Teresa E. Lever

A mutation in the Warburg syndrome gene, RAB3GAP1, causes a similar syndrome with polyneuropathy and neuronal vacuolation in Black Russian Terrier dogs.

An autosomal recessive disease of Black Russian Terriers was previously described as a juvenile-onset, laryngeal paralysis and polyneuropathy similar to Charcot Marie Tooth disease in humans. We found that in addition to an axonal neuropathy, affected dogs exhibit microphthalmia, cataracts, and miotic pupils. On histopathology, affected dogs exhibit a spongiform encephalopathy characterized by accumulations of abnormal, membrane-bound vacuoles of various sizes in neuronal cell bodies, axons and adrenal cells. DNA from an individual dog with this polyneuropathy with ocular abnormalities and neuronal vacuolation (POANV) was used to generate a whole genome sequence which contained a homozygous RAB3GAP1:c.743delC mutation that was absent from 73 control canine whole genome sequences. An additional 12 Black Russian Terriers with POANV were RAB3GAP1:c.743delC homozygotes. DNA samples from 249 Black Russian Terriers with no known signs of POANV were either heterozygotes or homozygous for the reference allele. Mutations in human RAB3GAP1 cause Warburg micro syndrome (WARBM), a severe developmental disorder characterized by abnormalities of the eye, genitals and nervous system including a predominantly axonal peripheral neuropathy. RAB3GAP1 encodes the catalytic subunit of a GTPase activator protein and guanine exchange factor for Rab3 and Rab18 respectively. Rab proteins are involved in membrane trafficking in the endoplasmic reticulum, axonal transport, autophagy and synaptic transmission. The neuronal vacuolation and membranous inclusions and vacuoles in axons seen in this canine disorder likely reflect alterations of these processes. Thus, this canine disease could serve as a model for WARBM and provide insight into its pathogenesis and treatment.

Improving the Utility of Laryngeal Adductor Reflex Testing A Translational Tale of Mice and Men

Objectives Evaluation of the laryngeal adductor reflex (LAR) entails delivering air through an endoscope positioned 1 to 2 mm from the arytenoid mucosa to elicit bilateral vocal fold (VF) closure. This short working distance limits visualization to only the ipsilateral arytenoid and results in quantification of a single LAR metric: threshold pressure that evokes the LAR. Our goal was to evolve the LAR procedure to optimize its utility in clinical practice and translational research. Study Design Prospective translational experiment. Setting Academic institution. Subjects Young healthy human adults (n = 13) and 3 groups of mice: healthy, primary aging mice (n = 5), a transgenic mouse model of amyotrophic lateral sclerosis (ALS; n = 4), and young healthy controls (n = 10). Methods The VFs were visualized bilaterally during supramaximal air stimulation through an endoscope. Responses were analyzed to quantify 4 novel metrics: VF adduction phase duration, complete glottic closure duration, VF abduction phase duration, and total LAR duration. Results The 4 LAR metrics are remarkably similar between healthy young humans and mice. Compared to control mice, aging mice have shorter glottic closure durations, whereas ALS-affected mice have shorter VF abduction phase durations. Conclusions We have established a new LAR protocol that permits quantification of novel LAR metrics that are translatable between mice and humans. Using this protocol, we showed that VF adduction is impaired in primary aging mice, whereas VF abduction is impaired in ALS-affected mice. These preliminary findings highlight the enhanced diagnostic potential of LAR testing.

Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models

This study adapted human videofluoroscopic swallowing study (VFSS) methods for use with murine disease models for the purpose of facilitating translational dysphagia research. Successful outcomes are dependent upon three critical components: test chambers that permit self-feeding while standing unrestrained in a confined space, recipes that mask the aversive taste/odor of commercially-available oral contrast agents, and a step-by-step test protocol that permits quantification of swallow physiology. Elimination of one or more of these components will have a detrimental impact on the study results. Moreover, the energy level capability of the fluoroscopy system will determine which swallow parameters can be investigated. Most research centers have high energy fluoroscopes designed for use with people and larger animals, which results in exceptionally poor image quality when testing mice and other small rodents. Despite this limitation, we have identified seven VFSS parameters that are consistently quantifiable in mice when using a high energy fluoroscope in combination with the new murine VFSS protocol. We recently obtained a low energy fluoroscopy system with exceptionally high imaging resolution and magnification capabilities that was designed for use with mice and other small rodents. Preliminary work using this new system, in combination with the new murine VFSS protocol, has identified 13 swallow parameters that are consistently quantifiable in mice, which is nearly double the number obtained using conventional (i.e., high energy) fluoroscopes. Identification of additional swallow parameters is expected as we optimize the capabilities of this new system. Results thus far demonstrate the utility of using a low energy fluoroscopy system to detect and quantify subtle changes in swallow physiology that may otherwise be overlooked when using high energy fluoroscopes to investigate murine disease models.

Semiautomatic marker tracking of tongue positions captured by videofluoroscopy during primate feeding

Videofluoroscopy (VF) is one of the most commonly used tools to assess oropharyngeal dysphagia as well as to visualize musculoskeletal structures of humans and animals engaged in various behaviors, including feeding. Despite its importance in clinical and scientific use, processing VF data has historically been extremely tedious because it is performed using manual frame-by-frame methods. With recent technological advances, the frame rate for scientific use has been increasing along with the use of high speed data capture systems. In the current study, we used non-human primates as a model animal to study human feeding behaviors to capture tongue movement based on markers implanted into the tongue. Here, we introduce a semi-automatic marker tracking algorithm that yields high tracking accuracy (> 90%) and dramatic speed improvements (faster than real time labeling). Furthermore, we quantify the sources of tracking errors and the tracking performance as a function of marker speeds. Our results indicate that there is more room for methodological improvements both in detection and prediction of marker positions. Moreover, correspondingly faster frame rates will be required to capture faster kinematic behaviors such as those of mice, which are extensively used to study both control and pathological conditions.

Hypoglossal Motor Neuron Death Via Intralingual CTB–saporin (CTB–SAP) Injections Mimic Aspects of Amyotrophic Lateral Sclerosis (ALS) Related to Dysphagia

Amyotrophic lateral sclerosis (ALS) is a devastating disease leading to degeneration of motor neurons and skeletal muscles, including those required for swallowing. Tongue weakness is one of the earliest signs of bulbar dysfunction in ALS, which is attributed to degeneration of motor neurons in the hypoglossal nucleus in the brainstem, the axons of which directly innervate the tongue. Despite its fundamental importance, dysphagia (difficulty swallowing) and strategies to preserve swallowing function have seldom been studied in ALS models. It is difficult to study dysphagia in ALS models since the amount and rate at which hypoglossal motor neuron death occurs cannot be controlled, and degeneration is not limited to the hypoglossal nucleus. Here, we report a novel experimental model using intralingual injections of cholera toxin B conjugated to saporin (CTB-SAP) to study the impact of only hypoglossal motor neuron death without the many complications that are present in ALS models. Hypoglossal motor neuron survival, swallowing function, and hypoglossal motor output were assessed in Sprague-Dawley rats after intralingual injection of either CTB-SAP (25 g) or unconjugated CTB and SAP (controls) into the genioglossus muscle. CTB-SAP treated rats exhibited significant (p ≤ 0.05) deficits vs. controls in: (1) lick rate (6.0 ± 0.1 vs. 6.6 ± 0.1 Hz; (2) hypoglossal motor output (0.3 ± 0.05 vs. 0.6 ± 0.10 mV); and (3) hypoglossal motor neuron survival (398 ± 34 vs. 1018 ± 41 neurons). Thus, this novel, inducible model of hypoglossal motor neuron death mimics the dysphagia phenotype that is observed in ALS rodent models, and will allow us to study strategies to preserve swallowing function.

A retrospective investigation of the relationship between baseline covariates and rate of ALSFRS-R decline in ALS clinical trials

Abstract The revised ALS functional rating scale (ALSFRS-R) is a longitudinal measure of global function commonly used to assess progression of amyotrophic lateral sclerosis (ALS), and as an endpoint in ALS clinical trials. Understanding how baseline covariates affect the rate of functional decline in ALS offers valuable information to clinical trialists. We used a mixed modeling approach in a retrospective study of the pooled resource open-Access ALS clinical trials database to elucidate the associations between baseline covariates and the rate of ALSFRS-R decline over time. In a cohort of 3203 patients followed for an average of 337 days, older age at disease onset (p < 0.001), less time since disease onset (p < 0.001), and bulbar site of onset (p < 0.001) were associated with a significantly faster decline of the ALSFRS-R, while sex did not have a statistically significant effect (p = 0.82). Selective inclusion of ‘age at disease onset’ and ‘time since disease onset’ as covariates provided the best tradeoff between model fit and model precision. The effect of bulbar onset on rate of disease progression was primarily due to accelerated decline in the bulbar subscale of the ALSFRS-R. These findings, which are novel in the clinical trial time frame, contribute to the understanding of disease trajectory in ALS and can be used to guide future design and analysis of clinical trials.

Development of semi-automatic procedure for detection and tracking of fiducial markers for orofacial kinematics during natural feeding

Feeding is a highly complex, essential behavior for survival in all species. Characterization of feeding behaviors has implications in basic science and translational medicine. We have been developing methods to study feeding behaviors using high speed videofluoroscopy (XROMM) in rats while self-feeding radiopaque flavored kibble. The rat is a popular model in translational medicine; however, it has not been studied using this methodology. Towards this goal, we surgically implanted radiopaque fiducial markers into the skull, mandible, and tongue of rats to enable motion tracking. We are developing computer vision tools to extract kinematics and behavioral features from XROMM videos to overcome barriers of current analysis methods. By understanding feeding dynamics, we will gain basic scientific knowledge and translational insights for feeding disorders caused by neurological conditions such as ALS, Parkinsons disease, and stroke.

Creation of resin rodent skulls to reduce animal numbers for stereotactic surgery practice

Lab personnel must practice stereotactic techniques multiple times to become proficient before accurate data can be collected. This learning curve often results in a large number of rodents being euthanized purely as a result of practice surgeries, often due to inaccurate positioning of implant devices or headstage attachment failure. In order to reduce the number of animals used, our lab has created a method for constructing resin rodent skull models to practice various stereotactic techniques. To create the skull models, a single rodent of the strain and approximate weight of future experimental procedures attachment of wires to transmit signals to/from electrophysiology equipment1. Attaching headstages and implanting devices requires careful and precise drilling into the skull, without damaging the brain, to place anchor screws, followed by applying dental cement to secure the headstage and implant in place1,4. Dental cement must be applied in a time-dependent fashion at the proper consistency to mold the cement into crevices on the skull while remaining solid enough to create a steadfast foundation. If the cement is not applied correctly, the headstage will easily fall from the skull within a few days, leaving the rodent unusable for data collection1. Stereotactic brain surgery Stereotactic brain surgery in laboratory rodents is an essential procedure used for various applications in neuroscience research to study neurologic function in many healthy and disease states of animal models1–3. This technique can be used to implant cannulas2–4, electrodes,1 or other devices such as optical fibers5 into specific brain regions to directly manipulate and/or record neuronal activity. Stereotactic placement of cranial implants allows neuroscience experiments in unanesthetized animals that are alert and freely behaving. Implanting devices requires immobilization of the animal in ear bars and the use of precise coordinates to allow insertion of electrodes or cannulas into specific regions of the brain without harming the animal. Furthermore, screws and dental cement are often used to secure protective headstages to the skull.

Neural Mechanisms Contributing to Dysphagia in Mouse Models

Investigative research into curative treatments for dysphagia is hindered by our incomplete understanding of the neural mechanisms of swallowing in health and disease. Development of translational research models is essential to bridge this knowledge gap by fostering innovative methodology. Toward this goal, our laboratory has developed a translational research assessment tool to investigate the neural mechanistic control of swallowing in unrestrained, self-feeding mice. Here we describe our initial development of synchronous brainstem neural recordings with a videofluoroscopic swallow study assay in healthy mice across the life span. Refinement of this combined methodology is currently underway. Ultimately, we envision that this assessment tool will permit systematic analysis of therapeutic interventions for dysphagia in preclinical trials with numerous mouse models of human conditions that cause dysphagia, such as amyotrophic lateral sclerosis, Parkinson’s disease, stroke, and advanced aging.