Cambridge Neuro

Caroline Williams-Gray is a Principal Research Associate in the Department of Clinical Neurosciences, University of Cambridge, and an honorary consultant neurologist specializing in Parkinson’s disease and movement disorders. She leads a translational research group investigating the clinical and biological heterogeneity of PD, with the ultimate goal of developing more targeted therapies for different Parkinson’s subtypes. Her recent work has focused on the theory that the immune system plays a significant role in mediating the heterogeneity of PD and its progression. Her lab is investigating this using blood and CSF -based immune markers, PET neuroimaging and neuropathology in stratified PD cohorts; and she is leading the first randomized controlled trial repurposing a peripheral immunosuppressive drug (azathioprine) to slow the progression of PD.

The nervous system is fundamentally a closed loop control device: the output of actions continually influences the internal state and subsequent actions. This is true at the single cell and even the molecular level, where “actions” take the form of signals that are fed back to achieve a variety of functions, including homeostasis, excitability and various kinds of multistability that allow switching and storage of memory. It is also true at the behavioural level, where an animal’s motor actions directly influence sensory input on short timescales, and higher level information about goals and intended actions are continually updated on the basis of current and past actions. Studying the brain in a closed loop setting requires a multidisciplinary approach, leveraging engineering and theory as well as advances in measuring and manipulating the nervous system. I will describe our recent attempts to achieve this fusion of approaches at multiple levels in the nervous system, from synaptic signalling to closed loop brain machine interfaces.

Maladaptive emotional memories contribute to the persistence of numerous mental health disorders, including post-traumatic stress disorder (PTSD), drug addiction and obsessive-compulsive disorder (OCD). Using rodent behavioural models of the psychological processes relevant to these disorders, it is possible to identify potential treatment targets for the development of new therapies, including those based upon disrupting the reconsolidation of maladaptive emotional memories. Using examples from rodent models relevant to multiple mental health disorders, this talk will consider some of the opportunities and challenges that this approach provides.

Post traumatic stress disorder (PTSD) is a prevalent and disabling condition that affects larger numbers of children and adolescents worldwide. Until recently, we have understood little about the nature of PTSD reactions in our youngest children (aged under 8 years old). This talk describes our work over the last 15 years working with this very young age group. It overviews how we need a markedly different PTSD diagnosis for very young children, data on the prevalence of this new diagnostic algorithm, and the development of a psychological intervention and its evaluation in a clinical trial.

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.

Cognitive science and cognitive neuroscience researchers have agreed that the replication of findings is important for establishing which ideas (or theories) are integral to the study of cognition across the lifespan. Recently, high-profile papers have called into question findings that were once thought to be unassailable. Much attention has been paid to how p-hacking, publication bias, and sample size are responsible for failed replications. However, much less attention has been paid to the fidelity by which researchers enact study protocols. Researchers conducting education or clinical trials are aware of the importance in fidelity – or the extent to which the protocols are delivered in the same way across participants. Nevertheless, this idea has not been applied to cognitive contexts. This seminar discusses factors that impact the replicability of findings alongside recent models suggesting that even small fidelity deviations have real impacts on the data collected.

Current disease-modifying therapies in multiple sclerosis are all focused on suppressing the inflammatory phase of the disease. This has been extremely successful, and it is doubtful that significantly more efficacious anti-inflammatory treatments will be found. However, it remains the case that people with relapsing-remitting multiple sclerosis acquire disability on treatment, and enter the secondary progressive phase. I argue that we now need treatments that prevent neuronal degeneration. The most promising approach is to prevent axons degenerating by remyelination. Since the discovery that the adult brain contains stem cells which can remyelinate, the problem now is how to promote endogenous remyelination, and how to know when we have achieved this! We have successfully identified one drug which promotes remyelination but unfortunately it is too toxic for use in the clinic. So the hunt continues.

Socially Assistive Robots (SARs) have shown great potential to help children in therapeutic and healthcare contexts. SARs have been used for companionship, learning enhancement, social and communication skills rehabilitation for children with special needs (e.g., autism), and mood improvement. Robots can be used as novel tools to assess and rehabilitate children’s communication skills and mental well-being by providing affordable and accessible therapeutic and mental health services. In this talk, I will present the various studies I have conducted during my PhD and at the Cambridge Affective Intelligence and Robotics Lab to explore how robots can help assess and rehabilitate children’s communication skills and mental well-being. More specifically, I will provide both quantitative and qualitative results and findings from (i) an exploratory study with children with autism and global developmental disorders to investigate the use of intelligent personal assistants in therapy; (ii) an empirical study involving children with and without language disorders interacting with a physical robot, a virtual agent, and a human counterpart to assess their linguistic skills; (iii) an 8-week longitudinal study involving children with autism and language disorders who interacted either with a physical or a virtual robot to rehabilitate their linguistic skills; and (iv) an empirical study to aid the assessment of mental well-being in children. These findings can inform and help the child-robot interaction community design and develop new adaptive robots to help assess and rehabilitate linguistic skills and mental well-being in children.

Programmed axon death is a widespread and completely preventable mechanism in injury and disease. Mouse and Drosophila studies define a molecular pathway involving activation of SARM1 NA Dase and its prevention by NAD synthesising enzyme NMNAT2 . Loss of axonal NMNAT2 causes its substrate, NMN , to accumulate and activate SARM1 , driving loss of NAD and changes in ATP , ROS and calcium. Animal models caused by genetic mutation, toxins, viruses or metabolic defects can be alleviated by blocking programmed axon death, for example models of CMT1B , chemotherapy-induced peripheral neuropathy (CIPN), rabies and diabetic peripheral neuropathy (DPN). The perinatal lethality of NMNAT2 null mice is completely rescued, restoring a normal, healthy lifespan. Animal models lack the genetic and environmental diversity present in human populations and this is problematic for modelling gene-environment combinations, for example in CIPN and DPN , and identifying rare, pathogenic mutations. Instead, by testing human gene variants in WGS datasets for loss- and gain-of-function, we identified enrichment of rare SARM1 gain-of-function variants in sporadic ALS , despite previous negative findings in SOD1 transgenic mice. We have shown in mice that heterozygous SARM1 loss-of-function is protective from a range of axonal stresses and that naturally-occurring SARM1 loss-of-function alleles are present in human populations. This enables new approaches to identify disorders where blocking SARM1 may be therapeutically useful, and the existence of two dominant negative human variants in healthy adults is some of the best evidence available that drugs blocking SARM1 are likely to be safe. Further loss- and gain-of-function variants in SARM1 and NMNAT2 are being identified and used to extend and strengthen the evidence of association with neurological disorders. We aim to identify diseases, and specific patients, in whom SARM1 -blocking drugs are most likely to be effective.

This talk will examine how approaches such as ‘big data’ and new ways of delivering clinical trials can improve current services for older people with mental illness (jam today) and identify and deliver new treatments in the future (jam tomorrow).

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.

Post-diagnostic research on rare genetic developmental disorders presents new opportunities (and a few challenges) for discovery neuroscience and translation. In this talk, Kate will describe and discuss neurodevelopmental phenotypes arising from rare, high penetrance genomic variants which directly influence pre-synaptic vesicle cycling (SVC disorders). She will focus on Synaptotagmin-1 Associated Neurodevelopmental Disorder (also known as Baker Gordon Syndrome), first described in 2015 and now diagnosed in more than 50 children and young people worldwide. She will then present work-in-progress by her group on the neurodevelopmental spectrum of SVC disorders more broadly, and discuss opportunities for collaborative neuroscience which can bridge the gaps between genetic cause and complex neurological, cognitive and mental health outcomes.

The hypothalamus controls diverse homeostatic functions including fertility. Neural episode generators are required to drive the intermittent pulsatile and surge profiles of reproductive hormone secretion that control gonadal function. Studies in genetic mouse models have been fundamental in defining the neural circuits forming these central pattern generators and the full range of in vitro and in vivo optogenetic and chemogenetic methodologies have enabled investigation into their mechanism of action. The seminar will outline studies defining the hypothalamic “GnRH pulse generator network” and current understanding of its operation to drive pulsatile hormone secretion.

By the time a baby is born, its brain is equipped with tens of billions of intricately crafted neurons wired together to form a compact and breathtakingly efficient supercomputer. The book is meant to give a broad audience (i.e. non-neuroscientists) a sense of the step-by-step construction of a human brain as well as our current conceptual understanding of various processes involved. The book also hopes to highlight relevance of brain development to our growing understanding of cognitive and psychological variations and syndromes. The author will talk about the book including the many challenges and rewards involved in writing it.

Results: the main areas which were modified based on participatory feedback were the variety of immersive scenarios to cover a range of ages and interests, the number of levels of complexity to ensure small improvements were measured, the feedback and reward schemes to ensure positive reinforcement, and specific provision for participants with balance issues, who had difficulties when using head-mounted displays. The effectiveness of the finalised BEARS suite will be evaluated in a large-scale clinical trial. We have added in additional login options for other members of the family and based on patient feedback we have improved the accompanying reward schemes. Conclusions: Through participatory design we have developed a training package (BEARS) for young people with bilateral cochlear implants. The training games are appropriate for use by the study population and ultimately should lead to patients taking control of their own management and reducing the reliance upon outpatient-based rehabilitation programmes. Virtual reality training provides a more relevant and engaging approach to rehabilitation for young people.

The human brain sets us apart as a species, with its size being one of its most striking features. Brain size is largely determined during development as vast numbers of neurons and supportive glia are generated. In an effort to better understand the events that determine the human brain’s cellular makeup, and its size, we use a human model system in a dish, called cerebral organoids. These 3D tissues are generated from pluripotent stem cells through neural differentiation and a supportive 3D microenvironment to generate organoids with the same tissue architecture as the early human fetal brain. Such organoids are allowing us to tackle questions previously impossible with more traditional approaches. Indeed, our recent findings provide insight into regulation of brain size and neuron number across ape species, identifying key stages of early neural stem cell expansion that set up a larger starting cell number to enable the production of increased numbers of neurons. We are also investigating the role of extrinsic regulators in determining numbers and types of neurons produced in the human cerebral cortex. Overall, our findings are pointing to key, human-specific aspects of brain development and function, that have important implications for neurological disease.

Abuse, neglect, and other forms of uncontrollable stress during childhood and early adolescence can lead to adverse outcomes later in life, including especially perturbations in the regulation of mood and emotional states, and specifically anxiety disorders and depression. However, stress experiences vary from one individual to the next, meaning that causal relationships and mechanistic accounts are often difficult to establish in humans. This interdisciplinary talk considers the value of research in experimental animals where stressor experiences can be tightly controlled and detailed investigations of molecular, cellular, and circuit-level mechanisms can be carried out. The talk will focus on the widely used repeated maternal separation procedure in rats where rat offspring are repeatedly separated from maternal care during early postnatal life. This early life stress has remarkably persistent effects on behaviour with a general recognition that maternally-deprived animals are susceptible to depressive-like phenotypes. The validity of this conclusion will be critically appraised with convergent insights from a recent longitudinal study in maternally separated rats involving translational brain imaging, transcriptomics, and behavioural assessment.

The last twenty years have witnessed extraordinarily rapid progress in basic neuroscience, including breakthrough technologies such as optogenetics, and the collection of unprecedented amounts of neuroimaging, genetic and other data relevant to neuroscience and mental health. However, the translation of this progress into improved understanding of brain function and dysfunction has been comparatively slow. As a result, the development of therapeutics for mental health has stagnated too. One central challenge has been to extract meaning from these large, complex, multivariate datasets, which requires a shift towards systems-level mathematical and computational approaches. A second challenge has been reconciling different scales of investigation, from genes and molecules to cells, circuits, tissue, whole-brain, and ultimately behaviour. In this talk I will describe several strands of work using mathematical, statistical, and bioinformatic methods to bridge these gaps. Topics will include: using artificial neural networks to link the organization of large-scale brain connectivity to cognitive function; using multivariate statistical methods to link disease-related changes in brain networks to the underlying biological processes; and using network-based approaches to move from genetic insights towards drug discovey. Finally, I will discuss how simple organisms such as C. elegans can serve to inspire, test, and validate new methods and insights in networks neuroscience.

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