Frank R. Sharp - US grants

Previous work has demonstrated survival of peptidergic, diaphorase, and pyramidal neurons in fetal cortex transplants which connect to host cortex and subcortical structures. This proposal addresses the question of whether these transplants are functional, and if so, whether this is due to appropriate connections or to trophic interactions between host and transplant. To answer whether transplants are functional, rats are first trained to perform a forelimb motor task. One week after lesioning forelimb motor cortex, one group receives fetal frontal cortex, one receives fetal cerebellar, and one receives gelfoam implants. The motor behavior of each transplanted group is compared to the gelfoam implanted controls. Following this, transplants are removed. It is hypothesized that forelimb motor function will deteriorate following removal of functional transplants. Secondly, it will be determined whether adult host brain thalamic connections to fetal parietal cortex transplants are functional. The whisker sensory barrelfield of adult rats is removed, and fetal parietal cortex transplanted into the cavity. Later, the vibrissae contralateral to the transplants are stimulated. 2-deoxyglucose is injected and the resting and stimulated transplant glucose metabolic rates determined using a double label autoradiographic method. Transplants with functional host connections should be metabolically activated during the whisker sensory stimulation. Lastly, trophic effects of fetal cortical transplants on neonatal host thalamus will be examined. One week after removal of the frontal cortex of newborn rats, either fetal frontal cortex, fetal cerebellum, fetal parietal cortex, minced fetal frontal cortex, or gelfoam is transplanted into lesion cavities. Since marked host thalamic atrophy normally occurs ipsilateral to fetal frontal cortex lesions, this will determine which transplants ameliorate the atrophy. Host-transplant connections are examined in the above experiments to determine which effects correlate with formation of connections. Cortex injury due to strokes, head trauma, and other diseases can lead to devastating, permanent motor and sensory impairments in humans. The data from this proposal will help determine whether fetal transplants might offer some hope for treating such deficits.

Previous work has demonstrated survival of peptidergic, diaphorase, and pyramidal neurons in fetal cortex transplants which connect to host cortex and subcortical structures. This proposal addresses the question of whether these transplants are functional, and if so, whether this is due to appropriate connections or to trophic interactions between host and transplant. To answer whether transplants are functional, rats are first trained to perform a forelimb motor task. One week after lesioning forelimb motor cortex, one group receives fetal frontal cortex, one receives fetal cerebellar, and one receives gelfoam implants. The motor behavior of each transplanted group is compared to the gelfoam implanted controls. Following this, transplants are removed. It is hypothesized that forelimb motor function will deteriorate following removal of functional transplants. Secondly, it will be determined whether adult host brain thalamic connections to fetal parietal cortex transplants are functional. The whisker sensory barrelfield of adult rats is removed, and fetal parietal cortex transplanted into the cavity. Later, the vibrissae contralateral to the transplants are stimulated. 2-deoxyglucose is injected and the resting and stimulated transplant glucose metabolic rates determined using a double label autoradiographic method. Transplants with functional host connections should be metabolically activated during the whisker sensory stimulation. Lastly, trophic effects of fetal cortical transplants on neonatal host thalamus will be examined. One week after removal of the frontal cortex of newborn rats, either fetal frontal cortex, fetal cerebellum, fetal parietal cortex, minced fetal frontal cortex, or gelfoam is transplanted into lesion cavities. Since marked host thalamic atrophy normally occurs ipsilateral to fetal frontal cortex lesions, this will determine which transplants ameliorate the atrophy. Host-transplant connections are examined in the above experiments to determine which effects correlate with formation of connections. Cortex injury due to strokes, head trauma, and other diseases can lead to devastating, permanent motor and sensory impairments in humans. The data from this proposal will help determine whether fetal transplants might offer some hope for treating such deficits.

[unreadable] DESCRIPTION (provided by applicant): The pre-induction or over-expression of heat shock proteins (Hsps) protects cells against a wide variety of injuries that produce either necrosis or apoptosis. Ischemia induces the Hsp70 heat shock protein in brain, and Hsp70 over-expression in transgenic mice protects against stroke. In addition, a Hsp90 binding drug, geldanamycin, induces Hsp70 and other Heat Shock Proteins in brain and protects against focal and global ischemia. Lastly, a recombinant Hsp70 protein with a TAT protein transduction domain (PTD) has been synthesized (PTD-Hsp70) that markedly facilitates entry of the PTD-Hsp70 protein directly into cells and into brain. This proposal will continue to test the hypothesis that heat shock proteins protect brain from injury. The first Aim will test which recombinant Hsp70 proteins with TAT, modified PTD, VP22 and ANTP transduction sequences enter cells the best in vitro; it will determine whether mutation of the EEVD and DEVQ sequences in the Hsp70 protein to DEVDs directly inhibits already activated caspase 3 and improves protection against injury in vitro; confirm that Hsp70 directly blocks NF-kB transactivation in vitro and whether this is due to a direct interaction with NF-kB or not; determine which of the wild type and mutant recombinant proteins enter the uninjured brain the best when injected intravenously. The second Aim will demonstrate that the wild type PTD-Hsp70 protein, and mutant PTD-HSP70 proteins with DEVD mutations protect brain against: temporary focal cerebral ischemia; permanent focal cerebral ischemia; global cerebral ischemia; and decrease the incidence and severity of hemorrhage following tPA (tissue plasminogen activator) lysis of clot induced strokes. The last Aim will determine whether geldanamycin, a drug that induces endogenous heat shock proteins, protects against stroke when given prior to and following focal and global cerebral ischemia. Possible mechanisms of protection will be examined including whether heat shock proteins decrease numbers of TUNEL stained cells; decrease caspase 3, 8 and 9 activation and cleavage; and, decrease mitochondrial release of cytochrome C, apoptosis inducing factor (AIF) and Smac into the cytosol. Heat shock proteins should also decrease protein denaturation and increase free ubiquitin in cells as assessed by Western blots. These studies will show that Heat Shock Proteins can protect the ischemic brain, and will test whether recombinant PTD-Hsp70 proteins or a drug that induces heat shock proteins could be used to treat or prevent stroke. [unreadable] [unreadable]

Despite intensive experimental research activities devoted to neuronal injury following cerebral ischemia and trauma, our understanding of the mechanisms by which the neurons undergo necrosis and apoptosis is still rather poor. The objective of our CNS Injury and Edema Research Center is to employ both in vivo models of cerebral ischemia and trauma and in vitro cell culture systems to further elucidate cellular and molecular mechanisms of neuronal cell death. Our long-term goal is to develop pharmacological and therapeutic interventions to ameliorate the brain injuries. We will primarily focus on the role of oxidative stress, novel gene expression, and astrocytes on ischemic dismutase gene will be employed. Thus the research project of this proposal provides for interdisciplinary studies ranging from molecular biology, physiology, molecular genetics, biochemistry and morphology to investigate the basis of ischemic and traumatic brain injury. The program includes four interrelated projects: Oxidative stress and neuronal injury in cerebral ischemia; Role of stress protein and SOD expression on neuronal resistance to ischemia; Mechanism of subarachnoid hemorrhage-induced brain injury after head trauma; and Stress genes in cerebral ischemia. All projects are conceptually integrated with one another. Experimentally, they will rely heavily on the Scientific Core. Extensive utilization of transgenic and knockout mutant mice will provide a common vehicle for our interaction among the projects to study the mechanisms of neuronal injury following cerebral ischemia and trauma.

DESCRIPTION (From Abstract): New cells are born in the brain throughout adult life. One source of newborn cells is the subgranular zone of the dentate gyrus of the hippocampus. The newborn cells have the potential for forming neurons, astrocytes or oligodendrocytes. Many cells born in the subgranular zone that migrate into the granule cell layer form mature neurons. NMDA receptors, seizures and stress hormones regulate this neurogenesis. We have found that ischemia also up-regulates neurogenesis. BrdU immunohistochemistry was used to show a 9-fold increase of cell birth in the dentate subgranular zone 1-2 weeks following global ischemia. The newborn cells in the subgranular zone migrate into the granule cell layer where 60-66% mature into neurons. Some of the cells born in the subgranular zone also migrate into the dentate hilus where 10-20% become astrocytes. The ischemia-induced dentate neurogenesis was not caused by stress of by cell death in entorhinal cortex. The present study is designed to examine the fate of the newborn neurons and to examine the mechanism of ischemic induction of neurogenesis in the rodent brain. It is hypothesized that the neurons born in the dentate following global ischemia: extend axons to the target CA3 pyramidal neurons; up-regulate synaptic proteins; increase the numbers of synapses on CA3 pyramidal neurons; and increase the total number of neurons in the dentate granule cell layer. Experiments will determine: whether retrogradely transported dyes injected into the CA3 zone of hippocampus co-localize with BrdU labeled nuclei and the NeuN, MAP-2 and calbindin neuronal markers in the dentate granule cell layer following global ischemia; Whether pre-synaptic proteins are up-regulated following global ischemia in the newborn neurons and in the CA3 zone of hippocampus; whether the number of mossy fiber synapses on CA3 pyramidal neurons increases following ischemia; and whether the total number of granule cell neurons changes following global ischemia. It is also hypothesized that erythropoetin is induced in glial cells in the ischemic hippocampus, is released and acts on erythropoetin receptors on dentate progenitor cells to initiate proliferation of the progenitor cells and increased neurogenesis. Experiments will determine whether: erythropoetin and/or erythropoetin receptors are increased in hippocampus following global ischemia; whether ventricular infusion of erythropoetin increases neurogenesis from dentate progenitor cells; and whether ventricular infusion of antibodies to erythropoetin and/or erythropoetin receptors attenuate neurogenesis following global ischemia. These studies are important for understanding the mechanism of recovery of function following ischemic injury to the hippocampus.

Subarachnoid hemorrhage and intracerebral hemorrhage are important causes of stroke. In spite of the common occurrence of hemorrhage, little is known about how blood and the hemoglobin in blood are metabolized in the CNS, what role hemoglobin might play in mediating injury, and whether there are specific therapeutic approaches that improve outcome from hemorrhage. Hemoglobin contributes to oxidative stress and produces vasospasm when placed around cerebral blood vessels. This proposal will examine the role of the HO-1 and HO-2 hemeoxygenase enzymes in the brain since they are two of the enzymes that metabolize heme in hemoglobin. Subarachnoid injections of whole blood, lysed blood or hemoglobin induce hemeoxygenase-1 (HO-1) in microglia throughout the entire brain. Subarachnoid injections of lysed blood induced the HSP70, HO-1 and HSP47 stress genes in focal regions of rodent brain. The focal regions of heat shock gene injection can be blocked by pre-treatment with anti-oxidant drugs. This proposal will continue to examine experimental subarachnoid hemorrhages produced by injections of lysed blood into the cisterna magna of adult rats or mice. The following series of experiments will test three major hypotheses. (1) Hypothesis: The focal regions of stress gene induction following experimental subarachnoid hemorrhage are ischemic. Experiments: (1) Blood flow, glucose metabolism and the blood brain barrier will be examined in focal regions of stress gene expression following experimental subarachnoid hemorrhage. (2) Hypothesis: HO-1 and HO-2 protect against experimental subarachnoid hemorrhage. Experiments: (2) Focal stress gene expression will be assessed following experimental subarachnoid hemorrhage in HO-1 and HO-2 knockout mice, and following induction of HO-1 with either systemic or subarachnoid injections of pure hemoglobin or stabilized hemin. (3) Hypothesis: Drugs that protect against oxidative stress and ischemic injury block focal regions of stress gene expression following experimental subarachnoid hemorrhage. Experiments: (3) Focal stress gene expression due to subarachnoid hemorrhage will be assessed following treatment with nimodipine, potent anti-oxidants like spin-trap compounds, and following treatment with glutamate receptor antagonists. These studies will help delineate mechanisms of injury following subarachnoid hemorrhage, and will develop a new approach for assessing whether drugs decrease or block injury due to subarachnoid hemorrhage.

DESCRIPTION (Applicant's abstract): This project will examine the brain genomic response to hypoxia. Chronic hypoxia induces "tolerance" to ischemia, chronic hypoxia protecting against a stroke whereas acute hypoxia does not. The identification of genes induced by chronic hypoxia would help delineate genes that produce tolerance. The genomic effects of hypoxia are also of interest since we have identified a transcription factor, HIF-1, that is induced in response to chronic but not acute hypoxia, and therefore is a candidate gene for conferring hypoxia induced tolerance. It would be important to identify target genes of HIF using genomic approaches. Lastly, the induction of genes related to acute hypoxia is of interest because acute hypoxia stimulates a "stress response," and could help in characterizing the genes that mediate physiological stress in contrast to psychic stress. These studies are designed to test several hypotheses: (1) short durations of hypoxia induce genes that are mainly related to stress; (2) chronic hypoxia induces genes that protect the brain against ischemia; and differences in gene expression in HIF-1a knockout mice compared to their normal littermates will identify candidate HIF-1a target genes. The aims are to: Aim #1a. Examine the genomic response of 7d old and adult rat brain to acute hypoxia; (#lb); examine the genomic response of 7d old and adult rat brain to chronic hypoxia that produces tolerance to focal ischemia; and (#lc); and confirm that chronic hypoxia, but not acute hypoxia, produces hypoxia-induced tolerance to ischemia. Aim #2. Perform Suppressive Subtractive Hybridization (SSH) by making cDNA from acutely hypoxic brain compared to chronically hypoxic brains of 7-day old rats. Clone SSH products to make subtracted libraries. PCR amplify the clone inserts and array the inserts. The microarrays are then screened with cDNA made from mRNA from the acute and chronically hypoxia brains. Genes that are confirmed to be induced by chronic hypoxia are sequenced. Aim #3. Examine the genomic response to chronic hypoxia in HlF-1a knockout mice compared to wild type mice. The long-term goals are to identify the acute and chronic hypoxia responsive genes in the mammalian genome, to describe the mechanisms of induction, to identify those genes that mediate physiological responses to hypoxia via the carotid body, and to identify genes that mediate hypoxia induced tolerance to ischemia.

The diagnosis of cute stroke is based upon clinical findings and brain imaging. Blood markers of acute ischemic stroke or tPA-induced hemorrhage would be useful for initiating early treatment with tPA (tissue plasminogen activator) and related agents. This proposal will examine white blood cell RNA expression following ischemic compared to hemorrhagic stroke because microarray technology can survey thousands of RNAs at one time and because transcriptional responses can be rapid. Moreover, preliminary data in rodents shows a unique genomic response of white blood cells one day following ischemic stroke and hemorrhagic stroke when compared to each other and when compared to controls. This proposal will demonstrate the blood genomic changes at 24h following ischemic strokes and intracerebral hemorrhages in patients that do or do not receive tPA. The first aim will use human oligonucleotide arrays to examine the white blood cell genomic response at 24h after ischemic stroke, 24h after intracerebral hemorrhages, and in age, race and sex-matched control patients without neurological disease. We will show that there is a specific blood genomic profile that correlates with ischemic strokes compared to intracerebral hemorrhage and control patients; and that there is a blood genomic profile that correlates with intracerebral hemorrhages as compared to control and ischemic stroke patients. The second aim will use olgionucleo9tide microarrays to examine the blood genomic response at 24H in ischemic stroke patients that receive tPA+ eptifibatide by 3 hours. The blood genomic expression patterns in patients with tPA associated hemorrhages will be compared to those without hemorrhages as assessed by CT/MRI. One of the long-term goals as to identify, among the genes induced at 24h following an ischemic stroke in order to be able to diagnose ischemic cerebral events between 2 and 24h after the stroke using a blood test. Another long-term goal is to identify a set of genes in peripheral white blood cells at 2h after stroke that would be associated with tPA-associated intracerebral hemorrhages that might help guide the dose or decision to give thrombolytics.

DESCRIPTION (Adapted from applicant?s abstract): The non-competitive NMDA receptor antagonists, including phencyclidine (PCP, angel dust), ketamine (Special K), and dizocilpine (MK-801), have been used as anesthetics, protect against experimental stroke, are increasing as drugs of abuse, and continue to be developed for treatment of various neurological diseases. However, these drugs produce psychosis in normal people and exacerbate psychosis in patients with schizophrenia. The drugs also injure rodent limbic cortex, killing some neurons and injuring others that have cytoplasmic vacuoles and express HSP7O and HO-i heat shock proteins. Since anti-psychotic drugs prevent the injury, the circuits mediating the injury in rodents may be similar to the circuits that mediate psychosis in humans. Our preliminary data demonstrate that NMDA antagonists injure limbic, retrosplenial cortex of rats by blocking NMDA receptors on GABA neurons in anterior thalamus, leading to thalamic excitotoxic injury of retrosplenial cortical pyramidal neurons via AMPA and other non-NMDA receptors. This proposal will continue to define the mechanisms of this neurotoxic injury. The first aim will determine whether injections of Dl, D2 and D4 dopamine receptor antagonists into retrosplenial cortex and anterior thalamus prevent the induction of HSP7O and other markers of injury produced by systemic PCP and MK-801. The second aim will determine whether blockade of NMDA receptors in substantia nigra (SN) and the adjacent ventral tegmental area (VTA) by PCP and ketamine produce and/or aggravate injury to retrosplenial cortex. The third aim will determine whether specific AMPA receptor antagonists, specific kainate receptor antagonists, and specific metabotropic glutamate receptor agents prevent injury to limbic cortex produced by systemic PCP and ketamine. The fourth aim will determine whether activation of substantia nigral ventral tegmental area and limbic cortex GABA receptors with GABA agonists prevent the injury produced by systemic PCP and MK-801. The fifth aim will determine whether visual sensory input contributes to the non-NMDA glutamate-mediated limbic cortical injury produced by NMDA antagonists. The last aim will determine whether NMDA receptor antagonists produce limbic cortical injury in cats and whether typical and atypical antipsychotic drugs, like haloperidol and clozapine, block injury. These studies will define the circuits and receptors that mediate the cortical injury produced by NMDA receptor antagonists in experimental animals. These studies will also contribute to understanding the circuits and transmitters that mediate psychosis due to psychomimetic drugs like PCP and Special K in people, and they will also contribute to understanding the circuits and receptors that mediate acute psychosis in patients with schizophrenia and other psychotic disorders.

DESCRIPTION (Adapted from applicant?s abstract): It is hypothesized that the white blood cell genomic response can be used to deduce the presence of neuronal injury due to acute neurological diseases, and that the blood genomic response patterns can be used to differentiate between the diseases causing the neuronal injury. Our preliminary data using microarray technology show unique patterns of gene expression by lymphocytes of adult rats subjected to ischemic strokes, hemorrhagic strokes, status epilepticus, hypoxia, hypoglycemia and sham-surgeries as compared to untouched controls. The first Aim of this proposal will determine whether short durations of global cerebral ischemia, focal cerebral ischemia (transient ischemic attack), hypoglycemia and seizures produce different white blood cell genomic responses in rats that can be used to differentiate between these conditions hours to days later. The second Aim will determine whether long durations of global ischemia, hypoglycemia and status epilepticus regulate specific genes in white blood cells in response to the diffuse neuronal injury caused by all of these conditions, and whether these genes can serve as indicators of the diffuse neuronal injury. The genomic expression of neutrophils, lymphocytes and whole blood will be examined at various times after cerebral ischemia, insulin-induced hypoglycemia, seizures and status epilepticus. Genes regulated in the different white blood cells by these conditions will be correlated with the presence of diffuse neuronal cell death in brain using TUNEL staining. The third set of Aims will determine whether the same genes regulated in white blood cells of rodents following single seizures and status epilepticus are also regulated in the white blood cells of men and women patients following seizures and status epilepticus. These studies will also determine whether blood genomic responses can be used to distinguish whether patients have had seizures, pseudoseizures or syncope, and whether some of the neuronal injury-related genes regulated in the blood of rodents with status epilepticus are regulated in patients with status epilepticus. Genes regulated more than two fold on microarrays will be confirmed by quantitative RT-PCR for all of the aims. The goal is to objectively differentiate seizures, syncope, global cerebral ischemia, hypoglycemia, and transient ischemic attacks hours to days after they occur; and to begin to identify blood genomic markers of neuronal death associated with acute neurological diseases that might also be useful in chronic neurological diseases.

DESCRIPTION (Adapted from applicant's abstract): Though it has been suggested that brain is ischemic around intracerebral hemorrhages (ICHs), blood flow studies are contradictory - reporting decreases, little change, and increases of blood flow. The investigators hypothesize that these contradictory findings may be due to the opposing actions of mass effect and glutamate. Mass effect from hemorrhages would decrease blood flow and produce tissue hypoxia. Glutamate, derived from blood plasma, lysed red blood cells, and injured brain cells, would increase blood flow and metabolism. Lactate also increases around ICHs; their porcine data shows lactate increases of ten-fold in white matter and four-fold in gray matter without changes of ATP. They propose that these lactate increases are partly due to mild hypoxia around hematomas without associated ischemia. Aerobic glycolysis to lactate may occur because of excitotoxic concentrations of glutamate around ICHs. These studies propose to test the hypothesis that increased blood flow and metabolism around ICHs are due to actions of glutamate by measuring local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCGU) using autoradiographic techniques in rats at different times following ICH and determining whether GLU antagonists prevent the increases of LCBF and LCGU. To determine whether moderate hypoxia exists around ICH, tissue oxygen concentrations will be measured using oxygen electrodes, and the induction of hypoxia inducible factor (HIF) and its target genes will be assessed using Western blots, Northern blots, and in situ hybridization. DNA microarrays will be used to determine whether the pattern of gene expression in tissue around rat ICH is similar to that produced by hypoxia, excitotoxins, and/or ischemia. They also postulate that LGU, released into brain following ICH, acts on GLU receptors to mediate cell stress and cell death and to increase lactate around ICHs; therefore, peri-hematomal glutamate and lactate concentrations will be measured using microdialysis in the rat ICH model. They will test whether AMPA/KA and NMDA glutamate receptor antagonists decrease cell stress, cell death, and lactate concentrations in the rat ICH model. The final experiments will address the hypothesis that excitotoxic injury due to ICH will be different in white matter versus gray matter because AMPA/KA receptors predominate in white matter and glutamate uptake will differ in white matter compared to gray matter. Because hemorrhages can be placed selectively in white matter or in gray matter using the porcine ICH model, it will be used to measure extracellular glutamate concentrations with microdialysis around hemorrhages in white matter and in gray matter. The porcine ICH model will also be used to determine if AMPA/KA receptor antagonists are superior to NMDA antagonists for decreasing cell death, cell stress, edema, and lactate around ICH located in white matter and compared to ICH located in gray matter. These studies address mechanisms of injury due to ICH and test probable therapies that could be used in patients with ICH.

Core 4 is the Molecular Core. It serves as the central resource for the projects that isolate and process[unreadable] RNA on Affymetrix microarrays, and for performing RT-PCR confirmation of the microarray data for those[unreadable] projects. The UCD Affymetrix Core Facility is run by Dr. Jeffrey Gregg and is equipped with fluidics[unreadable] stations, hybridization ovens, and the new scanner required to scan the human Affymetrix U133 2.0PLUS[unreadable] arrays. Preliminary data from the previous CHARGE study has shown that there are changes in gene[unreadable] expression in the blood of children with autism compared to control children in the general population (GP)[unreadable] and to control children with mental retardation and developmental delay (MR/DD). The blood genomic[unreadable] profile in children with autism without regression (A) was different from controls, autism spectrum disorder[unreadable] (ASD) and different from children with autism with regression (A-R). In addition, there is a group of[unreadable] regulated genes in most children with A, A-R and with ASD that are expressed by natural killer (NK) cells[unreadable] in peripheral blood, suggesting an abnormality in this cell type that is common to all types of autism. These[unreadable] NK-cell related genes are expressed by all of the autism phenotypes including A, A-R and ASD, and hence[unreadable] may point to common pathways that underlie the common language and behavioral abnormalities in all[unreadable] three disorders. This core will be utilized by the projects as follows. Project #1: Aim #1: Perform genomic[unreadable] (RNA expression on microarrays) studies on blood from children with autism in the 4-9 year old range, and[unreadable] compare to the blood genomic profiles we have obtained in children with autism in the 2-5 year old age[unreadable] range. Aim #2. Compare gene expression as a function of blood metal levels in both age groups in A, A-R,[unreadable] ASD, MR/DD and GP groups. Aim #3. Examine genomic profiles in pregnant mothers who have[unreadable] previously given birth to an autistic child to determine if there is a specific genomic profile that correlates[unreadable] with whether the mother's fetus is destined to develop autism. Project #2. Aim #1. Describe the gene[unreadable] expression profiles in the blood using specific white blood cell subsets including NK cells for children with[unreadable] autism without regression, autism with regression, and ASD children compared to GP and delayed[unreadable] children. Aim #2. Examine gene expression following stimulation or activation of specific white blood cell[unreadable] subsets of A, A-R, ASD, MR/DD and GP children with: low level mercury; immune cell[unreadable] stimulation/activation with vaccine antigens and cell-specific mitogens; and xenobiotics. Project #3.[unreadable] Compare gene expression profiles in the blood of children with autism to the blood of experimental animals[unreadable] exposed to toxicants including organic mercury, PCB 95, and PBDE 47 (Project #3).

[unreadable] DESCRIPTION (provided by applicant): Intracerebral hemorrhage (ICH) is a devastating stroke. The damage that occurs in brain from ICH is due to the growing hematoma and clot formation that damages the adjacent brain through edema and apoptosis. Though these are distinct pathologic entities that occur following ICH, we have data that they share some common mechanisms. We found that apoptosis in peri-hematoma brain is mediated in part by glutamate excitotoxicity. This led us to the non-receptor tyrosine kinase, pp60-Src (Src) because it potentiates function of NMDA receptors through direct phosphorylation of the NR2A subunit. We found that Src kinase activity increases 4 fold following experimental ICH in rats, the Src family kinase (SFK) member Lyn increases over 21 fold following ICH, and Src inhibitors decrease apoptosis and improve behavioral outcome following ICH. We hypothesize that Src plays a central role in ICH mediated apoptosis and edema: ICH causes thrombin receptor activation of Src that activates NR2A subunits that mediate apoptosis; and ICH activates thrombin receptors which activates HIF and MMPs via Src to produce edema and poor behavioral outcome. These hypotheses are based upon previous studies showing that thrombin mediates the acute brain edema following ICH, and that thrombin activates Src via the thrombin receptor. Therefore, these studies will examine: (a) the effect of ICH on Src; (b) thrombin activation of Src; (c) ICH induced phosphorylation of NMDA receptors by Src; (d) Src activation of HIF-1, HIF-1 target genes and MMPs; and (e) the effect of Src blockade on cell survival, edema and behavioral outcome using rat models of intracerebral hemorrhage (ICH). The following aims will be addressed: Aims #1a-d: Demonstrate that Src mRNA, Src protein, Src phosphorylation and Src activity increase following ICH. Determine whether thrombin antagonists block these ICH induced changes of Src and whether thrombin and thrombin receptor agonists reproduce the ICH induced changes of Src. Aim #2. Demonstrate changes of HIF-1, of the HIF-1 target gene VEGF, and the Matrix Metalloproteinases and the phosphorylation state of NMDA receptor subunits after ICH in rats with and with out pharmacological blockade of Src. Aim #3. Demonstrate that pharmacological inhibition of Src improves cell survival, decreases brain edema and improves behavioral outcome following ICH in rats (a) using a blood infusion model of ICH and (b) using a suture induced vessel rupture model of ICH. [unreadable] [unreadable] [unreadable]

DESCRIPTION: Ischemic stroke is currently diagnosed using the clinical presentation combined with brain imaging. Brain imaging also helps differentiate ischemic stroke from intracerebral hemorrhage. Though imaging is excellent for diagnosing stroke, it would be desirable if stroke therapies could be given at early times without brain imaging. Thus the Stroke PRG determined that the development of stroke blood markers is among the top NINDS stroke research priorities. To address this, our group first demonstrated that ischemic stroke, intracerebral hemorrhage, status epilepticus and hypoglycemia produced unique gene expression profiles in blood of experimental animals. We confirmed this in human patients with stroke that show changes of gene expression in whole blood at 3, 5 and 24 hours after ischemic stroke, with the changes of expression of 18 genes predicting 14 of 15 patients with stroke at 5 hours and 15 of 15 patients with stroke at 24 hours. The data strongly supports the studies in the present proposal that will show different blood genomic profiles in patients with ischemic strokes as compared to patients with intracerebral hemorrhage and as compared to controls. There are two aims in this study. Aim #1a: Describe the whole blood genomic profiles of patients with ischemic strokes at 3, 24 and 72 hours as compared to age, gender and race-matched control patients without strokes. Aim#1b: Confirm that the genes most regulated on microarrays following ischemic stroke are similarly regulated using quantitative RT-PCR, and that these genes predict a second cohort of ischemic stroke patients compared to controls. Aim #2a: Describe the whole blood genomic profiles of patients with intracerebral hemorrhages at 3 to 72 hours after the hemorrhages, and compare to the profiles of control patients and to patients with ischemic strokes. Aim #2b: Confirm that the genes regulated following intracerebral hemorrhage on microarrays are similarly regulated using RT-PCR, and that these genes predict a second cohort of intracerebral hemorrhage patients compared to ischemic stroke patients and compared to controls. Hypotheses: The blood genomic profiles of patients with intracerebral hemorrhages will differ from patients with ischemic strokes and from control patients. The genomic responses of white blood cells will be useful for diagnosis, and will increase understanding of the etiology, pathogenesis and prognosis of ischemic stroke and intracerebral hemorrhage, and potentially guide acute and chronic treatment in the future.

DESCRIPTION (provided by applicant): This proposal is submitted in response to the following Title: Recovery Act Limited Competition: Research to Address the Heterogeneity in Autism Spectrum Disorders (R21). Request for Applications (RFA) Number: RFA-MH-09-172 Abstract: Though most studies have examined immune abnormalities in children with autism, it is also possible that an aberrant immune response in mothers during vulnerable, critical periods of neurodevelopment could produce neuronal injury in the fetal or neonatal brain, and produce long term neurological dysfunction characteristic of autism. We will examine several quantifiable biological signatures of immune cells in blood of mothers of children with autism: (1) RNA levels, (2) functional assays of white blood cells and (3) the presence of antibodies that are directed to fetal-brain proteins. We have preliminary data showing that a number of mothers of children with autism have RNA expression profiles in their peripheral blood that differ from mothers of control children. We have discovered that the function of Natural Killer (NK) cells in blood of a number of children with autism is impaired. We have also discovered that some mothers of children with autism have antibodies in their blood that are directed at fetal-brain proteins. Based upon these promising findings, we propose the following Specific Aims for this exploratory R21. Specific Aim #1. Determine whether there are subgroups of mothers of children with autism with different RNA expression profiles in their peripheral blood that differ from each other and differ from controls. Specific Aim #2: Examine Natural Killer (NK) cell function in mothers of children with autism;whether the NK functional changes are associated with changes of NK gene expression;and whether some of these mothers have autistic children with abnormal NK cell function. Specific Aim #3. Determine whether mothers of children with autism, who have antibodies that are directed at fetal-brain proteins and which are detectable in blood, have abnormal NK function and/or abnormal RNA expression profiles in blood that differ from other mothers of children with autism and differ from mothers of typically developing children. Hypotheses: We postulate that there is a subgroup of mothers with children with autism who has an immune abnormality detectable in peripheral blood that can be assessed using (1) RNA expression in the immune/ white blood cells (2) functional assays of white blood cells and (3) and by showing the presence of antibodies directed to fetal-brain proteins in blood. Significance and Impact. The ability to identify a subgroup of mothers of children with autism into a specific immune-related phenotype will improve the success of linkage and whole genome association studies to detect genes associated with this subgroup. The identification of biological signatures in mothers that are highly associated with having children with autism could eventually lead to the characterization of specific immune abnormalities in the mothers of children with autism and may shed light on the cause(s) of autism in this subgroup and potentially lead to prevention or treatment strategies prior to or during pregnancy. PUBLIC HEALTH RELEVANCE: There has been relatively little attention paid to the immune system of mothers of children with autism. The maternal immune system is important since a dysfunctional immune response during pregnancy might affect the fetal brain and result in autism. Thus, this proposal will focus on the immune system of women with children with autism compared to women of typically developing children.

DESCRIPTION (provided by applicant): Heat shock proteins, including Hsp70, are chaperones induced by heat shock and many stresses including ischemia and assist protein folding during protein synthesis and re-folding after protein denaturation. Hsp70 protein expression is neuroprotective in a variety of models using a number of different methods of over expression. This proposal will address protective, anti-apoptotic and anti-inflammatory roles of Hsp70 in: (1) primary cultures of neurons and glia;and (2) following focal cerebral ischemia. A novel aspect of the study will be to intravenously administer recombinant Hsp70, Hsp70C and mutant Hsp70C-DEVD proteins using a newly developed single-chain fragment of an anti-DNA antibody referred to as Fv. Fv-Hsp70 binds to the nucleoside salvage transporter ENT2 found on all cells and the Fv-Hsp70 enters these cells via the ATP independent ENT2 transporter. Our preliminary data show: (a) that Fv-Hsp70 protects neurons and glia in vitro;(b) FvHsp70 decreases infarct volumes and improves behavioral outcomes following middle cerebral artery occlusions (MCAO) in vivo;(c) and pro-inflammatory and pro-apoptotic genes induced in blood leukocytes following MCAO are decreased by treatment with FvHsp70 in vivo. Therefore, we propose the following aims. Specific Aim #1a: Demonstrate that Fv-Hsp70, Fv-Hsp70C and mutant Fv-Hsp70C-DEVD protect cultured neurons and astrocytes from oxygen glucose deprivation (OGD). Specific Aim #1b: Begin to explore the anti- apoptotic and anti-inflammatory mechanisms of protection by examining the interaction between Hsp70, NF:B and TNF in primary cells from brain;and show that Hsp70 blocks NF:B activation in primary brain cells. Specific Aim #2: Demonstrate that the Fv-Hsp70 constructs decrease infarct volumes and improve behavioral outcomes in rat models of focal cerebral ischemia. The effects of Fv-Hsp70, Fv-Hsp70C and Fv-Hsp70C-DEVD will be compared to each other and to vehicle, Hsp70 alone, Fv alone and Fv-Green Fluorescent Protein (GFP) controls. Specific Aim #3a. Perform genomic profiling of rat blood following the MCAO strokes produced in Aim #2 and demonstrate that MCAO induces a damaging set of pro-apoptotic and pro-inflammatory genes while suppressing pro-survival genes in leukocytes in blood. Specific Aim #3b: Demonstrate that treatment with Fv- Hsp70 constructs in rats following MCAO attenuates the deleterious gene response in blood leukocytes and will increase anti-apoptotic, increase anti-inflammatory and increase other pro-survival genes in rat blood leukocytes. Significance: These studies will provide a proof of principle that Hsp70, administered intravenously as a Fv- fusion protein, enters brain and improves outcome from stroke. More generally, the Fv protein delivery method used here could be useful for delivering any protein to treat stroke, other acute injuries to the brain and spinal cord, and possibly to treat degenerative neurological diseases. We also propose that monitoring gene expression changes in peripheral blood that correlate with effective stroke treatments in rodents can be used to assess potential treatment responsiveness in humans. PUBLIC HEALTH RELEVANCE: This proposal will examine the neuroprotective properties of the heat shock protein, Hsp70. A newly developed protein delivery method, termed Fv, will be used to deliver Fv-Hsp70 and Hsp70 mutants to primary brain cells and to brain. We will demonstrate that Fv-Hsp70 constructs protect neurons and glia from oxygen and glucose deprivation and that FvHsp70 constructs protect rat brain against stroke. The Fv-Hsp70 mediated protection will be due in part to blockade of inflammation and blockade of pro-apoptotic pathways in both blood and brain. It is proposed that FvHsp70 could be used to treat humans with stroke, and that changes of gene expression in blood of rats that correlate with improved outcome in rats can be used as biomarkers to predict improved outcomes in humans treated with FvHsp70.

DESCRIPTION (provided by applicant): This proposal will examine the molecular response of cells in blood to ischemic stroke in humans. The proposal is based upon our preliminary data showing specific gene expression profiles in blood for large vessel atherosclerotic, cardioembolic and lacunar causes of stroke. These profiles were derived in part to predict the 30% of stroke patients who have unknown (cryptogenic) causes of their strokes. Using these profiles, 17% of cryptogenic stroke patients were predicted to have large vessel atherosclerosis, 41% were predicted to be cardioembolic, and 27% of the cardioembolic strokes were predicted to have paroxysmal atrial fibrillation (PAF). These findings are important since they affect what treatment is used - anticoagulants like coumadin for cardioembolic causes, vascular procedures and anti-platelet agents for large vessel atherosclerotic causes, and anti-platelet agents for lacunar stroke. Based upon these data we propose the following aims. (1) Use PCR arrays and the genes from our expression profiles for large vessel atherosclerotic, cardioembolic and lacunar stroke to predict the causes of ischemic strokes in this study using whole blood with >90% sensitivity and specificity. (2) For the cryptogenic stroke patients predicted to have cardioembolic strokes due to PAF using PCR arrays in Aim #1, demonstrate they have PAF during cardiac monitoring following their stroke. (3) Derive gene expression profiles from isolated PMNs and monocytes for large vessel, cardioembolic and lacunar causes of ischemic stroke in one half of the patients matched for age, gender, race and vascular risk factors and corrected for multiple comparisons. Show that these profiles predict the causes of ischemic stroke in the second half of the stroke patients with >90% sensitivity and specificity. The first aim will be the first to use the gene expression profiles from our previous studies of whole blood to predict the causes of stroke using PCR arrays in a separate independent cohort in this study. The second aim predicts which cryptogenic strokes are caused by PAF and will confirm these using cardiac monitoring. The studies of PMNs and monocytes will begin to assess the roles of these cells in different causes of stroke. Predicting the causes of cryptogenic strokes has the potential to soon decrease the incidence of recurrent ischemic strokes since the results can be obtained within days of the stroke using current PCR array technology. The gene profiles for cryptogenic stroke will speed delivery of the most appropriate treatments and make further evaluations of the causes of the cryptogenic strokes quicker, less expensive and more successful.

DESCRIPTION (provided by applicant): Though the causes of ischemic stroke are often identified, the ~35% of patients without a known cause are labeled as cryptogenic strokes. Since there are no current methods for identifying causes of cryptogenic strokes, our laboratory has used a molecular approach in an attempt to solve this problem. We have examined gene expression in whole blood using whole genome microarrays and shown specific gene expression profiles in whole blood of patients who have known causes of stroke due to cardioembolism due to paroxysmal atrial fibrillation (PAF), non-PAF cardioembolism and large vessel atherosclerosis. PAF often causes a blood clot in the heart that embolizes to brain to produce a stroke. However, by the time an EKG and/or Holter monitor are performed after the stroke, the heart rhythm has returned to normal with no evidence of PAF and the stroke is designated as cryptogenic. In the following aims we test whether our gene expression profiles for known PAF causes of cardioembolic stroke will detect cryptogenic strokes caused by PAF cardioembolism. In addition, we will examine gene expression differences in women and men following strokes caused by PAF because women are at a significantly higher risk for PAF related stroke than men, and the biological reasons for this are not understood. Aim #1. Predict which cryptogenic strokes are caused by PAF using qRT-PCR measurement of RNA levels of genes identified in our previous microarray studies of strokes caused by PAF. Aim #2. Demonstrate the cryptogenic cortical strokes predicted to be caused by PAF in Aim #1 have in fact: (a) PAF on prolonged outpatient cardiac monitoring after the stroke; (b) or have PAF on repeated Holter monitoring after the stroke(c) or PAF on repeat EKGs after the stroke. Aim #3. Determine the gene expression differences in women compared to men following cryptogenic strokes caused by PAF using the subjects proven to have PAF in Aim#2. significance. The first two aims will predict PAF causes of cryptogenic strokes and confirm these by cardiac monitoring. The third aim will address molecular pathways that are different between women and men with PAF to begin identifying the biological factors associated with the increased risk of PAF related stroke in women. There are over 260,000 cryptogenic strokes/ year in the US which compares to 270,000 new breast cancer cases/ year and 50,000 new Parkinson's cases/year. Our data suggest that >50% of cryptogenic cortical strokes may be due to unrecognized cardioembolism and half of these would be due to PAF. If we could identify all of the PAF cardioembolic cryptogenic strokes, then these patients would be treated with coumadin, Dabigatran or other oral anti-coagulant instead of anti-platelet agents or nothing. This would prevent thousands of strokes per year and is equivalent to the number of strokes treated with tPA per year.

DESCRIPTION (provided by applicant): White Matter Hyperintensities (WMH) are areas of discrete high signal intensity on T2 and FLAIR brain MRI. They are associated with increasing age, vascular disease and other factors and cause cognitive decline, depression and gait impairment. Since accrual of WMH may diminish with treatment of vascular risk factors, there is a potential for therapeutic intervention Recent studies of mutant mice show that knockout of the Nrf2 (Nuclear factor erythroid-derived 2-like 2) gene results in loss of brain myelin with a vacuolar leukoencephalopathy that occurs with advancing age. Nrf2 activates antioxidant response elements (ARE) to modulate downstream anti-oxidant target genes. These findings, coupled with our preliminary data showing increased expression of Nrf2 target genes in the blood of patients with WMH, has led us to focus this study on Nrf2 and propose these aims. Aim #1a: Demonstrate that the number of OLIGOs and OPCs in WMH identified by post-mortem MRI are decreased in WMH compared to distant unaffected white matter. Aim# 1b. Show that markers of oxidative stress, F2-isoprostane (myelin) and 8-OH-2dG (DNA), stain myelin sheaths and OLIGO nuclei in WMH compared to no staining in distant unaffected white matter. Aim# 1c. Demonstrate increased nuclear Nrf2 protein and increased Nrf2 target gene expression in WMH and at the margins of WMH as compared to distant unaffected white matter. Aim #2a: Demonstrate that expression of Nrf2 target genes in blood using qRT-PCR is increased in subjects with large volume WMH compared to those with low volume WMH as measured using in vivo MRI. Aim# 2b: Demonstrate that the expression of Nrf2 target genes using qRT-PCR is either persistently elevated or markedly increases in blood of subjects whose WMH volumes increase the most over 2 years compared to matched subjects who have the smallest changes in WMH volumes over 2 years. Aim #3. Demonstrate that brain pathological changes and Nrf2 target gene expression changes in blood and WMH in Aims #1 and #2 are present in the blood and brain obtained from the same individual. In this study we will determine whether systemic and brain oxidative stress correlate with WMH damage, large WMH volumes and progression of WMH volumes over time. Systemic ROS damage brain endothelial cells allowing pro-oxidant molecules into brain that increase brain ROS that contribute to WMH. This study will begin to identify novel Nrf2 therapeutic targets for decreasing or preventing WMH. It will also begin to provide the rationale and preliminary data needed before antioxidant trials would be undertaken to reduce WMH with the goal of delaying or preventing cognitive decline.

? DESCRIPTION (provided by applicant): Transient ischemic attacks (TIA) are critical to identify because prevention therapy can reduce the risk of future vascular events by > 50%. Diagnostic testing and therapeutic intervention must start as soon as possible because 10-25% of TIAs have a stroke within 90 days. Because so many patients present emergently with transient neurological events the large majority of whom do not go on to have a stroke, methods for identifying TIAs at high risk for stroke have been sought so that work up and treatment can be targeted to those who need it most to save time, money and limited resources. Though the ABCD2 score and brain Diffusion Weighted Imaging-MRI (DWI-MRI) have improved prediction of which TIAs have a stroke, their sensitivity and specificity for prediction of individual cases i poor. In this proposal we propose that peripheral blood leukocytes and platelets play pivotal roles in which TIAs go on to have a stroke and by assessing RNA in whole blood we can evaluate leukocyte and platelet function in TIA patients who go on to have stroke versus those that do not have a stroke. We hypothesize that specific coagulation and immune genes are activated in TIA patients that predispose them to have a stroke by 90 days compared to those TIA patients who do NOT have a stroke by 90 days. A subset of these leukocyte and platelet mRNA genes will predict TIAs who have a stroke by 90 days. This hypothesis is addressed by the following specific aims. Aim #1 (Derivation Cohort): Demonstrate that mRNA expression measured using RNAseq from whole blood differs in a derivation cohort of TIAs that go on to have a stroke by 90 days compared to those TIAs who do not have a stroke by 90 days. Demonstrate that most mRNA found to be regulated using RNAseq are also significantly regulated when measured using qRT-PCR. Aim #2 (Derivation Cohort): Apply machine learning algorithms to the mRNA from Aim #1 to derive an optimal subset of mRNA regulated by both RNAseq and qRT-PCR that predict which TIAs have strokes by 90 days compared to those who do not with >95% sensitivity on cross-validation. Aim #3 (Validation Cohort): Use machine/prediction learning algorithms to demonstrate that the genes from Aim #2 when measured using qRT-PCR on an independent validation cohort predict which TIAs have a stroke by 90 days with >85% sensitivity. The goal of these studies is to discover mRNA profiles in blood that predict which TIA patients go on to have strokes by 90 days. When confirmed in future studies, this will direct in depth testing to those high risk TIAs most in need in order to prevent strokes, and decrease unnecessary testing in those with low risk of stroke. Equally as important, the genes discovered to be associated with high risk of stroke in TIA patients will represent potential novel stroke prevention targets.

Abstract Lacunar strokes are small infarctions of deep penetrator end arteries that supply deep areas of brain including the basal ganglia, internal capsule, thalamus and pons. The ?cause? of lacunar strokes has been controversial. C Miller Fisher was the first to suggest that hypertension was one cause, noting lipohyalinosis (inflammation, fibrinoid necrosis of vessel wall) in smaller penetrating arteries (<200um) occurred only in hypertensives. He also showed, however, that larger lacunar strokes were often associated with microatheroma associated narrowing of larger penetrating arteries. This pathology is now thought to be the most common and associated with lipid abnormalities and diabetes. Moreover, some lacunar strokes are now thought to be associated with intracranial atherosclerosis of the parent artery at the origin of the penetrators. Though lacunar strokes were not traditionally associated with large vessel extracranial atherosclerosis or cardioembolism, there are now a number of cases where lacunar strokes have been associated with large vessel atherosclerosis or cardiac causes. Indeed, in our own recent study we showed that as many as ~50% of small deep infarcts (>15mm in size) were predicted to be due to large vessel atherosclerosis or to cardioembolic disease. It is crucial to identify the correct causes of lacunar strokes because treatments differ: drugs for hypertension vs drugs for lipid abnormalities, surgery for large vessel carotid disease, anticoagulants for cardioembolic disease, and anti-platelet agents for lacunar strokes associated with hypertension or abnormal lipids or diabetes. The biology of lacunar strokes has been studied very little, and there are no accepted biomarkers for lacunar stroke or its causes. Our group, however, has begun to provide novel insights into how the immune and clotting profiles in peripheral blood differ in lacunar strokes compared to large vessel and cardioembolic strokes. We have shown that the immune response in large vessel and cardioembolic cortical strokes is mainly associated with neutrophil genes, whereas the immune response in lacunar stroke associated with hypertension /lipids/ diabetes is associated with inflammatory monocyte-related genes. However, since the preliminary studies were performed on whole blood, there is a great need to study individual immune cell types in these different causes of ischemic stroke. Therefore, in this study we will isolate neutrophils and monocytes in patients with lacunar stroke compared to large vessel and cardioembolic stroke. We will perform RNA sequencing on those cells in the following aims which allows us to measure expression levels of >250,000 alternatively spliced transcripts which are derived from the ~20,000 coding genes. Specific Aim #1. Use RNAseq to demonstrate that alternatively spliced transcript level expression profiles in monocytes, neutrophils and whole blood differ for subcortical lacunar strokes associated with hypertension, abnormal lipids, diabetes, large vessel atherosclerosis, or cardioembolism compared to each other and compared to matched controls. Specific Aim #2. Use RNAseq to demonstrate that alternatively spliced transcript level expression profiles for subcortical lacunar strokes with hypertension, lipids or diabetes are associated with monocytes, and differ from cortical large vessel and cardioembolic strokes which are associated mainly with neutrophils. Specific Aim #3a. Use Support Vector Machine (SVM) to derive the minimum number of transcripts from Aim #1 that differentiate the different causes of lacunar strokes including hypertension, abnormal lipids, diabetes, large vessel atherosclerosis, or cardiac disease. Specific Aim #3b. Use the profiles derived in Aim #3a to predict the cause of lacunar stroke in a second cohort using qRT-PCR to measure expression and SVM to perform predictions with >85% sensitivity and specificity. Significance: Identifying the causes of lacunar strokes based upon splice variant expression in individual blood cell types is important since it would affect therapy used for secondary stroke prevention.

Abstract Following Intracerebral Hemorrhage (ICH), the blood?brain barrier (BBB) is disrupted with associated edema and leukocyte extravasation from blood into the tissue/hematoma. Neutrophils, monocytes and lymphocytes enter brain. Increased neutrophils or increased neutrophil to lymphocyte ratio in humans are associated with worse ICH outcomes. Thus this proposal will examine gene expression in neutrophils, monocytes and T lymphocytes following ICH as compared to ischemic stroke and controls. ICH mortality is very high, with ICH volumes and edema volumes and causes of ICH being important factors in survival. Thus, this proposal will examine gene expression in neutrophils, monocytes and T lymphocytes as function of ICH volume, edema volume and ischemic lesion volume around ICH, as well as causes of ICH. We expect different blood/ leukocyte/ platelet profiles for different ICH volumes and different ICH causes that affect hematoma resolution, recurrent bleeding, and severity of recurrent bleeding that would be molecular targets for improving survival. Based upon very robust preliminary data we propose the following aims. Aim #1a. Demonstrate that proinflammatory genes are expressed at early times (12h, 1d, 3d) in neutrophils, M1 monocytes and specific T cell subsets (??T cells) following ICH; and immune-related repair genes in M2 monocytes and specific T cell subsets (e.g. T helper cells) are expressed at later times following ICH (3d, 7d); and, show the genes and pathways differ from those for ischemic stroke. Aim #1b. Demonstrate specific T cell, and T-cell receptor gene expression decreases in blood following ICH and this may correlate with decreased numbers of blood T lymphocytes (??T early; T helper, Tregs later). Aim #2. Determine the genes and pathways that correlate with volume of ICH, edema and ischemic lesions around ICH over time, after accounting for differences in treatment for different sized ICH. Aim #3a. Identify specific genes and pathways associated with deep ICH related to hypertension compared to cortical lobar ICH related to probable CAA as defined by the modified Boston Criteria23-25. Aim #3b. Demonstrate that, though there are some common genes and pathways associated with all causes of ICH, there are large numbers of genes and pathways that are specific for each cause. The molecular underpinnings underlying human ICH are largely unexplored. Thus, this proposal will begin to increase our understanding of human ICH by identifying molecules that correlate with factors associated with ICH outcomes (neutrophils, monocytes, T lymphocytes, as well as ICH volumes and edema volumes, and causes of ICH) that might be treatment targets to improve ICH outcomes.

Abstract It has been known for some time that there is a pro-inflammatory state in blood and brain of subjects with Alzheimer?s Disease (AD). The explanation for this inflammation has been unknown. However, we have made several discoveries: Lipopolysaccharide (LPS) from Gram negative bacteria combined with cerebral ischemia and hypoxia causes amyloid-like plaques in rat brain; LPS levels in human AD brains are much greater than controls; and LPS levels in peripheral blood increase with age in controls; and LPS blood levels in AD subjects are three times those of controls. Thus, we hypothesize that LPS from the gut, gums and exogenous Gram-negative bacteria increases in blood and brain with age and promotes inflammation in blood and brain of AD patients. Moreover, LPS causes an increase in levels of Lipopolysacch- aride Binding Protein (LBP) in blood and brain to detoxify LPS. In this proposal we will: (1) demonstrate LPS and LBP levels increase in blood of controls with increasing age since age is the number one risk factor for AD; (2) demonstrate that LPS and LPB levels are higher in blood of patients with AD compared to age, sex and race matched controls; and (3) demonstrate that LPS and LBP levels are higher in AD compared to control brains, and in AD brain that LPS and LBP co-localize with amyloid plaques. This will be one of the first studies to explain the pro- inflammatory state in blood and brain of patients with AD. Thus, the results of this study will be used to support future studies that will aim to show that blood levels of LBP and LPS can be used to: (a) identify those patients at greatest risk for developing AD; (b) identify those patients who likely have AD; (c) and use blood LBP or LPS levels to assess the efficacy of various treatment or prevention strategies including probiotics, antibiotics, supplements and formal drug trials.

Abstract Subarachnoid hemorrhage (SAH) accounts for 5% of all strokes, has a high mortality and the cost to society is similar to ischemic stroke since subjects are much younger. Though SAH fatality has decreased ~50% in the last 25 years due to immediate repair of aneurysms, improved medical management and nimodipine, nearly 1/3 of SAH patients develop delayed cerebral ischemia (DCI) often with cerebral infarction which is associated with poor outcomes. Though this was thought to be due delayed cerebral vasospasm, recent studies have shown that decreasing or preventing vasospasm does not improve outcomes. This has led to alternative hypotheses that combined effects of microvessel thrombosis and vasospasm combined with cortical spreading ischemia and peripheral and central inflammation may cause DCI. Thus, there is a great unmet need to assess potential treatment targets that contribute to DCI following SAH in humans and that could be used to predict DCI to begin early treatment and to predict outcome to better allocate resources. The premise of the proposal is based upon the findings that we have shown that gene expression in blood can predict SAH patients who develop vasospasm. This led us to Hypothesize that clotting and inflammatory molecules in blood interact with the brain microvasculature and other factors to cause Delayed Cerebral Ischemia (DCI) and delayed cerebral infarction following SAH which lead to poor outcomes. We propose that gene profiles in blood will predict DCI and predict outcomes using the modified Rankin Scale (mRS). R61 Phase. Specific Aim #1a: Perform RNA sequencing (RNAseq) on whole blood of a training cohort of patients 1, 2 and 3 days after a SAH but prior to DCI compared to matched vascular risk factor controls. Specific Aim #1b. Identify the most significantly regulated genes and pathways in blood at 1, 2 or 3d that distinguish SAH patients who develop DCI at 4-14 days from SAH patients who do not develop DCI. Specific Aim #1c: Use WGCNA to identify key hub genes and upstream genes expressed at 1, 2 or 3d after SAH and which are associated with developing DCI at 4-14d and might be causative. Specific Aim #1d. Use Support Vector Machine (SVM) learning to identify the least number of genes at 1, 2 or 3d from Aim #1b that best predict (1) SAH patients who develop DCI at 4-14 days (2) and predict mRS of 0, 1-3, 4-5, and 6 at 3 months. Specific Aim #1e. Confirm RNAseq with qRT-PCR and assess qRT-PCR accuracy and precision. R33 Phase. Specific Aim #2. In a separate validation cohort of SAH patients perform qRT-PCR on their peripheral blood to measure expression of genes derived in Aim #1 to predict using Support Vector Machine (SVM) on day 1, 2 and/or day 3 which patients will develop DCI at 4-14 days and which patients will have mRS=0 (no deficit), 1-2, 3-5 and mRS=6 (dead) at 3 months. Contexts of Use. The molecules/pathways that predict DCI and mRS could serve as future treatment or prevention targets of DCI. Predicting who will develop DCI would make it possible to treat DCI earlier. In addition, future clinical trials to prevent DCI following SAH would enroll just those patients predicted to develop DCI after SAH. Predicting mRS outcomes could be used to stratify patients in future DCI trials.