interventions

Increasing Lung Cancer Screening Uptake Among High-Risk Emergency Department Patients

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer death in the US. Although lung cancer screening (LCS), using low- dose CT scan, decreases lung cancer mortality through early disease identification, fewer than 1 in 6 eligible individuals get screened, with significant differences based on demographic and socio-economic factors. LCS is a process, not just a test. The critical first steps in this process are (1) identification of high-risk individuals who are eligible for LCS, and (2) recruitment of these individuals into an LCS program. The Emergency Department (ED) setting is optimal for an intervention to promote LCS by accomplishing these steps. Individuals at high risk for lung cancer are over-represented in the ED population, including: individuals that smoke, non-White individuals, patients with lower education levels, and the under-insured. In fact, over 2.3 million high-risk people pass through EDs every year who are eligible for LCS but have never been screened. The investigators’ long-term goal is to develop a low-cost, scalable intervention that increases LCS uptake among ED patients and is deployable in any ED with a regionally referrable LCS program. The objective of the proposed randomized clinical trial is to test the efficacies of text messaging and a facilitated referral strategy to promote uptake of LCS in order to achieve this goal. Step 1 of the approach is to identify participants that are eligible for LCS. Step 2 is to randomize eligible participants, using a 2x2 design, among four study arms: (1) basic referral for LCS (i.e. verbal referral with written materials; comprising an enhanced control arm), (2) basic referral plus a subsequent series of text messages, grounded in behavioral change theory, aimed at generating intention and motivation to get screened, (3) facilitated referral for LCS (i.e. submission of a requisition to LCS program by staff), and (4) facilitated referral plus text messages. The investigators’ pilot work demonstrated the feasibility and efficacy of the proposed approach. A total of 1036 individuals eligible for LCS will be recruited from a high-volume urban ED and a low-volume rural ED, randomized among study arms, and followed-up at 120 days to assess interval LCS uptake. The Specific Aims of the proposed project are, (1) Compare LCS program uptake among study arms that receive text messages to study arms that do not, (2) Compare LCS program uptake among study arms with basic referral to study arms with facilitated referral, (3) Investigate the interaction between receipt of text messages (yes/no) and referral type (basic/facilitated), and (4) Evaluate participant feedback on (a) differential barriers to LCS across sub-groups and (b) acceptability and appropriateness of ED-based promotion of LCS. The study team is at the forefront of developing ED-based interventions to promote cancer screening. This project leverages the universal access setting of the ED to identify individuals at greatest risk for lung cancer and get them screened. A scalable ED-based intervention that increases LCS uptake would save lives.

Factory-treated, long-lasting permethrin baby wraps for the prevention of malaria: A phase III randomized controlled trial

PROJECT SUMMARY/ABSTRACT Progress against malaria has stalled. Novel interventions – particularly those targeting outdoor and daytime biting – are needed. In a randomized, placebo-controlled trial of permethrin- vs. sham-treated baby wraps in Uganda, we found a significant reduction in clinical malaria incidence among children carried in permethrin- as compared to sham-treated wraps (Boyce et al, NEJM, 2025). Despite these promising results, our trial incorporated a monthly re-treatment strategy that would be difficult to operationalize at scale. Furthermore, we only followed participants for 6 months, which is shorter than the expected period of use. Therefore, implementation studies - and specifically trials of long-lasting, factory-treated textiles - are now needed. Factory-treated materials would not only eliminate the need for retreatment for up to 12 months, but because the chemicals are more tightly bound, result in less absorption across the skin. Therefore, we now propose to conduct a randomized, double-blind trial of factory-treated, long-lasting (FTLL) wraps. AIM 1: Determine the effectiveness of FTLL permethrin wraps in combination with existing interventions for the prevention of malaria in children. We will enroll 750 mother-infant pairs from routine immunization visits (~3 months of age) at 3 sites of varying transmission intensity across Uganda. All participants will receive new dual active ingredient (AI) bed nets and be randomized (1:1) to either FTLL or untreated wraps. The primary outcome will be clinical malaria incidence during the period of wrap use, defined as fever a positive malaria rapid diagnostic test (RDT) between the FTLL and untreated arms. AIM 2: Confirm the safety of extended exposure to FTLL permethrin wraps for use in young children. Although a review of factory-treated clothing by the US Environmental Protection Agency, including clothing for children and toddlers, did not identify scenarios of concern, the frequency of use envisioned here may be beyond that modeled. To accomplish this, we will perform semi-annual assessments of growth (e.g., height-for-weight) and neurodevelopment (ND) during the period of use and 12-months after discontinuation. AIM 3: Assess the effect of FTLL permethrin wraps on Anopheles mosquito indices and blood-meal seeking behaviors. We will conduct longitudinal entomological surveillance, including CDC-light trap and aspirator collections, supplemented by human landing catches at sentinel households (~10-15%) from both the FTLL and untreated arms. This work tests a novel intervention, which leverages technology developed by the US military, to reduce the burden of malaria in endemic countries. Addressing malaria in these countries minimizes the risk of importation into the US. If successful, the project will provide additional evidence for treated textiles, which may be used to protect American travelers and deployed military servicemembers. The project will be conducted in Uganda, where malaria is highly endemic and it will be possible to enroll at-risk women-infant pairs.

FIRE-PF: Developing and Testing a Trauma-Informed Alcohol Intervention to Enhance Mental Health in Firefighters

PROJECT SUMMARY Alcohol use and hazardous drinking are ubiquitous among firefighters in the United states and is associated with significant physical and mental health risks for this population. Due to the nature of their work, firefighters experience substantially higher rates of trauma exposure and are subsequently at greater risk of developing specific mental health conditions compared to the general population, particularly trauma-related psychopathology (e.g., posttraumatic stress). Hazardous drinking and posttraumatic stress frequently co-occur among firefighters, leading to poorer health outcomes compared to either condition alone. Despite this elevated risk, firefighters often lack access to tailored, empirically supported interventions, and no existing mental health interventions address hazardous drinking in a trauma-informed framework for this at-risk population. Personalized feedback interventions (PFIs) are a promising approach that could address this gap. By delivering brief, patient-centered feedback on drinking behaviors and perceptions within the context of trauma and occupational stress, PFIs aim to reduce problematic drinking behaviors and stigma related to coping-orientated drinking and improve stress management strategies. PFIs can be brief, cost-effective, and easily disseminated in a format accessible to large groups, making them a strong candidate for use with firefighters who face critical barriers to engaging in traditional mental health programs. This innovative study aims to develop a single-session, trauma-informed, online PFI tailored specifically for firefighters, using a comprehensive, three-phase approach to address three primary aims. The Development Phase involves developing, adapting, and enhancing a trauma-informed PFI by gathering qualitative feedback from firefighters (N = 45) and using an iterative, rapid user-centered design approach to ensure the intervention is engaging for firefighters as well as relevant and aligned with fire service culture. The Evaluation Phase will assess the feasibility, acceptability, and preliminary impact of the PFI in a mixed-methods longitudinal open trial with firefighters (N = 50), with a focus on the intervention's usability, delivery, and influence on drinking behaviors. The Implementation Planning Phase will involve qualitative and quantitative assessments with fire service leaders (N = 15) to identify implementation barriers and shape future research testing the implementation process for the intervention and inform future strategies for resource integration and fostering sustainable community partnerships. This proposal will equip Dr. Lebeaut with essential training for an independent research career, including training in (1) qualitative methodologies, (2) user-centered design, (3) developing, adapting, and enhancing trauma-informed alcohol interventions, and (4) developing collaborative relationships with community partners in the fire service. The proposed study will directly inform a future R01 to evaluate the intervention’s efficacy and scalability and support the development of a firefighter-focused research program.

Mentoring investigators in patient-oriented research on HIV and public health

PROJECT SUMMARY/ABSTRACT Despite marked progress in treatment and prevention, HIV remains a significant public health threat in the US and globally. Innovative strategies are needed to effectively deploy interventions and reduce HIV incidence, which requires a sustained and committed workforce. Dr. Dennis is an infectious disease physician and researcher at the University of North Carolina (UNC) at Chapel Hill, Division of Infectious Diseases. She seeks the protected time of the K24 award to ensure adequate time and effort to provide mentorship in patient- oriented HIV research focused on applied public health strategies. Dr. Dennis has a track record of performing high-quality patient-oriented research supported by independent funding. Her research bridges basic, clinical, and epidemiologic science by using HIV-1 molecular epidemiology and phylogenetics to understand HIV transmission at the population level and to use this information to direct prevention. She has expanded this work to optimize strategies to detect and respond to HIV networks using mixed-methods approaches. The overall goal of this work is to uncover the links between these sub-epidemics - which are overlapping sub- epidemics defined by risk groups, geography, social interaction - to facilitate the design of timely, effective interventions. The research specific aims are 1) Investigate HIV transmission networks using molecular epidemiology and phylodynamics (R01AI135970), 2) Evaluate uptake of HIV treatment and prevention services in public health with social network approaches (supported by R01AI169602), and 3) Pilot a network-based characterization of early syphilis infections to inform strategies to increase the uptake of injectable antiretrovirals for HIV treatment and prevention (supported by K24). With the support of the K24, she will leverage resources at UNC to support mentorship and professional development to strengthen new directions (implementation science, community-engaged research). Dr. Dennis is deeply committed to expanding her mentorship and dedicated to fostering diverse mentees with lived experiences that are critical for sustaining the HIV workforce. Dr. Dennis is Co-Director of the UNC Center for AIDS Research (CFAR) Scientific Working Group which focuses on Ending the HIV Epidemic efforts in North and South Carolina. She has strong institutional support and a multidisciplinary team of advisors, including the UNC CFAR, and is an advisor on the UNC T32 HIV/STI institutional training program. She has collaborated for the past 10 years with NC Division of Public Health and with multiple investigators and trainees at the UNC Gillings School of Public Health. She is active in the UNC Infectious Diseases Fellowship program, providing clinical and research mentorship to numerous ID fellows. Her clinical activity provides practical grounding and relevance in patient-oriented research. The K24 will provide 50% of Dr. Dennis’ salary and additional funds to support mentees’ research. The proposed research is timely and aligned with the National HIV/AIDS Strategy and will support the protected time needed to mentor the next-generation of investigators in HIV patient-oriented research.

Multimodal computational models for early prediction of peritoneal recurrence in gastric cancer

ABSTRACT Gastric cancer represents a significant disease burden and is a leading cause of cancer-related deaths in the United States and globally. Approximately 80% of gastric cancer patients are diagnosed at an advanced stage, with the peritoneum being the most common site of relapse (peritoneal recurrence) after radical surgery. Nearly 50% of patients with advanced-stage gastric cancer develop peritoneal recurrence post-surgery, resulting in a median survival of only 3–6 months and a markedly reduced quality of life. Early peritoneal recurrence is primarily characterized by micro-metastasis, which traditional imaging techniques struggle to detect due to the small size of metastatic nodules. Predicting the likelihood and timing of peritoneal recurrence is crucial for identifying at- risk patients, enabling timely interventions that could improve survival rates and quality of life. Unfortunately, reliable predictive biomarkers and models for peritoneal recurrence in gastric cancer are lacking in clinical practice, highlighting an urgent need for innovative predictive tools. This proposal aims to develop and validate novel predictive models for early peritoneal recurrence in gastric cancer, leveraging advanced deep learning techniques and multimodal integration of clinical, radiological (CT), and histopathological (hematoxylin and eosin, H&E) data. In Aim 1, we will develop a rational approach for predicting peritoneal recurrence by creating a novel deep learning multimodal method guided by genomics knowledge. Additionally, we will integrate both deep learning-extracted features and traditional hand-crafted radiomics features with clinical data to improve prediction accuracy. Aim 2 focuses on developing a robust prediction model of peritoneal recurrence utilizing a pre-trained foundation model from large-scale H&E image data. Aim 3 will combine CT, H&E, and clinical data to further enhance predictive capabilities, employing an innovative cross-modal collaborative optimization approach for multimodal data integration. All models will be trained and internally validated using a retrospective cohort from Atrium Health Wake Forest Baptist Comprehensive Cancer Center and externally validated in two independent cohorts from additional institutions to ensure robustness across populations and imaging protocols. Additionally, we will compare our models with existing methods, including clinical staging and alternative fusion strategies. If successful, these models will enhance risk stratification and prediction of peritoneal recurrence in gastric cancer patients, significantly improving survival rates and quality of life by identifying those likely to develop peritoneal recurrence post-surgery and facilitating timely intervention. Furthermore, they can help avoid the risk of complications and extra medical costs associated with overtreatment. Since the information is derived from routinely examined CT, H&E and clinical data, they could be seamlessly integrated into current clinical workflows. The AI technology developed through this project has the potential to benefit underserved populations in low- resource settings and reduce healthcare disparities in the U.S.

Borrelia burgdorferi genotypic diversity, pathogenesis, and host cellular responses

PROJECT SUMMARY Lyme disease is the most common tick-borne illness in the United States, with an estimated 476,000 cases annually, and Pennsylvania (PA) consistently reports one of the highest case numbers nationwide. Borrelia burgdorferi sensu stricto (Bb) is a causative agent of Lyme disease in the US and is transmitted by Ixodes spp. ticks. Bb produces various outer surface proteins (Osp) and other mechanisms to survive in vectors, evade host immune systems, and to propagate infection within a host. Over 35 OspC genotypes have been characterized, which fluctuate in abundance in natural vector and host populations, suggesting host adaptation. While many Lyme-infected patients recover following antibiotic treatment, some may experience neurological symptoms, Lyme neuroborreliosis (LNB), which may be associated with specific genotypes. While previous studies focused on clinical manifestations, pathogenicity, genetic variations, and host immune responses using mouse models or patient samples, the genotype-specific immune responses that contribute to disease progression in humans remain poorly understood. Our central hypothesis is that certain Bb OspC genotypes, maintained in natural populations, are associated with distinct host immune responses that influence disease severity, progression, and persistence. Aim 1 will define the dynamics of OspC genotypes in tick and small mammal populations over time in Western PA to establish a 16-year longitudinal tick study and an 8-year longitudinal small mammal study. Using deep amplicon sequencing, we will quantify genotype diversity, detect low-abundance genotypes, and identify potential host-adapted genotypes. These empirical data will inform a compartmental mathematical model to evaluate OspC genotype prevalence, distribution, and public health risks, including LNB, across space and time. Aim 2 will assess how distinct Bb OspC genotypes affect the host immune landscape and cellular responses using human samples. To determine how Bb genotype contributes to disease phenotype, we will perform immune profiling studies which will include microscopy-based assessment of infected cell cultures, flow cytometric analysis of immune cell phenotypes, and measurement of genotype-specific cytokine, chemokine, and antigen production (sub-Aim2a). We will also employ multi-omics approaches that integrate single cell RNA sequencing with antibody-based protein profiling (scRNA-seq/Ab-seq) to characterize transcriptional and functional changes in immune cell populations exposed to different Bb genotypes (sub-Aim2b). This work is innovative in its integration of long-term ecological data with advanced immune profiling and single cell multi- omics to uncover genotype-specific mechanisms of Bb pathogenicity and human immune response—an approach not previously applied in Lyme disease research. These studies will clarify how specific genotypes influence immune responses and disease severity. Together, the proposed aims will identify critical genetic and immunological mechanisms that drive Bb pathogenicity and human susceptibility, informing the development of improved diagnostics, targeted therapies, and public health interventions to reduce the burden of Lyme disease.

Investigating the nonlinear complex dynamics of the tuft cell-microbiome cross-talk: the impact of feedback loops on immune regulation, microbial modulation and response to tissue insults

Project Abstract Tuft cells (TCs) are specialized chemosensory epithelial cells that are emerging as critical regulators of intestinal homeostasis. Named over 70 years ago based on their distinct morphology, a defined function for TCs was only elucidated in the last decade. TCs in the small intestine sense succinate from helminths to initiate type 2 immune responses that mediate parasite expulsion. Recently, we discovered a novel physiologic function for TCs in the colon, where their role had been considered minimal. Succinate, a key microbial metabolite, is produced by colonic microbiota as both a precursor to other metabolites and a cross-feeding fuel source for pathogens. TCs respond to succinate by secreting interleukin-25 (IL-25), which activates type 2 cytokine- producing lymphocytes (T2Ls), amplifying TC expansion and reinforcing barrier function. We recently demonstrated that this SPB–TC–IL-25–T2L feedback loop is essential for protection against pathogen-induced colitis. Our preliminary data further suggest that TCs actively promote colonization by succinate-producing bacteria (SPBs), establishing positive feedback on TC-supporting microbes, while other epithelial cells such as goblet cells (GCs) and Paneth cells (PCs) may exert complementary or counterbalancing influences. Supported by new modeling insights, we hypothesize that these epithelial–immune–microbiome interactions form coordinated feedback loops that collectively optimize intestinal resilience. These loops may create a dynamic, multi-stable system that flexibly transitions between homeostatic and hyperplastic states, buffering against microbial fluctuations and pathogenic insults while preventing uncontrolled type 2 inflammation. Using a combination of mathematical modeling and experimental validation, we will develop a multi- layered systems framework to explore how epithelial–immune–microbial feedbacks shape resilience or breakdown in clinically relevant models of colonic infection and inflammation. Our three Aims will (1) develop, calibrate, and validate a mathematical model that integrates TCs, GCs, PCs, SPBs, and SCBs; (2) define the immunological circuits governing epithelial–microbiome equilibrium; and (3) determine how epithelial feedbacks regulate microbial community structure and resilience. In line with NIH’s new initiative to prioritize human-based research, our proposal combines computational modeling, human colonic organoids, and complementary mouse models. Organoid experiments will provide human-relevant data for model calibration, while in vivo studies validate systemic predictions, ensuring both rigor and translational relevance while minimizing reliance on animal models. This work will generate interoperable models that integrate epithelial, microbial, and immune networks, providing predictive insight into intestinal outcomes under homeostatic, infectious, and inflammatory conditions and informing therapeutic strategies for microbiome-targeted interventions.

Behavioral, Implementation & Community Sciences Core

PROJECT SUMMARY: BEHAVIORAL, IMPLEMENTATION, AND COMMUNITY SCIENCES (BICS) CORE Like many US jurisdictions, New York City (NYC) is not on track to achieve 2030 End the Epidemic (EHE) 95- 95-95 goals. By the end of 2023, 95% of people with HIV (PWH) in NYC had been diagnosed with HIV, but only 88% of those were in HIV care, and of those, only 80% were virally suppressed. Further, in 2022, only 40% of individuals estimated to need PrEP were prescribed it. Highly efficacious biomedical HIV treatment and prevention interventions have the potential to end the HIV epidemic, but only if they are accessed and used. Yet, behavioral, social, and structural determinants of real-world adoption as well as population-level impact of HIV prevention, care, and treatment innovations have not been addressed adequately for individuals or communities. Meeting EHE goals will depend on behavioral, implementation, and community sciences research that identifies factors contributing to these outcomes, informs interventions to address them, and ensures that communities affected by HIV are engaged throughout the research process. The Behavioral, Implementation, and Community Sciences (BICS) Core will facilitate such rigorous, innovative research by Columbia University (CU) and Weill Cornell Medicine (WCM) investigators – particularly early career investigators (ECIs) and those new to HIV research – to help achieve EHE 2030 goals. The BICS Core will support the use of relevant theories, methods, and analytic approaches to advance the integration of context-specific behavioral, implementation, and community sciences perspectives across the research continuum – from basic research through scale-up and sustainment of evidence-based interventions. The Core has three Aims: (1) Behavioral science: To support CFAR users in developing, selecting, and integrating behavioral science methodologies across the research continuum; (2) Implementation science: To support CFAR users in designing and conducting implementation studies and related health services research and (3) Community science: To facilitate rigorous community-based participatory research across the research continuum to strengthen and sustain stakeholder engagement that will optimize research translation and impact. Led by Core Co-Directors Robert Remien and Bruce Schackman and Core Associate Directors Delivette Castor, Shashi Kapadia, and Justin Knox, the BICS Core will use multiple approaches to achieve each of these aims, including substantive scientific consultations on proposed or ongoing research; access to resources and tools; and seminars and educational activities that promote integration of these methods into EHE research. The Core, thus, will support CU-WCM CFAR investigators and outside collaborators – including ECIs and investigators new to HIV research – to advance local and national EHE goals.

Clinical Trial Readiness of MEG Biomarkers in Children Across the Autism Spectrum

PROJECT SUMMARY Biological and phenotypic heterogeneity of autism spectrum disorder (ASD) poses a major challenge for clinically focused research and interventions. Brain electrophysiological phenotyping holds promise for parsing this heterogeneity. Using magnetoencephalography (MEG), findings of diminished and delayed auditory evoked responses (e.g. the ~50ms component, M50 and, specifically, its latency: M50L) have reproducibly been shown in ASD, with correlation to behavior. Additionally, abnormal resting state activity and network functional connectivity has been identified as an electrophysiological hallmark. Such passively-acquired signatures may serve as objective biomarkers in subtyping autistic individuals, including stratifying patients for inclusion in clinical trials according to biology, rather than behavior alone. However, despite their abundant promise, these measures are not yet permeating clinical trial design, nor being utilized in clinical practice, in part because of their lack of standardized implementation and analysis. This proposal seeks to remedy this by using rigorous and standardized, scalable and sharable methods with two leading MEG measures to determine their measurement- reliability as well as their sensitivity to inter-individual differences in clinically-relevant aspects of autism features, general cognitive ability and language and communication. Specifically adopting a 12-week repeated scanning design, mimicking the duration of a typical pharmaceutical trial or behavioral intervention, we will acquire each of these two MEG metrics at baseline and 12-week follow-up to assess interval change. Additionally, we will evaluate test-retest variability with an intermediate measurement point 4-weeks after baseline. As such we will characterize both intra-subject variability (measurement precision) and inter-subject variability which will be correlated with dimension axes of autism features, general cognitive ability and language skills, as well as major co-occurring condition confounds. These studies will recruit a broad range of 240 autistic children, paralleling the CDC’s prevalence data on intellectual ability and encompassing the group considered as having “profound autism”. This is enabled by our adoption of MEG-PLAN, a strategy developed over the last decade in our group and demonstrated to enhance inclusive participation in MEG scanning studies, even in non-verbal participants. Data will be compared to a control group of age-matched typically-developing peers. The two MEG measures will also be assessed for their ability to identify clusters of less heterogeneous neurophysiological phenotype as a novel basis for stratification or subtyping of the heterogeneous autism population. In culmination, this study addresses key “clinical readiness” aspects of utilization of MEG biomarkers for ASD including profound autism, for both stratification (inclusion/trial selection) and monitoring of response to intervention, and will, ultimately, pave the way for the adoption of such biomarkers as adjunctive tests in increasingly-routine clinical practice.

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.

Tbx4-Driven Pulmonary Hypertension: Mechanisms and Therapeutic Targets

Project Summary: Heterozygous rare variants in TBX4 are the second most common cause of heritable pulmonary arterial hypertension (PAH). Presentation of this form is commonly in children. Patients with mutations in TBX4 generally have alveolar simplification or hypoplasia in addition to elevated pulmonary vascular resistance. We have developed a set of three tools to help determine the molecular etiology of TBX4-induced PAH; (1) we identified the direct binding targets using a combination of ChIP-seq and RNA-seq; (2) we developed a mouse model with Tbx4 knockout after birth, that substantially phenocopies human disease; (3) we performed single-cell RNA-seq on these mice. By combining these three tools, we can develop a complete model for how loss of a transcription factor leads to the molecular and physiologic changes we see in our mice. The phenotype in mice appears to be dominated by defects in pericytes, resulting in impaired angiogenesis. Pericytes, which strongly express Tbx4, are cells located on the outside of capillaries and precapillary arterioles, and can either stabilize vessels (mesh pericytes), or drive angiogenesis (angiogenic pericytes). The pericytes in Tbx4 mutant mice are heavily skewed towards mesh and away from the angiogenic phenotype. Loss of Tbx4 results in derepression of Tbx4 binding target Rgs5 (10x induction), which directly results in inhibition of Pi3K, and the phenotypic switch in pericytes. We will test this hypothesis through pericyte-specific Tbx4 knockout (Aim 1) and pharmacologic induction of Pi3K in vivo in prevention and rescue models, as well as by siRNA to Rgs5 in precision-cut lung slices from Tbx4 KO mice (Aim 3). We will also test the role of Tbx4 in fibroblasts and smooth muscle using cell-specific knockouts – based on our mouse and single cell data, we expect they contribute somewhat, but primarily through increased stiffness (Aim 2). Finally, we will confirm relevance to human disease through spatial transcriptomics in lung sections explanted from patients with TBX4 mutation or rearrangement (Aim 1), and through determining whether defects in human patient iPSC-derived pericytes can be corrected through Rgs5 or Pi3K interventions (Aim 3). In combination, these aims determine the cellular and molecular mechanisms leading from mutation to physiology with loss of TBX4, and establish therapeutic targets.

Development of an at-home weight-shifting balance game with musical biofeedback for older adults

Reducing fall risk is a dire societal need that requires interventions that over-prepare individuals to perform maneuvers important to daily mobility. Falling is often caused by improper weight shifting, and interventions that focus on developing weight-shifting abilities have shown improvements in clinical balance outcomes, including reduced fall incidence. Interventions that combine challenges to the cognitive and motor systems may be necessary to reduce fall-risk. Our central hypothesis is that leveraging gamification and “musical biofeedback” will improve balance abilities through practicing weight-shifting skills with increased cognitive and physical demands. Musical biofeedback conveys biological sensor data from the participant through specific musical sound parameters in real-time. Of particular interest in the proposal is the applicability to use musical biofeedback to train weight-shifting skills in a musical game. The goal is to develop a wearable sensor system that can be used at-home to practice and develop balance skills, while supporting cognitive engagement and motivation to adhere to exercise goals. To start, we are focusing on older adult end-users who typically have home exercise programs focused on weight-shifting. However, in the future, many other populations can benefit from this technology. In this Trailblazer award, the PI is leveraging her background in studying complex human maneuvers, developing musical biofeedback for older adults, and in algorithm development for mHealth sensors. The transdisciplinary team includes expertise in engineering, gamified rehabilitation technologies, home exercise programs, psychology of aging, and music. In the proposed research, our goals are to evaluate responses to the musical biofeedback game (Aim 1), validate the mHealth sensor system (Aim 2), and phenotype the gameplay behavior of fallers vs. non-fallers (Aim 3), relative to their baseline characteristics (Sub-Aim 3). Our long-term goal is for a variety of people to improve their balance control patterns while supporting and building their self-efficacy. We envision users, including older adults, training with musical biofeedback to safely (and enjoyably) prepare themselves to ambulate in their community – improving and preserving their mobility. The proposed research will pioneer using an emerging clinical technology – musical biofeedback – to train balance during weight-shifting tasks. The proposed research innovates how musical biofeedback, gamification, and focusing on weight-shifting and turns in balance training can be leveraged to challenge cognitive and physical body systems in fall-risk populations. By developing new therapy options and better understanding responses relative to baseline characteristics, this research improves clinical practices to reduce fall risk and deepens our understanding of dynamic balance control. Finally, the results of the proposed research will have translational impacts to help other fall-risk groups.

Temporomandibular Joint Disc Replacement: Biomechanical Characterization and Novel Implant Assessment

Project Summary/Abstract Temporomandibular joint (TMJ) disorders inflict approximately 5% to 12% of the population. For advanced disorders of the articular TMJ disc, which typically do not respond to conservative treatments, disc resection is the most common surgical intervention. However, the TMJ disc plays a critical role in distributing mechanical stress and preventing wear to the articular surfaces of the joint. Thus, removing the disc can further disrupt joint homeostasis, driving degeneration and the development of osteoarthritis, which can lead to highly invasive and challenging surgical interventions such as joint reconstructions and total joint replacement. Therefore, there is a critical need for disc replacements that can restore the homeostasis of the joint when disc resection is required. Prior attempts at replacing the disc with alloplastic implants have led to deleterious pathological changes related to wear debris, implant fragmentation, and adverse inflammatory responses. Therefore, it is crucial to consider wear, mechanical strength, and biocompatibility of disc replacement materials in the context of long-term cyclic loading in the TMJ. Accordingly, the objective of this proposal is to create an artificial TMJ disc that replaces the mechanical function of the native disc and prevents subsequent degeneration of the joint. Towards this goal, the proposed research will characterize the mechanical loading environment of the TMJ in order to determine the mechanical criteria of a TMJ disc replacement needed to minimize internal stress in the joint (Specific Aim 1). Further, non-resorbable composite hydrogels will be fabricated using biocompatible materials, refined to exhibit biomimetic properties, and molded into a TMJ disc implant. Rigorous mechanical evaluations will determine material durability and suitability as a TMJ disc replacement (Specific Aim 2). Finally, a large animal study will be utilized to evaluate the safety and efficacy of the developed TMJ disc replacement (Specific Aim 3). Successful completion of the proposed work would represent a paradigm shift in the treatment of TMJ disc disorders that can mitigate further joint degeneration and prevent more invasive and complicated surgeries.

SUPPORT SERVICES FOR THE PREVENTION AND TREATMENT THROUGH A COMPREHENSIVE CARE CONTINUUM FOR HIV-AFFECTED ADOLESCENTS IN RESOURCE CONSTRAINED SETTINGS IMPLEMENTATION SCIENCE NETWORK

Support Services for the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings Implementation Science Network (PATC3H-IN) (UG1/UM2) Program The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) requires support for logistical and operational coordination, website and communication management, analytic and data management, infrastructure for emerging research, regulatory, and monitoring of research activities for the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings Implementation Science Network (PATC3H-IN) (UG1/UM2) Program. The NICHD and partner NIH Institutes anticipate funding 8 PATC3H-IN UG1 awards in Asia and throughout sub-Saharan Africa in 2023 through a cooperative agreement mechanism for interventions of high public health significance: The prevention of new HIV infections among adolescents at risk, and the identification of, linkage to and retention in care of, and long-term viral suppression among youth living with HIV in low-to-middle income countries with high HIV burden. The PATC3H-IN network will expand and/or improve on successes achieved by its predecessor, PATC3H, to new geographic settings and/or risk populations and stimulate much needed implementation science (IS) research in the prevention of new HIV infections among adolescents at risk and the identification of, and linkage and retention to care of and long-term viral suppression among youth living with HIV in low-to-middle income countries (LMICs). PATC3H-IN will establish a network of investigators with multidisciplinary expertise on the youth-specific PHCC and in IS research, whose mission will be to evaluate promising prevention innovations contextually and developmentally tailored for HIV uninfected at-risk youth, and treatment and care interventions for youth living with HIV which have demonstrated efficacy and/or effectiveness in adolescent or adult populations and to translate them into public health practices. The structure of PATC3H-IN will consist of multiple interdependent functional components: (1) Five Clinical Research Centers (CRC) awarded through the UG1 grant mechanism; (2) one Implementation Science Coordinating Center (ISCC) to be awarded through a UM2 grant mechanism in 2024; and (3) a Scientific Leadership Committee (SLC). The CRCs will conduct clinical research and clinical trials, including implementation, effectiveness, and hybrid implementation-effectiveness studies at their 8-or more participating Clinical Research Performance Sites (CRPS). The ISCC will establish infrastructure to support research education and capacity building across PATC3H-IN, as well as infrastructure for stakeholder engagement in and dissemination of findings from PATC3H-IN and advanced statistical modeling support across PATC3H-IN. The ISCC will also provide infrastructure for conducting foundational research to support the work of clinical sites, including possible modeling studies and translation projects, as well as national surveys, and/or systematic collection and analysis of relevant policies and laws. Lastly, the SLC will be responsible for PATC3H-IN governance, oversight, and coordination, and will develop and implement the network research agenda, convening working groups as needed, prioritizing emerging research projects, efficiently managing the development of clinical protocols, implementing and completing clinical trials, and ensuring timely publication and communication of results.

Impact of environmental toxicants on frontal cortical circuits

Abstract: Human mercury (Hg) exposure has been known for many decades to produce cognitive impairment and mood disorder symptoms. Hg is a global pollutant that poses widespread potential for neurotoxic exposure, earning it a position on the WHO’s list of the top 10 chemicals of major public health concern. However, little is known about the neural mechanisms that lead to neuropsychiatric symptoms from Hg exposure. The objective of this application is to identify specific mechanisms, within the neocortical circuits that control emotion and cognition, that are disrupted by the neurotoxicant, methylmercury (MeHg). The neocortex exhibits especially strong bioaccumulation of Hg, magnifying the risk to these circuits. Therefore, we hypothesize that chronic MeHg exposure leads to persistent circuit dysfunction in prefrontal and insular cortices (mPFC and aIC) – two brain regions critical in control of emotion and cognition. Our recent work showed that mPFC neurons in brain slices are negatively affected by acute MeHg exposure, resulting in hyperexcitability and altered synaptic transmission. Currently, it unknown how these acute effects on synaptic transmission translate to altered neuronal function in vivo. This proposal applies an integrative approach to determine the in vivo effects of MeHg on mPFC and aIC circuits, at the systems neurophysiology, synaptic and molecular levels. We will compare the effects of MeHg exposure on in vivo spiking activity patterns in brain regions of the mPFC-aIC circuit, using multiunit electrophysiological recordings in awake animals. Action potentials will be recorded simultaneously from multiple neurons, distributed across cortical layers, to evaluate effects on spike frequency, temporal patterning and correlation. Using acute brain slices derived from animals chronically treated with MeHg in vivo, electrophysiologically recorded synaptic estimates will be made to compare the effects of MeHg exposure on synaptic transmission and EI-balance within brain regions of the mPFC-aIC circuit. Based on previous evidence, we hypothesize that TDP-43 hyper-phosphorylation and aggregation link MeHg exposure to mPFC and aIC dysfunction. Therefore, immunohistochemistry will be used to measure TDP-43 hyper-phosphorylation and nuclear redistribution from animals treated in vivo +/- MeHg. In addition, tissue will be co-labeled with antibodies for nPAS4, a well-stablished molecular marker of activity, to determine whether TDP-43 hallmarks correlate with MeHg-induced hyper-excitability. The results of our study will substantively improve our mechanistic understanding of how Hg disrupts frontal cortical function and contribute to our understanding of the biological basis of emotional and cognitive sympoms. Identifying specific actions of MeHg at the functional microcircuitry level and cellular/molecular level will help significantly in finding novel targets for therapeutic interventions. If our hypothesis is correct, this will also raise the question of the extent to which chronic low-level environmental mercury exposure contributes to the etiology of fronto-cortical disorders with symptoms that overlap mercury exposure but do not have definitive genetic origins. This is particularly important because fronto-cortical disorders are predominantly sporadic in nature.

Post-diagnosis changes in body composition and renal cell cancer survival

ABSTRACT Significance. Clear cell renal cell carcinoma (ccRCC) is the most common form of kidney cancer and most lethal subtype, and there is great interest in the identification of potentially modifiable prognostic factors. Although weight status seems to be relevant, the relationship between body mass index (BMI) at diagnosis and survival among ccRCC patients indicates that mortality is lowest among those classified as overweight or obese at the time of diagnosis by BMI. This has resulted in confusion in clinical guidance for weight management among ccRCC patients. Recent work involving body composition features (adipose and muscle tissue) has provided some insight, but we do not understand how weight or body composition changes after diagnosis relate to survival, nor how these changes relate to pathological and molecular tumor features— information which is needed to resolve this controversy. Rigorous analytical approaches are further required to accurately address these questions. Innovation. Our study is highly innovative in that 1) we will be the first to leverage a large-scale cohort of ccRCC patients with multiple assessments of weight and body composition from diagnosis onward; 2) we will examine tumor characteristics, including molecular features, as potential drivers of these changes; and 3) we will use a rigorous joint modeling approach to simultaneously model the post-diagnosis trajectories of weight and body composition and their relationships with cancer outcomes in the most statistically sound manner. Our findings will inform clinical management of, and identify modifiable body composition features to improve survival for the growing number of ccRCC patients. Approach. We will use available data from the RESOLVE cohort, an NCI-funded retrospective cohort of 1,239 Stage I-III clear-cell renal cell carcinoma (ccRCC) patients diagnosed between 2000-2020 at Memorial Sloan Kettering Cancer Center. These data include clinical and patient-level factors collected from the medical record, including repeated height and weight assessments, body composition measures from existing computed tomography scans, pathological and molecular tumor characteristics, and overall survival (OS) and disease-free survival (DFS). We will use a joint modeling approach to simultaneously model changes in post-diagnosis body weight (Aim 1) and OS and DFS, as well as post-diagnosis changes in muscle and adipose tissue features (Aim 2) and OS and DFS. Models will include molecular tumor characteristics as predictors of these longitudinal trajectories. Impact. These results will provide crucial insight into the relationship between body composition changes and outcomes among ccRCC patients, and potentially identify tumor-related characteristics driving these associations. These results will resolve apparent paradoxes around the relationship between obesity and ccRCC mortality and identify potential targets for nutrition and physical activity interventions on body composition.

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

Magnetic resonance true temperature imaging with high spatial and temporal resolution

ABSTRACT The knowledge of temperature and temperature distribution within the brain can be critical to understanding the healthy and diseased brain, its response to acute injury, and in monitoring critically important thermal interventions. There are several temperature sensitive properties such relaxation rates and the proton resonance frequency shift (PRFS) that can be measured with magnetic resonance imaging (MRI) methods but these methods can only measure temperature change. The PRFS method, which provides the most accurate measurement of temperature change can only measure true tissue temperature if the starting true temperature distribution is known. Fortunately, MR spectroscopy (MRS) methods have been developed that show great promise in the measurement of true temperature. These methods rely on the detection of a temperature independent spectral peak of protons bound to carbon atoms in high concentration metabolites, such as N- acetylaspartate (NAA), creatine (Cr) and choline (Cho) which can be used as a reference for the temperature dependent spectral peak of water protons. Both single voxel spectroscopy (SVS) methods and MRS imaging (MRSI) methods have been described but are slow because of the long readout time needed to achieve adequate spectral resolution and the need to perform multiple averages due to the low signal being measured. Echo-planar spectroscopic imaging (EPSI) speeds up MRSI by interleaving an oscillating imaging gradient to spatially encode one of the imaging dimensions simultaneously with spectral readout. Unfortunately, SVS, MRSI, and even EPSI are unsuitable for clinical applications because of the low spatial resolution (voxel size 1 cm3) and temporal resolution (multiple minutes). The goal of this project is to develop an MRI technique that can measure true temperature in the whole brain at spatial and temporal resolutions that enable clinical utility for acutely assessing and longitudinally monitoring healthy and diseased brain tissue, and real time monitoring of thermal interventional therapies. This innovative true temperature measurement technique combines EPSI, for low resolution background field measurements, with PRFS for high spatial and temporal resolution water proton measurements. While conventional EPSI methods interleave volumetric acquisitions with and without water suppression, we propose an innovative modification to take advantage of the very strong water signal to obtain a very high resolution, dynamic method for true temperature measurements. The MRI pulse sequence will be refined, validated (Aim 1), applied to healthy subjects and post-surgery patients at risk for infections (Aim 2), and applied to essential tremor (ET) patients during the required delay between repeated focused ultrasound sonications (Aim 3). Successful completion of the aims of this study will result in a clinically practical method to obtain true temperature measurements in the brain with a spatial and temporal resolution sufficiently high to meet the needs of monitoring focal thermal therapy treatments as well as to provide true temperature measurements over the entire brain for assessment of the state of the brain with disease, infection, and injury.

A NOVEL GEMM TO ELUCIDATE THE ROLE OF CHAF1A IN NEUROBLASTOMA DEVELOPMENT

PROJECT SUMMARY: This proposal focuses on the fundamental understanding on how the CHAF1A oncogene drives molecular mechanisms, cellular signaling, and metabolic processes in the oncogenesis of neuroblastoma (NB). NB is an aggressive pediatric cancer, which accounts for 15% of pediatric cancer mortalities. High-risk NB is thought to arise from a small number of recurrent genetic alterations that block the ability of neural crest cells (NCCs) to differentiate. To assess the molecular mechanisms governing NC differentiation, our laboratory has established a definitive role of the epigenetic regulator CHAF1A in blocking NC differentiation and driving NB oncogenesis. In this proposal, we will determine the impact of CHAF1A on NB initiation and progression. To accomplish this goal, we propose to develop a novel CHAF1A-driven genetically-engineered mouse model (GEMM) of NB and test the impact of CHAF1A on NB incidence, histology and metastasis, and the tumor immune microenvironment (TIME). We hypothesize that CHAF1A will increase de novo incidence of NB, reduce mouse survival, and promote a suppressive TIME. By developing a novel GEMM of NB and employing innovative technology (including ATAC-seq, lipidomics, and scRNA-seq), we will: 1- elucidate the role of CHAF1A in NB tumor initiation and progression; and 2- determine the impact of CHAF1A on MYCN-induced oncogenesis. These findings will provide a novel view on the molecular mechanisms driving NB initiation, and will have high clinical implications, informing future differentiation-based interventions for high-risk NBs.

Intrinsic and extrinsic mechanisms underlying trigeminal nerve deficits in familial dysautonomia

PROJECT SUMMARY Rare diseases impose a significant burden on the US healthcare system, accounting for nearly half of all expenditures for their treatment. This statistic alone supports the need to invest in research to develop therapeutic interventions for rare diseases since the economic benefit outweighs the continued expense of financial resources. Familial dysautonomia (FD) is a rare, hereditary disease that arises from a splice site mutation in Elongator acetyltransferase complex subunit 1 (ELP1) and impacts the nervous system. To date, FD patients continue to face life-threatening complications involving basic involuntary functions like swallowing and somatosensation because there is no cure for this ultimately fatal neuropathy. FD patients exhibit symptoms due to defects in their somatosensory trigeminal nerves, whose cell bodies reside in the trigeminal ganglion (TG) and are derived from neural crest and placode cells. Recent studies from our lab using an FD mouse model (Elp1 deleted from neural crest cells) revealed TG axon outgrowth and target tissue innervation deficits, recapitulating phenotypes observed in FD patients. However, the mechanisms by which Elp1 mediates normal TG development, and how this goes awry in FD, remain largely elusive. To gain insight into Elp1 function, we performed mass spectrometry to evaluate the TG proteome of normal and FD mouse embryos. Our results uncovered statistically significant increases in extracellular matrix (ECM) and ECM binding proteins, pointing to altered TG biomechanical properties and, more broadly, changes in mechanotransduction, the process by which cells translate extrinsic cues into intrinsic signaling pathways that modulate gene expression. Importantly, proper axon outgrowth relies upon mechanotransduction as growth cones on axons sense and respond to their environment. In the head, this environment consists of ECM and cranial mesenchyme cells, but the impact of Elp1 loss from the latter is not known, including the potential for altered tissue biomechanics that could influence TG axon outgrowth. We hypothesize that loss of Elp1 induces changes in the biomechanical properties of both the TG/nerves and ECM/cranial mesenchyme, modifying mechanotransduction and leading to TG defects in FD, which we will interrogate in the following Specific Aims: 1) define the biomechanical properties of the TG/nerves and ECM/cranial mesenchyme and 2) determine the role of cranial mesenchyme Elp1 in mediating proper TG axon outgrowth. Our innovative research proposal takes a systems-level, multidisciplinary approach involving embryology, biomechanics, and high-resolution microscopy, with the goal of integrating molecular, cellular, and tissue data. These results will significantly advance our knowledge of the molecular mechanisms underscoring TG development and, collectively, inform treatment strategies for birth defects or disorders like FD with TG dysfunction, as well as nerve repair and/or regeneration after injury or disease.

Organization of thalamic networks and mechanisms of dysfunction in schizophrenia and autism

Thalamic networks, at the core of thalamocortical and thalamosubcortical communications, underlie processes of perception, attention, memory, emotions, and the sleep-wake cycle, and are disrupted in mental disorders, including schizophrenia and autism. However, the underlying mechanisms of pathology are unknown. I will present novel evidence on key organizational principles, structural, and molecular features of thalamocortical networks, as well as critical thalamic pathway interactions that are likely affected in disorders. This data can facilitate modeling typical and abnormal brain function and can provide the foundation to understand heterogeneous disruption of these networks in sleep disorders, attention deficits, and cognitive and affective impairments in schizophrenia and autism, with important implications for the design of targeted therapeutic interventions

Fear learning induces synaptic potentiation between engram neurons in the rat lateral amygdala

Fear learning induces synaptic potentiation between engram neurons in the rat lateral amygdala. This study by Marios Abatis et al. demonstrates how fear conditioning strengthens synaptic connections between engram cells in the lateral amygdala, revealed through optogenetic identification of neuronal ensembles and electrophysiological measurements. The work provides crucial insights into memory formation mechanisms at the synaptic level, with implications for understanding anxiety disorders and developing targeted interventions. Presented by Dr. Kenneth Hayworth, this journal club will explore the paper's methodology linking engram cell reactivation with synaptic plasticity measurements, and discuss implications for memory decoding research.

Enhancing Real-World Event Memory

Memory is essential for shaping how we interpret the world, plan for the future, and understand ourselves, yet effective cognitive interventions for real-world episodic memory loss remain scarce. This talk introduces HippoCamera, a smartphone-based intervention inspired by how the brain supports memory, designed to enhance real-world episodic recollection by replaying high-fidelity autobiographical cues. It will showcase how our approach improves memory, mood, and hippocampal activity while uncovering links between memory distinctiveness, well-being, and the perception of time.

Neural mechanisms governing the learning and execution of avoidance behavior

The nervous system orchestrates adaptive behaviors by intricately coordinating responses to internal cues and environmental stimuli. This involves integrating sensory input, managing competing motivational states, and drawing on past experiences to anticipate future outcomes. While traditional models attribute this complexity to interactions between the mesocorticolimbic system and hypothalamic centers, the specific nodes of integration have remained elusive. Recent research, including our own, sheds light on the midline thalamus's overlooked role in this process. We propose that the midline thalamus integrates internal states with memory and emotional signals to guide adaptive behaviors. Our investigations into midline thalamic neuronal circuits have provided crucial insights into the neural mechanisms behind flexibility and adaptability. Understanding these processes is essential for deciphering human behavior and conditions marked by impaired motivation and emotional processing. Our research aims to contribute to this understanding, paving the way for targeted interventions and therapies to address such impairments.

Exploring the cerebral mechanisms of acoustically-challenging speech comprehension - successes, failures and hope

Comprehending speech under acoustically challenging conditions is an everyday task that we can often execute with ease. However, accomplishing this requires the engagement of cognitive resources, such as auditory attention and working memory. The mechanisms that contribute to the robustness of speech comprehension are of substantial interest in the context of hearing mild to moderate hearing impairment, in which affected individuals typically report specific difficulties in understanding speech in background noise. Although hearing aids can help to mitigate this, they do not represent a universal solution, thus, finding alternative interventions is necessary. Given that age-related hearing loss (“presbycusis”) is inevitable, developing new approaches is all the more important in the context of aging populations. Moreover, untreated hearing loss in middle age has been identified as the most significant potentially modifiable predictor of dementia in later life. I will present research that has used a multi-methodological approach (fMRI, EEG, MEG and non-invasive brain stimulation) to try to elucidate the mechanisms that comprise the cognitive “last mile” in speech acousticallychallenging speech comprehension and to find ways to enhance them.

How Intermittent Bioenergetic Challenges Enhance Brain and Body Health

Humans and other animals evolved in habitats fraught with a range of environmental challenges to their bodies and brains. Accordingly, cells and organ systems possess adaptive stress-responsive signaling pathways that enable them to not only withstand environmental challenges, but also to prepare for future challenges and function more efficiently. These phylogenetically conserved processes are the foundation of the hormesis principle in which repeated exposures to low to moderate amounts of an environmental challenge improve cellular and organismal fitness. Here I describe cellular and molecular mechanisms by which cells in the brain and body respond to intermittent fasting and exercise in ways that enhance performance and counteract aging and disease processes. Switching back and forth between adaptive stress response (during fasting and exercise) and growth and plasticity (eating, resting, sleeping) modes enhances the performance and resilience of various organ systems. While pharmacological interventions that engage a particular hormetic mechanism are being developed, it seems unlikely that any will prove superior to fasting and exercise.

Doubting the neurofeedback double-blind do participants have residual awareness of experimental purposes in neurofeedback studies?

Neurofeedback provides a feedback display which is linked with on-going brain activity and thus allows self-regulation of neural activity in specific brain regions associated with certain cognitive functions and is considered a promising tool for clinical interventions. Recent reviews of neurofeedback have stressed the importance of applying the “double-blind” experimental design where critically the patient is unaware of the neurofeedback treatment condition. An important question then becomes; is double-blind even possible? Or are subjects aware of the purposes of the neurofeedback experiment? – this question is related to the issue of how we assess awareness or the absence of awareness to certain information in human subjects. Fortunately, methods have been developed which employ neurofeedback implicitly, where the subject is claimed to have no awareness of experimental purposes when performing the neurofeedback. Implicit neurofeedback is intriguing and controversial because it runs counter to the first neurofeedback study, which showed a link between awareness of being in a certain brain state and control of the neurofeedback-derived brain activity. Claiming that humans are unaware of a specific type of mental content is a notoriously difficult endeavor. For instance, what was long held as wholly unconscious phenomena, such as dreams or subliminal perception, have been overturned by more sensitive measures which show that degrees of awareness can be detected. In this talk, I will discuss whether we will critically examine the claim that we can know for certain that a neurofeedback experiment was performed in an unconscious manner. I will present evidence that in certain neurofeedback experiments such as manipulations of attention, participants display residual degrees of awareness of experimental contingencies to alter their cognition.

Movement planning as a window into hierarchical motor control

The ability to organise one's body for action without having to think about it is taken for granted, whether it is handwriting, typing on a smartphone or computer keyboard, tying a shoelace or playing the piano. When compromised, e.g. in stroke, neurodegenerative and developmental disorders, the individuals’ study, work and day-to-day living are impacted with high societal costs. Until recently, indirect methods such as invasive recordings in animal models, computer simulations, and behavioural markers during sequence execution have been used to study covert motor sequence planning in humans. In this talk, I will demonstrate how multivariate pattern analyses of non-invasive neurophysiological recordings (MEG/EEG), fMRI, and muscular recordings, combined with a new behavioural paradigm, can help us investigate the structure and dynamics of motor sequence control before and after movement execution. Across paradigms, participants learned to retrieve and produce sequences of finger presses from long-term memory. Our findings suggest that sequence planning involves parallel pre-ordering of serial elements of the upcoming sequence, rather than a preparation of a serial trajectory of activation states. Additionally, we observed that the human neocortex automatically reorganizes the order and timing of well-trained movement sequences retrieved from memory into lower and higher-level representations on a trial-by-trial basis. This echoes behavioural transfer across task contexts and flexibility in the final hundreds of milliseconds before movement execution. These findings strongly support a hierarchical and dynamic model of skilled sequence control across the peri-movement phase, which may have implications for clinical interventions.

Microbial modulation of zebrafish behavior and brain development

There is growing recognition that host-associated microbiotas modulate intrinsic neurodevelopmental programs including those underlying human social behavior. Despite this awareness, the fundamental processes are generally not understood. We discovered that the zebrafish microbiota is necessary for normal social behavior. By examining neuronal correlates of behavior, we found that the microbiota restrains neurite complexity and targeting of key forebrain neurons within the social behavior circuitry. The microbiota is also necessary for both localization and molecular functions of forebrain microglia, brain-resident phagocytes that remodel neuronal arbors. In particular, the microbiota promotes expression of complement signaling pathway components important for synapse remodeling. Our work provides evidence that the microbiota modulates zebrafish social behavior by stimulating microglial remodeling of forebrain circuits during early neurodevelopment and suggests molecular pathways for therapeutic interventions during atypical neurodevelopment.

The Picower Institute Spring 2023 Symposium "Environmental and Social Determinants of Child Mental Health

Studies show that abuse, neglect or trauma during childhood can lead to lifelong struggles including with mental health. Fortunately research also indicates that solutions and interventions at various stages of life can be developed to help. But even among people who remain resilient or do not experience acute stresses, a lack of opportunity early in life due to poverty or systemic racism can still constrain their ability to realize their full potential. In what ways are health and other outcomes affected by early life difficulty? What can individuals and institutions do to enhance opportunity?" "This daylong event will feature talks by neuroscientists, policy experts, physicians, educators and activists as they discuss how our experiences and biology work together to affect how our minds develop and what can be accomplished in helping people overcome early disadvantages.

Distinct contributions of different anterior frontal regions to rule-guided decision-making in primates: complementary evidence from lesions, electrophysiology, and neurostimulation

Different prefrontal areas contribute in distinctly different ways to rule-guided behaviour in the context of a Wisconsin Card Sorting Test (WCST) analog for macaques. For example, causal evidence from circumscribed lesions in NHPs reveals that dorsolateral prefrontal cortex (dlPFC) is necessary to maintain a reinforced abstract rule in working memory, orbitofrontal cortex (OFC) is needed to rapidly update representations of rule value, and the anterior cingulate cortex (ACC) plays a key role in cognitive control and integrating information for correct and incorrect trials over recent outcomes. Moreover, recent lesion studies of frontopolar cortex (FPC) suggest it contributes to representing the relative value of unchosen alternatives, including rules. Yet we do not understand how these functional specializations relate to intrinsic neuronal activities nor the extent to which these neuronal activities differ between different prefrontal regions. After reviewing the aforementioned causal evidence I will present our new data from studies using multi-area multi-electrode recording techniques in NHPs to simultaneously record from four different prefrontal regions implicated in rule-guided behaviour. Multi-electrode micro-arrays (‘Utah arrays’) were chronically implanted in dlPFC, vlPFC, OFC, and FPC of two macaques, allowing us to simultaneously record single and multiunit activity, and local field potential (LFP), from all regions while the monkey performs the WCST analog. Rule-related neuronal activity was widespread in all areas recorded but it differed in degree and in timing between different areas. I will also present preliminary results from decoding analyses applied to rule-related neuronal activities both from individual clusters and also from population measures. These results confirm and help quantify dynamic task-related activities that differ between prefrontal regions. We also found task-related modulation of LFPs within beta and gamma bands in FPC. By combining this correlational recording methods with trial-specific causal interventions (electrical microstimulation) to FPC we could significantly enhance and impair animals performance in distinct task epochs in functionally relevant ways, further consistent with an emerging picture of regional functional specialization within a distributed framework of interacting and interconnected cortical regions.

Causal Symptom Network Mapping Based on Lesions and Brain Stimulation; Converging Evidence about a Depression Circuit Using Causal Sources of Information

It’s our pleasure to announce that we will host Shan Siddiqi and Michael D. Fox on Thursday, March 30th at noon ET / 6PM CET. Shan Siddiqi, MD, is an Assistant Professor of Psychiatry at Harvard Medical School and the director of Psychiatric Neuromodulation Research at the Brigham and Women’s Hospital. Michael D. Fox, MD, PhD, is an Associate Professor of Neurology at Harvard Medical School and the founding director of the Center for Brain Circuit Therapeutics at the Brigham and Women’s Hospital. The talks will be followed by a shared discussion. You can register via talks.stimulatingbrains.org to receive the (free) Zoom link!

Neural epigenetic mechanisms of early life exercise interventions

LifePerceives

Life Perceives is a symposium bringing together scientists and artists for an open exploration of how “perception” can be understood as a phenomenon that does not only belong to humans, or even the so-called “higher organisms”, but exists across the entire spectrum of life in a myriad of forms. The symposium invites leading practitioners from the arts and sciences to present unique insights through short talks, open discussions, and artistic interventions that bring us slightly closer to the life worlds of plants and fungi, microbial communities and immune systems, cuttlefish and crows. What do we mean when we talk about perception in other species? Do other organisms have an experience of the world? Or does our human-centred perspective make understanding other forms of life on their own terms an impossible dream? Whatever your answers to these questions may be, we hope to unsettle them, and leave you more curious than when you arrived.

Taking the pulse of ageing: the role of cerebrovascular risk factors in ageing and dementia

Cerebrovascular support is critical for healthy cognitive ageing. Reduced cerebral blood flow in ageing is caused, among other things, by hypertension, arteriosclerosis (i.e. stiffening of the arteries) and plaque formation. Arterial stiffness is predictive of cognitive decline, is a critical risk factor for cerebrovascular accidents, and has been linked to heightened risks for Alzheimer’s Disease and other forms of dementia. The elasticity of cerebral arteries is influenced by lifestyle factors, including cardiorespiratory fitness. Monica will discuss data obtained in their laboratory with new noninvasive measures of cerebrovascular health (pulse-DOT, a diffuse optical tomographic method for studying cerebral arteriosclerosis), in conjunction with structural and functional brain measures and cognitive assessments. These findings support a model in which localised changes in arteriosclerosis lead to specific profiles of structural, functional, and cognitive declines, paving a way to individualised interventions.

Bridging the gap between artificial models and cortical circuits

Artificial neural networks simplify complex biological circuits into tractable models for computational exploration and experimentation. However, the simplification of artificial models also undermines their applicability to real brain dynamics. Typical efforts to address this mismatch add complexity to increasingly unwieldy models. Here, we take a different approach; by reducing the complexity of a biological cortical culture, we aim to distil the essential factors of neuronal dynamics and plasticity. We leverage recent advances in growing neurons from human induced pluripotent stem cells (hiPSCs) to analyse ex vivo cortical cultures with only two distinct excitatory and inhibitory neuron populations. Over 6 weeks of development, we record from thousands of neurons using high-density microelectrode arrays (HD-MEAs) that allow access to individual neurons and the broader population dynamics. We compare these dynamics to two-population artificial networks of single-compartment neurons with random sparse connections and show that they produce similar dynamics. Specifically, our model captures the firing and bursting statistics of the cultures. Moreover, tightly integrating models and cultures allows us to evaluate the impact of changing architectures over weeks of development, with and without external stimuli. Broadly, the use of simplified cortical cultures enables us to use the repertoire of theoretical neuroscience techniques established over the past decades on artificial network models. Our approach of deriving neural networks from human cells also allows us, for the first time, to directly compare neural dynamics of disease and control. We found that cultures e.g. from epilepsy patients tended to have increasingly more avalanches of synchronous activity over weeks of development, in contrast to the control cultures. Next, we will test possible interventions, in silico and in vitro, in a drive for personalised approaches to medical care. This work starts bridging an important theoretical-experimental neuroscience gap for advancing our understanding of mammalian neuron dynamics.

Learning with less labels for medical image segmentation

Accurate segmentation of medical images is a key step in developing Computer-Aided Diagnosis (CAD) and automating various clinical tasks such as image-guided interventions. The success of state-of-the-art methods for medical image segmentation is heavily reliant upon the availability of a sizable amount of labelled data. If the required quantity of labelled data for learning cannot be reached, the technology turns out to be fragile. The principle of consensus tells us that as humans, when we are uncertain how to act in a situation, we tend to look to others to determine how to respond. In this webinar, Dr Mehrtash Harandi will show how to model the principle of consensus to learn to segment medical data with limited labelled data. In doing so, we design multiple segmentation models that collaborate with each other to learn from labelled and unlabelled data collectively.

Potential pathways for novel interventions in TLE

Inhibition of seizures can come from expected – and surprising – sources. In this talk I will explore circuit elements, both within and external to the temporal lobe, which may be able inhibit hippocampal seizures, and how specific aspects of intervention strategies can be critical for outcomes. We’ll discuss novel sources of inhibition within the hippocampus, the cerebellum as a potential target, and closed-loop optimization of stimulation parameters

Clinical neuroscience and the heart-brain axis (BACN Mid-career Prize Lecture 2021)

Cognitive and emotional processes are shaped by the dynamic integration of brain and body. A major channel of interoceptive information comes from the heart, where phasic signals are conveyed to the brain to indicate how fast and strong the heart is beating. This talk will discuss how interoceptive processes operate across conscious and unconscious levels to influence emotion and memory. The interoceptive channel is disrupted in distinct ways in individuals with autism and anxiety. Selective interoceptive disturbance is related to symptomatology including dissociation and the transdiagnostic expression of anxiety. Interoceptive training can reduce anxiety, with enhanced interoceptive precision associated with greater insula connectivity following targeted interoceptive feedback. The discrete cardiac effects on emotion and cognition have broad relevance to clinical neuroscience, with implications for peripheral treatment targets and behavioural interventions.

Reversing chronic stress effects through life-style interventions

The neuroscience of lifestyle interventions for mental health: the BrainPark approach

Our everyday behaviours, such as physical activity, sleep, diet, meditation, and social connections, have a potent impact on our mental health and the health of our brain. BrainPark is working to harness this power by developing lifestyle-based interventions for mental health and investigating how they do and don’t change the brain, and for whom they are most effective. In this webinar, Dr Rebecca Segrave and Dr Chao Suo will discuss BrainPark’s approach to developing lifestyle-based interventions to help people get better control of compulsive behaviours, and the multi-modality neuroimaging approaches they take to investigating outcomes. The webinar will explore two current BrainPark trials: 1. Conquering Compulsions - investigating the capacity of physical exercise and meditation to alter reward processing and help people get better control of a wide range of unhelpful habits, from drinking to eating to cleaning. 2. The Brain Exercise Addiction Trial (BEAT) - an NHMRC funded investigation into the capacity of physical exercise to reverse the brain harms caused by long-term heavy cannabis use. Dr Rebecca Segrave is Deputy Director and Head of Interventions Research at BrainPark, the David Winston Turner Senior Research Fellow within the Turner Institute for Brain and Mental Health, and an AHRPA registered Clinical Neuropsychologist. Dr Chao Suo is Head of Technology and Neuroimaging at BrainPark and a Research Fellow within the Turner Institute for Brain and Mental Health.

fMRI of cognitive reappraisal, acceptance, and suppression emotion regulation strategies in basic and clinically applied contexts

The ability to effectively regulate emotions is a fundamental skill related to physical and psychological health. In this talk, I will present behavioral and fMRI data from several different studies that examined cognitive reappraisal, acceptance, and suppression emotion regulation strategies in healthy controls participants and in the context of randomized trials of cognitive behavioral therapy, mindfulness- based stress reduction, and aerobic exercise as interventions for adults with anxiety disorders. We will also examine the implementation of different types of functional connectivity analytic approaches to probe intervention-related brain mechanism changes.

Cross-modality imaging of the neural systems that support executive functions

Executive functions refer to a collection of mental processes such as attention, planning and problem solving, supported by a frontoparietal distributed brain network. These functions are essential for everyday life. Specifically in the context of patients with brain tumours there is a need to preserve them in order to enable good quality of life for patients. During surgeries for the removal of a brain tumour, the aim is to remove as much as possible of the tumour and at the same time prevent damage to the areas around it to preserve function and enable good quality of life for patients. In many cases, functional mapping is conducted during an awake surgery in order to identify areas critical for certain functions and avoid their surgical resection. While mapping is routinely done for functions such as movement and language, mapping executive functions is more challenging. Despite growing recognition in the importance of these functions for patient well-being in recent years, only a handful of studies addressed their intraoperative mapping. In the talk, I will present our new approach for mapping executive function areas using electrocorticography during awake brain surgery. These results will be complemented by neuroimaging data from healthy volunteers, directed at reliably localizing executive function regions in individuals using fMRI. I will also discuss more broadly challenges ofß using neuroimaging for neurosurgical applications. We aim to advance cross-modality neuroimaging of cognitive function which is pivotal to patient-tailored surgical interventions, and will ultimately lead to improved clinical outcomes.

Emerging Treatment Options in Psychiatry

The World Health Organization (WHO) estimates that untreated mental disorders accountfor 13% of the total global burden of disease, and by 2030, depression alone will be the leadingcause of disability around the world – outpacing heart disease, cancer, and HIV. This grim pictureis further compounded by the mental health burden delivered by the coronavirus pandemic.The lack of novel treatment options in psychiatry is restricted by a limited understanding in theneuroscience basis of mental disorders, availability of relevant biomarkers, poor predictability inanimal models, and high failure rates in psychiatric drug development. However, theannouncement in 2019 from the Federal Drug Administration (FDA) for approvals of newinterventions for treatment-resistant depression (intranasal esketamine) and postpartumdepression (i.v. brexanolone), demand critical attention. Novel public-private partnerships indrug discovery, new translational data on co-morbid biology, in particular the ascendance ofpsycho-immunology, have highlighted the arrival of a new frontier in biological psychiatryresearch for depressive disorders.

Neurocognitive mechanisms of enhanced implicit temporal processing in action video game players

Playing action video games involves both explicit (conscious) and implicit (non-conscious) expectations of timed events, such as the appearance of foes. While studies revealed that explicit attention skills are improved in action video game players (VGPs), their implicit skills remained untested. To this end, we investigated explicit and implicit temporal processing in VGPs and non-VGPs (control participants). In our variable foreperiod task, participants were immersed in a virtual reality and instructed to respond to a visual target appearing at variable delays after a cue. I will present behavioral, oculomotor and EEG data and discuss possible markers of the implicit passage of time and explicit temporal attention processing. All evidence indicates that VGPs have enhanced implicit skills to track the passage of time, which does not require conscious attention. Thus, action video game play may improve a temporal processing found altered in psychopathologies, such as schizophrenia. Could digital (game-based) interventions help remediate temporal processing deficits in psychiatric populations?

Deception, ExoNETs, SmushWare & Organic Data: Tech-facilitated neurorehabilitation & human-machine training

Making use of visual display technology and human-robotic interfaces, many researchers have illustrated various opportunities to distort visual and physical realities. We have had success with interventions such as error augmentation, sensory crossover, and negative viscosity.  Judicial application of these techniques leads to training situations that enhance the learning process and can restore movement ability after neural injury. I will trace out clinical studies that have employed such technologies to improve the health and function, as well as share some leading-edge insights that include deceiving the patient, moving the "smarts" of software into the hardware, and examining clinical effectiveness

Primary Motor Cortex Circuitry in a Mouse Model of Parkinson’s Disease

The primary motor cortex (M1) is a major output center for movement execution and motor learning, and its dysfunction contributes to the pathophysiology of Parkinson’s disease (PD). While human studies have indicated that a loss of midbrain dopamine neurons alters M1 activation, the mechanisms underlying this phenomenon remain unclear. Using a mouse model of PD, we uncovered several shifts within M1 circuitry following dopamine depletion, including impaired excitation by thalamocortical afferents and altered excitability. Our findings add to the growing body of literature highlighting M1 as a major contributor in PD, and provide targeted neural substrates for possible therapeutic interventions.

Common elements: An innovative methodology for identifying effective interventions in early childhood education

Evidence-based education programmes, like many clinical interventions, are multi-faceted and can be expensive to implement. In this talk I will describe an alternative: distilling the common elements across many evidence-based programmes. Published programme manuals are selected through systematic review, then extensively coded and cross-referenced. Finally, the common elements that emerge are shared with practitioners as part of a ‘library’ of practices (rather than a holistic programme manual). Although the common elements methodology has been used in the prevention and intervention sciences, this project reflects the first attempt at applying this approach to early childhood education. I will describe the common elements methods and preliminary findings from our Nuffield-funded project, in collaboration with the Early Intervention Foundation. I will discuss the challenges and opportunities we have encountered, alongside our strategies for sharing evidence with practitioners in a digestible way.

​Improving the identification of cardiometabolic risk in early psychosis

People with chronic schizophrenia die on average 10-15 years sooner than the general population, mostly due to physical comorbidity. While sociodemographic, chronic lifestyle and iatrogenic factors are important contributors to this comorbidity, a growing body of research is beginning to suggest that early signs of cardiometabolic dysfunction may be present from the onset of psychosis in some young adults, and may even be detectable before the onset of psychosis. Given that primary prevention is the best means to prevent the onset of more chronic and severe cardiometabolic phenotypes such as CVD, there is clear need to be able to identify young adults with psychosis who are most at risk of future adverse cardiometabolic outcomes, such that the most intensive interventions can be directed in an informed way to attenuate the risk or even prevent those adverse outcomes from occurring.In this talk, Ben will first outline some recent advances in our understanding of the association between cardiometabolic and schizophrenia spectrum disorders. He will then introduce the field of cardiometabolic risk prediction, and highlight how existing tools developed for older general population adults are unlikely to be suitable for young people with psychosis. Finally, he will discuss the current state of play and the future of the Psychosis Metabolic Risk Calculator (PsyMetRiC), a novel clinically useful cardiometabolic risk prediction algorithm tailored for young people with psychosis, which has been developed and externally validated using data from three psychosis early intervention services in the UK.

How inclusive and diverse is non-invasive brain stimulation in the treatment of psychiatric disorders?

How inclusive and diverse is non-invasive brain stimulation in the treatment of psychiatric disorders?Indira Tendolkar, Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry. Mental illness is associated with a huge socioeconomic burden worldwide, with annual costs only in the Netherlands of €22 billion. Over two decades of cognitive and affective neuroscience research with modern tools of neuroimaging and neurophysiology in humans have given us a wealth of information about neural circuits underlying the main symptom domains of psychiatric disorders and their remediation. Neuromodulation entails the alteration of these neural circuits through invasive (e.g., DBS) or non-invasive (e.g., TMS) techniques with the aim of improving symptoms and/or functions and enhancing neuroplasticity. In my talk, I will focus on neuromodulation studies using repetitive transcranial magnetic stimulation (rTMS) as a relatively safe, noninvasive method, which can be performed simultaneously with neurocognitive interventions. Using the examples of two chronifying mental illnesses, namely obsessive compulsive disorders and major depressive disorder (MDD), I will review the concept of "state dependent" effects of rTMS and highlight how simultaneous or sequential cognitive interventions could help optimize rTMS therapy by providing further control of ongoing neural activity in targeted neural networks. Hardly any attention has been paid to diversity aspects in the studies. By including studies from low- and middle income countries, I will discuss the potential of non-invasive brain stimulation from a transcultural perspective.

Neural stem cells as biomarkers of cognitive aging and dementia

Adult hippocampal neurogenesis is implicated in memory formation and mood regulation. The Thuret lab investigates environmental and molecular mechanisms controlling the production of these adult-born neurons and how they impact mental health. We study neurogenesis in healthy ageing as well as in the context of diseases such as Alzheimer’s and depression. By approaching neurogenesis in health and disease, the strategy is two folds: (i) Validating the neurogenic process as a target for prevention and pharmacological interventions. (ii) Developing neurogenesis as a biomarker of disease prediction and progression. In this talk, I will focus on presenting some recent human studies demonstrating how hippocampal neural stem cells fate can be used as biomarkers of cognitive aging and dementia.

The pathophysiology of prodromal Parkinson’s disease

Studying the pathophysiology of late stage Parkinson’s disease (PD) – after the patients have experienced severe neuronal loss – has helped develop various symptomatic treatments for PD (e.g., deep brain stimulation). However, it has been of limited use in developing neuroprotective disease-modifying therapies (DMTs), because DMTs require interventions at much earlier stages of PD when vulnerable neurons are still intact. Because PD patients exhibit various non-motor prodromal symptoms (ie, symptoms that predate diagnosis), understanding the pathophysiology underlying these symptom could lead to earlier diagnosis and intervention. In my talk, I will present a recently elucidated example of how PD pathologies alter the channel biophysics of intact vagal motoneurons (known to be selectively vulnerable in PD) to drive dysautonomia that is reminiscent of prodromal PD. I will discuss how elucidating the pathophysiology of prodromal symptoms can lead to earlier diagnosis through the development of physiological biomarkers for PD.

Thalamocortical circuits from neuroanatomy to mental representations

In highly volatile environments, performing actions that address current needs and desires is an ongoing challenge for living organisms. For example, the predictive value of environmental signals needs to be updated when predicted and actual outcomes differ. Furthermore, organisms also need to gain control over the environment through actions that are expected to produce specific outcomes. The data to be presented will show that these processes are highly reliant on thalamocortical circuits wherein thalamic nuclei make a critical contribution to adaptive decision-making, challenging the view that the thalamus only acts as a relay station for the cortical stage. Over the past few years, our work has highlighted the specific contribution of multiple thalamic nuclei in the ability to update the predictive link between events or the causal link between actions and their outcomes via the combination of targeted thalamic interventions (lesion, chemogenetics, disconnections) with behavioral procedures rooted in experimental psychology. We argue that several features of thalamocortical architecture are consistent with a prominent role for thalamic nuclei in shaping mental representations.

AI-guided solutions for early detection of neurodegenerative disorders

Despite the importance of early diagnosis of dementia for prognosis and personalised interventions, we still lack robust tools for predicting individual progression to dementia. We propose a trajectory modelling approach that mines multimodal data from patients at early dementia stages to derive individualised prognostic scores of cognitive decline Our approach has potential to facilitate effective stratification of individuals based on prognostic disease trajectories, reducing patient misclassification with important implications for clinical practice.

The Picower Institute Spring 2021 Symposium: Early Life Stress & Mental Health

Though studies show that abuse, neglect or trauma during childhood can lead to lifelong lifelong struggles including in mental health, research also indicates that solutions and interventions at various stages of life can be developed to help. And while many people manage to remain resilient, a lack of opportunity early in life, including because of poverty and systemic racism, can constrain their ability to realize their full potential. In what ways are health and other outcomes affected? How can systems instead restore opportunity? "The Picower Institute for Learning and Memory's biennial spring symposium, 'Early Life Stress & Mental Health,' will examine these issues. The daylong event will feature talks by neuroscientists, policy experts, physicians, educators and activists as they discuss how our experiences and biology work together to affect how our minds develop and what can be accomplished in helping people overcome early disadvantages.

Applications of Multisensory Facilitation of Learning

In this talk I’ll discuss translation of findings of multisensory facilitation of learning to cognitive training. I’ll first review some early findings of multisensory facilitation of learning and then discuss how we have been translating these basic science approaches into gamified training interventions to improve cognitive functions. I’ll touch on approaches to training vision, hearing and working memory that we are developing at the UCR Brain Game Center for Mental Fitness and Well-being. I look forward to discussing both the basic science but also the complexities of how to translate approaches from basic science into the more complex frameworks often used in interventions.

Portable neuroscience: using devices and apps for diagnosis and treatment of neurological disease

Scientists work in laboratories; comfortable spaces which we equip and configure to be ideal for our needs. The scientific paradigm has been adopted by clinicians, who run diagnostic tests and treatments in fully equipped hospital facilities. Yet advances in technology mean that that increasingly many functions of a laboratory can be compressed into miniature devices, or even into a smartphone app. This has the potential to be transformative for healthcare in developing nations, allowing complex tests and interventions to be made available in every village. In this talk, I will give two examples of this approach from my recent work. In the field of stroke rehabilitation, I will present basic research which we have conducted in animals over the last decade. This reveals new ways to intervene and strengthen surviving pathways, which can be deployed in cheap electronic devices to enhance functional recovery. In degenerative disease, we have used Bayesian statistical methods to improve an algorithm to measure how rapidly a subject can stop an action. We then implemented this on a portable device and on a smartphone app. The measurement obtained can act as a useful screen for Parkinson’s Disease. I conclude with an outlook for the future of this approach, and an invitation to those who would be interesting in collaborating in rolling it out to in African settings.

Gut Feelings: The Microbiota-Gut-Brain Axis Across the Lifespan

The microbiota-gut-brain axis is emerging as a research area of increasing interest for those investigating the biological and physiological basis of brain development and behaviour during early life, adolescence & ageing. The routes of communication between the gut and brain include the vagus nerve, the immune system, tryptophan metabolism, via the enteric nervous system or by way of microbial metabolites such as short chain fatty acids. Studies in animal models have shown that the development of an appropriate stress response is dependent on the microbiota. Developmentally, a variety of factors can impact the microbiota in early life including mode of birth delivery, antibiotic exposure, mode of nutritional provision, infection, stress as well as host genetics. Recently, the gut microbiota has been implicated in regulating the stress response, and social behaviour. Moreover, fundamental brain processes from adult hippocampal neurogenesis to myelination to microglia activation have been shown to be regulated by the microbiome. Further studies will focus on understanding the mechanisms underlying such brain effects and how they can be exploited by microbiota-targeted interventions including ‘psychobiotics’ and diet

A developmental-cognitive perspective on the impact of adolescent social media use

Concerns about the impact of social media use on adolescent well-being and mental health are common. While the amount of research in this area has increased rapidly over the last 5 years, most outputs are still marred by a multitude of limitations. These shortcomings have left our understanding of social media effects severely limited, holding back both scientific discovery and policy interventions. This talk discusses how developmental, cognitive and neuroscientific approaches might provide a new and improved way of studying social media effects. It will detail new studies in support of this idea, and raise potential avenues for collaborative work across the Cambridge Neuroscience community. As the digital world now (re)shapes what it means for us to live, communicate and develop, only an interdisciplinary approach will allow us to truly understand its impacts.

Playing fast and loose with glutamate builds healthy circuits in the developing cortex

The construction of cortical circuits requires the precise formation of connections between excitatory and inhibitory neurons during early development. Multiple factors, including neurotransmitters, neuronal activity, and neuronal-glial interactions, shape how these critical circuits form. Disruptions of these early processes can disrupt circuit formation, leading to epilepsy and other neurodevelopmental disorders. Here, I will describe our work into understanding how prolonged post-natal astrocyte development in the cortex creates a permissive window for glutamate signaling that provides tonic activation of developing interneurons through Grin2D NMDA receptors. Experimental disruption of this pathway results in hyperexcitable cortical circuits and human mutations in the Grin2D gene, as well as other related molecules that regulate early life glutamate signaling, are associated with devastating epileptic encephalopathies. We will explore fundamental mechanisms linking early life glutamate signaling and later circuit hyperexcitability, with an emphasis on potential therapeutic interventions aimed at reducing epilepsy and other neurological dysfunction.

Reward processing in psychosis: adding meanings to the findings

Much of our daily behavior is driven by rewards. The ability to learn to pursue rewarding experiences is, in fact, an essential metric of mental health. Conversely, reduced capacity to engage in adaptive goal-oriented behavior is the hallmark of apathy, and present in the psychotic disorder. The search for its underlying mechanisms has resulted in findings of profound impairments in learning from rewards and the associated blunted activation in key reward areas of the brain of patients with psychosis. An emerging research field has been relying on digital phenotyping tools and ecological momentary assessments (EMA) that map patients’ current mood, behavior and context in the flow of their daily lives. Using these tools, we have started to see a different picture of apathy, one that is exquisitely driven by the environment. For one, reward sensitivity appears to be blunted by stressors, and exposure to undue chronic stress in the daily life may result in apathy in those predisposed to psychosis. Secondly, even patients with psychosis who exhibit clinically elevated levels of apathy are perfectly capable of seeking out and enjoying social interactions in their daily life, if their environment allows them to do so. The use of digital phenotyping tools in combination with neuroimaging of apathy not only allows us to add meanings to the neurobiological findings, but could also help design rational interventions.

Is it Autism or Alexithymia? explaining atypical socioemotional processing

Emotion processing is thought to be impaired in autism and linked to atypical visual exploration and arousal modulation to others faces and gaze, yet evidence is equivocal. We propose that, where observed, atypical socioemotional processing is due to alexithymia, a distinct but frequently co-occurring condition which affects emotional self-awareness and Interoception. In study 1 (N = 80), we tested this hypothesis by studying the spatio-temporal dynamics and entropy of eye-gaze during emotion processing tasks. Evidence from traditional and novel methods revealed that atypical eye-gaze and emotion recognition is best predicted by alexithymia in both autistic and non-autistic individuals. In Study 2 (N = 70), we assessed interoceptive and autonomic signals implicated in socioemotional processing, and found evidence for alexithymia (not autism) driven effects on gaze and arousal modulation to emotions. We also conducted two large-scale studies (N = 1300), using confirmatory factor-analytic and network modelling and found evidence that Alexithymia and Autism are distinct at both a latent level and their intercorrelations. We argue that: 1) models of socioemotional processing in autism should conceptualise difficulties as intrinsic to alexithymia, and 2) assessment of alexithymia is crucial for diagnosis and personalised interventions in autism.

From oscillations to laminar responses - characterising the neural circuitry of autobiographical memories

Autobiographical memories are the ghosts of our past. Through them we visit places long departed, see faces once familiar, and hear voices now silent. These, often decades-old, personal experiences can be recalled on a whim or come unbidden into our everyday consciousness. Autobiographical memories are crucial to cognition because they facilitate almost everything we do, endow us with a sense of self and underwrite our capacity for autonomy. They are often compromised by common neurological and psychiatric pathologies with devastating effects. Despite autobiographical memories being central to everyday mental life, there is no agreed model of autobiographical memory retrieval, and we lack an understanding of the neural mechanisms involved. This precludes principled interventions to manage or alleviate memory deficits, and to test the efficacy of treatment regimens. This knowledge gap exists because autobiographical memories are challenging to study – they are immersive, multi-faceted, multi-modal, can stretch over long timescales and are grounded in the real world. One missing piece of the puzzle concerns the millisecond neural dynamics of autobiographical memory retrieval. Surprisingly, there are very few magnetoencephalography (MEG) studies examining such recall, despite the important insights this could offer into the activity and interactions of key brain regions such as the hippocampus and ventromedial prefrontal cortex. In this talk I will describe a series of MEG studies aimed at uncovering the neural circuitry underpinning the recollection of autobiographical memories, and how this changes as memories age. I will end by describing our progress on leveraging an exciting new technology – optically pumped MEG (OP-MEG) which, when combined with virtual reality, offers the opportunity to examine millisecond neural responses from the whole brain, including deep structures, while participants move within a virtual environment, with the attendant head motion and vestibular inputs.

The developing visual brain – answers and questions

We will start our talk with a short video of our research, illustrating methods (some old and new) and findings that have provided our current understanding of how visual capabilities develop in infancy and early childhood. However, our research poses some outstanding questions. We will briefly discuss three issues, which are linked by a common focus on the development of visual attentional processing: (1) How do recurrent cortical loops contribute to development? Cortical selectivity (e.g., to orientation, motion, and binocular disparity) develops in the early months of life. However, these systems are not purely feedforward but depend on parallel pathways, with recurrent feedback loops playing a critical role. The development of diverse networks, particularly for motion processing, may explain changes in dynamic responses and resolve developmental data obtained with different methodologies. One possible role for these loops is in top-down attentional control of visual processing. (2) Why do hyperopic infants become strabismic (cross-eyes)? Binocular interaction is a particularly sensitive area of development. Standard clinical accounts suppose that long-sighted (hyperopic) refractive errors require accommodative effort, putting stress on the accommodation-convergence link that leads to its breakdown and strabismus. Our large-scale population screening studies of 9-month infants question this: hyperopic infants are at higher risk of strabismus and impaired vision (amblyopia and impaired attention) but these hyperopic infants often under- rather than over-accommodate. This poor accommodation may reflect poor early attention processing, possibly a ‘soft sign’ of subtle cerebral dysfunction. (3) What do many neurodevelopmental disorders have in common? Despite similar cognitive demands, global motion perception is much more impaired than global static form across diverse neurodevelopmental disorders including Down and Williams Syndromes, Fragile-X, Autism, children with premature birth and infants with perinatal brain injury. These deficits in motion processing are associated with deficits in other dorsal stream functions such as visuo-motor co-ordination and attentional control, a cluster we have called ‘dorsal stream vulnerability’. However, our neuroimaging measures related to motion coherence in typically developing children suggest that the critical areas for individual differences in global motion sensitivity are not early motion-processing areas such as V5/MT, but downstream parietal and frontal areas for decision processes on motion signals. Although these brain networks may also underlie attentional and visuo-motor deficits , we still do not know when and how these deficits differ across different disorders and between individual children. Answering these questions provide necessary steps, not only increasing our scientific understanding of human visual brain development, but also in designing appropriate interventions to help each child achieve their full potential.

Multilevel Causal Modeling

Complex systems can be modeled at various levels of granularity, e.g., we can model a person at the cognitive level, on the neuronal level, or down to the biochemical level. When multiple models represent the same system at different scales, we would like to be able to reason about the causal effects of interventions on each level in such a way that the models remain consistent across levels. In the first part of this talk, I consider which conditions must be fulfilled for two structural equation models (SEMs) to stand in such a causally consistent relation. In the second part of the talk, I present recent work on learning causally consistent SEMs across multiple levels, distinguishing between bottom-up (micro- to macro-level) and top-down (macro- to micro-level) approaches.

The interaction of Reminiscence Therapy plus walking interventions on cognitive performance and well-being of older adults with early stage dementia of Alzheimer type

Toward novel therapeutic interventions for STXBP1-associated disorders

Brain networks underlying brief cognitive interventions to reduce anxiety

FENS Forum 2024

Effects of 5-HT2AR-mGluR2-based interventions on electrophysiological biomarkers in a rat model of alcohol addiction

FENS Forum 2024

Exploration of interventions that modulate stroke via gut-brain axis: A meta-analysis

FENS Forum 2024

Neuroprosthetic interventions for orthostatic hypotension in neurological diseases

FENS Forum 2024