Sitagliptin in Glutamic Acid Decarboxylase Antibody-Positive Diabetes Mellitus

ObjectiveTo describe a case illustrating the use of sitagliptin, an inhibitor of dipeptidyl-peptidase-4 (DPP-4), in anti-glutamic acid decarboxylase antibody-positive diabetes mellitus in association with a rare ataxic variant of stiff person syndrome.MethodsWe present our experience with use of the DPP-4 inhibitor sitagliptin for management of autoimmune diabetes in a elderly woman and highlight the association of diabetes with other autoimmune conditions.ResultsA 68-year-old Japanese woman presented with poorly controlled “type 2” diabetes mellitus, cerebral palsy, cerebellar ataxia, and hypothyroidism. She complained of stiffness and spasms, which had resulted in multiple falls and immobility. Antidiabetic medications included gliclazide, rosiglitazone, and acarbose; various insulins had been tried but discontinued because they worsened her stiffness and spasms. Her hemoglobin A_1c values remained above 9% despite maximal doses of the aforementioned orally administered hypoglycemic agents. After sitagliptin therapy was initiated, her hemoglobin A_1c level decreased from 9.3% (78 mmol/mol) to 7.3% (56 mmol/mol) in 5 months. Investigations confirmed the presence of an ataxic variant of stiff person syndrome. On repeated testing 18 months later, her anti-glutamic acid decarboxylase antibody levels had declined by more than 85%.ConclusionApart from the well-known mechanism of an increase in glucagonlike peptide-1, sitagliptin may exert its glucose-lowering effect by other mechanisms in patients with autoimmune diabetes. Further studies should be undertaken to address the effectiveness of DPP-4 inhibitors in non-type 2 diabetes. (Endocr Pract. 2012;18: e65-e68)     

Co-localization of Glutamic Acid Decarboxylase and Phosphate-activated Glutaminase in Neurons of Lateral Reticular Nucleus in Feline Thalamus

Immunohistochemical methods were used to label singly and/or in combination glutamic acid decarboxylase (GAD, the sole synthesizing enzyme for the inhibitory neurotransmitter γ-aminobutyric acid) and phosphate-activated glutaminase (GLN, a synthesizing enzyme for glutamate) in neurons of lateral reticular nucleus (LRN) of thalamus of adult cats. (1) GAD- and GLN-immunoreactivity (IR) exhibited matching regional patterns of organization within LRN. (2) GAD- and GLN-IR co-localized within most if not all LRN neuronal cell bodies as shown by light microscopy. (3) GAD- and GLN-IR had distinct subcellular localizations in LRN neurons as shown by correlative light/electron microscopy. LRN neurons are important conceptual models where strongly inhibitory cells receive predominant excitatory glutamatergic afferents (from neocortex). Consistent with known actions of intermediary astrocytes, LRN neurons demonstrate GLN enrichment synergistically coupled with glutamatergic innervation to supplement the glutamate pool for GABA synthesis (via GAD) and for metabolic utilization (via the GABA shunt/tricarboxylic acid cycle) but not, apparently, for excitatory neurotransmission. Special issue dedicated to John P. Blass.     

钾通道在培养大鼠海马神经元凋亡性容积减少中的作用

为探讨钾通道参与神经元凋亡的可能机制,在星形孢菌素（STS)诱导的培养海马神经元凋亡模型上,研究了凋亡时神经细胞容积的动态变化及钾通道在其中的作用.实验结果显示,钾通道阻断剂四乙铵或升高细胞外K⁺均能够明显抑制STS诱导的神经元凋亡,并且大电导钙激活钾通道（BK）选择性阻断剂iberiotoxin和paxilline具有同样程度的抗细胞凋亡作用,表明钾通道（可能主要是BK通道）参与了STS诱导的培养海马神经元凋亡.在STS诱导神经元凋亡的早期就出现了细胞容积的显著减少,而钾通道阻断剂或升高细胞外K⁺均可阻断该细胞容积减少.研究结果提示细胞内钾离子的外流可能参与了凋亡性细胞容积减少,这也可能是钾通道介导细胞凋亡的重要机制之一.     

谷氨酸脱羧酶与Ⅰ型糖尿病发病机制

谷氨酸脱羧酶（glutamic acid decarboxylase,GAD）与Ⅰ型糖尿病（type 1 diabetes,T1DM）的发病有很大关系,被认为是Ⅰ型糖尿病发病的自身免疫启动靶抗原。谷氨酸脱羧酶对于Ⅰ型糖尿病的预测、诊断、预防和治疗都有很大应用价值。该文阐述了谷氨酸脱羧酶的最新研究进展,以及谷氨酸脱羧酶与Ⅰ型糖尿病自身免疫发病机制的联系。     

Characterization of Glutamic Acid Decarboxylase Activity in Cerebral Blood Vessels

Abstract: Glutamic acid decarboxylase activity associated with cerebral blood vessels appears to be part of a specific cerebrovascular system involving γ-aminobutyric acid. This activity was characterized kinetically and pharmacologically and compared with that in brain and several nonneuronal tissues. Formation of γ-aminobutyric acid from [¹⁴C]glutamate was measured in a soluble extract of pia-arachnoid blood vessels isolated from bovine brain. The vascular activity was like brain glutamate decarboxylase in that it required pyridoxal phosphate, was completely inhibited by aminooxyacetic acid, and had a similar affinity for glutamate. Cerebrovascular decarboxylase activity differed, however, from brain decarboxylase in that it was less sensitive to sulfhydryl reagents, was stimulated by 3-mercaptopropionic and cysteic acids, and was competitively inhibited by cysteine sulfinic acid. The glutamate decarboxylase activity of the cerebral vessels was similar to that in renal cortex and mesenteric blood vessels in its responses to sulfhydryl reagents and 3-mercaptopropionic acid. These findings are consistent with previous suggestions of a nonneuronal form of the enzyme and offer the possibility that synthesis of γ-aminobutyric acid in cerebral blood vessels can be manipulated independently from that in neuronal tissue.     

Striatal Expression of Glutamic Acid Decarboxylase Gene in Alzheimer's Disease

Abstract: To examine potential alteration of GABAergic striatal neurons in Alzheimer's disease, we used quantitative in situ hybridization to analyze the messenger RNA coding for M_r 67,000 glutamic acid decarboxylase (GAD₆₇ mRNA) in the striatum of five patients with Alzheimer's disease (AD) and nine matched control subjects. We found a 51–57% increase in the optical density of hybridization signal in the caudate nucleus and putamen, corresponding to a 30–42% increase in the number of neurons expressing a detectable amount of GAD₆₇ mRNA. By contrast, no alteration was observed in the ventral striatum. The expression of GAD₆₇ mRNA per neuron was similar in AD and control subjects both in the dorsal and ventral striatum. Taken together, our data indicate that, in AD, GABAergic neurotransmission is increased in the dorsal striatum but not in the ventral striatum. We suggest that this increased GABAergic neurotransmission may explain extrapyramidal signs often observed in AD.     

Some Characteristics of Glutamic Acid Decarboxylase of Chick Ampullary Cristae

Abstract: In a previous study, it was demonstrated that enzyme-mediated γ-aminobutyric acid (GABA) synthesis occurs in the vestibule of the chick inner ear. As deeper knowledge of the properties of its synthesizing enzyme might contribute to the understanding of the role of GABA in inner ear function, some characteristics of glutamate decarboxylase (GAD) were studied in chick isolated ampullary cristae under conditions in which ¹⁴CO₂ release from [1-¹⁴C]glutamate and [¹⁴C]GABA formation from [U-¹⁴C]glutamate for estimating GAD activity were equal. It was found that K _m for glutamate is 5 m M and that the enzyme pH optimum is 7.3. These values fall within the range described for the corresponding enzyme in nervous tissue of other species. Pyridoxal phosphate (PLP) activates the enzyme and aminooxyacetic acid inhibits it, the same as these agents activate or inhibit GAD from several nervous tissue sources. 2-Mercaptoethanol shows some protection from inactivation of the PLP-de-pendent enzyme and Triton X-100 exerts some inhibition of vestibular GAD activity, as previously shown in other nervous tissue preparations. Although its cellular localization is at present uncertain, these results indicate that GAD of chick vestibular tissue possesses properties resembling those of the brain enzyme and might be controlled in a manner similar to that of GAD in brain, thus possibly participating in the regulation of inner ear function.     

Co-Expression of Glutamic Acid Decarboxylase Isoform 67, Membrane Nicotinic Acetylcholine Receptors,and Connexin 36 in Ischemia-Resistant Hippocampal Interneurons

As is known, hippocampal pyramidal neurons are highly sensitive to cerebral ischemia, while some other hippocampal neurons (particularly, interneurons) survive and keep their functional activity under these conditions for a longer time. We studied interneurons of the rat hippocampal organotypic culture after 30-min-long oxygen-glucose deprivation (OGD) using immunohistochemical approaches. Four and 24 h after OGD, the somata of interneurons with no signs of degeneration (revealed by propidium iodide, PI, staining) were immunopositive to antibodies against glutamic acid decarboxylase isoform 67 (GAD67) and to an extracellular domain of a7 nicotinic acetylcholine receptor (nAChR) but negative with respect to choline acetyltransferase (ChAT). GAD67/nAChR-positive interneurons were abundant within all layers of the hippocampal CA1-CA4 zones and also in the dentate gyrus. Co-localized GAD67/nAChR immunopositivity was also observed on numerous punctuate terminals close to the somata of pyramidal neurons stained by PI. After OGD followed by incubation with a blocker of gap junctions, carbenoxolone, only single PI-stained units were revealed in the pyramidal layer. In experiments with connexin 36 cyan fluorescent protein (Cx36-CFP) on gene-reporter mice, we have found that the combination of GAD67/nAChR immunopositivity and ChAT negativity in the hippocampus is specific for the interneuronal somata expressing Cx36-CFP, a component of electrotonic gap contacts in the neuronal networks. Our results indicate that OGD-resistant hippocampal interneurons display co-localization of GAD67, a7 nAChR, and Cx36-CFP. By these neurochemical features, OGD-resistant neurons can be classified as inhibitory GABA-ergic acetylcholine-sensitive interneurons able to couple electrotonically with other hippocampal units through Cx36-CFP-containing gap junctions. The existence of hippocampal interneurons coexpressing the above factors shows that further investigations towards elucidation of cooperative endogenic mechanisms responsible for cerebral neuroresistance are expedient.     

Live Imaging of Dense-core Vesicles in Primary Cultured Hippocampal Neurons

Observing and characterizing dynamic cellular processes can yield important information about cellular activity that cannot be gained from static images. Vital fluorescent probes, particularly green fluorescent protein (GFP) have revolutionized cell biology stemming from the ability to label specific intracellular compartments and cellular structures. For example, the live imaging of GFP (and its spectral variants) chimeras have allowed for a dynamic analysis of the cytoskeleton, organelle transport, and membrane dynamics in a multitude of organisms and cell types [1-3]. Although live imaging has become prevalent, this approach still poses many technical challenges, particularly in primary cultured neurons. One challenge is the expression of GFP-tagged proteins in post-mitotic neurons; the other is the ability to capture fluorescent images while minimizing phototoxicity, photobleaching, and maintaining general cell health. Here we provide a protocol that describes a lipid-based transfection method that yields a relatively low transfection rate (~0.5%), however is ideal for the imaging of fully polarized neurons. A low transfection rate is essential so that single axons and dendrites can be characterized as to their orientation to the cell body to confirm directionality of transport, i.e., anterograde v. retrograde. Our approach to imaging GFP expressing neurons relies on a standard wide-field fluorescent microscope outfitted with a CCD camera, image capture software, and a heated imaging chamber. We have imaged a wide variety of organelles or structures, for example, dense-core vesicles, mitochondria, growth cones, and actin without any special optics or excitation requirements other than a fluorescent light source. Additionally, spectrally-distinct, fluorescently labeled proteins, e.g., GFP and dsRed-tagged proteins, can be visualized near simultaneously to characterize co-transport or other coordinated cellular events. The imaging approach described here is flexible for a variety of imaging applications and can be adopted by a laboratory for relatively little cost provided a microscope is available.     

Perampanel Inhibition of AMPA Receptor Currents in Cultured Hippocampal Neurons

Perampanel is an aryl substituted 2-pyridone AMPA receptor antagonist that was recently approved as a treatment for epilepsy. The drug potently inhibits AMPA receptor responses but the mode of block has not been characterized. Here the action of perampanel on AMPA receptors was investigated by whole-cell voltage-clamp recording in cultured rat hippocampal neurons. Perampanel caused a slow (τ∼1 s at 3 µM), concentration-dependent inhibition of AMPA receptor currents evoked by AMPA and kainate. The rates of block and unblock of AMPA receptor currents were 1.5×10⁵ M⁻¹ s⁻¹ and 0.58 s⁻¹, respectively. Perampanel did not affect NMDA receptor currents. The extent of block of non-desensitizing kainate-evoked currents (IC₅₀, 0.56 µM) was similar at all kainate concentrations (3–100 µM), demonstrating a noncompetitive blocking action. Parampanel did not alter the trajectory of AMPA evoked currents indicating that it does not influence AMPA receptor desensitization. Perampanel is a selective negative allosteric AMPA receptor antagonist of high-affinity and slow blocking kinetics.     

Corticosterone Enhances Kainic Acid-Induced Calcium Elevation in Cultured Hippocampal Neurons

Abstract: Corticosterone, a steroid secreted during stress, increases hippocampal neuronal vulnerability to excitotoxins, hypoxia-ischemia, and antimetabolites. Energy supplementation and N -methyl-d-aspartate receptor antagonists prevent this corticosterone-enhanced neurotoxicity. Because neuronal calcium regulation is energy dependent and a large calcium influx accompanies N -methyl-d-aspartate receptor activation, we investigated whether corticosterone exacerbates the elevation of hippocampal neuronal calcium induced by the glutamatergic excitotoxin kainic acid. Corticosterone caused a 23-fold increase in the magnitude of the calcium response to kainic acid, a sevenfold increase in the peak magnitude of the calcium response, and a twofold increase in calcium recovery time. This corticosterone effect may be energetic in nature as corticosterone decreases hippocampal neuronal glucose transport. Glucose supplementation reduced the corticosterone effect on the magnitude and peak magnitude of the calcium response to kainic acid. Glucose reduction, by the approximate magnitude by which corticosterone inhibits glucose transport, mimicked the corticosterone effect on the peak magnitude of the calcium response to kainic acid. Thus, corticosterone increases calcium after kainic acid exposure in hippocampal neurons in an energy-dependent manner. Elevated calcium is strongly implicated in stimulating neurotoxic cascades during other energetic insults and may be the mechanism for the corticosterone-induced hippocampal neuronal vulnerability and toxicity.     

Effects of Variations in Glutamic Acid Decarboxylase Activity on Acute Oxygen Poisoning

Abstract— A study was made to test the influence of rapid variations in glutamic acid decarboxylase (GAD) activity on the susceptibility of rats to hyperbaric oxygen (HBO). GAD was inhibited by the convulsant drug unsymmetrical dimethylhydrazine (UDMH) and reactivated by pyridoxine (PYR) after onset of convulsive activity. There was a relatively long induction period after UDMH injection until the onset of convulsions and the predictable interictal periods between successive periodic convulsions made it possible to study the impact of variations in GAD activity on survival rates, suspectibility to HBO and brain glycogen levels in a time sequence after UDMH administration. The experiments showed that UDMH interferes with aerobic metabolism in brain in such a way that profound alterations in resistance to acute oxygen poisoning resulted. An accumulation of substrate proximal to the enzyme block is assumed to develop during UDMH poisoning. The protective effect against HBO toxicity that was achieved after reactivation of GAD by PYR injection, as well as the rapid re-establishment of glycogen levels, is believed to speak in favour of this hypothesis.     

Phylogenesis of Brain Glutamic Acid Decarboxylase from Vertebrates: Immunochemical Studies

Brain high-speed supernatants from various lower and higher vertebrates were subjected to sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis, electroblot on nitrocellulose membranes, and immunolabelling using an anti-glutamic acid decarboxylase (anti-GAD) antiserum prepared from rat antigen. Rat brain extracts showed two distinct immunolabelled bands (MW 59,000 and 62,000 daltons). The molecular weight of the native enzyme was 120,000 daltons. The immunoblot pattern was not affected by a 3-h incubation of the homogenate. In the substantia nigra, the decrease in the immunolabelling of both bands corresponded very closely to the decrease of GAD activity following lesioning of the striato-nigral pathway. Moreover, experiments with preadsorbed antiserum showed that both subunits have common antigenic determinants. The immunolabelling was consistently more intense over the lightest band. The autoradiography of immunoprecipitated rat brain GAD, iodinated prior to electrophoresis, revealed two radiolabelled bands corresponding to the two immunolabelled ones. Their radioactivity was found in a one-to-five ratio which closely paralleled their respective immunolabelling intensity. Thus, the two subunits recognized by the antiserum are not present in stoichiometric proportions in the rat brain high-speed supernatant. These findings suggest the existence of two homodimeric GAD with common antigenic determinants which are present in different amounts. Immunoprecipitation curves of brain GAD from rat, mouse, rabbit, monkey, human, quail, frog, and trout were similar, with a less than 10-fold maximum shift in affinity for GAD. GAD immunoblots from the various higher vertebrates showed a pattern similar to that obtained in rat.(ABSTRACT TRUNCATED AT 250 WORDS)     

大鼠脑谷氨酸脱羧酶基因的cDNA克隆及序列分析

胰岛β－细胞自身抗原蛋白之一是脑中谷氨酸脱羧酶（Ｇｌｕｔａｍｉｃａｃｉｄｄｅｃａｒｂｏｘｙｌａｓｅ,ＧＡＤ,ＥＣ４．１．１．１５）同源物。以双链ｃＤＮＡ为模板,用ＰＣＲ方法快速克隆了Ｗｉｓｔａｒ大鼠脑ＧＡＤ基因的ｃＤＮＡ,将此包括编码５９３个氨基酸的全长ＤＮＡ片段重组入ｐＵＣ质粒并用双脱氧末端终止法测定了全部序列,证明其全长为１７７９ｂｐ．经比较发现Ｗｉｓｔａｒ大鼠脑与Ｒｕｓｓｅｌｌ报导的大鼠脑ＧＡＤ基因序列,有一处碱基的差别,但并不涉及氨基酸的改变。同时还对用ＰＣＲ扩增长片段ＤＮＡ进行了方法学上的探讨。     

Glutamic Acid Decarboxylase-Containing Neurons in the Dorsal Column Nuclei of the Cat

The retrograde transport of horseradish peroxidase (HRP) and immunocytochemistry for glutamic acid decarboxylase (GAD) have been employed to examine whether local circuit neurons (LCNs) exist in the dorsal column nuclei (DCN) and whether these neurons may be GABA-ergic. Observations focused on the dorsal part of the middle cuneate nucleus (MCd), since this region has been previously shown to contain projecting neurons whose axons terminate almost exclusively in the contralateral thalamus. After large injections of HRP in the nucleus ventralis posterolateralis and surrounding structures of the feline thalamus, the majority of neurons in MCd are labeled. These represent about 89% of the neurons in MCd as counted in 40-μm frozen sections, and about 69% as counted in plastic-embedded, 2.5-μm-thick section. Unlabeled by the same injections are some medium to largeneurons at the dorsal rim of MCd, and many characteristically small (X ±250/μm²) neurons at the periphery of the cell clusters formed by thalamic-projecting neurons. These small neurons represent 10-12% of the neuronal population of MCd, as counted in 40-μm-thick frozen sections, and about 30%, as counted in plastic-embedded, 2.5-μm-thick sections. Neurons in this size range are also unlabeled after injection of retrograde tracer in the pretectal area, inferior and superior colliculi, inferior olivary complex, and/or spinal cord. These injections, however, result in the labeling of neurons along the dorsal rim of MCd and/or in other regions of the cuneate nucleus.

In adult, colchicine-treated cats, the use of anti-GAD serum reveals a population of labeled neurons uniformly distributed throughout the DCN. In MCd, these are small (X =±235 μm²) neurons mainly intercalated between cell clusters, and represent about 25% of the neuronal population of this nuclear subdivision as counted in plastic-embedded, 2.5-μm-thick sections. Labeled processes densely infiltrate the cell clusters, and labeled varicosities appear to cover the soma and dendrites of unlabeled neurons. At the electron-microscopic level, most labeled profiles contain vesicles and correpond to F boutons usually involved in “axoaxonic” contacts with terminals of dorsal root afferent and presynaptic to dendrites. Other vesicle-containing, GAD-positive endings seem to correspond to the P boutons described by Ellis and Rustioni (1981) and are believed to be, at least in part, of dendritic origin. It is suggested that GAD-positive neurons are GABA-ergic LCNs and that these can mediate both pre- and postsynaptic inhibition. Their integrative role is likely to be more complex than postulated by previous electrophysiological studies.