David Jaffe

Prefrontal cognitive deficits in mice with altered cerebral cortical GABAergic interneurons.

Alterations of inhibitory GABAergic neurons are implicated in multiple psychiatric and neurological disorders, including schizophrenia, autism and epilepsy. In particular, interneuron deficits in prefrontal areas, along with presumed decreased inhibition, have been reported in several human patients. The majority of forebrain GABAergic interneurons arise from a single subcortical source before migrating to their final regional destination. Factors that govern the interneuron populations have been identified, demonstrating that a single gene mutation may globally affect forebrain structures or a single area. In particular, mice lacking the urokinase plasminogen activator receptor (Plaur) gene have decreased GABAergic interneurons in frontal and parietal, but not caudal, cortical regions. Plaur assists in the activation of hepatocyte growth factor/scatter factor (HGF/SF), and several of the interneuron deficits are correlated with decreased levels of HGF/SF. In some cortical regions, the interneuron deficit can be remediated by endogenous overexpression of HGF/SF. In this study, we demonstrate decreased parvalbumin-expressing interneurons in the medial frontal cortex, but not in the hippocampus or basal lateral amygdala in the Plaur null mouse. The Plaur null mouse demonstrates impaired medial frontal cortical function in extinction of cued fear conditioning and the inability to form attentional sets. Endogenous HGF/SF overexpression increased the number of PV-expressing cells in medial frontal cortical areas to levels greater than found in wildtype mice, but did not remediate the behavioral deficits. These data suggest that proper medial frontal cortical function is dependent upon optimum levels of inhibition and that a deficit or excess of interneuron numbers impairs normal cognition.

Astrocyte-Mediated Hepatocyte Growth Factor/Scatter Factor Supplementation Restores GABAergic Interneurons and Corrects Reversal Learning Deficits in Mice

Many psychiatric and neurological disorders present persistent neuroanatomical abnormalities in multiple brain regions that may reflect a common origin for a developmental disturbance. In mammals, many of the local GABAergic inhibitory interneurons arise from a single subcortical source. Perturbations in the ontogeny of the GABAergic interneurons may be reflected in the adult by interneuron deficits in both frontal cerebral cortical and striatal regions. Disrupted GABAergic circuitry has been reported in patients with schizophrenia and frontal lobe epilepsy and may contribute to their associated impairments in behavioral flexibility. The present study demonstrates that one type of behavioral flexibility, reversal learning, is dependent upon proper numbers of GABAergic interneurons. Mice with abnormal interneuron ontogeny have reduced numbers of parvalbumin-expressing GABAergic local interneurons in the orbitofrontal cortical and striatal regions and impaired reversal leaning. Using a genetic approach, both the anatomical and functional deficiencies are restored with exogenous postnatal growth factor supplementation. These results show that GABAergic local circuitry is critical for modulating behavioral flexibility and that birth defects can be corrected by replenishing crucial growth factors.

Erosive Breast Cancer Metastasis to the Ankle: A Case Report

Intra-articular tumors in the ankle are a rare presentation for metastatic disease. Metastatic breast disease presenting distal to the knee or within any joint is especially rare. We present a case of a painful intra-articular breast metastasis in a 56-year-old female with known breast carcinoma. The patient presented with anterior ankle pain and was found to have an intra-articular ankle tumor that was eroding into the anteromedial talus. The distinct soft tissue tumor was excised from the ankle and the talar lesion curetted and treated with adjuvant chemical ablation. The void in the talus was filled with cement. Despite the patients poor prognosis, she did not have ankle pain at 6 months postoperatively and was able to ambulate without assistive devices. When treating unknown tumors in the ankle, the treating surgeon must be prepared with different operative plans that will depend on the preliminary pathology report to best treat their patients safely.