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Background Periventricular extracellular oedema, myelin damage, inflammation, and glial reactions are common neuropathological events that occur in the brain in congenital hydrocephalus. The periventricular white matter is the most affected region. The present study aimed to identify altered molecular and cellular biomarkers in the neocortex that can function as potential therapeutic targets to both treat and evaluate recovery from these neurodegenerative conditions. The hyh mouse model of hereditary hydrocephalus was used for this purpose. Methods The hyh mouse model of hereditary hydrocephalus (hydrocephalus with hop gait) and control littermates without hydrocephalus were used in the present work. In tissue sections, the ionic content was investigated using energy dispersive X-ray spectroscopy scanning electron microscopy (EDS-SEM). For the lipid analysis, matrix-assisted laser desorption ionization mass spectrometry imaging (MALDI-MSI) was performed in frozen sections. The expression of proteins in the cerebral white matter was analysed by mass spectrometry. The oligodendrocyte progenitor cells (OPCs) were studied with immunofluorescence in cerebral sections and whole-mount preparations of the ventricle walls. Results High sodium and chloride concentrations were found indicating oedema conditions in both the periventricular white matter and extending towards the grey matter. Lipid analysis revealed lower levels of two phosphatidylinositol molecular species in the grey matter, indicating that neural functions were altered in the hydrocephalic mice. In addition, the expression of proteins in the cerebral white matter revealed evident deregulation of the processes of oligodendrocyte differentiation and myelination. Because of the changes in oligodendrocyte differentiation in the white matter, OPCs were also studied. In hydrocephalic mice, OPCs were found to be reactive, overexpressing the NG2 antigen but not giving rise to an increase in mature oligodendrocytes. The higher levels of the NG2 antigen, diacylglycerophosphoserine and possibly transthyretin in the cerebrum of hydrocephalic hyh mice could indicate cell reactions that may have been triggered by inflammation, neurocytotoxic conditions, and ischaemia. Conclusion Our results identify possible biomarkers of hydrocephalus in the cerebral grey and white matter. In the white matter, OPCs could be reacting to acquire a neuroprotective role or as a delay in the oligodendrocyte maturation.

Background In obstructive congenital hydrocephalus, cerebrospinal fluid accumulation is associated with high intracranial pressure and the presence of periventricular edema, ischemia/hypoxia, damage of the white matter, and glial reactions in the neocortex. The viability and short time effects of a therapy based on bone marrow-derived mesenchymal stem cells (BM-MSC) have been evaluated in such pathological conditions in the hyh mouse model. Methods BM-MSC obtained from mice expressing fluorescent mRFP1 protein were injected into the lateral ventricle of hydrocephalic hyh mice at the moment they present a very severe form of the disease. The effect of transplantation in the neocortex was compared with hydrocephalic hyh mice injected with the vehicle and non-hydrocephalic littermates. Neural cell populations and the possibility of transdifferentiation were analyzed. The possibility of a tissue recovering was investigated using 1H High-Resolution Magic Angle Spinning Nuclear Magnetic Resonance (1H HR-MAS NMR) spectroscopy, thus allowing the detection of metabolites/osmolytes related with hydrocephalus severity and outcome in the neocortex. An in vitro assay to simulate the periventricular astrocyte reaction conditions was performed using BM-MSC under high TNFα level condition. The secretome in the culture medium was analyzed in this assay. Results Four days after transplantation, BM-MSC were found undifferentiated and scattered into the astrocyte reaction present in the damaged neocortex white matter. Tissue rejection to the integrated BM-MSC was not detected 4 days after transplantation. Hyh mice transplanted with BM-MSC showed a reduction in the apoptosis in the periventricular neocortex walls, suggesting a neuroprotector effect of the BM-MSC in these conditions. A decrease in the levels of metabolites/osmolytes in the neocortex, such as taurine and neuroexcytotoxic glutamate, also indicated a tissue recovering. Under high TNFα level condition in vitro, BM-MSC showed an upregulation of cytokine and protein secretion that may explain homing, immunomodulation, and vascular permeability, and therefore the tissue recovering. Conclusions BM-MSC treatment in severe congenital hydrocephalus is viable and leads to the recovery of the severe neurodegenerative conditions in the neocortex. NMR spectroscopy allows to follow-up the effects of stem cell therapy in hydrocephalus.

In congenital hydrocephalus, cerebrospinal fluid accumulation is associated with increased intracranial pressure (ICP), ischemia/hypoxia, metabolic impairment, neuronal damage, and astrocytic reaction. The aim of this study was to identify whether a metabolite profile revealing tissue responses according to the severity of hydrocephalus can be detected. The hyh mutant mouse used for this study exhibits 2 different forms of hydrocephalus, severe and moderate. In a comprehensive investigation into the 2 progressions of hydrocephalus, mice with severe hydrocephalus were found to have higher ICP and astrocytic reaction. Several metabolites from the mouse brain cortex were analyzed with 1H high-resolution magic angle spinning nuclear magnetic resonance (1H HR-MAS NMR) spectroscopy. A differential profile for metabolites including glutamate and glutamine was found to correlate with the severity of hydrocephalus and can be explained due to differential astrocytic reactions, neurodegenerative conditions, and the presence of ischemia. The glutamate transporter EAAT2 and the metabolite taurine were found to be key histopathological markers of affected parenchymata. In conclusion, a differential metabolite profile can be detected according to the severity of hydrocephalus and associated ICP and therefore can be used to monitor the efficacy of experimental therapies.

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espanolIntroduccion El dolor lumbar cronico tiene una alta prevalencia en los paises industrializados, donde es una de las principales causas de incapacidad laboral. Con frecuencia, los pacientes con dolor lumbar cronico en tratamiento con opiaceos sufren episodios de dolor irruptivo, pero los datos de prevalencia y preferencias de tratamiento son escasos. La prevalencia, caracteristicas y manejo del dolor irruptivo de pacientes con dolor cronico de origen lumbar en Andalucia y Melilla es desconocida. Objetivos 1. Evaluacion de la prevalencia del dolor irruptivo en pacientes con dolor cronico secundario a lumbalgia cronica en Andalucia y Melilla (objetivo primario). 2. Caracterizacion del dolor irruptivo en pacientes con dolor cronico secundario a lumbalgia cronica basado en la etiologia, patologia, asi como en otras caracteristicas clinicas. 3. Evaluacion de la prevalencia de cada una de las diferentes causas de dolor. 4. Identificar las posibles asociaciones entre los diferentes tipos de dolor irruptivo y aspectos sociodemograficos, clinicos y asistenciales. Material y metodos En el estudio de prevalencia del dolor irruptivo participaron 1.868 pacientes y en el de caracterizacion 295 pacientes. En el estudio de prevalencia se recogieron las siguientes variables: presencia de dolor irruptivo, sexo y edad. En el estudio de caracterizacion se recogieron datos relativos al tipo y localizacion del dolor, tratamiento, cumplimiento y satisfaccion del paciente. Resultados La prevalencia del dolor irruptivo en pacientes con dolor cronico secundario a lumbalgia cronica es del 37,5 % (IC 95 %: 35,3-39,7 %), y es similar en hombres y mujeres. Un 75 % de los pacientes son mayores de 50 anos. La media de dolor irruptivo fue de 84,4 puntos en la escala visual analogica (EVA). El tratamiento del dolor cronico es tratado con una amplia gama de opiaceos. El farmaco preferente de los pacientes que controlan el dolor irruptivo con opiaceos es fentanilo (78,3 %) y la forma de administracion mas comun de este es la nasal (53,2 %). El grado de cumplimiento es alto y un 46,3 % de los pacientes consideran muy satisfactorio el control de su dolor irruptivo. Conclusiones Los datos epidemiologicos sobre el dolor irruptivo en Andalucia y Melilla generados por este estudio nos ha permitido conocer su prevalencia y caracteristicas, asi como los tratamientos preferidos y el grado de satisfaccion de los pacientes. EnglishIntroduction Chronic low back pain is highly prevalent in industrialized countries, where it is one of the main causes of incapacity for work. Patients with chronic low back pain in treatment with opioids often experience episodes of breakthrough pain, but prevalence and treatment preferences data are scarce. The prevalence, characteristics, and management of breakthrough pain of patients with chronic pain of lumbar origin in Andalusia and Melilla are unknown. Objectives 1. Evaluation of the prevalence of breakthrough pain in patients with chronic pain secondary to chronic low back pain in Andalusia and Melilla (primary endpoint). 2. Characterization of breakthrough pain in patients with chronic pain secondary to chronic low back pain based on etiology, pathology, and other clinical characteristics. 3. Assessment of the prevalence of each of the different causes of pain. 4. Identify the possible associations between different types of breakthrough pain and sociodemographic, clinical and healthcare factors. Materials and methods 1,868 patients participated in the study of prevalence of breakthrough pain and 295 patients participated in the characterization study. In the prevalence study the following variables were collected: presence of breakthrough pain, sex and age. In the characterization study data were collected regarding the type and location of pain, treatment, compliance, and patient satisfaction. Results: The prevalence of breakthrough pain in patients with chronic pain secondary to chronic low back pain is 37.5% (95 % CI: 35.3-39.7%), and is similar in men and women. 75% of the patients are older than 50 years. The mean value of breakthrough pain was 84.4 points in a visual analogue scale (VAS). Chronic lumbar pain is treated with a wide range of opiates. The preferred drug of patients who control breakthrough pain with opioids is fentanyl (78.3%) and its most common form of administration is nasal (53.2%). The degree of compliance is high and 46.3 % of patients consider the control of their breakthrough pain very satisfactory. Conclusions: Epidemiological data on the breakthrough pain in Andalusia and Melilla generated by this study has allowed us to know its prevalence and characteristics, as well as the preferred treatments and the degree of satisfaction of the patients.

Most cells of the developing mammalian brain derive from the ventricular (VZ) and the subventricular (SVZ) zones. The VZ is formed by the multipotent radial glia/neural stem cells (NSCs) while the SVZ harbors the rapidly proliferative neural precursor cells (NPCs). Evidence from human and animal models indicates that the common history of hydrocephalus and brain maldevelopment starts early in embryonic life with disruption of the VZ and SVZ. We propose that a "cell junction pathology" involving adherent and gap junctions is a final common outcome of a wide range of gene mutations resulting in proteins abnormally expressed by the VZ cells undergoing disruption. Disruption of the VZ during fetal development implies the loss of NSCs whereas VZ disruption during the perinatal period implies the loss of ependyma. The process of disruption occurs in specific regions of the ventricular system and at specific stages of brain development. This explains why only certain brain structures have an abnormal development, which in turn results in a specific neurological impairment of the newborn. Disruption of the VZ of the Sylvian aqueduct (SA) leads to aqueductal stenosis and hydrocephalus, while disruption of the VZ of telencephalon impairs neurogenesis. We are currently investigating whether grafting of NSCs/neurospheres from normal rats into the CSF of hydrocephalic mutants helps to diminish/repair the outcomes of VZ disruption.

The multiciliated ependyma forms an epithelial-like layer that could act as a selective barrier between the brain parenchyma and cerebrospinal fluid. In the present study, tyrosine hydroxylase-containing fibres have been detected in the basal pole of the ependymal cells of the lateral ventricles of rat, mouse and calf. The use of antibodies against at least two different peptide sequences of each D(2), D(3), D(4) and D(5) dopamine receptor subtype has allowed their detection in: (i) sections of mouse, rat and bovine lateral ventricles, by means of immunocytochemistry; and (ii) membrane protein extracts obtained from the ependymal layer of the bovine lateral ventricles, using immunoblotting. The immunocytochemical study has shown the presence of all these subtypes of dopamine receptors in the ependymal cells. Immunoblotting demonstrated similar immunoreactive bands for all receptor subtypes in both ependymal and corpus striatum membrane extracts.

Previous studies have shown the existence of proliferating cells in explants from bovine (Bos Taurus) lateral ventricle walls that were maintained for several days in vitro in the absence of serum and growth factors. In this study we have characterized the nature of new cells and have assessed whether the insulin-like growth factor-1 (IGF-1) receptor regulates their survival and/or proliferation. The explants were composed of the ependymal layer and attached subependymal cells. Ependymal cells in culture were labelled with glial markers (S-100, vimentin, GFAP, BLBP, 3A7 and 3CB2) and did not incorporate bromodeoxiuridine when this molecule was added to the culture media. Most subependymal cells were immunoreactive for beta III-tubulin, a neuronal marker, and did incorporate bromodeoxiuridine. Subependymal neurons displayed immunoreactivity for IGF-1 and its receptor and expressed IGF-1 mRNA, indicating that IGF-1 is produced in the explants and may act on new neurons. Addition to the culture media of an IGF-1 receptor antagonist, the peptide JB1, did not affect the incorporation of bromodeoxiuridine to proliferating subependymal cells. However, JB1 significantly increased the number of TUNEL positive cells in the subependymal zone, suggesting that IGF-1 receptor is involved in the survival of subependymal neurons. In conclusion, these findings indicate that neurogenesis is maintained in explants from the lateral cerebral ventricle of adult bovine brains and that IGF-1 is locally produced in the explants and may regulate the survival of the proliferating neurons.

Under normal physiological conditions the cerebrospinal fluid (CSF) is secreted continuously, although this secretion undergoes circadian variations. Mechanisms operating at the vascular side of the choroidal cells involve a sympathetic and a cholinergic innervation, with the former inhibiting and the latter stimulating CSF secretion. There are also regulatory mechanisms operating at the ventricular side of the choroidal cells, where receptors for monoamines such as dopamine, serotonin, and melatonin, and for neuropeptides such as vasopressin, atrial natriuretic hormone, and angiotensin II, have been identified. These compounds, that are normally present in the CSF, participate in the regulation of CSF secretion. Although the mechanisms responsible for the CSF circulation are not fully understood, several factors are known to play a role. There is evidence that the subcommissural organ (SCO)–Reissner's fiber (RF) complex is one of the factors involved in the CSF circulation. In mammals, the predominant route of escape of CSF into blood is through the arachnoid villi. In lower vertebrates, the dilatation of the distal end of the central canal, known as terminal ventricle or ampulla caudalis, represents the main site of CSF escape into blood. Both the function and the ultrastructural arrangement of the ampulla caudalis suggest that it may be the ancestor structure of the mammalian arachnoid villi. RF-glycoproteins reaching the ampulla caudalis might play a role in the formation and maintenance of the route communicating the CSF and blood compartments. The SCO-RF complex may participate, under physiological conditions, in the circulation and reabsorption of CSF. Under pathological conditions, the SCO appears to be involved in the pathogeneses of congenital hydrocephalus. Changes in the SCO have been described in all species developing congenital hydrocephalus. In these reports, the important question whether the changes occurring in the SCO precede hydrocephalus, or are a consequence of the hydrocephalic state, has not been clarified. Recently, evidence has been obtained indicating that a primary defect of the SCO-RF complex may lead to hydrocephalus. Thus, a primary and selective immunoneutralization of the SCO-RF complex during the fetal and early postnatal life leads to absence of RF, aqueductal stenosis, increased CSF concentration of monoamines, and a moderate but sustained hydrocephalus. Microsc. Res. Tech. 52:591–607, 2001. © 2001 Wiley-Liss, Inc.

The neuroepithelium is a germinal epithelium containing progenitor cells that produce almost all of the central nervous system cells, including the ependyma. The neuroepithelium and ependyma constitute barriers containing polarized cells covering the embryonic or mature brain ventricles, respectively; therefore, they separate the cerebrospinal fluid that fills cavities from the developing or mature brain parenchyma. As barriers, the neuroepithelium and ependyma play key roles in the central nervous system development processes and physiology. These roles depend on mechanisms related to cell polarity, sensory primary cilia, motile cilia, tight junctions, adherens junctions and gap junctions, machinery for endocytosis and molecule secretion, and water channels. Here, the role of both barriers related to the development of diseases, such as neural tube defects, ciliary dyskinesia, and hydrocephalus, is reviewed.

Galanin is a brain-gut peptide present in the central nervous system of vertebrates and invertebrates. The distribution of galanin-like immunoreactive perikarya and fibers in the brain of the river lamprey Lampetra fluviatilis (Agnatha) has been studied immunocytochemically by using antisera against rat and porcine galanin. Galanin-like immunoreactive perikarya were seen in the telencephalon and mediobasal diencephalon. In the telencephalon, they were present in the nucleus olfactorius anterior, nucleus basalis, and especially, in the nucleus commissurae anterioris. The diencephalon contained most of the immunoreactive neurons. They were located in the nucleus commissurae praeinfundibularis, nucleus ventralis hypothalami, nucleus commissurae postinfundibularis, nucleus ventralis thalami, and nucleus dorsalis thalami pars medius. Most of the galanin-like immunoreactive infundibular neurons showed apical processes contacting the cerebrospinal fluid. Immunoreactive fibers and terminals were widely distributed throughout the neuraxis. In the telencephalon, the richest galaninergic innervation was found in the nucleus olfactorius anterior, lobus subhippocampalis, corpus striatum, and around the nucleus septi and the nucleus praeopticus. In the diencephalon, the highest density of galanin-like immunoreactive fibers was seen in the nucleus commissurae postopticae, nucleus commissurae praeinfundibularis, nucleus ventralis hypothalami, nucleus dorsalis hypothalami, and neurohypophysis. In the mesencephalon and rhombencephalon, the distribution of immunoreactive fibers was heterogeneous, being most pronounced in a region between the nucleus nervi oculomotorii and the nucleus interpeduncularis mesencephali, in the nucleus isthmi, and in the raphe region. A subependymal plexus of immunoreactive fibers was found throughout the ventricular system. The distribution of immunoreactive neurons and fibers was similar to that of teleosts but different to those of other vertebrate groups. The possible hypophysiotropic and neuroregulatory roles of galanin are discussed.

Dystrophic neurites associated with amyloid plaques precede neuronal death and manifest early in Alzheimer's disease (AD). In this work we have characterized the plaque-associated neuritic pathology in the hippocampus of young (4- to 6-month-old) PS1(M146L)/APP(751SL) mice model, as the initial degenerative process underlying functional disturbance prior to neuronal loss. Neuritic plaques accounted for almost all fibrillar deposits and an axonal origin of the dystrophies was demonstrated. The early induction of autophagy pathology was evidenced by increased protein levels of the autophagosome marker LC3 that was localized in the axonal dystrophies, and by electron microscopic identification of numerous autophagic vesicles filling and causing the axonal swellings. Early neuritic cytoskeletal defects determined by the presence of phosphorylated tau (AT8-positive) and actin-cofilin rods along with decreased levels of kinesin-1 and dynein motor proteins could be responsible for this extensive vesicle accumulation within dystrophic neurites. Although microsomal A beta oligomers were identified, the presence of A11-immunopositive A beta plaques also suggested a direct role of plaque-associated A beta oligomers in defective axonal transport and disease progression. Most importantly, presynaptic terminals morphologically disrupted by abnormal autophagic vesicle buildup were identified ultrastructurally and further supported by synaptosome isolation. Finally, these early abnormalities in axonal and presynaptic structures might represent the morphological substrate of hippocampal dysfunction preceding synaptic and neuronal loss and could significantly contribute to AD pathology in the preclinical stages.

A heterogeneous population of ependymal cells lines the brain ventricles. The evidence about the origin and birth dates of these cell populations is scarce. Furthermore, the possibility that mature ependymal cells are born (ependymogenesis) or self-renewed (ependymal proliferation) postnatally is controversial. The present study was designed to investigate both phenomena in wild-type (wt) and hydrocephalic α-SNAP mutant (hyh) mice at different postnatal stages. In wt mice, proliferating cells in the ventricular zone (VZ) were only found in two distinct regions: the dorsal walls of the third ventricle and Sylvian aqueduct (SA). Most proliferating cells were monociliated and nestin+, likely corresponding to radial glial cells. Postnatal cumulative BrdU-labeling showed that most daughter cells remained in the VZ of both regions and they lost nestin-immunoreactivity. Furthermore, some labeled cells became multiciliated and GLUT-1+, indicating they were ependymal cells born postnatally. Postnatal pulse BrdU-labeling and Ki-67 immunostaining further demonstrated the presence of cycling multiciliated ependymal cells. In hydrocephalic mutants, the dorsal walls of the third ventricle and SA expanded enormously and showed neither ependymal disruption nor ventriculostomies. This phenomenon was sustained by an increased ependymogenesis. Consequently, in addition to the physical and geometrical mechanisms traditionally explaining ventricular enlargement in fetal-onset hydrocephalus, we propose that postnatal ependymogenesis could also play a role. Furthermore, as generation of new ependymal cells during postnatal stages was observed in distinct regions of the ventricular walls, such as the roof of the third ventricle, it may be a key mechanism involved in the development of human type 1 interhemispheric cysts.

Background In human foetal hydrocephalus and spina bifida aperta (SBA), the pathogenesis of abnormal cortical development is poorly understood. Previous reports have shown that neuroepithelial/ependymal denudation is involved in the neuropathogenesis of human foetal hydrocephalus and SBA. Interestingly, loss of the neuroepithelium/ ependyma (denudation) at the Sylvian aqueduct is preceded by defective expression of adherent and gap junction proteins. In human foetal hydrocephalus, we aimed to investigate whether abnormal cortical development is similarly associated with intercellular ependymal defects at the telencephalic (sub)ventricular zones.

BACKGROUND: Despite the excellent prognostic of chronic myeloid leukemia (CML) patients since the introduction of tyrosine kinase inhibitors (TKIs), approximately 50% of patients that are treated with TKIs will discontinue first line treatment due to lack of efficacy or intolerance. Once patients need a second line treatment, a considerable proportion of patients will need third or even fourth line therapy during further evolution. At this moment, there is a lack of data about real benefit of this group of patients. We have recently published our experience of 30 CML patients treated with bosutinib in 4th line. We present an update of the study where we have increased the number of patients, and the follow-up. The aim of this study is to present safety and efficacy data CML chronic phase patients treated with bosutinib in 4th line. METHODS: We have collected data from 59 CML patients treated with bosutinib in 4th line after resistance or intolerance to IM, NI and DA. 51 patients have been treated under the Spanish compassionate use program (36 centers) and 10 patients were treated in a single institution from United Kingdom. Median age of patients at diagnosis was 53 years. The percentage of low, intermediate and high risk Sokal groups were 47%, 37% and 16%. Median time TKIs exposure before bosutinib was 9 years. The most common indication (30/59) was intolerant to DA and NI. Patients' dispositions and main line characteristics are shown in table 1. RESULTS: Median follow-up was 14.3 months. All patients started bosutinib at 500mg/d, median dose of was 450mg/d. Overall probabilities to either achieve or maintain previous response were 96% (57/59), 62% (37/59), 40% (24/59) and 17% (10/59) for complete hematological response (CHR), complete cytogenetic response (CCyR), major molecular response (MMR) and MR4.5 respectively. However, probabilities to obtain responses (in patients without response evaluated at baseline) were 27% (7/26), 26% (12/45) and 12% (7/55) for CCyR, MMR and MR4.5. As expected, probabilities to obtain CCyR were lower for patients resistant to DA and NI patients than for patients intolerant to DA and NI (8% VS 44%). Event free survival (EFS) and progression free survival (PFS) probabilities were 50% and 83% by 27 month. Treatment was discontinued in 20/58 (34%), most frequent reasons being adverse events 9/59(15%), lack of efficacy 5/59 (8.5%), disease progression 2/59 (3.4%) and death 1/59 (1.7%). Two patients discontinued due to stem cell transplantation. The adverse events that led to treatment discontinuation were pleural effusion (3), diarrhea (2), rash, renal impairment, auricular fibrillation and liver enzyme elevation one patient each. Overall, bosutinib was well tolerated. Grade 3-4 hematological toxicities were 3%, 6% and 6% for anemia, thromboctytopenia and neutropenia. Most common non hematological side effects were diarrhea (39%, nauseas 13% and liver alterations 14% and pleural effusion 14%. CONCLUSIONS: Little is known about the therapeutic role of Bosutinib in 4th line. The series presented here is, to our knowledge, the largest being presented. Bosutinib seems to be an appropriate treatment option for patients resistant or intolerant to three prior TKIs. | | IM+NI-I+DA-R (N=4) | IM+NI-R+DA-R (N=18) | IM+NI-I+DA-I (N=30) | IM+NI-R+DA-I (N=7) | Total (N=59) | | ------------------------------------------------ | ----------------------- | ------------------------ | ----------------------- | ------------------------ | ------------------------- | ------------------------- | | Sex, N (%) Male | 2 (50) | 11 (61.1) | 16 (53.3) | 2 (28.6) | 31 (52.5) | | Median age of diagnosis, yr (range) | 57.32 (50-64) | 49.19 (23-73) | 54.95 (21-89) | 48.87 (26-68) | 53.15 (21-89) | | Median age of Bosutinib initiation, yr (range) | 69.13 (61-70) | 62.27 (39-79) | 64.85 (25-90) | 64.79(35-74) | 63.7 (25-9) | | Median follow up, months (range) | 18.5(7.8-34.1) | 8.4(1.22-36.1) | 16.3(0.5-34.7) | 23.4(3.3-28.9) | 14.3(0.7-36.1) | | SOKAL Index at diagnosis, N (%) | High | 2(50.0) | 4 (23.5) | 1 (4.3) | 1 (20) | 8 (16.3) | | Intermediate | 1 (25.0) | 5 (29.4) | 10(43.5) | 2 (40) | 18 (36.7) | | Low | 1 (25.0) | 8 (47.1) | 12 (52.2) | 2 (40) | 23 (46.9) | | Median Time from first TKI to BOS, (yr, range) | 10.3 (4.8-11.9) | 9.3 (2.0-11.4) | 8.8 (0.7-13.6) | 8.2 (5.1-12.3) | 8.8 (0.7-13.6) | | Median duration of prior therapy, months (range) | Imatinib | 38.8 (11.8-69.8) | 32.6 (6.3-96.8) | 26.2 (1.6-102.6) | 23.1 (8.3-66.8) | 28.8 (1.6-102.6) | | Dasatinib | 21.5 (12.6-75) | 21.8 (7.7-69) | 31.4 (0.4-87.1) | 23.7 (10.3-53.6) | 23.44 (0.4-87.1) | | Nilotinib | 19.1 (2.1-46.2) | 16.7 (5-65.6) | 8.9 (0.2-58.5) | 30.9 (6.9-49.3) | 14.3 (0.2-65.6) | * BOS: bosutinib, IM, imatinib; DA, dasatinib; NI, nilotinib, I: Intolerance, R: Resistant, Yr: year Table 1. Disclosures Garcia-Gutierrez: Ariad: Consultancy; Pfizer: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Milojkovic: Novartis: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Ariad: Consultancy, Honoraria; BMS: Consultancy, Honoraria. Boque: Novartis: Honoraria; BMS: Honoraria; Celgene: Honoraria. Casado: Novartis: Honoraria, Research Funding; BMS: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; Roche: Honoraria, Research Funding. Jimenez: Pfizer: Consultancy, Honoraria. Giraldo: Pfizer: Consultancy. Steegmann: Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; Pfizer: Consultancy, Honoraria, Research Funding, Speakers Bureau; Ariad: Consultancy, Honoraria, Research Funding, Speakers Bureau.

Background A population (30%) of hydrocephalic hyh mutant mice develop a slowly progressive hydrocephalus and survive for periods ranging between 2 months and 2 years. Certain characteristics of these mice, such as time of onset of hydrocephalus, type of abnormality of CSF dynamics, clinical evolution and survival/death rate, resemble several types of human congenital hydrocephalus. They represent an exceptional animal model to investigate neuropathological and physiopathological aspects of a brain "adapting" to a virtually life-lasting hydrocephalus

The hyh mouse carrying a point mutation in the gene encoding for soluble N-ethylmaleimide-sensitive factor (NSF) attachment protein alpha (alpha-SNAP) develops inherited hydrocephalus. The investigation was designed to study: (i) the clinical evolution of hyh mice; (ii) factors other than the alpha-SNAP mutation that may influence the expression of hydrocephalus; (iii) the neuropathological features underlying the different forms of clinical evolution. The study included 3017 mice, 22.4% of which were hydrocephalic. The neuropathological study was performed in 112 mice by use of light and electron microscopy. It was found that maternal- and sex-related factors are involved in the heterogeneous expression of hyh phenotype. The clinical evolution recorded throughout a 4-year period also revealed a heterogeneous expression of the hydrocephalic phenotype. Two subpopulations were distinguished: (i) 70% of mice underwent a rapidly progressive hydrocephalus and died during the first 2 months of life; they presented macrocephaly, extremely large expansion of the ventricles, equilibrium impairment and decreased motor activity. (ii) Mice with slowly progressive hydrocephalus (30%) survived for periods ranging between 2 months and 2 years. They had no or moderate macrocephaly; moderate ventricular dilatation and preserved general motor activity; they all presented spontaneous ventriculostomies communicating the ventricles with the subarachnoid space, indicating that such communications play a key role in the long survival of these mice. The hyh mutant represents an ideal animal model to investigate how do the brain "adapt" to a virtually life-lasting hydrocephalus.

The hyh (hydrocephalus with hop gait) mutant micedevelop inherited hydrocephalus. A key feature in thismutant is that there is a foetal-onset ependymal denuda-tion which precedes cerebral aqueduct obliteration andhydrocephalus [1]. Recently, a point mutation in alpha-SNAP protein has been identified as responsible of thehyh phenotype [2]. However, preliminary findings fromour laboratory have suggested clinical and pathologicalheterogeneity in the expression of hydrocephalus, indicat-ing that other (nongenetic?) factors may influence thedegree of severity of this pathology. This is in accordancewith findings in other hydrocephalic mutant strains [3,4].The present investigation was designed to (a) study theclinical evolution of hydrocephalic mice in order to eval-uate wether or not clinical heterogeneity does actuallyoccur, (b) identify nongenetic factors (maternal age, mul-tiparity) that may affect such an evolution, and (c) iden-tify neuropathologic events underlying clinicalheterogeneity.

The subcommissural organ (SCO) is a brain gland located in the roof of the third ventricle that releases glycoproteins into the cerebrospinal fluid, where they form a structure known as Reissner's fiber (RF). On the basis of SCO-spondin sequence (the major RF glycoprotein) and experimental findings, the SCO has been implicated in central nervous system development; however, its function(s) after birth remain unclear. There is evidence suggesting that SCO activity in adult animals may be regulated by serotonin (5HT). The use of an anti-5HT serum showed that the bovine SCO is heterogeneously innervated with most part being poorly innervated, whereas the rat SCO is richly innervated throughout. Antibodies against serotonin receptor subtype 2A rendered a strong immunoreaction at the ventricular cell pole of the bovine SCO cells and revealed the expected polypeptides in blots of fresh and organ-cultured bovine SCO. Analyses of organ-cultured bovine SCO treated with 5HT revealed a twofold decrease of both SCO-spondin mRNA level and immunoreactive RF glycoproteins, whereas no effect on release of RF glycoproteins into the culture medium was detected. Rats subjected to pharmacological depletion of 5HT exhibited an SCO-spondin mRNA level twofold higher than untreated rats. These results indicate that 5HT down-regulates SCO-spondin biosynthesis but apparently not its release, and suggest that 5HT may exert the effect on the SCO via the cerebrospinal fluid.

Dopamine receptors have been found in certain populations of non-neuronal cells in the brain, viz., discrete areas of ciliated ependyma and the ependymal cells of the choroid plexus. We have studied the presence of both tyrosine-hydroxylase-immunoreactive nerve fibers and dopamine receptors in the subcommissural organ (SCO), an ependymal brain gland that is located in the roof of the third ventricle and that secretes, into the cerebrospinal fluid, glycoproteins that aggregate to form Reissner’s fiber (RF). Antibodies against D2, D3, D4, and D5 dopamine receptors were used in immunoblots of bovine striatum, fresh SCO, and organ-cultured SCO, and in immunocytochemistry of the bovine, rat, and mouse SCO. Only a few tyrosine-hydroxylase fibers appeared to reach the SCO. However, virtually all the secretory ependymal and hypendymal cells of the SCO immunoreacted with antibodies against D2, D4, and D5 receptors, with the last-mentioned rendering the strongest reaction, especially at the ventricular cell pole of the secretory ependymocytes, suggesting that dopamine might reach the SCO via the cerebrospinal fluid. The antibodies against the four subtypes of receptors revealed corresponding bands in immunoblots of striatum and fresh SCO. Although the cultured SCO displayed dopamine receptors, dopamine had no apparent effect on the expression of the SCO-spondin gene/protein or on the release of RF-glycoproteins (SCO-spondin included) by SCO explants, suggesting that dopamine affects the function(s) of the SCO differently from the secretion of RF-glycoproteins.

Hydrocephalic hyh mice are born with moderate hydrocephalus and a normal cerebral aqueduct. At about the fifth postnatal day the aqueduct becomes obliterated and severe hydrocephalus develops. The aim of the present investigation was to investigate the mechanism of this hydrocephalus, probably starting during fetal life when the cerebral aqueduct is still patent. By use of immunocytochemistry and scanning electron microscopy, mutant (n = 54) and normal (n = 61) hyh mouse embryos were studied at various developmental stages to trace the earliest microscopic changes occurring in the brains of embryos becoming hydrocephalic. The primary defect begins at an early developmental stage (E-12) and involves cells lining the brain cavities, which detach following a well-defined temporo-spatial pattern. This ependymal denudation mostly involves the ependyma of the basal plate derivatives. There is a relationship between ependymal denudation and ependymal differentiation evaluated by the expression of vimentin and glial fibrillary acidic protein. The ependymal cells had a normal appearance before and after detachment, suggesting that their separation from the ventricular wall might be due to abnormalities in cell adhesion molecules. The process of detachment of the ventral ependyma, clearly visualized under scanning electron microscope, is almost completed before the onset of hydrocephalus. Furthermore, this ependymal denudation does not lead to aqueductal stenosis during prenatal life. Thus, the rather massive ependymal denudation appears to be the trigger of hydrocephalus in this mutant mouse, raising the question about the mechanism responsible for this hydrocephalus. It seems likely that an uncontrolled bulk flow of brain fluid through the extended areas devoid of ependyma may be responsible for the hydrocephalus developed by the hyh mutant embryos. The defect in these embryos also includes loss of the hindbrain floor plate and a delayed in the expression of Reissner fiber glycoproteins by the subcommissural organ.

The innervation of the frog subcommissural or- gan was studied by light-microscopic and ultrastructural immunocytochemistry using antisera against serotonin, noradrenaline, dopamine, γ-aminobutyric acid (GABA), glutamic acid decarboxylase, different GABA receptor subunits and bovine Reissner's fibre material (AFRU). In the proximity of the organ, serotonin- and noradrenaline- containing fibres were rare whereas dopamine-immuno- reactive fibres were more numerous. Many GABA- and glutamic acid decarboxylase-containing nerve fibres were found at the basal portion of the ependymal cells of the subcommissural organ. Under the electron microscope, these GABA-immunolabelled nerve endings appeared to establish axoglandular synapses with secretory ependy- mal cells of the subcommissural organ. In addition, the secretory ependymal cells expressed high amounts of the β2-subunit of the GABAA receptor. Since GABA-immu- noreactive neurons were present in the frog pineal organ proper and apparently contributed axons to the pineal tract, we suggest that at least part of the GABAergic fi- bres innervating the frog subcommissural organ could originate from the pineal organ.

The present study was designed to investigate the controversial subject of the existence of a neural input from the pineal organ via the pineal tract to the subcommissural organ (SCO) in teleosts and anurans. Horseradish peroxidase was injected into the pineal organ and pineal tract of Carassius auratus and Rana perezi. Within the pinealofugal fibers the tracer was visualized at the light-and electron-microscopic levels either by immunocytochemistry using an anti-peroxidase serum, or by revealing the enzymatic activity of peroxidase. In both species, labeled myelinated and unmyelinated fibers of the pineal tract were readily traced by means of electron microscopy. In R. perezi, numerous terminals contacting the SCO cells in a synapse-like (synaptoid, hemisynaptic) manner bore the label, whereas a different population of endings was devoid of the tracer, indicating that in this species the SCO receives a dual neural input, one of pineal origin, the other of unknown source and nature. In the SCO of C. auratus, neither labeled nor unlabeled synapse-like contacts were found. Thus, in this latter species, a direct neural input to the SCO is missing. It is concluded that the secretory activity of the SCO can be controlled by different mechanisms in different species, and that more than one neural input mechanism may operate in the same species.

Background The hyh (hydrocephalus with hop gait) mouse carries a point mutation in alpha-SNAP protein and develops inherited hydrocephalus. Mutant mice are born with moderate hydrocephalus and a patent Sylvius aqueduct (SA). During the first postnatal week, SA obliterates and a severe hydrocephalus characterized by an enormous expansion of the dorsal third ventricle and of the collicular recess of the SA, develops. Interestingly, neither of these dilated cavities present spontaneous ventriculostomies. The aim of the present investigation was to elucidate some of the cellular phenomena occurring at the ventricular walls that allow such enormous ventricular dilatations.