Cause of damage in hypoxia-ischemia

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In a patient with prolonged ischemia, does the ischemia lead to any sort of receptor-mediated toxicity?
a. Acetylcholine
b. Dopamine
c. NMDA
d. Epinephrine
e. Serotonin

First of all I hope this is not an NBME o rUWorld q. because it would be nice if you could do a spoiler warning. Otherwise- does the q give a choice for no or none of the above? Because that would be a tougher q.

I would guess NMDA since it is voltage gated channel that is also ligand dependent. Since it is an ion channel I would suspect that prolonged ischemia which leads to irreversible membrane damage would make it difficult to maintain teh ion gradient. The other difficulty maybe identifying receptors that have lipid membrane interactions such as with DAG in a Gq receptor complex. I believe D2 dopamine receptors may have this activity but I am not sure if that is affected by prolonged ischemia....i hhavent seen this concept anywhere so its interesting.
 
It's most likely NMDA. Glutamate causes damage post ischemic stroke.

This is true. I did not know that per se...I wonder if there is a good review sources that covers this material?

The other thing that made me guess NMDA- its primariliy in the brain which is very oxygen dependent.

I dunno, when Im not sure I try and reason it out as best as I can...the other ones are everywhere and in tissues not as O2 dependent but obviously as you say its the glutamate issue.
 
First of all I hope this is not an NBME o rUWorld q. because it would be nice if you could do a spoiler warning. Otherwise- does the q give a choice for no or none of the above? Because that would be a tougher q.

I would guess NMDA since it is voltage gated channel that is also ligand dependent. Since it is an ion channel I would suspect that prolonged ischemia which leads to irreversible membrane damage would make it difficult to maintain teh ion gradient. The other difficulty maybe identifying receptors that have lipid membrane interactions such as with DAG in a Gq receptor complex. I believe D2 dopamine receptors may have this activity but I am not sure if that is affected by prolonged ischemia....i hhavent seen this concept anywhere so its interesting.
Dont worry, its not nbme or UW. I ALWAYS give a spoiler warning. I actually just sort of made up this question myself, its not a real question. If I said more specifically, what is the cause of memory impairment, would that make it more or less likely to be NMDA toxicity?
 
Ischemia = lack of blood flow and O2 = lack of final electron acceptor (O2) = cessation of aerobic metabolism = loss of efficient ATP production, reliance on glycolysis and limited cytoplasmic ATP stores = reduced ATP to power important ATPases, like the Na+/K+ ATPase or Na+/Ca++ ATPase = loss of hyperpolarization of cell, increased build up of Ca++ in cell due to that latter ATPase = Increased Ca++ concentration turns on many enzymes that could be harmful to cell.

In this setting, it is possible that NMDA could further exacerbate problem by allowing more Ca++ in.
 
Dont worry, its not nbme or UW. I ALWAYS give a spoiler warning. I actually just sort of made up this question myself, its not a real question. If I said more specifically, what is the cause of memory impairment, would that make it more or less likely to be NMDA toxicity?

imo without any review I would say more. NMDA is exquisitely associated with memory because of its unique ligand AND voltage dependency. NMDA is an Mg depenent plus voltage dependnet in memory cells. When the two combine- an event associated with both the memory sequence incurred and the act of exciting the neuron takes place - meaning both are required as explained by the ligand and the voltage. The stimualtion of the memory- ligand and the stimulation of a concurrent nerve dendrite on it- the voltage leads to the memory to be essentially stored.
 
imo without any review I would say more. NMDA is exquisitely associated with memory because of its unique ligand AND voltage dependency. NMDA is an Mg depenent plus voltage dependnet in memory cells. When the two combine- an event associated with both the memory sequence incurred and the act of exciting the neuron takes place - meaning both are required as explained by the ligand and the voltage. The stimualtion of the memory- ligand and the stimulation of a concurrent nerve dendrite on it- the voltage leads to the memory to be essentially stored.

Sure, except that sounds like NMDA excitability CAUSES memory formation. With that as a given, would you still argue that too much excitability (ie, excitotoxicity), would have a paradoxical effect on memory formation?
 
Sure, except that sounds like NMDA excitability CAUSES memory formation. With that as a given, would you still argue that too much excitability (ie, excitotoxicity), would have a paradoxical effect on memory formation?

yeah....

Increased extracellular glutamate levels leads to the activation of Ca2+ permeable NMDA receptors on myelin sheaths and oligodendrocytes, leaving oligodendrocytes susceptible to Ca2+ influxes and subsequent excitotoxicity.[14][15] One of the damaging results of excess calcium in the cytosol is initiating apoptosis through cleaved caspase processing.[16] Another damaging result of excess calcium in the cytosol is the opening of the mitochondrial permeability transition pore, a pore in the membranes of mitochondria that opens when the organelles absorb too much calcium. Opening of the pore may cause mitochondria to swell and release reactive oxygen species and other proteins that can lead to apoptosis. The pore can also cause mitochondria to release more calcium. In addition, production of adenosine triphosphate (ATP) may be stopped, and ATP synthase may in fact begin hydrolysing ATP instead of producing it.[17]
Inadequate ATP production resulting from brain trauma can eliminate electrochemical gradients of certain ions. Glutamate transporters require the maintenance of these ion gradients to remove glutamate from the extracellular space. The loss of ion gradients results in not only the halting of glutamate uptake, but also the reversal of the transporters. The Na+-glutamate transporters on neurons and astrocytes can reverse their glutamate transport and start secreting glutamate at a concentration capable of inducing excitotoxicity.[18] This results in a buildup of glutamate and further damaging activation of glutamate receptors.


Second paragraph seems to indicate what I said earlier- its the ion gradient thats lost. First para seems to indicate general ways to damage cells.

Look- I dont know that everyone is expected to retain all these details but looking at the general properties of cell damage it seems that based on that knowledge alone one could come up with the right answer by guessing right. I didnt know about glutamate toxicity but know that ions are easily damaged and NMDA is ion dependent- decreased ATp leads to ion gradient loss. so that makes sense.

In terms of excitotoxicity- i think most of these cell types would allow for greater Ca entry (not just glutamate specific) over time and cause increased Ca damage.

The only reason this may be mitigated and not seen in catecholamines and acytlcholine is because they rapidly down regulate receptors- the same with hormones.

So in the absence of that data - say for unique receptors like NMDA it makes sense that they would be more susceptible to damage. Which menas you can take this concept to almost any tissue/drug and generalize broadly (except when you have downregulation of receptors which we know for sure happens in catecholamesn and acetylcholine)

I know what I said is not an absolute- but its these general concepts that are invaluable in coming up wtih answers- IMO
 
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