Tetrahydrobiopterin metabolism in mental disorders

Changes in DHPR activity in those aged 12 and under with a variety of mental disorders were investigated using dried blood spots on Guthrie cards. DHPR activity was found to be lowered in autism and Rett's syndrome. DHPR activity was unaffected in non specific mental retardation suggesting that the deficit seen in autism and Rett's syndrome does not arise secondary to the mental dysfunction. In Down's syndrome blood biopterin levels correlated with blood spot DHPR activity. Human brain BH4 synthetic activity was investigated in aging and senile dementia of the Alzheimer type (SDAT). BH4 synthetic activity and DHPR activity decline with age in non-demented controls. In SDAT, decreases in BH4 synthetic activity were seen in temporal and visual cortices and locus coeruleus. The site of the defect is probably at 6-pyruvoyl-tetrahydropterin synthase. Aluminium inhibits human brain BH4 synthesis in vitro and produces an `Alzheimeresque' pattern of abnormalities in rats chronically exposed to the acetate salt in drinking water. Aluminium appears to chiefly affect enzymes requiring a metal ion cofactor. Aluminium induced inhibition of BH4 synthesis can be reversed by treatment with transferrin, an aluminium chelator. Transferrin treatment improves BH4 synthetic activity in SDAT brains whilst having no effect on controls, further implicating aluminium as the key neurotoxin in SDAT. Lithium inhibits human brain BH4 synthesis in vitro and lowers rat brain total biopterins and inhibits rat brain BH4 synthesis on chronic exposure to the carbonate salt in drinking water. A possible mechanism for the anti-manic actions of lithium is suggested. Monoamine oxidase inhibitors decrease human brain BH4 synthetic activity in vitro. 5-methyl-tetrahydrofolate had no effect on human brain BH4 synthesis in vitro but methionine increased BH4 synthesis in vitro. Oxotremorine is a potent inhibitor of BH4 synthesis in man and the rat. This may prove useful as a tool for modelling BH4 deficiency.

Bidirectional transport between the trans-Golgi network and the endosomal system

The exchange of proteins and lipids between the trans-Golgi network (TGN) and the endosomal system requires multiple cellular machines, whose activities are coordinated in space and time to generate pleomorphic, tubulo-vesicular carriers that deliver their content to their target compartments. These machines and their associated protein networks are recruited and/or activated on specific membrane domains where they select proteins and lipids into carriers, contribute to deform/elongate and partition membrane domains using the mechanical forces generated by actin polymerization or movement along microtubules. The coordinated action of these protein networks contributes to regulate the dynamic state of multiple receptors recycling between the cell surface, endosomes and the TGN, to maintain cell homeostasis as exemplified by the biogenesis of lysosomes and related organelles, and to establish/maintain cell polarity. The dynamic assembly and disassembly of these protein networks mediating the exchange of membrane domains between the TGN and endosomes regulates cell-cell signalling and thus the development of multi-cellular organisms. Somatic mutations in single network components lead to changes in transport dynamics that may contribute to pathological modifications underlying several human diseases such as mental retardation.

Photosensitive benign myoclonic epilepsy in infancy

Purpose: To describe the electroclinical features of subjects who presented with a photosensitive benign myoclonic epilepsy in infancy (PBMEI). Methods: The patients were selected from a group of epileptic subjects with seizure onset in infancy or early childhood. Inclusion criteria were the presence of photic-induced myoclonic seizures and a favorable outcome. Cases with less than 24 month follow up were excluded from the analysis. Results: Eight patients were identified (4 males, 4 females). Personal history was uneventful. All of them had familial antecedents of epilepsy. Psychomotor development was normal in 6 cases, both before and after seizure onset. One patient showed a mild mental retardation and a further patient showed some behavioral disturbances. Neuroradiological investigations, when performed (5 cases), gave normal results. The clinical manifestations were typical and could vary from upward movements of the eyes to myoclonic jerks of the head and shoulders, isolated or briefly repetitive, never causing a fall. Age of onset was between 11 months and 3 years and 2 months. Characteristically, the seizures were always triggered by photic stimulation. Non photo-induced spontaneous myoclonic attacks were reported in 2 cases during the follow-up. Other types of seizures were present at follow-up in 2 cases. The outcome was favorable, even if, usually, seizure control required high AED plasma levels. Since the clinical symptoms were not recognized early, some patients were treated only many years after the onset of symptoms. Conclusion: Among BMEI patients, our cases constitute a subgroup in which myoclonic jerks were always triggered by photostimulation, in particular at onset of their epilepsy. © 2006 International League Against Epilepsy.

A case of bilateral perisylvian syndrome with reading disability

Bilateral Perisylvian Syndrome (BPS) often presents with epilepsy and significant behavioral impairments that can include mental retardation, dysarthria, delayed speech development, and delayed fine motor development (Graff-Radford et al., 1986 and Kuzniecky et al., 1993). While a small subset of BPS cases have been described as having relatively isolated language delays (Leventer et al., 2010), BPS is not expected in children with dyslexia. As part of a Medical University of South Carolina, IRB approved multi-site study involving retrospective and de-identified dyslexia data, we unexpectedly identified a 14.05 year old male with evidence of BPS whose father had been diagnosed with dyslexia and dysgraphia. This child had been recruited for a neuroimaging study on dyslexia from a school specializing in educating children with dyslexia. The T1-weighted MRI scan from this child demonstrated a highly unusual perisylvian sulcal/gyral patterning that is a defining feature of BPS (Fig. 1). BPS cases exhibit bilateral dysgenesis of the Sylvian fissure and surrounding gyri, which appears to occur because of a limited or absent arcuate fasciculus (Kilinc, Ekinci, Demirkol, & Agan, 2015). This BPS case also had a relatively enlarged atrium of the lateral ventricle that is consistent with the BPS anatomical presentation and reduction of parietal white matter (Graff-Radford et al., 1986, Kilinc et al., 2015 and Toldo et al., 2011).