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Improving Disease-Modifying Therapy Uptake among Patients with Multiple Sclerosis

Project Summary/Abstract Recent advances in the epidemiology of multiple sclerosis (MS) indicate that its prevalence is similar among White (238 per 100,000) and Black (226 per 100,000) populations. These data challenge historic assumptions about individuals with northern European heritage having higher risk and prevalence of MS. Evidence also suggests that MS incidence may be higher than previously recognized in the United States and increasing over time with more individuals identified and diagnosed year over year. MS continues to impose significant and growing burden on patients, healthcare systems and society. These health differences in the diagnosis, treatment and symptom management of MS in light of the increasing prevalence of MS in the US are an important public health issue that requires broader urgent research and policy attention to reduce the overall disease burden. In this study, we will use real-world data derived from the electronic health records (EHR) from four large academic medical centers (University of Kentucky, University of Virginia, Virginia Commonwealth University, and University of Southern California). Extracted EHR data from these four medical centers will be deidentified, combined, and harmonized. We will use this combined data set to examine (1) whether there are any differences in the timely treatment of disease modifying therapy (DMT) among different MS populations, (2) any disparities in the management of symptoms and comorbidities, (3) how non-medical factors of health such as income, education, and health insurance status (patientlevel), linguistically appropriate care provision (provider-level), and neighborhood factors (system-level) affect these outcomes and influence disparities across populations, and (4) assess whether disparities exist in the risks of cardiovascular disease CVD and mortality in MS subgroups and examine if these disparities can be reduced with improved treatment of MS and vascular comorbidities. In pursuing these objectives, we will identify clinical solutions (e.g., optimal DMT sequences) and non-medical factors such as neighborhood factors such as poverty, educational achievement, crime rates, civic participation, and housing quality, access to care factors, and cultural and linguistic match between providers and patients that substantially contribute to health disparities. For actionable solutions, we will rank-order these factors by their relative importance in addressing disparities, which will guide decision-making at the policy, system, and provider level. Our long-term objective is to develop public health strategies and scalable solutions to reduce overall burden in the management of MS. This project is expected to help policy makers and health system administrators in prioritizing interventions and to have implications for clinical practice in improving care of all patients with MS in neurology clinics, at the healthcare system level, and for national health policy.

Targeting subtype specification as a driver of PDAC health disparities

PROJECT SUMMARY Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease that is refractory to current treatment strategies due in part to adaptive mechanisms of chemoresistance. Racial health disparities also confound the treatment and care of these patients. Blacks (people with African genetic ancestry) have significantly higher incidence rates of PDAC and decreased survival times compared to Caucasians (White genetic ancestry) even after socioeconomic status and tumor stages are controlled. Therefore, it is possible different racial groups exhibit unique molecular characteristics in PDAC tumors that contribute to these health disparities. The unique molecular characteristics that distinguish PDAC tumors between racial groups exhibiting disparities have the potential to identify new therapeutic targets. In a previous study, we identified 4 distinct subtypes of PDAC (Metabolic, Progenitor-like, Proliferative, and Inflammatory) that can be distinguished using multivariate analysis of quantitative proteomic data. While these PDAC subtypes are predictive of therapeutic response, this has not yet been analyzed in disparity factor balanced studies. We have examined the proteomes of primary PDAC tumors using quantitative mass spectrometry and identified unique protein signatures for Blacks and Whites. PDAC tumors from Black patients display features consistent with the Inflammatory subtype of PDAC, which is characterized by an inflamed microenvironment expressing complement proteins that can promote resistance to chemotherapy. Therefore, it is possible that race influences subtype and Blacks could preferentially develop the more aggressive and treatment refractory Inflammatory subtype. Strategies are needed to modulate subtype to improve response to chemotherapy. Toward this goal, our proteomic analysis identified polycomb repressor complex 1 (PRC1) protein RNF2 as being upregulated in PDACs from Blacks compared to Whites. We have also discovered that RNF2 regulates mRNA expression of the PDAC subtype specification factor GATA6 and inhibiting RNF2 promotes a molecular shift toward the more chemosensitive Classical subtype of PDAC. Therapeutic targeting can be achieved with Tazemetostat that inhibits the upstream PRC2 to prevent RNF2 binding the GATA6 promoter leading to its increased expression. Additionally, the Inflammatory subtype characterized by innate immune complement protein activation could be targeted with another FDA approved drug, Avacopan, which has not previously been studied in PDAC. Therefore, the Specific Aims of this proposal are designed to: 1) Evaluate the extent to which Tazemetostat treatment impacts chemotherapy-induced subtype plasticity in patient derived organoids; and 2) To determine the extent to which strategies targeting pathways associated with PDAC disparities affect progression and subtype characteristics in vivo. The successful completion of these aims has the potential to be moved quickly into phase I clinical trials since both Tazemetostat and Avacopan are FDA approved drugs. Furthermore, if successful, this project has the potential to mitigate health disparities in PDAC and broadly improve patient outcomes by implementing new precision interventions. The mouse models we propose faithfully recapitulate pancreatic cancer's clinical syndrome, histopathology and molecular properties, including the often-unique features of the stromal and immune responses that constitute the complex desmoplasia of this disease, which cannot be addressed using in vitro model systems

Multi-level theory of neural representations in the era of large-scale neural recordings: Task-efficiency, representation geometry, and single neuron properties

A central goal in neuroscience is to understand how orchestrated computations in the brain arise from the properties of single neurons and networks of such neurons. Answering this question requires theoretical advances that shine light into the ‘black box’ of representations in neural circuits. In this talk, we will demonstrate theoretical approaches that help describe how cognitive and behavioral task implementations emerge from the structure in neural populations and from biologically plausible neural networks. First, we will introduce an analytic theory that connects geometric structures that arise from neural responses (i.e., neural manifolds) to the neural population’s efficiency in implementing a task. In particular, this theory describes a perceptron’s capacity for linearly classifying object categories based on the underlying neural manifolds’ structural properties. Next, we will describe how such methods can, in fact, open the ‘black box’ of distributed neuronal circuits in a range of experimental neural datasets. In particular, our method overcomes the limitations of traditional dimensionality reduction techniques, as it operates directly on the high-dimensional representations, rather than relying on low-dimensionality assumptions for visualization. Furthermore, this method allows for simultaneous multi-level analysis, by measuring geometric properties in neural population data, and estimating the amount of task information embedded in the same population. These geometric frameworks are general and can be used across different brain areas and task modalities, as demonstrated in the work of ours and others, ranging from the visual cortex to parietal cortex to hippocampus, and from calcium imaging to electrophysiology to fMRI datasets. Finally, we will discuss our recent efforts to fully extend this multi-level description of neural populations, by (1) investigating how single neuron properties shape the representation geometry in early sensory areas, and by (2) understanding how task-efficient neural manifolds emerge in biologically-constrained neural networks. By extending our mathematical toolkit for analyzing representations underlying complex neuronal networks, we hope to contribute to the long-term challenge of understanding the neuronal basis of tasks and behaviors.

Structure, Function, and Learning in Distributed Neuronal Networks

A central goal in neuroscience is to understand how orchestrated computations in the brain arise from the properties of single neurons and networks of such neurons. Answering this question requires theoretical advances that shine light into the ‘black box’ of neuronal networks. In this talk, I will demonstrate theoretical approaches that help describe how cognitive and behavioral task implementations emerge from structure in neural populations and from biologically plausible learning rules. First, I will introduce an analytic theory that connects geometric structures that arise from neural responses (i.e., neural manifolds) to the neural population’s efficiency in implementing a task. In particular, this theory describes how easy or hard it is to discriminate between object categories based on the underlying neural manifolds’ structural properties. Next, I will describe how such methods can, in fact, open the ‘black box’ of neuronal networks, by showing how we can understand a) the role of network motifs in task implementation in neural networks and b) the role of neural noise in adversarial robustness in vision and audition. Finally, I will discuss my recent efforts to develop biologically plausible learning rules for neuronal networks, inspired by recent experimental findings in synaptic plasticity. By extending our mathematical toolkit for analyzing representations and learning rules underlying complex neuronal networks, I hope to contribute toward the long-term challenge of understanding the neuronal basis of behaviors.

Interactions between visual cortical neurons that give rise to conscious perception

I will discuss the mechanisms that determine whether a weak visual stimulus will reach consciousness or not. If the stimulus is simple, early visual cortex acts as a relay station that sends the information to higher visual areas. If the stimulus arrives at a minimal strength, it will be stored in working memory and can be reported. However, during more complex visual perceptions, which for example depend on the segregation of a figure from the background, early visual cortex’ role goes beyond a simply relay. It now acts as a cognitive blackboard and conscious perception depends on it. Our results inspire new approaches to create a visual prosthesis for the blind, by creating a direct interface with the visual brain. I will discuss how high-channel-number interfaces with the visual cortex might be used to restore a rudimentary form of vision in blind individuals.

The neuroscience of color and what makes primates special

Among mammals, excellent color vision has evolved only in certain non-human primates. And yet, color is often assumed to be just a low-level stimulus feature with a modest role in encoding and recognizing objects. The rationale for this dogma is compelling: object recognition is excellent in grayscale images (consider black-and-white movies, where faces, places, objects, and story are readily apparent). In my talk I will discuss experiments in which we used color as a tool to uncover an organizational plan in inferior temporal cortex (parallel, multistage processing for places, faces, colors, and objects) and a visual-stimulus functional representation in prefrontal cortex (PFC). The discovery of an extensive network of color-biased domains within IT and PFC, regions implicated in high-level object vision and executive functions, compels a re-evaluation of the role of color in behavior. I will discuss behavioral studies prompted by the neurobiology that uncover a universal principle for color categorization across languages, the first systematic study of the color statistics of objects and a chromatic mechanism by which the brain may compute animacy, and a surprising paradoxical impact of memory on face color. Taken together, my talk will put forward the argument that color is not primarily for object recognition, but rather for the assessment of the likely behavioral relevance, or meaning, of the stuff we see.

Race and the brain: Insights from the neural systems of emotion and decisions

Investigations of the neural systems mediating the processing of social groups defined by race, specifically Black and White race groups in American participants, reveals significant overlap with brain mechanisms involved in emotion. This talk will provide an overview of research on the neuroscience of race and emotion, focusing on implicit race attitudes. Implicit race attitudes are expressed without conscious effort and control, and contrast with explicit, conscious attitudes. In spite of sharp decline in the expression of explicit, negative attitudes towards outgroup race members over the last half century, negative implicit attitudes persist, even in the face of strong egalitarian goals and beliefs. Early research demonstrated that implicit, but not explicit, negative attitudes towards outgroup race members correlate with blood oxygenation level dependent (BOLD) signal in the amygdala – a region implicated in threat representations, as well as emotion’s influence on cognition. Building on this initial finding, we demonstrate how learning and decisions may be modulated by implicit race attitudes and involve neural systems mediating emotion, learning and choice. Finally, we discuss techniques that may diminish the unintentional expression of negative, implicit race attitudes.

The Impact of Racism-related Stress on Neurobiological Systems in Black Americans”

Black Americans experience diverse racism-related stressors throughout the lifespan. Disproportionately high trauma exposure, economic disadvantage, explicit racism and inequitable treatment are stressors faced by many Black Americans. These experiences have a cumulative negative impact on psychological and physical health. However, little is understood about how experiences of racism, such as discrimination, can mediate health outcomes via their effects on neurobiology. I will present clinical, behavioral, physiological and neurobiological data from Black American participants in the Grady Trauma Project, a longstanding study of trauma conducted in inner-city Atlanta. These data will be discussed in the context of both risk and resilience/adaptation perspectives. Finally, recommendations for future clinical neuroscience research and targets for intervention in marginalized populations will be discussed.

ALBA-BIN Networking event: Black in (N)Euro

The ALBA Network and Black in Neuro are partnering to bring the Black neuroscientific community in Europe together. Are you a Black neuroscientist based in Europe? If so, join us for this casual online networking event. We will share our experience, stories and knowledge about what it is to be black in Europe while working in brain research. We will also discuss potential actions ALBA and BiN could take to provide better visibility to the community. This is a time to get to know each other, share, network and relate. Please register to receive the link to the zoom meeting.

Interactions between neurons during visual perception and restoring them in blindness

I will discuss the mechanisms that determine whether a weak visual stimulus will reach consciousness or not. If the stimulus is simple, early visual cortex acts as a relay station that sends the information to higher visual areas. If the stimulus arrives at a minimal strength, it will be stored in working memory. However, during more complex visual perceptions, which for example depend on the segregation of a figure from the background, early visual cortex’ role goes beyond a simply relay. It now acts as a cognitive blackboard and conscious perception depends on it. Our results also inspire new approaches to create a visual prosthesis for the blind, by creating a direct interface with the visual cortex. I will discuss how high-channel-number interfaces with the visual cortex might be used to restore a rudimentary form of vision in blind individuals.

Kamala Harris and the Construction of Complex Ethnolinguistic Political Identity

Over the past 50 years, sociolinguistic studies on black Americans have expanded in both theoretical and technical scope, and newer research has moved beyond seeing speakers, especially black speakers, as a monolithic sociolinguistic community (Wolfram 2007, Blake 2014). Yet there remains a dearth of critical work on complex identities existing within black American communities as well as how these identities are reflected and perceived in linguistic practice. At the same time, linguists have begun to take greater interest in the ways in which public figures, such as politicians, may illuminate the wider social meaning of specific linguistic variables. In this talk, I will present results from analyses of multiple aspects of ethnolinguistic variation in the speech of Vice President Kamala Harris during the 2019-2020 Democratic Party Primary debates. Together, these results show how VP Harris expertly employs both enregistered and subtle linguistic variables, including aspects of African American Language morphosyntax, vowels, and intonational phonology in the construction and performance of a highly specific sociolinguistic identity that reflects her unique positions politically, socially, and racially. The results of this study expand our knowledge about how the complexities of speaker identity are reflected in sociolinguistic variation, as well as press on the boundaries of what we know about how speakers in the public sphere use variation to reflect both who they are and who we want them to be.

Towards hybrid models of retinal circuits - integrating biophysical realism, anatomical constraints and predictive performance

Visual processing in the retina has been studied in great detail at all levels such that a comprehensive picture of the retina's cell types and the many neural circuits they form is emerging. However, the currently best performing models of retinal function are black-box CNN models which are agnostic to such biological knowledge. Here, I present two of our recent attempts to develop computational models of processing in the inner retina, which both respect biophysical and anatomical constraints yet provide accurate predictions of retinal activity

Associations of depressive symptomatology, social engagement and support, and lifestyle behaviors among non-Hispanic Black and Hispanic men with chronic conditions in the United States

In search for the avian trigeminal magnetic sensor: organization of the ophthalmic sensory complex in the night-migratory Eurasian blackcap (Sylvia atricapilla)