Dysregulation of alternative splicing in spinocerebellar ataxia type 1.

Spinocerebellar ataxia type 1 is caused by an expansion of the polyglutamine tract in ATAXIN-1. Ataxin-1 is broadly expressed throughout the brain and is involved in regulating gene expression. However, it is not yet known if mutant ataxin-1 can impact the regulation of alternative splicing events. We performed RNA sequencing in mouse models of spinocerebellar ataxia type 1 and identified that mutant ataxin-1 expression abnormally leads to diverse splicing events in the mouse cerebellum of spinocerebellar ataxia type 1. We found that the diverse splicing events occurred in a predominantly cell autonomous manner. A majority of the transcripts with misregulated alternative splicing events were previously unknown, thus allowing us to identify overall new biological pathways that are distinctive to those affected by differential gene expression in spinocerebellar ataxia type 1. We also provide evidence that the splicing factor Rbfox1 mediates the effect of mutant ataxin-1 on misregulated alternative splicing and that genetic manipulation of Rbfox1 expression modifies neurodegenerative phenotypes in a Drosophila model of spinocerebellar ataxia type 1 in vivo. Together, this study provides novel molecular mechanistic insight into the pathogenesis of spinocerebellar ataxia type 1 and identifies potential therapeutic strategies for spinocerebellar ataxia type 1.

Phase 3 randomized trial of mavorixafor, CXCR4 antagonist, in WHIM syndrome.

We investigated efficacy and safety of mavorixafor, an oral CXCR4 antagonist for participants with Warts, Hypogammaglobulinemia, Infections, and Myelokathexis (WHIM) syndrome, a rare immunodeficiency caused by CXCR4 gain-of-function variants. This randomized (1:1), double-blind, placebo-controlled, phase 3 trial enrolled participants aged ≥12 years with WHIM syndrome and absolute neutrophil count (ANC) ≤400/µL. Participants received once-daily mavorixafor or placebo for 52 weeks. Primary endpoint was time (hours) above ANC threshold ≥500/µL (TATANC; over 24 hours). Secondary endpoints included TAT absolute lymphocyte count ≥1000/µL (TATALC; defined similar to TATANC); absolute changes in white blood cell (WBC), ANC, and ALC from baseline; annualized infection rate; infection duration and total infection score (combined infection number/severity). In 31 participants (mavorixafor, n=14; placebo, n=17), mavorixafor least squares (LS) mean TATANC was 15.0 hours, placebo 2.8 hours (P<0.001). Mavorixafor LS mean TATALC was 15.8 hours, placebo 4.6 hours (P<0.001). Higher absolute WBC, ANC, and ALC levels were seen with mavorixafor than placebo at each timepoint assessed. Annualized infection rates were 60% lower with mavorixafor versus placebo (LS mean 1.7 versus 4.2; nominal P=0.007) and total infection scores were 40% lower (7.4 [95% CI, 1.6-13.2] versus 12.3 [95% CI, 7.2-17.3]). Treatment with mavorixafor reduced infection frequency, severity, duration, and antibiotic use. No discontinuations occurred due to treatment-emergent adverse events (TEAEs); no related serious TEAEs were observed. Overall, mavorixafor-treated participants showed significant increases in LS mean TATANC and TATALC, reduced infection frequency, severity/duration. Mavorixafor was well tolerated in participants with WHIM syndrome. Trial was registered at ClinicalTrials.gov NCT03995108.

Clonally expanded CD8 T cells patrol the cerebrospinal fluid in Alzheimer's disease.

Alzheimer's disease is an incurable neurodegenerative disorder in which neuroinflammation has a critical function1. However, little is known about the contribution of the adaptive immune response in Alzheimer's disease2. Here, using integrated analyses of multiple cohorts, we identify peripheral and central adaptive immune changes in Alzheimer's disease. First, we performed mass cytometry of peripheral blood mononuclear cells and discovered an immune signature of Alzheimer's disease that consists of increased numbers of CD8+ T effector memory CD45RA+ (TEMRA) cells. In a second cohort, we found that CD8+ TEMRA cells were negatively associated with cognition. Furthermore, single-cell RNA sequencing revealed that T cell receptor (TCR) signalling was enhanced in these cells. Notably, by using several strategies of single-cell TCR sequencing in a third cohort, we discovered clonally expanded CD8+ TEMRA cells in the cerebrospinal fluid of patients with Alzheimer's disease. Finally, we used machine learning, cloning and peptide screens to demonstrate the specificity of clonally expanded TCRs in the cerebrospinal fluid of patients with Alzheimer's disease to two separate Epstein-Barr virus antigens. These results reveal an adaptive immune response in the blood and cerebrospinal fluid in Alzheimer's disease and provide evidence of clonal, antigen-experienced T cells patrolling the intrathecal space of brains affected by age-related neurodegeneration.

The Digital Navigator: Standardizing Human Technology Support in App-Integrated Clinical Care.

Background: Mental health apps offer scalable care, yet clinical adoption is hindered by low user engagement and integration challenges into clinic workflows. Human support staff called digital navigators, trained in mental health technology, could enhance care access and patient adherence and remove workflow burdens from clinicians. While the potential of this role is clear, training staff to become digital navigators and assessing their impact are primary challenges. Methods: We present a detailed manual/framework for implementation of the Digital Navigator within a short-term, cognitive-behavioral therapy-focused hybrid clinic. We analyze patient engagement, satisfaction, and digital phenotyping data quality outcomes. Data from 83 patients, for the period spanning September 2022 to September 2023, included Digital Navigator satisfaction, correlated with demographics, mindLAMP app satisfaction, engagement, and passive data quality. Additionally, average passive data across 33 clinic patients from November 2023 to January 2024 were assessed for missingness. Results: Digital Navigator satisfaction averaged 18.8/20. Satisfaction was not influenced by sex, race, gender, or education. Average passive data quality across 33 clinic patients was 0.82 at the time this article was written. Digital Navigator satisfaction scores had significant positive correlation with both clinic app engagement and perception of that app. Conclusions: Results demonstrate preliminary support and patient endorsement for the Digital Navigator role and positive outcomes around digital engagement and digital phenotyping data quality. Through sharing training resources and standardizing the role, we aim to enable clinicians and researchers to adapt and utilize the Digital Navigator for their own needs.

Differences of sexual development: genetic counseling considerations in the prenatal setting.

PURPOSE OF REVIEW: With the rapid adoption of noninvasive prenatal screening (NIPS), predictive fetal sex information is available early in pregnancy. This information can conflict with the results of other prenatal tests such as fetal ultrasound or diagnostic testing and raise the possibility of a fetal difference of sexual development (DSD). In this review, we describe recent studies examining the counseling and outcomes of prenatally suspected DSD. RECENT FINDINGS: Discordance in prenatal genetic testing results can cause confusion and anxiety in families as expectations of testing are not often discussed in detail prior to testing. There are no established guidelines for the counseling or management of such situations. SUMMARY: We present case vignettes to highlight relevant counseling points and considerations to aid in the development of guidelines and best practices in the management of DSD in the prenatal setting.

Comparison of two sedation protocols, with and without analgesia, in pigs: Assessment of sedation end points and propofol requirements.

OBJECTIVE: To compare the effects of intramuscular premedication with a novel nonanalgesic [alfaxalone-midazolam-acepromazine (AMA)] and an analgesic [ketamine-midazolam-detomidine (KMD)] protocol on sedation end points and propofol requirements for induction of anesthesia in swine. STUDY DESIGN: Prospective experimental study. ANIMALS: A total of 27 Yorkshire cross gilts weighing approximately 30 kg. METHODS: Two sedation protocols, AMA and KMD, were compared. Time from intramuscular injection to ataxia, recumbency and nonresponsiveness to tactile stimulation was recorded. The propofol dose requirement for induction of general anesthesia and tracheal intubation, and any adverse events (paddling, twitching), were recorded. Data were tested for normality using a Shapiro-Wilk test. Propofol requirements were compared using a Student's t test. Times from injection to sedation end points were compared using a Mood's test, and significance was confirmed using a Kaplan-Meier curve with Wilcoxon test survival analysis. RESULTS: Sedation end points were reached significantly faster with KMD than with AMA. Nonresponsiveness occurred in 5 (0-16) and 9.5 (5-36) minutes for KMD and AMA, respectively (p = 0.011). No significant difference (p = 0.437) was found between propofol doses used in either group (KMD; 64.38 ± 5.98 mg, AMA; 72.00 ± 7.57 mg). More adverse events were noted with AMA (11/16 pigs) than with KMD (1/11 pigs). CONCLUSIONS AND CLINICAL RELEVANCE: In pigs, AMA can be used as a reliable sedation protocol. Frequency of adverse events and time to reach sedation end points between AMA and KMD differed, but the dose of propofol needed to induce general anesthesia was not significantly different.

Binding Sites of a Positron Emission Tomography Imaging Agent in Alzheimer's ß-Amyloid Fibrils Studied Using 19F Solid-State NMR.

Amyloid imaging by positron emission tomography (PET) is an important method for diagnosing neurodegenerative disorders such as Alzheimer's disease. Many 11C- and 18F-labeled PET tracers show varying binding capacities, specificities, and affinities for their target proteins. The structural basis of these variations is poorly understood. Here we employ 19F and 13C solid-state NMR to investigate the binding sites of a PET ligand, flutemetamol, to the 40-residue Alzheimer's ß-amyloid peptide (Aß40). Analytical high-performance liquid chromatography and 19F NMR spectra show that flutemetamol binds the current Aß40 fibril polymorph with a stoichiometry of one ligand per four to five peptides. Half of the ligands are tightly bound while the other half are loosely bound. 13C and 15N chemical shifts indicate that this Aß40 polymorph has an immobilized N-terminus, a non-ß-sheet His14, and a non-ß-sheet C-terminus. We measured the proximity of the ligand fluorine to peptide residues using 19F-13C and 19F-1H rotational-echo double-resonance (REDOR) experiments. The spectra show that three segments in the peptide, 12VHH14, 18VFF20, and 39VV40, lie the closest to the ligand. REDOR-constrained docking simulations indicate that these three segments form multiple binding sites, and the ligand orientations and positions at these sites are similar across different Aß polymorphs. Comparison of the flutemetamol-interacting residues in Aß40 with the small-molecule binding sites in other amyloid proteins suggest that conjugated aromatic compounds preferentially bind ß-sheet surface grooves lined by aromatic, polar, and charged residues. These motifs may explain the specificity of different PET tracers to different amyloid proteins.

Synthesis and Characterization of Core-Shell Cu-Ru, Cu-Rh, and Cu-Ir Nanoparticles.

Optimizing the use of expensive precious metals is critical to developing sustainable and low-cost processes for heterogeneous catalysis or electrochemistry. Here, we report a synthesis method that yields core-shell Cu-Ru, Cu-Rh, and Cu-Ir nanoparticles with the platinum-group metals segregated on the surface. The synthesis of Cu-Ru, Cu-Rh, and Cu-Ir particles allows maximization of the surface area of these metals and improves catalytic performance. Furthermore, the Cu core can be selectively etched to obtain nanoshells of the platinum-group metal components, leading to a further increase in the active surface area. Characterization of the samples was performed with X-ray absorption spectroscopy, X-ray powder diffraction, and ex situ and in situ transmission electron microscopy. CO oxidation was used as a reference reaction: the three core-shell particles and derivatives exhibited promising catalyst performance and stability after redox cycling. These results suggest that this synthesis approach may optimize the use of platinum-group metals in catalytic applications.

Individual differences in threat and reward neural circuitry activation: Testing dimensional models of early adversity, anxiety and depression.

Altered functioning of the brain's threat and reward circuitry has been linked to early life adversity and to symptoms of anxiety and depression. To date, however, these relationships have been studied largely in isolation and in categorical-based approaches. It is unclear to what extent early life adversity and psychopathology have unique effects on brain functioning during threat and reward processing. We examined functional brain activity during a face processing task in threat (amygdala and ventromedial prefrontal cortex) and reward (ventral striatum and orbitofrontal cortex) regions of interest among a sample (N = 103) of young adults (aged 18-19 years) in relation to dimensional measures of early life adversity and symptoms of anxiety and depression. Results demonstrated a significant association between higher scores on the deprivation adversity dimension and greater activation of reward neural circuitry during viewing of happy faces, with the largest effect sizes observed in the orbitofrontal cortex. We found no significant associations between the threat adversity dimension, or symptom dimensions of anxiety and depression, and neural activation in threat or reward circuitries. These results lend partial support to theories of adversity-related alterations in neural activation and highlight the importance of testing dimensional models of adversity and psychopathology in large sample sizes to further our understanding of the biological processes implicated.

Off-resonance 13C-2H REDOR NMR for site-resolved studies of molecular motion.

We introduce a 13C-2H Rotational Echo DOuble Resonance (REDOR) technique that uses the difference between on-resonance and off-resonance 2H irradiation to detect dynamic segments in deuterated molecules. By selectively inverting specific regions of the 2H magic-angle spinning (MAS) sideband manifold to recouple some of the deuterons to nearby carbons, we distinguish dynamic and rigid residues in 1D and 2D 13C spectra. We demonstrate this approach on deuterated GB1, H/D exchanged GB1, and perdeuterated bacterial cellulose. Numerical simulations reproduce the measured mixing-time and 2H carrier-frequency dependence of the REDOR dephasing of bacterial cellulose. Combining numerical simulations with experiments thus allow the extraction of motionally averaged quadrupolar couplings from REDOR dephasing values.

Pregnancy from mosaic embryo transfer: genetic counseling considerations.

PURPOSE OF REVIEW: The transfer of mosaic embryos during an IVF procedure is becoming more common. There is limited information regarding the outcomes for such transfers, making it difficult to establish best practices for prenatal counseling of patients considering transfer of mosaic embryos. In addition, genetic counseling may be delivered by different providers in the preimplantation and pregnancy timeframes which can contribute to inconsistent information. RECENT FINDINGS: There are many types of aneuploid results from preimplantation genetic testing for aneuploidy (PGT-A), with mosaicism being a possibility. Recent studies have reported normal prenatal diagnostic results, pregnancy and birth outcomes with mosaic embryo transfers. Reproductive and prenatal society guidelines recommend diagnostic testing in pregnancy following a mosaic result by PGT-A. Prenatal genetic counseling providers should consider the available information from the PGT-A result, emphasizing the benefits and limitations of each available prenatal test in detecting the fetal chromosome complement. SUMMARY: While transfer of mosaic embryos can allow couples without euploid embryos to have a chance of a viable pregnancy, further studies are necessary to better guide this decision-making. In addition, better coordination between reproductive providers and prenatal providers could improve prenatal care.

Effects of intracoelomic alfaxalone-dexmedetomidine on righting reflex in common garter snakes (Thamnophis sirtalis): preliminary data.

OBJECTIVE: To evaluate the effect of dexmedetomidine on alfaxalone immobilization in snakes. STUDY DESIGN: Nonblinded, crossover study. ANIMALS: A total of eight mature common garter snakes (Thamnophis sirtalis). METHODS: Snakes were administered each of three treatments intracoelomically: alfaxalone (30 mg kg-1; treatment A), alfaxalone (30 mg kg-1) combined with dexmedetomidine (0.05 mg kg-1; treatment AD0.05); and alfaxalone (30 mg kg-1) combined with dexmedetomidine (0.10 mg kg-1; treatment AD0.10). A minimum of 10 days elapsed between experimental trials. Times to loss of righting reflex (LRR) and return of righting reflex (RRR) were recorded. Heart rate (HR) was recorded every 5 minutes throughout the period of LRR and averaged for each snake. Times to LRR and RRR, and mean HR in snakes that achieved LRR were reported. RESULTS: LRR occurred in eight (100%), five (63%) and three (38%) snakes in treatments A, AD0.05 and AD0.10, respectively. For all treatments, time to LRR ranged 3-20 minutes. Median (range) times to RRR were 39 (30-46), 89 (62-128) and 77 (30-185) minutes for treatments A, AD0.05 and AD0.10, respectively. In animals where righting reflex was lost, mean HR was lower in all dexmedetomidine treatments compared with treatment A. CONCLUSIONS AND CLINICAL RELEVANCE: In this pilot study, alfaxalone resulted in reliable immobilization, whereas dexmedetomidine and alfaxalone combinations resulted in highly variable durations of immobilization with low HR in immobilized animals. For snakes that achieved LRR, the addition of dexmedetomidine (0.05 mg kg-1) to alfaxalone appeared to extend the period of immobilization compared with alfaxalone alone.

Correction to: Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population.

In the original publication, the co-author name Kelly-Marie Chen was misspelled and Shenae Miller was missed in the author group. The correct author group has been provided in this correction.

The Effect of Initiatives to Overcome Language Barriers and Improve Attendance: A Cross-Sectional Analysis of Adherence in an Inner City Chronic Pain Clinic.

Language barriers can prevent pain physicians and patients from forming meaningful rapport and drive health care disparities. Non-adherence with scheduled pain clinic appointments deprives patients with chronic pain of needed specialist care. Objective: We evaluated the benefit of comprehensive initiatives to overcome language barriers to improve patient adherence with initial scheduled chronic pain clinic appointments. Design: After implementation of our initiative, we performed a retrospective cross-sectional analysis and fit logistic regression models to investigate the association between demographic factors and adherence. Setting: We collected retrospective data from an observational cohort with a scheduled appointment at the adult inner-city underserved outpatient Pain Center at Montefiore Medical Center, Bronx, New York. Patients: Between March 2012 and March 2014, 14,459 appointments were scheduled; 3,035 of these appointments represented initial first visits; patients had a mean age of 53 years; 15% were predominantly Spanish-speaking, 65% were female. Interventions: Our initiative to overcome language barriers in our pain clinic included appointment reminders in the patient's preferred language, Spanish-speaking staff, and unified locations with equitable access. Outcome Measures: Our dependent variable was adherence with a first scheduled pain clinic appointment. Results: We found that after implementation of our initiative, speaking Spanish was now statistically significantly associated with higher rates of adherence with appointments (Odds Ratio 1.32, 95% confidence interval [1.06­1.64]). Conclusions: We infer from our results that coordinated initiatives to overcome language barriers can be beneficial in improving appointment adherence and access to care by enhancing rapport and communication between pain physicians and their patients. Perspective: The results of this retrospective cross-sectional analysis of patients' adherence with scheduled appointments in an inner-city chronic pain clinic suggests that targeted initiatives including a pre-clinic reminder phone call in the patient's own language may help to overcome language barriers and improve access to care.

Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population.

PURPOSE: There is relative inattention to caregiving burden in black populations in developing economies. This study seeks to assess the level of perceived burden and social determinants of burden of care in caregivers of adult patients with schizophrenia. METHODS: In this cross-sectional study, 115 dyads of patients with schizophrenia caregivers attending public mental health clinics were consecutively recruited. Burden of care was evaluated using the 22-item Zarit Burden Scale (maximum score, 88). Multiple linear regression model explored factors associated with caregiver burden. RESULTS: Caregivers were predominantly females (75.7 %) and were on average 50.8 ± 15.0 years. Most patients with schizophrenia were males (65.2 %) and were on average 43.6 ± 17.2 years old. Caregivers showed on average, mild-to-moderate burden (score, 30.0 ± 14.7; median, 28.0). There was tendency for caregivers of patients who were parents or spouses to have higher levels of burden. In multivariable analyses, higher burden of caregiving was associated with patient's inability to perform self-care (B ± SE, 5.12 ± 1.40; p = 0.0001), closer kinship and higher numbers of psychotic episodes in previous year. The length of caregiving relationship was inversely related. CONCLUSIONS: Poorer functioning and demographic factors were important determinants of caregiver burden. Community mental health services should include self-care interventions in rehabilitation programs in Jamaica.

Prenatal Testing for Adult-Onset Conditions: the Position of the National Society of Genetic Counselors.

Advances in genetic testing and the availability of such testing in pregnancy allows prospective parents to test their future child for adult-onset conditions. This ability raises several complex ethical issues. Prospective parents have reproductive rights to obtain information about their fetus. This information may or may not alter pregnancy management. These rights can be in conflict with the rights of the future individual, who will be denied the right to elect or decline testing. This paper highlights the complexity of these issues, details discussions that went into the National Society of Genetic Counselors (NSGC) Public Policy Task Force's development of the Prenatal testing for Adult-Onset Conditions position statement adopted in November 2014, and cites relevant literature on this topic through December 2015. Issues addressed include parental rights and autonomy, rights of the future child, the right not to know, possible adverse effects on childhood and the need for genetic counseling. This paper will serve as a reference to genetic counselors and healthcare professionals when faced with this situation in clinical practice.

Subtle Modulation of Cu4X4L2 Phosphine Cluster Cores Leads to Changes in Luminescence.

A series of Cu4X4(PPh2py)2 compounds (X = Cl (1), Br (2), I (3), PPh2py = 2-(diphenylphosphino)pyridine) were prepared and characterized using X-ray crystallography, NMR, UV-vis, and luminescence spectroscopy. The copper chloride and bromide clusters have Cu4X4 octahedral cores while the copper iodide clusters contain an unprecedented butterfly shaped core. Crystallization of the copper bromide and iodide clusters from the appropriate solvent produced the solvates 2·2CH2Cl2, 2·2CHCl3, and 3·0.5CH2Cl2 where the presence of the lattice solvate influences the overall structural properties. Using TD-DFT calculations, the emission was assigned to a mixed metal- and halide-to-ligand charge transfer, (M + X)LCT. Subtle differences in the copper core geometry and µ-halide bonding perturb the emissions of these copper(I) halide clusters.

Luminescent Mechanochromism in a Gold(I)-Copper(I) N-Heterocyclic Carbene Complex.

The silver(I) species [Ag(benzim(CH2py)2)2]PF6 (1) was prepared by refluxing the ligand precursor [H(benzim(CH2py)2)2]PF6 with Ag2O and aqueous sodium hydroxide in dichloromethane. Simple transmetalation of 1 with tetrahydrothiophenegold(I) chloride forms the gold(I) analogue [Au(benzim(CH2py)2)2]PF6 (2). The addition of 2 equiv of [Cu(NCCH3)4]PF6 to 2 in acetonitrile produces a blue-luminescent, trimetallic complex, [AuCu2(benzim(CH2py)2)2(NCCH3)4](PF6)3·2CH3CN (3·2CH3CN). When blue-luminescent 3·2CH3CN is exposed to air, the complex loses four acetonitrile molecules, and the emission of the desolvated complex (4) appears aquamarine. Crystallization of 4 from different solvents produces the complexes [AuCu2(benzim(CH2py)2)2](PF6)3 (5) and [AuCu2(benzim(CH2py)2)2(NCCH2CH3)2](PF6)3 (6). Upon grinding, both 3·2CH3CN and 4 exhibit mechanochromic transformations to a yellow-luminescent powder (ground-4). The reversible mechanochromic transformation of 3·2CH3CN to ground-4 is a crystalline-to-amorphous conversion accompanied by partial desolvation. The luminescent mechanochromism of 4 to ground-4 is an "amorphous-to-amorphous" process and does not require solvent loss. In addition to their mechanochromic properties, both 3·2CH3CN and 4 exhibit luminescent thermochromism through desolvation to form a weak luminescent powder (7).