Kadan-Lottick et al. (1) recently published an article in the Journal on the analysis of neurocognitive functioning in adult survi- vors of childhood noncentral nervous system cancers, in which they concluded that there is a statistically significant higher percentage of neurocognitive functioning impairment among these adult survivors than among their siblings. They found that radiation therapy and also chemotherapy (mostly with methotrexate, which hinders DNA synthesis) of noncentral nervous system cancers are associated with delayed impairment in task efficiency (1). Albini et al. (2) showed in the Journal that cancer chemotherapeutic agents (eg, 5-fluoro- uracil, capecitabine, and cytarabine) also cause cardiotoxicity, an increasingly rele- vant toxic side effect of this therapy. A stronger association among patients in these cells, the number of mitochondria remained constant. These results establish a link between myelin sheath construction and mitochondrial proliferation because oligodendrocytes produce myelin in the central nervous system. In fact, mitochon- drial DNA, which has a higher turnover than nuclear DNA, is more likely to be sensitive to antimetabolites that inhibit DNA synthesis than nuclear DNA. Therefore, cells with high mitochondrial turnover, such as oligodendrocytes (5), are more likely to be sensitive to antimetabo- lites that inhibit DNA synthesis. We have reported (7) that extramito- chondrial oxidative production of ATP takes place in isolated myelin vesicles, indi- cating that myelin production may be asso- ciated with extramitochondrial oxidative phosphorylation. Such a mechanism could reconcile the high energy demand of the brain with the scarcity of mitochondria in brain tissue (7). In light of our recent report (7), it is tempting to hypothesize that the fate of mitochondria in oligodendrocytes is to be delivered to the site of sheath formation so that they can fuse with the myelin sheath. Although this process remains to be docu- mented, it is in keeping with our increasing knowledge about mitochondrial dynamics and with the trophic role that has been at- tributed to myelin. Because oligodendro- cytes have an elevated mitochondrial turnover and because the myelin sheath apparently contains components of oxida- tive phosphorylation, future investigations should examine the hypotheses that the cognitive impairment after cancer therapy with antimetabolites is a delayed conse- quence of defective myelin sheath produc- tion and that impairment of oxidative phosphorylation, which is essential for chemical energy production, is the ultimate cause of demyelination.
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