RESUMO
In vertebrates, muscles of the pectoral girdle connect the forelimbs with the thorax. During development, the myogenic precursor cells migrate from the somites into the limb buds. Whereas most of the myogenic precursors remain in the limb bud to form the forelimb muscles, several cells migrate back toward the trunk to give rise to the superficial pectoral girdle muscles, such as the large pectoral muscle, the latissimus dorsi and the deltoid. Recently, this developing mode has been referred to as the "In-Out" mechanism. The present study focuses on the mechanisms of the "In-Out" migration during formation of the pectoral girdle muscles. Combining in ovo electroporation, tissue slice-cultures and confocal laser scanning microscopy, we visualize live in detail the retrograde migration of myogenic precursors from the forelimb bud into the trunk region by live imaging. Furthermore, we present for the first time evidence for the involvement of the chemokine receptor CXCR4 and its ligand SDF-1 during these processes. After microsurgical implantations of CXCR4 inhibitor beads in the proximal forelimb region of chicken embryos, we demonstrate with the aid of in situ hybridization and live-cell imaging that CXCR4/SDF-1 signaling is crucial for the retrograde migration of pectoral girdle muscle precursors. Moreover, we analyzed the MyoD expression in CXCR4-mutant mouse embryos and observed a considerable decrease in pectoral girdle musculature. We thus demonstrate the importance of the CXCR4/SDF-1 axis for the pectoral girdle muscle formation in avians and mammals.
Assuntos
Movimento Celular , Quimiocina CXCL12/metabolismo , Mioblastos Esqueléticos/citologia , Músculos Peitorais/citologia , Músculos Peitorais/metabolismo , Receptores CXCR4/metabolismo , Transdução de Sinais , Animais , Embrião de Galinha , Camundongos , Mioblastos Esqueléticos/metabolismo , Músculos Peitorais/efeitos dos fármacos , Músculos Peitorais/embriologia , Peptídeos/farmacologia , Receptores CXCR4/antagonistas & inibidores , Receptores CXCR4/genética , Transdução de Sinais/efeitos dos fármacosRESUMO
We previously demonstrated that in astrocytes, SDF-1/CXCL12 exclusively signals through CXCR7 despite the additional presence of the alternate SDF-1/CXCL12 receptor, CXCR4. In addition, we provided evidence that astrocytic CXCR7-signalling involves a G protein-dependent mechanism. This is insofar remarkable as in all other cell types studied to date, CXCR7 either acts as a scavenger chemokine receptor, a modulator of CXCR4, or a non-classical chemokine receptor, signalling through ß-arrestin. To begin to unravel the molecular framework impinging the selective function of CXCR7 on a given cell type, we have now analysed the role of G protein-coupled receptor kinases (Grks) in astrocytic CXCR7 signalling. We demonstrate that Grk2 mediates signalling of SDF-1/CXCL12-bound CXCR7 as suggested by the finding that SDF-1/CXCL12-induced activation of Erk1/2 and Akt is abrogated following RNAi-mediated inhibition of Grk2, but not of Grk3, Grk5, or Grk6. We further unravel that Grk2 additionally controls signalling of SDF-1/CXCL12-bound CXCR7 in astrocytes by mediating internalization and subsequent silencing of CXCR7. Finally, we demonstrate that Grk2 is likewise expressed by microglial cells and Schwann cells, cell types in which CXCR7 does not act as a classical chemokine receptor. In conclusion, our findings establish that Grk2 tightly controls CXCR7 signalling in astrocytes, but does not imprint the cell type-specific function of this chemokine receptor.
Assuntos
Astrócitos/metabolismo , Quinase 2 de Receptor Acoplado a Proteína G/fisiologia , Receptores CXCR/metabolismo , Transdução de Sinais/fisiologia , Animais , Animais Recém-Nascidos , Astrócitos/citologia , Astrócitos/fisiologia , Células Cultivadas , Microglia/química , Microglia/metabolismo , Ratos , Ratos Sprague-Dawley , Receptores CXCR/fisiologia , Células de Schwann/química , Células de Schwann/metabolismoRESUMO
The chemokine, SDF-1/CXCL12, and its receptor, CXCR4, have been implied to play major roles during limb myogenesis. This concept was recently challenged by the identification of CXCR7 as an alternative SDF-1 receptor, which can either act as a scavenger receptor, a modulator of CXCR4, or an active chemokine receptor. We have now re-examined this issue by determining whether SDF-1 would signal to C2C12 myoblasts and subsequently influence their differentiation via CXCR4 and/or CXCR7. In addition, we have analyzed CXCR7, CXCR4, and SDF-1 expression in developing and injured mouse limb muscles. We demonstrate that in undifferentiated C2C12 cells, SDF-1-dependent cell signaling and resulting inhibitory effects on myogenic differentiation are entirely mediated by CXCR4. We further demonstrate that CXCR7 expression increases in differentiating C2C12 cells, which in turn abrogates CXCR4 signaling. Moreover, consistent with the view that CXCR4 and CXCR7 control limb myogenesis in vivo by similar mechanisms, we found that CXCR4 expression is the highest in late embryonic hindlimb muscles and drops shortly after birth when secondary muscle growth terminates. Vice versa, CXCR7 expression increased perinatally and persisted into adult life. Finally, underscoring the role of the SDF-1 system in muscle regeneration, we observed that SDF-1 is continuously expressed by endomysial cells of postnatal and adult muscle fibers. Analysis of dystrophin-deficient mdx mice additionally revealed that muscle regeneration is associated with muscular re-expression of CXCR4. The apparent tight control of limb muscle development and regeneration by CXCR4 and CXCR7 points to these chemokine receptors as promising therapeutic targets for certain muscle disorders.
Assuntos
Diferenciação Celular , Quimiocina CXCL12/metabolismo , Membro Posterior/crescimento & desenvolvimento , Desenvolvimento Muscular/fisiologia , Receptores CXCR4/metabolismo , Receptores CXCR/metabolismo , Regeneração/fisiologia , Animais , Western Blotting , Proliferação de Células , Células Cultivadas , Quimiocina CXCL12/genética , Quimiocinas/metabolismo , Regulação da Expressão Gênica no Desenvolvimento , Membro Posterior/lesões , Membro Posterior/metabolismo , Técnicas Imunoenzimáticas , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos mdx , Mioblastos/citologia , Mioblastos/metabolismo , Organogênese/fisiologia , RNA Interferente Pequeno/genética , Ratos , Receptores CXCR/antagonistas & inibidores , Receptores CXCR/genética , Receptores CXCR4/antagonistas & inibidores , Receptores CXCR4/genética , Transdução de SinaisRESUMO
SDF-1/CXCL12 binds to the chemokine receptors, CXCR4 and CXCR7, and controls cell proliferation and migration during development, tumorigenesis, and inflammatory processes. It is currently assumed that CXCR7 would represent an atypical or scavenger chemokine receptor which modulates the function of CXCR4. Contrasting this view, we demonstrated recently that CXCR7 actively mediates SDF-1 signaling in primary astrocytes. Here, we provide evidence that CXCR7 affects astrocytic cell signaling and function through pertussis toxin-sensitive G(i/o) proteins. SDF-1-dependent activation of G(i/o) proteins and subsequent increases in intracellular Ca(2+) concentration persisted in primary rodent astrocytes with depleted expression of CXCR4, but were abolished in astrocytes with depleted expression of CXCR7. Moreover, CXCR7-mediated effects of SDF-1 on Erk and Akt signaling as well as on astrocytic proliferation and migration were all sensitive to pertussis toxin. Likewise, pertussis toxin abolished SDF-1-induced activation of Erk and Akt in CXCR7-only expressing human glioma cell lines. Finally, consistent with a ligand-biased function of CXCR7 in astrocytes, the alternate CXCR7 ligand, I-TAC/CXCL11, activated Erk and Akt through ß-arrestin. The demonstration that SDF-1-bound CXCR7 activates G(i/o) proteins in astrocytes could help to explain some discrepancies previously observed for the function of CXCR4 and CXCR7 in other cell types.
Assuntos
Subunidades alfa Gi-Go de Proteínas de Ligação ao GTP/metabolismo , Neuroglia/metabolismo , Receptores CXCR/metabolismo , Transdução de Sinais/fisiologia , Animais , Animais Recém-Nascidos , Arrestinas/metabolismo , Astrocitoma/patologia , Cálcio/metabolismo , Proliferação de Células , Células Cultivadas , Córtex Cerebral/citologia , Quimiocina CXCL12/metabolismo , Quimiotaxia/efeitos dos fármacos , Quimiotaxia/genética , Embrião de Mamíferos , Inibidores Enzimáticos/farmacologia , Guanosina 5'-O-(3-Tiotrifosfato)/farmacocinética , Humanos , Camundongos , Camundongos Knockout , Neuroglia/efeitos dos fármacos , Interferência de RNA/fisiologia , Ratos , Ratos Sprague-Dawley , Receptores CXCR/genética , Receptores CXCR4/deficiência , Transdução de Sinais/efeitos dos fármacos , Isótopos de Enxofre/farmacocinética , beta-ArrestinasRESUMO
The endothelin and epidermal growth factor (EGF) systems are central to the control of reactive brain processes and are thought to partly exert these tasks by endothelin-induced transactivation of the epidermal growth factor receptor (EGFR) Here we show that beyond EGFR transactivation, endothelins prevent the ligand-induced internalization of the EGFR. We unravel that endothelins abrogate internalization of the EGFR by either promoting the formation of "internalization-deficient" EGFR/ErB2-heterodimers or by activating c-Abl kinase, a negative regulator of EGFR internalization. We further provide evidence that this cross-talk is operational in the control of astrocytic glutamate transport. Specifically, we establish that the inhibitory effects exerted by endothelins on basal as well as EGF-induced expression of the major astroglial glutamate transporter subtype, glutamate transporter 1, are a direct consequence of the endothelin-dependent retention of the EGFR at the cell surface. Together our findings unravel a previously unknown cross-talk between endothelin and epidermal growth factor receptors, which may have implications for a variety of pathological conditions.
Assuntos
Sistema X-AG de Transporte de Aminoácidos/biossíntese , Astrócitos/metabolismo , Astrócitos/fisiologia , Endotelinas/farmacologia , Receptor Cross-Talk/fisiologia , Receptor ErbB-2/fisiologia , Sistema X-AG de Transporte de Aminoácidos/genética , Animais , Animais Recém-Nascidos , Astrócitos/efeitos dos fármacos , Biotinilação , Western Blotting , Química Encefálica/fisiologia , DNA Complementar/genética , Fator de Crescimento Epidérmico/metabolismo , Receptores ErbB/fisiologia , Proteína Glial Fibrilar Ácida/metabolismo , Imuno-Histoquímica , Interferência de RNA , Ratos , Ratos Sprague-Dawley , Receptor Cross-Talk/efeitos dos fármacos , Receptor ErbB-2/efeitos dos fármacos , Receptor ErbB-2/genética , Receptores de Superfície Celular/metabolismo , Transdução de Sinais/fisiologia , TransfecçãoRESUMO
The alternative SDF-1 (stromal cell derived factor-1) receptor, CXCR7, has been suggested to act as either a scavenger of extracellular SDF-1 or a modulator of the primary SDF-1 receptor, CXCR4. CXCR7, however, also directly affects the function of various tumor-cell types. Here, we demonstrate that CXCR7 is an active component of SDF-1 signalling in astrocytes and Schwann cells. Cultured cortical astrocytes and peripheral nerve Schwann cells exhibit comparable total and cell-surface levels of expression of both SDF-1 receptors. Stimulation of astrocytes with SDF-1 resulted in the temporary activation of Erk1/2, Akt and PKCzeta/lambda, but not p38 and PKCalpha/beta. Schwann cells showed SDF-1-induced activation of Erk1/2, Akt and p38, but not PKCalpha/beta and PKCzeta/lambda. The respective signalling pattern remained fully inducible in astrocytes from CXCR4-deficient mice, but was abrogated following depletion of astrocytic CXCR7 by RNAi. In Schwann cells, RNAi-mediated depletion of either CXCR4 or CXCR7 silenced SDF-1 signalling. The findings of the astrocytic receptor-depletion experiments were reproduced by CXCR7 antagonist CCX754, but not by CXCR4 antagonist AMD3100, both of which abolished astrocytic SDF-1 signalling. Further underlining the functional importance of CXCR7 signalling in glial cells, we show that the mitogenic effects of SDF-1 on both glial cell types are impaired upon depleting CXCR7.
Assuntos
Astrócitos/metabolismo , Quimiocina CXCL12/metabolismo , Receptores CXCR4/metabolismo , Receptores CXCR/metabolismo , Células de Schwann/metabolismo , Animais , Astrócitos/efeitos dos fármacos , Astrócitos/patologia , Benzilaminas , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Cérebro , Ciclamos , Embrião de Mamíferos , Compostos Heterocíclicos/farmacologia , Camundongos , Camundongos Knockout , RNA Interferente Pequeno/genética , Ratos , Ratos Sprague-Dawley , Receptores CXCR/genética , Receptores CXCR4/antagonistas & inibidores , Receptores CXCR4/genética , Células de Schwann/efeitos dos fármacos , Células de Schwann/patologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genéticaRESUMO
OBJECTIVE: Differentiation of oligodendroglial precursor cells is crucial for central nervous system (re)myelination and is influenced by multiple extrinsic and intrinsic factors. Chemokines, a group of small proteins, are highly conserved among mammals and have been implicated in a variety of biological processes during development, tissue homeostasis, and repair. We investigated whether the chemokine CXCL12 influences oligodendrocytes and what cellular differentiation/maturation processes are controlled by this molecule. METHODS: Experimental autoimmune encephalomyelitis was induced using myelin oligodendrocyte glycoprotein. Immunostainings and quantitative gene expression analysis were used to study expression of the 2 currently known CXCL12 receptors on oligodendroglial cells. Stimulation of cultured primary oligodendroglial precursor cells was performed to determine the impact of the ligand/receptor interaction on morphological maturation and on myelin expression. Blocking and suppression experiments were conducted to reveal the identity of the transmitting receptor. RESULTS: This analysis revealed the presence of CXCR4 as well as CXCR7 and that cellular maturation in vivo and in vitro is accompanied by upregulation of CXCR7 and downregulation of CXCR4. Of note, in the diseased demyelinating central nervous system, CXCR7 expression is maintained on oligodendroglial cells, whereas CXCR4 could not be detected. We then demonstrated that CXCL12 stimulation promotes morphological maturation of cultured primary oligodendrocyte precursor cells as well as their myelin expression. Pharmacological inhibition of the CXCR7 receptor was shown to block CXCL12-dependent effects entirely. INTERPRETATION: Our findings suggest that a specific activation of the CXCR7 receptor could provide a means to promote oligodendroglial differentiation in the diseased or injured central nervous system.
Assuntos
Diferenciação Celular/fisiologia , Encefalomielite Autoimune Experimental/patologia , Oligodendroglia/fisiologia , Receptores CXCR/metabolismo , 2',3'-Nucleotídeo Cíclico Fosfodiesterases/metabolismo , Animais , Animais Recém-Nascidos , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células , Células Cultivadas , Quimiocina CXCL12/genética , Quimiocina CXCL12/metabolismo , Quimiocina CXCL12/farmacologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/metabolismo , Feminino , Gangliosídeos/metabolismo , Regulação da Expressão Gênica no Desenvolvimento/efeitos dos fármacos , Regulação da Expressão Gênica no Desenvolvimento/fisiologia , Proteínas da Mielina , Glicoproteína Associada a Mielina/efeitos adversos , Glicoproteína Mielina-Oligodendrócito , Oligodendroglia/efeitos dos fármacos , Nervo Óptico/crescimento & desenvolvimento , Nervo Óptico/metabolismo , RNA Interferente Pequeno/genética , RNA Interferente Pequeno/metabolismo , Ratos , Receptores CXCR/genética , Receptores CXCR4/genética , Receptores CXCR4/metabolismo , Células-Tronco/efeitos dos fármacos , Células-Tronco/fisiologia , Transfecção/métodosRESUMO
Stromal-cell-derived factor-1 (SDF-1) and its receptor CXC chemokine receptor 4 (CXCR4) play a well-established role during embryonic development of dentate gyrus granule cells. However, little is known about the regulation and function of CXCR4 in the postnatal dentate gyrus. Here, we identify a striking mismatch between intense CXCR4 mRNA and limited CXCR4 protein expression in adult rat subgranular layer (SGL) neurons. We demonstrate that CXCR4 protein expression in SGL neurons is progressively lost during postnatal day 15 (P15) to P21. This loss of CXCR4 protein expression was paralleled by a reduction in the number of SDF-1-responsive SGL neurons and a massive upregulation of SDF-1 mRNA in granule cells. Intraventricular infusion of the CXCR4-antagonist AMD3100 dramatically increased CXCR4 protein expression in SGL neurons, suggesting that CXCR4 is tonically activated and downregulated by endogenous SDF-1. Infusion of AMD3100 also facilitated detection of CXCR4 protein in bromodeoxyuridine-, nestin-, and doublecortin-labeled cells and showed that the vast majority of adult-born granule cells transiently expressed CXCR4. Chronic AMD3100 administration impaired formation of new granule cells as well as neurogenesis-dependent long-term recognition of novel objects. Therefore, our findings suggest that tonic activation of CXCR4 in newly formed granule cells by endogenous SDF-1 is essential for neurogenesis-dependent long-term memory in the adult hippocampus.
Assuntos
Diferenciação Celular , Giro Denteado/metabolismo , Neurônios/metabolismo , Receptores CXCR4/metabolismo , Células-Tronco/metabolismo , Animais , Animais Recém-Nascidos , Benzilaminas , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/genética , Linhagem Celular , Células Cultivadas , Ciclamos , Giro Denteado/citologia , Giro Denteado/efeitos dos fármacos , Giro Denteado/crescimento & desenvolvimento , Proteína Duplacortina , Compostos Heterocíclicos/agonistas , Compostos Heterocíclicos/farmacologia , Humanos , Masculino , Neurônios/citologia , Neurônios/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Receptores CXCR4/antagonistas & inibidores , Receptores CXCR4/biossíntese , Receptores CXCR4/fisiologia , Células-Tronco/citologia , Células-Tronco/efeitos dos fármacosRESUMO
Mice deficient in the SDF1-chemokine-receptor CXCR4, exhibit severe defects of secondary limb myogenesis. To further elucidate the role of SDF1 in muscle development, we have now analyzed putative effects of this chemokine on proliferation, migration and myogenic differentiation of mouse C2C12 myogenic progenitor/myoblast cells. In addition, we have characterized the signaling pathways employed by SDF1-CXCR4 to control myogenesis. We found that SDF1 stimulates proliferation and induces migration of C2C12 cells with a potency similar to that of FGF2 and HGF, which both represent prototypical extracellular regulators of myogenesis. In addition, SDF1 inhibits myogenic differentiation in both C2C12 cells and primary myoblasts, as assessed by MyoD, myosin heavy chain and/or myogenin expression. Regarding signaling pathways, C2C12 cells responded to SDF1 with activation (phosphorylation) of Erk and PKCzeta, whereas even after prolonged SDF1 treatment for up to 120 minutes, levels of activated Akt, p38 and PKCalpha or PKCbeta remained unaffected. Preventing activation of the classic MAP kinase cascade with the Erk inhibitor UO126 abolished SDF1-induced proliferation and migration of C2C12 cells but not the inhibitory action of SDF1 on myogenic differentiation. Moreover, the effects of SDF1 on proliferation, migration and differentiation of C2C12 cells were all abrogated in the presence of myristoylated PKCzeta peptide pseudosubstrate and/or upon cellular depletion of PKCzeta by RNA interference. In conclusion, our findings unravel a previously unknown role of CXCR4-PKCzeta signaling in myogenesis. The potent inhibitory effects of SDF1 on myogenic differentiation point to a major function of CXCR4-PKCzeta signaling in the control of secondary muscle growth.
Assuntos
Quimiocina CXCL12/farmacologia , Desenvolvimento Muscular/efeitos dos fármacos , Proteína Quinase C/metabolismo , Animais , Diferenciação Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Fatores Quimiotáticos/farmacologia , Ativação Enzimática/efeitos dos fármacos , Imuno-Histoquímica , Camundongos , Mitógenos/farmacologia , Mioblastos/citologia , Mioblastos/efeitos dos fármacos , Mioblastos/enzimologia , Miogenina/metabolismo , Cadeias Pesadas de Miosina/metabolismo , Ligação Proteica/efeitos dos fármacos , SoroRESUMO
The chemokine CXCL12/SDF-1 and its receptor CXCR4 regulate the development and the function of the hematopoietic system and control morphogenesis of distinct brain areas. Here, we demonstrate that inactivation of CXCR4 results in a massive loss of spinal cord motoneurons and dorsal root ganglion neurons and, subsequently, in a reduced innervation of the developing mouse fore- and hindlimbs. However, only the death of sensory neurons seems to be a direct consequence of receptor inactivation as suggested by the observations that DRG neurons, but not motoneurons, of wild-type animals express CXCR4 and respond to CXCL12 with an increase in cell survival. In contrast, the increased death of motoneurons in CXCR4-deficient animals seems to result from impaired limb myogenesis and a subsequent loss of muscle-derived neurotrophic support. In summary, our findings unravel a previously unrecognized complex role of CXCL12/CXCR4 in the control of limb neuromuscular development.
Assuntos
Deformidades Congênitas dos Membros/genética , Músculo Esquelético/anormalidades , Músculo Esquelético/inervação , Nervos Periféricos/anormalidades , Receptores CXCR4/genética , Medula Espinal/anormalidades , Animais , Morte Celular/efeitos dos fármacos , Morte Celular/genética , Quimiocina CXCL12 , Quimiocinas CXC/metabolismo , Quimiocinas CXC/farmacologia , Extremidades , Feminino , Gânglios Espinais/anormalidades , Gânglios Espinais/patologia , Gânglios Espinais/fisiopatologia , Deformidades Congênitas dos Membros/imunologia , Deformidades Congênitas dos Membros/metabolismo , Masculino , Camundongos , Camundongos Knockout , Microscopia Eletrônica de Transmissão , Neurônios Motores/metabolismo , Neurônios Motores/patologia , Neurônios Motores/ultraestrutura , Músculo Esquelético/fisiopatologia , Fatores de Crescimento Neural/deficiência , Neurônios Aferentes/metabolismo , Neurônios Aferentes/patologia , Neurônios Aferentes/ultraestrutura , Nervos Periféricos/patologia , Nervos Periféricos/fisiopatologia , Medula Espinal/patologia , Medula Espinal/fisiopatologiaRESUMO
The chemokine stromal cell-derived factor-1 (SDF-1) and its receptor CXCR4 control the migration of neurons and microglial cells in the central nervous system. Although functional CXCR4 is also expressed by astroglia, recent studies have failed to observe a chemotactic response of these cells to SDF-1. Here, we demonstrate that SDF-1-dependent chemotaxis can be induced by treating cultured cortical astroglia with either dibutyryl cyclic AMP (dbcAMP; 10(-4) m) or interleukin-6 (IL-6; 10 ng/ml). Flow cytometric analysis revealed that both the dbcAMP- and IL-6-induced onset of SDF-1-dependent chemotaxis of astroglia are due to the increased cell surface expression of CXCR4. In addition, dbcAMP and IL-6 also increased CXCR4 transcript levels, further suggesting that both treatments primarily affect CXCR4 surface expression in astroglia by stimulation of gene expression. Moreover, unlike the case with IL-6 and dbcAMP, which allowed for an optimal chemotactic response to SDF-1 only after 48 h, a similar chemotactic response, associated with an increase in CXCR4 cell surface expression, already occurred after 24 h when astroglial cultures were maintained with medium conditioned by IL-6- or dbcAMP-pretreated astrocytes, indicating that the stimulatory effects of IL-6 and cAMP on CXCR4 cell surface expression involve a secondary mechanism. The findings that elevated extracellular levels of IL-6 or factors positively coupled to cAMP result in increased CXCR4 cell surface expression levels and subsequent SDF-1-dependent chemotaxis in central nervous system astrocytes point to a crucial role of this chemokine during reactive gliosis and human immunodeficiency virus-mediated dementia.