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Category: Volume 4 Issue 10 Oct 2016
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Title: Estimation of Serum Neurokinin A Level in Correlation to Visual Evoked Potentials and Morphological Brain Changes in Malnourished Children: A Follow-Up Case-Control Study

Authors: Enas Mahmoud Hassan, Laila Elmorsi Aboul-Fotoh Elmorsi,  Doaa Mohamed Mahrous, Aliaa Monir Higazi, Gihan Mohamed Bebars, Mahmoud Mounir Higazi

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i10.67

Abstract

Aim: To investigate the effects of protein energy malnutrition (PEM) on the developing brain and to show the association between these changes and neurokinin A (NKA) levels .Re-evaluation after treatment was done.

Methods: A prospective case control study including 30 children with PEM plus 30 healthy age and sex matched controls was planned. Clinical examination along with laboratory measurement of albumin, iron, ferritin and NKA levels were done for all participants. Visual evoked potential (VEPs) and brain MRI were performed. Investigations were repeated after treatment and compared with previous data.

Results: Significant reduction in serum NKA levels of malnourished children was reported. NKA levels were associated negatively with significant latencies in VEPs at P2-N2 in Oz and Cz but positively at P2-N2 amplitudes inO1, Oz and Cz within PEM group compared to controls. Malnourished children mostly showed grade 2 brain atrophy, with significant negative correlation between NKA levels and degree of brain atrophy. Nutritional rehabilitation was associated with increased NKA levels and significant improvement in both VEPs and brain atrophy.

Conclusion: PEM during early infancy significantly affects the developing central nervous system (CNS) in the form of morphological brain atrophy and altered neurophysiological function. These PEM-induced brain changes seem to be reversible thus malnutrition should be detected and treated early to prevent permanent CNS damage. As well, we shed new lights on NKA deficiency within these patients that may play a potential role in the etiological basis for PEM-induced brain atrophy in addition to the resultant functional disorders. Further extended researches are required to validate this tachykinin as a new alarm in early screening for the development of brain harms in PEM children within poor districts.  Also, this may be helpful in predicting the prognosis of such patients.

Keywords: protein energy malnutrition (PEM); neurokinin A (NKA); visual evoked potential (VEPs); brain magnetic resonance imaging (MRI).

References

1.      WHO Guideline: updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization; 2013.

2.      Agozie C, Ngozi S, Chika, Chinyeaka M and Chinelo A. Under-five Protein Energy Malnutrition Admitted at the University of In Nigeria Teaching Hospital, Enugu: a 10 year retrospective review. Nutrition Journal 2012: 11-43.

3.      Udani PM. Protein energy malnutrition (PEM), brain and various facets of child development. Indian J Pediatr1992; 59(2):165-86.

4.      Labadarios, D, Mchiza Z.J.R., Steyn NP et al. Food security in South Africa: a review of national surveys. Bulletin of the World Health Organization 2011; 89(12):891-899.

5.      Hemalatha G, Anuradha B, and Adinar-ayana R. Processing of Visual Evoked Potentials using Mode Deviation. International Journal of Engineering. Trends and Technology (IJETT) 2015.

6.      Chaudhary R, Chugh M, Darokhan Z, Katreddi R, Ramachandra R and Rema V. Physiological Slowing and Upregulation of Inhibition in Cortex are Correlated with Behavioral Deficits in Protein Malnourished Rats. PLoS one 2013; 8(10).

7.      Vaudry H, Conlon JM. Identification of a peptide arising from the specific post translation processing of secretogranin II. FEBS Lett 1991;284:31–3.

8.      Kirchmair R, Hogue-Angeletti R, Gutierrez J, Fischer-Colbrie R, Winkler H. Secretoneurin — a neuropeptide generated in brain, adrenal medulla and other endocrine tissues by proteolytical process-sing of secretogranin II (chromogranin C). Neuroscience 1993;53:359–65.

9.      Maudsley, Stuart; et al. "The Mammalian Tachykinin Ligand-Receptor System: An Emerging Target For Central Neurological Disorders". CNS & Neurological Disord-ers - Drug Targets2010; 9 (5): 627–635.

10.  Nakanishi, Shigetada. "Molecular Mechan-isms Of Intercellular Communication In The Hormonal And Neural Systems". IUBMB Life 2006; 58 (5/6): 349–357.

11.  Schäffer DA, Gábriel R. Two major tachykinins, substance P and substance K, are localized to distinct subsets of amacrine cells in the anuran retina. NeurosciLett.2005; 7;386(3):194-8.

12.  Nagano, Masatoshi;Oishi, Takao; Suzuki, Hidenori. "Distribution And Pharmacolo-gical Characterization Of Primate NK-2 Tachykinin Receptor In The Central Nervous System Of The Rhesus Monkey". NeurosciLett. 2011;503 (1): 23–26.

13.  Martin S. Steinhoff, Bengt von Mentzer, PierangeloGeppetti, CharalabosPothoulakis, and Nigel W. BunnettDepartment of Dermatology, University of California, San Francisco, California; Pharmnovo AB, Göteborg, Sweden; Department of Preclinical and Clinical Pharmacology, University of Florence, Florence, Italy; Inflammatory Bowel Disease Center, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California; Monash Institute of Pharmaceutical Sciences, Parkville, Victoria, Australia; and Department of Pharmacology, University of Melbourne, Parkville, Victoria, Australia. Tachykinins and Their Receptors: Contributions to Physiological Control and the Mechanisms of Disease. Physiol Rev, 2014; 94(1):265-301.

14.  WHO. Child growth standards and the identification of severe acute malnutritionin infants and children.World Health Organization and the United NationsChildren’s Fund1995.

15.  Baranak C, Marsh R and PotsicW .Seda-tion in brainstem response audiometry. International Journal of Pediatric Otorhinolaryngology,1984; 8: 55-59.

16.  Koedam EL, Lehmann M, Van der FlierWM et al.Visual assessment of posterior atrophy development of a MRI rating scale. Eur Radiol 2011;21:2618-2625.

17.  El-Zanaty, Fatma and Ann Way. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International.2009

18.  Miller J. Iron Deficiency Anemia: A Common and Curable Disease. Cold SpringHarbPerspect Med 2013;3.

19.  Elizabeth L Prado and Kathryn G Dewey. Nutrition and brain development in early life. 2014; (72) 4, 267–284.

20.  El-Sherif A ,Babrs G and Ismail A. Cranial Magnetic Resonance Imaging (MRI) Changes in Severely Malnourished Children before and after Treatment.Life science journal 2012;9.

21.  Atalabi OM, Lagunju IA, Tongo OO, Akinyinka OO.Cranial magnetic imaging findings in Kwashiorkor". Int J Neurosci2010; 120(1):23-7.

22.  Odabaş D, Caksen H, Sar S et al. Cranial MRI findings in children with protein energy malnutrition. Int J Neurosci. 2005;115(6):829-37

23.  Mahaman Y., Akuyam S., Danborno B.,Galadima O., Belemsigri M. and Moussa SM. Evaluation of some Laboratory Parameters of Malnourished Children in Magaria District, Zinder, Niger Republic. Sub-Saharan African Journal of Medicine 2014; 1( 2).

24.  Adegbusi H., Sule M. Anthropometric and biochemical assessment among under five children in Kusada Local Government Area, Katsina State, Nigeria.Bayero J Pure Appl Sci 2011;4:137-40.

25.  Rahman M. and Begum BA. Serum total protein, albumin and A/G ratio in different grades of protein energy malnutrition. Mymensingh Med J 2005;l:38-40.

26.  Muller O. and Krawinkel M. Malnutrition and health in developing countries.Can Med Ass J 2005;171:279-93.

27.  Shaaban S., Marzouk D, Nassar M., Ezzat N., Mohamed I. Early detection of protein energy malnutrition in Sharkia Governo-rate. J Egypt Public Health Assoc. 2005; 80(5-6):665-85.

28.  This email address is being protected from spambots. You need JavaScript enabled to view it.. Tachykinin: recent developments and novel roles in health and disease.Biomolecular Concepts.2014;3(5) : 225–243.

29.  Emerson Krock, J. Brooke Currie, Michael H. Weber, Jean A. Ouellet, Laura S. Stone, Derek H. Rosenzweig and Lisbet Haglund. Nerve Growth Factor Is Regulated by Toll-Like Receptor 2 in Human Intervertebral Discs. The Journal of Biological Chemistry 2016; 291:3541-3551.

30.  Burbach, Guido J; Kyu; Zivony, Adam S; Kim, Amy; Aranda, Jennifer; Wright, Stacey; Naik, Shubhada M; Caughman, S Wright; Ansel, John C; Armstrong, Cheryl A. The Neurosensory Tachykinins Substance P and Neurokinin A Directly Induce Keratinocyte Nerve Growth Factor". Journal of Investigative Dermatology. 2001; 117 (5): 1075–1082

31.  Taoka M, Song SY, Kubota M, Minegishi A, Yamakuni T, Konishi S. Increased level of neurokinin-1 tachykinin receptor gene expression during early postnatal development of rat brain. Neuroscience 1996; 74(3):845-53.

32.  Component analysis. Clin Neurophy-siol.2007 ;118(4):896-900.

33.  Grady EF, Gamp PD, Jones E, Baluk P, McDonald DM, Payan DG, BunnettNW. Endocytosis and recycling of neurokinin 1 receptors in enteric neurons. Neuroscience 1996;75: 1239–1254.

34.  Southwell BR, Seybold VS, Woodman HL, Jenkinson KM, Furness JB. Quantitation of neurokinin 1 receptor internalization and recycling in guinea-pig myenteric neurons. Neuroscience 1998;87: 925–931.

35.  Alex G, Kunze WA, Furness JB, ClercN. Comparison of the effects of neurokinin-3 receptor blockade on two forms of slow synaptic transmission in myenteric AH neurons. Neuroscience 2001; 104: 263–269, 2001.

36.  Barbara Teuchner, Andreas Dimmer, Josef Troger  et al.  Secretoneurin and the tachykinins substance P and neurokinin-A/B in NMDA-induced excitotoxicity in the rat retina. Regulatory Peptides 165 (2010) 123–127

37.  McDonald CG, Joffe CL, Barnet AB, Flinn JM. Abnormal flash visual evoked potentials in malnourished infants: an evaluation using principal dos Santos Natanael Antonio ; Caroline Costa Gomes Alencar. Early malnutrition diffusely affects children contrast sensitivity to sine-wave gratings of different spatial frequencies. 2010;4(13), 189-194

38.  Colon E, VisserSL . Evoked Potential Manual: A Practical Guide to Clinical Applications (2012).

39.  Durmaz S, Karagöl U, Deda G, OnalMz. Brainstem auditory and visual evoked potentials in children with protein-energy malnutrition. Pediatr Int. 1999 ;41(6):615-9.

40.  Faldella G., Marina G., Rosina A., et al. Visual evoked potentials and dietary long chain polyunsaturated fatty acids in preterm infants. Archives of Disease in Childhood 1996;75:108-1 12.

41.  Gunston GD, Burkimsher D, Malan H, Sive AA.Reversible cerebral shrinkage in kwashiorkor: an MRI study". Arch Dis Child1992;67(8):1030–2.

Corresponding Author

Doaa Mohamed Mahrous, MD, PhD

Department of Pediatrics,  Minia University, Minia, Egypt

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Tel: +201002699385