How race + TBI experience affect views of informed consent

The upcoming HBO movie of The Immortal Life of Henrietta Lacks reminds us that biomedical research has a complex legacy, when it comes to informed consent and people of color.

A paper from Emory investigators, published in AJOB Empirical Bioethics, touches on related current issues. The paper examines how race and close experience with traumatic brain injury affect study participants’ views of informed consent in clinical research.

This emerged from a study of community consultation for EFIC (exception from informed consent), in connection with a nationwide clinical trial of progesterone for traumatic brain injury (TBI). EFIC describes clinical research performed when the normal process of obtaining patients’ informed consent is not possible, because of emergency conditions such as seizures or TBI. Before such studies can be undertaken, the FDA calls for protective procedures and community consultation.

In this case, researchers surveyed 2612 people at 12 sites involved in the TBI study. The survey asked about attitudes toward the EFIC aspects of the study and also asked if they had personal experience with traumatic brain injury – either themselves or someone close to them. How that personal connection affected their responses was influenced by race.

Key paragraph from discussion:

Among white participants, increased levels of acceptance of EFIC were found among those with any connections to TBI. On the other hand, among participants identifying as black or other nonwhite races, there was decreased acceptance of EFIC enrollment among TBI patients and no increase in acceptance among those with a family member/loved one with TBI. The fact that black and white participants with no personal TBI experience or with a more distant connection to TBI had similar acceptance rates suggests that baseline acceptance of EFIC among these two groups is fairly similar and that the experience with the condition itself plays a role in driving the observed differences…

Posted on April 21, 2017 by Quinn Eastman in Heart, Neuro, Uncategorized Leave a comment

Enhanced verbal abilities in the congenitally blind

A recent paper in Experimental Brain Research from Emory neuroscientist Krish Sathian and colleagues demonstrates that congenitally blind study participants displayed superior verbal, but not spatial abilities, when compared to their sighted counterparts. This may reflect both greater reliance on verbal information, and the recruitment of the visual cortex for verbal tasks.

Sathian’s team has also been investigating, through brain imaging studies, whether the visual cortex is involved in the processing of metaphors (2016 SFN abstract) in the congenitally blind. They previously showed that blind study participants were better at identifying rotated objects by touch. Read more

Posted on March 21, 2017 by Quinn Eastman in Neuro Leave a comment

Anti-TNF vs Alzheimer’s mouse model

An experimental anti-inflammatory drug has positive effects on neuron function and amyloid plaques in a mouse model of Alzheimer’s disease, Emory neuroscientists report. The findings are published in the journal Neurobiology of Disease.

Inflammation’s presence in Alzheimer’s is well established, but it is usually thought of as an accelerator, rather than an initiating cause. While everybody argues about the amyloid hypothesis, there’s a case to be made for intervening against the inflammation. Exactly how is an open question.

The drug tested, called XPro1595, targets the inflammatory signaling molecule tumor necrosis factor (TNF). Commercialized drugs such as etanercept and infliximab, used to treat autoimmune diseases, also block TNF. However, XPro1595 only interferes with the soluble form of TNF and is supposed to have less of an effect on overall immune function.

Senior author Malu Tansey (pictured) and her colleagues say that interfering with TNF could have direct effects on neurons, as well as indirect effects on the immune cells infiltrating the brain. They write that “the most promising finding in our study” is the ability of XPro1595 to restore long-term potentiation or LTP, which is impaired in the Alzheimer’s model mice. Read more

Posted on March 16, 2017 by Quinn Eastman in Immunology, Neuro Leave a comment

‘Matchmaker’ role for protein behind SMA

Motor neurons connect the spinal cord to the muscles. They can be a meter long in adult humans. SMA (spinal muscular atrophy) affects approximately 1 in 10,000 babies. It impairs the ability to move and breathe, and in its most severe form, kills before the age of two.

A puzzling question has lurked behind SMA (spinal muscular atrophy), the leading genetic cause of death in infants.

The disorder leads to reduced levels of the SMN (survival of motor neurons) protein, which is thought to be involved in processing RNA, something that occurs in every cell in the body. So why does interfering with a process that happens everywhere affect motor neurons first?

Scientists at Emory University School of Medicine have been building a case for an answer. It’s because motor neurons have long axons. And RNA must be transported to the end of the axons for motor neurons to survive and keep us moving, eating and breathing.

Now the Emory researchers have a detailed picture for what they think the SMN protein is doing, and how its deficiency causes problems in SMA patients’ cells. The findings are published in Cell Reports.

Wilfried Rossoll, PhD in the lab.

“Our model explains the specificity — why motor neurons are so vulnerable to reductions in SMN,” says Wilfried Rossoll, PhD, assistant professor of cell biology at Emory University School of Medicine [and soon moving to the Mayo Clinic in Jacksonville]. “What’s new is that we have a mechanism.”

Rossoll and his colleagues showed that the SMN protein is acting like a “matchmaker” for messenger RNA that needs partners to transport it into the cell axon.

RNA carries messages from DNA, huddled in the nucleus, to the rest of the cell so that proteins can be produced locally. But RNA can’t do that on its own, Rossoll says. In the paper, the scientists call SMN a “molecular chaperone.” That means SMN helps RNA hook up with processing and transport proteins, but doesn’t stay attached once the connections are made.

“It loads the truck, but it’s not on the truck,” Rossoll says. [Read the rest of Emory’s press release here.]

He also tells me that even though the two diseases affect very different age groups, SMA and ALS (amyotrophic lateral sclerosis) have two things in common: they both affect motor neurons and they both involve proteins that transport RNA. He says an emerging idea in the field is that SMA represents a problem of “hypo-assembly” while ALS is a problem of “hyper-assembly.”

Posted on February 15, 2017 by Quinn Eastman in Neuro Leave a comment

Parkinson’s disease: hold the AMPs

Pathologist Keqiang Ye and colleagues recently published a paper in PNAS that may have implications for Parkinson’s disease pathology and treatment strategies.

The protein alpha-synuclein is a bad actor in PD (nice explainer from Michael J. Fox Foundation); it’s a major constituent of Lewy bodies, the protein clumps that appear in PD patients’ brains, and there is a genetic link too. Alpha-synuclein seems to bring other proteins into the clumps, which may disrupt neuron function.

In particular, it sequesters PIKE-L, an inhibitor of AMP kinase, leading to AMP kinase hyperactivation and cell death. AMP kinase is a metabolic regulator activated by metformin, a common treatment for diabetes. So activating AMP kinase in some situations can be good for your body; however for the neurons affected by alpha-synuclein, activating it too much is bad.

Posted on February 3, 2017 by Quinn Eastman in Neuro Leave a comment

More on NMDA receptor variants + epilepsy/ID

NMDA receptors are complex electrochemical machines, important for signaling between brain cells. Rare mutations in the corresponding genes cause epilepsy and intellectual disability.

Pre-M1 helices in multi-subunit NMDA receptor. Adapted from Ogden et al PLOS Genetics (2017).

In Emory’s Department of Pharmacology, the Traynelis and Yuan labs have been harvesting the vast amounts of information now available from public genome databases, to better understand how changes in the NMDA receptor genes relate to function. (Take a “deeper dive” into their November 2016 publication on this topic here.)

Their recent paper in PLOS Genetics focuses on a particular region in the NMDA receptor, called the pre-M1 helix (see figure). It also includes experiments on whether drugs now used for Alzheimer’s disease, such as memantine, could be repurposed to have beneficial effects for patients with certain mutations. The in vitro data reported here could inform clinical use. Read more

Posted on January 31, 2017 by Quinn Eastman in Neuro Leave a comment

How estrogen modulates fear learning — molecular insight into PTSD in women

Low estrogen levels may make women more susceptible to the development of post-traumatic stress disorder (PTSD) at some points in their menstrual cycles or lifetimes, while high estrogen levels may be protective.

New research from Emory University School of Medicine and Harvard Medical School provides insight into how estrogen changes gene activity in the brain to achieve its protective effects.

The findings, published in Molecular Psychiatry, could inform the design of preventive treatments aimed at reducing the risk of PTSD after someone is traumatized.

The scientists examined blood samples from 278 women from the Grady Trauma Project, a study of low-income Atlanta residents with high levels of exposure to violence and abuse. They analyzed maps of DNA methylation, a modification to the shape of DNA that is usually a sign of genes that are turned off.

The group included adult women of child-bearing age, in which estrogen rises and falls with the menstrual cycle, and women that had gone through menopause and had much lower estrogen levels.

“We knew that estrogen affects the activity of many genes throughout the genome,” says Alicia Smith, PhD, associate professor and vice chair of research in the Department of Gynecology and Obstetrics at Emory University School of Medicine. “But if you look at the estrogen-modulated sites that are also associated with PTSD, just one pops out.”

That site is located in a gene called HDAC4, known to be critical for learning and memory in mice. Genetic variation in HDAC4 among the women was linked to a lower level of HDAC4 gene activity and differences in their ability to respond to and recover from fear, and also differences in “resting state” brain imaging. Women with the same variation also showed stronger connections in activation between the amygdala and the cingulate cortex, two regions of the brain involved in fear learning.

Posted on January 20, 2017 by Quinn Eastman in Neuro Leave a comment

Breath test for Parkinson’s?

Using one to see into the other. Left: canister for breath sample. Right: basal ganglia, a region of the brain usually affected by Parkinson’s.

Scientists think that it may be possible to detect signs of Parkinson’s disease through a breath test.

The Michael J. Fox Foundation for Parkinson’s Research is supporting a clinical study at Emory that will probe this idea. Neuro-immunologist Malu Tansey is working with Hygieia, a Georgia-based company that has developed technology for analyzing volatile organic compounds present in exhaled air.

From the MJFF’s blog:

By collecting and analyzing breath samples in 100 people (50 non-smoking early-stage PD patients and 50 age and sex-matched controls), the researchers hope to define a unique inflammatory PD-specific breath fingerprint that could be used to predict and monitor disease in combination with blood analyses of conventional or newly discovered biomarkers.

“We hypothesize that breath volatile organic compounds (BVOCs) fingerprinting can enable sensitive and specific measures of ongoing inflammation and other processes implicated in the development and/or progression of PD, and thus could represent an early detection tool,” Tansey says.

If results indicate moving forward, Tansey says it will be important to compare the breath sample method against blood tests for inflammatory markers. Other reports on the breath test approach for Parkinson’s have been encouraging. Read more

Posted on January 17, 2017 by Quinn Eastman in Neuro 1 Comment

Four biomedical research topics to watch in 2017

HIV/AIDS

The example of the “Berlin patient,” the only person ever cured of HIV infection, has energized HIV/AIDS researchers around the world. They are exploring a variety of tactics to attack the HIV reservoir in infected people, ranging from gene editing to “kick and kill.” A host of Emory/Yerkes researchers are among those pushing this forward.

This past year, an Emory/NIAID team led by Tab Ansari showed that a gentle, antibody-based approach could suppress SIV infection in macaques for extended periods, which surprised many in the field. The human test of this approach is now underway at the National Institutes of Health.

On the preventive vaccine side, a large scale efficacy study recently begun in South Africa, the first in seven years. Geovax’s Emory-rooted technology continues to advance in clinical studies. Further back in the pipeline, Yerkes researchers are testing innovative approaches, such as Rama Amara’s milk-bacteria-based mucosal vaccine and the potent nanoparticle adjuvants developed by Bali Pulendran’s group.

Zika

Despite the World Health Organization’s declaration in November that the public health emergency is over, Zika infection is still driving brain-related birth defects in several countries. Expect to hear more about Zika epidemiology and vaccine research, including from Emory investigators, next year.

In contrast with HIV, which seems to escape from almost anything we or our immune systems throw at it, Zika is doable, scientists think. At a Vaccine Dinner Club talk in September, Harvard’s Dan Barouch made the case that Zika is a slam dunk, immunologically. Two big questions remain: does dengue get in the way? And can vaccine makers test quickly and distribute widely?

FMT for antibiotic-resistant infections

Emory physicians have been leaders in developing fecal microbiota transplant as a remedy for recurrent Clostridium dificile infection. This form of diarrhea, which can be life-threatening, sometimes arises as a result of antibiotics that wipe out the helpful bacteria that live in the intestines, paving the way for “C diff.”

Now the Emory team (Colleen Kraft/Tanvi Dhere/Aneesh Mehta/Rachel Friedman-Moraco) is testing whether FMT could prevent other antibiotic-resistant infections besides C diff. This approach will be examined in a group of patients that tends to have a lot of antibiotic exposure: kidney transplant recipients. The team’s first publication on this topic from 2014 is here. Read more

Posted on December 21, 2016 by Quinn Eastman in Immunology, Neuro Leave a comment

How “twist my arm” engages the brain

Listening to metaphors involving arms or legs loops in a region of the brain responsible for visual perception of those body parts, scientists have discovered.

The finding, recently published in Brain & Language, is another example of how neuroscience studies are providing evidence for “grounded cognition” – the idea that comprehension of abstract concepts in the brain is built upon concrete experiences, a proposal whose history extends back millennia to Aristotle.

The EBA was shown in 2001 to respond selectively to images of the human body by Nancy Kanwisher and colleagues.

When study participants heard sentences that included phrases such as “shoulder responsibility,” “foot the bill” or “twist my arm”, they tended to engage a region of the brain called the left extrastriate body area or EBA.

The same level of activation was not seen when participants heard literal sentences containing phrases with a similar meaning, such as “take responsibility” or “pay the bill.” The study included 12 right-handed, English-speaking people, and blood flow in their brains was monitored by functional MRI (magnetic resonance imaging).

“The EBA is part of the extrastriate visual cortex, and it was known to be involved in identifying body parts,” says senior author Krish Sathian, MD, PhD, professor of neurology, rehabilitation medicine, and psychology at Emory University. “We found that the metaphor selectivity of the EBA matches its visual selectivity.” Read more

Posted on December 14, 2016 by Quinn Eastman in Neuro Leave a comment

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