We study how mishaps and damage in the cerebellum lead to the symptoms experienced by ataxia and tremor patients. By looking at human brains, as well as brains from mouse models, we study how different changes in brain structure can lead to symptoms. This includes how well different parts of the brain can communicate with each other.
Why do you do this research?
When you ask patients about the challenges living with ataxia or tremor, they will talk to you about their symptoms. Symptoms can make different activities of daily living very challenging! By connecting specific brain changes to specific symptoms, we want to develop treatment options that target specific diseases. By doing this, we hope to improve patient’s quality of life.
The Kuo lab is part of the Initiative for Columbia Ataxia and Tremor. It’s a new Initiative at Columbia University to bring a group of physicians, scientists, surgeons, and engineers to advance the knowledge of the cerebellum and to develop effective therapies for ataxia and tremor.
Are you recruiting human participants for research?
Yes, we are! We are looking for participants for clinical research and trials. You can learn more about the studies we are currently recruiting for at this link.
In the Kuo Lab, we call ourselves “the Protector of the Cerebellum in New York City”.
Neurons are the cells that serve as building blocks of the nervous system. The brain contains an enormous variety of neurons, and they all need to get a start somewhere. The process by which neurons are formed is called neurogenesis.
When does neurogenesis happen?
Nearly all neurogenesis occurs before the age of 2 when the brain is in the early stages of being formed and refined. While most cells in the body are replaced as they wear out or get injured, neurons in the brain do not. By young adulthood, the brain has largely stopped making new neurons. Other than serving as an excellent reason to wear a helmet and otherwise protect your head from injury, this lack of new neuron formation doesn’t have a noticeable effect on how we go about our daily lives. After all, neurons are an incredibly adaptable cell type that readily change in response to a person’s environment and experiences.
In the past few decades, we have learned that there is an exception to the “all neurons are born early in life” rule. Some research has shown that new neurons can, in fact, be formed during adulthood in specific brain areas. For example, the hippocampus, a brain structure important for its role in forming and maintaining memories, continues to create neurons over the course of one’s life.
The purpose of these newly generated neurons is still debated. However, numerous studies have shown that neuron formation in the hippocampus is reduced in instances of psychiatric and neurodegenerative disorders. This includes certain types of ataxia like SCA1. This is thought to contribute to changes in cognitive function and mood, though the exact mechanisms are still being determined.
Why is neurogenesis interesting for the spinocerebellar ataxias (SCAs), aren’t these neurodegenerative disorders?
Since the discovery of neurodegenerative disorders, most research has focused on symptoms and how to delay symptom onset. This view sees neurodegenerative disorders, like the SCAs, as outcomes of mid to late-life when the toxic effects of mutant proteins become suddenly rampant. However, these disorders are caused by proteins that are present from the very earliest stages of brain formation.
In 2018, researchers studying SCA1 found that neurogenesis is increased in the cerebellum of young mice. This changed how the cerebellum communicates with the rest of the brain. This suggests that cerebellar function can be affected by more than neuronal loss. It could be of wider interest in the SCAs given the cerebellar dysfunction that is common between them. No research on cerebellar neurogenesis has been performed in other SCAs by this point. However, there are some indications that neurogenesis may also be altered in SCA2.
Additionally, Huntington’s Disease, a polyglutamine repeat disorder in the same disease family as several SCAs, has been shown to have increased neurogenesis in the cortex in both young mice and prenatal babies. The combination of these recent studies has made early neuron formation an area of key interest in the study of neurodegenerative disorders.
Current theories in the field contend that while the brain can compensate for changes in neuron numbers in early life, altered neurogenesis could be creating unique brain circuitry in individuals with known disorder-causing protein mutations. These changes could make them more vulnerable to neuronal dysfunction and neurodegeneration later in life.
Evidence for changed neurogenesis in SCAs, both early and late in life, adds a new layer of consideration to what we broadly think of as a mid- to late-life neurodegenerative disease. Additional research in coming years will hopefully provide more insight into how these additional facets of neural health may inform the development of new therapies.
Snapshot written by Carrie Sheeler and edited by Dr. Chloe Soutar.
Cvetanovic M, Hu YS, Opal P. Mutant Ataxin-1 Inhibits Neural Progenitor Cell Proliferation in SCA1. Cerebellum. 2017 Apr;16(2):340-347. doi: 10.1007/s12311-016-0794-9. PMID: 27306906; PMCID: PMC5510931.
Shukla JP, Deshpande G, Shashidhara LS. Ataxin 2-binding protein 1 is a context-specific positive regulator of Notch signaling during neurogenesis in Drosophila melanogaster. Development. 2017 Mar 1;144(5):905-915. doi: 10.1242/dev.140657. Epub 2017 Feb 7. PMID: 28174239; PMCID: PMC5374347.
Xia G, Santostefano K, Hamazaki T, Liu J, Subramony SH, Terada N, Ashizawa T. Generation of human-induced pluripotent stem cells to model spinocerebellar ataxia type 2 in vitro. J Mol Neurosci. 2013 Oct;51(2):237-48. doi: 10.1007/s12031-012-9930-2. Epub 2012 Dec 9. PMID: 23224816; PMCID: PMC3608734.
Barnat M, Capizzi M, Aparicio E, Boluda S, Wennagel D, Kacher R, Kassem R, Lenoir S, Agasse F, Braz BY, Liu JP, Ighil J, Tessier A, Zeitlin SO, Duyckaerts C, Dommergues M, Durr A, Humbert S. Huntington’s disease alters human neurodevelopment. Science. 2020 Aug 14;369(6505):787-793. doi: 10.1126/science.aax3338. Epub 2020 Jul 16. PMID: 32675289; PMCID: PMC7859879.
Nerve cells (aka neurons) are unique cells in that they have long, and thin extensions called axons which form connections with and talk to other neurons. This particular shape of neurons determines how quickly they can get their messages to other cells. You can think of the axons in the brain like the wires connecting all the components of a dense electrical network.
NfL stands for Neurofilament light protein (Not to be confused with the national football league!). Neurofilaments are proteins found in our neurons. They are important for helping these cells hold their structure and size. We know this is important for their ability to send messages to other neurons. NfL is the smallest unit of three types of neurofilaments (light, medium and heavy). There is a lot of NfL found in the axons of neurons.
How do you measure NfL levels?
Like other proteins, NfL levels can be measured in fluids using tools known as immunoassays. These tools make use of antibodies generated by the immune systems to capture and count the protein of interest. It has been possible to measure NfL in cerebrospinal fluid (CSF) – the clear fluid that surrounds the brain and has lots of brain proteins – since 2005. In recent years, immunoassay technology has improved significantly, permitting the quantification of proteins previously too low in concentration to detect. One of these technologies is Single Molecule Array (Simoa) and has made it possible to measure NfL reliably in blood.
Why is NfL used as a biomarker?
Biomarkers are biological characteristics that can be measured and that tell us about a particular biological or disease process or response to a therapy. They can be used to make drug development more efficient. NfL is released into CSF after brain injury and also in many neurodegenerative diseases. This makes it a biomarker of neuronal injury. The problem with CSF is that it requires a safe but relatively invasive medical procedure called a lumbar puncture or spinal tap to collect. It would be a lot easier for both patients and doctors if we could get the same information from a blood test. Being able to quantify NfL – a brain protein – in blood, and more importantly, that it reflected what was happening in the brain was very exciting for many diseases.
In neurodegenerative diseases with effective disease modifying therapies (such as Multiple Sclerosis and Spinal Muscular Atrophy), a lowering of NfL reflects the clinical benefit in response to these therapies. In another genetic neurodegenerative disease caused by a CAG expansion, Huntington’s disease, NfL increase has been shown to be the earliest detectable change in asymptomatic gene carriers who are very far from their predicted age of disease onset. Many results like these suggest that NfL could help monitor disease even before symptoms appear, decide when to start therapies, and tell us if a drug is improving the health of neurons.
What NfL research is being done in ataxia research?
So what about ataxias? You will be pleased to know that Ataxia researchers have also jumped on the NfL band wagon. We previously wrote an article on two independently published studies in SCA3 which showed in many patients that NfL levels increased as Ataxia severity got worse, they were correlated with a measure of clinical severity (SARA) and increased with the level of brain loss (atrophy). One of the studies showed NfL levels increased with a higher number of CAG repeats in someone’s SCA3 mutation. There is also work using mouse models of SCA3 to understand this biomarker further. Two studies have now shown that NfL is also increased in Friedreich’s ataxia. With more research, NfL could potentially be used to design better clinical trials for ataxias and to monitor disease.
If you would like to learn more about NfL, take a look at this article by NeurologyLive.
Snapshot written by Dr. Lauren Byrne and edited by Dr. Gülin Öz.
The human brain contains about 170 billion cells. Half of these are neurons and the other half are lesser known cells called glia. Glial cells include astrocytes, oligodendrocytes and microglia. Astrocytes tile the entire brain and interact closely with neurons. Astrocytes are very important for neuronal function, in many ways playing a parenting-like role. They provide energy and support to neurons, and they clean after them. Astrocytes make sure that neuronal surroundings are “just right” for optimal function of neurons. They can also actively influence neuronal activity.
Similar to neurons, there are important differences in astrocytes from different brain regions. For instance, in the cerebellum there are about 5 times more neurons than astrocytes. Meanwhile in the cortex there are 10 times more astrocytes than neurons. In addition, astrocytes in the cerebellum and hippocampus (a brain region that plays an important role in memory) express different sets of proteins. These brain region differences can contribute to the role that astrocytes play in neuronal function in health as well as in disease.
Bergman Glia: An Important type of Astrocyte in Ataxia
In the cerebellum, there is a special type of astrocyte called Bergman glia that are very closely connected with Purkinje cells, neurons that are often vulnerable in ataxia. In fact, the relationship between Purkinje cells and Bergmann glia is often referred to as the most intimate neuron-astrocyte relationship in the brain. This is important as in brain injury and neurodegenerative diseases astrocytes undergo process called gliosis that changes their function. Gliosis can make them either more neuroprotective (helpful) or harmful.
For instance, when there is disease Bergmann glia can increase their support to help Purkinje neurons maintain their function and delay onset of disease symptoms. But also, Bergmann glia can become harmful worsening the dysfunction of Purkinje neurons and more severe disease symptoms.
It is important to learn more about how astrocytes are altered in ataxia for these reasons. We can use that knowledge about astrocytes to develop novel therapies to delay onset of ataxia symptoms and their severity.
One of the most important features of neurons (Purkinje cells, for example), is that they are capable of electrical communication. Think of the last time you saw a TV intro or movie montage with a depiction of the brain on a microscopic level – though it’s technically invisible to the naked eye, that ‘spark’ you can see traveling down a portion of the neuron is actually not too far from reality. One of the most common ways to describe an active neuron, in fact, is to say that it’s “firing.” Essentially, when a neuron is activated, it ‘fires off’ an electrical impulse that is transmitted down a long, slender extension known as the axon. The axon ends where the next neuron in the circuit begins, and when the impulse arrives at that point, it initiates a series of events that allows the signal to jump to the next cell.
This electrical signal is made possible by molecular machines known as ion channels. These proteins span the cell membrane, which is the barrier between the interior and exterior of the cell. When they receive a certain signal, the channel opens, allowing ions – atoms that carry an electrical charge, such as sodium, potassium, and calcium – to pass through. There are many types of proteins that allow the transport of small molecular components, but the source of a neuron’s electrical capabilities is that its channels specifically allow ions to pass into or out of the cell. Though a single ion’s charge is quite small, the large number of ions that are exchanged when a neuron’s channels open makes for a significant electrical effect – enough to produce an electrical signal that allows neurons to communicate with one another, giving us the ability to think, move, and interact with our environment.
Though the mutations that cause SCAs typically occur in genes that are expressed in every cell of the body, disease is usually restricted to the brain. One theory about why this is the case is that these SCA-related genes are necessary for the health and maintenance of ion channels in certain brain tissues – namely, the cerebellum and brainstem. At any rate, there is evidence that the electrical activity of these brain regions is abnormal in many SCAs, which strongly suggests that ion channels play a critical role in these disorders.