Faculty Bibliography

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

Background: We previously reported human catalytic autoantibodies to amyloid b peptide (Ab). We hypothesize that recognition of electrophilic amyloid epitopes by nucleophilic autoantibodies is an innate immune function that is recruited for catalytic clearance of amyloid deposits associated with aging and Alzheimer's disease (AD). Methods: Ab cleavage was measured by HPLC, acid precipitation, mass spectroscopy or electrophoresis. Electrophilic Ab (E-Ab) was prepared by carbonylation with the lipid peroxidation end products 4-hydroxynonenal (HNE)/malonaldehyde (MDA) or phosphonate diester insertion. Covalent immune complexes were analyzed by SDS-electrophoresis. Ab1-42 aggregates were identified by antibody or Thioflavin-T staining. Results: IgM from healthy human sera, the first antibody class produced during B cell differentiation, catalyzed Ab cleavage at rates superior to IgGs. Preferential Ab cleavage by IgMs was also observed for antibodies from the sera and cerebrospinal fluid from patients with AD. Two Ab cleaving antibody fragments were isolated from a phage library, a heterodimeric V L -V L construct (2E6) and a single domain V L construct (5D3). Treatment with antibody 2E6 induced disappearance of oligomeric and fibrillar Ab. Intracranial antibody injection in Ab-overexpressing transgenic mice cleared the Ab plaques. Traditional antibodies bind antigens at complementarity determining regions (CDRs). The Ab cleaving antibodies contained CDRs with no or minimum mutations acquired by antigen-driven diversification. Deleting the CDRs did not attenuate Ab cleavage by antibody 2E6 but the catalytic activity was lost by replacing the framework regions (FRs) with corresponding FRs from a non-catalytic antibody. The FRs are evolutionarily conserved segments important for innate recognition of B cell superantigens without requirement for adaptive immune processes. From protease inhibitor and epitope mapping studies, the catalytic mechanism entails noncovalent binding at the Ab C terminus followed by nucleophilic peptide bond cleavage. Antibody 2E6 reacted covalently with an electrophilic phosphonate-containing Ab analog and the naturally-occurring Ab-HNE/Ab-MDA analogs (E-Ab). Monoclonal murine antibodies (MAbs) that cleaved Ab at low substrate concentrations were identified by immunization with non-electrophilic Ab. A subset of MAbs induced by immunization with E-Ab cleaved Ab robustly. Conclusions: Amplification of the innate noncovalent recognition and catalytic functions of antibodies driven by age/ disease-associated Ab accumulation can remove toxic amyloid deposits

Many neurological and psychiatric diseases are associated with clinically detectable, altered brain dynamics. The aberrant brain activity, in principle, can be restored through electrical stimulation. In epilepsies, abnormal patterns emerge intermittently, and therefore, a closed-loop feedback brain control that leaves other aspects of brain functions unaffected is desirable. Here, we demonstrate that seizure-triggered, feedback transcranial electrical stimulation (TES) can dramatically reduce spike-and-wave episodes in a rodent model of generalized epilepsy. Closed-loop TES can be an effective clinical tool to reduce pathological brain patterns in drug-resistant patients.

The network architecture of functional connectivity within the human brain connectome is poorly understood at the voxel level. Here, using resting state functional magnetic resonance imaging data from 1003 healthy adults, we investigate a broad array of network centrality measures to provide novel insights into connectivity within the whole-brain functional network (i.e., the functional connectome). We first assemble and visualize the voxel-wise (4 mm) functional connectome as a functional network. We then demonstrate that each centrality measure captures different aspects of connectivity, highlighting the importance of considering both global and local connectivity properties of the functional connectome. Beyond "detecting functional hubs," we treat centrality as measures of functional connectivity within the brain connectome and demonstrate their reliability and phenotypic correlates (i.e., age and sex). Specifically, our analyses reveal age-related decreases in degree centrality, but not eigenvector centrality, within precuneus and posterior cingulate regions. This implies that while local or (direct) connectivity decreases with age, connections with hub-like regions within the brain remain stable with age at a global level. In sum, these findings demonstrate the nonredundancy of various centrality measures and raise questions regarding their underlying physiological mechanisms that may be relevant to the study of neurodegenerative and psychiatric disorders.

BACKGROUND: Spinal cord stimulation (SCS) has been shown to modulate atrial electrophysiology and confer protection against ischemia and ventricular arrhythmias in animal models. OBJECTIVE: To determine whether SCS reduces the susceptibility to atrial fibrillation (AF) induced by tachypacing (TP). METHODS: In 21 canines, upper thoracic SCS systems and custom cardiac pacing systems were implanted. Right atrial and left atrial effective refractory periods were measured at baseline and after 15 minutes of SCS. Following recovery in a subset of canines, pacemakers were turned on to induce AF by alternately delivering TP and searching for AF. Canines were randomized to no SCS therapy (CTL) or intermittent SCS therapy on the initiation of TP (EARLY) or after 8 weeks of TP (LATE). AF burden (percent AF relative to total sense time) and AF inducibility (percentage of TP periods resulting in AF) were monitored weekly. After 15 weeks, echocardiography and histology were performed. RESULTS: Effective refractory periods increased by 21 +/- 14 ms (P = .001) in the left atrium and 29 +/- 12 ms (P = .002) in the right atrium after acute SCS. AF burden was reduced for 11 weeks in EARLY compared with CTL (P <.05) animals. AF inducibility remained lower by week 15 in EARLY compared with CTL animals (32% +/- 10% vs 91% +/- 6%; P <.05). AF burden and inducibility were not significantly different between LATE and CTL animals. There were no structural differences among any groups. CONCLUSIONS: SCS prolonged atrial effective refractory periods and reduced AF burden and inducibility in a canine AF model induced by TP. These data suggest that SCS may represent a treatment option for AF.

The neuroimaging literature on attention-deficit/hyperactivity disorder (ADHD) is growing rapidly. Here, we provide a critical overview of neuroimaging studies published recently, highlighting perspectives that may be of relevance for clinicians. After a comprehensive search of PubMed, Ovid, Web of Science, and EMBASE, we located 41 pertinent papers published between January 2011 and April 2012, comprising both structural and functional neuroimaging studies. This literature is increasingly contributing to the notion that the pathophysiology of ADHD reflects abnormal interplay among large-scale brain circuits. Moreover, recent studies have begun to reveal the mechanisms of action of pharmacological treatment. Finally, imaging studies with a developmental perspective are revealing the brain correlates of ADHD over the lifespan, complementing clinical observations on the phenotypic continuity and discontinuity of the disorder. However, despite the increasing potential to eventually inform clinical practice, current imaging studies do not have validated applications in day-to-day clinical practice. Although novel analytical techniques are likely to accelerate the pace of translational applications, at the present we advise caution regarding inappropriate commercial misuse of imaging techniques in ADHD.

A topographical relationship exists between the hippocampus-entorhinal cortex and the neocortex. However, it is not known how these anatomical connections are utilized during information exchange and behavior. We recorded theta oscillations along the entire extent of the septotemporal axis of the hippocampal CA1 pyramidal layer. While the frequency of theta oscillation remained same along the entire long axis, the amplitude and coherence between recording sites decreased from dorsal to ventral hippocampus (VH). Theta phase shifted monotonically with distance along the longitudinal axis, reaching approximately 180 degrees between the septal and temporal poles. The majority of concurrently recorded units were phase-locked to the local field theta at all dorsoventral segments. The power of VH theta had only a weak correlation with locomotion velocity, and its amplitude varied largely independently from theta in the dorsal part. Thus, theta oscillations can temporally combine or segregate neocortical representations along the septotemporal axis of the hippocampus.