restoration

BKCa Channel Contributions to Cerebellar Regulated TSC-Associated Neuropsychiatric Disorders

Project Summary TSC is associated with neurodevelopmental disability including cognitive disability and autism spectrum disorders (ASD) that make up part of TSC associated neuropsychiatric disorders (TAND). The mechanisms for TAND remain poorly understood but studies have increasingly implicated cerebellar dysfunction in the pathogenesis of cognitive and behavioral deficits in both TSC and other neurodevelopmental disorders. A shared feature is cerebellar Purkinje cell (PC) dysfunction. Changes in intrinsic properties of PCs results in both motor and cognitive/ behavioral changes in disease models and in individuals afflicted by these disorders. Mechanistic underpinnings of these altered properties remain unknown, but a significant emerging body of data implicate ion channel dysfunction as the primary etiology of these deficits. The current proposal seeks to delineate the ion channel contribution to PC dysfunction and to TAND-relevant behaviors. In doing so, these studies will produce significant both short- and long-term impact. Short-term: These proposed studies will provide a mechanistic understanding of the contribution of ion channels to the neuronal dysfunction in the cerebellum that has been demonstrated to be causally linked to abnormal TAND-relevant behaviors. In addition, we will target specific ion channels both genetically and pharmacologically to evaluate the benefits of ion channel restoration on both electrophysiological abnormalities but also the TAND-relevant behaviors observed in the model. Long-term: These studies, thus, provide a framework for subsequent clinically-relevant therapeutic development for TAND. First, these studies will uncover the ability for TAND-relevant behaviors to be improved upon targeting ion channel alterations in TSC. These studies will also define molecular targets on which therapeutic development can be targeted, thereby potentially providing a molecular-informed pipeline for therapeutic development. In addition, these studies will utilize clinically-available, FDA-approved pharmacological agents to target ion channel function and investigate the potential therapeutic benefits for these agents for TAND-relevant behaviors. Thus, these studies will address a core gap in knowledge to achieve a better mechanistic understanding of TAND and to develop therapeutic opportunities to address TAND. These studies will not only reveal previously understudied and novel mechanistic underpinnings for these behaviors but will provide pre-clinical insights into the therapeutic utility of clinically-utilized agents for the treatment of TAND-related behaviors, thus potentially providing both immediate and long-term opportunities for the treatment of TAND. Moreover, although these studies focus on TSC, these mechanisms may prove generalizable beyond TSC and provide a shared basis and therapeutic opportunity for other neuropsychiatric/developmental conditions.

Hepatotoxicity of Legacy and Replacement PFAS: Role of BRUCE-Mitochondrial Interactions

Epidemiological studies have shown a strong association between exposure to PFAS (Per- and Poly- fluoroalkyl Substances) and liver toxicity. Particularly, legacy C8-PFAS members, PFOS (perfluorooctane sulfonate) and PFOA (perfluorooctanoic acid), are highly toxic, with PFOS estimated to be approximately 10 times more toxic than PFOA in ecotoxicity models. Consequently, PFAS replacements such as GenX and PFBS are marketed as safe alternatives, although growing evidence indicates that these substitutes also exhibit toxic effects. Lab animal model studies have shown hepatotoxic effects of both legacy and replacement PFAS members, characterized by Metabolic dysfunction-associated steatotic liver disease (MASLD) and its severe form Metabolic dysfunction- associated steatohepatitis (MASH), the two chronic liver diseases affecting an estimated 80-100 million Americans. The broader objective of this project is to understand the underlying mechanisms of PFAS hepatotoxicity in MASLD/MASH. In this context, our initial studies have shown that PFAS exposure of mice downregulates hepatic BRUCE, an autophagy inhibitor, resulting in development of MASLD in WT, and more severe MASLD and even progression to MASH in BRUCE liver-knockdown (BKO) mice. Using primary hepatocytes, we found PFAS-induced BRUCE reduction compromised mitochondrial (mt) functions (respiration, fatty acid oxidation/FAO, and ATP production) and suppressed mitophagy in WT and more so in BKO mice. Pharmacological restoration of mt function in mice prevented PFAS-induced MASLD/MASH. Guided by these compelling preliminary data and scientific premise, we hypothesize that PFAS degradation of BRUCE in hepatocytes induces excessive autophagy (resulting in cytotoxicity) and inhibits mitophagy (resulting in accumulation of damaged mitochondria), leading to release of mtDAMPs to activate inflammation/ fibrosis, thereby facilitating progression from MASLD to MASH. We will test this by three specific aims. Aim 1 (ex vivo) is to determine the human-relevant PFAS doses that modulate BRUCE levels for homeostatic vs cytotoxic autophagy and how BRUCE in turn regulates autophagy. Aim 2 (ex vivo) will investigate BRUCE-driven mitophagy pathway specific to PFAS exposure at human-relevant doses. Aim 3 (ex vivo and in vivo) will involve ex vivo simulation experiments to characterize the role of PFAS-induced, BRUCE-dependent hepatocyte- released mt DAMPs in activation of immune and fibrogenic cells using co-culture assays. Next, we will perform in vivo intervention to validate the role of PFAS-damaged mitochondria in driving MASH progression in mouse models. Furthermore, human relevance of the delineated mechanisms will be ascertained and validated using iPSC-derived human liver organoid system. Impact: This project will advance our understanding of autophagy/mitophagy-centric mechanisms with therapeutic potential in the context of PFAS-induced liver disease MASLD/MASH.

RECONJOINT: A Preference Elicitation Tool to Improve Shared Decision Making for Breast Reconstruction Surgery

PROJECT SUMMARY/ABSTRACT Breast reconstruction is a critical component of comprehensive breast cancer care, offering physical and emotional restoration after mastectomy. However, 40% of women undergoing breast reconstruction report dissatisfaction and decisional regret due to low involvement with treatment decisions and poor alignment between treatment preferences and the chosen reconstructive technique. Current approaches to shared decision-making (SDM) often fail to elicit and integrate individual-level preferences into treatment planning. This serves as a barrier to effective SDM and patient-centered care. To address this gap, we developed a web- based decision tool that uses adaptive choice–based conjoint (ACBC) analysis to elicit patient-level preferences for breast reconstruction. Preliminary studies indicate that the decision tool is acceptable and usable; patients wanted to view their results and use the tool in clinic, which we could not accommodate at the time because the decision tool currently lacks a structured method for clinical integration. We propose to develop an implementation toolkit for the decision tool to facilitate clinical integration and then test the feasibility, acceptability, and implementation of the intervention, RECONJOINT (decision tool and toolkit). In Aim 1, we will design an implementation toolkit informed by focus groups and developed with input from key partners, including patients, providers, and patient advocates. Candidate elements for the implementation toolkit include components developed for site-level implementation: treatment preferences report, video introducing the tool and existing evidence, and recommendations for patients and providers to incorporate preferences into SDM. In Aim 2, we will evaluate the feasibility, acceptability, and preliminary efficacy of the intervention in a pilot cluster-randomized hybrid type 1 trial conducted at two cancer centers (Memorial Sloan Kettering and Duke University). Our primary outcome of interest is the feasibility of the intervention. Secondary outcomes include acceptability and preliminary efficacy. Using a hybrid design, we will simultaneously evaluate facilitators, barriers, and strategies to implementation and how these factors influence the feasibility and acceptability of the intervention. The Consolidated Framework for Implementation Research and the Theoretical Domains Framework will serve as conceptual frameworks. This study is innovative as it leverages ACBC analysis to elicit patient preferences, designs an intervention with multilevel input from clinical and community partners, and uses a hybrid trial design to simultaneously evaluate feasibility, acceptability, preliminary efficacy, and implementation. By addressing critical barriers to SDM and enhancing patient–provider communication, this research aligns with the goals of PA-25-253 and the National Cancer Plan to deliver high quality, patient-centered cancer care. Findings from this study will inform a full-scale multi-site trial to evaluate the efficacy of the intervention and implementation outcomes (e.g., reach).

Dual mRNA Therapeutics for Liver Metastatic Uveal Melanoma

Abstract Uveal melanoma (UM) is the most common primary intraocular cancer in adults, accounting for approximately 70% of all ocular malignancies. Current treatments for primary UM include surgical tumor removal, transpupillary thermotherapy, and radiotherapy. Unfortunately, both surgical enucleation and brachytherapy have shown similar survival outcomes and carry an equivalent risk of metastasis. While the survival rate for patients with primary, non-metastatic UM is relatively high, metastatic uveal melanoma (MUM), especially when it spreads to the liver, remains universally fatal. The liver is the first site of metastasis in 80 to 90 percent of cases, and about 50 percent of UM patients develop liver metastases within 15 years of initial diagnosis. Median survival following liver metastasis is only 5 to 7 months, with an almost zero percent five-year survival rate. Currently, no available therapy significantly improves outcomes for patients with liver MUM. This R21 project addresses this urgent unmet need by developing liver-tropic mRNA therapeutics targeting two key drivers of MUM progression and metastasis: (1) constitutive activation of Gαq/11 caused by single-point mutations, and (2) loss-of-function mutations in BAP1. Both alterations occur in over 80 percent of UM patients and are associated with poor prognosis. We hypothesize that inhibition of constitutively active Gαq/11 and/or restoration of BAP1 tumor suppressor function will significantly suppress MUM progression and improve survival outcomes. Aim 1 focuses on delivering mRNA encoding a novel protein trap designed to specifically inhibit constitutively active Gαq/11 and its downstream oncogenic signaling pathways. Aim 2 seeks to restore wild-type BAP1, which is mutated or lost in approximately 84 percent of MUM cases, through liver-tropic mRNA delivery using a liver MUM model established via splenic inoculation. We will also evaluate the potential synergy between Gαq/11 inhibition and BAP1 restoration. The success of this project will not only advance our understanding of the disease mechanisms underlying MUM but also provide clinically viable strategies for treating liver metastases in uveal melanoma.

Restoring Sight to the Blind: Effects of Structural and Functional Plasticity

Visual restoration after decades of blindness is now becoming possible by means of retinal and cortical prostheses, as well as emerging stem cell and gene therapeutic approaches. After restoring visual perception, however, a key question remains. Are there optimal means and methods for retraining the visual cortex to process visual inputs, and for learning or relearning to “see”? Up to this point, it has been largely assumed that if the sensory loss is visual, then the rehabilitation focus should also be primarily visual. However, the other senses play a key role in visual rehabilitation due to the plastic repurposing of visual cortex during blindness by audition and somatosensation, and also to the reintegration of restored vision with the other senses. I will present multisensory neuroimaging results, cortical thickness changes, as well as behavioral outcomes for patients with Retinitis Pigmentosa (RP), which causes blindness by destroying photoreceptors in the retina. These patients have had their vision partially restored by the implantation of a retinal prosthesis, which electrically stimulates still viable retinal ganglion cells in the eye. Our multisensory and structural neuroimaging and behavioral results suggest a new, holistic concept of visual rehabilitation that leverages rather than neglects audition, somatosensation, and other sensory modalities.

An inconvenient truth: pathophysiological remodeling of the inner retina in photoreceptor degeneration

Photoreceptor loss is the primary cause behind vision impairment and blindness in diseases such as retinitis pigmentosa and age-related macular degeneration. However, the death of rods and cones allows retinoids to permeate the inner retina, causing retinal ganglion cells to become spontaneously hyperactive, severely reducing the signal-to-noise ratio, and creating interference in the communication between the surviving retina and the brain. Treatments aimed at blocking or reducing hyperactivity improve vision initiated from surviving photoreceptors and could enhance the signal fidelity generated by vision restoration methodologies.

Vision Unveiled: Understanding Face Perception in Children Treated for Congenital Blindness

Restoring function in advanced disease with photoreceptor cell replacement therapy

Targeting thalamic circuits rescues motor and mood deficits in PD mice

Although bradykinesia, tremor, and rigidity are hallmark motor defects in Parkinson’s disease (PD) patients, they also experience motor learning impairments and non-motor symptoms such as depression. The neural basis for these different PD symptoms are not well understood. While current treatments are effective for locomotion deficits in PD, therapeutic strategies targeting motor learning deficits and non-motor symptoms are lacking. We found that distinct parafascicular (PF) thalamic subpopulations project to caudate putamen (CPu), subthalamic nucleus (STN), and nucleus accumbens (NAc). While PF-->CPu and PF-->STN circuits are critical for locomotion and motor learning respectively, inhibition of the PF-->NAc circuit induced a depression-like state. While chemogenetically manipulating CPu-projecting PF neurons led to a long-term restoration of locomotion, optogenetic long-term potentiation at PF-->STN synapses restored motor learning behavior in PD model mice. Furthermore, activation of NAc-projecting PF neurons rescued depression-like PD phenotypes. Importantly, we identified nicotinic acetylcholine receptors capable of modulating PF circuits to rescue different PD phenotypes. Thus, targeting PF thalamic circuits may be an effective strategy for treating motor and non-motor deficits in PD.

Genetic-based brain machine interfaces for visual restoration

Visual restoration is certainly the greatest challenge for brain-machine interfaces with the high pixel number and high refreshing rate. In the recent year, we brought retinal prostheses and optogenetic therapy up to successful clinical trials. Concerning visual restoration at the cortical level, prostheses have shown efficacy for limited periods of time and limited pixel numbers. We are investigating the potential of sonogenetics to develop a non-contact brain machine interface allowing long-lasting activation of the visual cortex. The presentation will introduce our genetic-based brain machine interfaces for visual restoration at the retinal and cortical levels.

Mutation targeted gene therapy approaches to alter rod degeneration and retain cones

My research uses electrophysiological techniques to evaluate normal retinal function, dysfunction caused by blinding retinal diseases and the restoration of function using a variety of therapeutic strategies. We can use our understanding or normal retinal function and disease-related changes to construct optimal therapeutic strategies and evaluate how they ameliorate the effects of disease. Retinitis pigmentosa (RP) is a family of blinding eye diseases caused by photoreceptor degeneration. The absence of the cells that for this primary signal leads to blindness. My interest in RP involves the evaluation of therapies to restore vision: replacing degenerated photoreceptors either with: (1) new stem or other embryonic cells, manipulated to become photoreceptors or (2) prosthetics devices that replace the photoreceptor signal with an electronic signal to light. Glaucoma is caused by increased intraocular pressure and leads to ganglion cell death, which eliminates the link between the retinal output and central visual processing. We are parsing out of the effects of increased intraocular pressure and aging on ganglion cells. Congenital Stationary Night Blindness (CSNB) is a family of diseases in which signaling is eliminated between rod photoreceptors and their postsynaptic targets, rod bipolar cells. This deafferents the retinal circuit that is responsible for vision under dim lighting. My interest in CSNB involves understanding the basic interplay between excitation and inhibition in the retinal circuit and its normal development. Because of the targeted nature of this disease, we are hopeful that a gene therapy approach can be developed to restore night vision. My work utilizes rodent disease models whose mutations mimic those found in human patients. While molecular manipulation of rodents is a fairly common approach, we have recently developed a mutant NIH miniature swine model of a common form of autosomal dominant RP (Pro23His rhodopsin mutation) in collaboration with the National Swine Resource Research Center at University of Missouri. More genetically modified mini-swine models are in the pipeline to examine other retinal diseases.

Emerging therapeutic targets for migraine

Migraine is the third most prevalent disease worldwide and is estimated to affect upwards of 14% of the population. Our lab has used novel preclinical models to identify the delta opioid receptor (DOR) as a therapeutic target for multiple headache disorders, including migraine. We have also investigated the relationship between DOR with the pro-migraine peptide, CGRP. There is regional variation between the co-expression of DOR with CGRP or its receptor in the trigeminal complex. This work indicates that DOR agonists can moderate both CGRP release and signaling, thus regulating pro-migraine effects at two different levels. Recent work in our lab has also explored how cytoarchitectural changes in pain processing regions are critical for the maintenance of the chronic migraine state. We show that there is decreased neuronal complexity in two different models of migraine, and that restoration of tubulin dynamics, directly by HDAC6 inhibitor or indirectly by CGRP receptor antagonist, can inhibit migraine-associated symptoms. These studies provide fundamental information on how cytoskeletal dynamics are altered in chronic migraine, and form the basis for the development of HDAC6 inhibitors for headache treatment.

NMC4 Short Talk: Decoding finger movements from human posterior parietal cortex

Restoring hand function is a top priority for individuals with tetraplegia. This challenge motivates considerable research on brain-computer interfaces (BCIs), which bypass damaged neural pathways to control paralyzed or prosthetic limbs. Here, we demonstrate the BCI control of a prosthetic hand using intracortical recordings from the posterior parietal cortex (PPC). As part of an ongoing clinical trial, two participants with cervical spinal cord injury were each implanted with a 96-channel array in the left PPC. Across four sessions each, we recorded neural activity while they attempted to press individual fingers of the contralateral (right) hand. Single neurons modulated selectively for different finger movements. Offline, we accurately classified finger movements from neural firing rates using linear discriminant analysis (LDA) with cross-validation (accuracy = 90%; chance = 17%). Finally, the participants used the neural classifier online to control all five fingers of a BCI hand. Online control accuracy (86%; chance = 17%) exceeded previous state-of-the-art finger BCIs. Furthermore, offline, we could classify both flexion and extension of the right fingers, as well as flexion of all ten fingers. Our results indicate that neural recordings from PPC can be used to control prosthetic fingers, which may help contribute to a hand restoration strategy for people with tetraplegia.

Gene therapy for Optic Neuropathies

Assessing and improving vision restoration using ex vivo retina

Multisensory development and the role of visual experience

Visual restoration from prosthesis to optogenetic therapy

Photovoltaic Restoration of Sight in Age-related Macular Degeneration

On the acquisition of visual functions following early-onset and prolonged visual deprivation

New Strategies and Approaches to Tackle and Understand Neurological Disorder

Broadly, the Mauro Costa-Mattioli laboratory (The MCM Lab) encompasses two complementary lines of research. The first one, more traditional but very important, aims at unraveling the molecular mechanisms underlying memory formation (e.g., using state-of-the-art molecular and cell-specific genetic approaches). Learning and memory disorders can strike the brain during development (e.g., Autism Spectrum Disorders and Down Syndrome), as well as during adulthood (e.g., Alzheimer’s disease). We are interested in understanding the specific circuits and molecular pathways that are primarily targeted in these disorders and how they can be restored. To tackle these questions, we use a multidisciplinary, convergent and cross-species approach that combines mouse and fly genetics, molecular biology, electrophysiology, stem cell biology, optogenetics and behavioral techniques. The second line of research, more recent and relatively unexplored, is focused on understanding how gut microbes control CNS driven-behavior and brain function. Our recent discoveries, that microbes in the gut could modulate brain function and behavior in a very powerful way, have added a whole new dimension to the classic view of how complex behaviors are controlled. The unexpected findings have opened new avenues of study for us and are currently driving my lab to answer a host of new and very interesting questions: - What are the gut microbes (and metabolites) that regulate CNS-driven behaviors? Would it be possible to develop an unbiased screening method to identify specific microbes that regulate different behaviors? - If this is the case, can we identify how members of the gut microbiome (and their metabolites) mechanistically influence brain function? - What is the communication channel between the gut microbiota and the brain? Do different gut microbes use different ways to interact with the brain? - Could disruption of the gut microbial ecology cause neurodevelopmental dysfunction? If so, what is the impact of disruption in young and adult animals? - More importantly, could specific restoration of selected bacterial strains (new generation probiotics) represent a novel therapeutic approach for the targeted treatment of neurodevelopmental disorders? - Finally, can we develop microbiota-directed therapeutic foods to repair brain dysfunction in a variety of neurological disorders?

The thalamus that speaks to the cortex: spontaneous activity in the developing brain

Our research team runs several related projects studying the cellular and molecular mechanisms involved in the development of axonal connections in the brain. In particular, our aim is to uncover the principles underlying thalamocortical axonal wiring, maintenance and ultimately the rewiring of connections, through an integrated and innovative experimental programme. The development of the thalamocortical wiring requires a precise topographical sorting of its connections. Each thalamic nucleus receives specific sensory information from the environment and projects topographically to its corresponding cortical. A second level of organization is achieved within each area, where thalamocortical connections display an intra-areal topographical organization, allowing the generation of accurate spatial representations within each cortical area. Therefore, the level of organization and specificity of the thalamocortical projections is much more complex than other projection systems in the CNS. The central hypothesis of our laboratory is that thalamocortical input influences and maintains the functional architecture of the sensory cortices. We also believe that rewiring and plasticity events can be triggered by activity-dependent mechanisms in the thalamus. Three major questions are been focused in the laboratory: i) the role of spontaneous patterns of activity in thalamocortical wiring and cortical development, ii) the role of the thalamus and its connectivity in the neuroplastic cortical changes following sensory deprivation, and iii) reprogramming thalamic cells for sensory circuit restoration. Within these projects we are using several experimental programmes, these include: optical imaging, manipulation of gene expression in vivo, cell and molecular biology, biochemistry, cell culture, sensory deprivation paradigms and electrophysiology. The results derived from our investigations will contribute to our understating of how reprogramming of cortical wiring takes place following brain damage and how cortical structure is maintained.

Toward a High-fidelity Artificial Retina for Vision Restoration

Electronic interfaces to the retina represent an exciting development in science, engineering, and medicine – an opportunity to exploit our knowledge of neural circuitry and function to restore or even enhance vision. However, although existing devices demonstrate proof of principle in treating incurable blindness, they produce limited visual function. Some of the reasons for this can be understood based on the precise and specific neural circuitry that mediates visual signaling in the retina. Consideration of this circuitry suggests that future devices may need to operate at single-cell, single-spike resolution in order to mediate naturalistic visual function. I will show large-scale multi-electrode recording and stimulation data from the primate retina indicating that, in some cases, such resolution is possible. I will also discuss cases in which it fails, and propose that we can improve artificial vision in such conditions by incorporating our knowledge of the visual system in bi-directional devices that adapt to the host neural circuitry. Finally, I will introduce the Stanford Artificial Retina Project, aimed at developing a retinal implant that more faithfully reproduces the neural code of the retina, and briefly discuss the implications for scientific investigation and for other neural interfaces of the future.

Brain plasticity in unilateral deafness and its restoration with a cochlear implantation

Deep Learning of Brain Spacetime to Predict Outcome of Vision Restoration Therapy using Non-invasive Brain Stimulation

How does optogenetic restoration of retinal light sensitivity affect visual processing in mice?

Restoration of dopamine D2 receptors in the sensorimotor striatum of D2R knockdown mice selectively ameliorates deficits in motor skill learning

Restoration of ER proteostasis augments the autophagic flux and mitigates remote degeneration after spinal cord injury

Sonogenetic Therapy For Visual Restoration

Towards Sensation Restoration through Electrical Stimulation in Diabetics

Visual encoding by retinal ganglion cells in optogenetic models for vision restoration

In vivo biocompatibility and functionality of porous-graphene-based subretinal implants for vision restoration

Advancing optogenetic hearing restoration through cross-modal optimization

FENS Forum 2024

CCL5 promotes neuronal restoration after brain injury

FENS Forum 2024

Dissecting the requirements for biological repair and restoration of walking following increasingly severe spinal cord injuries at different timepoints

FENS Forum 2024

Evaluation of optogenetic gene therapy for hearing restoration in in vivo rodent models of sensorineural hearing loss

FENS Forum 2024

Exploring the phenotypic impact of constitutive or late restoration of Nav1.1 in GABAergic neurons in a reversible mouse model of Dravet syndrome

FENS Forum 2024

REST as a target for vision restoration

FENS Forum 2024

Sex-dependent effects of voluntary physical exercise on object recognition memory restoration after traumatic brain injury in middle-aged rats

FENS Forum 2024

Sonogenetics: From the mechano-sensitive channel to brain stimulation for visual restoration

FENS Forum 2024

Unveiling the potential of HBK-15 as a dual-action drug candidate for mood and cognition restoration in mouse depression model

FENS Forum 2024