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Litif CG, Flom LT, Sandum KL, Hodgins SL, Vaccaro L, Stitzel JA, Blouin NA, Mannino MC, Gigley JP, Schoborg TA, Bobadilla AC. Differential genetic expression within reward-specific ensembles in mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.11.02.565378. [PMID: 37961222 PMCID: PMC10635086 DOI: 10.1101/2023.11.02.565378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Maladaptive reward seeking is a hallmark of cocaine use disorder. To develop therapeutic targets, it is critical to understand the neurobiological changes specific to cocaine-seeking without altering the seeking of natural rewards, e.g., sucrose. The prefrontal cortex (PFC) and the nucleus accumbens core (NAcore) are known regions associated with cocaine- and sucrose-seeking ensembles, i.e., a sparse population of co-activated neurons. Within ensembles, transcriptomic alterations in the PFC and NAcore underlie the learning and persistence of cocaine- and sucrose-seeking behavior. However, transcriptomes exclusively driving cocaine seeking independent from sucrose seeking have not yet been defined using a within-subject approach. Using Ai14:cFos-TRAP2 transgenic mice in a dual cocaine and sucrose self-administration model, we fluorescently sorted (FACS) and characterized (RNAseq) the transcriptomes defining cocaine- and sucrose-seeking ensembles. We found reward- and region-specific transcriptomic changes that will help develop clinically relevant genetic approaches to decrease cocaine-seeking behavior without altering non-drug reward-based positive reinforcement.
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Affiliation(s)
- Carl G. Litif
- School of Pharmacy, University of Wyoming, Laramie, Wyoming, USA
| | - Levi T. Flom
- School of Pharmacy, University of Wyoming, Laramie, Wyoming, USA
| | | | | | - Lucio Vaccaro
- School of Pharmacy, University of Wyoming, Laramie, Wyoming, USA
| | - Jerry A. Stitzel
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Nicolas A. Blouin
- Department of Molecular Biology, University of Wyoming, Laramie, Wyoming, USA
| | | | - Jason P. Gigley
- Department of Molecular Biology, University of Wyoming, Laramie, Wyoming, USA
| | - Todd A. Schoborg
- Department of Molecular Biology, University of Wyoming, Laramie, Wyoming, USA
| | - Ana-Clara Bobadilla
- School of Pharmacy, University of Wyoming, Laramie, Wyoming, USA
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Genetically modified mice for research on human diseases: A triumph for Biotechnology or a work in progress? THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022] Open
Abstract
Abstract
Genetically modified mice are engineered as models for human diseases. These mouse models include inbred strains, mutants, gene knockouts, gene knockins, and ‘humanized’ mice. Each mouse model is engineered to mimic a specific disease based on a theory of the genetic basis of that disease. For example, to test the amyloid theory of Alzheimer’s disease, mice with amyloid precursor protein genes are engineered, and to test the tau theory, mice with tau genes are engineered. This paper discusses the importance of mouse models in basic research, drug discovery, and translational research, and examines the question of how to define the “best” mouse model of a disease. The critiques of animal models and the caveats in translating the results from animal models to the treatment of human disease are discussed. Since many diseases are heritable, multigenic, age-related and experience-dependent, resulting from multiple gene-gene and gene-environment interactions, it will be essential to develop mouse models that reflect these genetic, epigenetic and environmental factors from a developmental perspective. Such models would provide further insight into disease emergence, progression and the ability to model two-hit and multi-hit theories of disease. The summary examines the biotechnology for creating genetically modified mice which reflect these factors and how they might be used to discover new treatments for complex human diseases such as cancers, neurodevelopmental and neurodegenerative diseases.
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Childebayeva A, Goodrich JM, Chesterman N, Leon-Velarde F, Rivera-Ch M, Kiyamu M, Brutsaert TD, Bigham AW, Dolinoy DC. Blood lead levels in Peruvian adults are associated with proximity to mining and DNA methylation. ENVIRONMENT INTERNATIONAL 2021; 155:106587. [PMID: 33940396 PMCID: PMC9903334 DOI: 10.1016/j.envint.2021.106587] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 06/05/2023]
Abstract
BACKGROUND Inorganic lead (Pb) is common in the environment, and is toxic to neurological, renal, and cardiovascular systems. Pb exposure influences the epigenome with documented effects on DNA methylation (DNAm). We assessed the impact of low levels of Pb exposure on DNAm among non-miner individuals from two locations in Peru: Lima, the capital, and Cerro de Pasco, a highland mining town, to study the effects of Pb exposure on physiological outcomes and DNAm. METHODS Pb levels were measured in whole blood (n = 305). Blood leukocyte DNAm was determined for 90 DNA samples using the Illumina MethylationEPIC chip. An epigenome-wide association study was performed to assess the relationship between Pb and DNAm. RESULTS Individuals from Cerro de Pasco had higher Pb than individuals from Lima (p-value = 2.00E-16). Males had higher Pb than females (p-value = 2.36E-04). Pb was positively associated with hemoglobin (p-value = 8.60E-04). In Cerro de Pasco, blood Pb decreased with the distance from the mine (p-value = 0.04), and association with soil Pb was approaching significance (p-value = 0.08). We identified differentially methylated positions (DMPs) associated with genes SOX18, ZMIZ1, and KDM1A linked to neurological function. We also found 45 differentially methylated regions (DMRs), seven of which were associated with genes involved in metal ion binding and nine to neurological function and development. CONCLUSIONS Our results demonstrate that even low levels of Pb can have a significant impact on the body including changes to DNAm. We report associations between Pb and hemoglobin, Pb and distance from mining, and between blood and soil Pb. We also report associations between loci- and region-specific DNAm and Pb.
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Affiliation(s)
- Ainash Childebayeva
- Department of Anthropology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Department of Archaeogenetics, Max Planck Institute for the Science of Human History, Jena 07745, Germany.
| | - Jaclyn M Goodrich
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nathan Chesterman
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI 48109, USA
| | - Fabiola Leon-Velarde
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Rivera-Ch
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Melisa Kiyamu
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tom D Brutsaert
- Department of Exercise Science, Syracuse University, Syracuse, NY 13244, USA
| | - Abigail W Bigham
- Department of Anthropology, University of California, Los Angeles, CA 90095, USA
| | - Dana C Dolinoy
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Nesbit N, Wallace R, Harihar S, Zhou M, Jung JY, Silberstein M, Lee PH. Genomewide alteration of histone H3K4 methylation underlies genetic vulnerability to psychopathology. J Genet 2021. [DOI: 10.1007/s12041-021-01294-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Nesbit N, Wallace R, Harihar S, Zhou M, Jung JY, Silberstein M, Lee PH. Genomewide alteration of histone H3K4 methylation underlies genetic vulnerability to psychopathology. J Genet 2021; 100:44. [PMID: 34282735 PMCID: PMC8459212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Dysregulated histone methylation has emerged as a recurring theme in multiple neuropsychiatric disorders. However, it is yet unclear whether the altered histone methylation is associated with aetiologic mechanisms or an outcome of disease manifestation. In this study, we examined the genomewide association studies datasets of three major psychiatric disorders, schizophrenia (SCZ), bipolar disorder (BIP), and major depression disorder (MDD), which represents a total of 231,783 cases and 425,444 controls, to clarify the relationship. Our gene-set enrichment analysis results identified statistically significant association of genes involved in three histone methylation biological processes with the three adult-onset psychiatric disorders, which is mainly driven by the histone H3K4 methylation pathway (GO: 0051568). Further analysis of histone H3K4 methylation pathway genes revealed a widespread role of the genes in brain function and disease; 29 (52%) and 41 genes (73.2%) were associated with at least one brain-related trait or brain disorder, respectively. Spatiotemporal gene expression analysis suggests that these pathway genes play a critical role during the prenatal period and are consistent regulators in the cerebral cortex throughout an individual's life. AUTS2, DNMT1 and TET2 are genes of particular interest due to their pervasive role in various aspects of brain function. Our findings support a critical aetiologic role of H3K4 methylation genes shared across SCZ, BIP and MDD, providing new direction for the development of epigenetically-focussed drugs targeting common causal factors of these devastating disorders.
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Affiliation(s)
- Nicholas Nesbit
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Bussone S, Iacono LL. The “systems approach” to treating the brain: opportunities in developmental psychopharmacology. DIALOGUES IN CLINICAL NEUROSCIENCE 2019. [PMID: 31636495 PMCID: PMC6787541 DOI: 10.31887/dcns.2019.21.2/lloiacono] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The significance of early life for the long-term programming of mental health is
increasingly being recognized. However, most psychotropic medications are
currently intended for adult patients, and early psychopharmacological
approaches aimed at reverting aberrant neurodevelopmental trajectories are
missing. Psychopharmacologic intervention at an early age faces the challenge of
operating in a highly plastic system and requires a comprehensive knowledge of
neurodevelopmental mechanisms. Recently the systems biology approach has
contributed to the understanding of neuroplasticity mechanisms from a new
perspective that interprets them as the result of complex and dynamic networks
of signals from different systems. This approach is creating opportunities for
developmental psychopharmacology, suggesting novel targets that can modulate the
course of development by interfering with neuroplasticity at an early age. We
will discuss two interconnected systems—the immune and gut microbiota—that
regulate neurodevelopment and that have been implicated in preclinical research
as new targets in the prevention of aberrant brain development.
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Affiliation(s)
- Silvia Bussone
- Author affiliations: PhD student, Department of Dynamic and Clinical Psychology, University of Rome "La Sapienza", Via degli Apuli, 1, 00185, Rome, Italy (Silvia Bussone); Senior researcher, IRCCS Santa Lucia Foundation, Via del Fosso di Fiorano 64, 00143, Rome, Italy; Department of Psychology, University of Rome "La Sapienza", Via dei Marsi, 78, 00185, Rome, Italy (Luisa Lo Iacono). Address for correspondence: IRCCS Santa Lucia Foundation, Via del Fosso di Fiorano 64, 00143, Rome, Italy. (e-mail: )
| | - Luisa Lo Iacono
- Author affiliations: PhD student, Department of Dynamic and Clinical Psychology, University of Rome "La Sapienza", Via degli Apuli, 1, 00185, Rome, Italy (Silvia Bussone); Senior researcher, IRCCS Santa Lucia Foundation, Via del Fosso di Fiorano 64, 00143, Rome, Italy; Department of Psychology, University of Rome "La Sapienza", Via dei Marsi, 78, 00185, Rome, Italy (Luisa Lo Iacono). Address for correspondence: IRCCS Santa Lucia Foundation, Via del Fosso di Fiorano 64, 00143, Rome, Italy. (e-mail: )
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Ariana M, Pornour M, Mehr SS, Vaseghi H, Ganji SM, Alivand MR, Salari M, Akbari ME. Preventive effects of oxytocin and oxytocin receptor in breast cancer pathogenesis. Per Med 2018; 16:25-34. [PMID: 30451597 DOI: 10.2217/pme-2018-0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM Modifications of oxytocin (OT) concentration and OT receptor (OXTR) expression level have different effects on breast cancer-derived cells. This study was conducted to evaluate OT variation in breast cancer patients and to evaluate OXTR expression changes in breast cancer tissues. METHODS The plasma concentrations of OT in both breast cancer patients and healthy individuals' samples were assessed. OXTR variations were then assessed in both cancerous and noncancerous breast tissues. RESULTS OT had an increase in breast cancer patients and expression of OXTR in contralateral breast was more than cancerous tissues. CONCLUSION Despite the high levels of OT concentration in breast cancer patients, it seems that a lower expression of OXTR in cancerous tissues can be effective in the breast cancer progression.
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Affiliation(s)
- Mehdi Ariana
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Pornour
- Department of Photo Healing & Regeneration, Medical Laser Research Center, Yara Institute, Academic Center for Education, Culture & Research (ACECR), Tehran, Iran
| | - Saeedeh Sarafraz Mehr
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hajar Vaseghi
- Department of Photo Healing & Regeneration, Medical Laser Research Center, Yara Institute, Academic Center for Education, Culture & Research (ACECR), Tehran, Iran
| | | | - Mohammad R Alivand
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Salari
- Department of Biostatistics, Faculty of Medical Sciences, Terabit Modares University, Tehran, Iran
| | - Mohammad E Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Uchida S, Yamagata H, Seki T, Watanabe Y. Epigenetic mechanisms of major depression: Targeting neuronal plasticity. Psychiatry Clin Neurosci 2018; 72:212-227. [PMID: 29154458 DOI: 10.1111/pcn.12621] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/02/2017] [Accepted: 11/14/2017] [Indexed: 12/27/2022]
Abstract
Major depressive disorder is one of the most common mental illnesses as it affects more than 350 million people globally. Major depressive disorder is etiologically complex and disabling. Genetic factors play a role in the etiology of major depression. However, identical twin studies have shown high rates of discordance, indicating non-genetic mechanisms as well. For instance, stressful life events increase the risk of depression. Environmental stressors also induce stable changes in gene expression within the brain that may lead to maladaptive neuronal plasticity in regions implicated in disease pathogenesis. Epigenetic events alter the chromatin structure and thus modulate expression of genes that play a role in neuronal plasticity, behavioral response to stress, depressive behaviors, and response to antidepressants. Here, we review new information regarding current understanding of epigenetic events that may impact depression. In particular, we discuss the roles of histone acetylation, DNA methylation, and non-coding RNA. These novel mechanisms of action may lead to new therapeutic strategies for treating major depression.
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Affiliation(s)
- Shusaku Uchida
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Tomoe Seki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Yoshifumi Watanabe
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Funahashi Y, Yoshino Y, Yamazaki K, Mori Y, Mori T, Ozaki Y, Sao T, Ochi S, Iga JI, Ueno SI. DNA methylation changes at SNCA intron 1 in patients with dementia with Lewy bodies. Psychiatry Clin Neurosci 2017; 71:28-35. [PMID: 27685250 DOI: 10.1111/pcn.12462] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/07/2016] [Accepted: 09/22/2016] [Indexed: 12/15/2022]
Abstract
AIM It is difficult to diagnose dementia with Lewy bodies (DLB) because it exhibits clinical and neuropathological overlap with both Alzheimer's disease and Parkinson's disease. The α-synuclein protein is a major component of Lewy bodies, and accumulation of α-synuclein aggregates causes synaptic dysfunction in DLB. Epigenetic changes at the synuclein alpha ( SNCA ) gene may be involved in DLB pathogenesis. METHODS We examined DNA methylation rates at 10 CpG sites located in intron 1 of SNCA and SNCA mRNA expression in peripheral leukocytes to compare DLB patients (n = 20; nine men, 11 women; age = 78.8 ± 7.7 years) with healthy controls (n = 20; eight men, 12 women; age = 77.0 ± 6.9 years). RESULTS The methylation rate at CpG 4 ( P = 0.002) and the overall mean methylation rate at these sites (P < 0.001) were significantly lower in DLB patients than in healthy controls after Bonferroni correction. Although SNCA126 , a partial form of SNCA mRNA expression, was significantly increased in DLB ( P = 0.017), there was no significant difference in total SNCA mRNA expression between DLB patients and healthy controls ( P = 0.165). No correlation was observed between SCNA mRNA expression levels and blood DNA methylation rates in either DLB or healthy controls. CONCLUSION Our findings indicated that lower methylation rates may be a biomarker for DLB.
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Affiliation(s)
- Yu Funahashi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yuta Yoshino
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kiyohiro Yamazaki
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoko Mori
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takaaki Mori
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yuki Ozaki
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tomoko Sao
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shu-Ichi Ueno
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Ehime, Japan
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Ricq EL, Hooker JM, Haggarty SJ. Toward development of epigenetic drugs for central nervous system disorders: Modulating neuroplasticity via H3K4 methylation. Psychiatry Clin Neurosci 2016; 70:536-550. [PMID: 27485392 PMCID: PMC5764164 DOI: 10.1111/pcn.12426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 12/19/2022]
Abstract
The mammalian brain dynamically activates or silences gene programs in response to environmental input and developmental cues. This neuroplasticity is controlled by signaling pathways that modify the activity, localization, and/or expression of transcriptional-regulatory enzymes in combination with alterations in chromatin structure in the nucleus. Consistent with this key neurobiological role, disruptions in the fine-tuning of epigenetic and transcriptional regulation have emerged as a recurrent theme in studies of the genetics of neurodevelopmental and neuropsychiatric disorders. Furthermore, environmental factors have been implicated in the increased risk of heterogeneous, multifactorial, neuropsychiatric disorders via epigenetic mechanisms. Aberrant epigenetic regulation of gene expression thus provides an attractive unifying model for understanding the complex risk architecture of mental illness. Here, we review emerging genetic evidence implicating dysregulation of histone lysine methylation in neuropsychiatric disease and outline advancements in small-molecule probes targeting this chromatin modification. The emerging field of neuroepigenetic research is poised to provide insight into the biochemical basis of genetic risk for diverse neuropsychiatric disorders and to develop the highly selective chemical tools and imaging agents necessary to dissect dynamic transcriptional-regulatory mechanisms in the nervous system. On the basis of these findings, continued advances may lead to the validation of novel, disease-modifying therapeutic targets for a range of disorders with aberrant chromatin-mediated neuroplasticity.
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Affiliation(s)
- Emily L. Ricq
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
- Chemical Neurobiology Laboratory, Center for Human Genetic Research, Departments of Neurology & Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Jacob M. Hooker
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts 02129, United States
| | - Stephen J. Haggarty
- Chemical Neurobiology Laboratory, Center for Human Genetic Research, Departments of Neurology & Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
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