and large uncoupling that occurs simultaneously with high mitochondrial ROS production (see Fig. 3). Future studies should be aimed at assessing whether the role suggested for cyt c in this paper in connection with excitotoxic pathways may also hold in neuronal apoptotic death, where a role for the released cyt c only in the caspase cascade activation (14-23) and in the maintenance of adequate cell ATP (18) has to our knowledge has been attributed. Previous Section Next Section ACKNOWLEDGEMENTS We thank Dr. Stephan Reshkin for the critical review of this manuscript and Vito Giannoccaro for excellent technical assistance. Previous Section Next Section Footnotes ↵* This work was partially financed by PRIN Bioenergetica e Trasporto di Membrana (MURST), Fondi di Ricerca di Ateneo del Molise (to S. P.), Programma Biotecnologie legge 95/95 MURST (to P. C.), and by Programma, Operativo Plurifond Molise and European Union 1994-99 fund. A preliminary account of this work was presented at the Keystone Symposia Mitochondrial Dysfunction in Pathogenesis, January 15–20, 2000, Santa Fe, New Mexico.The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. ↵‖ To whom correspondence should be addressed. 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