Tau ablation rescues vascular amyloid‐related deficits in a cerebral amyloid angiopathy model

Background: Close to 80 to 90% of subjects with AD also present cerebral amyloid angiopathy (CAA) a disease in which amyloid accumulation damages the vasculature and impairs blood flow. Since current AD therapies are targeting the disease focusing on amyloid, we are interested on determine how to decrease the accumulation of amyloid in the vasculature observed in CAA and our aim is to determine the impact of tau reduction in CAA pathogenesis. Method: We crossed the Tg‐FDD mice CAA model with Mapt‐/‐ mice to decrease tau levels and analyzed the disease pathogenesis in the different genotypes though behavioral tests, histological and morphometric assays and transcriptomic analysis using the nCounter neuroimmflamation panel from Nanostring. Result: We determined that tau ablation improved motor strength in the Tg‐FDD mice model, reduced amyloid deposition in the vasculature, decrease fibrinogen levels in the cortex, reduced astrocyte branching process associated to immunoreactivity. Nanostring analysis revealed that microglia function, oligodendrocyte and cytokine signaling are altered in the Tg‐FDD mice and that in the Tg‐FDD, Mapt ‐/‐ mice there is an increase in this mechanisms restoring the values to the ones observed in wild type mice. Conclusion: We are currently evaluating the pathways observed in the distinct inflammatory profile in microglia and oligodendrocytes. Our results suggest that tau ablation decreased CAA pathology in the Tg‐FDD mice model, which shows the potential therapeutic implications of targeting tau in CAA and related neurodegenerative diseases

Identifying anatomical subtypes of sporadic EOAD in LEADS via unsupervised clustering of MRI‐based regional atrophy patterns

Background: Neurodegeneration in sporadic early‐onset Alzheimer disease (EOAD) is topographically heterogeneous, as suggested by variability in syndromic presentation. We performed an unsupervised clustering analysis of structural MRI data to identify anatomical subtypes of EOAD. We hypothesized that distinct clusters will be present but will: (1) share areas of overlap focused around posterior regions of our newly developed EOAD signature of cortical atrophy (Touroutoglou et al., 2023), including the posterior default mode (DMN) and frontoparietal control networks (FPN) of the cerebral cortex; and (2) show non‐overlapping topography inclusive of nodes of other networks including dorsal attention (DAN) and visual association (VIS) networks. Methods: We analyzed structural MRI data from 183 individuals with EOAD and 88 cognitively unimpaired (CU) participants from the Longitudinal Early‐Onset Alzheimer's Disease Study (LEADS). MRI data were processed using FreeSurfer v6.0 to estimate vertex‐wise cortical thickness, which was converted to W‐scores (i.e., Z‐scores relative to CU participants adjusted for age and sex). We then performed an agglomerative hierarchical clustering analysis on a between‐patients similarity matrix computed from rank‐ordered whole‐cortex W‐scores. Results: Analysis yielded 2 major clusters, with subordinate clustering failing to delineate additional unique topographies. One cluster (n=54) exhibited prominent atrophy in the anterior DMN (medial prefrontal cortex, anterior lateral temporal cortex) and rostral FPN (rostral middle and superior frontal gyri). The other cluster (n=129) showed prominent atrophy in the DAN (superior parietal lobule, caudal superior frontal gyrus, posterior temporal cortex) and VIS (posterior inferior temporal/occipital cortex, posterior parietal cortex). Both clusters showed atrophy in the posterior DMN (posterior cingulate cortex, precuneus, posterior inferior parietal lobule, mid lateral temporal cortex) and the FPN (middle and superior frontal gyri, anterior inferior parietal lobule, mid inferior temporal cortex). The clusters did not differ with respect to age, sex, education, APOE status, or clinical measures of disease severity. Conclusions: Our sample of sporadic EOAD patients comprised 2 principal anatomical subtypes, commonly overlapping with the posterior DMN and FPN that constitute the EOAD signature, one subtype uniquely overlapped with the anterior DMN/rostral FPN and the other with the DAN/VIS network. Anatomical differences between the subtypes likely correspond to aspects of phenotypic heterogeneity

SHIP1 phosphatase as a Late‐Onset Alzheimer’s Disease therapeutic target

Background: Alzheimer’s disease (AD) is a highly complex neurological disorder, with Late‐Onset AD (LOAD) being its most common form. INPP5D has been identified as a risk gene for AD and is involved in the TREM2 signaling pathway, which is crucial for microglial activity. INPP5D encodes SHIP1, a protein phosphatase that disrupts TREM2 signaling by converting PIP3 into PIP2, thereby inhibiting the PI3K‐mediated activation of Akt‐dependent signaling, which is essential for the clearance of amyloid oligomers, fibrils, and plaques. SHIP1 is a large, multidomain protein, and many aspects of its structure and function are poorly understood. Method: We have expressed, purified, and characterized the kinetic and biophysical properties of various domain constructs of SHIP1 to better understand the roles of individual domains. Ongoing work involves screening of inhibitors using a range of biochemical and biophysical assays with different constructs of SHIP1. Result: The response of different SHIP1 domain constructs with different substrates surprisingly revealed no significant differences in kinetic parameters between different domain constructs with the same substrate suggesting that the various domains surrounding the catalytic domain do not influence catalysis in solution. However, use of a designed chemical probe with a covalent warhead that targets SHIP1 allosterically between the catalytic and C2 domains shows significant inhibition of SHIP1 (in the absence of its SH2 domain) identifying a potential druggable site. X‐ray crystallography was used to confirm the binding pose within this site. Binding affinity with additional compounds has been determined for different domain constructs using enzyme kinetics and biophysical methods including Microscale Thermophoresis (MST) and Differential Scanning Fluorescence (DSF). Conclusion: SHIP1 is highly active in vitro (solution) without much regulation of its catalytic activity by surrounding domains. A potential druggable site has been identified between the SHIP1 catalytic and C2 domains that can be targeted allosterically by small molecule compounds. These discoveries will aid in identifying new molecules that can inhibit SHIP1 as a potential therapeutic target for AD

The Dynamics of Cognitive Decline towards Alzheimer’s Disease Progression: Results from ADSP-PHC’s Harmonized Cognitive Composites

Introduction: Accurately assessing temporal order of cognitive decline across multiple domains is critical in Alzheimer's disease (AD). Existing literature presented controversial conclusions likely due to the use of a single cohort and different analytical strategies. Methods: Harmonized composite cognitive measures in memory, language and executive functions from 13 cohorts in the ADSP-PHC data are used. A novel double anchoring events-based sigmoidal mixed model was developed using time to the incident of AD diagnosis as the time scale. Results: Decline in memory occurred before decline in language which was followed by the decline in executive function. Throughout the entire AD continuum, APOE-ε4 non-carriers and non-Hispanic Whites showed better memory performance, respectively, in all three cognitive domains. Discussion: Using harmonized data across multiple cohorts is the key to accurately characterizing the temporal order of AD biomarkers. Time to incident AD diagnosis should be used as the time scale for reproducibility purposes

Mineralized tissue loss at the femoral ACL enthesis in young male ACL‐injured patients

Purpose: Primary anterior cruciate ligament (ACL) reconstruction graft failure remains a significant health concern in young patients. Despite the high incidence of poor graft integration in these patients and the resulting high failure rate, little consideration has been given to the quality of the bone into which the graft is anchored at reconstruction. Therefore, we investigated post ACL injury mineralized tissue changes in the ACL femoral entheses of young males and compared them to changes previously reported for young females. Methods: ACL femoral entheses and adjacent bone specimens were harvested from the injured knees of 51 young males during primary ACL reconstructive surgery and from 10 non-injured male cadaveric donors. The specimens were imaged via nano-computed tomography and analyzed for volumetric bone mineral density (vBMD) and architectural changes. Results: Male femoral ACL explant specimens had significantly lower cortical vBMD (p 0.05) to those of control specimens from male cadaveric donors. Cortical and trabecular bone loss increased significantly with time from ACL injury to reconstructive surgery (p's < 0.05). While cortical loss occurred in both males and females, significant trabecular loss occurred only in females (p = 0.009). Conclusion: Femoral entheseal bone loss occurs in males following ACL injury. This bone loss increases with time following ACL injury, with cortical bone loss occurring sooner after injury than trabecular bone loss. The effects of ACL injury and time from injury to surgery on trabecular bone microarchitecture differed between male and female patients

Neuromuscular junction visualization in paraffin‐embedded thyroarytenoid muscle sections: Expanding options beyond frozen section analysis

Objectives: The current gold standard for immunofluorescent (IF) visualization of neuromuscular junctions (NMJs) in muscle utilizes frozen tissue sections with fluorescent conjugated antibodies to demarcate neurons and IF alpha-bungarotoxin (α-BTX) to demarcate motor endplates. Frozen tissue sectioning comes with inherent inescapable limitations, including cryosectioning artifact and limited sample shelf-life. However, a parallel approach to identify NMJs in paraffin-embedded tissue sections has not been previously described. Methods: Yucatan minipig thyroarytenoid (TA) muscle was harvested and prepared as 5-μm thick paraffin-embedded tissue sections. A variety of antibodies at various concentrations were selected to target nicotinic acetylcholine receptors, synaptic vesicles, and neurons. Results: Neurofilament (NEFL, Invitrogen, 1:500) and synaptic vesicle glycoprotein (SV2, DSHB, 1:230) bound and demarcated the neurons and synaptic vesicles, respectively. Following consistent visualization of nerve tissue, rabbit anti-nicotinic acetylcholine receptor alpha-1 subunit (CHRNα1, Abcam, 1:500) was used to identify the acetylcholine receptors within motor endplates. Complete NMJ visualization was then achieved with an optimized protocol using primary antibodies to the neurofilament light chain, nerve synaptic vesicle glycoprotein 2, and the alpha 1 subunit of the nicotinic acetylcholine receptor. Slide imaging was performed with the Echo Revolve Microscope (40×). Conclusions: Herein, we describe a new methodology to visualize NMJs within paraffin-embedded TA muscle sections. Our protocol avoids the known limitations associated with cryosectioned samples and introduces a new neurolaryngologic research tool that utilizes the advantageous ability of paraffin-embedded sectioning to preserve tissue morphology. In conjunction with standard cryosectioned methods, the described paraffin-embedded protocol serves to enhance histological analysis of NMJs

Longitudinal neurodegeneration in Early‐Onset Alzheimer’s Disease: A summary of MRI‐derived atrophy in LEADS

Background: Prior work has advanced our understanding of cortical atrophy in early‐onset Alzheimer’s disease (EOAD), but longitudinal data are sparse. Current longitudinal MRI studies point to progressive atrophy in cerebral cortex exhibiting a posterior‐to‐anterior gradient, but these studies include small samples with mostly amnestic EOAD. Here, we analyzed a large sample of sporadic EOAD patients from the Longitudinal Early‐Onset Alzheimer's Disease Study (LEADS) to test the central hypothesis that areas in our recently described EOAD signature (Touroutoglou et al., 2023) affected at baseline in the posterior lateral temporal cortex, inferior parietal lobule, and PCC/precuneus will continue to degenerate and additional longitudinal atrophy will be found in the medial temporal lobe and frontal regions as cognitive decline progresses over time in multiple domains. Method: We investigated longitudinal changes in cortical thickness by analyzing structural MRI data collected from 367 patients with EOAD and 99 cognitively unimpaired (CN) older adults, totaling 839 MRI scans across the cohorts with up to 4 years of follow‐up. MRI data were longitudinally processed in FreeSurfer 6.0. Linear mixed effects models were constructed to estimate the rate of cortical atrophy with random intercepts and slopes for individual participants while controlling for baseline age and sex. Result: EOAD patients exhibited cortical atrophy at a faster rate than controls in widespread areas of the cerebral cortex. As expected, the regions exhibiting accelerated longitudinal atrophy included not only the EOAD signature regions as a whole (EOAD: ‐0.052±0.002 mm/year vs. CN: 0.0001±0.002 mm/year; Dslopes = ‐0.052, p<.001), but also those that were minimally atrophied at baseline, such as superior frontal gyrus (EOAD: ‐0.052+/‐0.004 vs. CN: ‐0.001+/‐0.004, Dslopes = ‐ 0.051, p<.001) and medial temporal lobe (EOAD: ‐0.083±0.005 mm/year vs. CN: 0.001±0.006 mm/year; Dslopes = ‐0.082, p<.001). We observed no difference in the rate of atrophy in the calcarine fissure (a control region not expected to change; Dslopes = ‐0.002, p£.69). Conclusion: Our findings show that neurodegeneration in EOAD accelerates over time in the EOAD signature regions and spreads to additional areas within large‐scale brain networks (consistent with those observed in late‐onset AD) contributing to the worsening of symptoms over time

Associations between Amyloid, Cardiovascular Risk, and Cognitive Function in Korean Older Adults: Insights from the KBASE Cohort

Background: Understanding the relationship between cardiovascular burden, amyloid, and cognition in Alzheimer’s disease (AD) is essential for targeted interventions, especially in ethnically diverse populations where research remains limited. This study aimed to investigate these relationships in a cohort of Korean older adults along the AD spectrum. Method: 526 participants from the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer’s Disease (KBASE) cohort were included in this study. Vascular burden was quantified using Framingham Risk Score (FRS) and participants were categorized into four groups based on combinations of FRS (FRS High or FRS Low with a median split) and amyloid status (Aβ+ or Aβ‐ based on a cut‐off of 1.2373). Cognitive function was evaluated using standardized neuropsychological tests processed with structural equation models to produce domain scores for memory, executive functioning, language, and visuospatial. ANOVA was employed at baseline to analyze cognitive differences among these groups and within each clinical diagnosis. Longitudinal mixed effects models spanning a period of four years from the initial visit captured cognitive changes over time within these groups (Figure 1). Result: Significant group and pairwise differences were observed among the four groups in all cognitive domains (p < 0.0001). Stratified analysis within each clinical diagnoses group revealed that CN individuals in FRS high Aβ‐ demonstrated significantly lower memory scores compared to those with FRS low Aβ‐ (p < 0.0001), this trend was absent from MCI and AD groups (Figure 2). Longitudinally, FRS high Aβ+ and FRS low Aβ+ groups consistently demonstrated lower memory scores compared to the FRS low Aβ‐ group. Interestingly, no significant difference in cognition was observed between FRS high Aβ‐ and FRS low Aβ‐ groups over time. However, the most pronounced divergence in longitudinal cognition of the four FRS and Amyloid groups was observed within the MCI diagnosis group (Figure 3). Conclusion: This study highlights the differential impact of cardiovascular risk on cognition depending on amyloid status and clinical diagnosis group. This underscores the importance of considering both cardiovascular risk factors and amyloid pathology early‐on in understanding clinical manifestation and cognitive decline in the AD spectrum, particularly in ethnically diverse populations

Over‐Representation of Extremely Wealthy Neighborhood Social Exposomes for Brain Donors within Alzheimer’s Disease Research Center Brain Banks assessed by the Neighborhoods Study

Background: Adverse social exposome (indexed by national Area Deprivation Index [ADI] 80‐100 or ‘high ADI’) is linked to structural inequities and increased risk of Alzheimer’s disease neuropathology. Twenty percent of the US population resides within high ADI areas, predominantly in inner cities, tribal reservations and rural areas. The percentage of brain donors from high ADI areas within the Alzheimer’s Disease Research Center (ADRC) brain bank system is unknown. Objective: Determine ADI for brain donors from 21 ADRC sites as part of the on‐going Neighborhoods Study. Methods: All brain donors in participating ADRC sites with NACC neuropathology data and personal identifiers for ADI linkage (N = 8,637) were included (Figure 1). Geocoded donor addresses were linked to time‐concordant ADI percentiles for year of death. Results: Overall, only 5.6% of ADRC brain donors (N = 488) resided in a high ADI (disadvantaged) neighborhood at death. The remaining donors resided in more advantaged neighborhoods, with nearly 40% of donors living in the wealthiest quintile of neighborhoods, and over 300 brain donors originating from the wealthiest 1% of US neighborhoods (Figure 2). Donors from high ADI (disadvantaged) neighborhoods identified as 87% White (n = 424), 11% Black (55), 1% Multiracial (6) and <1% other/unknown race (3), with 1% Hispanic (5). None identified as American Indian/Alaska Native or Native Hawaiian/Pacific Islander/Asian. In comparison, donors from low ADI neighborhoods were 94% White (n = 7680), 3% Black (273), 1% Multiracial (75), <1% American Indian/Alaska Native (11), <1% Native Hawaiian/Pacific Islander/Asian (60), and <1% other/unknown race (50), with 3% Hispanic (230). Sex distribution was similar (54%, 51% female, respectively). Inclusion of high ADI donors varied dramatically across the 21 ADRC brain banks from a low of 0.6% to high of 20% of all a site’s donors (Figure 3). Conclusions: ADI was determined for over 8,600 brain donors in the ADRC system, demonstrating a marked over‐representation of donors from very low ADI (extremely wealthy) neighborhoods, in addition to site‐to‐site variability. This is the first time a comprehensive cross‐sectional social exposome assessment of this nature has been performed, opening windows for additional mechanistic study of the social exposome on brain pathology. Life course ADI assessments are on‐going

Evaluating Meta‐Learners to Analyze Treatment Heterogeneity in Survival Data: Application to Electronic Health Records of Pediatric Asthma Care in COVID‐19 Pandemic

An important aspect of precision medicine focuses on characterizing diverse responses to treatment due to unique patient characteristics, also known as heterogeneous treatment effects (HTE) or individualized treatment effects (ITE), and identifying beneficial subgroups with enhanced treatment effects. Estimating HTE with right-censored data in observational studies remains challenging. In this paper, we propose a pseudo-ITE-based framework for analyzing HTE in survival data, which includes a group of meta-learners for estimating HTE, a variable importance metric for identifying predictive variables to HTE, and a data-adaptive procedure to select subgroups with enhanced treatment effects. We evaluate the finite sample performance of the framework under various observational study settings. Furthermore, we applied the proposed methods to analyze the treatment heterogeneity of a written asthma action plan (WAAP) on time-to-ED (Emergency Department) return due to asthma exacerbation using a large asthma electronic health records dataset with visit records expanded from pre- to post-COVID-19 pandemic. We identified vulnerable subgroups of patients with poorer asthma outcomes but enhanced benefits from WAAP and characterized patient profiles. Our research provides valuable insights for healthcare providers on the strategic distribution of WAAP, particularly during disruptive public health crises, ultimately improving the management and control of pediatric asthma