Faculty Bibliography

To address the pending public health crisis due to Alzheimer's disease (AD) and related neurodegenerative disorders, the Marian S. Ware Alzheimer Program at the University of Pennsylvania held a meeting entitled "State of the Science Conference on the Advancement of Alzheimer's Diagnosis, Treatment and Care," on June 21-22, 2012. The meeting comprised four workgroups focusing on Biomarkers; Clinical Care and Health Services Research; Drug Development; and Health Economics, Policy, and Ethics. The workgroups shared, discussed, and compiled an integrated set of priorities, recommendations, and action plans, which are presented in this article.

BACKGROUND: Obesity is frequently associated with respiratory symptoms despite normal large airway function as assessed by spirometry. However, reduced functional residual capacity and expiratory reserve volume are common and might reflect distal airway dysfunction. Impulse oscillometry (IOS) might identify distal airway abnormalities not detected using routine spirometry screening. Our objective was to test the hypothesis that excess body weight will result in distal airway dysfunction detected by IOS that reverses after bariatric surgery. The setting was a university hospital. METHODS: A total of 342 subjects underwent spirometry, plethysmography, and IOS before bariatric surgery. Of these patients, 75 repeated the testing after the loss of 20% of the total body weight. The data from 47 subjects with normal baseline spirometry and complete pre- and postoperative data were analyzed. RESULTS: IOS detected preoperative distal airway dysfunction despite normal spirometry findings by an abnormal airway resistance at an oscillation frequency of 20 Hz (4.75 +/- 1.2 cm H(2)O/L/s), frequency dependence of resistance from 5 to 20 Hz (2.20 +/- 1.6 cm H(2)O/L/s), and reactance at 5 Hz (-3.47 +/- 2.1 cm H(2)O/L/s). Postoperatively, the subjects demonstrated 57% +/- 15% excess weight loss. The body mass index decreased (from 44 +/- 6 to 32 +/- 5 kg/m(2), P < .001). Improvements in functional residual capacity (from 59% +/- 11% to 75% +/- 20% predicted, P < .001) and expiratory reserve volume (from 41% +/- 20% to 75% +/- 20% predicted, P < .001) were demonstrated. Distal airway function also improved: airway resistance at an oscillation frequency of 20 Hz (3.91 +/- .9, P < .001), frequency dependence of resistance from 5 to 20 Hz (1.17 +/- .9, P < .001), and reactance at 5 Hz (-1.85 +/- .9, P < .001). CONCLUSION: The present study detected significant distal airway dysfunction despite normal preoperative spirometry findings. The effect of increased body weight was likely the main mechanism for these abnormalities. However, the inflammatory state of obesity or associated respiratory disease could also be invoked. These abnormalities improved significantly toward normal after weight loss. The results of the present study highlight the importance of bariatric surgery as an effective intervention in reversing these respiratory abnormalities.

When monitoring neural activity using intracranial electrical recordings, researchers typically consider the signals to have two primary components: fast action potentials (APs) from neurons near the electrode, and the slower local field potential (LFP), thought to be dominated by postsynaptic currents integrated over a larger volume of tissue. In general, a decrease in signal power with increasing frequency is observed for most brain rhythms. The 100-200 Hz oscillations in the rat hippocampus, including "fast gamma" or "epsilon" oscillations and sharp wave-ripples (SPW-Rs), are one exception, showing an increase in power with frequency within this band. We have used detailed biophysical modeling to investigate the composition of extracellular potentials during fast oscillations in rat CA1. We find that postsynaptic currents exhibit a decreasing ability to generate large-amplitude oscillatory signals at high frequencies, whereas phase-modulated spiking shows the opposite trend. Our estimates indicate that APs and postsynaptic currents contribute similar proportions of the power contained in 140-200 Hz ripples, and the two combined generate a signal that closely resembles in vivo SPW-Rs. Much of the AP-generated signal originates from neurons further than 100 mum from the recording site, consistent with ripples appearing similarly strong regardless of whether or not they contain recognizable APs. Additionally, substantial power can be generated in the 90-150 Hz epsilon band by the APs of rhythmically firing pyramidal neurons. Thus, high-frequency LFPs may generally contain signatures of local cell assembly activation.

BACKGROUND: Notch signaling has previously been shown to play an essential role in regulating cell fate decisions and differentiation during cardiogenesis in many systems including Drosophila, Xenopus, and mammals. We hypothesized that Notch may also be involved in directing the progressive lineage restriction of cardiomyocytes into specialized conduction cells. METHODS AND RESULTS: In hearts where Notch signaling is activated within the myocardium from early development onward, Notch promotes a conduction-like phenotype based on ectopic expression of conduction system-specific genes and cell autonomous changes in electrophysiology. With the use of an in vitro assay to activate Notch in newborn cardiomyocytes, we observed global changes in the transcriptome, and in action potential characteristics, consistent with reprogramming to a conduction-like phenotype. CONCLUSIONS: Notch can instruct the differentiation of chamber cardiac progenitors into specialized conduction-like cells. Plasticity remains in late-stage cardiomyocytes, which has potential implications for engineering of specialized cardiovascular tissues.

Background: Tau pathology is involved in multiple neurodegenerative disorders, for example in Alzheimer's disease, Parkinson's disease, and Frontotemporal dementia (FTD). Tau is a neuronal protein that binds microtubules and is thought to be involved in the stabilization of microtubules. Over 50 different mutations within the MAPT gene, the gene encoding for Tau, have been associated with inherited FTD. FTD is thought to involve deficits in the communication between neurons and in the mechanisms neuronal adaptation to experience, synaptic plasticity. The role of Tau in mechanisms of synaptic plasticity is not well-understood. To address this gap in the field, we have investigated synaptic plasticity and behavior in P301L mice, a mouse model for tau pathology that over-expresses human Tau protein carrying an inherited human mutation. Methods: Long-lasting forms of plasticity, late-phase long term potentiation (L-LTP) were examined in P301L (JNPL3) mice and age-matched controls by measuring field excitatory postsynaptic potentiation (fEPSP) in the CA1 hippocampal region after high frequency electrophysiological stimulation. Two behaviors associated with GABAergic function were assayed, prepulse inhibition of startle response (PPI) and susceptibility to epileptic seizures. GABAergic interneurons were stained using two markers; paravalbumin and somatostatin. Results: By examining long-lasting forms of plasticity in aged (>18 months old) in hippocampal brain slices we found surprisingly enhanced L-LTP in P301L mice compared to age-matched controls. The enhanced L-LTP in P301L slices was rescued by treatment with a GABA agonist, Zolpidem. These results suggest a loss of GABAergic neurons in P301L mice. Next we examined PPI and susceptibility to epileptic seizures in P301L and control mice. We found an altered PPI response and differences in epileptic seizures grades. Finally, we stained GABAergic interneurons in the hippocampus using two markers that identify GABAergic cell types showing a decrease in GABAergic neurons in the hippocampal CA1 region. Conclusions: Our results suggest that GABAergic interneurons are more vulnerable to molecular lesions caused by pathological Tau, which may result in the selective loss of hippocampal GABAergic interneurons. The molecular mechanisms involved in this specific GABAergic loss remains to be resolved, but may help to explain the pathophysiological symptoms of diseases like FTD, which involve altered Tau function

Background: Immunotherapy targeting hyperphosphorylated tau is a promising prospect to mitigate the neurodegenerative effects of tauopathies. Assessing the effectiveness of such immunotherapies often involves sacrifice of the animal. However, Manganese-Enhanced Magnetic Resonance Imaging (MEMRI) permits the longitudinal study of neuronal function with minimal risk to the animal. We hypothesize that tract-tracing MEMRI in a mouse model of tau pathology should enable non-invasive monitoring of various tau targeting therapies aimed at improving neuronal integrity. Methods: Twenty-five homozygous JNPL3 tangle transgenic mice underwent MEMRI at 6 months of age. Thirteen of the mice received tau immunotherapy with Tau379-408[P-Ser396,404] in alum adjuvant from 3 months of age, and twelve controls received an adjuvant alone. Imaging studies were performed on a 7-T micro-MRI. Mice were imaged pre-injection, then injected in one nostril with a solution of 2.5 M MnCl 2, under isoflurane anesthesia. Image sets were acquired at 1, 4, 8, 12, 24, 36 and 48 hours, and finally at 7 days (Fig 1). The datasets were processed using ImageJ. Normalized measurements for each mouse were plotted and fitted to a tract tracing bolus model using MATLAB. Fitting enabled the estimation of the timing (Pt) and intensity (Pv) of the bolus peak of Mn, and maximal slope of uptake (Sv). Results: A significant increase in maximal slope of manganese uptake, Sv, was observed in the mitral cell layer (35%, P <.005) and glomerular layer (36%, P <0.02) in treated JNPL3 mice compared to identical controls. There was also a significant increase in bolus peak value, Pv, in the mitral layer in the treated group (7%, P = 0.02). Furthermore, in the immunized mice, there was a strong trend for a decrease in the time to peak value, Pt (-9%P = 0.10), in the mitral cell layer, compared to the controls. Conclusions: Utilizing MEMRI's non-invasive, longitudinal measurements from 1 hour to 7 days, allowed us to detect substantial improvements in neuronal transport following tau immunotherapy. We are analyzing tau pathology in olfactory sections from these mice to assess the correlation of these benefits with clearance of tau lesions, which we have shown previously to occur with this treatment

Background: Biomarkers such as amyloid beta (e.g. Ab42) and hyperphosphorylated tau (e.g. pTau181) in cerebral spinal fluid (CSF) and hippocampal volume loss measured by magnetic resonance imaging (MRI) are useful for identifying cognitively normal elderly likely to have "preclinical" Alzheimer's disease (AD), but such methods are invasive and/or expensive. We investigated whether cognitive tasks dependent on brain regions affected in early AD can serve as proxies of AD biomarkers. Research indicates that the hippocampal formation (Hipp), particularly CA3/dentate gyrus (CA3/DG) and the entorhinal cortex (EC) are affected in preclinical AD. Therefore, we hypothesized that performance on a CA3/DG-dependent spatial pattern separation task (PST) and a Hipp/ EC-dependent discrimination and generalization task (DGT) would be impaired in cognitively normal individuals with biomarker evidence for AD. Methods: We collected initial data on our tasks from 31 cognitively normal NYU Alzheimer's Disease Center/Center for Brain Health participants who had MRI and who also provided CSF for longitudinal studies. In the PST, participants discriminated between two identical dots, one in a previously viewed location and one in a new location. In the DGT, participants learned to discriminate pairs of stimuli determined by shapes or colors in a discrimination phase, then had to generalize the "preferred" shapes and colors to novel stimuli in a generalization phase. Results: Linear regression analyses (with age and years of education as covariates) were used to determine whether task performance correlates with bilateral Hipp volume (used as a surrogate for CA3/DG and controlled for total intracranial volume) and CSF biomarkers. Performance on the PST correlates with bilateral Hipp volume (n = 31; R 2 = 0.151, P = 0.004) and CSF Ab42/pTau181 ratio (n = 26; R 2 = 0.182, P = 0.026). Performance on generalization correlates with Ab42 (R 2 = 0.182, P = 0.026) and marginally with Ab42/pTau181 ratio (R 2 = 0.119, P = 0.079). Performance on discrimination correlates with Ab42/ pTau181 ratio only (R 2 = 0.159, P = 0.039). A standard memory test (NYU Paragraph Recall) shows no significant correlations. Conclusions: These preliminary results are consistent with our hypothesis that cognitive tasks dependent on brain regions affected by early AD pathology may provide a non-invasive and cost-effective method to identify and track change in clinically normal individuals at high risk for progressing to theMCI and dementia stages of AD

Background: Anti-amyloid immunotherapy reduces Ab plaques and prevents cognitive decline in transgenic mouse models of Alzheimer's disease (AD) (Asuni et al, 2006). Nevertheless, in humans, a strategy based on Ab1- 42 peptide induced encephalomyelitis and possibly microhemorrhages (Orgogozo et al, 2003; Ferrer et al, 2004). These outcomes were not expected from studies in rodents. Mouse lemur, as a primate model may be more predictive of human side effects. A small proportion of old animals develop spontaneously Ab plaques (Mestre-Franc-es et al, 2000). Thus this primate models prodromal AD stages, and we used it to evaluate side effects of immunotherapies. Methods: Animals were treated with K6Ab1-30 (n = 4; 5.860.2 years) or Ab1-42 (n = 4; 5.960.2 years) immunogens in alum adjuvant. They were followed-up for 9 months with biochemistry (anti-Ab40 antibodies and Ab40 levels in the plasma), as well as T2-weighted (T2w) and T2-weighted (T2w) MRI (7T PharmaScan-Bruker; resolutions =(234x234x234)mm3. Histological analyses was performed to evaluate amyloidosis, neuroinflammation, and iron deposits/microhemorrhages. Age-associated occurrences of hypointense signals were evaluated in twenty other naive animals (1.5 to 4.9 years). Results: In this particular study, the animals responded mainly to the Ab1-42 immunogen, which differs from our prior study with this Ab derivative (Trouche et al, 2009). This treatment induced an immune response and increased Ab levels in plasma. No severe neuroinflammation were observed (either on MRI or histology). Compared to K6Ab1-30 vaccine, Ab1-42 immunogen increased microhemorrhages (Mann Whitney test U=1, P<0.05) and the size of hypointense signal corresponding to iron deposits in the choroid plexus (CP) (F(2,5)= 4.627; P<0.05). The study in naive lemurs showed that iron accumulates in the CP with normal aging (r=0.60; P<0.001). Hence, immunotherapy with Ab1-42 immunogen accelerated this age-associated phenomenon. Conclusions: Ab-immunization can lead to side effects such as microhemorrhages in a primate model of normal aging or prodromal stage of AD with minimal extracellular Ab deposition. Also, iron accumulation in the CP is a potential side effect of Ab-immunization. This should be taken into account in future evaluations of clinical trials with AD patients

Alzheimer's disease (AD) is a neurodegenerative disease that is associated with epigenetic dysregulation. However, the mechanisms mediating epigenetic dysfunction in AD are unknown. Our objective was to determine if Regulator of Calcineurin 1 (RCAN1) has a role in AD-related epigenetic changes. RCAN1 is located on human chromosome 21, trisomy of which results in Down syndrome (DS), a disorder characterized with early onset AD. Moreover, RCAN1 is overexpressed in both DS and AD. RCAN1 modulates the activity of calcineurin (CaN), a calcium-sensitive phosphatase that can in turn regulate the transcription factor cyclic AMP response element binding protein (CREB). CREB affects epigenetic modification by recruiting histone acetylase activity that promotes transcription at specific DNA sites. To test the idea that RCAN1 overexpression may mediate aberrant CaN/CREB signaling leading to epigenetic dysregulation in AD, we generated transgenic mice that selectively overexpress RCAN1 in the brain using the Cre/lox system. Using immunoblotting, enzymatic assays and chromatin immunoprecipitation of hippocampal tissue from these mice, we found altered CaN activity and trafficking to the nucleus, CREB activation and histone acetylation. Overall, this work provides critical new understanding of a role for RCAN1 in regulating epigenetic mechanisms and gene expression in AD