Prolonged or high-intensity exposure to visible light leads to photoreceptor cell death. In this study, we demonstrate a novel pathway of light-induced photoreceptor apoptosis involving the low-affinity neurotrophin receptor p75 (p75NTR). Retinal degeneration upregulated both p75NTR and the high-affinity neurotrophin receptor TrkC in different parts of Müller glial cells. Exogenous neurotrophin-3 (NT-3) increased, but nerve growth factor (NGF) decreased basic fibroblast growth factor (bFGF) production in Müller cells, which can directly rescue photoreceptor apoptosis. Blockade of p75NTR prevented bFGF reduction and resulted in both structural and functional photoreceptor survival in vivo. Furthermore, the absence of p75NTR significantly prevented light-induced photoreceptor apoptosis. These observations implicate glial cells in the determination of neural cell survival, and suggest functional glial-neuronal cell interactions as new therapeutic targets for neurodegeneration.

In the retina, the glutamate transporter GLAST is expressed in Müller cells, whereas the glutamate transporter GLT-1 is found only in cones and various types of bipolar cells. To investigate the functional role of this differential distribution of glutamate transporters, we have analyzed GLAST and GLT-1 mutant mice. In GLAST-deficient mice, the electroretinogram b-wave and oscillatory potentials are reduced and retinal damage after ischemia is exacerbated, whereas GLT-1-deficient mice show almost normal electroretinograms and mild increased retinal damage after ischemia. These results demonstrate that GLAST is required for normal signal transmission between photoreceptors and bipolar cells and that both GLAST and GLT-1 play a neuroprotective role during ischemia in the retina.L-Glutamate is the major excitatory neurotransmitter in the mammalian retina (1). High-affinity glutamate transporters are believed to be essential for terminating synaptic transmission as well as for keeping the extracellular glutamate concentration below neurotoxic levels (1, 2). Five subtypes of glutamate transporter (GLAST, GLT-1, EAAC1, EAAT4, and EAAT5) (3-8) have been cloned, but the contributions of individual transporter subtypes to retinal function are poorly understood. Studies have been hampered by the lack of subtype-selective glutamate transporter drugs. As an alternative approach, we have analyzed GLAST-and GLT-1-deficient mice (9, 10). Our results demonstrate that GLAST is required in retinal signal transmission at the level of the photoreceptor and bipolar cell and that GLAST and GLT-1 are crucial for the protection of retinal cells from glutamate neurotoxicity. MATERIALS AND METHODSImmunohistochemistry. Mice were anesthetized with diethyl ether and perfused transcardially with saline, followed by 4% paraformaldehyde in 0.1 M sodium phosphate buffer containing 0.5% picric acid at room temperature. Eyes were removed and postfixed overnight in the same fixative, and 7-m-thick paraffin or frozen sections were cut and mounted onto gelatin-and poly-L[D]-lysine-coated slides. The sections were incubated overnight with an affinity-purified rabbit polyclonal antibody against the carboxyl-terminal sequence of the mouse GLAST (1.0 g͞ml) (KKPYQLIAQDNEPEKPVAD-SETKM) (11, 12), an affinity-purified rabbit polyclonal antibody against the rat GLT-1 (0.2 g͞ml) [anti-B12; gift from N. C. Danbolt] (13), or a mouse monoclonal antibody against glutamate synthetase (GS) (2.0 g͞ml) (Chemicon) at room temperature. The sections were then incubated with biotinylated goat anti-rabbit IgG (Nichirei, Tokyo) for GLAST and GLT-1 or biotinylated rabbit anti-mouse IgG (Nichirei) for GS for 1 hr, followed by further incubation with streptavidin-Texas red (NEN) for 30 min at room temperature. Sections were examined by a confocal laser scanning microscope (Molecular Dynamics).Electroretinograms (ERGs). Mice (9-11 weeks old) were anesthetized by intraperitoneal injection of a mixture of xylazine (10 mg͞kg) and ketamine (25 mg͞kg). The pupils were dilat...

Objective:We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research.Methods:An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement).Results:The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1–4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1–4.4) for panel members and 4.5 (95% CI 4.3–4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1–4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9–4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019–0.033).Conclusions:This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.

BackgroundThe aim of this study was to elucidate the correlation between angiographic coronary vasomotor responses to intracoronary acetylcholine (ACh) injection, clinical features, and long‐term prognosis in patients with vasospastic angina (VSA).Methods and ResultsThis is a retrospective, observational, single‐center study of 1877 consecutive patients who underwent ACh‐provocation test between January 1991 and December 2010. ACh‐provoked coronary spasm was observed in 873 of 1637 patients included in the present analysis. ACh‐positive patients were more likely to be older male smokers with dyslipidemia, to have a family history of ischemic heart disease, and to have a comorbidity of coronary epicardial stenosis than were ACh‐negative patients. ACh‐positive patients were divided into 2 groups: those with focal (total or subtotal obstruction, n=511) and those with diffuse (severe diffuse vasoconstriction, n=362) spasm patterns. Multivariable logistic regression analysis identified female sex and low comorbidity of coronary epicardial stenosis to correlate with the ACh‐provoked diffuse spasm pattern in patients with VSA. Kaplan–Meier survival curve indicated better 5‐year survival rates free from major adverse cardiovascular events in patients with diffuse spasm pattern compared with those with focal spasm pattern (P=0.019). Multivariable Cox hazard regression analysis identified diffuse spasm pattern as a negative predictor of major adverse cardiovascular events in patients with VSA.ConclusionsACh‐induced diffuse coronary spasm was frequently observed in female VSA patients free of severe coronary epicardial stenosis and was associated with better prognosis than focal spasm. These results suggest the need to identify the ACh‐provoked coronary spasm subtypes in patients with VSA.