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Fabry disease (FD) is an X-linked lysosomal storage disorder caused by deficiency of the α-galactosidase A (GLA), leading to intracellular accumulations of globotriaosylceramide (Gb3). Acral burning pain, which can be triggered by heat, fever or physical activity is an early hallmark of FD and greatly reduces patients’ quality of life. The pathophysiology of FD pain is unknown and research is hindered by the limited in vivo availability of suitable human biomaterial. To overcome this obstacle, we generated induced pluripotent stem cells (iPSC) from one female and two male patients with a differing pain phenotype, and developed a refined differentiation protocol for sensory neurons to increase reliability and survival of these neurons, serving as an in vitro disease model. Neurons were characterized for the correct neuronal subtype using immunocytochemistry, gene expression analysis, and for their functionality using electrophysiological measurements.
iPSC and sensory neurons from the male patients showed Gb3 accumulations mimicking the disease phenotype, whereas no Gb3 depositions were detected in sensory neurons derived from the female cell line, likely caused by a skewed X-chromosomal inactivation in favor of healthy GLA. Using super-resolution imaging techniques we showed that Gb3 is localized in neuronal lysosomes of male patients and in a first experiment using dSTORM microscopy we were able to visualize the neuronal membrane in great detail. To test our disease model, we treated the neurons with enzyme replacement therapy (ERT) and analyzed its effect on the cellular Gb3 load, which was reduced in the male FD-lines, compared to non-treated cells. We also identified time-dependent differences of Gb3 accumulations, of which some seemed to be resistant to ERT. We also used confocal Ca2+ imaging to investigate spontaneous neuronal network activity, but analysis of the dataset proofed to be difficult, nonetheless showing a high potential for further investigations. We revealed that neurons from a patient with pain pain are more easily excitable, compared to cells from a patient without pain and a healthy control.
We provide evidence for the potential of patient-specific iPSC to generate a neuronal in vitro disease model, showing the typical molecular FD phenotype, responding to treatment, and pointing towards underlying electrophysiological mechanisms causing different pain phenotypes. Our sensory neurons are suitable for state-of-the-art microscopy techniques, opening new possibilities for an in-depth analysis of cellular changes, caused by pathological Gb3 accumulations. Taken together, our system can easily be used to investigate the effect of the different mutations of GLA on a functional and a molecular level in affected neurons.
Neuropsychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD), represent a burden which deeply impair the patient’s life. Neurobiological research has therefore increasingly focused on the examination of brain neurotransmitter systems, such as the serotonin (5-HT) system, since a dysfunction has been repeatedly implicated in the pathology of these diseases. However, investigation of functional human neurons in vitro has been restricted by technical limitations for a long time until the discovery of human induced pluripotent stem cells (iPSCs) revolutionized the field of experimental disease models. Since the pathogenesis of neuropsychiatric disorders involves a complex genetic component, genome-wide association studies (GWAS) revealed numerous risk genes that are associated with an increased risk for ADHD. For instance, the novel ADHD candidate gene SLC2A3 which encodes the glucose transporter-3 (GLUT3), facilitates the transport of glucose across plasma membranes and is essential for the high energy demand of several cell types, such as stem cells and neurons. Specifically, copy number variants (CNVs) of SLC2A3 might therefore impact cerebral glucose metabolism as well as the assembly of synaptic proteins in human neurons which might contribute to the pathogenesis of ADHD.
We hypothesized that an altered SLC2A3 gene dosage in human neurons can exert diverse protective or detrimental effects on neurodevelopmental processes as well as the coping of glucometabolic stress events, such as hypo- and hyperglycaemic conditions. The generation of specific iPSC lines from ADHD patients and healthy probands served as basis to efficiently differentiate stem cells into 5-HT specific neurons. Using this neuronal culture, we were able to examine effects of SLC2A3 CNVs on the basal expression of SCL2A3 and GLUT3 in human neurons. Furthermore, the focus was on potentially altered coping of the cells with glucose deprivation and the treatment with specific high- and low glycaemic media.
High-resolution fluorescence imaging in combination with electrophysiological and molecular biological techniques showed that:
1) The generated human iPSCs are fully reprogrammed human stem cells showing typical characteristics of embryonic stem cell-like morphology, growth behaviour, the ability to differentiate into different cell types of the human body and the expression of pluripotency-specific markers.
2) The neuronal subtype derived from our stem cells display typical characteristics of 5-HT specific median and dorsal neurons and forms synapses reflected by the expression of pre- and postsynaptic proteins.
3) Even if SLC2A3 CNVs influence SLC2A3 and GLUT3 basal expression, no significant alterations in gene and protein expression caused by hyper- and hypoglycaemic conditions, nor in the assembly of proteins associated with synapse formation could be observed in human iPSC-derived neurons.