Could the Answer to Treating Parkinson’s Disease Come From Within the Brain?

Sometimes a solution to a disease doesn’t come in the form of a drug or a stem cell therapy, but from within ourselves.

Yesterday, scientists from the Karolinska Institutet in Sweden reported an alternative strategy for treating Parkinson’s disease that involves reprogramming specific cells in the brain into the nerve cells killed off by the disease. Their method, which involves delivering reprogramming genes into brain cells called astrocytes, was able to alleviate motor symptoms associated with Parkinson’s disease in mice.

What is Parkinson’s Disease and how is it treated?

Parkinson’s disease (PD) is a progressive neurodegenerative disease that’s characterized by the death of dopamine-producing nerve cells (called dopaminergic neurons) in an area of the brain that controls movement.

Dopaminergic neurons grown in a culture dish. (Image courtesy of Faria Zafar, Parkinson’s Institute).

PD patients experience tremors in their hands, arms and legs, have trouble starting and stopping movement, struggle with maintaining balance and have issues with muscle stiffness. These troublesome symptoms are caused by a lack dopamine, a chemical made by dopaminergic neurons, which signals to the part of the brain that controls how a person initiates and coordinates movement.

Over 10 million people in the world are affected by PD and current therapies only treat the symptoms of the disease rather than prevent its progression. Many of these treatments involve drugs that replace the lost dopamine in the brain, but these drugs lose their effectiveness over time as the disease kills off more neurons, and they come with their own set of side effects.

Another strategy for treating Parkinson’s is replacing the lost dopaminergic neurons through cell-based therapies. However this research is still in its early stages and would require patients to undergo immunosuppressive therapy because the stem cell transplants would likely be allogeneic (from a donor) rather than autologous (from the same individual).

Drug and cell-based therapies both involve taking something outside the body and putting it in, hoping that it does the right thing and prevents the disease. But what about using what’s already inside the human body to fight off PD?

This brings us to today’s study where scientists reprogrammed brain cells in vivo (meaning inside a living organism) to produce dopamine in mice with symptoms that mimic Parkinson’s. Their method, which was published in the journal Nature Biotechnology, was successful in alleviating some of the Parkinson’s-related movement problems the mice had. This study was funded in part by a CIRM grant and received a healthy amount of coverage in the media including STATnews, San Diego Union-Tribune and Scientific American.

Reprogramming the brain to make more dopamine

Since Shinya Yamanaka published his seminal paper on reprogramming adult somatic cells into induced pluripotent stem cells, scientists have taken the building blocks of his technology a step further to reprogram one adult cell type into another. This process is called “direct reprogramming” or “transdifferentiation”. It involves delivering a specific cocktail of genes into cells that rewrite the cells identity, effectively turning them into the cell type desired.

The Karolinska team found that three genes: NEUROD1, ASCL1 and LMX1A combined with a microRNA miR218 were able to reprogram human astrocytes into induced dopaminergic neurons (iDANs) in a lab dish. These neurons looked and acted like the real thing and gave the scientists hope that this combination of factors could reprogram astrocytes into iDANs in the brain.

The next step was to test these factors in mice with Parkinson’s disease. These mice were treated with a drug that killed off their dopaminergic neurons giving them Parkinson’s-like symptoms. The team used viruses to deliver the reprogramming cocktail to astrocytes in the brain. After a few weeks, the scientists observed that some of the “infected” astrocytes developed into iDANs and these newly reprogrammed neurons functioned properly, and more importantly, helped reverse some of the motor symptoms observed in these mice.

This study offers a new potential way to treat Parkinson’s by reprogramming cells in the brain into the neurons that are lost to the disease. While this research is still in its infancy, the scientists plan to improve the safety of their technology so that it can eventually be tested in humans.

Bonus Blog Interview for World Parkinson’s Day

Ernest Arenas, Karolinska Institutet

In honor of World Parkinson’s day (April 11th), I’m providing a bonus blog interview about this research. I reached out to the senior author of this study, Dr. Ernest Arenas, to ask him a few more questions about his publication and the future studies his team is planning.

Q) What are the major findings of your current study and how do they advance research on Parkinson’s disease?

The current treatment for Parkinson’s disease (PD) is symptomatic and does not change the course of the disease. Cell replacement therapies, such as direct in vivo reprogramming of in situ [local] astrocytes into dopamine (DA) neurons, work by substituting the cells lost by disease and have the potential to halt or even reverse motor alterations in PD.

Q) Can you comment on the potential for gene therapy treatments for Parkinson’s patients?

We see direct in vivo reprogramming of brain astrocytes into dopamine neurons in situ as a possible future alternative to DA cell transplantation. This method represents a gene therapy approach to cell replacement since we use a virus to deliver four reprogramming factors. In this method, the donor cells are in the host brain and there is no need to search for donor cells and no cell transplantation or immunosuppression. The method for the moment is an experimental prototype and much more needs to be done in order to improve efficiency, safety and to translate it to humans.

Q) Will reprogrammed iDANs be susceptible to Parkinson’s disease over time?

As any other cell replacement therapy, the cells would be, in principle, susceptible to Parkinson’s disease. It has been found that PD catches up with transplanted cells in 15-20 years. We think that this is a sufficiently long therapeutic window.

In addition, direct in vivo reprogramming may also be performed with drug-inducible constructs that could be activated years after, as disease progresses. This might allow adding more cells by turning on the reprogramming factors with pharmacological treatment to the host. This was not tested in our study but the basic technology to develop such strategies currently exist.

Q) What are your plans for future studies and translating this research towards the clinic?

In our experiments, we used transgenic mice in order to test our approach and to ensure that we only reprogrammed astrocytes. There is a lot that still needs to be done in order to develop this approach as a therapy for Parkinson’s disease. This includes improving the efficiency and the safety of the method, as well as developing a strategy suitable for therapy in humans. This can be achieved by further improving the reprogramming cocktail, by using a virus with a selective tropism [affinity] for astrocytes and that do not incorporate the constructs into the DNA of the host cell, as well as using constructs with astrocyte-specific promoters and capable of self-regulating depending on the cell context.

Our study demonstrates for the first time that it is possible to use direct reprogramming of host brain cells in order to rescue neurological symptoms. These results indicate that direct reprogramming has the potential to become a novel therapeutic approach for Parkinson’s disease and opens new opportunities for the treatment of patients with neurological disorders.

Good from bad: UCSF scientists turn scar-forming cells into healthy liver cells

Most people know that a healthy liver is key for survival. Unfortunately, maintaining a healthy liver isn’t always easy. There are more than 100 different types of liver disease caused by various factors like viral infection, obesity, and genetics. If left untreated, they can progress to end-stage liver disease, also known as cirrhosis, which effects more than 600,000 Americans and has a high mortality rate. While there is a cure in the form of liver transplantation, there aren’t enough healthy donors available to help out the number of patients who desperately need new livers.

Cirrhosis occurs when liver damage accumulates over time causing the development of scar tissue that eventually replaces healthy liver tissue and impairs liver function. The liver is an amazing organ and can function even with the build-up of scar tissue as long as at least 20% of its composition is healthy cells. This impressive nature is actually a problem because most patients with liver disease aren’t aware of their condition until its progressed past the point of no return.

What’s a damaged liver to do?

So what do patients with end-stage liver disease do if they can’t get a liver transplant? One answer comes in the form of regenerative medicine. Scientists can generate new healthy liver cells in a dish from stem cells derived from the skin cells of patients and could eventually transplant these cells into the damaged liver. However, a major roadblock that prevents this type of cell transplantation therapy from helping patients with liver disease is the built-up scar tissue that prevents the integration of these healthy cells into the damaged liver.

Scientists from UC San Francisco (UCSF) have come up with a new solution to this problem. In a CIRM-funded study published today in journal Cell Stem Cell, UCSF professor Holger Willenbring details a new approach to repairing damaged livers in mice – one that generates good, healthy liver cells from bad, scar-tissue forming cells already present in the damaged liver.

The bad cells in this case are called myofibroblasts. Initially, these cells play an important role in repairing injuries in the liver. They secrete proteins called collagen that form a support structure that helps maintain composition of the liver as it repairs itself. However, if liver damage persists as is the case with chronic injury, the excess buildup of collagen secreted by myofibroblasts causes the accumulation of permanent scar tissue or fibrosis, which can negatively impact liver function.

Reducing damage by improving function

Cirrhosis causing myofibroblast cells (red) are converted into healthy liver cells (green) to regenerate the damaged liver. (Willenbring lab)

Cirrhosis causing myofibroblast cells (red) are converted into healthy liver cells (green) to regenerate the damaged liver. (Willenbring lab)

In an “Ah-Ha” moment, Willenbring proposed that they could stop myofibroblasts in the damaged livers of mice from causing more fibrosis by turning them into healthy liver cells. Willenbring and his team used a specific type of virus called an adeno-associated virus that only infects myofibroblasts to deliver a cocktail of liver-specific genes that have the ability to transform cells into liver cells called hepatocytes. When they treated mice with end-stage liver disease with their viral cocktail, they observed that a small percentage of myofibroblasts were converted into hepatocytes that developed into new healthy liver tissue, which improved the overall liver function of these mice. They also tested their viral method on human myofibroblasts and found that it was successful in converting these cells into functional hepatocytes.

Willenbring explained the science behind their new technique in a UCSF news release:

“Part of why this works is that the liver is a naturally regenerative organ, so it can deal with new cells very well. What we see is that the converted cells are not only functionally integrated in the liver tissue, but also divide and expand, leading to patches of new liver tissue.”

Solution to a healthy liver?

It’s important to realize that these studies are still in their early stages. The UCSF team has plans to expand on their human cell studies and to improve their viral delivery method so that it is more specific to myofibroblasts and more efficient at converting these cells into functioning hepatocytes.

They also recognize that their strategy will not be the panacea for liver disease and cirrhosis. Willenbring commented:

“A liver transplant is still the best cure. This is more of a patch. But if it can boost liver function by just a couple percent, that can hopefully keep patients’ liver function over that critical threshold, and that could translate to decades more of life.”

However, their study does offer a number of advantages over cell transplant therapies for liver disease including repairing the liver and improving its function from within the organ itself and also offering a simpler and cheaper form of treatment that would be accessible to more patients.

Willenbring puts it best:

Holger Willenbring, UCSF

Holger Willenbring, UCSF

“The new results suggest that in the fibrotic liver, this approach could produce a more efficient and stable improvement of liver function than cell transplant approaches. Once the viral packaging is optimized, such a treatment could be done cheaply at a broad range of medical facilities, not just in the specialized research hospitals where stem-cell transplants could be conducted.”

Computer “Magic” Helps Scientists Morph One Cell’s Identity Into Another

Mogrify. Sounds like one of Harry Potter’s spells, doesn’t it? In reality, it’s something cooler than that. As reported on Tuesday in Nature Genetics, Mogrify is a new research tool that uses the magic of mathematics and computer programming to help stem cell scientists determine the necessary ingredients to convert one human cell type into another.

mogrifyharrypotter

It may sound like a magical spell but Mogrify is based on real science to help researchers predict what factors are needed to convert a given cell into another. Image credit: Warner Bros.

Now, make no mistake, the stem cell field already has the knowhow to manipulate the identity of cells and stem cells in order to study human disease and work toward cell therapies. Got a human embryonic stem cell? Scientists can specialize, or differentiate, that into an insulin-producing pancreatic cell or a beating heart muscle cell to name just two examples. Got a skin cell from an autistic patient? Using the induced pluripotent stem cell (iPS) technique, researchers have worked out the steps to transform that skin cell into an embryonic stem cell-like state and then differentiate it to a nerve cell – providing new insights into the disorder. This iPS technique can even be skipped altogether to directly convert a skin cell into, say, a liver cell through a technique called transdifferentiation.

But these methods require trial and error to pinpoint the right combination of genetic on/off switches to “flip” in the cells. These switches are called transcription factors, proteins that bind to DNA and activate or repress genes. The interaction between transcription factors and genes that give a cell it’s specific identity is extremely complex. To mimic these interactions in a lab dish, scientists use their expert knowledge and make educated guesses about which combinations of genes to modulate to generate certain cell types. Still, trial and error is a necessary part of the workflow which can require months and even years of work. And with about 2000 transcription factors and 400 cell types in humans, there’s an enormous number of possible combinations to potentially test.

Meet Mogrify
This is where Mogrify, a computational algorithm developed by a collaboration between scientists at the University of Bristol in the UK and Monash University in Australia, comes into the picture. Without lifting a pipette, Mogrify appears to be able to determine the most likely combination of transcription factors to transdifferentiate a given cell type into another without forcing the cell back to an embryonic stem cell state.

Mogrify was applied to FANTOM5, a dataset created by a large international effort to describe gene activity networks in all the cell types of the human body. With Mogrify and FANTOM5 in hand, the team first validated their algorithm by making predictions for transdifferentiation recipes that have already been established in scientific publications. For example, Mogrify correctly predicted that the transcription factor, MYOD1, could directly convert a skin cell to a muscle cell, one of the early examples of transdifferentiated cells described back in the 1980’s by the lab of Harold Weintraub. Altogether these “in silico” validation experiments recovered the correct published transcription factors at a rate of 84% compared to 31% and 51% for two other computer algorithms published by independent groups. And in 6 out of the 10 conversion experiments, Mogrify predicted 100% of the required transcription factors. As the team points out in their research article, had Mogrify been available to these scientists, they would have saved a lot of time:

“If Mogrify had been used in the original studies, the experiments could have been a success the first time.”

In addition to these validation tests, the team also tried out Mogrify in lab experiments without the help of previous publications. In one of the experiments they asked Mogrify to suggest transdifferentiation factors for converting adult fibroblasts, which are collagen-producing cells, into keratinocytes, the cells that make up the outer layer of our skin.  The algorithm predicted a set of five transcription factors which were then introduced into the fibroblasts in the lab. Within three weeks, most of the fibroblasts had converted into cells resembling keratinocytes – they had the appropriate protein markers on their surface and had taken on the typical shape seen in keratinocytes.

mogrify

The image shows the results of converting fibroblasts (collagen producing cells) to keratinocytes (skin cells) using the Mogrify algorithm. In the image it can be seen that the converted keratinocytes, which are stained green, have a ‘cobble-stone’ pattern while fibroblasts have a long thin morphology. Credit: Nature Genetics & Rackham et al.

Insights and Questions
I think Mogrify is a fascinating example of how machines and human brain power together can push the envelope of biological discoveries. Through laboratory research, scientists gradually build mental models of various cellular processes. These mental models are sources of thought experiments that they test in the lab. Yet, the countless interactions between genes, proteins and cells is so complex that the intuition of even the greatest scientific minds breaks down at some point. That’s where researchers can leverage the insight of tools like Mogrify.

Will Mogrify be a breakthrough game-changer in the world of stem cell science? Only time will tell as more scientists around the world put it to use. And thanks to the team, one can start using it right now because it’s available to anyone online. Just select your starting and finishing cell types from a pull down menu to begin.

mogrify_screenshot2

Screenshot from Mogrify.net. Just select your desired starting and finishing cell types and Mogrify recommends which transcription factors to use for your cell conversion. 

Will Mogrify completely eliminate the need to do some trial and error? Not likely, as the authors knowledge, but it’s a great starting point. If scientists can dramatically shorten the time needed to generate the cells related to their particular disease of interest, then they can more quickly move on to the hard work ahead: gaining a deeper understanding of the disease and developing cures. Julian Gough, professor of bioinformatics at the University of Bristol and one of the senior researchers on the report, spoke of the potential impact of Mogrify in a university press release:

“The ability to produce numerous types of human cells will lead directly to tissue therapies of all kinds, to treat conditions from arthritis to macular degeneration, to heart disease. The fuller understanding, at the molecular level of cell production leading on from this, may allow us to grow whole organs from somebody’s own cells.”