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Hudac CM, Dommer K, Mahony M, DesChamps TD, Cairney B, Earl R, Kurtz-Nelson EC, Bradshaw J, Bernier RA, Eichler EE, Neuhaus E, Webb SJ, Shic F. Visual and auditory attention in individuals with DYRK1A and SCN2A disruptive variants. Autism Res 2024. [PMID: 39080977 DOI: 10.1002/aur.3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024]
Abstract
This preliminary study sought to assess biomarkers of attention using electroencephalography (EEG) and eye tracking in two ultra-rare monogenic populations associated with autism spectrum disorder (ASD). Relative to idiopathic ASD (n = 12) and neurotypical comparison (n = 49) groups, divergent attention profiles were observed for the monogenic groups, such that individuals with DYRK1A (n = 9) exhibited diminished auditory attention condition differences during an oddball EEG paradigm whereas individuals with SCN2A (n = 5) exhibited diminished visual attention condition differences noted by eye gaze tracking when viewing social interactions. Findings provide initial support for alignment of auditory and visual attention markers in idiopathic ASD and neurotypical development but not monogenic groups. These results support ongoing efforts to develop translational ASD biomarkers within the attention domain.
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Affiliation(s)
- Caitlin M Hudac
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
- Center for Autism and Neurodevelopment (CAN) Research Center, University of South Carolina, Columbia, South Carolina, USA
- Institute for Mind and Brain, University of South Carolina, Columbia, South Carolina, USA
| | - Kelsey Dommer
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Monique Mahony
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Trent D DesChamps
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Brianna Cairney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Rachel Earl
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | | | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
- Center for Autism and Neurodevelopment (CAN) Research Center, University of South Carolina, Columbia, South Carolina, USA
- Institute for Mind and Brain, University of South Carolina, Columbia, South Carolina, USA
| | - Raphael A Bernier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
- Howard Hughes Medical Institute, University of Washington, Seattle, Washington, USA
| | - Emily Neuhaus
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Sara Jane Webb
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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2
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Jonak CR, Assad SA, Garcia TA, Sandhu MS, Rumschlag JA, Razak KA, Binder DK. Phenotypic analysis of multielectrode array EEG biomarkers in developing and adult male Fmr1 KO mice. Neurobiol Dis 2024; 195:106496. [PMID: 38582333 DOI: 10.1016/j.nbd.2024.106496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
Fragile X Syndrome (FXS) is a leading known genetic cause of intellectual disability with symptoms that include increased anxiety and social and sensory processing deficits. Recent electroencephalographic (EEG) studies in humans with FXS have identified neural oscillation deficits that include increased resting state gamma power, increased amplitude of auditory evoked potentials, and reduced phase locking of sound-evoked gamma oscillations. Similar EEG phenotypes are present in mouse models of FXS, but very little is known about the development of such abnormal responses. In the current study, we employed a 30-channel mouse multielectrode array (MEA) system to record and analyze resting and stimulus-evoked EEG signals in male P21 and P91 WT and Fmr1 KO mice. This led to several novel findings. First, P91, but not P21, Fmr1 KO mice have significantly increased resting EEG power in the low- and high-gamma frequency bands. Second, both P21 and P91 Fmr1 KO mice have markedly attenuated inter-trial phase coherence (ITPC) to spectrotemporally dynamic auditory stimuli as well as to 40 Hz and 80 Hz auditory steady-state response (ASSR) stimuli. This suggests abnormal temporal processing from early development that may lead to abnormal speech and language function in FXS. Third, we found hemispheric asymmetry of fast temporal processing in the mouse auditory cortex in WT but not Fmr1 KO mice. Together, these findings define a set of EEG phenotypes in young and adult mice that can serve as translational targets for genetic and pharmacological manipulation in phenotypic rescue studies.
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Affiliation(s)
- Carrie R Jonak
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, United States of America
| | - Samantha A Assad
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, United States of America
| | - Terese A Garcia
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, United States of America
| | - Manbir S Sandhu
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, United States of America
| | - Jeffrey A Rumschlag
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States of America
| | - Khaleel A Razak
- Neuroscience Graduate Program, University of California, Riverside, CA, United States of America; Department of Psychology, University of California, Riverside, CA, United States of America
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, United States of America; Neuroscience Graduate Program, University of California, Riverside, CA, United States of America.
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Lazar SM, Challman TD, Myers SM. Etiologic Evaluation of Children with Autism Spectrum Disorder. Pediatr Clin North Am 2024; 71:179-197. [PMID: 38423715 DOI: 10.1016/j.pcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Autism spectrum disorder (ASD) is clinically and etiologically heterogeneous. A causal genetic variant can be identified in approximately 20% to 25% of affected individuals with current clinical genetic testing, and all patients with an ASD diagnosis should be offered genetic etiologic evaluation. We suggest that exome sequencing with copy number variant coverage should be the first-line etiologic evaluation for ASD. Neuroimaging, neurophysiologic, metabolic, and other biochemical evaluations can provide insight into the pathophysiology of ASD but should be recommended in the appropriate clinical circumstances.
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Affiliation(s)
- Steven M Lazar
- Section of Pediatric Neurology and Developmental Neuroscience, Meyer Center for Developmental Pediatrics & Autism, Baylor College of Medicine - Texas Children's Hospital, 6701 Fannin Street Suite 1250, Houston, TX 77030, USA.
| | - Thomas D Challman
- Geisinger Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, USA
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, USA
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Ethridge LE, Pedapati EV, Schmitt LM, Norris JE, Auger E, De Stefano LA, Sweeney JA, Erickson CA. Validating brain activity measures as reliable indicators of individual diagnostic group and genetically mediated sub-group membership Fragile X Syndrome. RESEARCH SQUARE 2024:rs.3.rs-3849272. [PMID: 38313274 PMCID: PMC10836101 DOI: 10.21203/rs.3.rs-3849272/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Recent failures translating preclinical behavioral treatment effects to positive clinical trial results in humans with Fragile X Syndrome (FXS) support refocusing attention on biological pathways and associated measures, such as electroencephalography (EEG), with strong translational potential and small molecule target engagement. This study utilized guided machine learning to test promising translational EEG measures (resting power and auditory chirp oscillatory variables) in a large heterogeneous sample of individuals with FXS to identify best performing EEG variables for reliably separating individuals with FXS, and genetically-mediated subgroups within FXS, from typically developing controls. Best performing variables included resting relative frontal theta power, all combined whole-head resting power bands, posterior peak alpha frequency (PAF), combined PAF across all measured regions, combined theta, alpha, and gamma power during the chirp, and all combined chirp oscillatory variables. Sub-group analyses best discriminated non-mosaic FXS males via whole-head resting relative power (AUC = .9250), even with data reduced to a 20-channel clinical montage. FXS females were nearly perfectly discriminated by combined theta, alpha, and gamma power during the chirp (AUC = .9522). Results support use of resting and auditory oscillatory tasks to reliably identify neural deficit in FXS, and to identify specific translational targets for genetically-mediated sub-groups, supporting potential points for stratification.
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Erickson CA, Shaffer RC, Will M, Schmitt LM, Horn P, Hirst K, Pedapati EV, Ober N, Tumuluru RV, Handen BL, Beversdorf DQ. Brief Report: A Double-Blind, Placebo-Controlled, Crossover, Proof-of-Concept Study of Minocycline in Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06132-1. [PMID: 38102393 DOI: 10.1007/s10803-023-06132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 12/17/2023]
Abstract
Neuroinflammatory mechanisms have been implicated in the pathophysiology of autism spectrum disorder (ASD). Minocycline is a matrix metalloproteinase inhibitor 9 (MMP9) inhibitor tetracycline antibiotic with known anti-inflammatory properties. In preclinical animal models of ASD, minocycline has demonstrated potential positive effects on phenotypes that may have relevance to ASD. We conducted the first placebo-controlled study of minocycline in ASD. This double-blind, placebo-controlled crossover trial employed four week treatment periods with a two week washout period. Twenty-four 12-22 year olds (mean age 17.4 years; range 12.9-22.5 years) with ASD were enrolled. Overall minocycline was well tolerated. No minocycline-associated clinical changes were noted with treatment on any performance or clinician or caregiver completed measures were noted. We hypothesize that either minocycline does not have potential therapeutic effects in ASD or our project was underpowered to define potential subject subgroups who may potentially respond positively to this drug.
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Affiliation(s)
- Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Rebecca C Shaffer
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Meredith Will
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren M Schmitt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul Horn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathy Hirst
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Ernest V Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4002, Cincinnati, OH, 45229, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nicole Ober
- Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | | | - Benjamin L Handen
- Psychiatry, Pediatrics, Psychology, and Education Departments, University of Pittsburgh, Pittsburgh, USA
| | - David Q Beversdorf
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
- Radiology, Neurology, and Psychological Sciences, William and Nancy Thompson Endowed Chair in Radiology, University of Missouri, Columbia, MO, USA
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Gupta S, Hwang Y, Ludwig N, Henry J, Kadam SD. Case report: Off-label use of low-dose perampanel in a 25-month-old girl with a pathogenic SYNGAP1 variant. Front Neurol 2023; 14:1221161. [PMID: 37662032 PMCID: PMC10469904 DOI: 10.3389/fneur.2023.1221161] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Preclinical studies in a mouse model have shown that SYNGAP1 haploinsufficiency results in an epilepsy phenotype with excessive GluA2-AMPA insertion specifically on the soma of fast-spiking parvalbumin-positive interneurons associated with significant dysfunction of cortical gamma homeostasis that was rescued by perampanel (PER), an AMPA receptor blocker. In this single case, we aimed to investigate the presence of dysregulated cortical gamma in a toddler with a pathogenic SYNGAP1 variant and report on the effect of low-dose PER on electroencephalogram (EEG) and clinical profile. Methods Clinical data from physician's clinic notes; genetic testing reports; developmental scores from occupational therapy, physical therapy, speech and language therapy evaluations; and applied behavioral analysis reports were reviewed. Developmental assessments and EEG analysis were done pre- and post-PER. Results Clinically, the patient showed improvements in the developmental profile and sleep quality post-PER. EEG spectral power analysis in our patient revealed a loss of gamma power modulation with behavioral-state transitions similar to what was observed in Syngap1+/- mice. Furthermore, the administration of low-dose PER rescued the dysfunctional cortical gamma homeostasis, similar to the preclinical study. However, as in the epileptic mice, PER did not curb epileptiform discharges or clinical seizures. Conclusion Similar to the Syngap1+/- mice, cortical gamma homeostasis was dysregulated in the patient. This dysfunction was rescued by PER. These encouraging results necessitate further validation of gamma dysregulation as a potential translational EEG biomarker in SYNAP1-DEE. Low-dose PER can be explored as a therapeutic option through clinical trials.
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Affiliation(s)
- Siddharth Gupta
- Department of Neurology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yun Hwang
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States
| | - Natasha Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Psychiatry and Behavior Psychology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Julia Henry
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Shilpa D. Kadam
- Department of Neurology, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States
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7
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Deguire F, López-Arango G, Knoth IS, Côté V, Agbogba K, Lippé S. EEG repetition and change detection responses in infancy predict adaptive functioning in preschool age: a longitudinal study. Sci Rep 2023; 13:9980. [PMID: 37340003 DOI: 10.1038/s41598-023-34669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023] Open
Abstract
Neurodevelopmental disorders (NDDs) are mostly diagnosed around the age of 4-5 years, which is too late considering that the brain is most susceptive to interventions during the first two years of life. Currently, diagnosis of NDDs is based on observed behaviors and symptoms, but identification of objective biomarkers would allow for earlier screening. In this longitudinal study, we investigated the relationship between repetition and change detection responses measured using an EEG oddball task during the first year of life and at two years of age, and cognitive abilities and adaptive functioning during preschool years (4 years old). Identification of early biomarkers is challenging given that there is a lot of variability in developmental courses among young infants. Therefore, the second aim of this study is to assess whether brain growth is a factor of interindividual variability that influences repetition and change detection responses. To obtain variability in brain growth beyond the normative range, infants with macrocephaly were included in our sample. Thus, 43 normocephalic children and 20 macrocephalic children were tested. Cognitive abilities at preschool age were assessed with the WPPSI-IV and adaptive functioning was measured with the ABAS-II. Time-frequency analyses were conducted on the EEG data. Results indicated that repetition and change detection responses in the first year of life predict adaptive functioning at 4 years of age, independently of head circumference. Moreover, our findings suggested that brain growth explains variability in neural responses mostly in the first years of life, so that macrocephalic children did not display repetition suppression responses, while normocephalic children did. This longitudinal study demonstrates that the first year of life is an important period for the early screening of children at risk of developing NDDs.
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Affiliation(s)
- Florence Deguire
- Psychology Department, University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada.
- Pôle en neuropsychologie et neuroscience cognitive et computationnelle (CerebrUM), University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada.
- Research Center of the CHU Sainte-Justine, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada.
| | - Gabriela López-Arango
- Psychology Department, University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada
- Pôle en neuropsychologie et neuroscience cognitive et computationnelle (CerebrUM), University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada
- Research Center of the CHU Sainte-Justine, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
| | - Inga Sophia Knoth
- Research Center of the CHU Sainte-Justine, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
| | - Valérie Côté
- Psychology Department, University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada
- Pôle en neuropsychologie et neuroscience cognitive et computationnelle (CerebrUM), University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada
- Research Center of the CHU Sainte-Justine, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
| | - Kristian Agbogba
- Research Center of the CHU Sainte-Justine, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
- École de technologie supérieure, University of Quebec, 1100 Notre-Dame W, Montreal, QC, Canada
| | - Sarah Lippé
- Psychology Department, University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada
- Pôle en neuropsychologie et neuroscience cognitive et computationnelle (CerebrUM), University of Montreal, Marie Victorin Building, 90 Vincent-D'Indy Avenue, Montreal, QC, Canada
- Research Center of the CHU Sainte-Justine, University of Montreal, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada
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Pedapati EV, Sweeney JA, Schmitt LM, Ethridge LE, Miyakoshi M, Liu R, Smith E, Shaffer RC, Wu SW, Gilbert DL, Horn PS, Erickson C. Empirical Frequency Bound Derivation Reveals Prominent Mid-Frontal Alpha Associated with Neurosensory Dysfunction in Fragile X Syndrome. RESEARCH SQUARE 2023:rs.3.rs-2855646. [PMID: 37162907 PMCID: PMC10168472 DOI: 10.21203/rs.3.rs-2855646/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The FMR1 gene is inactive in Fragile X syndrome (FXS), resulting in low levels of FMRP and consequent neurochemical, synaptic, and local circuit neurophysiological alterations in the fmr1 KO mouse. In FXS patients, electrophysiological studies have demonstrated a marked reduction in global alpha activity and regional increases in gamma oscillations associated with intellectual disability and sensory hypersensitivity. Since alpha activity is associated with a thalamocortical function with widely distributed modulatory effects on neocortical excitability, insight into alpha physiology may provide insight into systems-level disease mechanisms. Herein, we took a data-driven approach to clarify the temporal and spatial properties of alpha and theta activity in participants with FXS. High-resolution resting-state EEG data were collected from participants affected by FXS (n = 65) and matched controls (n = 70). We used a multivariate technique to empirically classify neural oscillatory bands based on their coherent spatiotemporal patterns. Participants with FXS demonstrated: 1) redistribution of lower-frequency boundaries indicating a "slower" dominant alpha rhythm, 2) an anteriorization of alpha frequency activity, and 3) a correlation of increased individualized alpha power measurements with auditory neurosensory dysfunction. These findings suggest an important role for alterations in thalamocortical physiology for the well-established neocortical hyper-excitability in FXS and, thus, a role for neural systems level disruption to cortical hyperexcitability that has been studied primarily at the local circuit level in animal models.
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Affiliation(s)
| | | | | | | | | | - Rui Liu
- Cincinnati Children's Hospital Medical Center
| | | | | | - Steve W Wu
- Cincinnati Children's Hospital Medical Center
| | | | - Paul S Horn
- Cincinnati Children's Hospital Medical Center
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Murari K, Abushaibah A, Rho JM, Turner RW, Cheng N. A clinically relevant selective ERK-pathway inhibitor reverses core deficits in a mouse model of autism. EBioMedicine 2023; 91:104565. [PMID: 37088035 PMCID: PMC10149189 DOI: 10.1016/j.ebiom.2023.104565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Extracellular signal-regulated kinase (ERK/MAPK) pathway in the brain is hypothesized to be a critical convergent node in the development of autism spectrum disorder. We reasoned that selectively targeting this pathway could reverse core autism-like phenotype in animal models. METHODS Here we tested a clinically relevant, selective inhibitor of ERK pathway, PD325901 (Mirdametinib), in a mouse model of idiopathic autism, the BTBR mice. FINDINGS We report that treating juvenile mice with PD325901 reduced ERK pathway activation, dose and duration-dependently reduced core disease-modeling deficits in sociability, vocalization and repetitive behavior, and reversed abnormal EEG signals. Further analysis revealed that subchronic treatment did not affect weight gain, locomotion, or neuronal density in the brain. Parallel treatment in the C57BL/6J mice did not alter their phenotype. INTERPRETATION Our data indicate that selectively inhibiting ERK pathway using PD325901 is beneficial in the BTBR model, thus further support the notion that ERK pathway is critically involved in the pathophysiology of autism. These results suggest that a similar approach could be applied to animal models of syndromic autism with dysregulated ERK signaling, to further test selectively targeting ERK pathway as a new approach for treating autism. FUNDING This has beenwork was supported by Alberta Children's Hospital Research Foundation (JMR & NC), University of Calgary Faculty of Veterinary Medicine (NC), Kids Brain Health Network (NC), and Natural Sciences and Engineering Research Council of Canada (NC).
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Affiliation(s)
- Kartikeya Murari
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Canada; Department of Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Canada
| | - Abdulrahman Abushaibah
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Bachelor of Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Jong M Rho
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada
| | - Ray W Turner
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Cell Biology & Anatomy, Cumming School of Medicine, University of Calgary, Canada
| | - Ning Cheng
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Canada.
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10
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Dorokhov VB, Runnova A, Tkachenko ON, Taranov AO, Arseniev GN, Kiselev A, Selskii A, Orlova A, Zhuravlev M. Analysis two types of K complexes on the human EEG based on classical continuous wavelet transform. CHAOS (WOODBURY, N.Y.) 2023; 33:031102. [PMID: 37003802 DOI: 10.1063/5.0143284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/20/2023] [Indexed: 06/19/2023]
Abstract
In our work, we compare EEG time-frequency features for two types of K-complexes detected in volunteers performing the monotonous psychomotor test with their eyes closed. Type I K-complexes preceded spontaneous awakenings, while after type II K-complexes, subjects continued to sleep at least for 10 s after. The total number of K-complexes in the group of 18 volunteers was 646, of which of which type I K-complexes was 150 and type II K-complexes was 496. Time-frequency analysis was performed using continuous wavelet transform. EEG wavelet spectral power was averaged upon several brain zones for each of the classical frequency ranges (slow wave, δ, θ, α, β1, β2, γ bands). The low-frequency oscillatory activity ( δ-band) preceding type I K-complexes was asymmetrical and most prominent in the left hemisphere. Statistically significant differences were obtained by averaging over the left and right hemispheres, as well as projections of the motor area of the brain, p<0.05. The maximal differences between the types I and II of K-complexes were demonstrated in δ-, θ-bands in the occipital and posterior temporal regions. The high amplitude of the motor cortex projection response in β2-band, [20;30] Hz, related to the sensory-motor modality of task in monotonous psychomotor test. The δ-oscillatory activity preceding type I K-complexes was asymmetrical and most prominent in the left hemisphere may be due to the important role of the left hemisphere in spontaneous awakening from sleep during monotonous work, which is an interesting issue for future research.
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Affiliation(s)
- V B Dorokhov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117865 Moscow, Russia
| | - A Runnova
- Center for Coordination of Fundamental Scientific Activities, National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia
| | - O N Tkachenko
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117865 Moscow, Russia
| | - A O Taranov
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117865 Moscow, Russia
| | - G N Arseniev
- Laboratory of Sleep/Wake Neurobiology, Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117865 Moscow, Russia
| | - A Kiselev
- Center for Coordination of Fundamental Scientific Activities, National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia
| | - A Selskii
- Institute of Physics, Saratov State University, 410012 Saratov, Russia
| | - A Orlova
- Center for Coordination of Fundamental Scientific Activities, National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia
| | - M Zhuravlev
- Center for Coordination of Fundamental Scientific Activities, National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia
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11
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Mintz Hemed N, Melosh NA. An integrated perspective for the diagnosis and therapy of neurodevelopmental disorders - From an engineering point of view. Adv Drug Deliv Rev 2023; 194:114723. [PMID: 36746077 DOI: 10.1016/j.addr.2023.114723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/14/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
Neurodevelopmental disorders (NDDs) are complex conditions with largely unknown pathophysiology. While many NDD symptoms are familiar, the cause of these disorders remains unclear and may involve a combination of genetic, biological, psychosocial, and environmental risk factors. Current diagnosis relies heavily on behaviorally defined criteria, which may be biased by the clinical team's professional and cultural expectations, thus a push for new biological-based biomarkers for NDDs diagnosis is underway. Emerging new research technologies offer an unprecedented view into the electrical, chemical, and physiological activity in the brain and with further development in humans may provide clinically relevant diagnoses. These could also be extended to new treatment options, which can start to address the underlying physiological issues. When combined with current speech, language, occupational therapy, and pharmacological treatment these could greatly improve patient outcomes. The current review will discuss the latest technologies that are being used or may be used for NDDs diagnosis and treatment. The aim is to provide an inspiring and forward-looking view for future research in the field.
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Affiliation(s)
- Nofar Mintz Hemed
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA.
| | - Nicholas A Melosh
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
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Webb SJ, Naples AJ, Levin AR, Hellemann G, Borland H, Benton J, Carlos C, McAllister T, Santhosh M, Seow H, Atyabi A, Bernier R, Chawarska K, Dawson G, Dziura J, Faja S, Jeste S, Murias M, Nelson CA, Sabatos-DeVito M, Senturk D, Shic F, Sugar CA, McPartland JC. The Autism Biomarkers Consortium for Clinical Trials: Initial Evaluation of a Battery of Candidate EEG Biomarkers. Am J Psychiatry 2023; 180:41-49. [PMID: 36000217 PMCID: PMC10027395 DOI: 10.1176/appi.ajp.21050485] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Numerous candidate EEG biomarkers have been put forward for use in clinical research on autism spectrum disorder (ASD), but biomarker development has been hindered by limited attention to the psychometric properties of derived variables, inconsistent results across small studies, and variable methodology. The authors evaluated the basic psychometric properties of a battery of EEG assays for their potential suitability as biomarkers in clinical trials. METHODS This was a large, multisite, naturalistic study in 6- to 11-year-old children who either had an ASD diagnosis (N=280) or were typically developing (N=119). The authors evaluated an EEG battery composed of well-studied assays of resting-state activity, face perception (faces task), biological motion perception, and visual evoked potentials (VEPs). Biomarker psychometrics were evaluated in terms of acquisition rates, construct performance, and 6-week stability. Preliminary evaluation of use was explored through group discrimination and phenotypic correlations. RESULTS Three assays (resting state, faces task, and VEP) show promise in terms of acquisition rates and construct performance. Six-week stability values in the ASD group were moderate (intraclass correlations ≥0.66) for the faces task latency of the P1 and N170, the VEP amplitude of N1 and P1, and resting alpha power. Group discrimination and phenotype correlations were primarily observed for the faces task P1 and N170. CONCLUSIONS In the context of a large-scale, rigorous evaluation of candidate EEG biomarkers for use in ASD clinical trials, neural response to faces emerged as a promising biomarker for continued evaluation. Resting-state activity and VEP yielded mixed results. The study's biological motion perception assay failed to display construct performance. The results provide information about EEG biomarker performance that is relevant for the next stage of biomarker development efforts focused on context of use.
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Affiliation(s)
- Sara Jane Webb
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Adam J Naples
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - April R Levin
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Gerhard Hellemann
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Heather Borland
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Jessica Benton
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Carter Carlos
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Takumi McAllister
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Megha Santhosh
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Helen Seow
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Adham Atyabi
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Raphael Bernier
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Katarzyna Chawarska
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Geraldine Dawson
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - James Dziura
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Susan Faja
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Shafali Jeste
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Michael Murias
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Charles A Nelson
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Maura Sabatos-DeVito
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Damla Senturk
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Frederick Shic
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - Catherine A Sugar
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
| | - James C McPartland
- Center for Child Health, Behavior, and Development and Seattle Children's Research Institute, Seattle (Webb, Borland, Benton, Santhosh, Shic); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Webb, Bernier); Yale Child Study Center (Naples, Carlos, McAllister, Chawarska, McPartland), Yale Center for Clinical Investigation (Seow), and Department of Emergency Medicine (Dziura), Yale University, New Haven, Conn.; Department of Neurology, Boston Children's Hospital, Boston (Levin); Department of Neurology, Harvard Medical School, Boston (Levin); Department of Psychiatry and Biobehavioral Sciences (Hellemann, Jeste, Senturk, Sugar) and Department of Biostatistics (Senturk, Sugar), University of California Los Angeles, Los Angeles; Department of Computer Science, University of Colorado, Colorado Springs (Atyabi); Duke Center for Autism and Brain Development (Dawson, Sabatos-DeVito) and Department of Psychiatry and Behavioral Sciences (Dawson), Duke University, Durham, N.C.; Department of Pediatrics, Harvard University, Boston (Faja, Nelson); Division of Developmental Medicine, Boston Children's Hospital, Boston (Faja, Nelson); Department of Medical Social Sciences, Northwestern University, Chicago (Murias); Graduate School of Education, Harvard University, Boston (Nelson); Department of Pediatrics, University of Washington, Seattle (Shic)
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13
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Jonak CR, Pedapati EV, Schmitt LM, Assad SA, Sandhu MS, DeStefano L, Ethridge L, Razak KA, Sweeney JA, Binder DK, Erickson CA. Baclofen-associated neurophysiologic target engagement across species in fragile X syndrome. J Neurodev Disord 2022; 14:52. [PMID: 36167501 PMCID: PMC9513876 DOI: 10.1186/s11689-022-09455-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/03/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Fragile X syndrome (FXS) is the most common inherited form of neurodevelopmental disability. It is often characterized, especially in males, by intellectual disability, anxiety, repetitive behavior, social communication deficits, delayed language development, and abnormal sensory processing. Recently, we identified electroencephalographic (EEG) biomarkers that are conserved between the mouse model of FXS (Fmr1 KO mice) and humans with FXS. METHODS In this report, we evaluate small molecule target engagement utilizing multielectrode array electrophysiology in the Fmr1 KO mouse and in humans with FXS. Neurophysiologic target engagement was evaluated using single doses of the GABAB selective agonist racemic baclofen (RBAC). RESULTS In Fmr1 KO mice and in humans with FXS, baclofen use was associated with suppression of elevated gamma power and increase in low-frequency power at rest. In the Fmr1 KO mice, a baclofen-associated improvement in auditory chirp synchronization was also noted. CONCLUSIONS Overall, we noted synchronized target engagement of RBAC on resting state electrophysiology, in particular the reduction of aberrant high frequency gamma activity, across species in FXS. This finding holds promise for translational medicine approaches to drug development for FXS, synchronizing treatment study across species using well-established EEG biological markers in this field. TRIAL REGISTRATION The human experiments are registered under NCT02998151.
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Affiliation(s)
- Carrie R. Jonak
- grid.266097.c0000 0001 2222 1582Division of Biomedical Sciences, School of Medicine, University of California, Riverside, USA
| | - Ernest V. Pedapati
- grid.239573.90000 0000 9025 8099Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.239573.90000 0000 9025 8099Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Lauren M. Schmitt
- grid.239573.90000 0000 9025 8099Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Samantha A. Assad
- grid.266097.c0000 0001 2222 1582Division of Biomedical Sciences, School of Medicine, University of California, Riverside, USA
| | - Manbir S. Sandhu
- grid.266097.c0000 0001 2222 1582Division of Biomedical Sciences, School of Medicine, University of California, Riverside, USA
| | - Lisa DeStefano
- grid.239573.90000 0000 9025 8099Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.266900.b0000 0004 0447 0018Department of Psychology, University of Oklahoma, Norman, OK USA
| | - Lauren Ethridge
- grid.266900.b0000 0004 0447 0018Department of Psychology, University of Oklahoma, Norman, OK USA ,grid.266902.90000 0001 2179 3618Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Khaleel A. Razak
- grid.266097.c0000 0001 2222 1582Neuroscience Graduate Program, University of California, Riverside, USA ,grid.266097.c0000 0001 2222 1582Psychology Graduate Program, University of California, Riverside, USA
| | - John A. Sweeney
- grid.24827.3b0000 0001 2179 9593Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Devin K. Binder
- grid.266097.c0000 0001 2222 1582Division of Biomedical Sciences, School of Medicine, University of California, Riverside, USA ,grid.266097.c0000 0001 2222 1582Neuroscience Graduate Program, University of California, Riverside, USA
| | - Craig A. Erickson
- grid.239573.90000 0000 9025 8099Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH USA
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14
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Pedapati EV, Schmitt LM, Ethridge LE, Miyakoshi M, Sweeney JA, Liu R, Smith E, Shaffer RC, Dominick KC, Gilbert DL, Wu SW, Horn PS, Binder DK, Lamy M, Axford M, Erickson CA. Neocortical localization and thalamocortical modulation of neuronal hyperexcitability contribute to Fragile X Syndrome. Commun Biol 2022; 5:442. [PMID: 35546357 PMCID: PMC9095835 DOI: 10.1038/s42003-022-03395-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2022] [Indexed: 12/13/2022] Open
Abstract
Fragile X Syndrome (FXS) is a monogenetic form of intellectual disability and autism in which well-established knockout (KO) animal models point to neuronal hyperexcitability and abnormal gamma-frequency physiology as a basis for key disorder features. Translating these findings into patients may identify tractable treatment targets. Using source modeling of resting-state electroencephalography data, we report findings in FXS, including 1) increases in localized gamma activity, 2) pervasive changes of theta/alpha activity, indicative of disrupted thalamocortical modulation coupled with elevated gamma power, 3) stepwise moderation of low and high-frequency abnormalities based on female sex, and 4) relationship of this physiology to intellectual disability and neuropsychiatric symptoms. Our observations extend findings in Fmr1-/- KO mice to patients with FXS and raise a key role for disrupted thalamocortical modulation in local hyperexcitability. This systems-level mechanism has received limited preclinical attention but has implications for understanding fundamental disease mechanisms.
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Affiliation(s)
- Ernest V Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Lauren M Schmitt
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lauren E Ethridge
- Department of Pediatrics, Section on Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Psychology, University of Oklahoma, Norman, OK, USA
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA, USA
| | - John A Sweeney
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rui Liu
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Smith
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca C Shaffer
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, USA
| | - Martine Lamy
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Megan Axford
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Key AP. Searching for a "Brain Signature" of Neurodevelopmental Disorders: Event-Related Potentials and the Quest for Biomarkers of Cognition. J Clin Neurophysiol 2022; 39:113-120. [PMID: 34366396 DOI: 10.1097/wnp.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY This review summarizes main applications of event-related potentials (ERPs) to the study of cognitive processes in persons with neurodevelopmental disorders, for whom traditional behavioral assessments may not be suitable. A brief introduction to the ERPs is followed by a review of empirical studies using passive ERP paradigms to address three main questions: characterizing individual differences, predicting risk for poor developmental outcomes, and documenting treatment effects in persons with neurodevelopmental disorders. Evidence across studies reveals feasibility of ERP methodology in a wide range of clinical populations and notes consistently stronger brain-behavior associations involving ERP measures of higher-order cognition compared with sensory-perceptual processes. The final section describes the current limitations of ERP methodology that need to be addressed before it could be used as a clinical tool and highlights the needed steps toward translating ERPs from group-level research applications to individually interpretable clinical use.
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Affiliation(s)
- Alexandra P Key
- Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Nashville, Tennessee, U.S.A
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16
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Abstract
SUMMARY The field of clinical EEG has had an uneasy relationship with the use of this technology for clinical cognitive applications and often for good reason. However, apart from its clinical use, EEG has had a tradition as a major tool in cognitive psychology and cognitive neuroscience dating back at least to the 1960s. Based on accumulated knowledge from its research application, EEG-based biomarkers are beginning to see applications in clinical trials and may eventually enter clinical care. We address concerns surrounding quality control, the treatment of artifact, and normal variants and how developments in engineering, biomarker validation, and implementation science rigorously applied to these tools can lead to well-justified approaches.
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Affiliation(s)
- Joshua B. Ewen
- Kennedy Krieger Institute, Baltimore, MD
- Johns Hopkins University, Baltimore, MD
| | - April R. Levin
- Harvard Medical School, Boston, MA
- Boston Children’s Hospital, Boston, MA
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17
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Abstract
SUMMARY Although interictal spikes (IISs) are a well-established EEG biomarker for epilepsy, whether they are also a biomarker of cognitive deficits is unclear. Interictal spikes are dynamic events consisting of a synchronous discharge of neurons producing high frequency oscillations and a succession of action potentials which disrupt the ongoing neural activity. There are robust data showing that IISs result in transitory cognitive impairment with the type of deficit specific to the cognitive task and anatomic location of the IIS. Interictal spike, particularly if frequent and widespread, can impair cognitive abilities, through interference with waking learning and memory and memory consolidation during sleep. Interictal spikes seem to be particularly concerning in the developing brain where animal data suggest that IISs can lead to adverse cognitive effects even after the disappearance of the spikes. Whether a similar phenomenon occurs in human beings is unclear. Thus, although IISs are a clear biomarker of transitory cognitive impairment, currently, they lack sensitivity and specificity as a biomarker for enduring cognitive impairment.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences Larner College of Medicine at the University of Vermont, Burlington, Vermont, U.S.A
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18
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Benjamin CFA. Cognitive Biomarkers in the Clinic: Lessons From Presurgical fMRI. J Clin Neurophysiol 2022; 39:121-128. [PMID: 34366397 DOI: 10.1097/wnp.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Cognitive biomarkers are vital and uniquely challenging clinical tools. There has been marked growth in neuroimaging-based cognitive biomarkers across the past 40 years with more in development (e.g., clinical cognitive EEG). The challenges involved in developing cognitive biomarkers and key milestones in their development are reviewed here using clinical functional MRI's evolution as a case study. It is argued that indexing cognition is uniquely challenging because it requires patients to consistently use specific cognitive processes, and it is difficult or impossible to independently verify this occurred. This limitation can be successfully managed through careful analysis of standardized protocols for acquisition and interpretation, and ensuring the clinical application of biomarkers integrates disciplines with complementary expertise. Factors beneficial to the adoption of a novel cognitive biomarker include a clinical need and inadequate alternatives. Key milestones in the development of functional MRI included (1) demonstration that its performance was equivalent to its predecessor; (2) demonstration it predicted a clinically meaningful outcome; and (3) the establishment of infrastructure for both its execution and billing. Review of functional MRI and its predecessors suggest a cycle whereby successful cognitive biomarkers are validated, experience widespread adoption and customization/fragmentation, go through a period of review, and finally are refined and standardized. Those applying future cognitive biomarkers in the clinic can avoid some of the failures of clinical functional MRI by defining the skills and disciplines the method requires and routinely evaluating patient outcomes.
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19
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Kenny A, Wright D, Stanfield AC. EEG as a translational biomarker and outcome measure in fragile X syndrome. Transl Psychiatry 2022; 12:34. [PMID: 35075104 PMCID: PMC8786970 DOI: 10.1038/s41398-022-01796-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 01/08/2023] Open
Abstract
Targeted treatments for fragile X syndrome (FXS) have frequently failed to show efficacy in clinical testing, despite success at the preclinical stages. This has highlighted the need for more effective translational outcome measures. EEG differences observed in FXS, including exaggerated N1 ERP amplitudes, increased resting gamma power and reduced gamma phase-locking in the sensory cortices, have been suggested as potential biomarkers of the syndrome. These abnormalities are thought to reflect cortical hyper excitability resulting from an excitatory (glutamate) and inhibitory (GABAergic) imbalance in FXS, which has been the target of several pharmaceutical remediation studies. EEG differences observed in humans also show similarities to those seen in laboratory models of FXS, which may allow for greater translational equivalence and better predict clinical success of putative therapeutics. There is some evidence from clinical trials showing that treatment related changes in EEG may be associated with clinical improvements, but these require replication and extension to other medications. Although the use of EEG characteristics as biomarkers is still in the early phases, and further research is needed to establish its utility in clinical trials, the current research is promising and signals the emergence of an effective translational biomarker.
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Affiliation(s)
- Aisling Kenny
- Patrick Wild Centre, Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF, Edinburgh, UK.
| | - Damien Wright
- grid.4305.20000 0004 1936 7988Patrick Wild Centre, Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Andrew C. Stanfield
- grid.4305.20000 0004 1936 7988Patrick Wild Centre, Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
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20
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An WW, Nelson CA, Wilkinson CL. Neural response to repeated auditory stimuli and its association with early language ability in male children with Fragile X syndrome. Front Integr Neurosci 2022; 16:987184. [PMID: 36452884 PMCID: PMC9702328 DOI: 10.3389/fnint.2022.987184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Fragile X syndrome (FXS) is the most prevalent form of inherited intellectual disability and is commonly associated with autism. Previous studies have linked the structural and functional alterations in FXS with impaired sensory processing and sensory hypersensitivity, which may hinder the early development of cognitive functions such as language comprehension. In this study, we compared the P1 response of the auditory evoked potential and its habituation to repeated auditory stimuli in male children (2-7 years old) with and without FXS, and examined their association with clinical measures in these two groups. Methods We collected high-density electroencephalography (EEG) data in an auditory oddball paradigm from 12 male children with FXS and 11 age- and sex-matched typically developing (TD) children. After standardized EEG pre-processing, we conducted a spatial principal component (PC) analysis and identified two major PCs-a frontal PC and a temporal PC. Within each PC, we compared the P1 amplitude and inter-trial phase coherence (ITPC) between the two groups, and performed a series of linear regression analysis to study the association between these EEG measures and several clinical measures, including assessment scores for language abilities, non-verbal skills, and sensory hypersensitivity. Results At the temporal PC, both early and late standard stimuli evoked a larger P1 response in FXS compared to TD participants. For temporal ITPC, the TD group showed greater habituation than the FXS group. However, neither group showed significant habituation of the frontal or temporal P1 response. Despite lack of habituation, exploratory analysis of brain-behavior associations observed that within the FXS group, reduced frontal P1 response to late standard stimuli, and increased frontal P1 habituation were both associated with better language scores. Conclusion We identified P1 amplitude and ITPC in the temporal region as a contrasting EEG phenotype between the FXS and the TD groups. However, only frontal P1 response and habituation were associated with language measures. Larger longitudinal studies are required to determine whether these EEG measures could be used as biomarkers for language development in patients with FXS.
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Affiliation(s)
- Winko W An
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States.,Translational Neuroscience Center, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Charles A Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard Graduate School of Education, Cambridge, MA, United States
| | - Carol L Wilkinson
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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21
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Luo Y, Adamek JH, Crocetti D, Mostofsky SH, Ewen JB. Dissociation in Neural Correlates of Hyperactive/Impulsive vs. Inattentive Symptoms in Attention-Deficit/Hyperactivity Disorder. Front Neurosci 2022; 16:893239. [PMID: 35812240 PMCID: PMC9256983 DOI: 10.3389/fnins.2022.893239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders characterized in current diagnostic criteria by two dominant symptoms, inattention and hyperactivity/impulsivity. Here, we show that task-related alpha (8-12 Hz) interhemispheric connectivity changes, as assessed during a unimanual finger-tapping task, is correlated with inattentive symptom severity (r = 0.55, p = 0.01) but not with severity of hyperactive/impulsive symptoms. Prior published analyses of the same dataset have already show that alpha event-related desynchronization (ERD) in the hemisphere contralateral to unimanual tapping is related to hyperactive/impulsive symptom severity (r = 0.43, p = 0.04) but not to inattentive symptom severity. Our findings demonstrate a neurobiological dissociation in ADHD symptom severity, with implications for understanding the structure of endophenotypes in the disorder as well as for biomarker development.
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Affiliation(s)
- Yu Luo
- Kennedy Krieger Institute, Baltimore, MD, United States.,School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jack H Adamek
- Kennedy Krieger Institute, Baltimore, MD, United States
| | | | - Stewart H Mostofsky
- Kennedy Krieger Institute, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joshua B Ewen
- Kennedy Krieger Institute, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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22
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Yrjölä P, Stjerna S, Palva JM, Vanhatalo S, Tokariev A. Phase-Based Cortical Synchrony Is Affected by Prematurity. Cereb Cortex 2021; 32:2265-2276. [PMID: 34668522 PMCID: PMC9113310 DOI: 10.1093/cercor/bhab357] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Inter-areal synchronization by phase–phase correlations (PPCs) of cortical oscillations mediates many higher neurocognitive functions, which are often affected by prematurity, a globally prominent neurodevelopmental risk factor. Here, we used electroencephalography to examine brain-wide cortical PPC networks at term-equivalent age, comparing human infants after early prematurity to a cohort of healthy controls. We found that prematurity affected these networks in a sleep state-specific manner, and the differences between groups were also frequency-selective, involving brain-wide connections. The strength of synchronization in these networks was predictive of clinical outcomes in the preterm infants. These findings show that prematurity affects PPC networks in a clinically significant manner, suggesting early functional biomarkers of later neurodevelopmental compromise that may be used in clinical or translational studies after early neonatal adversity.
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Affiliation(s)
- Pauliina Yrjölä
- Department of Clinical Neurophysiology, BABA Center, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, 00029 HUS, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, 00076 AALTO, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
| | - Susanna Stjerna
- Department of Clinical Neurophysiology, BABA Center, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, 00029 HUS, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland.,Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, PL 340, 00029 HUS, Finland
| | - J Matias Palva
- Department of Neuroscience and Biomedical Engineering, Aalto University, Helsinki, 00076 AALTO, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland.,Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow G12 8QB, UK
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, BABA Center, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, 00029 HUS, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
| | - Anton Tokariev
- Department of Clinical Neurophysiology, BABA Center, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, 00029 HUS, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, 00014 Helsinki, Finland
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23
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Beker S, Foxe JJ, Venticinque J, Bates J, Ridgeway EM, Schaaf RC, Molholm S. Looking for consistency in an uncertain world: test-retest reliability of neurophysiological and behavioral readouts in autism. J Neurodev Disord 2021; 13:43. [PMID: 34592931 PMCID: PMC8483424 DOI: 10.1186/s11689-021-09383-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism spectrum disorders (ASD) are associated with altered sensory processing and perception. Scalp recordings of electrical brain activity time-locked to sensory events (event-related potentials; ERPs) provide precise information on the time-course of related altered neural activity, and can be used to model the cortical loci of the underlying neural networks. Establishing the test-retest reliability of these sensory brain responses in ASD is critical to their use as biomarkers of neural dysfunction in this population. METHODS EEG and behavioral data were acquired from 33 children diagnosed with ASD aged 6-9.4 years old, while they performed a child-friendly task at two different time-points, separated by an average of 5.2 months. In two blocked conditions, participants responded to the occurrence of an auditory target that was either preceded or not by repeating visual stimuli. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability of measures of sensory (auditory and visual) ERPs and performance, for the two experimental conditions. To assess the degree of reliability of the variability of responses within individuals, this analysis was performed on the variance of the measurements, in addition to their means. This yielded a total of 24 measures for which ICCs were calculated. RESULTS The data yielded significant good ICC values for 10 of the 24 measurements. These spanned across behavioral and ERPs data, experimental conditions, and mean as well as variance measures. Measures of the visual evoked responses accounted for a disproportionately large number of the significant ICCs; follow-up analyses suggested that the contribution of a greater number of trials to the visual compared to the auditory ERP partially accounted for this. CONCLUSIONS This analysis reveals that sensory ERPs and related behavior can be highly reliable across multiple measurement time-points in ASD. The data further suggest that the inter-trial and inter-participant variability reported in the ASD literature likely represents replicable individual participant neural processing differences. The stability of these neuronal readouts supports their use as biomarkers in clinical and translational studies on ASD. Given the minimum interval between test/retest sessions across our cohort, we also conclude that for the tested age-range of ~ 6 to 9.4 years, these reliability measures are valid for at least a 3-month interval. Limitations related to EEG task demands and study length in the context of a clinical trial are considered.
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Affiliation(s)
- Shlomit Beker
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
- The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John Venticinque
- School of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juliana Bates
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth M Ridgeway
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roseann C Schaaf
- Department of Occupational Therapy, Jefferson College of Health Professions Faculty, Farber Institute for Neurosciences Thomas Jefferson University Philadelphia, Philadelphia, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA.
- The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
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24
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Quantitative EEG improves prediction of Sturge-Weber syndrome in infants with port-wine birthmark. Clin Neurophysiol 2021; 132:2440-2446. [PMID: 34454271 DOI: 10.1016/j.clinph.2021.06.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/05/2021] [Accepted: 06/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Port-wine birthmark (PWB) is a common occurrence in the newborn, and general pediatricians, dermatologists, and ophthalmologists are often called on to make an assessment of risk for Sturge-Weber syndrome (SWS) due to workforce shortages in pediatric neurologists and MRI's low sensitivity for SWS brain involvement in infants. We therefore aimed to develop a quantitative EEG (qEEG) approach to safely screen young infants with PWB for SWS risk and optimal timing of diagnostic MRI. METHODS Forty-eight infants (prior to first birthday) underwent EEG recording. Signal processing methods compared voltage between left and right sides using a previously defined pipeline and diagnostic threshold. In this test sample, we compared sensitivity/specificity of the qEEG metric against MRI performed after the first birthday. We also used likelihood ratio testing to determine whether qEEG adds incremental information beyond topographical extent of PWB, another risk marker of brain involvement. RESULTS qEEG helped predict SWS risk in the first year of life (p = 0.031), with a sensitivity of 50% and a specificity of 81%. It added about 40% incremental information beyond PWB extent alone (p = 0.042). CONCLUSION qEEG adds information to risk prediction in infants with facial PWB. SIGNIFICANCE qEEG can be used to help determine whether to obtain an MRI in the first year of life. The data collected can assist in developing a predictive model risk calculator that incorporates both PWB extent and qEEG results, which can be validated and then employed in the community.
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25
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Ewen JB, Puts NA, Mostofsky SH, Horn PS, Gilbert DL. Associations between Task-Related Modulation of Motor-Evoked Potentials and EEG Event-Related Desynchronization in Children with ADHD. Cereb Cortex 2021; 31:5526-5535. [PMID: 34231840 PMCID: PMC8568000 DOI: 10.1093/cercor/bhab176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) have previously shown a decreased magnitude of event-related desynchronization (ERD) during a finger-tapping task, with a large between-group effect. Because the neurobiology underlying several transcranial magnetic stimulation (TMS) measures have been studied in multiple contexts, we compared ERD and 3 TMS measures (resting motor threshold [RMT], short-interval cortical inhibition [SICI], and task-related up-modulation [TRUM]) within 14 participants with ADHD (ages 8-12 years) and 17 control children. The typically developing (TD) group showed a correlation between greater RMT and greater magnitude of alpha (10-13 Hz, here) ERD, and there was no diagnostic interaction effect, consistent with a rudimentary model of greater needed energy input to stimulate movement. Similarly, inhibition measured by SICI was also greater in the TD group when the magnitude of movement-related ERD was higher; there was a miniscule diagnostic interaction effect. Finally, TRUM during a response-inhibition task showed an unanticipated pattern: in TD children, the greater TMS task modulation (TRUM) was associated with a smaller magnitude of ERD during finger-tapping. The ADHD group showed the opposite direction of association: Greater TRUM was associated with larger magnitude of ERD. Prior EEG results have demonstrated specific alterations of task-related modulation of cortical physiology, and the current results provide a fulcrum for multimodal study.
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Affiliation(s)
- Joshua B Ewen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nicolaas A Puts
- Neurodevelopmental Sciences, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - Stewart H Mostofsky
- Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD 21205, USA.,Pediatrics and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Paul S Horn
- Department of Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH 45229, USA
| | - Donald L Gilbert
- Department of Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH 45229, USA
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26
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Huberty S, Carter Leno V, van Noordt SJR, Bedford R, Pickles A, Desjardins JA, Webb SJ, Elsabbagh M. Association between spectral electroencephalography power and autism risk and diagnosis in early development. Autism Res 2021; 14:1390-1403. [PMID: 33955195 PMCID: PMC8360065 DOI: 10.1002/aur.2518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023]
Abstract
Autism spectrum disorder (ASD) has its origins in the atypical development of brain networks. Infants who are at high familial risk for, and later diagnosed with ASD, show atypical activity in multiple electroencephalography (EEG) oscillatory measures. However, infant-sibling studies are often constrained by small sample sizes. We used the International Infant EEG Data Integration Platform, a multi-site dataset with 432 participants, including 222 at high-risk for ASD, from whom repeated measurements of EEG were collected between the ages of 3-36 months. We applied a latent growth curve model to test whether familial risk status predicts developmental trajectories of spectral power across the first 3 years of life, and whether these trajectories predict ASD outcome. Change in spectral EEG power in all frequency bands occurred during the first 3 years of life. Familial risk, but not a later diagnosis of ASD, was associated with reduced power at 3 months, and a steeper developmental change between 3 and 36 months in nearly all absolute power bands. ASD outcome was not associated with absolute power intercept or slope. No associations were found between risk or outcome and relative power. This study applied an analytic approach not used in previous prospective biomarker studies of ASD, which was modeled to reflect the temporal relationship between genetic susceptibility, brain development, and ASD diagnosis. Trajectories of spectral power appear to be predicted by familial risk; however, spectral power does not predict diagnostic outcome above and beyond familial risk status. Discrepancies between current results and previous studies are discussed. LAY SUMMARY: Infants with an older sibling who is diagnosed with ASD are at increased risk of developing ASD themselves. This article tested whether EEG spectral power in the first year of life can predict whether these infants did or did not develop ASD.
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Affiliation(s)
- Scott Huberty
- Montreal Neurological Institute-Hospital, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
| | - Virginia Carter Leno
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England, UK
| | - Stefon J R van Noordt
- Montreal Neurological Institute-Hospital, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
| | - Rachael Bedford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England, UK.,University of Bath, Bath, England, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England, UK
| | | | - Sara Jane Webb
- Center on Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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- Centre for Brain and Cognitive Development, England, UK
| | - Mayada Elsabbagh
- Montreal Neurological Institute-Hospital, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
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27
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Häger LA, Åsberg Johnels J, Kropotov JD, Weidle B, Hollup S, Zehentbauer PG, Gillberg C, Billstedt E, Ogrim G. Biomarker support for ADHD diagnosis based on Event Related Potentials and scores from an attention test. Psychiatry Res 2021; 300:113879. [PMID: 33882399 DOI: 10.1016/j.psychres.2021.113879] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022]
Abstract
ADHD is a heterogeneous neurodevelopmental disorder associated with dysfunctions in several brain systems. Objective markers of brain dysfunction for clinical assessment are lacking. Many studies applying electroencephalography (EEG) and neuropsychological tests find significant differences between ADHD and controls, but the effect sizes (ES) are often too small for diagnostic purposes. This study aimed to compute a diagnostic index for ADHD by combining behavioral test scores from a cued visual go/no-go task and Event Related Potentials (ERPs). Sixty-one children (age 9-12 years) diagnosed with ADHD and 69 age- and gender-matched typically developing children (TDC) underwent EEG-recording while tested on a go/no-go task. Based on comparisons of ERP group-means and task-performance, variables that differed significantly between the groups with at least moderate ES were converted to a five points percentile scale and multiplied by the ES of the variable. The sum-scores of the variables constituted the diagnostic index. The index discriminated significantly between patients and TDC with a large ES. This index was applied to an independent sample (20 ADHD, 21 TDC), distinguishing the groups with an even larger ES. The diagnostic index described has the potential to support assessment. Further research establishing diagnostic indexes for differential diagnoses is needed.
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Affiliation(s)
- L A Häger
- Neuropsychiatric Team, Åsebråten Clinic, Østfold Hospital Trust, Fredrikstad, Norway; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - J Åsberg Johnels
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - J D Kropotov
- N.P. Bechtereva Institute of the Human Brain, Russian Academy of Science, St. Petersburg, Russian Federation; Department of Neuropsychology, Andrzej Frycz Modrzewski Krakow University, Poland
| | - B Weidle
- St. Olavs University Hospital, Trondheim, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway
| | - S Hollup
- Institute of Psychology, Norwegian Institute of Science and Technology (NTNU), Trondheim, Norway
| | | | - C Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - E Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - G Ogrim
- Neuropsychiatric Team, Åsebråten Clinic, Østfold Hospital Trust, Fredrikstad, Norway; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Institute of Psychology, Norwegian Institute of Science and Technology (NTNU), Trondheim, Norway.
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28
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Smith E, Pedapati E, Liu R, Schmitt L, Dominick K, Shaffer R, Sweeney J, Erickson C. Sex differences in resting EEG power in Fragile X Syndrome. J Psychiatr Res 2021; 138:89-95. [PMID: 33836434 PMCID: PMC8192450 DOI: 10.1016/j.jpsychires.2021.03.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/10/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022]
Abstract
Electrophysiological alterations may represent a neural substrate of impaired neurocognitive processes and other phenotypic features in Fragile X Syndrome (FXS). However, the role of biological sex in electroencephalography (EEG) patterns that differentiate FXS from typical development has not been determined. This limits use of EEG in both the search for biomarkers of impairment in FXS as well as application of those markers to enhance our understanding of underlying neural mechanisms to speed treatment discovery. We investigated topographical relative EEG power in participants at rest in a sample of males and females with FXS and in age- and sex-matched typically developing controls (TDC) using a cluster-based analysis. While alterations in theta and low beta power were similar across males and females in FXS, relative power varied by sex in the alpha, upper beta, gamma, and epsilon frequency bands. Follow up analyses showed that Individual Alpha Peak Frequency (IAPF), a continuous variable that may capture atypicalities across the theta and alpha ranges in neurodevelopmental disorders, also varied by sex. Finally, performance on an auditory filtering task correlated with theta power in males, but not females with FXS. The impact of biological sex on resting state EEG power differences in FXS is discussed as it relates to potential GABAergic and glutamatergic etiologies of neurocognitive deficits in FXS.
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Affiliation(s)
- Elizabeth Smith
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA,Elizabeth G. Smith, corresponding author Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 7039 Cincinnati, OH 45229 , (513) 517-1383
| | - Ernest Pedapati
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA,Department of Psychiatry, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Rui Liu
- Department of Psychiatry, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Lauren Schmitt
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA,Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Kelli Dominick
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA,Department of Psychiatry, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Rebecca Shaffer
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA,Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - John Sweeney
- Department of Psychiatry, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Craig Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA,Department of Psychiatry, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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29
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Hendrix SB, Mogg R, Wang SJ, Chakravarty A, Romero K, Dickson SP, Sauer JM, McShane LM. Perspectives on statistical strategies for the regulatory biomarker qualification process. Biomark Med 2021; 15:669-684. [PMID: 34037457 PMCID: PMC8293027 DOI: 10.2217/bmm-2020-0523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Qualification of a biomarker for use in a medical product development program requires a statistical strategy that aligns available evidence with the proposed context of use (COU), identifies any data gaps to be filled and plans any additional research required to support the qualification. Accumulating, interpreting and analyzing available data is outlined, step-by-step, illustrated by a qualified enrichment biomarker example and a safety biomarker in the process of qualification. The detailed steps aid requestors seeking qualification of biomarkers, allowing them to organize the available evidence and identify potential gaps. This provides a statistical perspective for assessing evidence that parallels clinical considerations and is intended to guide the overall evaluation of evidentiary criteria to support a specific biomarker COU.
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Affiliation(s)
| | - Robin Mogg
- Bill & Melinda Gates Medical Research Institute, MA 02139, USA
| | - Sue Jane Wang
- Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food & Drug Administration, MD 20993, USA
| | - Aloka Chakravarty
- Office of the Commissioner, US Food & Drug Administration, MD 20993, USA
| | - Klaus Romero
- Translational and Safety Sciences Program, Critical Path Institute, AZ 85718, USA
| | | | - John-Michael Sauer
- Translational and Safety Sciences Program, Critical Path Institute, AZ 85718, USA
| | - Lisa M McShane
- Biometric Research Program, Division of Cancer Treament and Diagnosis, National Cancer Institute, National Institutes of Health, MD 20892, USA
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30
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Reviewing Evidence for the Relationship of EEG Abnormalities and RTT Phenotype Paralleled by Insights from Animal Studies. Int J Mol Sci 2021; 22:ijms22105308. [PMID: 34069993 PMCID: PMC8157853 DOI: 10.3390/ijms22105308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
Rett syndrome (RTT) is a rare neurodevelopmental disorder that is usually caused by mutations of the MECP2 gene. Patients with RTT suffer from severe deficits in motor, perceptual and cognitive domains. Electroencephalogram (EEG) has provided useful information to clinicians and scientists, from the very first descriptions of RTT, and yet no reliable neurophysiological biomarkers related to the pathophysiology of the disorder or symptom severity have been identified to date. To identify consistently observed and potentially informative EEG characteristics of RTT pathophysiology, and ascertain areas most worthy of further systematic investigation, here we review the literature for EEG abnormalities reported in patients with RTT and in its disease models. While pointing to some promising potential EEG biomarkers of RTT, our review identify areas of need to realize the potential of EEG including (1) quantitative investigation of promising clinical-EEG observations in RTT, e.g., shift of mu rhythm frequency and EEG during sleep; (2) closer alignment of approaches between patients with RTT and its animal models to strengthen the translational significance of the work (e.g., EEG measurements and behavioral states); (3) establishment of large-scale consortium research, to provide adequate Ns to investigate age and genotype effects.
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31
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Sebold AJ, Day AM, Ewen J, Adamek J, Byars A, Cohen B, Kossoff EH, Mizuno T, Ryan M, Sievers J, Smegal L, Suskauer SJ, Thomas C, Vinks A, Zabel TA, Hammill AM, Comi AM. Sirolimus Treatment in Sturge-Weber Syndrome. Pediatr Neurol 2021; 115:29-40. [PMID: 33316689 PMCID: PMC8209677 DOI: 10.1016/j.pediatrneurol.2020.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sturge-Weber syndrome is a rare neurovascular disorder associated with capillary malformation, seizures, cognitive impairments, and stroke-like episodes (SLEs), arising from a somatic activating mutation in GNAQ. Studies suggest this mutation may cause hyperactivation of the mammalian target of rapamycin pathway. Sirolimus is an mammalian target of rapamycin inhibitor studied in other vascular anomalies and a potentially promising therapy in Sturge-Weber syndrome. METHODS Ten patients with Sturge-Weber syndrome brain involvement and cognitive impairments were enrolled. Oral sirolimus was taken for six months (maximum dose: 2 mg/day, target trough level: 4-6 ng/mL). Neuropsychological testing, electroencephalography, and port-wine score were performed at baseline and after six months on sirolimus. Neuroquality of life, adverse events, and Sturge-Weber Syndrome Neurological Score (neuroscore) were recorded at each visit. RESULTS Sirolimus was generally well tolerated; one subject withdrew early. Adverse events considered related to sirolimus were mostly (15/16) grade 1. A significant increase in processing speed was seen in the overall group (P = 0.031); five of nine patients with available data demonstrated statistically rare improvement in processing speed. Improvements were seen in the neuroquality of life subscales measuring anger (P = 0.011), cognitive function (P = 0.015), and depression (P = 0.046). Three subjects experiencing SLEs before and during the study reported shortened recovery times while on sirolimus. CONCLUSIONS Sirolimus was well tolerated in individuals with Sturge-Weber syndrome and may be beneficial for cognitive impairments, especially in patients with impaired processing speed or a history of SLE. A future, randomized, placebo-controlled trial of sirolimus in patients with Sturge-Weber syndrome is needed to further understand these potentially beneficial effects.
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Affiliation(s)
- Alison J. Sebold
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Alyssa M. Day
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Joshua Ewen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jack Adamek
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Anna Byars
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bernard Cohen
- Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Eric H. Kossoff
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Hospital, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tomoyuki Mizuno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Matthew Ryan
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jacqueline Sievers
- Clinical Trials Compliance and Quality Assurance, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Lindsay Smegal
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Stacy J. Suskauer
- Johns Hopkins Hospital, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Department of Pediatric Rehabilitation Medicine, Krieger Institute, Baltimore, Maryland, USA,Johns Hopkins University School of Medicine, Departments of Physical Medicine and Rehabilitation, Baltimore, Maryland, USA
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander Vinks
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - T. Andrew Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adrienne M. Hammill
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Anne M. Comi
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Johns Hopkins Hospital, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.,Communications should be addressed to: Dr. Anne M. Comi; Department of Neurology, Hugo Moser Kennedy Krieger Research Institute,801 N. Broadway; Baltimore, MD, 21205. (A.M. Comi)
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32
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Thurm A, Kelleher B, Wheeler A. Outcome Measures for Core Symptoms of Intellectual Disability: State of the Field. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:418-433. [PMID: 33211819 DOI: 10.1352/1944-7558-125.6.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Intellectual disability (ID) is defined by impairments in intellectual and adaptive functioning. As such, tools designed to assess these domains would theoretically be ideal outcome measures for treatment trials targeting core symptoms of ID. However, measures of intellectual and adaptive functioning have rarely been used as primary outcome measures to date and further study is needed regarding their usefulness to measure change. This area of inquiry is important because promising, mechanism-modifying treatments for conditions leading to ID are being initiated. To show efficacy, these treatments need to demonstrate an impact on core features of ID. After reviewing literature on this topic, we suggest solutions to several problems outlined, including use of out-of-age-range testing, alternative metrics, and development of new measures.
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Affiliation(s)
- Audrey Thurm
- Audrey Thurm, National Institute of Mental Health
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van Noordt S, Desjardins JA, Huberty S, Abou-Abbas L, Webb SJ, Levin AR, Segalowitz SJ, Evans AC, Elsabbagh M. EEG-IP: an international infant EEG data integration platform for the study of risk and resilience in autism and related conditions. Mol Med 2020; 26:40. [PMID: 32380941 PMCID: PMC7203847 DOI: 10.1186/s10020-020-00149-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Establishing reliable predictive and diganostic biomarkers of autism would enhance early identification and facilitate targeted intervention during periods of greatest plasticity in early brain development. High impact research on biomarkers is currently limited by relatively small sample sizes and the complexity of the autism phenotype. METHODS EEG-IP is an International Infant EEG Data Integration Platform developed to advance biomarker discovery by enhancing the large scale integration of multi-site data. Currently, this is the largest multi-site standardized dataset of infant EEG data. RESULTS First, multi-site data from longitudinal cohort studies of infants at risk for autism was pooled in a common repository with 1382 EEG longitudinal recordings, linked behavioral data, from 432 infants between 3- to 36-months of age. Second, to address challenges of limited comparability across independent recordings, EEG-IP applied the Brain Imaging Data Structure (BIDS)-EEG standard, resulting in a harmonized, extendable, and integrated data state. Finally, the pooled and harmonized raw data was preprocessed using a common signal processing pipeline that maximizes signal isolation and minimizes data reduction. With EEG-IP, we produced a fully standardized data set, of the pooled, harmonized, and pre-processed EEG data from multiple sites. CONCLUSIONS Implementing these integrated solutions for the first time with infant data has demonstrated success and challenges in generating a standardized multi-site data state. The challenges relate to annotation of signal sources, time, and ICA analysis during pre-processing. A number of future opportunities also emerge, including validation of analytic pipelines that can replicate existing findings and/or test novel hypotheses.
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Affiliation(s)
- Stefon van Noordt
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
| | - James A. Desjardins
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
- Compute Ontario, St. Catharines, Canada
| | - Scott Huberty
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
| | | | - Sara Jane Webb
- Center on Child Health, Behavior and Development, Washington Children’s Research Institute, Washington, WA USA
| | | | - Sidney J. Segalowitz
- Cognitive and Affective Neuroscience Lab, Brock University, St. Catharines, ON Canada
| | - Alan C. Evans
- McConnell Brain Imaging Centre, McGill Univeristy, Montréal, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montréal, Canada
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Dumitras DC, Petrus M, Bratu AM, Popa C. Applications of Near Infrared Photoacoustic Spectroscopy for Analysis of Human Respiration: A Review. Molecules 2020; 25:E1728. [PMID: 32283766 PMCID: PMC7180475 DOI: 10.3390/molecules25071728] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
In this review, applications of near-infrared photoacoustic spectroscopy are presented as an opportunity to evaluate human respiration because the measurement of breath is fast, intact and simple to implement. Recently, analytical methods for measuring biomarkers in exhaled air have been extensively developed. With laser-based photoacoustic spectroscopy, volatile organic compounds can be identified with high sensitivity, at a high rate, and with very good selectivity. The literature review has shown the applicability of near-infrared photoacoustic spectroscopy to one of the problems of the real world, i.e., human health. In addition, the review will consider and explore different breath sampling methods for human respiration analysis.
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Affiliation(s)
- Dan C. Dumitras
- University “Politehnica” of Bucharest, Physics Department, Faculty of Applied Sciences, University “Politehnica” of Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania
| | - Mioara Petrus
- National Institute for Laser, Plasma and Radiation Physics, Laser Department, 409 Atomistilor St., PO Box MG 36, 077125 Magurele, Romania; (M.P.); (A.-M.B.); (C.P.)
| | - Ana-Maria Bratu
- National Institute for Laser, Plasma and Radiation Physics, Laser Department, 409 Atomistilor St., PO Box MG 36, 077125 Magurele, Romania; (M.P.); (A.-M.B.); (C.P.)
| | - Cristina Popa
- National Institute for Laser, Plasma and Radiation Physics, Laser Department, 409 Atomistilor St., PO Box MG 36, 077125 Magurele, Romania; (M.P.); (A.-M.B.); (C.P.)
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McPartland JC, Bernier RA, Jeste SS, Dawson G, Nelson CA, Chawarska K, Earl R, Faja S, Johnson SP, Sikich L, Brandt CA, Dziura JD, Rozenblit L, Hellemann G, Levin AR, Murias M, Naples AJ, Platt ML, Sabatos-DeVito M, Shic F, Senturk D, Sugar CA, Webb SJ. The Autism Biomarkers Consortium for Clinical Trials (ABC-CT): Scientific Context, Study Design, and Progress Toward Biomarker Qualification. Front Integr Neurosci 2020; 14:16. [PMID: 32346363 PMCID: PMC7173348 DOI: 10.3389/fnint.2020.00016] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
Clinical research in neurodevelopmental disorders remains reliant upon clinician and caregiver measures. Limitations of these approaches indicate a need for objective, quantitative, and reliable biomarkers to advance clinical research. Extant research suggests the potential utility of multiple candidate biomarkers; however, effective application of these markers in trials requires additional understanding of replicability, individual differences, and intra-individual stability over time. The Autism Biomarkers Consortium for Clinical Trials (ABC-CT) is a multi-site study designed to investigate a battery of electrophysiological (EEG) and eye-tracking (ET) indices as candidate biomarkers for autism spectrum disorder (ASD). The study complements published biomarker research through: inclusion of large, deeply phenotyped cohorts of children with ASD and typical development; a longitudinal design; a focus on well-evidenced candidate biomarkers harmonized with an independent sample; high levels of clinical, regulatory, technical, and statistical rigor; adoption of a governance structure incorporating diverse expertise in the ASD biomarker discovery and qualification process; prioritization of open science, including creation of a repository containing biomarker, clinical, and genetic data; and use of economical and scalable technologies that are applicable in developmental populations and those with special needs. The ABC-CT approach has yielded encouraging results, with one measure accepted into the FDA’s Biomarker Qualification Program to date. Through these advances, the ABC-CT and other biomarker studies in progress hold promise to deliver novel tools to improve clinical trials research in ASD.
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Affiliation(s)
| | - Raphael A Bernier
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Shafali S Jeste
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, United States
| | - Charles A Nelson
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.,Harvard University, Boston, MA, United States
| | | | - Rachel Earl
- Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | - Susan Faja
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.,Harvard University, Boston, MA, United States
| | - Scott P Johnson
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Linmarie Sikich
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, United States
| | | | | | | | - Gerhard Hellemann
- University of California, Los Angeles, Los Angeles, CA, United States
| | - April R Levin
- Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.,Harvard University, Boston, MA, United States
| | | | - Adam J Naples
- Yale Child Study Center, New Haven, CT, United States
| | | | - Maura Sabatos-DeVito
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, United States
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, United States.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Damla Senturk
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Catherine A Sugar
- University of California, Los Angeles, Los Angeles, CA, United States
| | - Sara J Webb
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
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36
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Webb SJ, Shic F, Murias M, Sugar CA, Naples AJ, Barney E, Borland H, Hellemann G, Johnson S, Kim M, Levin AR, Sabatos-DeVito M, Santhosh M, Senturk D, Dziura J, Bernier RA, Chawarska K, Dawson G, Faja S, Jeste S, McPartland J. Biomarker Acquisition and Quality Control for Multi-Site Studies: The Autism Biomarkers Consortium for Clinical Trials. Front Integr Neurosci 2020; 13:71. [PMID: 32116579 PMCID: PMC7020808 DOI: 10.3389/fnint.2019.00071] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/28/2019] [Indexed: 12/31/2022] Open
Abstract
The objective of the Autism Biomarkers Consortium for Clinical Trials (ABC-CT) is to evaluate a set of lab-based behavioral video tracking (VT), electroencephalography (EEG), and eye tracking (ET) measures for use in clinical trials with children with autism spectrum disorder (ASD). Within the larger organizational structure of the ABC-CT, the Data Acquisition and Analytic Core (DAAC) oversees the standardization of VT, EEG, and ET data acquisition, data processing, and data analysis. This includes designing and documenting data acquisition and analytic protocols and manuals; facilitating site training in acquisition; data acquisition quality control (QC); derivation and validation of dependent variables (DVs); and analytic deliverables including preparation of data for submission to the National Database for Autism Research (NDAR). To oversee consistent application of scientific standards and methodological rigor for data acquisition, processing, and analytics, we developed standard operating procedures that reflect the logistical needs of multi-site research, and the need for well-articulated, transparent processes that can be implemented in future clinical trials. This report details the methodology of the ABC-CT related to acquisition and QC in our Feasibility and Main Study phases. Based on our acquisition metrics from a preplanned interim analysis, we report high levels of acquisition success utilizing VT, EEG, and ET experiments in a relatively large sample of children with ASD and typical development (TD), with data acquired across multiple sites and use of a manualized training and acquisition protocol.
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Affiliation(s)
- Sara Jane Webb
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Frederick Shic
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Murias
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, United States
| | - Catherine A. Sugar
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Statistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adam J. Naples
- Yale Child Study Center, Yale University, New Haven, CT, United States
| | - Erin Barney
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Heather Borland
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Scott Johnson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Minah Kim
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - April R. Levin
- Department of Neurology, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Maura Sabatos-DeVito
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, United States
| | - Megha Santhosh
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Damla Senturk
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Statistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - James Dziura
- Yale Child Study Center, Yale University, New Haven, CT, United States
| | - Raphael A. Bernier
- Center on Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
- Center on Human Development and Disability, University of Washington, Seattle, WA, United States
| | | | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, United States
| | - Susan Faja
- Harvard Medical School, Harvard University, Boston, MA, United States
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Shafali Jeste
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - James McPartland
- Yale Child Study Center, Yale University, New Haven, CT, United States
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37
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Jonak CR, Lovelace JW, Ethell IM, Razak KA, Binder DK. Multielectrode array analysis of EEG biomarkers in a mouse model of Fragile X Syndrome. Neurobiol Dis 2020; 138:104794. [PMID: 32036032 DOI: 10.1016/j.nbd.2020.104794] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 02/05/2020] [Indexed: 02/06/2023] Open
Abstract
Fragile X Syndrome (FXS) is a leading known genetic cause of intellectual disability with symptoms that include increased anxiety and social and sensory processing deficits. Recent EEG studies in humans with FXS have identified neural oscillation deficits that include increased resting state gamma power, increased amplitude of auditory evoked potentials, and reduced inter-trial phase coherence of sound-evoked gamma oscillations. Identification of comparable EEG biomarkers in mouse models of FXS could facilitate the pre-clinical to clinical therapeutic pipeline. However, while human EEG studies have involved 128-channel scalp EEG acquisition, no mouse studies have been performed with more than three EEG channels. In the current study, we employed a recently developed 30-channel mouse multielectrode array (MEA) system to record and analyze resting and stimulus-evoked EEG signals in WT vs. Fmr1 KO mice. Using this system, we now report robust MEA-derived phenotypes including higher resting EEG power, altered event-related potentials (ERPs) and reduced inter-trial phase coherence to auditory chirp stimuli in Fmr1 KO mice that are remarkably similar to those reported in humans with FXS. We propose that the MEA system can be used for: (i) derivation of higher-level EEG parameters; (ii) EEG biomarkers for drug testing; and (ii) mechanistic studies of FXS pathophysiology.
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Affiliation(s)
- Carrie R Jonak
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, United States of America
| | - Jonathan W Lovelace
- Department of Psychology, University of California, Riverside, United States of America
| | - Iryna M Ethell
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, United States of America; Neuroscience Graduate Program, University of California, Riverside, United States of America
| | - Khaleel A Razak
- Neuroscience Graduate Program, University of California, Riverside, United States of America; Department of Psychology, University of California, Riverside, United States of America
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, United States of America; Neuroscience Graduate Program, University of California, Riverside, United States of America.
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38
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McAuliffe D, Hirabayashi K, Adamek JH, Luo Y, Crocetti D, Pillai AS, Zhao Y, Crone NE, Mostofsky SH, Ewen JB. Increased mirror overflow movements in ADHD are associated with altered EEG alpha/beta band desynchronization. Eur J Neurosci 2019; 51:1815-1826. [PMID: 31821643 DOI: 10.1111/ejn.14642] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/14/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023]
Abstract
Children with ADHD show developmentally abnormal levels of mirror overflow-unintentional movements occurring symmetrically opposite of intentional movements. Because mirror overflow correlates with ADHD behavioral symptoms, the study of disinhibition in motor control may shed light on physiologic mechanisms underlying impaired behavioral/cognitive control. This is a case-controlled study of EEG recording from 25 children with ADHD and 25 typically developing (TD) controls performing unilateral sequential finger tapping, with overflow movements measured using electronic goniometers. Consistent with previously published findings, children with ADHD showed increased mirror overflow as compared with TD peers. EEG findings revealed less lateralized alpha modulation (event-related desynchronization; ERD) and decreased magnitude of beta ERD in ADHD; both alpha and beta ERD reflect cortical activation. Moderation analysis revealed a significant association between beta ERD and overflow, independent of diagnosis; and an equivocal (p = .08) effect of diagnosis on the relationship between alpha ERD and overflow, with a significant effect in children with ADHD but not TD children. These results suggest two mechanisms involved with mirror overflow: one reflected in beta ipsilateral to the intentional movement and relevant to both children with ADHD and controls, and the other seemingly more specific to ADHD (alpha, contralateral to movement).
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Affiliation(s)
| | | | | | - Yu Luo
- Kennedy Krieger Institute, Baltimore, MD, USA.,Beihan University, Beijing, China
| | | | - Ajay S Pillai
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University, Baltimore, MD, USA
| | - Yi Zhao
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Stewart H Mostofsky
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University, Baltimore, MD, USA
| | - Joshua B Ewen
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins University, Baltimore, MD, USA
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