During repetitive stimulation of motor nerve terminals, mitochondrial Ca2+ uptake limits increases in free cytosolic [Ca2+] and helps ensure faithful neuromuscular transmission. Changes in cytosolic [Ca2+] and in mitochondrial [Ca2+] as well as changes in mitochondrial membrane potential (Psi m) were studied in mouse motor nerve terminals using Ca2+ sensitive indicator and potentiometric dyes, respectively. Trains of action potentials (APs) at 50 to 100 Hz produced a rapid increase in mitochondrial [Ca2+] followed by a plateau which usually continued beyond the end of stimulation. After stimulation, mitochondrial [Ca2+] decayed back to baseline over the course of tens of seconds to minutes. Increasing the Ca2+ load delivered to the terminal by increasing the number of stimuli (500-2000), increasing bath [Ca2+], or prolonging the AP with 3,4-diaminopyridine (3-4, DAP, 100 micromolar), prolonged the post-stimulation decay of mitochondrial [Ca2+] without increasing the amplitude of the plateau. Inhibiting openings of the mitochondrial permeability transition pore with cyclosporin A (5 micromolar) had no significant effect on the decay of mitochondrial [Ca2+]. Inhibition of the mitochondrial Na+-Ca2+ exchanger with CGP-37157 (50 micromolar) dramatically prolonged the post-stimulation decay of mitochondrial [Ca2+], reduced post-stimulation residual cytosolic [Ca2+], and reduced the amplitude of end-plate potentials evoked after the end of stimulation. Stimulation-induced mitochondrial Ca2+ uptake resulted in Psi m depolarizations that were small or undetectable at near-physiological temperatures (~30 degrees C). Their amplitude became larger at lower temperatures (~20 degrees C), or when AP duration was increased with 3,4-DAP (20 micromolar). Psi m depolarizations were inhibited by lowering bath [Ca2+] or by blocking P/Q-type Ca2+ channels with omega-agatoxin (0.3 micromolar). Partial inhibition of complex I of the electron transport chain (ETC) with rotenone (50 nM) increased the amplitude of stimulation-induced Psi m depolarizations. These findings suggest that: (1) Ca2+ extrusion from motor terminal mitochondria occurs primarily via the Na+-Ca2+ exchanger and helps sustain post-tetanic transmitter release, and (2) that the depolarization of Psi m that accompanies Ca2+ uptake is limited by accelerated proton extrusion via the ETC.

Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive disorder characterized by degeneration of motor neurons in the cortex, brainstem and spinal cord. The patients usually die within 3-5 years after onset. The full etiology of ALS is unknown and many hypotheses have been proposed to explain the neurodegeneration. However, basic mechanisms of cellular function such as transmethylation and polyamine metabolism have not been extensively studied in ALS. Transmethylation reactions are very important in the synthesis of substrates such as proteins, neurotransmitters, DNA and RNA. The polyamines, putrescine, spermidine and spermine, are involved in essential functions such as cellular growth, proliferation and differentiation. An initial study in this thesis concerned the process of neuronal death (apoptosis) in ALS spinal cord. The results showed increased levels of an apoptosis-stimulating protein and increased levels of DNA fragmentation indicative of an apoptotic process in the tissue. A comparative study of MAT-enzyme activity in spinal cord from different mammalian species was undertaken to provide a background for future studies on transmethylation and neurodegeneration. Transmethylation reactions were found altered in erythrocytes from males with ALS but not in spinal cord from ALS patients as compared to controls. An adaptation of previously described polyamine assays was made for the study of polyamines in ALS spinal cord. The method was validated and applied for polyamine analysis in human materials of different characteristics. Determination of polyamines in control and ALS spinal cords showed no major differences. However, in female ALS patients, significantly increased spermidine and spermine levels were observed in ventral horn regions. These gender-related alterations in transmethylation and polyamine metabolism are of interest since there is a male preponderance for the disease. The lack of major differences in polyamine levels between ALS and control spinal cord suggests a maintained regulation of polyamines at the end stage of this neurodegenerative disease.

Amyotrophic lateral sclerosis, ALS, is a progressive fatal neurodegenerative disorder affecting motor neurones in motor cortex, brain stem and spinal cord. This inevitably leads to paralysis, respiratory failure and death. In about 5% of patients with ALS there is an association with mutations in gene for the abundant intracellular scavenging enzyme superoxide dismutase1, SOD1. The noxious property of SOD1 is proposed to be due to gain of function. In familial cases the inheritance is most commonly dominant. This study focus on two disparate SOD1 mutations occurring in Scandinavia. The recessive D90A mutation which has properties similar to that of the normal wild-type human SOD1. The dominantly inherited G127insTGGG mutation, G127X, causes a C-terminal truncation of the last 21 amino acids and is a highly unstable protein. Transgenic mice were created expressing D90A and G127X mutated human SOD1. Results from studies of tissue from the central nervous system of patients carrying either of these mutations were compared with similar tissue collected from transgenic mice generated with the same mutations. Tissue from the mice were also compared to central nervous tissue from several other transgenic mouse strains expressing human wild type SOD1 as well as other ALS associated human SOD1 mutations. The transgenic mice expressing D90A respectively G127X mutated human SOD1 develop motor neurone disease. Microscopic studies of central nervous tissues from G127X transgenic mice reveals inclusions of aggregated misfolded SOD1 in motor neurones and adjacent supporting cells. These inclusions are composed of detergent resistant aggregates and preceded by accumulations of minute quantities of detergent-soluble aggregates. The inclusions mimic those found in G127X patients. In D90A transgenic mice the progression, as in the humans, was slower and the mice, as the patients, showed bladder disturbance. In the D90A patients, the SOD1 inclusions mimic those found in sporadic ALS patients. Aggregation of SOD1 in central nervous tissue appears to be related to severity of disease. Degenerative features as vacuolization and gliosis precedes phenotypic alterations. Changes are seen not only in motor areas but also in higher centres of the telencephalon.

Proteins are the most important molecules in the cell since they take care of most of the biological functions which resemble life. To ensure that everything is working properly the cell has a rigorous control system to monitor the proper function of its proteins and sends old or dysfunctional proteins for degradation. Unfortunately, this system sometimes fails and the once so vital proteins start to misbehave or to accumulate and in the worst case scenario these undesired processes cause the death of their host. One example is Amyotrophic Lateral Sclerosis (ALS); a progressive and always fatal neurodegenerative disorder that is proposed to derive from accumulation of aberrant proteins. Over 140 mutations in the human gene encoding the cytosolic homodimeric enzyme Cu/Zn-Superoxide Dismutase (SOD1) are linked to ALS. The key event in SOD1 associated ALS seems to be the pathological formation of toxic protein aggregates as a result of initially unfolded or partly structured SOD1-mutants. Here, we have compared the folding behaviour of a set of ALS associated SOD1 mutants. Based on our findings we propose that SOD1 mediated ALS can be triggered by a decrease in protein stability but also by mutations which reduce the net charge of the protein. Both findings are in good agreement with the hypothesis for protein aggregation. SOD1 has also been found to be able to interact with mitochondrial membranes and SOD1 inclusions have been detected in the inter-membrane space of mitochondria originating from the spinal cord. The obvious question then arose; does the misfolding and aggregation of SOD1 involve erroneous interactions with membranes? Here, we could show that there is an electrostatically driven interaction between the reduced apo SOD1 protein including ALS associated SOD1-mutants and charged lipid membrane surfaces. This association process changes the secondary structures of these mutants in a way quite different from the situation found in membrane free aqueous environment. However, the result show that mutants interact with charged lipid vesicles to lesser extent than wildtype SOD1. This opposes the correlation between decreased SOD1 stability and disease progression. We therefore suggest that the observed interaction is not a primary cause in the ALS mechanism.

Syftet med denna studie var att beskriva hur människor med Amyotrofisk lateralskleros (ALS) upplever sin livskvalitet. Metoden som användes var en litteraturstudie med beskrivande design. Olika kombinationer av sökorden ”ALS”, ”amyotrophic lateral sclerosis” ”quality of life”, och ”människor” användes vid sökning i databaserna Medline (PubMed) och Science Direct. Totalt analyserades tretton vetenskapliga artiklar som sedan kvalitetsbedömdes och kategoriserades i fyra kategorier: fysisk, psykisk, social och existentiell livskvalitet. Forskning kring de fysiska aspekterna av livskvalitet visade att det främst är den nedsättande funktionsförmågan och begränsningarna relaterade till sjukdomen som bidrar till det fysiska lidandet. Med tiden ändrades patienternas intressen från mer aktiva till passiva. Till skillnad från detta var upplevelsen av det psykiska lidandet mycket låg. Resultat tillhörande den sociala aspekten visade att patienternas förhållande med familj och vänner var av störst värde för att uppleva livskvalitet samt det främsta stödet för att bemästra de svårigheter som sjukdomen medför. Patienternas religiösa tro och tillgång till präst var av betydande roll vad gällande bemästringen av existentiella frågor och funderingar. / The purpose of this study was to describe how people with Amyotrophic lateral sclerosis (ALS) experience their quality of life. The method used was a study of literature with design description. A various combination of search words, such as “amyotrophic lateral sclerosis”, “ALS”, “quality of life” and “people” were used in searching the computer bases Medline (Pubmed) and Science Direct. In total, thirteen scientific articles were analysed and quality tested, subsequently they were categorized into four categories: physical, mental, social and existential quality of life. Research into the physical aspects surrounding the quality of life showed that it is, above all, the disparaging functional capabilities and restrictions related to the illness which causes the mental suffering. In time, the patients interests changed from active to passive. In contrast to this, the experience of mental suffering was very low. Results of the studies into the social aspects showed that the patients relationship with family and friends was of the greatest value to quality of life, as well as the foremost support towards conquering the difficulties which the illness causes. The patients religious beliefs and access to a priest, play a significant part regarding the conquering of existential questions and thoughts.

Amyotrofisk lateralskleros och multipel skleros är båda neurologiska sjukdomar som orsakar fysiska begränsningar och påverkar vardagslivet. Syftet med studien var att undersöka hur vardagslivet gestaltar sig för dessa patienter. Studien baseras på en kvalitativ metod utifrån sex självbiografier och en biografi, vilket ger en insyn i patienternas egna upplevelser av hur det är att leva med ALS eller MS. Resultatet består av fyra huvudteman; Relationer, Begränsningar, Psykisk hälsa och Tankar. I samband med sjukdomen blir relationer mer betydelsefulla samtidigt som den för med sig påfrestningar i förhållandet. Begränsningarna kan leda till att den sjuke får allt svårare att klara av sin vardag vad det gäller hemmet, fritiden samt arbete. Den psykiska hälsan kan yttra sig som depression och det blir en daglig kamp där de söker mening med livet och försöker ta kontroll över situationen. Tankarna handlar om nya värderingar i livet och deras ovisshet om framtiden samt att acceptera situationen. Denna studie kan öka sjuksköterskans kunskap och förståelse för patientens situation, samt vara till hjälp vid individanpassningen av omvårdnaden för dessa patienter. Den kan även vara till hjälp för andra personer som vårdar dessa patienter, som till exempel anhöriga och annan ansvarig vårdpersonal. / Amyotrophic lateral sclerosis and multiple sclerosis are both neurological diseases that cause physical limitations and have consequences on daily life. The aim of this study was to clarify how this daily life appears for these patients. The study is based on a qualitative method with six autobiographies and one biography, which gives an insight of their own, lived experiences on how it is to live with ALS or MS. The result contains four main subjects; Relations, Limitations, Psychical health and Thoughts. In sickness relations becomes more of value, but it also cause stress within a relationship. The limitations make life more difficult in different aspects, such as home environment, leisure activities and work. The mental health can develop into a depression and it becomes a daily fight where they seek a meaning with life and try to take control over the situation. Thoughts are about new values in life, an uncertainty about the future and to accept the situation. The findings of this study can give nurses more knowledge and understanding and be helpful when adjusting nursing care for each of these individuals. It can also be a help to other people who take care of these patients, such as family members and other involved care staff.

A P56S mutation in the VAPB MSP domain is linked to adult-onset amyotrophic lateral sclerosis 8. The objective of this study is to characterize the functional role of VAPB in transport of NE and NPC proteins from the ER to the NE. Over-expression of VAPB-P56S blocked the transport of nucleoporins (Nups) and NE proteins, resulting in their sequestration in dilated cytoplasmic membranes. Simultaneous overexpression of the FFAT motif (two phenylalanines in an acidic track) antagonizes mutant VAPB effects and restores transport to the NE. VAPB function is required for transport to the NE because knockdown of endogenous VAPB recapitulates this phenotype. Moreover, the compartment in which Nups and NE proteins are sequestered and retained was identified as ER-Golgi intermediate compartment (ERGIC). Moreover, a defect in the transport of NE and NPC proteins attenuates nucleocytoplasmic shuttling of the glucocorticoid receptor (GR). Further, VAPB-P56S which is only soluble in SDS was solubilized in the Triton-X-100 fraction similar to VAPB-WT upon co-transfection with the FFAT motif suggesting that FFAT interacts with the insoluble VAPB-P56S protein changing its biophysical properties.

Purpose: The purpose of this project was to look at the costs of individuals with Alzheimer’s disease and related dementias (ADRD), ALS, and MS in long stay home care in Ontario, Canada. The specific goals were to produce estimates of costs for these individuals, as well as identify clinical and personal characteristics associated with these costs. This project also tested the effectiveness of the Resource Utilization Group for home care case-mix system for use in these special populations. Methods: This project was conducted using a secondary analysis of assessment data from the Canadian Staff Time Resource Intensity Verification Project, a 13-week study of home care costs (N=435 141). The project was guided by the Andersen and Newman (1973) framework for healthcare resource utilization. Descriptive characteristics and mean costs were produced using bivariate frequency and means procedures for each of three conditions. Predictors of costs were identified for each of the three neurological conditions through multivariate regression analysis conducted separately for each condition. In total 41 independent variables were included into the bivariate and multivariate analyses. The dependent variable was the total weekly formal and informal home care costs across all multivariate analyses. Results: In total, ADRD, ALS, or MS diagnoses were present in 16% of the assessments. The mean costs for the three conditions combined were $594.81. The mean costs for ADRD, ALS, and MS were $593.32, $898.41, and $574.92, respectively. Characteristics that were predictive of cost across all conditions included the Resource Utilization Group for home care case-mix system, ADL functionality, IADL functionality, cognitive performance, unsteady gait, stair use, difficulty swallowing, respiratory challenges, and bowel incontinence. The Resource Utilization Group for home care case-mix system had the highest level of explained variance of any single item tested in this project across all conditions. However, other clinical characteristics also contributed substantial levels of explained variance to the models for each of the three conditions. Conclusions: The findings from this project suggest that although diagnosis of ADRD, ALS, and/or MS can describe cost, clinical characteristics are the most important predictors of costs for individuals with these conditions. In addition, the Resource Utilization Group for home care case-mix system can adequately predict costs of individuals with these conditions. The addition of some clinical characteristics would likely improve the predictive abilities of the Resource Utilization Group for home care case-mix system.

Amyotrophic lateral sclerosis (ALS) is a debilitating, incurable, neurodegenerative disease characterized by degradation of motor neurons leading to paralysis and ultimately death in ~3-5 years. Approximately 10% of ALS cases have a dominant inheritance pattern, termed familial ALS (fALS). Mutations in the gene encoding the dimeric superoxide scavenger Cu, Zn superoxide dismutase (SOD), were found to be associated with ~20% of fALS cases. Over 110 predominantly missense SOD mutations lead to fALS by an unknown mechanism; however, it is thought that mutant SOD acquires a toxic gain of function. Mice as well as human post mortem studies have identified mutant SOD-rich aggregates in affected neurons, leading to the hypothesis that mutations in SOD increase the tendency of the protein to form toxic aggregates. SOD has a complex maturation process whereby the protein is synthesized in an apo or demetalated state, followed by formation of an intramolecular disulfide bond and binding of Zn2+ and Cu2+. Each of these post-translational modifications increases the stability of the protein. SOD has been shown to aggregate more readily from destabilized immature states, including the apo state both with and without the disulfide bond, highlighting the importance of these states. Thermal unfolding monitored by differential scanning calorimetry (DSC) and chemical denaturation monitored by optical spectroscopy were used to elucidate the folding mechanism and stability of both the apo SOD disulfide-intact and disulfide-reduced states. Chemically and structurally diverse fALS-associated mutants were investigated to gain insights into why mutant SODs may be more prone to misfold and ultimately aggregate. The mutations were introduced into a pseudo wild-type (PWT) background lacking free cysteines, resulting in highly reversible unfolding amenable to accurate thermodynamic analysis. Similarly to what was previously described for fully metallated (holo) SODs, chemical denaturation of the apo disulfide-intact SODs is well described by a 3-state dimer mechanism with native dimer, monomeric intermediate and unfolded monomer populated at equilibrium. Although removal of metals has a relatively small effect on the stability of the dimer interface, the stability of the monomer intermediate is dramatically reduced. Thermal unfolding of some disulfide-intact apo SOD mutants as well as PWT is well described by a 2-state dimer mechanism, while others unfold via a 3-state mechanism similar to chemical denaturation. All but one of the studied disulfide-intact apo mutations are destabilizing as evidenced by reductions in ΔG of unfolding. Additionally, several mutants show an increased tendency to aggregate in thermal unfolding studies through increased ratios of van’t Hoff to calorimetric enthalpy (HvH/ Hcal ). The effects of the mutations on dimer interface stability in the apo disulfide-intact form were further investigated by isothermal titration calorimetry (ITC) which provided a quantitative measure of the dissociation constant of the dimer (Kd). ITC results revealed that disulfide-intact apo SOD mutants generally have increased Kd values and hence favor dimer dissociation to the less stable monomer which has been proposed to be a precursor to toxic aggregate formation. Reduction of the disulfide bond in apo SOD leads to marked destabilization of the dimer interface, and both thermal unfolding and chemical denaturation of PWT and mutants are well described by a 2-state monomer unfolding mechanism. Most mutations destabilize the disulfide-reduced apo SOD to such an extent that the population of unfolded monomer under physiological conditions exceeds 50%. The disulfide-reduced apo mutants show increased tendency to aggregate relative to PWT in DSC experiments through increased HvH /Hcal, low or negative change in heat capacity of unfolding and/or decreased unfolding reversibility. Further evidence of enhanced aggregation tendency of disulfide-reduced apo mutants was derived from analytical ultracentrifugation sedimentation equilibrium experiments that revealed the presence of weakly associated aggregates. Overall, the results presented here provide novel insights into SOD maturation and the possible impact of stability on aggregation.

Bakgrund: Amyotrofisk lateral skleros (ALS) är en obotlig neurologisk sjukdom som gör att nervceller dör. Det gör att muskler förtvinar och efter en tids sjukdom blir individen successivt förlamad. Således drabbas även tal- samt sväljförmåga som gör det svårt att tala och äta. Sjukdomen påverkar inte den ALS-drabbades intellekt eller tankeförmåga men inverkar psykiskt till följd av konsekvenserna av att drabbas av sjukdomen. Årligen får cirka 200 personer i Sverige diagnosen ALS som vanligen leder till döden inom tre till fem år efter diagnos. Syfte: Syftet med studien var att belysa personers upplevelser av att leva med ALS Metod: En kvalitativ studie valdes med inriktning mot att granska självbiografier skrivna av författare diagnostiserade med ALS. Resultat: Studiens resultat visade att sjukdomen begränsade individernas vardagliga liv men även skapade möjligheter till personlig utveckling. Det upplevdes smärtsamt att mista kroppsfunktioner och bli beroende av hjälp från andra personer. Sjukdomen skapade ett kaos av känslor och medförde att de lärde sig att leva på ett nytt sätt. De uppskattade vardagssituationer med skratt och närhet samtidigt som tankar på döden ständigt återkom. Slutsats: För att vårda dessa patienter, eller patienter under liknande omständigheter, behövs förståelse, respekt, lyhördhet och empati från sjukvårdspersonalen. / Background: Amyotrophic lateral sclerosis (ALS) is an incurable neurological disorder that causes nerve cells to die. This leads to muscle atrophy and the diseased becomes progressively paralyzed. The disease is also affecting speech and swallowing. ALS doesn’t affect the intellectual ability but the person is psychologically affected. ALS annually effects 200 people in Sweden and leads to death within three to five years after the diagnosis. Aim: The purpose of this study was to develop understanding of patients by illuminating the ALS-affected people’s experience to live with the illness. Methods: It was a qualitative study aimed at examining autobiographies written by authors diagnosed with ALS. Results: The results showed that the disease gave individuals considerable limitations to everyday life but also opportunities for personal development. It felt painful for patients to gradually lose body functions and therefore become dependent on help from others. The disease created a chaos of emotions and meant to learn a new way of life. They learned to appreciate everyday situations with laughter and closeness while thoughts of death were recurrent. Conclusion: To care for these patients, or patients in similar circumstances, it’s necessary for health care professionals to meet them with understanding, respect, sensitivity and empathy.