Faculty Bibliography

BACKGROUND:Measurement of the angular depth of insertion (aDOI) of cochlear implant electrode arrays has numerous clinical and research applications. Plain-film radiographs are easily obtained intraoperatively and have been described as a means to calculate aDOI. CT imaging with 3D reformatting can also be used for this measurement, but is less conveniently obtained and requires higher radiation doses, a particular concern in pediatrics. The extent to which plain-film and 3D CT image-based measurements are representative of the true position of the electrode within the cochlea is unknown. METHODS:Cochlear implantation was performed on 10 cadaveric temporal bones. Five bones were implanted with perimodiolar electrodes (Contour Advance TM, Cochlear, Sydney, Australia) and five were implanted with lateral wall electrodes (Slim Straight, Cochlear). The insertion depths of the electrodes were varied. Each bone was imaged with a radiograph and CT. aDOI was measured for each bone in each imaging modality by a neurotologist and a neuroradiologist. To obtain a 'gold standard' estimate of aDOI, the implanted temporal bones were embedded in an epoxy resin and methodically sectioned at 100 μm intervals; histologic images were captured at each interval. A 3D stack of the images was compounded, and a MATLAB script used to calculate aDOI of the most apical electrode. Measurements in the three modalities (radiograph, CT, and histology) were then compared. RESULTS:The average aDOI across all bones was similar for all modalities: 423° for radiographs, 425° for CT scans, and 427° for histology, indicating that neither imaging modality resulted in large systematic errors. Using the histology-measured angles as a reference, the average error for CT-based measures (regardless of whether the error was in the positive or negative direction) was 12°, and that for radiograph-based measures was 15°. This small difference (12 vs 15° error) was not statistically significant. CONCLUSION/CONCLUSIONS:Based on this cadaveric temporal bone model, both radiographs and CTs can provide reasonably accurate aDOI measurements. In this small sample, and as expected, the CT-based estimates were more accurate than the radiograph-based measurements. However, the difference was small and not statistically significant. Thus, the use of plain radiographs to calculate aDOI seems judicious whenever it is desired to prevent unnecessary radiation exposure and expense.

Diet influences dopamine transmission in motor- and reward-related basal ganglia circuitry. In part, this reflects diet-dependent regulation of circulating and brain insulin levels. Activation of striatal insulin receptors amplifies axonal dopamine release in brain slices, and regulates food preference in vivo. The effect of insulin on dopamine release is indirect, and requires striatal cholinergic interneurons that express insulin receptors. However, insulin also increases dopamine uptake by promoting dopamine transporter (DAT) surface expression, which counteracts enhanced dopamine release. Here we determined the functional consequences of acute insulin exposure and chronic diet-induced changes in insulin on DAT activity after evoked dopamine release in striatal slices from adult ad-libitum fed (AL) rats and mice, and food-restricted (FR) or high-fat/high-sugar obesogenic (OB) diet rats. Uptake kinetics were assessed by fitting evoked dopamine transients to the Michaelis-Menten equation and extracting C_peak and V_max . Insulin (30 nM) increased both parameters in the caudate putamen and nucleus accumbens core of AL rats in an insulin receptor- and PI3-kinase-dependent manner. A pure effect of insulin on uptake was unmasked using mice lacking striatal acetylcholine, in which increased V_max caused a decrease in C_peak . Diet also influenced V_max , which was lower in FR versus AL. The effects of insulin on C_peak and V_max were amplified by FR but blunted by OB, consistent with opposite consequences of these diets on insulin levels and insulin receptor sensitivity. Overall, these data reveal acute and chronic effects of insulin and diet on dopamine release and uptake that will influence brain reward pathways.

OBJECTIVES/OBJECTIVE:Familial dysautonomia (FD) is a rare hereditary sensory and autonomic neuropathy characterized by chronic lung disease and cyclic vomiting due to hyper-adrenergic crises. Most FD patients are in a depleted nutritional state; however the phenotype of the disease is quite different between patients, as for the severity of lung disease and the intensity and frequency of these pathognomonic crises. In this study we wanted to investigate whether resting energy expenditure (REE) levels are increased in this population, and if correlations exist between REE levels and phenotype severity. METHODS:Data was collected from 12 FD patients (6/6 m/f). REE measurements were conducted by indirect calorimeter. Measured REE % predicted were correlated with pulmonary function, severity of the scoliosis, serum C- reactive protein, yearly frequency of hyper-adrenergic crisis, hospital admissions and the use of nocturnal noninvasive positive pressure ventilation. RESULTS:Mean REE was 112 ±13% predicted with 50% being in a hypermetabolic state (REE/HB > 110%). Body Mass Index (BMI) was below normal range in 75% of patients, and reduced energy intake was also decreased in 75%. No significant correlations to disease severity factors were found. When dividing the subjects to REE levels above or below 125% predicted, Patients with REE above 125% predicted presented with significantly lower Inspiratory Capacity (IC) (42.7% predicted vs 62.8% predicted; p=0.04). CONCLUSIONS:Hypermetabolic state was described in 50% of FD patients. The Low BMI is explained by combination of relative anorexia and increased REE. The REE levels are related to the underling respiratory disease.

Bone cancer metastasis is extremely painful and decreases the quality of life of the affected patients. Available pharmacological treatments are not able to sufficiently ameliorate the pain and as cancer patients are living longer new treatments for pain management are needed. Decitabine (5-aza-2'-deoxycytidine), a DNA methyltransferases inhibitor, has analgesic properties in pre-clinical models of post-surgical and soft tissue oral cancer pain by inducing an up-regulation of endogenous opioids. In this study, we report that daily treatment with decitabine (2µg/g, i.p.) attenuated nociceptive behavior in the 4T1-luc2 mouse model of bone cancer pain. We hypothesized that the analgesic mechanism of decitabine involved activation of the endogenous opioid system through demethylation and reexpression of the transcriptionally silenced endothelin B receptor gene, Ednrb. Indeed, Ednrb was hypermethylated and transcriptionally silenced in the mouse model of bone cancer pain. We demonstrated that expression of Ednrb in the cancer cells lead to release of β-endorphin in the cell supernatant which reduced the number of responsive DRG neurons in an opioid-dependent manner. Our study supports a role of demethylating drugs, such as decitabine, as unique pharmacological agents targeting the pain in the cancer microenvironment.

Increased reaction time variability (RTV) is one of the most replicable behavioral correlates of attention-deficit/hyperactivity disorder (ADHD). However, this may not be specific to ADHD but a more general marker of psychopathology. Here we compare RT variability in individuals with ADHD and those with other childhood internalizing and externalizing conditions both in terms of standard (i.e., the standard deviation of reaction time) and alternative indices that capture low-frequency oscillatory patterns in RT variations over time thought to mark periodic lapses of attention in ADHD. A total of 667 participants (6-12 years old) were classified into non-overlapping diagnostic groups consisting of children with fear disorders (n = 91), distress disorders (n = 56), ADHD (n = 103), oppositional defiant or conduct disorder (ODD/CD; n = 40) and typically developing controls (TDC; n = 377). We used a simple two-choice reaction time task to measure reaction time. The strength of oscillations in RTs across the session was extracted using spectral analyses. Higher RTV was present in ADHD compared to all other disorder groups, effects that were equally strong across all frequency bands. Interestingly, we found that lower RTV to characterize ODD/CD relative to TDC, a finding that was more pronounced at lower frequencies. In general, our data support RTV as a specific marker of ADHD. RT variation across time in ADHD did not show periodicity in a specific frequency band, not supporting that ADHD RTV is the product of spontaneous periodic lapses of attention. Low-frequency oscillations may be particularly useful to differentiate ODD/CD from TDC.

Introduction: Vagus nerve stimulation is currently used as a medical treatment for those suffering from severe epilepsy or depression, but the mechanisms underlying vagus nerve stimulation are poorly understood. The vagus nerve helps connect essentially all peripheral organs to the central nervous system, sending afferents to the nucleus tractus solitarius. Recent studies indicate that vagus nerve stimulation can produce long-lasting plasticity in the cerebral cortex, leading to improved sensory processing and recovery of motor behavior after stroke (Boreland et al, Brain Stimul (2016). An understanding of the circuit mechanisms by which vagus nerve stimulation can produce these results would be important for enhancing behavioral outcomes and developing less invasive or non-invasive neuromodulatory therapeutic techniques. Method(s): Studies in mice provide an opportunity for monitoring and manipulating various aspects of neural circuits involved in behavior. One difficulty in the mouse model is the lack of vagus nerve cuff electrodes given the small size of the mouse vagus nerve. We first built a novel vagus nerve cuff electrode for mice and demonstrated reliable low-impedance recordings and stimulation during behavior in mice chronically implanted for months. Two-photon imaging of the auditory cortex was used to track neural responses to tones paired with vagus nerve stimulation. Animals are then trained on either a paired go/no-go or two-alternative forced choice auditory detection and recognition task (Martins and Froemke, Nat Neurosci 2015; Kuchibhotla et al. Nat Neurosci 2017). Result(s): Stimulation of the vagus nerve was calibrated to transiently reduce respiration without affecting other physiological processes (e.g., heart rate). Using two-photon imaging, we found that pairing target tones with vagus nerve stimulation for five minutes led to a short-term enhancement of sensory responses in the mouse auditory cortex. After several days of these brief 5-minute pairing sessions, long-term plasticity was observed with increases in representation of the target tone for at least days thereafter. Conclusion(s): These changes are reminiscent of the effects of basal forebrain stimulation (Froemke et al. Nature 2007) and we are now investigating how vagus nerve stimulation might lead to direct or indirect activation of central modulatory systems to improve plasticity and behavior in mice.

Transcutaneous electric stimulation (TES) using weak currents has been used extensively in attempts to influence brain activity. In vitro and in vivo experiments in rodents and computational modeling suggest that the magnitude of voltage gradient of the induced electric field should exceed 1 mV/mm to instantaneously and reproducibly alter neuronal spiking and consequent brain network patterns. Evidence for immediate and unconditional neuronal effects of TES in the human brain is still lacking, mainly due to the saturation of the recording amplifiers by the large induced electromagnetic fields. For many therapeutic applications, it is desirable to affect neurons in a regionally constrained manner to reach maximum on-target effects and reduce side effects on unintended brain networks. Here, we determine the needed TES currents in human cadavers to achieve 1 mV/mm fields. Scalp stimulation greatly reduced the generated intracerebral electric fields (>50% in cadavers) and these measurements predicted that ~5 mA is needed to achieve 1mV/mm electric field gradient via scalp stimulation. To reach the desired intracerebral field strength without the adverse peripheral effects of >5 mA currents, we introduce a spatially focused multiple site, Intersectional Short-Pulse (ISP) stimulation. We demonstrate the instantaneous entraining effect of ISP on alpha waves in human subjects and on neuronal spiking in rats. Immediate effects of TES can be best utilized in disorders with sudden, major electrographic changes such as epileptic seizures. We showed earlier that thalamocortical seizures can be quickly terminated by temporally targeted, diffuse transcranial stimulation, however secondarily generalized temporal lobe seizures are more resistant to these diffuse interference interventions. ISP also has the capacity to spatially focus its effect, thus it is capable to overcome the unwanted mirror effect (anodal vs cathodal) of the traditional TES protocols. We report here a novel stimulation pattern, that can simultaneously entrain both hippocampi. To evaluate its utility, temporal lobe seizures were induced in rats by electrical kindling, and each electrically kindled seizures were automatically detected and silenced by a closed loop ISP stimulation. By comparing to closed-loop diffuse TES, we found that ISP with bilateral foci is more effective in early seizure termination. Lastly, we introduce our prototyping efforts to implement an implantable, minimal-invasive, transcranial closed-loop seizure termination device, aiming for human clinical applications.

Introduction: The mammalian enteric nervous system (ENS) regulates intestinal function in response to luminal changes in nutrients and microbiota. The ENS also modulates immune cells to control microbial homeostasis and fight infections. Enteric neurons signal to the brain via the vagus nerve, providing a mechanism by which microbiota can influence neural activity and behavior at homeostasis or during infections with gut pathogens. However, little is known about the relation between vagus nerve activity and 'sickness behaviors' such as decreased attention, increased irritability and depression, and decreased interest and energy. Here we aimed to record vagus nerve responses in behaving animals towards understanding this gut-brain signaling connection in sickness behavior. Method(s): Custom nerve cuff electrodes were used to monitor vagus nerve activity of wild-type male mice. Cuffs were made with 0.2 mm micro-renathane tubing to surround the upper branch of the sensory vagus nerve and connected to socket gold pins and medwire. Chronic nerve cuffs were implanted in mice aged 6-12 weeks. Surgery consisted of securing gold pins to the cranial vertex and connecting electrodes to the vagus nerve in the neck, around which the cuff was placed. The grounding wire was secured near the cuff. One to two weeks post-surgery, each mouse underwent sickness induction via lipopolysaccharide (LPS) injection. LPS solution was formulated with 9.5/g muL of 0.9% saline solution and 0.5/g muL of pure LPS via intraperitoneal injection. Electrophysiological activity of the vagus nerve was recorded together with video monitoring of behavior, prior to injection to first establish a baseline, and post-injection activity was recorded for up to 24 hours. Sickness behavior was ethogrammed and neural activity analyzed in each animal. Result(s): LPS injection led to reduction of several different behaviors including overall motion in the homecage for hours afterwards. Analysis of simultaneously-recorded vagus activity is ongoing. Conclusion(s): We here describe an integrated system that combines long-term videography and behavioral analysis with recordings of the peripheral nerve activity using a custom chronic nerve cuff for the mouse vagus. Using this system, we have begun to relate neural activity in the sensory vagus to physiological state and behavioral changes in mice for the first time.

BACKGROUND:Genetic variation in ion channel genes ('channelopathies') are often associated with inherited arrhythmias and sudden death. Genetic testing ('molecular autopsies') of channelopathy genes can be used to assist in determining the likely causes of sudden unexpected death. However, different in silico approaches can yield conflicting pathogenicity predictions and assessing their impact on ion channel function can assist in this regard. METHODS AND RESULTS/RESULTS:channels, as determined with biotinylation assays, suggesting that all of the variants led to an enhanced open state. CONCLUSIONS:channels in the heart and specialized cardiac conduction, vascular smooth muscle and respiratory neurons, it is conceivable that electrical silencing of these cells may contribute to the vulnerability element, which is a component of the triple risk model of sudden explained death in infants. The gain-of-function phenotype of these ABCC9 variants should be considered when assessing their potential pathogenicity.