risk

Cardiorespiratory and autonomic impacts of coolants in e-cigarette aerosols

PROJECT SUMMARY / ABSTRACT Coolants such as menthol, WS-3, and WS-23 are widely used in electronic cigarettes (e-cigs) to reduce irritation and enhance appeal—especially among youth. Despite their prevalence, the cardiopulmonary toxicity of these agents remains poorly characterized. Recent work shows that e-cig aerosols can disrupt autonomic nervous system regulation and cardiac electrophysiology, increasing catecholamine release, enhancing sympathetic regulation of cardiac rhythm, and provoking arrhythmias. Proof is also mounting that nicotine’s sympathomimetic traits mediate these pathogenic effects. Preliminary data from our laboratory show that coolants increase systemic nicotine levels, blunt respiratory reflexes, and potentiate arrhythmias upon exposures to e-cigarette aerosols, suggesting a paradoxical role for coolants in suppressing ventilatory responses while intensifying cardiovascular risk. These findings take on added significance in light of recent case reports of sudden cardiac arrest in young e-cigarette users, including some in otherwise healthy individuals. This project will elucidate how e-cigarette coolants alter exposure to harmful and potentially harmful constituents (HPHCs)—particularly nicotine and aldehydes—concurrent with their effects on cardiovascular and respiratory physiology. Using robust murine models with continuous ECG, blood pressure, and pleural pressure telemetry, we will assess how coolants alter the acute and chronic effects of e-cigarette aerosols on cardiac electrophysiology, autonomic tone, ventilatory function, hemodynamics, and toxicant exposure. We will also evaluate how coolant concentration and device power modulate these effects. In parallel, we will determine whether adolescent mice exhibit heightened susceptibility to these effects compared to adults, with attention to sex differences and the persistence of cardiotoxicity after exposure cessation. This comprehensive, multi-modal approach incorporates novel protocols for arrhythmia inducibility, high-resolution physiologic monitoring, and complementary analyses of biomarkers of exposure and effect. By clarifying how coolants interact with HPHCs—especially nicotine and aldehydes—to drive cardiopulmonary injury across age and sex, this work addresses high-priority research areas identified in RFA-OD-25-001, including the toxicological evaluation of e-cigarette constituents and their cardiopulmonary effects. The results will inform regulatory policy and public health strategies aimed at mitigating cardiovascular risk associated with e-cigarette use, particularly among vulnerable youth.

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.

From B-cell decisions to antibody repertoires

PROJECT SUMMARY/ABSTRACT Vaccine responses are highly variable across the population and not without risk for debilitating side-effects. Antibody-mediated immunity is generated by a Darwinian process to generate B-cells that contain B-cell receptors (BCR) that have high affinity for the pathogen-derived antigen, while also eliminating B-cells that happen to react to self-antigens. This process depends on cell fate decisions such as (i) death vs survival, (ii) entry into a proliferative program, (iii) differentiation into antibody-secreting plasma cells. According to clonal selection theory, B-cell fate decisions are made based on the genetically encoded affinity of the the BCR to the antigen (Signal 1) and the cognate T-cells’ TCR to the antigen peptide (Signal 2). However, single-cell resolution studies have revealed that fate decisions of genetically identical B-cells are remarkably heterogeneous. Our studies of the previous funding period revealed that B-cell epigenetic heterogeneity is in fact dynamically controlled: it is generated during the selection process but remains largely stable during the proliferative burst. This leads to our newly proposed Aim 1 to examine how the dynamic control of epigenetic state variability affects antibody responses. An innovative multi-scale model of Darwinian evolution directs and interprets experimental studies by life cell video microscopy in vitro and in immunization studies in vivo. Our previous studies also found that B-cells are capable of sensing the time gap between signal 1 and 2, suggesting a temporal proofreading mechanism for negative selection. This leads to newly proposed Aim 2 which seeks to identify the regulatory circuits that control the stringency of negative selection, as well as contextual germinal center (GC) cytokines that could be manipulable in vivo. These in silico and in vitro studies are followed by in vivo immunization to extend their physiological relevance. Finally, in Aim 3, we will ask what determines the time-gap of signal1 and signal 2, which occur in the immune- induced structure of the GC. We will develop a new model that simulates B-cell fate decisions as a function of their interactions with antigen-presenting stromal cells and T-cells that may be cognate or non-cognate. Model simulations will be used to interpret spatial transcriptomic data to test different adjuvants and predictions will be tested in in vivo immunization studies. With mouse models of inflammation and aging we will examine how adjuvants alter vaccine efficacy and risk.

Optimizing CD45-Targeted Astatine-211-Radioimmunotherapy for Malignant and Non-Malignant Blood Disorders

ABSTRACT CD45 is expressed on almost all normal and neoplastic hematopoietic cells but not on non-blood cells and has, therefore, been pursued as a drug target. Initially centered on augmenting conditioning before hematopoietic cell transplantation (HCT) for blood cancers, there is increasing interest in expanding CD45-directed therapies into other settings, with radioimmunotherapy (RIT) being the major therapeutic modality so far. Investigators at our institution pioneered CD45 RIT with b-emitters such as iodine-131 (131I) using the murine monoclonal antibody (mAb), BC8. A phase 3 trial testing 131I-BC8 (131I-apamistamab [Iomab-B]) with allogeneic HCT in older adults with relapsed/refractory acute myeloid leukemia showed improved outcomes over conventional care, validating this approach. More recently, attention has shifted toward a-emitters that deliver substantially higher decay energies over much shorter distances than b-emitters, rendering them more suitable for precise and potent target cell killing. In our work, we focus on astatine-211 (211At) for its ideal half-life and decay without a-emitting daughters. For clinical application, mAbs are conjugated with the bifunctional boron cage molecule, isothiocyantophenethyl-ureido-closo-decaborate(2-) (B10-NCS), to enable stable protein astatination. Three early-phase trials testing 211At-BC8-B10 as augmentation of HCT conditioning for patients with malignant and non-malignant blood disorders are ongoing, with emerging data indicating significant anti-tumor efficacy. Nonetheless, relapses still occur. Other important limitations include marked infusion toxicities and human antimouse antibody (HAMA) responses related to the murine nature of BC8 and dimer formation after 211At labeling of mAb-B10 conjugates with tissue residualization from 211At atom oxidation. The latter may contribute to the risk of liver cell injury, the dose limiting extramedullary toxicity of CD45 RIT. As a first step toward our goal of optimizing CD45 RIT, we have raised new, fully human CD45 mAbs as basis for novel therapeutics. In preliminary in vivo studies in immunodeficient mice, we found some of these mAbs to have greater anti-tumor efficacy than a humanized version of BC8 (HuBC8) we generated as a reference mAb. We will now conduct comparative in vivo CD45+ cell targeting (“biodistribution”) and anti-tumor efficacy studies to select a lead candidate mAb for clinical application and use protein engineering to maximize the selectivity and efficacy of targeted radiation delivery. We will use immunodeficient mice xenotransplanted with human leukemia cells for this purpose as no human approaches are available and in vitro testing is inadequate to measure both the targeting and biologic RIT effects on human leukemia cells. Mice provide the in vivo milieu needed for comprehensive evaluation. Development of improved mAb astatination methodologies to minimize off-target toxicities of 211At-RIT will further increase therapy specificity and reduce toxicity. In parallel, we will conduct genome-scale, unbiased target identification/validation studies to identify partner drugs for rational combination therapies aimed at enhancing the anti-tumor efficacy of 211At-CD45 RIT.

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.

Urothelial Resurfacing with Irreversible Electroporation for Adjuvant Therapy of Bladder Cancer

PROJECT SUMMARY Over 70% of bladder cancer (BCa) patients are diagnosed with early-stage and localized non-muscle invasive disease (NMIBC), yet achieving durable cancer-free survival remains a significant challenge. Most of these patients will experience local tumor recurrence within five years following standard of care (SoC) transurethral resection of bladder tumor (TURBT) and intravesical adjuvant chemo- or immunotherapy. Recurrence is driven by microscopic tumors and premalignant lesions dispersed within the urothelial layer that survive and escape these treatments. As TURBT effectively treats tumors visible on imaging, current research has predominantly focused on drugs and biologics for improving intravesical adjuvant therapy. In this proposal we pose the provocative question whether a TURBT-like ablative technique can be extended to debulk malignancy in the entire bladder and investigate the synergy with intravesical adjuvant therapy in improving outcomes. Our objective is to address this technology and knowledge gap by developing and validating whole bladder urothelial resurfacing (WBUR) using irreversible electroporation (IRE). During IRE, microsecond-long pulsed electric fields (PEF) are used to induce rapid cell death by catastrophic permeabilization of the cell membrane, without affecting the extracellular matrix (ECM) within the treated tissue. In prior work, we designed devices that utilized this unique mechanism of IRE for performing penetrative ablation in the ureter, bile duct and bronchus of swine while preserving lumen function. Our findings provided strong rationale for IRE being an ideal candidate for WBUR as alternate techniques such as thermal ablation or ionizing radiation must be performed with extreme care in the bladder to avoid perforation or fistula formation. In subsequent preliminary work we developed technology to demonstrate the feasibility and safety of WBUR with IRE in a rat model of BCa and scalability in human-sized swine bladder. In Aim 1, we will investigate the cancer treatment efficacy of combination WBUR and intravesical adjuvant therapy. In Aim 2, validate WBUR derived liquid biopsy for monitoring cancer status. In Aim 3, engineer PEF delivery strategy to enhance the safety and specificity of WBUR. The innovation of our proposed work is defined by developing whole bladder ablation as a debulking strategy and examining its synergy with SOC adjuvant therapy (Aim 1), enabled by new electrode paradigm and PEF delivery strategy (Aim 3), monitoring by an unconventional liquid biopsy approach (Aim 2). Our work can immediately aid the management of NMIBC patients who cannot undergo radical cystectomy, with future application as a cancer prevention strategy in high-risk patients. Success of individual aims will result in major contributions to the topics of IRE, BCa treatment and diagnosis.

Perturbation of mammary immunoglobulins during maternal antibiotic administration

Project Summary Prescribed in up to 40% of pregnancies, antibiotics represent the most commonly used class of medication during pregnancy. Although this practice is often necessary for maternal health, accumulating evidence suggests that antibiotic exposure may have unintended consequences for the mother-infant dyad. Epidemiologic studies associate maternal antibiotic exposure, especially in the absence of infection, with increased risk of neonatal complications including late-onset sepsis (LOS) and necrotizing enterocolitis (NEC), yet the mechanisms driving these associations remain poorly understood. Secretory IgA (sIgA) in milk is an essential component of neonatal mucosal immunity, shaping early gut microbial colonization and providing protection against enteric pathogens. The mechanisms by which maternal physiology regulates the abundance and microbial specificity of these antibodies in milk remain poorly understood. In animal models, the maternal gut–mammary axis governs the generation of milk IgA: IgA-committed lymphocytes from the maternal intestine migrate to the mammary gland during advancing pregnancy via CCL- 28/CCR10 signaling. Our preliminary data suggest that maternal antibiotic exposure disrupts this process leading to a decrease in milk IgA. However, the timing and extent of antibody dysbiosis are undefined; the downstream effects on neonatal intestinal health are unknown; and the underlying mechanisms—whether due to altered microbial stimulation, impaired recruitment of IgA⁺ cells to the mammary gland, or both—remain to be elucidated. Our central hypothesis is that maternal antibiotic exposure reduces pathogen-reactive IgA in milk by impairing gut-to-mammary immune cell trafficking thereby compromising neonatal mucosal immunity and increasing infection susceptibility. We will address this hypothesis through three integrated aims: (1) Determine the magnitude and duration of antibiotic-mediated mammary antibody dysbiosis in women who deliver preterm and at term; (2) Identify microbial targets of mammary antibodies diminished by maternal antibiotic exposure and (3 Determine the role of maternal antibiotics in the disruption of mammary resident IgA+ plasma cells in animal models. This integrative human and animal study will uncover critical mechanisms by which maternal antibiotic use alters the maternal-infant immune axis. The results will provide mechanistic insight into the risks associated with perinatal antibiotic exposure and inform clinical strategies to mitigate risk to neonatal health.

Defining Microbial and Host Pathways Driving Asymptomatic C. difficile Colonization Associated with Aging and High-Sugar Diets

SUMMARY Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated diarrhea, with rising incidence in community settings and a growing burden of asymptomatic colonization. Asymptomatic car- riers, particularly among the elderly and individuals consuming high-sugar diets, represent a critical but underexplored reservoir for transmission and disease progression. This proposal introduces novel, anti- biotic-independent mouse models demonstrating that both dietary sugar and aging independently pro- mote asymptomatic C. difficile colonization. We hypothesize that these factors disrupt colonization re- sistance (CR) through distinct but overlapping microbial, metabolic, and immune pathways. In Aim 1, we will define how traditional and emerging dietary sugars alter the gut environment to permit C. difficile colonization using in vitro bioreactors and in vivo models. Aim 2 will identify age-associated changes in microbiota and mucosal immunity that impair CR, using longitudinal studies and fecal micro- biota transfer. Aim 3 will functionally validate C. difficile genes upregulated during asymptomatic carriage using CRISPR-Cas9 mutants in both sugar- and age-induced models. This integrative, multi-omics approach will uncover the mechanisms enabling asymptomatic colonization and identify microbial and host targets for intervention. The findings will inform microbiome-based strat- egies to prevent CDI in vulnerable populations and shift current paradigms in CDI risk assessment and prevention.

Causal mechanisms driving germline predisposition to myeloproliferative disorders

SUMMARY/ABSTRACT Although human genetic studies have indicated a significant hereditary predisposition to myeloproliferative neoplasms (MPNs) the underlying mechanisms driving the genetic risk remains unknown. Our large genome wide association study (GWAS) on MPNs identified several non-coding genetic risk loci associated with disease and implicated modulation of hematopoietic stem cell (HSC) self-renewal by the genetic variants. The long-term goal is to utilize our GWAS results to better understand MPN disease initiation and progression and draw out key unknown MPN predisposition genes. The overall objectives in this application are to elucidate the mechanisms by which MPN risk variants promote disease initiation and progression. The central hypothesis is that common genetic variants increase MPN risk by affecting regulatory elements that influence clonal expansion of HSCs carrying MPN driver mutations. The rationale for this project is that the HSC clones with most prevalent driver mutation found in MPN, JAK2V617F show individual specific growth rates and can develop into MPN or remain as clonal hematopoiesis without any consequences indicating that germline genetic factors influence this process. The central hypothesis will be tested by pursuing two specific aims: 1) To determine the mechanisms by which genetic variation at the GFI1B locus influences MPN predisposition in vivo. 2) To define upstream transcriptional mechanisms disrupted by common genetic variants that predispose to MPN. Under the first aim, a newly generated mouse model will be used to evaluate clonal expansion of JAK2V617F HSCs in the context of a germline Gfi1b enhancer deletion by in vivo competitive transplantation assays. The murine studies will be complemented by an assessment of Gfi1b allele specific clonal expansion in primary human hematopoietic stem and progenitor cells (HSPCs) engineered to carry JAK2V617F mutation. Mechanistically activated mitochondrial respiration will be examined in germline enhancer inactivated JAK2V617F HSPCs in murine models and human patient samples. For the second aim, perturbation of RUNX1 bound cis-regulatory elements by MPN risk variants will be evaluated as a mechanism of clonal expansion in MPN by using lentiviral reporter assays and endogenous CRISPR/Cas9 editing approaches in primary human HSPCs and degron tagged RUNX1 cell lines. A Runx1 haploinsufficiency mouse model will be used to assess global influences of RUNX1 transcriptional network on MPN initiation. Collectively, our proposed studies aim to bridge the gap between inherited genetic variations and the clonal expansion dynamics of MPN stem cells, shedding light on crucial factors influencing disease development. The mouse models proposed in this study provide the in vivo physiological context and functional readouts required to investigate HSC clonal expansion and MPN pathogenesis.

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.

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.

TACTIC: Tuberculosis Active Case Tracking via Interpersonal Connections

PROJECT SUMMARY/ABSTRACT Tuberculosis (TB) remains the leading infectious cause of death worldwide. Interruption of transmission is the most effective strategy to reduce incident infections, yet current approaches often fail to reach individuals for timely testing and treatment. This study addresses that gap by leveraging social networks to identify individuals at highest risk of transmitting TB, specifically, people who use drugs (PWUD). We will evaluate respondent-driven sampling (RDS), a peer7 based community recruitment strategy, to identify TB cases among PWUD and the household contacts (HHCs) of those with TB disease (RDS-TB) in Kampala, Uganda. Conducting this work in a high-prevalence setting such as Kampala where our team has established expertise allows us to overcome recruitment challenges common in settings in the United States while generating findings that are directly translatable. This is particularly relevant given that higher TB prevalence and larger outbreaks in the United States have been associated with the use of methamphetamine, heroin, and crack/cocaine, drugs that we will study. In Aim 1, we will compare the effectiveness and reach of RDS-TB with a traditional clinic-based index case HHC approach for TB case finding. We will screen 2,000 PWUD and their HHCs, estimate the number needed to screen to identify one case of TB disease, and compare the demographic and network characteristics of RDS-TB recruits with clinic-based HHCs. Whole genome sequencing will be used to characterize transmission dynamics. In Aim 2, we will compare the yield of individual and combined TB diagnostic strategies for community-based active case finding. Participants will undergo chest radiography with computer-aided detection, tongue swab testing for TB nucleic acid amplification tests (NAAT), and sputum testing for NAAT and mycobacterial culture. We will identify the minimal combination of tests needed to meet World Health Organization target product profile thresholds for screening. In Aim 3, we will define the conditions under which RDS-based screening can effectively interrupt TB transmission. We will develop an agent-based model informed by social network data from individuals with and without TB, incorporating drug use patterns and demographic characteristics. This project will generate a practical, scalable roadmap for social network–based TB active case finding in high28 risk communities. The approach will be readily adaptable to settings in the United States and will inform strategies to interrupt transmission and advance progress toward TB elimination, in alignment with the NIH Strategic Plan for TB Research.

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.

Improved Surgical Visibility and Navigation during Endoscopic Treatment of Upper Tract Urothelial Carcinoma

Project Summary The importance of localizing and treating all upper tract urothelial cancer (UTUC) tumors during a renal sparing, endoscopic treatment is emphasized by the high risk of cancer progression from inadequate tumor treatment. Insufficient treatment necessitates kidney and ureteral removal (i.e., nephroureterectomy). Nephroureterectomy permanently compromises renal function, and increases morbidity and mortality, while negatively impacting a patient’s quality of life. In contrast, endoscopic treatment (i.e., using a laser to ablate only the tumors) improves long-term outcomes by sparing healthy kidney tissue. However, endoscopic treatment is underutilized compared to nephroureterectomy because it is difficult to accomplish. Successful endoscopic treatment is dependent on the surgeon’s ability to create a mental 3D map of the branched, intrarenal endoscopic anatomy intraoperatively from preoperative 2D imaging, which is extremely difficult. Since mental mapping relies on hand-eye coordination, memory, and spatial reasoning, it is inherently imprecise and its impact on accuracy and tumor treatment is dependent on the surgeon’s experience. To make matters worse, even when tumors are successfully visualized, the surgeon often cannot accurately assess the location of tumor margins or infer pathologic grade due to the limited field of view and depth of field (10mm and 6mm on average, respectively) of current scopes. The scopes only provide visualization of a small part of the surgical field at any instant. These inherent challenges prevent many surgeons from attempting endoscopic tumor treatment since incomplete treatment leads to a devastating, oncologic outcome. Our overall goal is to create an enhanced visualization and navigational system that makes endoscopic UTUC tumor treatment easier and more accurate for all surgeons, enabling wider utilization. Toward this goal, our specific objective in this proposal is to test the hypothesis that our system can make endoscopic UTUC surgery more accurate and efficient. To test this hypothesis, we propose three Specific Aims: Aim 1 involves the development of an automatic, real-time segmentation and grading system of UTUC tumors during endoscopic treatment. Aim 2 integrates a 3D navigational map of collecting system anatomy, which includes tumor and endoscope location, during endoscopic surgery. Aim 3 evaluates the system in patients, with zero risk to the human subjects. The endpoint of this R01 will be a fully validated enhanced visualization and navigational system for endoscopic UTUC surgery, which would provide the necessary experimental data towards a large-scale, multi-center clinical trial and future FDA approval. As our system would require only software integration to current endoscopic surgical cameras, all existing endoscopic surgical systems could in principle immediately benefit from the results of this project. In this way, we believe the success of our project will facilitate improved UTUC treatment and mitigate progression to a higher risk extirpative surgery.

Neuroinflammation in Cerebral Small Vessel Disease

Project Summary/Abstract Cerebral small vessel disease (cSVD) is a leading cause of vascular contributions to cognitive impairment and dementia (VCID), which is the 2nd leading cause of dementia and a significant contributor to Alzheimer’s disease (AD). Thus far, the underlying pathogenesis of cSVD is poorly understood. Several lines of evidence, including animal models, postmortem human brain pathology, and systemic inflammatory markers, demonstrated the damaging role of chronic neuroinflammation in cSVD. Direct evidence of neuroinflammation at the tissue level in patients with cSVD is still critically needed. The sphingosine-1-phosphate receptor 1 (S1PR1) regulates neuroinflammation through microglial and astrocyte activation and trafficking and has emerged as a promising target for neuroinflammation. In postmortem brains of patients with cSVD, we observed elevated S1PR1 expression and colocalization of S1PR1 with astrocytes and microglia. A novel 11C-CS1P1 PET radiotracer with high affinity and specificity targeting S1PR1 has been recently developed and validated in animal models and post-mortem human specimens. Under an FDA-approved eIND (IND 146548), we have successfully completed the safety and dosimetry study in healthy participants and performed preliminary studies in patients with cSVD. We found that 11C-CS1P1 PET uptake is significantly associated with WMH lesion burden in patients with cSVD after controlling for age, sex, race, vascular risk factors, and amyloid deposition. We hypothesize that 11C-CS1P1 PET uptake is a tissue-level biomarker of neuroinflammation to provide insight into cSVD severity, progression, and prognosis. We will 1) evaluate the relationship between 11C-CS1P1 PET uptake and cSVD neuroimaging abnormalities and cognitive impairment, 2) evaluate the test-retest repeatability and longitudinal evolution, and 3) determine whether 11C-CS1P1 PET uptake at baseline predict cSVD progression. The successful completion of this study will establish 11C-CS1P1 PET as an neuroinflammation imaging biomarker and investigate the role of neuroinflammation in cSVD pathogenesis and progression. It will lay a foundation for developing future therapies in modulating neuroinflammation.

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.

Systems Biology of Early Atopy: Role of Human Milk (SunBEAm-Milk)

Surprisingly little is known about the effect of breastfeeding (BF) on infant immune system development besides an effect on the gut microbiome, but its impact on metabolites and Tregs could support protection against food allergy (FA). BF is currently recommended to prevent the development of allergic diseases, especially asthma/recurrent wheezing and AD in early childhood, but firm conclusions could not be drawn regarding FA due to high heterogeneity and low quality of studies. Reverse causation, recall bias and the poor accuracy of outcome assessment are significant limitations. Most are inadequately powered to specific FA; however, a recent study showed that exclusively BF infants had lower odds of egg, sesame, and peanut allergies. Importantly, immunomodulatory composition of HM varies between mothers, which has not been taken into consideration. For over two decades we have been developing methods to assess immunomodulatory factors in the complex matrix of HM and their association with infant FA. We have shown that high levels of HM total and specific IgA are associated with protection against cow’s milk allergy, but it is unclear whether HM IgA is responsible for or is a biomarker of the vertical transfer of protection. Infant fecal and systemic IgA levels during breastfeeding and after weaning are also elevated in infants at low risk for atopic disease raising the question of whether HM factors such as cytokines can promote IgA production in infants. Consistent with this, we showed that HM cytokines, such as APRIL, induce IgA production in naïve infant B cells, and infants receiving HM with higher levels of APRIL had lower incidence of allergic disease. Finally, lower levels of several HM fatty acids including short-chain fatty acids and DHA were associated with FA. While some these factors were are associated with maternal atopic disease, several of them are not and suggest a role for diet instead. The System Biology of Early Atopy (SunBEAm) population-based cohort of 2500 mother-infant pairs is >50% recruited and provides an unprecedented opportunity to assess association of HM feeding and immune factors in HM with development of infant immune system and FA/AD. The Common Sample comprises a subset of 100 dyads with FA, 100 with FA+AD, 100 with AD, 100 with no FA or AD and more extensively profiled biological data. Utilizing all 2-month HM samples available in the Common Sample, we will assess levels of immune factors in HM and their association with maternal/infant characteristics (Aim 1). Utilizing data from the whole cohort, we will assess the association between HM vs formula feeding on well-defined FA/AD further adjusted based on high vs low levels of HM immune components in the Common Sample (Aim 2b). Finally, we will examine the immune cell and epithelial effects of HM on infant immune markers and intestinal organoids (Aim 3). Key findings will be validated in an independent birth cohort. The ultimate goal is to uncover protective properties of BF and HM in FA and subsequent design of policies and prevention strategies to address the increasing rates of FA.

Factors Driving Wear and Implant Failure in Total Shoulder Arthroplasty

Polyethylene (PE) wear and implant-related failure remain leading causes of revision in total shoulder arthroplasty (TSA), a procedure which now surpasses the growth rate of hip and knee arthroplasty. Both anatomic (aTSA) and reverse (rTSA) TSA outcomes are heavily influenced by complex interactions between rotator cuff function, scapular motion, implant design, and patient-specific loading—factors not adequately captured in current preclinical implant testing standards. Emerging evidence suggests that PE wear progression in TSA is highly dependent on shoulder kinematics, joint loading, implant positioning, and individual patient factors. Nonetheless, data on in vivo motion and load profiles remain sparse, and few tools exist to link these profiles to clinically relevant wear patterns or associated periprosthetic inflammatory tissue responses. Accordingly, the primary objective of this project is to develop validated, patient-specific models that predict PE wear in TSA and identify modifiable surgical, design, and rehabilitation targets to improve implant longevity and restore patient mobility. Additionally, we will establish histopathological hallmarks that indicate TSA failure caused by PE wear debris. Our central hypothesis is that specific shoulder kinematics and joint loading drive distinct PE wear patterns in TSA associated with mechanical failure or inflammatory-mediated osteolysis, depending on implant design and positioning. To achieve the overall objective of this work, shoulder motions and muscle excitations across 25 activities of daily living will be collected at pre-op and post-op (>6 months) in both aTSA and rTSA patients, with long-term follow-up of patient-reported outcomes via validated surveys (5 years). Unsupervised machine learning will categorize patients into movement-based phenotypes, which will then inform a multi-scale modeling framework to estimate in vivo shoulder joint loads and implant wear across the varying movement strategies. Predicted wear patterns will be validated using state-of-the-art preclinical wear simulators. Simultaneously, we will quantify how patient, surgical, and implant factors contribute to wear in retrieved TSA components (>400 samples), correlating imaging-based wear patterns with clinical outcomes, patient-reported function, inflammatory tissue responses, and radiographic indications of loosening. For that purpose, we will establish benchmarks of TSA wear rates and introduce a new histopathological approach augmented by infrared spectroscopic imaging. This work is innovative because we are linking patient-specific movement patterns following TSA with multi-scale computational models to predict PE wear, breaking the current approaches of using generic motions and loads in existing testing standards. This work will produce the first integrated, publicly available database of TSA kinematics, joint loading, and PE wear patterns and rates, along with validated computational tools to inform implant design, surgical planning, rehabilitation strategies, and personalized risk assessment. Ultimately, these advances will improve functional outcomes and long-term success for TSA patients and enable better preclinical testing methods and standards.

Dissecting the role for astrocytes in mediating adverse outcomes of maternal immune activation.

Prenatal infections cause maternal immune activation (MIA), a major risk factor for several neurodevelopmental disorders, including schizophrenia, autism spectrum disorders (ASD), and attention deficit hyperactivity disorder (ADHD). Consequently, elucidating the mechanisms by which MIA alters brain function is critical for understanding the pathophysiology of these disorders and developing effective treatments. While the effects of MIA on neurons and microglia have been extensively studied, the impact of MIA on astrocytes, key regulators of brain physiology and homeostasis, remain unknown that significantly impedes our understanding the mechanisms of MIA-induced neurobehavioral abnormalities. To address this major knowledge gap, we conducted pilot studies that suggest that MIA increases impulsivity-like behaviors and amphetamine-induced hyperactivity and enhances extracellular levels of glutamate (GLU) and dopamine (DA) in the dorsal striatum (DS). MIA also increased pro-inflammatory signatures of astrocytes, including up- regulation of the Nuclear Factor kappa B (NF-κB) pathway and increased GFAP immunoreactivity in DS astrocytes. Collectively, these novel findings support our overarching hypothesis that MIA increases astrocyte reactivity, leading to increased gliotransmission (e.g., GLU), which in turn enhances DS DA release and DA- dependent behaviors. To test this hypothesis, we will leverage the expertise of the research team in molecular, physiological and neurobehavioral approaches and conduct the following Specific Aims: In Aim 1, we will identify the MIA-induced cellular and physiological changes characteristic of astrocyte reactivity. In Aim 2, we will determine the circuit mechanisms by which MIA increases DA signaling. In Aim 3, we will identify the molecular mechanisms whereby reactive astrocytes contribute to MIA-induced cellular and behavioral abnormalities. These studies will enhance the current understanding of the effects of MIA on brain functions and generate new insight into potential treatment strategies for MIA-associated neurodevelopmental disorders.

Examining the foundations of reading comprehension: a longitudinal study of brain and behavior starting in infancy

SUMMARY Reading comprehension (RC) is one of the most complex skills that we utilize daily and is crucial for functioning in modern society, but despite its significance for academic achievement, employment prospects, and mental health, many children and adults do not exhibit proficient RC abilities. New theoretical models aiming to explain variability in RC suggest a dynamic interplay and co-development among ‘precursor’ foundational and cognitive- linguistic skills, interacting with environmental and socio-ecological factors across the developmental timeline of learning to read. Behavioral and neuroimaging studies in school-age children have demonstrated critical mechanistic support for these multifactorial RC models by identifying the developmental trajectories of precursor skills and further showing that brain areas, tracts, and networks typically underlying language and cognitive skills are also involved in RC. Nevertheless, the precursor skills that support RC start developing in infancy and the brain correlates underlying these precursors begin to develop in utero, which suggests that typical and atypical RC developmental trajectories could diverge long before school age. As such, examining RC development using a multifactorial, longitudinal approach that includes brain and behavior starting in infancy is critical for developing theoretical frameworks that can inform early preventative and intervention strategies. Here, we propose a comprehensive longitudinal study of RC development in which we examine direct and indirect effects on RC from brain, behavioral, familial risk, and environmental data from infancy to adolescence. To achieve this goal, we will combine two existing longitudinal cohorts, one ranging from infancy to late childhood (n = 174) and the other from preschool to early adolescence (n = 137). By applying state-of-the-art pediatric neuroimaging analyses, multiple indicator growth model structural equation models, and an innovative behavior- brain co-development measurement index to this unique, combined dataset, we will be able to identify brain and behavioral measures in infancy that directly and indirectly support subsequent RC development (Aim1). We will further characterize how longitudinal trajectories of behavioral measures as well as brain structure, function, and white matter organization contribute to RC development and how familial risk and environmental factors shape these trajectories (Aim 2). Finally, we will examine how the co-development of brain and behavior, as measured with an innovative co-development index, relates to subsequent RC (Aim 3). If successful, we will contribute the first multifactorial longitudinal model of RC development comprising direct and indirect effects from brain, behavior, brain-behavior co-development, familial risk, and environmental measures beginning in infancy. Understanding RC development using a multifactorial longitudinal lens will be crucial for building theoretical models and developing experimental designs focused on early preventative and intervention approaches long before the start of formal schooling.

Maternal Depression and Antidepressant Effects on Fetal Brain Structure and Function (FABMOMS)

PROJECT ABSTRACT Major depressive disorder (MDD) is one of the most common diseases in childbearing women, with a prevalence of 12.7% in pregnancy and 21.9% the year after birth. Exposure to maternal stress and depressive symptoms alters fetal/infant neurodevelopment, functional brain connectivity, and networks implicated in stress processing. About 5% of pregnant women are prescribed a serotonin selective or serotonin norepinephrine reuptake inhibitor (collectively, SRI). Remission of maternal MDD is crucial to the health and functioning of the mother and family. In observational studies typical of this field, differentiating the effects of drug exposure on offspring from the sequelae of the underlying psychiatric disease, both physiological and psychosocial, is challenging. Substantial progress has been made using sophisticated study designs and analytic approaches with large pregnancy cohorts that reduce the risk of spurious associations. Increased rates of overall and cardiac defects, stillbirth, preterm birth, and fetal growth have been largely explained by confounding by factors associated with both MDD and these outcomes rather than SRI exposure. Assessing the neurobehavioral development of children exposed in utero to SRI is the current research priority in this field. Our team pioneered the development of novel and safe fetal and neonatal quantitative magnetic resonance imaging (qMRI) tools, which will be combined with an evaluation of maternal heart rate variability to explore associations between exposures to stress, psychiatric symptoms and SRI on fetal and neonatal brain structure and function. The overarching goal of this project is to evaluate the separate and interactive effects of exposure to antidepressants in utero and maternal MDD on fetal and infant brain structure and function, with a specific focus on the hippocampus. We will accomplish this by evaluating four groups of pregnant women who have: 1) MDD treated with SRI to remission), 2) MDD treated with SRI (non-remitted, with both depressive symptom and SRI exposure), 3) MDD untreated with antidepressants, and 4) no current MDD or SRI treatment. Maternal assessments will occur at intake and in the early third trimesters and in then newborn period (at the time of fetal/newborn MRI) after birth. Maternal and infant evaluations will continue at 6 and 12 months postpartum. Maternal psychosocial and psychiatric status will provide extensive data on the context in which mothers experience pregnancy and infant care and allow adjustment for factors that will inevitably differ across groups. Lastly, we will explore the effects of maternal choline on MDD and offspring brain development. As these exposures and neurodevelopmental studies are conducted, exploring primary preventive strategies is a public health imperative. We will explore a potential mediator, poor maternal choline intake, a modifiable risk factor for both maternal MDD and altered fetal hippocampal growth and infant neurobehavior.

Circulating extracellular vesicles as functional indicators of maternal mental and physical health in pregnancy and postpartum

Women with high levels of adverse childhood experiences (ACEs) are at significantly greater risk for negative health outcomes in pregnancy and postpartum, including gestational diabetes, PTB, and depressed mood. However, we still lack biomarkers or a sufficient understanding of causal mechanisms. Extracellular vesicles (EVs) are one of the most dynamic and abundant biological signals secreted into maternal circulation, largely produced by the placenta – where levels increase 4-5-fold during pregnancy. Similarly, removal of the placenta at delivery produces a dramatic drop in maternal EV concentration. Across species, we and others have identified significant EV changes during pregnancy associated with homeostatic regulation, including glucose and glucocorticoid levels, supporting key roles for EVs in maternal health. However, longitudinal studies in human pregnancy and postpartum have not been conducted. We know little as to the mechanisms controlling EV secretion or the roles for EVs in maternal pregnancy and postpartum health. Our decade’s long work identified the X-linked gene, O-glycosyltransferase (OGT), in mouse and human placenta as a master gage of the maternal milieu, where OGT regulation of annexin A1 (AA1) is key to EV cargo loading and secretion from the placenta. We recently reported that placental OGT levels positively correlate with maternal EV concentration. How this association may contribute toward postpartum health, including regulating maternal stress physiology and mood in humans is not known. We hypothesize that increased ACEs, similar to stress in preclinical models, are negatively associated with a cell’s ability to secrete EVs important to maintain homeostasis in the face of the challenges of pregnancy and postpartum, producing an increasingly unhealthy state. Therefore, the goals of these proposed studies in both mice and humans are as follows: 1) To identify cellular mechanisms involved in EV secretion important to maternal health outcomes utilizing the placenta as a tool to genetically target OGT in mice and examine maternal homeostatic control related to EV concentration and composition during pregnancy; 2) To examine the functional ability for a dynamic elevation in maternal EV concentration to improve homeostatic regulation in pregnancy and postpartum using chemogenetic activation (DREADDs) of placenta trophoblast cells in pregnancy, and by EV transfer by tail vein injection postpartum; and 3) To examine in women changes in maternal EVs in a longitudinal pregnancy and postpartum study in association with maternal glucose and cortisol changes, we will examine markers of physical (glucose challenge test), HPA stress (hair cortisol & stress- stimulated salivary cortisol) and psychological (Hamilton Rating Scale for Depression, Perceived Stress Scale) health across pregnancy and the postpartum period in 150 healthy women with varying degrees of exposure to ACEs as measured using the ACE Questionnaire (ACE-Q).

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.

Mechanisms and consequences of cerebrovascular dysfunction in preeclampsia

PROJECT SUMMARY/ABSTRACT Preeclampsia (PE) is a common hypertensive disorder of pregnancy that causes significant maternal and fetal morbidity and mortality worldwide. PE women are at a high risk of stroke, including intracerebral hemorrhage, during the peripartum period, suggesting the sequelae of PE adversely impacts the cerebral circulation to promote hemorrhage. In addition, women with severe early-onset PE are at an 85-fold increased risk of death from intracerebral hemorrhage, importantly suggesting severity of disease promotes greater vulnerability of the cerebral circulation to degradation and rupture. However, the consequences of PE extend far beyond pregnancy and are associated with excessive cardiovascular and cerebrovascular disease risk later in life. Women with previous pregnancy complicated by PE can develop cognitive impairment as early as in their 30’s and 40’s, suggesting PE predisposes the brain to early-onset cognitive impairment. Studies have shown that formerly PE women have changes in gray matter volume and increased white matter lesion burden that occurs as a function of time from pregnancy, suggesting that PE continues to progressively damage the brain long after the affected pregnancy. Thus, our overall goal is to elucidate mechanisms by which women with PE are at risk of intracerebral hemorrhage in pregnancy and cognitive decline later in life. Our preliminary studies found greater vascular degradation, hematoma and cerebral edema in a model of severe PE that was associated with vascular inflammation and microglia activation (neuroinflammation). In addition, we found endothelial dysfunction and diminished neurovascular coupling in PE rats that persisted 5 months postpartum. Impaired neurovascular coupling is well-recognized as an underlying contributor to cognitive decline. These effects in postpartum animals with previous exposure to PE were associated with memory impairment that was not present in the pregnant state, suggesting neurovascular dysfunction precedes cognitive decline. Our central hypothesis is that the sequela of PE accelerates hypertension-induced cerebrovascular dysfunction that predisposes to intracerebral hemorrhage during pregnancy and its persistence postpartum results in early-onset cognitive decline. We will therefore elucidate mechanisms by which PE accelerates vascular degradation and worsens outcome from hemorrhagic stroke, probing pathways involved in oxidative degradative processes using multi-omics and multivariate analysis (Aim 1). We will also determine underlying molecular mechanisms that cause persistent cerebral microvascular dysfunction and cognitive decline postpartum, including oxidative stress-induced BBB leakage and persistent neuroinflammation that drives potassium channel dysfunction, reduced neurovascular coupling and neurovascular uncoupling (Aim 2). We will also use machine learning approaches together with multi-omics and outcome measures to identify factors and cellular pathways that are most impactful for prediction of intracerebral hemorrhage and cognitive impairment. The ability to predict and prevent devasting neurovascular disorders associated with PE has the potential to have long-lasting impacts on the lives of women with PE.

Airway Epithelial Defense Mechanisms in Combating STAT3-Deficiency-Related Lung Infections

Airway Epithelial Defense Mechanisms in Combating STAT3-Deficiency-Related Lung Infections Signal transducer and activator of transcription 3 (STAT3) regulates the expression of genes essential for various cellular processes, including survival, proliferation, differentiation, self-renewal, angiogenesis, and immune response. Abnormal and persistent STAT3 activation is detected in diverse human cancers, driving multiple pro- oncogenic functions. Multiple antitumor drug development targets the inhibition of STAT3 to treat various types of cancer. Unfortunately, downregulated STAT3 significantly increases host susceptibility to recurrent infections, especially pneumonia. Additionally, individuals with genetic polymorphisms associated with lower STAT3 expression are more susceptible to severe tuberculosis. Furthermore, patients with autosomal dominant hyper- IgE syndrome (AD-HIES), also known as Job Syndrome, which is caused by de novo STAT3 mutations and substantially decreased STAT3 expression, have a significantly increased susceptibility to bacterial and fungal infections, with high mortality rates and a shortened life span often associated with Pseudomonas aeruginosa infections. Gram-negative bacteria, particularly P. aeruginosa, are opportunistic pathogens that frequently cause hospital-acquired infections. The problems are worsened by the emerging P. aeruginosa with multidrug resistance (MDR), especially in patients with repeated antibiotic treatments, such as Job Syndrome sufferers. Notably, airway epithelial cell-derived proteins play a significant role in the antimicrobial milieu, promoting effective host defense against invading pathogens. One of the most critical STAT3-regulated antimicrobial molecules is bactericidal permeability-increasing protein fold A1 (BPIFA1, also known as SPLUNC1), a multifunctional innate immunity molecule and indispensable host defense protein that is abundantly secreted in the lungs. This application aims to elucidate how STAT3 deficiency impairs host epithelial defense against microbial infections and whether BPIFA1-mediated innate immune responses can sufficiently restore effective antimicrobial protection to prevent pneumonia. The long-term objective is to advance our understanding of the respiratory innate immune response, particularly in relation to epithelial cell-specific antimicrobial defense. We characterized BPIFA1 as an airway lining fluid protein secreted apically in the airway lumen and in primary human airway epithelial cultures. In this study, we hypothesize that mucosal BPIFA1 is an essential antimicrobial protein that plays a critical role in host defense against microbial infections in STAT3-deficiency- associated pneumonia. Our proposed studies will assess innate immunity mechanisms regulating the antimicrobial activity of the airway epithelium in STAT3 deficiency-associated lung infections. By focusing on the crucial epithelial-derived protein product, BPIFA1, our study will provide an alternative treatment for respiratory infections by augmenting native host defense mechanisms in high-risk individuals, including AD-HIES, cancer, and immunocompromised patients.

Effects of Apolipoprotein A4 on Lipid Metabolism via Sympathetic Regulation

Obesity increases the risks and progression of hypertriglyceridemia, metabolic dysfunction- associated steatotic liver disease (MASLD), and cardiovascular diseases. Previous studies demonstrate that a single injection of apolipoprotein A4 (APOA4) elevates sympathetic neural activity and fatty acid β-oxidation in adipose tissues; and consistent infusion of APOA4 in obese mice fed a high-fat diet lowers fat mass, reduces hypertriglyceridemia, elevates brown adipose tissue thermogenesis, and attenuates steatosis and enhances sympathetic neural activity in the liver. This project hypothesizes that APOA4 reduces hypertriglyceridemia by regulating lipid metabolism through sympathetic stimulation in adipose tissues (Specific Aim 1) and sympathetic action in the liver (Specific Aim 2). The role of sympathetic action via the neurotransmitter norepinephrine and adrenergic receptor-mediated pathways will be investigated, and their necessity in APOA4-mediated lipid metabolism will be tested. A strength of this project is the interdisciplinary collaboration between investigators with established successful collaboration and publications. The project will provide physiological, molecular, and neurochemical mechanisms underlying how APOA4 differentially regulates metabolism through sympathetic activation in various types of adipose tissues and the liver in male and female obese mice. Findings would provide impetus to develop unique, novel, targeted therapeutic applications against hypertriglyceridemia and MASLD. Importantly, this project will expose undergraduates and graduate students to meritorious research, provide students with hands-on biomedical research experience, and strengthen research environment at R15 eligible institutions.

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.

From Evidence to Scale: Implementation Science and Simulation Modeling to Transform HIV-Hypertension Care Integration

Project Summary As HIV programs mature, cardiovascular disease (CVD) is becoming a leading contributor to morbidity and mortality. Integration of HIV and CVD prevention, with a focus on hypertension–the most prevalent and impactful modifiable CVD risk factor, presents an opportunity to build more robust primary health systems that improve health outcomes and advance health system sustainability–a key priority for the U.S. PEPFAR program. Using an expanded version of the HIV Synthesis microsimulation model—which incorporates hypertension and CVD outcomes—and data from the NHLBI-funded HLB-SIMPLe consortium’s cluster randomized trials in six African countries, we will evaluate the health effects, cost-effectiveness, and scalability of implementation strategies to promote HIV-hypertension integration to improve health outcomes for people with and without HIV under a range of health system constraints. Our first aim is to develop and validate an additional layer to HIV Synthesis model that accounts for health system constraints and implementation strategies for integration of HIV and hypertension care. This will include parameterization using data from the WHO Health System Building Blocks framework and empiric data from trials in the HLB-SIMPLe consortium. Our second aim is to evaluate the health effects and cost-effectiveness of implementation strategies for HIV-hypertension integration to identify the most effective and scalable approaches for settings with varying health system constraints representative of conditions in west, east, and southern Africa. Analyses will include scenarios targeting people with HIV and scaling up to the broader population. Our third aim focuses on engaging policymakers and program managers to promote uptake of findings through dissemination workshops and interactive modeling tools, with tailored model outputs to specific health system contexts. Using qualitative interviews with policymakers, we will use the Weiss schema for conceptualizing research utilization to assess model impact on decision-making. We will use the Translational Science Benefits Model, to capture, classify and conceptualize the clinical, policy, economic, and operational impacts and identify barriers and facilitators to use in country programs focused on HIV, hypertension, and related NCDs. The overarching project goal is to inform evidence-based, cost-effective implementation strategies for integrating NCD care into HIV platforms, improving population health outcomes in Africa and advancing implementation science through generalizable knowledge about the intersection of implementation strategies, health system strength, and service integration.

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.

Dosing and Deployment Trial: A Home-based Optokinetic Treatment for Ipsilesional Gaze Deviation

Stroke can have devastating consequences including ipsilesional gaze deviation (IGD), which directly impacts mobility and falls. IGD, a hallmark sign of spatial neglect (SN), is a major predictor of poor recovery and can persist after inpatient rehabilitation with targeted treatments. Our preliminary data show that more than half of stroke survivors who have SN at the time of admission to inpatient rehabilitation still have SN at time of discharge, even after treatment. Therefore, because of the challenges of the traditional rehabilitation paradigm we need to bring treatments into the home setting. We plan to examine the feasibility and deployment of Eyemove, an optokinetic stimulation treatment, which induces brain neural plasticity and improves spatial exploration, in turn reducing SN symptoms, including IGD. We hypothesize that by treating IGD, improvements in mobility and fall risk scores will occur, as participants can now interact with the space that was previously “neglected”. Here, we propose to test the following aims with 50 community-dwelling individuals with SN, by identifying the practical dosage associated with mobility improvement: Aim 1 will determine feasibility and acceptability of home deployment of Eyemove. We will collect qualitative information from stroke survivors and their care partners, to determine their pre-treatment and post-treatment perspectives of this home treatment. Aim 2 will determine whether Eyemove in the home is associated with improved mobility-related outcomes (including risk of falls) and to evaluate sufficient dosing. We will randomize participants into either 3 or 5 sessions of a 40-minute treatment given over a week-long intervention period. The primary outcome will be the Mobility Assessment Course and secondary outcomes will be the Stroke Assessment of Fall Risk and the Life Space Assessment. For Aim 1, we expect to learn practical suggestions for home implementation and obtain reports of post-experience enthusiasm and acceptability for specific aspects of the intervention. Our hypotheses for Aim 2 are: 1a-- After controlling for pre-treatment score changes (T2-T1), the intervention (T3) will lead to improved mobility/ fall risk compared to baseline (T1), regardless of treatment group; 1b-- The amount of mobility/ fall risk improvement (T3-T1) in the 3- session and 5-session groups will be different. The expected findings will provide critical insight into the use of Eyemove for spatial neglect remediation. Results from this research will be used to develop a subsequent R01 proposal that uses pragmatic, randomized clinical trial methods to determine the efficacy of Eyemove, in order to provide an effective, accessible treatment to remediate SN at home and improve individuals’ ability to move without spatial bias or risk of falls.

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.

Role of Two Medial Prefrontal Long-Range Recurrent Networks in Behavior Initiation and Inhibition

Abstract The medial prefrontal cortex (mPFC) is critical for executive function, yet how its dorsal (dmPFC) and ventral (vmPFC) motor-projecting (MP) neurons coordinate behavioral initiation, inhibition, and cognitive flexibility remains poorly understood. This R21 leverages four translational behavioral paradigms (head-fixed Persistent Licking/Shock-Escape; freely moving FED3-based Reversal Learning/Stop-Signal), high-density neural recordings, circuit manipulations, and Brian2 spiking neural network modeling to test our central hypothesis: dmPFC MP neurons drive action initiation and adaptive switching, while vmPFC MP neurons suppress impulsivity and perseveration. In Aim 1a, we quantify behavior using kinematic analyses (jerk, velocity, z-scored) aligned with human executive dysfunction metrics (Action Latency [AL], Reversal Accuracy [RA], Perseveration Errors [PE], Stop-Signal Reaction Time [SSRT]), combined with optogenetic (stGtACR2/ChR2) and chemogenetic (PSAM/varenicline) perturbations. Aim 1b employs optotagging and population analyses (PCA, SVM, Total Spiking Probability Edges) to decode dmPFC/vmPFC MP dynamics across tasks, resolving specialized versus mixed functional roles. Aim 1c integrates these datasets into Brian2 spiking network models to predict neural-behavioral correlations, validated through cross-validation. Exploratory analyses will link murine kinematic signatures to human stop-signal/reversal learning metrics. By elucidating strain-specific (C57BL/6 vs. CD1) circuit mechanisms and delivering translatable biomarkers (AL, RA, PE, SSRT, kinematics), this work addresses a critical gap in understanding neuropsychiatric disorders like ADHD (impulsivity) and schizophrenia (perseveration). The study’s innovative combination of recurrent neural network theory, FED3-based assays, and New Approach Methodology (NAM)-compliant computational modeling pioneers high-risk, high-reward tools for circuit dissection, fully aligning with NIH’s 2025 priorities.

Environmental sampling for the fungal pathogen Coccidioides spp. in New Mexico

PROJECT SUMMARY/ABSTRACT Coccidioidomycosis (also known as Valley fever) is a fungal disease endemic to the arid and semi-arid portions of the United States. Due to its alarming health impacts, it has recently been deemed as one of the fungal diseases of highest concern by the World Health Organization. Disease cases continue to rise, causing increasing concern and warranting further understanding of this disease. Though New Mexico has been considered endemic to the disease since the 1940s, few cases are reported in the state each year, suggesting cases may be going vastly underreported. Indeed, recent epidemiologic models suggest New Mexico is likely underreporting cases, which may be a result of low disease awareness in the state or a lack of understanding what populations are at risk. Meanwhile, the neighboring state of Arizona reports the highest number of cases in the country, despite similarities in climate and ecology to New Mexico. In general, very little is known about the health burden of coccidioidomycosis and the geographical distribution of the causative fungal pathogen, Coccidioides spp., in New Mexico. Interestingly, both species of Coccidioides are likely endemic to New Mexico and hybridization of the species may occur. This, in combination with a variety of different ecosystems across the state, makes New Mexico an ideal location for studying the ecology of Coccidioides spp. The objective of our proposal is to generate preliminary data to gain a better understanding of the geographical distribution of Coccidioides spp. in New Mexico, including any regions where hybridization of the species may be occurring. To achieve this, we will collect soil samples throughout New Mexico to: (1) identify what ecosystems are conducive for the growth of Coccidioides and each Coccidioides species in New Mexico and (2) assess whether locations directly surrounding New Mexico’s five largest population centers (Albuquerque, Las Cruces, Rio Rancho, Santa Fe, and Roswell) are endemic to Coccidioides spp. The positive impacts of our proposal are an understanding of what populations are at risk for contracting this disease, where future disease surveillance efforts should be targeted in the state, and where future soil samples should be collected to further explore the genomics and phenotypes of Coccidioides spp. and potential for hybridization. This will help us achieve our long-term goal: to understand the ecology and endemicity of Coccidioides spp. to increase disease awareness, mitigate the negative health impacts from coccidioidomycosis, and ultimately protect the health of all Americans.

Programming Offspring Metabolism: The Role of Milk Extracellular Vesicles in Fat Development

SUMMARY Obesity is a global health crisis, contributing significantly to the prevalence of metabolic disorders, cardiovascular diseases, and various chronic conditions. A growing body of evidence suggests that maternal obesity during pregnancy and lactation can predispose offspring to obesity and metabolic dysfunction later in life. However, the mechanisms by which maternal obesity programs these adverse outcomes in offspring remain poorly understood. Breast milk is not only a source of essential nutrients but also contains bioactive components, including extracellular vesicles (EVs), which play crucial roles in cellular communication and development. Recent studies have shown that EVs can survive digestion and enter the infant’s circulation, influencing immune and metabolic development. Despite the established link between maternal obesity and altered breast milk composition, no study has investigated the role of milk-derived EVs (mEVs) in programming offspring fat development and metabolism. Understanding this novel pathway could revolutionize our approach to preventing intergenerational transmission of obesity. Our preliminary studies using a mouse model of maternal high-fat diet-induced obesity revealed significant alterations in mEV biogenesis and cargo composition, including changes in specific miRNAs. Oral administration of mEVs from obese dams to neonatal mice increased adiposity and impaired lipid metabolism, indicating that mEVs are crucial in modulating fat development and metabolic pathways in offspring. Several key miRNAs found in mouse mEVs are conserved in human milk EVs, highlighting the potential translational relevance of our findings to human health. We hypothesize that mEVs are critical mediators of maternal obesity’s programming effects on offspring metabolism and adiposity. In specific aim 1, we will use mouse models and advanced molecular techniques (miRNA sequencing, proteomics, and lipidomics) to characterize how maternal obesity affects mEV biogenesis and the composition of their bioactive cargo. We will also evaluate how maternal dietary intake, independent of obesity, influences mEV composition. Specific aim 2 will define the programming effects of mEVs on offspring energy metabolism and obesity. In addition, we will explore whether human milk EVs from lean and obese mothers exert similar programming effects on fat development and metabolism in a mouse model. This R21 application embodies a high-risk, high-reward approach to obesity research. It ventures into uncharted territory by proposing that mEVs are novel regulators of metabolic programming, a concept that has not been explored in prior studies. The potential reward is substantial: discovering a new mechanism by which maternal obesity influences offspring health could fundamentally shift our understanding of early-life metabolic programming and lead to innovative strategies for obesity prevention. If successful, this research could open a new field of study with broad implications for maternal and child health.

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.

Understanding antiretroviral phosphorylation and dephosphorylation using mass spectrometry imaging-based enzyme histochemistry

PROJECT SUMMARY Our overall goal is to understand the mechanistic differences in the activation and deactivation of two widely used first-line antiretroviral drugs: tenofovir (TFV) and emtricitabine (FTC) in colonic tissues. HIV is a global health problem and roughly 1.3 million people became newly infected with HIV globally in 2022. Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy where HIV-negative individuals use antiretrovirals to reduce the risk of HIV infection. Specifically, oral fixed-dose combinations of two antiretrovirals, namely, TFV (TFV; prescribed as TFV disoproxil fumarate or TFV alafenamide prodrugs) and FTC are FDA-approved for HIV PrEP. The pharmacologically active forms of TFV and FTC are TFV-diphosphate (TFV-DP) and FTC-triphosphate (FTC-TP), respectively, and these phosphorylated metabolites are found in cells. Unfortunately, high variability in the responses of TFV and FTC can lead to poor clinical outcomes, including therapeutic failure. However, the molecular mechanisms responsible for the observed variability in TFV and FTC responses are poorly understood. Although the observed variability in TFV and FTC drug responses is likely to be multifactorial, alterations in drug activation and deactivation can contribute to the observed variability in drug responses. Phosphorylation of TFV is known and recent studies suggest that nucleotidases may involve in the dephosphorylation of TFV metabolites. Although the kinases that phosphorylate FTC in peripheral blood mononuclear cells are known, the kinases that are responsible for the phosphorylation of FTC in putative sites of HIV infection such as colonic tissues are yet to be determined. Notably, unprotected receptive anal intercourse has a 20-fold higher risk of HIV transmission than vaginal intercourse. Thus, understanding the biotransformation of TFV and FTC in colonic tissue is important since it is a susceptible tissue to HIV infection. Recently, we have reported the enzymatic activities of nucleotidases toward the pharmacologically active metabolites of TFV and FTC in vitro. However, the mechanistic details of the biotransformation of the above drugs in HIV susceptible tissues such as colonic tissues are yet to be elucidated. Gaining a mechanistic understanding of the biotransformation of TFV and FTC in putative sites of HIV infection is important to improve their therapeutic efficacy. As such, in this application, we propose an innovative mass spectrometry imaging-based interdisciplinary approach to understand the biotransformation of TFV and FTC in the colon. Aim 1 will establish the role of nucleotide kinases and nucleotidases in regulating TFV and FTC metabolites in colonic cells mechanistically. Aim 2 will characterize the region- and cell-type-specific expression patterns, as well as enzymatic activities of nucleotide kinases and nucleotidases in situ. The proposed project will provide novel understandings of TFV and FTC activating and deactivating mechanisms that can be leveraged to optimize the therapeutic efficacy of the above drugs.

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.

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.

Stability in disrupted maternal representations over the perinatal period: Contributors and consequences

Abstract High-quality mother-infant relationships promote social, emotional, and cognitive development while protecting against poor child behavioral, health, and psychological adaptation that create risk for long- term negative outcomes. As mothers transition to parenthood, their own experiences of being cared for influence their emerging views of parenting and representations of their developing child. Evidence suggests that ‘disrupted’ maternal representations of the child, i.e., representations characterized by mixed communication, role merging, extreme withdrawal, and other unusual psychological processes, are tied to both poor child socioemotional adjustment and both insecure and disorganized attachment. However, it is unclear whether disrupted representations that emerge during pregnancy remain stable across the first several years of the child’s life. In addition, to date, research has not examined how change/stability in these representations may affect maternal caregiving and subsequent child adaptation. Using data from a longitudinal, multi-method study, this proposed project will examine the stability of maternal representations of the child for 99 women living in high risk contexts using the Working Model of the Child Interview during the third trimester and again when the child is two years of age. Mothers’ demographic characteristics (i.e. SES and relationship status), interpersonal violence experiences (i.e. child maltreatment or intimate violence exposure), psychological health (i.e. depressive, anxious, and PTSD symptoms), and parenting stress (i.e. perceptions of the child as difficult and parent-child interactions as dysfunctional) are measured as well to examine influences on representation stability. Finally, the observed quality of maternal caregiving and child adaptation are measured and examined in relation to stability in maternal representations of the child. Findings from this study have the potential to identify which mother-child dyads are at greatest risk for poor adaptation across the perinatal period and to delineate the contributors and consequences of maternal representational stability. These findings will serve as an important step towards informing the development or modification of existing prevention/intervention approaches that are targeted specifically towards mother-child dyads who are most at need.

A novel MRI method for noninvasive imaging of bone quality in type 2 diabetes

ABSTRACT: Type 2 diabetes mellitus (T2DM) affects 500 million of the global population, which is expected to increase to 800 million in 20 years. One of the multiple complications involved with T2DM is the significantly increased bone fracture risk and post-fracture mortality. Dual-energy X-ray absorptiometry (DXA) scans are routinely performed to measure bone mineral density (BMD) and associated fracture risk. However, T2DM patients often show preserved or even elevated BMD despite the significantly increased fracture risk. This mismatch between the BMD measurement and actual fracture risk hampers the accurate assessment of fracture risk and the appropriate treatment of T2DM that considers patient bone health. The lack of an accurate fracture risk assessment tool also confounds the evaluation of the bone health effect of antidiabetic drugs, including recently highlighted glucagon-like peptide-1 receptor agonists (e.g., semaglutide) and sodium-glucose cotransporter-2 inhibitors. Previous studies have suggested that bone quality, rather than bone quantity, as represented by BMD, is a crucial factor contributing to fracture risk in T2DM settings. Collagen crosslinking via advanced glycation end-products (AGEs) in cortical bone has been identified as a distinctive bone quality characteristic of T2DM patients, which explains the increased bone fragility. Although this finding is highly promising for improving the bone health management of T2DM patients, currently, no non-invasive method can monitor collagen crosslinking in the bones. This proposal aims to develop an ultrashort echo time (UTE) MRI-based method for measuring the degree of bone collagen crosslinking by quantifying magnetization transfer between water and collagen in the bone. This method, termed UTE-quantitative magnetization transfer (UTE-qMT) MRI, measures not only the quantity of macromolecules (e.g., collagen) in the bone but also the rates of exchange between water and macromolecular protons, which are related to the degree of collagen crosslinking. The proposal will develop and optimize the accelerated UTE-qMT method for reliably measuring the exchange rate in Aim 1. The optimized technique will be validated by correlating exchange rates with AGE-driven collagen crosslinking and subsequent compromise of bone mechanical properties in Aim 2. Finally, the optimized UTE-qMT MRI method will be translated to animal and human studies to demonstrate its clinical feasibility for investigating the effect of antidiabetic drugs on bone health in patients with T2DM in Aim 3. The successful completion of these aims will enable rapid and accurate assessment of bone fracture risk in patients with T2DM. Furthermore, noninvasively probing bone quality can also accurately assess the effect of antidiabetic drugs on bone health and aid in screening novel T2DM therapeutics for their impact on bone health.

Decoding stress vulnerability

Although stress can be considered as an ongoing process that helps an organism to cope with present and future challenges, when it is too intense or uncontrollable, it can lead to adverse consequences for physical and mental health. Social stress specifically, is a highly prevalent traumatic experience, present in multiple contexts, such as war, bullying and interpersonal violence, and it has been linked with increased risk for major depression and anxiety disorders. Nevertheless, not all individuals exposed to strong stressful events develop psychopathology, with the mechanisms of resilience and vulnerability being still under investigation. During this talk, I will identify key gaps in our knowledge about stress vulnerability and I will present our recent data from our contextual fear learning protocol based on social defeat stress in mice.

Expanding mechanisms and therapeutic targets for neurodegenerative disease

A hallmark pathological feature of the neurodegenerative diseases amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) is the depletion of RNA-binding protein TDP-43 from the nucleus of neurons in the brain and spinal cord. A major function of TDP-43 is as a repressor of cryptic exon inclusion during RNA splicing. By re-analyzing RNA-sequencing datasets from human FTD/ALS brains, we discovered dozens of novel cryptic splicing events in important neuronal genes. Single nucleotide polymorphisms in UNC13A are among the strongest hits associated with FTD and ALS in human genome-wide association studies, but how those variants increase risk for disease is unknown. We discovered that TDP-43 represses a cryptic exon-splicing event in UNC13A. Loss of TDP-43 from the nucleus in human brain, neuronal cell lines and motor neurons derived from induced pluripotent stem cells resulted in the inclusion of a cryptic exon in UNC13A mRNA and reduced UNC13A protein expression. The top variants associated with FTD or ALS risk in humans are located in the intron harboring the cryptic exon, and we show that they increase UNC13A cryptic exon splicing in the face of TDP-43 dysfunction. Together, our data provide a direct functional link between one of the strongest genetic risk factors for FTD and ALS (UNC13A genetic variants), and loss of TDP-43 function. Recent analyses have revealed even further changes in TDP-43 target genes, including widespread changes in alternative polyadenylation, impacting expression of disease-relevant genes (e.g., ELP1, NEFL, and TMEM106B) and providing evidence that alternative polyadenylation is a new facet of TDP-43 pathology.

Feedback-induced dispositional changes in risk preferences

Contrary to the original normative decision-making standpoint, empirical studies have repeatedly reported that risk preferences are affected by the disclosure of choice outcomes (feedback). Although no consensus has yet emerged regarding the properties and mechanisms of this effect, a widespread and intuitive hypothesis is that repeated feedback affects risk preferences by means of a learning effect, which alters the representation of subjective probabilities. Here, we ran a series of seven experiments (N= 538), tailored to decipher the effects of feedback on risk preferences. Our results indicate that the presence of feedback consistently increases risk-taking, even when the risky option is economically less advantageous. Crucially, risk-taking increases just after the instructions, before participants experience any feedback. These results challenge the learning account, and advocate for a dispositional effect, induced by the mere anticipation of feedback information. Epistemic curiosity and regret avoidance may drive this effect in partial and complete feedback conditions, respectively.

Stress changes risk-taking by altering Bayesian magnitude coding in parietal cortex

Genomic investigation of sex-differential neurodevelopment and risk for autism

Trends in NeuroAI - SwiFT: Swin 4D fMRI Transformer

Trends in NeuroAI is a reading group hosted by the MedARC Neuroimaging & AI lab (https://medarc.ai/fmri). Title: SwiFT: Swin 4D fMRI Transformer Abstract: Modeling spatiotemporal brain dynamics from high-dimensional data, such as functional Magnetic Resonance Imaging (fMRI), is a formidable task in neuroscience. Existing approaches for fMRI analysis utilize hand-crafted features, but the process of feature extraction risks losing essential information in fMRI scans. To address this challenge, we present SwiFT (Swin 4D fMRI Transformer), a Swin Transformer architecture that can learn brain dynamics directly from fMRI volumes in a memory and computation-efficient manner. SwiFT achieves this by implementing a 4D window multi-head self-attention mechanism and absolute positional embeddings. We evaluate SwiFT using multiple large-scale resting-state fMRI datasets, including the Human Connectome Project (HCP), Adolescent Brain Cognitive Development (ABCD), and UK Biobank (UKB) datasets, to predict sex, age, and cognitive intelligence. Our experimental outcomes reveal that SwiFT consistently outperforms recent state-of-the-art models. Furthermore, by leveraging its end-to-end learning capability, we show that contrastive loss-based self-supervised pre-training of SwiFT can enhance performance on downstream tasks. Additionally, we employ an explainable AI method to identify the brain regions associated with sex classification. To our knowledge, SwiFT is the first Swin Transformer architecture to process dimensional spatiotemporal brain functional data in an end-to-end fashion. Our work holds substantial potential in facilitating scalable learning of functional brain imaging in neuroscience research by reducing the hurdles associated with applying Transformer models to high-dimensional fMRI. Speaker: Junbeom Kwon is a research associate working in Prof. Jiook Cha’s lab at Seoul National University. Paper link: https://arxiv.org/abs/2307.05916

Neuromodulation of subjective experience

Many psychoactive substances are used with the aim of altering experience, e.g. as analgesics, antidepressants or antipsychotics. These drugs act on specific receptor systems in the brain, including the opioid, serotonergic and dopaminergic systems. In this talk, I will summarise human drug studies targeting opioid receptors and their role for human experience, with focus on the experience of pain, stress, mood, and social connection. Opioids are only indicated for analgesia, due to their potential to cause addiction. When these regulations occurred, other known effects were relegated to side effects. This may be the cause of the prevalent myth that opioids are the most potent painkillers, despite evidence from head-to-head trials, Cochrane reviews and network meta-analyses that opioids are not superior to non-opioid analgesics in the treatment of acute or chronic non-cancer pain. However, due to the variability and diversity of opioid effects across contexts and experiences, some people under some circumstances may indeed benefit from prolonged treatment. I will present data on individual differences in opioid effects due to participant sex and stress induction. Understanding the effects of these commonly used medications on other aspects of the human experience is important to ensure correct use and to prevent unnecessary pain and addiction risk.

From the guts to the brain through adaptive immunity in the prevention of Alzheimer’ disease

Dr. Pasinetti is the Saunders Family Chair and Professor of Neurology at Icahn School of medicine at Mount Sinai, New York. His studies allowed him to develop novel therapeutic approaches through investigation of preventable risk factors including mood disorders in the promotion of resilience against neurodegenerative disorder. In his presentation Dr. Pasinetti will discuss novel concepts about the gut-brain axis in mechanisms associated to peripheral adaptive immunity as therapeutic targets to mitigate the onset and the progression of Alzheimer’s disease and other form of dementia.

Epigenomic (re)programming of the brain and behavior by ovarian hormones

Rhythmic changes in sex hormone levels across the ovarian cycle exert powerful effects on the brain and behavior, and confer female-specific risks for neuropsychiatric conditions. In this talk, Dr. Kundakovic will discuss the role of fluctuating ovarian hormones as a critical biological factor contributing to the increased depression and anxiety risk in women. Cycling ovarian hormones drive brain and behavioral plasticity in both humans and rodents, and the talk will focus on animal studies in Dr. Kundakovic’s lab that are revealing the molecular and receptor mechanisms that underlie this female-specific brain dynamic. She will highlight the lab’s discovery of sex hormone-driven epigenetic mechanisms, namely chromatin accessibility and 3D genome changes, that dynamically regulate neuronal gene expression and brain plasticity but may also prime the (epi)genome for psychopathology. She will then describe functional studies, including hormone replacement experiments and the overexpression of an estrous cycle stage-dependent transcription factor, which provide the causal link(s) between hormone-driven chromatin dynamics and sex-specific anxiety behavior. Dr. Kundakovic will also highlight an unconventional role that chromatin dynamics may have in regulating neuronal function across the ovarian cycle, including in sex hormone-driven X chromosome plasticity and hormonally-induced epigenetic priming. In summary, these studies provide a molecular framework to understand ovarian hormone-driven brain plasticity and increased female risk for anxiety and depression, opening new avenues for sex- and gender-informed treatments for brain disorders.

Obesity and Brain – Bidirectional Influences

The regulation of body weight relies on homeostatic mechanisms that use a combination of internal signals and external cues to initiate and terminate food intake. Homeostasis depends on intricate communication between the body and the hypothalamus involving numerous neural and hormonal signals. However, there is growing evidence that higher-level cognitive function may also influence energy balance. For instance, research has shown that BMI is consistently linked to various brain, cognitive, and personality measures, implicating executive, reward, and attentional systems. Moreover, the rise in obesity rates over the past half-century is attributed to the affordability and widespread availability of highly processed foods, a phenomenon that contradicts the idea that food intake is solely regulated by homeostasis. I will suggest that prefrontal systems involved in value computation and motivation act to limit food overconsumption when food is scarce or expensive, but promote over-eating when food is abundant, an optimum strategy from an economic standpoint. I will review the genetic and neuroscience literature on the CNS control of body weight. I will present recent studies supporting a role of prefrontal systems in weight control. I will also present contradictory evidence showing that frontal executive and cognitive findings in obesity may be a consequence not a cause of increased hunger. Finally I will review the effects of obesity on brain anatomy and function. Chronic adiposity leads to cerebrovascular dysfunction, cortical thinning, and cognitive impairment. As the most common preventable risk factor for dementia, obesity poses a significant threat to brain health. I will conclude by reviewing evidence for treatment of obesity in adults to prevent brain disease.

Integration of 3D human stem cell models derived from post-mortem tissue and statistical genomics to guide schizophrenia therapeutic development

Schizophrenia is a neuropsychiatric disorder characterized by positive symptoms (such as hallucinations and delusions), negative symptoms (such as avolition and withdrawal) and cognitive dysfunction1. Schizophrenia is highly heritable, and genetic studies are playing a pivotal role in identifying potential biomarkers and causal disease mechanisms with the hope of informing new treatments. Genome-wide association studies (GWAS) identified nearly 270 loci with a high statistical association with schizophrenia risk; however each locus confers only a small increase in risk therefore it is difficult to translate these findings into understanding disease biology that can lead to treatments. Induced pluripotent stem cell (iPSC) models are a tractable system to translate genetic findings and interrogate mechanisms of pathogenesis. Mounting research with patient-derived iPSCs has proposed several neurodevelopmental pathways altered in SCZ, such as neural progenitor cell (NPC) proliferation, imbalanced differentiation of excitatory and inhibitory cortical neurons. However, it is unclear what exactly these iPS models recapitulate, how potential perturbations of early brain development translates into illness in adults and how iPS models that represent fetal stages can be utilized to further drug development efforts to treat adult illness. I will present the largest transcriptome analysis of post-mortem caudate nucleus in schizophrenia where we discovered that decreased presynaptic DRD2 autoregulation is the causal dopamine risk factor for schizophrenia (Benjamin et al, Nature Neuroscience 2022 https://doi.org/10.1038/s41593-022-01182-7). We developed stem cell models from a subset of the postmortem cohort to better understand the molecular underpinnings of human psychiatric disorders (Sawada et al, Stem Cell Research 2020). We established a method for the differentiation of iPS cells into ventral forebrain organoids and performed single cell RNAseq and cellular phenotyping. To our knowledge, this is the first study to evaluate iPSC models of SZ from the same individuals with postmortem tissue. Our study establishes that striatal neurons in the patients with SCZ carry abnormalities that originated during early brain development. Differentiation of inhibitory neurons is accelerated whereas excitatory neuronal development is delayed, implicating an excitation and inhibition (E-I) imbalance during early brain development in SCZ. We found a significant overlap of genes upregulated in the inhibitory neurons in SCZ organoids with upregulated genes in postmortem caudate tissues from patients with SCZ compared with control individuals, including the donors of our iPS cell cohort. Altogether, we demonstrate that ventral forebrain organoids derived from postmortem tissue of individuals with schizophrenia recapitulate perturbed striatal gene expression dynamics of the donors’ brains (Sawada et al, biorxiv 2022 https://doi.org/10.1101/2022.05.26.493589).

Integrative Neuromodulation: from biomarker identification to optimizing neuromodulation

Why do we make decisions impulsively blinded in an emotionally rash moment? Or caught in the same repetitive suboptimal loop, avoiding fears or rushing headlong towards illusory rewards? These cognitive constructs underlying self-control and compulsive behaviours and their influence by emotion or incentives are relevant dimensionally across healthy individuals and hijacked across disorders of addiction, compulsivity and mood. My lab focuses on identifying theory-driven modifiable biomarkers focusing on these cognitive constructs with the ultimate goal to optimize and develop novel means of neuromodulation. Here I will provide a few examples of my group’s recent work to illustrate this approach. I describe a series of recent studies on intracranial physiology and acute stimulation focusing on risk taking and emotional processing. This talk highlights the subthalamic nucleus, a common target for deep brain stimulation for Parkinson’s disease and obsessive-compulsive disorder. I further describe recent translational work in non-invasive neuromodulation. Together these examples illustrate the approach of the lab highlighting modifiable biomarkers and optimizing neuromodulation.

Microglial efferocytosis: Diving into the Alzheimer's Disease gene pool

Genome-wide association studies and functional genomics studies have linked specific cell types, genes, and pathways to Alzheimer’s disease (AD) risk. In particular, AD risk alleles primarily affect the abundance or structure, and thus the activity, of genes expressed in macrophages, strongly implicating microglia (the brain-resident macrophages) in the etiology of AD. These genes converge on pathways (endocytosis/phagocytosis, cholesterol metabolism, and immune response) with critical roles in core macrophage functions such as efferocytosis. Here, we review these pathways, highlighting relevant genes identified in the latest AD genetics and genomics studies, and describe how they may contribute to AD pathogenesis. Investigating the functional impact of AD-associated variants and genes in microglia is essential for elucidating disease risk mechanisms and developing effective therapeutic approaches." https://doi.org/10.1016/j.neuron.2022.10.015

Cholesterol and matrisome pathways dysregulated in Alzheimer’s disease brain astrocytes and microglia

The impact of apolipoprotein E ε4 (APOE4), the strongest genetic risk factor for Alzheimer’s disease (AD), on human brain cellular function remains unclear. Here, we investigated the effects of APOE4 on brain cell types derived from population and isogenic human induced pluripotent stem cells, post-mortem brain, and APOE targeted replacement mice. Population and isogenic models demonstrate that APOE4 local haplotype, rather than a single risk allele, contributes to risk. Global transcriptomic analyses reveal human-specific, APOE4-driven lipid metabolic dysregulation in astrocytes and microglia. APOE4 enhances de novo cholesterol synthesis despite elevated intracellular cholesterol due to lysosomal cholesterol sequestration in astrocytes. Further, matrisome dysregulation is associated with upregulated chemotaxis, glial activation, and lipid biosynthesis in astrocytes co-cultured with neurons, which recapitulates altered astrocyte matrisome signaling in human brain. Thus, APOE4 initiates glia-specific cell and non-cell autonomous dysregulation that may contribute to increased AD risk." https://doi.org/10.1016/j.cell.2022.05.017

How can we treat visceral pain?

Chronic pain is a leading cause of morbidity, common to patients with gastrointestinal diseases such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Most pain killers are largely ineffective against this type of pain or restricted for use in these patients due to gut related complications and risk of addition. A significant unmet clinical need therefore exists to develop novel non-opioid based visceral analgesics.

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.

Hidden nature of seizures

How seizures emerge from the abnormal dynamics of neural networks within the epileptogenic tissue remains an enigma. Are seizures random events, or do detectable changes in brain dynamics precede them? Are mechanisms of seizure emergence identical at the onset and later stages of epilepsy? Is the risk of seizure occurrence stable, or does it change over time? A myriad of questions about seizure genesis remains to be answered to understand the core principles governing seizure genesis. The last decade has brought unprecedented insights into the complex nature of seizure emergence. It is now believed that seizure onset represents the product of the interactions between the process of a transition to seizure, long-term fluctuations in seizure susceptibility, epileptogenesis, and disease progression. During the lecture, we will review the latest observations about mechanisms of ictogenesis operating at multiple temporal scales. We will show how the latest observations contribute to the formation of a comprehensive theory of seizure genesis, and challenge the traditional perspectives on ictogenesis. Finally, we will discuss how combining conventional approaches with computational modeling, modern techniques of in vivo imaging, and genetic manipulation open prospects for exploration of yet hidden mechanisms of seizure genesis.

The peripheral airways in Asthma: significance, assessment, and targeted treatment

The peripheral airways are technically challenging to assess and have been overlooked in the assessment of chronic respiratory diseases such as Asthma, in both the clinical and research space. Evidence of the importance of the small airways in Asthma is building, and small airways dysfunction is implicated in poor Asthma control, airway hyperresponsiveness, and exacerbation risk. The aim of this research was to complete comprehensive global, regional, and spatial assessments of airway function and ventilation in Asthma using physiological and MRI techniques. Specific ventilation imaging (SVI) and Phase resolved functional lung imaging (PREFUL) formed the spatial assessments. SVI uses oxygen as a contrast agent and looks at rate of change in signal to assess ventilation heterogeneity, PREFUL is a completely contrast free technique that uses Fourier decomposition to determine fractional ventilation.

Linking GWAS to pharmacological treatments for psychiatric disorders

Genome-wide association studies (GWAS) have identified multiple disease-associated genetic variations across different psychiatric disorders raising the question of how these genetic variants relate to the corresponding pharmacological treatments. In this talk, I will outline our work investigating whether functional information from a range of open bioinformatics datasets such as protein interaction network (PPI), brain eQTL, and gene expression pattern across the brain can uncover the relationship between GWAS-identified genetic variation and the genes targeted by current drugs for psychiatric disorders. Focusing on four psychiatric disorders---ADHD, bipolar disorder, schizophrenia, and major depressive disorder---we assess relationships between the gene targets of drug treatments and GWAS hits and show that while incorporating information derived from functional bioinformatics data, such as the PPI network and spatial gene expression, can reveal links for bipolar disorder, the overall correspondence between treatment targets and GWAS-implicated genes in psychiatric disorders rarely exceeds null expectations. This relatively low degree of correspondence across modalities suggests that the genetic mechanisms driving the risk for psychiatric disorders may be distinct from the pathophysiological mechanisms used for targeting symptom manifestations through pharmacological treatments and that novel approaches for understanding and treating psychiatric disorders may be required.

Role of ASD risk genes on maturation of frontal-sensory cognitive control circuit

Studying genetic overlap between ASD risk and related traits: From polygenic pleiotropy to disorder-specific profiles

Systemic regulation and measurement of mammalian aging

Brain aging leads to cognitive decline and is the main risk factor for sporadic forms of neurodegenerative diseases including Alzheimer’s disease. While brain cell- and tissue-intrinsic factors are likely key determinants of the aging process recent studies document a remarkable susceptibility of the brain to circulatory factors. Thus, blood borne factors from young mice or humans are sufficient to slow aspects of brain aging and improve cognitive function in old mice and, vice versa, factors from old mice are detrimental for young mice and impair cognition. We found evidence that the cerebrovasculature is an important target of circulatory factors and that brain endothelial cells show prominent age-related transcriptional changes in response to plasma. Furthermore, plasma proteins are taken up broadly into the young brain through receptor mediated transport which declines with aging. At the same time, brain derived proteins are detectable in plasma allowing us to measure physiological changes linked to brain aging in plasma. We are exploring the relevance of these findings for neurodegeneration and potential applications towards therapies.

Social immunity in ants: disease defense of the colony

Social insects fight disease as a collective. Their colonies are protected against disease by the combination of the individual immune defenses of all colony members and their jointly performed nest- and colony-hygiene. This social immunity is achieved by cooperative behaviors to reduce pathogen load of the colony and to prevent transmission along the social interaction networks of colony members. Individual and social immunity interact: performance of sanitary care can affect future disease susceptibility, yet also vice versa, individuals differing in susceptibility adjust their sanitary care performance to their individual risk of infection. I present the integrated approach we use to understand how colony protection arises from the individual and collective actions of colony members and how it affects pathogen communities and hence disease ecology.

Multimodal investigation of the associations between sleep and Alzheimer's disease neuropathology in healthy individuals

Alterations in sleep are hallmarks of the ageing process and emerges as risk factors for Alzheimer’s disease (AD). While the fine-tuned coalescence of sleep microstructure elements may influence age-related cognitive trajectories, its association with AD-related processes is not fully established. We investigated whether sleep arousals and the coupling of spindles and slow waves, key elements of sleep microstructure, are associated with early amyloid-beta (Aβ) brain burden, hallmark of AD neuropathology, and cognitive change at 2 years in 100 late-midlife healthy individuals. We first found that arousals interrupting sleep continuity were positively linked to Aβ burden, while, by contrast, the more prevalent arousals upholding sleep continuity were associated with lower Aβ burden and better cognition. We further found that young-like co-occurrence of spindles and slow-depolarisation slow waves is associated to lower burden of Aβ over the medial prefrontal cortex and is predictive of memory decline at 2-year follow-up. We provide empirical evidence that arousals are diverse and differently associated with early AD-related neuropathology and cognition. We further show the altered coupling of sleep microstructure elements that are key to its mnesic functions may contribute to poorer brain and cognitive trajectories. The presentation will end with preliminary data show that activity of the locus coeruleus, essential to sleep and showing some of the earliest signs of AD-related pathological processes, is associated with sleep quality. These preliminary findings are the first of a project ailed at link sleep and AD through the locus coeruleus.

Inter-individual variability in reward seeking and decision making: role of social life and consequence for vulnerability to nicotine

Inter-individual variability refers to differences in the expression of behaviors between members of a population. For instance, some individuals take greater risks, are more attracted to immediate gains or are more susceptible to drugs of abuse than others. To probe the neural bases of inter-individual variability  we study reward seeking and decision-making in mice, and dissect the specific role of dopamine in the modulation of these behaviors. Using a spatial version of the multi-armed bandit task, in which mice are faced with consecutive binary choices, we could link modifications of midbrain dopamine cell dynamics with modulation of exploratory behaviors, a major component of individual characteristics in mice. By analyzing mouse behaviors in semi-naturalistic environments, we then explored the role of social relationships in the shaping of dopamine activity and associated beahviors. I will present recent data from the laboratory suggesting that changes in the activity of dopaminergic networks link social influences with variations in the expression of non-social behaviors: by acting on the dopamine system, the social context may indeed affect the capacity of individuals to make decisions, as well as their vulnerability to drugs of abuse, in particular nicotine.

Brain-body interactions that modulate fear

In most animals including in humans, emotions occur together with changes in the body, such as variations in breathing or heart rate, sweaty palms, or facial expressions. It has been suggested that this interoceptive information acts as a feedback signal to the brain, enabling adaptive modulation of emotions that is essential for survival. As such, fear, one of our basic emotions, must be kept in a functional balance to minimize risk-taking while allowing for the pursuit of essential needs. However, the neural mechanisms underlying this adaptive modulation of fear remain poorly understood. In this talk, I want to present and discuss the data from my PhD work where we uncover a crucial role for the interoceptive insular cortex in detecting changes in heart rate to maintain an equilibrium between the extinction and maintenance of fear memories in mice.

The ubiquity of opportunity cost: Foraging and beyond

A key insight from the foraging literature is the importance of assessing the overall environmental quality — via global reward rate or similar measures, which capture the opportunity cost of time and can guide behavioral allocation toward relatively richer options. Meanwhile, the majority of research in decision neuroscience and computational psychiatry has focused instead on how choices are guided by much more local, event-locked evaluations: of individual situations, actions, or outcomes. I review a combination of research and theoretical speculation from my lab and others that emphasizes the role of foraging's average rewards and opportunity costs in a much larger range of decision problems, including risk, time discounting, vigor, cognitive control, and deliberation. The broad range of behaviors affected by this type of evaluation gives a new theoretical perspective on the effects of stress and autonomic mobilization, and on mood and the broad range of symptoms associated with mood disorders.

Multi-modal biomarkers improve prediction of memory function in cognitively unimpaired older adults

Identifying biomarkers that predict current and future cognition may improve estimates of Alzheimer’s disease risk among cognitively unimpaired older adults (CU). In vivo measures of amyloid and tau protein burden and task-based functional MRI measures of core memory mechanisms, such as the strength of cortical reinstatement during remembering, have each been linked to individual differences in memory in CU. This study assesses whether combining CSF biomarkers with fMRI indices of cortical reinstatement improves estimation of memory function in CU, assayed using three unique tests of hippocampal-dependent memory. Participants were 158 CU (90F, aged 60-88 years, CDR=0) enrolled in the Stanford Aging and Memory Study (SAMS). Cortical reinstatement was quantified using multivoxel pattern analysis of fMRI data collected during completion of a paired associate cued recall task. Memory was assayed by associative cued recall, a delayed recall composite, and a mnemonic discrimination task that involved discrimination between studied ‘target’ objects, novel ‘foil’ objects, and perceptually similar ‘lure’ objects. CSF Aβ42, Aβ40, and p-tau181 were measured with the automated Lumipulse G system (N=115). Regression analyses examined cross-sectional relationships between memory performance in each task and a) the strength of cortical reinstatement in the Default Network (comprised of posterior medial, medial frontal, and lateral parietal regions) during associative cued recall and b) CSF Aβ42/Aβ40 and p-tau181, controlling for age, sex, and education. For mnemonic discrimination, linear mixed effects models were used to examine the relationship between discrimination (d’) and each predictor as a function of target-lure similarity. Stronger cortical reinstatement was associated with better performance across all three memory assays. Age and higher CSF p-tau181 were each associated with poorer associative memory and a diminished improvement in mnemonic discrimination as target-lure similarity decreased. When combined in a single model, CSF p-tau181 and Default Network reinstatement strength, but not age, explained unique variance in associative memory and mnemonic discrimination performance, outperforming the single-modality models. Combining fMRI measures of core memory functions with protein biomarkers of Alzheimer’s disease significantly improved prediction of individual differences in memory performance in CU. Leveraging multimodal biomarkers may enhance future prediction of risk for cognitive decline.

Biopsychosocial pathways in dementia inequalities

In the United States, racial/ethnic inequalities in Alzheimer's disease and related dementias persist even after controlling for socioeconomic factors and physical health. These persistent and unexplained disparities suggest: (1) there are unrecognized dementia risk factors that are socially patterned and/or (2) known dementia risk factors exhibit differential impact across social groups. Pursuing these research directions with data from multiple longitudinal studies of brain and cognitive aging has revealed several challenges to the study of late-life health inequalities, highlighted evidence for both risk and resilience within marginalized communities, and inspired new data collection efforts to advance the field.

Chemogenetic therapies for epilepsy: promises and challenges

Expression of Gi-coupled designer receptors exclusively activated by designer drugs (DREADDs) on excitatory hippocampal neurons in the hippocampus represents a potential new therapeutic strategy for drug-resistant epilepsy. During my talk I will demonstrate that we obtained potent suppression of spontaneous epileptic seizures in mouse and a rat models for temporal lobe epilepsy using different DREADD ligands, up to one year after viral vector expression. The chemogenetic approach clearly outperforms the seizure-suppressing efficacy of currently existing anti-epileptic drugs. Besides the promises, I will also present some of the challenges associated with a potential chemogenetic therapy, including constitutive DREADD activity, tolerance effects, risk for toxicity, paradoxical excitatory effects in non-epileptic hippocampal tissue.

The Role of Cerebrovascular Pathology in Aging and Neurodegenerative Disease Populations

Late-life cognitive impairment and dementia are heterogeneous and multifactorial conditions driven by a combination of genetic, vascular, and lifestyle-related factors. More than 75% of patients with dementia have evidence of cerebrovascular pathology at autopsy. Cerebrovascular disease lesions can be detected on structural MRI and used as biomarkers to determine the extent of cerebrovascular pathology. These biomarkers are associated with cognitive difficulties and increase the risk of dementia for the same level of neurodegenerative pathology. Given that some of the risk factors for cerebrovascular disease are potentially modifiable, identifying the role of cerebrovascular pathology in aging and neurodegenerative disease populations opens a window for prevention of cognitive decline and dementia.

Epilepsy Genetics – From Family Studies to Polygenic Risk Scores

Whilst epilepsy may be a consequence of an acquired insult including trauma, stroke, and brain tumours, the genetic component to epilepsies has been greatly under-estimated. Considerable progress has recently occurred in the understanding of epilepsy genetics, both at a clinical genetic level and in the basic science of epilepsies. The clinical evidence for genetic components will be first briefly discussed including data from population studies, twin analyses and multiplex family studies. Initial molecular discoveries occurred via classical methods of linkage and gene identification. Recent large-scale hypothesis-free whole exome studies searching for rare variants and genome-wide association studies detecting common variants have been very rewarding. These discoveries have now impacted on clinical practice, especially in severe childhood epilepsies but increasingly so in adult patients. The “genetic background” of patients has long been posited as part of the reason that some patients have epilepsy, or perhaps why some have more severe epilepsy. This has been unmeasurable but now, with the development of polygenic risk scores, the “background” is now in the research foreground. The current and future impact of polygenic risk scores will be explored.

Stress deceleration theory: chronic adolescent stress exposure results in decelerated neurobehavioral maturation

Normative development in adolescence indicates that the prefrontal cortex is still under development thereby unable to exert efficient top-down inhibitory control on subcortical regions such as the basolateral amygdala and the nucleus accumbens. This imbalance in the developmental trajectory between cortical and subcortical regions is implicated in expression of the prototypical impulsive, compulsive, reward seeking and risk-taking adolescent behavior. Here we demonstrate that a chronic mild unpredictable stress procedure during adolescence in male Wistar rats arrests the normal behavioral maturation such that they continue to express adolescent-like impulsive, hyperactive, and compulsive behaviors into late adulthood. This arrest in behavioral maturation is associated with the hypoexcitability of prelimbic cortex (PLC) pyramidal neurons and reduced PLC-mediated synaptic glutamatergic control of BLA and nucleus accumbens core (NAcC) neurons that lasts late into adulthood. At the same time stress exposure in adolescence results in the hyperexcitability of the BLA pyramidal neurons sending stronger glutamatergic projections to the NAcC. Chemogenetic reversal of the PLC hypoexcitability decreased compulsivity and improved the expression of goal-directed behavior in rats exposed to stress during adolescence, suggesting a causal role for PLC hypoexcitability in this stress-induced arrested behavioral development. (https://www.biorxiv.org/content/10.1101/2021.11.21.469381v1.abstract)

Sex, drugs, and bad choices: using rodent models to understand decision making

Nearly every aspect of life involves decisions between options that differ in both their expected rewards and the potential costs (such as delay to reward delivery or risk of harm) that accompany those rewards. The ability to choose adaptively when faced with such decisions is critical for well-being and overall quality of life. In neuropsychiatric conditions such as substance use disorders, however, decision making is often compromised, which can prolong and exacerbate their severity and co-morbidities. In this seminar, Dr. Setlow will discuss research in rodent models investigating behavioral and biological mechanisms of cost-benefit decision making. In particular, he will focus on factors (including sex) that contribute to differences in cost-benefit decision making across the population, how variability in decision making is related to substance use, and how substance use can produce long-lasting changes in decision preference.

​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.

Investigating genetic risk for psychiatric diseases in human neural cells

An economic decision-making model of anticipated surprise with dynamic expectation

When making decision under risk, people often exhibit behaviours that classical economic theories cannot explain. Newer models that attempt to account for these ‘irrational’ behaviours often lack neuroscience bases and require the introduction of subjective and problem-specific constructs. Here, we present a decision-making model inspired by the prediction error signals and introspective neuronal replay reported in the brain. In the model, decisions are chosen based on ‘anticipated surprise’, defined by a nonlinear average of the differences between individual outcomes and a reference point. The reference point is determined by the expected value of the possible outcomes, which can dynamically change during the mental simulation of decision-making problems involving sequential stages. Our model elucidates the contribution of each stage to the appeal of available options in a decision-making problem. This allows us to explain several economic paradoxes and gambling behaviours. Our work could help bridge the gap between decision-making theories in economics and neurosciences.

Identification and treatment of advanced, rupture-prone plaques to reduce cardiovascular mortality

Atherosclerosis is the underlying cause of major cardiovascular events, including heart attack and stroke. The build-up of plaque in coronary arteries can be a major risk for events, but risk is significantly higher in patients with vulnerable rather than stable plaque. Diagnostic imaging of vulnerable plaque is extremely useful for both stratifying patient risk and for determining effectiveness of experimental intervention in reducing cardiovascular risk. In the preclinical setting, being able to distinguish between stable and vulnerable plaque development and pair this with biochemical measures is critical for identification of new experimental candidates. In this webinar, Professor Stephen Nicholls and Dr Kristen Bubb from the Victorian Heart Institute will discuss the benefits of being able to visualise vulnerable plaque for both clinical and preclinical research. Professor Stephen Nicholls is a clinician-researcher and the Head of the Victorian Heart Institute. He is the lead investigator on multiple large, international, cardiovascular outcomes trials. He has attracted over $100 million in direct research funding and published more than 400 peer-reviewed manuscripts. He is focused on both therapeutic intervention to reduce vascular inflammation and lipid accumulation and precision medicine approaches to prevent cardiovascular mortality. Dr Kristen Bubb is a biomedical researcher and Group Leader within the Monash Biomedicine Discovery Institute Cardiovascular Program and Victorian Heart Institute. She focuses on preclinical/translational research into mechanisms underlying vascular pathologies including atherosclerosis and endothelium-driven hypertension within specific vascular systems, including pulmonary and pregnancy-induced. She has published >30 high impact papers in leading cardiovascular journals and attracted category 1&2 funding of >$750,000.

Thurstonian measurement of risk preferences: contemporary economic outlook

Recent economics literature has seen a revival of interest to psychologically-grounded theories of decision under risk. We review the recent proposals in this direction, compare it to classical estimations based on utility functions, and discuss their appropriateness using some original experimental data.

A transdiagnostic data-driven study of children’s behaviour and the functional connectome

Behavioural difficulties are seen as hallmarks of many neurodevelopmental conditions. Differences in functional brain organisation have been observed in these conditions, but little is known about how they are related to a child’s profile of behavioural difficulties. We investigated whether behavioural difficulties are associated with how the brain is functionally organised in an intentionally heterogeneous and transdiagnostic sample of 957 children aged 5-15. We used consensus community detection to derive data-driven profiles of behavioural difficulties and constructed functional connectomes from a subset of 238 children with resting-state functional Magnetic Resonance Imaging (fMRI) data. We identified three distinct profiles of behaviour that were characterised by principal difficulties with hot executive function, cool executive function, and learning. Global organisation of the functional connectome did not differ between the groups, but multivariate patterns of connectivity at the level of Intrinsic Connectivity Networks (ICNs), nodes, and hubs significantly predicted group membership in held-out data. Fronto-parietal connector hubs were under-connected in all groups relative to a comparison sample, and children with hot vs cool executive function difficulties were distinguished by connectivity in ICNs associated with cognitive control, emotion processing, and social cognition. This demonstrates both general and specific neurodevelopmental risk factors in the functional connectome. (https://www.medrxiv.org/content/10.1101/2021.09.15.21262637v1)

The bounded rationality of probability distortion

In decision-making under risk (DMR) participants' choices are based on probability values systematically different from those that are objectively correct. Similar systematic distortions are found in tasks involving relative frequency judgments (JRF). These distortions limit performance in a wide variety of tasks and an evident question is, why do we systematically fail in our use of probability and relative frequency information? We propose a Bounded Log-Odds Model (BLO) of probability and relative frequency distortion based on three assumptions: (1) log-odds: probability and relative frequency are mapped to an internal log-odds scale, (2) boundedness: the range of representations of probability and relative frequency are bounded and the bounds change dynamically with task, and (3) variance compensation: the mapping compensates in part for uncertainty in probability and relative frequency values. We compared human performance in both DMR and JRF tasks to the predictions of the BLO model as well as eleven alternative models each missing one or more of the underlying BLO assumptions (factorial model comparison). The BLO model and its assumptions proved to be superior to any of the alternatives. In a separate analysis, we found that BLO accounts for individual participants’ data better than any previous model in the DMR literature. We also found that, subject to the boundedness limitation, participants’ choice of distortion approximately maximized the mutual information between objective task-relevant values and internal values, a form of bounded rationality.

Transdiagnostic approaches to understanding neurodevelopment

Macroscopic brain organisation emerges early in life, even prenatally, and continues to develop through adolescence and into early adulthood. The emergence and continual refinement of large-scale brain networks, connecting neuronal populations across anatomical distance, allows for increasing functional integration and specialisation. This process is thought crucial for the emergence of complex cognitive processes. But how and why is this process so diverse? We used structural neuroimaging collected from a large diverse cohort, to explore how different features of macroscopic brain organisation are associated with diverse cognitive trajectories. We used diffusion-weighted imaging (DWI) to construct whole-brain white-matter connectomes. A simulated attack on each child's connectome revealed that some brain networks were strongly organized around highly connected 'hubs'. The more children's brains were critically dependent on hubs, the better their cognitive skills. Conversely, having poorly integrated hubs was a very strong risk factor for cognitive and learning difficulties across the sample. We subsequently developed a computational framework, using generative network modelling (GNM), to model the emergence of this kind of connectome organisation. Relatively subtle changes within the wiring rules of this computational framework give rise to differential developmental trajectories, because of small biases in the preferential wiring properties of different nodes within the network. Finally, we were able to use this GNM to implicate the molecular and cellular processes that govern these different growth patterns.

Evidence for the role of glymphatic dysfunction in the development of Alzheimer’s disease

Glymphatic perivascular exchange is supported by the astroglial water channel aquaporin-4 (AQP4), which localizes to perivascular astrocytic endfeet surrounding the cerebral vasculature. In aging mice, impairment of glymphatic function is associated with reduced perivascular AQP4 localization, yet whether these changes contribute to the development of neurodegenerative disease, such as Alzheimer’s disease (AD), remains unknown. Using post mortem human tissue, we evaluated perivascular AQP4 localization in the frontal cortical gray matter, white matter, and hippocampus of cognitively normal subjects and those with AD. Loss of perivascular and increasing cellular localization of AQP4 in the frontal gray matter was specifically associated with AD status, amyloid β (Aβ) and tau pathology, and cognitive decline in the early stages of disease. Using AAV-PHP.B to drive expression on non-perivascular AQP4 in wild type and Tg2576 (APPSwe, mouse model of Aβ deposition) mice, increased cellular AQP4 localization did not slow glymphatic function or change Aβ deposition. Using the Snta1 knockout line (which lacks perivascular AQP4 localization), we observed that loss AQP4 from perivascular endfeet slowed glymphatic function in wild type mice and accelerated Aβ plaque deposition in Tg2576 mice. These findings demonstrate that loss of perivascular AQP4 localization, and not increased cellular AQP4 localization, slows glymphatic function and promotes the development of AD pathology. To evaluate whether naturally occurring variation in the human AQP4 gene, or the alpha syntrophin (SNTA1), dystrobrevin (DTNA) or dystroglycan (DAG1) genes (whose products maintain perivascular AQP4 localization) confer risk for or protection from AD pathology or clinical progression, we evaluated 56 tag single nucleotide polymorphisms (SNPs) across these genes for association with CSF AD biomarkers, MRI measures of cortical and hippocampal atrophy, and longitudinal cognitive decline in the Alzheimer’s Disease Neuroimaging Initiative I (ADNI I) cohort. We identify 25 different significant associations between AQP4, SNTA1, DTNA, and DAG1 tag SNPs and phenotypic measures of AD pathology and progression. These findings provide complimentary human genetic evidence for the contribution of perivascular glymphatic dysfunction to the development of AD in human populations.

Dancing to a Different Tune: TANGO Gives Hope for Dravet Syndrome

The long-term goal of our research is to understand the mechanisms of SUDEP, defined as Sudden, Unexpected, witnessed or unwitnessed, nontraumatic and non-drowning Death in patients with EPilepsy, excluding cases of documented status epilepticus. The majority of SUDEP patients die during sleep. SUDEP is the most devastating consequence of epilepsy, yet little is understood about its causes and no biomarkers exist to identify at risk patients. While SUDEP accounts for 7.5-20% of all epilepsy deaths, SUDEP risk in the genetic epilepsies varies with affected genes. Patients with ion channel gene variants have the highest SUDEP risk. Indirect evidence variably links SUDEP to seizure-induced apnea, pulmonary edema, dysregulation of cerebral circulation, autonomic dysfunction, and cardiac arrhythmias. Arrhythmias may be primary or secondary to hormonal or metabolic changes, or autonomic discharges. When SUDEP is compared to Sudden Cardiac Death secondary to Long QT Syndrome, especially to LQT3 linked to variants in the voltage-gated sodium channel (VGSC) gene SCN5A, there are parallels in the circumstances of death. To gain insight into SUDEP mechanisms, our approach has focused on channelopathies with high SUDEP incidence. One such disorder is Dravet syndrome (DS), a devastating form of developmental and epileptic encephalopathy (DEE) characterized by multiple pharmacoresistant seizure types, intellectual disability, ataxia, and increased mortality. While all patients with epilepsy are at risk for SUDEP, DS patients may have the highest risk, up to 20%, with a mean age at SUDEP of 4.6 years. Over 80% of DS is caused by de novo heterozygous loss-of-function (LOF) variants in SCN1A, encoding the VGSC Nav1.1  subunit, resulting in haploinsufficiency. A smaller cohort of patients with DS or a more severe DEE have inherited, homozygous LOF variants in SCN1B, encoding the VGSC 1/1B non-pore-forming subunits. A related DEE, Early Infantile EE (EIEE) type 13, is linked to de novo heterozygous gain-of-function variants in SCN8A, encoding the VGSC Nav1.6. VGSCs underlie the rising phase and propagation of action potentials in neurons and cardiac myocytes. SCN1A, SCN8A, and SCN1B are expressed in both the heart and brain of humans and mice. Because of this, we proposed that cardiac arrhythmias contribute to the mechanism of SUDEP in DEE. We have taken a novel approach to the development of therapeutics for DS in collaboration with Stoke Therapeutics. We employed Targeted Augmentation of Nuclear Gene Output (TANGO) technology, which modulates naturally occurring, non-productive splicing events to increase target gene and protein expression and ameliorate disease phenotype in a mouse model. We identified antisense oligonucleotides (ASOs) that specifically increase the expression of productive Scn1a transcript in human and mouse cell lines, as well as in mouse brain. We showed that a single intracerebroventricular dose of a lead ASO at postnatal day 2 or 14 reduced the incidence of electrographic seizures and SUDEP in the F1:129S-Scn1a+/- x C57BL/6J mouse model of DS. Increased expression of productive Scn1a transcript and NaV1.1 protein were confirmed in brains of treated mice. Our results suggest that TANGO may provide a unique, gene-specific approach for the treatment of DS.

Motives and modulators of human decision making

Did we eat spaghetti for lunch because we saw our colleague eat spaghetti? What drives a risk decision? How can our breakfast impact our decisions throughout the day? Research from different disciplines such as economics, psychology and neuroscience have attempted to investigate the motives and modulators of human decision making. Human decisions can be flexibly modulated by the different experiences we have in our daily lives, at the same time, bodily processes, such as metabolism can also impact economic behavior. These modulations can occur through our social networks, through the impact of our own behavior on the social environment, but also simply by the food we have eaten. Here, I will present a series of recent studies from my lab in which we shed light on the psychological, neural and metabolic motives and modulators of human decision making.

Gestational exposure to environmental toxins, infections, and stressors are epidemiologically linked to neurodevelopmental disorders

Gestational exposure to environmental toxins, infections, and stressors are epidemiologically linked to neurodevelopmental disorders with strong male-bias, such as autism spectrum disorder. We modeled some of these prenatal risk factors in mice, by co-exposing pregnant dams to an environmental pollutant and limited-resource stress, which robustly dysregulated the maternal immune system. Male but not female offspring displayed long-lasting behavioral abnormalities and alterations in the activity of brain networks encoding social interactions, along with disruptions of gut structure and microbiome composition. Cellularly, prenatal stressors impaired microglial synaptic pruning in males during early postnatal development. Precise inhibition of microglial phagocytosis during the same critical period mimicked the impact of prenatal stressors on the male-specific social deficits. Conversely, modifying the gut microbiome rescued the social and cellular deficits, indicating that environmental stressors alter neural circuit formation in males via impairing microglia function during development, perhaps via a gut-brain disruption.

Neuro-Immune Coupling: How the Immune System Sculpts Brain Circuitry

In this lecture, Dr Stevens will discuss recent work that implicates brain immune cells, called microglia, in sculpting of synaptic connections during development and their relevance to autism, schizophrenia and other brain disorders. Her recent work revealed a key role for microglia and a group of immune related molecules called complement in normal developmental synaptic pruning, a normal process required to establish precise brain wiring. Emerging evidence suggests aberrant regulation of this pruning pathway may contribute to synaptic and cognitive dysfunction in a host of brain disorders, including schizophrenia. Recent research has revealed that a person’s risk of schizophrenia is increased if they inherit specific variants in complement C4, gene plays a well-known role in the immune system but also helps sculpt developing synapses in the mouse visual system (Sekar et al., 2016). Together these findings may help explain known features of schizophrenia, including reduced numbers of synapses in key cortical regions and an adolescent age of onset that corresponds with developmentally timed waves of synaptic pruning in these regions. Stevens will discuss this and ongoing work to understand the mechanisms by which complement and microglia prune specific synapses in the brain. A deeper understanding of how these immune mechanisms mediate synaptic pruning may provide novel insight into how to protect synapses in autism and other brain disorders, including Alzheimer’s and Huntington’s Disease.

From epigenetics to stratified therapies in neuropsychiatric diseases

The establishment of effective therapies for neurodegenerative and neuropsychiatric diseases is still challenging and one of the reasons is that especially for age-associated neurodegenerative diseases pathology accumulates long before there are any clinical signs of disease. Thus, patients are often only diagnosed at an already advanced state of molecular pathology, when causative therapies fail. Thus, there is an urgent need for molecular biomarkers that could detect individuals at risk for developing a CNS disease and stratify patients. I will address epigenetic processes such as histone-modifications and non-coding RNAs as potential approaches for patient stratification and therapeutic interaction, with a specific focus on RNA-therapies. Here, I plan to cover examples from our recent research on Alzheimer’s disease and Schizophrenia.

Parp mutations protect from mitochondrial toxicity in Alzheimer’s disease

Alzheimer’s disease is the most common age-related neurodegenerative disorder. Familial forms of Alzheimer’s disease associated with the accumulation of a toxic form of amyloid-β (Aβ) peptides are linked to mitochondrial impairment. The coenzyme nicotinamide adenine dinucleotide (NAD+) is essential for both mitochondrial bioenergetics and nuclear DNA repair through NAD+-consuming poly (ADP-ribose) polymerases (PARPs). Here, we analysed the metabolomic changes in flies over-expressing Aβ and showed a decrease of metabolites associated with nicotinate and nicotinamide metabolism, which is critical for mitochondrial function in neurons. We show that increasing the bioavailability of NAD+ protects against Aβ toxicity. Pharmacological supplementation using NAM, a form of vitamin B that acts as a precursor for NAD+ or a genetic mutation of PARP rescues mitochondrial defects, protects neurons against degeneration and reduces behavioural impairments in a fly model of Alzheimer’s disease. Next, we looked at links between PARP polymorphisms and vitamin B intake in patients with Alzheimer’s disease. We show that polymorphisms in the human PARP1 gene or the intake of vitamin B, are associated with a decrease in the risk and severity of Alzheimer’s disease. We suggest that enhancing the availability of NAD+ by either vitamin B supplements or the inhibition of NAD+-dependent enzymes, such as PARPs are potential therapies for Alzheimer’s disease.

The history, future and ethics of self-experimentation

Modern day “neurohackers” are radically self-experimenting, attempting genomic modification with CRISPR-Cas9 constructs and electrode insertion into their cortex amongst a host of other things. Institutions wanting to avoid the risks bought on by these procedures, generally avoid involvement with self-experimenting research. Modern day “neurohackers” are radically self-experimenting, attempting genomic modification with CRISPR-Cas9 constructs and electrode insertion into their cortex amongst a host of other things. Institutions wanting to avoid the risks bought on by these procedures, generally avoid involvement with self-experimenting research. But what is the ethical thing to do? Should researchers be allowed or encouraged to self-experiment? Should institutions support or hinder them? Where do you think that this process of self-experimentation could take us? This presentation by Dr Matt Lennon and Professor Zoltan Molnar of the University of Oxford, will explore the history, future and ethics of self-experimentation. It will explore notable examples of self-experimenters including Isaac Newton, Angelo Ruffini and Oliver Sacks and how a number of these pivotal experiments created paradigm shifts in neuroscience. The presentation will open up a forum for all participants to be involved asking key ethical questions around what should and should not be allowed in self-experimentation research.

Multimodal Ising-based connectomics reveals an excitation-inhibition imbalance in Alzheimer's Risk

COSYNE 2025

Acoustic analysis of speech for screening for suicide risk

Activity in distinct neural circuits predicts risk-seeking versus risk-averse choices

Alzheimer’s disease genetic risk factor APOE4 is associated with attenuated auditory responses

The autism risk gene DDX3X in shaping neuronal morphogenesis and synaptogenesis in a sex-specific manner

Body complexion and circulating lipids in the risk of Frontotemporal dementia and Amyotrophic Lateral Sclerosis

Chlamydia pneumoniae can infect the central nervous system via the olfactory and trigeminal nerves and contributes to Alzheimer’s disease risk

Context-Dependence and Asymmetric Update in Risky Decision-Making

Decision making and risk-taking: the role of cognitive reserve

Dexamethasone improves cell surface trafficking of R451C Neuroligin3, an autism gene risk

Early life adversity and a sex-specific polygenic risk score for altered fasting insulin are associated with executive functioning

Early-life adversity induces sex-specific dysfunction of the mOFC and leads to impulsive, hyperactive, and risk-taking behaviors in juvenile male mice

Gene connectivity analysis of co-expression networks provides insights into the omnigenic model and identifies novel genetic hubs of schizophrenia risk

Genetic variability of the Nerve Growth Factor Receptor (NGFR/p75NTR) gene and risk of sporadic Alzheimer's Disease: a case-control association study

High-content screening of alzheimer's disease genetic risk factors based on synaptic density analysis

The human dorsal prefrontal system reflects the source of value information during risky decisions

Impaired processing of amplitude-modulated tones in the inferior colliculus in Cacna2d3 mice - a risk gene for autism spectrum disorders in humans

Increased Dopamine Signaling in Caudate Nucleus Is Associated with Striatal Gene Co-expression In Individuals at Genetic Risk For Schizophrenia

Inhibition of the Age-Related Metabolic Risk Factor Quinone Reductase 2 (QR2) Reduces Brain Pathologies and Improves Memory of Aged Alzheimer’s Disease Model Mice

Inhibition of bromodomain and extraterminal (BET) proteins modulates the expression of Alzheimer’s disease risk genes in microglia

Investigating demographic and epigenetic risk factors for depression in young adults

Loss-of-function variants in the schizophrenia risk gene SETD1A alter neuronal network activity in human neurons through cAMP/PKA pathway

Modelling Sporadic AD In Mice With Risk Factors ApoE4 And Neuroinflammation

Mosaic Cas9 fusions to investigate regulatory phenotypes of schizophrenia risk genes in the rodent brain

Network Analysis between Suicide-Related Symptoms and Suicide Attempt Risk in Psychotic Disorder and Mood Disorder: A prospective cohort study

Obese mothers have a higher risk of developing depressive-like behaviour due to hormonal alterations

Oxidative stress markers as potential predictors of the transition to psychosis in individuals at ultra-high risk

Patterns of prefrontal-hippocampal circuit development in juvenile mice in health and a genetic risk model for schizophrenia

Post-synaptic scaffold protein TANC2 in psychiatric and somatic disease risk

Prefrontal cortex neuronal network processes risk assessment behaviors in mice

Pre-trauma behavioural risk factors of posttraumatic stress disorder

Prevalence of cardiovascular disease risk factors among professional rugby union athletes: Linking cardiovascular and cognitive health in professional rugby

Probing prefrontal cortical signals during risky economic decisions in mice

Psychosis risk candidate ZNF804A - a key player in synaptogenesis by regulating protein synthesis?

The Role of Ethno-Racial Factors in Assessing Risk for Parkinson’s Disease

The role of feedback in decision making under risk

Systematic comparison of risky choice preference reversals in human and monkey

A systematic review on the association of birth intervals and risk of autism spectrum and attention deficit hyperactivity disorders

Aggression control by type 2 diabetes risk gene Dusp8

FENS Forum 2024

EEG alpha power differences in the Icelandic winter between individuals with high vs. low risk for Seasonal Affective Disorder

FENS Forum 2024