Huntington’s disease (HD) is a heritable, neurodegenerative disorder characterized by motor, cognitive, and psychiatric disturbances. An unstable CAG expansion within the gene normally encoding for the Huntingtin protein is responsible. The expanded mutant form of Huntingtin and the putative protein co-factor Rhes interact and cause cell death within the striatum. We hypothesized chronic treatment with simvastatin, a cholesterol lowering drug, would disrupt the biosynthetical pathway which gives both Rhes and its target cells binding sites and render Rhes inactive. Healthy and HD mice were treated with simvastatin or a vehicle. Animals’ motor behavior was assessed with three separate tests over the first four months of life. No significant differences were found between the HD groups; however, the HD treated animals’ performance on the rotarod test, at month 4, was intermediate between healthy mice and HD vehicle treated mice. The results hint at simvastatin’s therapeutic potential, but are interpreted cautiously.

Expanded polyglutamine proteins are known to be the causative agents of a number of human neurodegenerative diseases but the molecular basis of their cytoxicity is still poorly understood. Polyglutamine tracts may impede the activity of the proteasome, and evidence from single cell imaging suggests that the sequestration of polyglutamine proteins into inclusion bodies can reduce the proteasomal burden and promote cell survival, at least in the short term. The presence of misfolded protein also leads to activation of stress kinases such as p38MAPK, which can be cytotoxic. The relationships of these systems are not well understood. We have used fluorescent reporter systems imaged in living cells, and stochastic computer modeling to explore the relationships of expanded polyglutamine proteins, p38MAPK activation, generation of reactive oxygen species (ROS), proteasome inhibition, and inclusion body formation. In cells expressing a polyglutamine protein, inclusion body formation was preceded by proteasome inhibition but cytotoxicity was greatly reduced by administration of a p38MAPK inhibitor. Computer simulations suggested that without the generation of ROS, the proteasome inhibition and activation of p38MAPK would have significantly reduced toxicity. Our data suggest a vicious cycle of stress kinase activation and proteasome inhibition that is ultimately lethal to cells. There was close agreement between experimental data and the predictions of a stochastic computer model, supporting a central role for proteasome inhibition and p38MAPK activation in inclusion body formation and ROS-mediated cell death.

La maladie de Huntington est neurodégénérative, génétique, rare, multifacette et de durée d'évolution longue, induisant une grande. Les biothérapies en cours d'essai sont réalisées sur des petits effectifs, avec un effet mesurable à long terme et hétérogène. Identifier des marqueurs d'évolution de la maladie et de réponse au traitement permettrait de mieux comprendre et d'améliorer les résultats des futurs essais cliniques. Nous avons développé une méthode de clustering pour l'efficacité d'un traitement dans le cadre de données longitudinales afin de définir des répondeurs et non répondeurs au traitement. Notre méthode, robuste pour les petits effectifs, combine un modèle linéaire mixte à deux pentes et un algorithme de clustering. Le modèle mixte génère des effets aléatoires, associés à la réponse au traitement, propres à chaque patient. L'algorithme de clustering permet de définir des sous-groupes selon la valeur des effets aléatoires. Trouver des sous-groupes de patients répondeurs permet de définir des marqueurs prédictifs de la réponse au traitement qui seront utilisés pour donner le traitement le mieux adapté à chaque patient. Nous avons discuté de l'intégration (i) des marqueurs prédictifs dans les plans expérimentaux des essais cliniques, en évaluant leur impact sur la puissance de l'étude; et (ii) des marqueurs pronostiques, en étudiant l¿impact du polymorphisme COMT sur le déclin cognitif des patients. Enfin, nous avons évalué l'effet d'apprentissage des tests neuropsychologiques, et montré comment une double évaluation à l'inclusion dans un essai clinique permettait de s'en affranchir quand le critère de jugement principal est le déclin cognitif. / Huntington's disease is neurodegenerative, genetic, rare, multifaceted and has a long evolution, inducing heterogeneity of conditions and progression of the disease. Current biotherapy trials are performed on small samples of patients, with a treatment effect measurable in the long-term that is heterogeneous. Identifying markers of the disease progression and of the treatment response may help to better understand and improve results of biotherapy studies in Huntington's disease. We have developed a clustering method for the treatment efficacy in the case of longitudinal data in order to identify treatment responders and nonresponders. Our method combines a linear mixed model with two slopes and a classical clustering algorithm. The mixed model generates random effects associated with treatment response, specific to each patient. The clustering algorithm is used to define subgroups according to the value of the random effects. Our method is robust in case of small samples. Finding subgroups of responders may help to define predictive markers of treatment response which will be used to give the most appropriate treatment for each patient. We discussed integration of (i) the predictive markers in study design of future clinical trials, assessing their impact on the power of the study; and (ii) the prognostic markers of disease progression by studying the COMT polymorphism as a prognostic marker of cognitive decline in Huntington's disease. Finally, we evaluated the learning effect of neuropsychological tasks measuring cognitive abilities, and showed how a double baseline in a clinical trial could take it into account when the primary outcome is the cognitive decline.

La maladie de Huntington (MH) est causée par une expansion de répétitions CAG sur l’exon 1 du gène huntingtine (htt), codant pour une protéine mutée. Il a été montré que la diminution d’expression de cette protéine est une piste thérapeutique très prometteuse. Dans ce projet, nous avons étudié et comparé trois approches dites «antisens» : une stratégie allèle non-spécifique, visant à diminuer de manière générale l’expression de htt ; une stratégie allèle spécifique ciblant les répétitions CAG afin d’impacter préférentiellement l’allèle muté ; et enfin une stratégie de saut d’exon permettant d’enlever des sites de clivage à l’origine d’une forme raccourcie et toxique de la protéine htt. Nous avons évalué ces approches grâce à deux outils différents : les tricyclo-DNA (TcDNA), qui sont une nouvelle classe d’oligonucléotides antisens (AON) plus performante que les chimies précédentes, et le système U7snRNA vectorisé, permettant d’induire une expression stable des séquences antisens. Dans un premier temps, ces différentes molécules ont été évaluées in vitro dans des lignées de fibroblastes de patients en quantifiant le niveau d’ARNm et de protéines htt par RTqPCR et Western blot respectivement. Par la suite, les séquences les plus efficaces in vitro ont été sélectionnées et les AON et AAV-U7snRNA correspondants ont été injectés en intracérébroventriculaire (ICV) dans un modèle murin de la MH (souris YAC128). Les résultats les plus encourageants ont été obtenus avec le TcDNA-NS (pour allèle Non Spécifique), permettant une diminution significative de l’expression de htt dans le cortex, l’hippocampe et le striatum 2 et 6 semaines après une injection ICV. Ces résultats prometteurs suggèrent le potentiel des TcDNA comme nouvel outil thérapeutique pour la MH. / Huntington’s disease (HD) is caused by a CAG repeat expansion in the exon 1 of huntingtin gene (htt), encoding for a mutant protein. It has been shown that the silencing/down regulation of huntingtin protein is a promising therapeutic lead. In this project, I have explored and compared three strategies using the antisense approach: a non-allele specific strategy, aiming to silence the global expression of htt; an allele specific strategy targeting CAG repeats to silence preferentially the mutant allele; and an exon-skipping strategy in order to remove cleavage sites which originally cause a shorter and toxic form of the htt protein. These strategies have been evaluated using two different tools: tricyclo-DNA (TcDNA), a new class of antisense oligonucleotides (AON) more efficient than the previous chemistries, and a vectorized approach using U7snRNA system allowing a stable expression of antisense sequences. Firstly, these different molecules have been assessed in vitro in HD fibroblasts quantifying mRNA and htt protein levels with RTqPCR and Western blot respectively. Subsequently, the most efficient sequences have been selected and intracerebroventricular (ICV) injections have been performed with corresponding AON and AAV-U7snRNA in a HD mouse model (YAC128). The most encouraging results have been obtained with the TcDNA-NS (for Non Specific allele), allowing a significant decrease of htt expression in cortex, hippocampus and striatum 2 and 6 weeks after ICV injection. These promising results suggest the potential of TcDNA as a new therapeutic tool for HD.

Background: Huntington’s disease (HD) and Parkinson’s disease (PD) are neurodegenerative diseases causing dysfunction and death of cells within the basal ganglia, and thus disruption of pathways with resultant impairment of cognition, motor function, and behavior. These impairments result in decreasing independence in activities of daily living and quality of life even from relatively early in the disease. Among the many motor deficits in HD and PD, impaired gait initiation is a cardinal motor characteristic in both diseases. However, the neurophysiological deficits that underlie gait impairments in people with HD and PD are not well understood. Movement related potentials derived from EEG may insight into the dynamics of areas of the brain involved in motor planning in people with HD and PD. Findings from this study provide a bridge between functional deficits and neuropathology in the progression of HD and has the potential to impact mechanistic understanding of gait initiation in basal ganglia disorders, and inform the development of clinical outcome measures and potential non-invasive biomarkers. The aims of this study were to: 1) identify the differences in movement-related potentials in individuals with manifest HD and mid-stage PD, and non-neurological peers, 2) verify kinetic differences in gait initiation reflective of postural stability in HD and PD, 3) determine force modulation impairments during gait initiation in the mediolateral (ML) and anteroposterior (AP) direction in HD and PD, and 4) determine the tolerance of a high repetition gait initiation protocol. Methods: EEG data were collected for participants for 5 blocks of 15 trials of gait initiation. Kinetic data was collected using an embedded force plate. EEG was time-locked with kinetic data in real-time. RPs amplitudes and latencies, and CNV amplitudes and latencies were determined prior to the onset of the first APA and heel-off. Center of pressure (COP) displacement averages and excursions were determined in the mediolateral (ML) and anteroposterior (AP) direction as measures of postural stability. COP accelerations and coefficient of variance (COV) of force were derived from gait initiation windows in the ML and AP direction as measures of force modulation. Tolerability of the protocol was determined by assessing fatigue from changes in COP averages and excursions from the first block of gait as compared to the last block of gait. Mean values, standard deviations, and mean differences between HD and PD were determined for individual and group data. Results: Three individuals with HD and three with PD were recruited with mean ages of 52.67 and 74.3 respectively. Mean differences and effect sizes indicated that HD participants had a greater average COP in the x direction and greater COP max excursions in the y direction relative to PD participants. PD displayed greater COP max excursions in the y direction relative to HD. There were no differences among COP max measures in the x direction. Similarly, there were no differences between HD and PD participants for CNV amplitudes and latencies, and RP amplitudes and latencies prior to APA onset and heel-off. Among impulse values, there were no differences in ML APA impulse between HD and PD participants, however PD participants exhibited a larger impulse in the AP APA. Lastly, participants were able to tolerate the high repetition protocol as indicated by COP values over three blocks of trials. Discussion: Results confirmed previous findings for kinetic parameters and validated the methodology in its ability to measure movement-related potentials prior to gait initiation in people with HD and PD. No study to date has used wireless EEG technology to measure neural signal in real-time during gait initiation in PD and HD. The values obtained from this system and methods were similar to the results determined in wired and tethered systems. The MRP amplitudes present in the PD participants, along with latencies of MRPs between HD and PD, may indicate potential specificity of MRP responses according to disease-stage and medication-state. Future work will explore the use of MRPs in larger cross-sectional studies and for the development of a meaningful clinical outcome measure.

The Huntington disease (HD) is a hereditary neuro-degenerative disorder caused by a mutation of the huntigtin gene that codes a protein of the same name. The mutated form of the huntigtin gene plays its part in many pathological interactions and influences a number of cellular mechanisms, including the immune system that could serve as a modifier of the neuropathology of the disease. The cells of the monocyte-macrophage system express cytokines whose production changes in relation to the activation of the cell. The presence of the mutated huntingtin protein in these cells renders them hyper-responsive to immunity incentives leading to changes in the production of cytokines. These differences are discernible a few years prior to the appearance of the symptoms. Therefore, the changes in the levels of certain cytokines could serve as appropriate biomarkers for monitoring of the onset of the disease and its progression. The HD pathogenesis includes an inflammation of the central neutral system. Inflammatory changes in peripheral tissues could reflect inflammatory processes in the central neural system. A miniature TgHD pig could represent an appropriate model organism for studying of the impact of the mHtt on the immune system. This model enables to observe a slow progression of the disease. Changes in...

The theme of this dissertation is to improve the exploration of patient subgroups with a precision medicine lens, specifically using repeated measures data to evaluate longitudinal trajectories of clinical, biological, and lifestyle measures. Our proposed methodological contributions fall into two branches of statistical methodology: undirected graphical models and functional data analysis. In the first part of this dissertation, our goal was to study longitudinal networks of brain imaging biomarkers and clinical symptoms during the time leading up to manifest Huntington's disease diagnosis among patients with known genetic risk of disease. Understanding the interrelationships between measures may improve our ability to identify patients who are nearing disease onset and who therefore might be ideal patients for clinical trial recruitment. Gaussian graphical models are a powerful approach for network modeling, and several extensions to these models have been developed to estimate time-varying networks. We propose a time-varying Gaussian graphical model specifically for a time scale that is centered on an anchoring event such as disease diagnosis. Our method contains several novel components intended to 1) reduce bias known to stem from 𝑙₁ penalization, and 2) improve temporal smoothness in network edge strength and structure. These novel components include time-varying adaptive lasso weights, as well as a combination of 𝑙₁, 𝑙₂, and 𝑙₀ penalization. We demonstrated via simulation studies that our proposed approach, as well as more computationally efficient subsets of our full proposed approach, have superior performance compared to existing methods. We applied our proposed approach to the PREDICT-HD study and found that the network edges did change with time leading up to and beyond diagnosis, with change points occurring at different times for different edges. For clinical symptoms, bradykinesia became well-connected with symptoms from several other domains. For imaging measures, we observed a loss of connection over time among gray matter regions, white matter regions, and the hippocampus. In the second part of this dissertation, we consider time-varying network models for settings in which data are not all Gaussian. We sought to compare longitudinal clinical symptom networks between patients with neuropathologically-defined Alzheimer's disease (AD) vs. neuropathologically-defined Lewy body dementia (LBD), two common types of dementia which can often be clinically misdiagnosed. Given that the clinical measures of interest were largely non-Gaussian, we examined the literature for undirected graphical models for mixed data types. We then proposed an extension to the existing time-varying mixed graphical model by adding time-varying adaptive lasso weights, modeling time in reverse in order to treat neuropathological diagnoses as baseline covariates. The proposed adaptive lasso extension serves a two-fold purpose: they alleviate well-known bias of 𝑙₁ penalization and they encourage temporal smoothness in edge estimation. We demonstrated the improved performance of our extension in simulations studies. Applying our method to the National Alzheimer's Coordinating Center database, we found that the edge structure surrounding the Wechsler Memory Scale Revised (WMS-R) Logical Memory parts IA (immediate recall) and IIA (delayed recall) may contain important markers for discriminant analysis of AD and LBD populations. In the third part of this dissertation, we explored a methodologically distinct area of research from the first two parts, moving from graphical models to functional data analysis. Our goal was to extract meaningful chronotypes, or phenotypes of circadian rhythms, from activity count data collected from accelerometers. Existing approaches for analyzing diurnal patterns using these data, including the cosinor model and functional principal components analysis, have revealed and quantified population-level diurnal patterns, but considerable subject-level variability remained uncaptured in features such as wake/sleep times and activity intensity. This remaining informative variability could provide a better understanding of chronotypes, or behavioral manifestations of one’s underlying 24-hour rhythm. Curve registration, or alignment, is a technique in functional data analysis that separates "vertical" variability in activity intensity from "horizontal" variability in time-dependent markers like wake and sleep times. We developed a parametric registration framework for 24-hour accelerometric rest-activity profiles that are represented as dichotomized into epoch-level states of activity or rest. Specifically, we estimated subject-specific piecewise linear time-warping functions parametrized with a small set of parameters. We applied this method to data from the Baltimore Longitudinal Study of Aging and illustrated how estimated parameters can give a more flexible quantification of chronotypes compared to traditional approaches.

Animals respond to changes in the environment and internal states to modify their behavior. The basal ganglia, including the striatum contribute to action selection by integrating sensory, motor and reward information. Therefore, dysregulation of striatal function is common in many neuropsychiatric disorders, including Parkinson’s disease, Huntington disease, schizophrenia, and addiction. Here, using fiber photometry, pharmacology, and behavioral approaches in transgenic mice, I explored the cellular and circuit mechanisms underlying key striatal functions. In Chapter 1, I begin by presenting the existing literature on the anatomy and physiology of the striatum. Next, I review the important functions of the striatum. Within this general review, I highlight the specific roles that striatal (DA) and acetylcholine (ACh) play in striatal circuitry and function. In Chapter 2, I demonstrate the naturally evoked ACh dip has a DA component and a non-DA component. Specifically, I show that DA via cholinergic DA D2 receptors (D2Rs) modulate the length of the ACh dip and rebound ACh levels following the dip. In addition, I show that DA coordinates the activity between DA and ACh during behavior. Finally, I present data that supports a role for ACh in motivated behavior. In Chapter 3, I show that cholinergic D2Rs are not necessary for reward learning but do facilitate reversal learning in a probabilistic choice task. In addition, I show that changes in DA and ACh levels contribute to reversal learning in a probabilistic choice task. Finally, in Chapter 4, I discuss the general conclusions and study implications, as well as future directions.

Abstract: The purpose of this study was to determine if a correlation exists between suicide and CAG repeat length in Huntington’s disease. Methodology: A case-control study using the COHORT Study de-identified database was conducted. Responses were collected from 163 participants. Depression, substance abuse history and use of benzodiazepines were covariates. Responses to the UHDRS behavioral section pertaining to the frequency and severity of suicidal ideation (“feels life is not worth living”, “has suicidal thoughts”) were analyzed. Results: Despite taking depression, benzodiazepine use, and history of substance abuse into account, there was a predictive relationship between CAG repeat length and frequency of suicidal ideation (p = .010). When the effect of depression was taken into account, there was no significant relationship between CAG repeat length and the severity of suicidal ideation. Recommendations: The findings from this quantitative analysis supported using CAG length in a clinician’s risk factor assessment to determine the frequency of suicidality.

Ferroptosis is a regulated junction between cell death, metabolism, and disease, and it hasbeen implicated in many pathologies. The assorted ferroptosis pharmacology modulators offer valuable means to modulate ferroptosis in multiple diseases, to explore disease etiology, and to develop potential therapeutics. In the first part, the work focuses on inhibiting ferroptosis in a Huntington’s disease model. Ferrostatin-1 (Fer-1) is a potent small-molecule ferroptosis inhibitor that has been adopted to investigate the role of ferroptosis in many disease models. However, its further application is limited by its low potency, poor stability, possible toxicity, and lack of brain penetration. We developed the fourth and fifth generations of ferrostatins and investigated the in vitro and in vivo pharmacokinetics of lead compounds. We identified PHB4082 preferentially accumulating in the kidney as a potential candidate for kidney disease-relevant contexts. Moreover, TH-4-55-2 displayed an excellent brain penetration, preferentially accumulating in the brain at concentrations of magnitude higher than the in vitro IC50 values. In the in vivo toxicity study, it was well-tolerated over 30 days in wild-type and R6/2 mice and exhibited a protective effect against weight loss in a Huntington’s disease model, suggesting it is a strong candidate for application in HD and more neurodegenerative disease models. The second part describes the efforts to explore the therapeutic potential of inducing ferroptosis in a tumor model. Imidazole ketone erastin (IKE) induced ferroptosis by specifically inhibiting system xc– in a subcutaneous xenograft model of Diffuse Large B Cell Lymphoma (DLBCL), suggesting the potential of IKE as a therapeutic strategy for cancer. A biodegradable polyethylene glycol-poly (lactic-co-glycolic acid) nanoparticle formulation was used to aid in delivering IKE to cancer cells in vivo, exhibiting improved tumor accumulation and therapeutic index relative to free IKE, indicating its potential for treating DLBCL. In summary, this work explored the possibility to modulate ferroptosis using small molecule modulators in multiple disease models and identified some potential drug candidates and useful chemical probes.