Exploring the Relationship Between High-SES and Anxiety/Depression in Adolescents: Development of a Method

Anxiety disorders are the most common mental health disorder among children and adolescents with the number of individuals impacted increasing, especially for children and adolescents with high socioeconomic status. Although mental health issues such as anxiety and depression are impacting affluent children and adolescents in steadily rising numbers, there is very little research about why this is happening and how to effectively treat this population. This thesis addressed the impact affluence has on mental health in adolescents attending an affluent school system and aimed to explore effective treatments for this population. A review of the literature was conducted surrounding the impact affluence has on mental health, specifically, as it relates to substance use, family and community influence, extracurriculars, stigma, the impact on adolescent girls, and available treatments, including expressive arts therapy. Based on the literature, an expressive arts therapy intervention was developed focusing on externalization of symptoms of mental illness through the arts and implemented with two high school students attending an affluent high school in Massachusetts. The observations and findings suggest that affluence is a little discussed factor that influences mental health in adolescents, and also that expressive arts in a school-setting may be an effective intervention for adolescents struggling with mental health issues correlated with affluence; however, it requires further exploration and research

20.1 DISSECTING THE FUNCTIONAL CONSEQUENCES OF RECIPROCAL GENOMIC DISORDERS

Abstract Background: Reciprocal genomic disorders (RGDs) represent a unique class of recurrent genomic variation that offer insight into highly dosage sensitive regions of the morbid human genome. However, the genomic architecture mediating RGDs, namely non-allelic homologous recombination (NAHR) of flanking segmental duplications, has rendered these genomic segments recalcitrant to conventional model studies. We recently developed a novel CRISPR method that leverages the homology of segmental duplications and efficiently generates large microdeletions and microduplications that mimic NAHR in humans, including ablation or duplication of one copy equivalent of the segmental duplications. Here, we explore the functional consequences of 16p11.2 RGD in iPS derived neuronal models and across mouse tissues. Methods: We generated CRISPR-engineered 16p11.2 RGD models against an isogenic iPSC background and performed transcriptome profiling in iPSC-derived neural stem cells (NSCs) and induced neurons (iN) (n = 10 isogenic deletions, 10 duplications, 6 controls). We then integrated these data with RNAseq from 306 libraries from multiple tissues in 70 mouse models of reciprocal deletion and duplication of the syntenic 7qf3 region (cortex, striatum, cerebellum, liver, white fat, brown fat in 16 mice; and replication from cortex, striatum, cerebellum in 54 mice). Results: In ongoing analyses, weighted-gene correlation network analysis (WGCNA) identified co-expression modules that were significantly enriched for 16p11.2 genes, evolutionarily constrained genes, genes robustly associated with autism spectrum disorder (ASD; TADA q < 0.1) and developmental disorders (DDD). Pathway analyses within modules discovered enrichment of genes critical to synaptic formation and neural connectivity as well as the protocadherin gene family. Network analyses specific to brain tissues within modules further identified a convergence on highly connected, or ‘hub’ genes, on Wnt signaling, including Ctnnb1 and Ctnnd1. The module was also again enriched for ASD loci (TADA, FDR < 0.1), constrained genes (ExAC, pLI ≥ 0.9) and brain specific genes from the Human Protein Atlas. Discussion These studies suggest the functional consequences of 16p11.2 RGD across models converge on transcriptional signatures associated with critical neurodevelopmental pathways and individual genes implicated in a spectrum of developmental and neuropsychiatric disorders

The dopaminergic network and genetic susceptibility to schizophrenia

Background: Schizophrenia is a disabling illness with unknown pathogenesis. Estimates of heritability suggest a substantial genetic contribution; however genetic studies to date have been equivocal. Uncovering liability loci may therefore require analyses of functionally related genes. Rooted in this assumption, this dissertation describes a series of studies investigating a genetic epidemiological foundation for the commonly cited hypothesis suggesting dopaminergic dysfunction in schizophrenia pathogenesis, i.e. the 'dopamine hypothesis'. Studies: The initial study investigated DRD3 and identified novel associations across the gene. The second study considered a larger network of dopaminergic genes in two independent Caucasian samples, detecting replicated associations and epistatic interactions. This study proposed a risk model for schizophrenia centered on the dopamine transporter. Study #3 investigated a dopamine precursor, phenylalanine hydroxylase, in four independent samples, identifying a single SNP (rs1522305) that was significantly replicated in two samples. Study #4 was motivated by the hypothesis of a shared genetic etiology for schizophrenia and bipolar disorder. This study comprehensively evaluated the dopaminergic network, selecting 431 'tag' SNPs from 40 genes among large schizophrenia and bipolar cohorts contrasted with adult controls. Across all genes 60% of nominally significant schizophrenia risk factors were also associated with bipolar disorder. The results supported DRD3 variations as risk factors for both disorders, confirmed several previously reported associations, and proposed new targets for future research. Conclusion: These results suggest dopaminergic gene variations could play an etiological role in the pathogenesis of schizophrenia and possibly bipolar 1 disorder. Additional replicate studies are warranted. Public Health Significance: Schizophrenia (SZ) is devastating. When the Global Burden of Disease study calculated disability adjusted life years, weighted for the severity of disability, they determined active psychosis seen in schizophrenia produces disability equal to quadriplegia. Schizophrenia has been estimated to be among the top ten causes of disability worldwide. As schizophrenia is common (roughly 1% point prevalence worldwide), the economic burden to society is substantial. Pathogenesis is unknown and treatment is palliative. Therefore understanding the genetic etiology could facilitate development of promising therapeutics

Quantifying Physical Activity in Community Dwelling Older Adults Using Accelerometry

Background: A physically inactive lifestyle is associated with an increased risk for a variety of chronic diseases and health conditions. One population at greatest risk of physical inactivity is older adults. Studies: The specific aims for my dissertation research focused on further development of the Actigraph accelerometer to measure physical activity in community dwelling older adults. I proposed to first further define what an "activity count" from the Actigraph accelerometer represents. By comparing Actigraph counts to raw accelerometry, oxygen consumption and pedometer step count data at usual and slow walking speeds we found that counts per second were correlated with raw accelerometry and energy cost. Actigraph counts, raw acceleration, pedometer step counts and oxygen consumption were higher for usual versus slow walking conditions as expected. We were able to formulate a regression equation to estimate energy cost from Actigraph counts in community dwelling older adults. For the next project, I investigated the reliability and validity of the various ways to present data from the Actigraph accelerometer. All Actigraph measurement units of interest were highly correlated with each other as well as with performance based measures of mobility, function, age and self reported physical activity. Actigraph counts per minute and standard deviations of counts were able to distinguish between low and high mobility and functioning groups. Using ROC curves, we established a cut off value of 150 counts per minute to detect mobility and function problems. Finally, I determined meaningful change values of physical activity measured by the Actigraph over a 12 week exercise intervention in community dwelling older adults with walking difficulty. We found a value of 30 counts per minute to indicate substantial change beyond spurious error. Actigraph counts per minute did not change over the course of exercise intervention. However, people who were more active at baseline exhibited improvements in mobility and functional measures compared to those who were less active at baseline.Conclusion: From the projects described above, Actigraph counts have been validated in older adults against raw accelerometry, oxygen consumption, mobility, function, and self-reported physical activity measures. Inter-rater reliability was excellent for the multiple outputs of the Actigraph accelerometer. Actigraph counts per minute data output is our recommendation since it is the default output, has the least amount of processing, produces high inter-rater reliability and validity against mobility and function

Autism Spectrum Disorder Genetics: Diverse Genes with Diverse Clinical Outcomes

The last several years have seen unprecedented advances in deciphering the genetic etiology of autism spectrum disorders (ASDs). Heritability studies have repeatedly affirmed a contribution of genetic factors to the overall disease risk. Technical breakthroughs have enabled the search for these genetic factors via genome-wide surveys of a spectrum of potential sequence variations, from common single-nucleotide polymorphisms to essentially private chromosomal abnormalities. Studies of copy-number variation have identified significant roles for both recurrent and nonrecurrent large dosage imbalances, although they have rarely revealed the individual genes responsible. More recently, discoveries of rare point mutations and characterization of balanced chromosomal abnormalities have pinpointed individual ASD genes of relatively strong effect, including both loci with strong a priori biological relevance and those that would have otherwise been unsuspected as high-priority biological targets. Evidence has also emerged for association with many common variants, each adding a small individual contribution to ASD risk. These findings collectively provide compelling empirical data that the genetic basis of ASD is highly heterogeneous, with hundreds of genes capable of conferring varying degrees of risk, depending on their nature and the predisposing genetic alteration. Moreover, many genes that have been implicated in ASD also appear to be risk factors for related neurodevelopmental disorders, as well as for a spectrum of psychiatric phenotypes. While some ASD genes have evident functional significance, like synaptic proteins such as the SHANKs, neuroligins, and neurexins, as well as fragile x mental retardation–associated proteins, ASD genes have also been discovered that do not present a clear mechanism of specific neurodevelopmental dysfunction, such as regulators of chromatin modification and global gene expression. In their sum, the progress from genetic studies to date has been remarkable and increasingly rapid, but the interactive impact of strong-effect genetic lesions coupled with weak effect common polymorphisms has not yet led to a unified understanding of ASD pathogenesis or explained its highly variable clinical expression. With an increasingly firm genetic foundation, the coming years will hopefully see equally rapid advances in elucidating the functional consequences of ASD genes and their interactions with environmental/experiential factors, supporting the development of rational interventions

Improving prenatal diagnosis through standards and aggregation.

Advances in sequencing and imaging technologies enable enhanced assessment in the prenatal space, with a goal to diagnose and predict the natural history of disease, to direct targeted therapies, and to implement clinical management, including transfer of care, election of supportive care, and selection of surgical interventions. The current lack of standardization and aggregation stymies variant interpretation and gene discovery, which hinders the provision of prenatal precision medicine, leaving clinicians and patients without an accurate diagnosis. With large amounts of data generated, it is imperative to establish standards for data collection, processing, and aggregation. Aggregated and homogeneously processed genetic and phenotypic data permits dissection of the genomic architecture of prenatal presentations of disease and provides a dataset on which data analysis algorithms can be tuned to the prenatal space. Here we discuss the importance of generating aggregate data sets and how the prenatal space is driving the development of interoperable standards and phenotype-driven tools

Lack of Association of Rare Functional Variants in TSC1/TSC2 Genes with Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is reported in 30 to 60% of patients with tuberous sclerosis complex (TSC) but shared genetic mechanisms that exist between TSC-associated ASD and idiopathic ASD have yet to be determined. Through the small G-protein Rheb, the TSC proteins, hamartin and tuberin, negatively regulate mammalian target of rapamycin complex 1 (mTORC1) signaling. It is well established that mTORC1 plays a pivotal role in neuronal translation and connectivity, so dysregulation of mTORC1 signaling could be a common feature in many ASDs. Pam, an E3 ubiquitin ligase, binds to TSC proteins and regulates mTORC1 signaling in the CNS, and the FBXO45-Pam ubiquitin ligase complex plays an essential role in neurodevelopment by regulating synapse formation and growth. Since mounting evidence has established autism as a disorder of the synapses, we tested whether rare genetic variants in TSC1, TSC2, MYCBP2, RHEB and FBXO45, genes that regulate mTORC1 signaling and/or play a role in synapse development and function, contribute to the pathogenesis of idiopathic ASD. Methods: Exons and splice junctions of TSC1, TSC2, MYCBP2, RHEB and FBXO45 were resequenced for 300 ASD trios from the Simons Simplex Collection (SSC) using a pooled PCR amplification and next-generation sequencing strategy, targeted to the discovery of deleterious coding variation. These detected, potentially functional, variants were confirmed by Sanger sequencing of the individual samples comprising the pools in which they were identified. Results: We identified a total of 23 missense variants in MYCBP2, TSC1 and TSC2. These variants exhibited a near equal distribution between the proband and parental pools, with no statistical excess in ASD cases (P > 0.05). All proband variants were inherited. No putative deleterious variants were confirmed in RHEB and FBXO45. Three intronic variants, identified as potential splice defects in MYCBP2 did not show aberrant splicing upon RNA assay. Overall, we did not find an over-representation of ASD causal variants in the genes studied to support them as contributors to autism susceptibility. Conclusions: We did not observe an enrichment of rare functional variants in TSC1 and TSC2 genes in our sample set of 300 trios

Next generation sequencing of chromosomal rearrangements in patients with split-hand/split-foot malformation provides evidence for DYNC1I1 exonic enhancers of DLX5/6 expression in humans

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this recordSplit-hand/foot malformation type 1 is an autosomal dominant condition with reduced penetrance and variable expression. We report three individuals from two families with split-hand/split-foot malformation (SHFM) in whom next generation sequencing was performed to investigate the cause of their phenotype.Wellcome Trus

A novel microduplication of ARID1B: Clinical, genetic, and proteomic findings

Genetic alterations of ARID1B have been recently recognized as one of the most common mendelian causes of intellectual disability and are associated with both syndromic and non-syndromic phenotypes. The ARID1B protein, a subunit of the chromatin remodeling complex SWI/SNF-A, is involved in the regulation of transcription and multiple downstream cellular processes. We report here the clinical, genetic, and proteomic phenotypes of an individual with a unique apparent de novo mutation of ARID1B due to an intragenic duplication. His neurodevelopmental phenotype includes a severe speech/language disorder with full scale IQ scores 78-98 and scattered academic skill levels, expanding the phenotypic spectrum of ARID1B mutations. Haploinsufficiency of ARID1B was determined both by RNA sequencing and quantitative RT-PCR. Fluorescence in situ hybridization analysis supported an intragenic localization of the ARID1B copy number gain. Principal component analysis revealed marked differentiation of the subject's lymphoblast proteome from that of controls. Of 3426 proteins quantified, 1014 were significantly up- or down-regulated compared to controls (q<0.01). Pathway analysis revealed highly significant enrichment for canonical pathways of EIF2 and EIF4 signaling, protein ubiquitination, tRNA charging and chromosomal replication, among others. Network analyses revealed down-regulation of: (1) intracellular components involved in organization of membranes, organelles, and vesicles; (2) aspects of cell cycle control, signal transduction, and nuclear protein export; (3) ubiquitination and proteosomal function; and (4) aspects of mRNA synthesis/splicing. Further studies are needed to determine the detailed molecular and cellular mechanisms by which constitutional haploinsufficiency of ARID1B causes syndromic and non-syndromic developmental disabilities.FCT Fellowship SFRH/BD/52049/2012 to CMS, NIH grant GM061354 to JFG, and MET, SFARI grant 308955 to JFG and R00MH095867 to MET and Autism Research Institute grant to MRNinfo:eu-repo/semantics/publishedVersio