BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized pathologically by the presence in the brain of intracellular protein inclusions highly enriched in aggregated alpha-synuclein (α-Syn). Although it has been established that progression of the disease is accompanied by sustained activation of microglia, the underlying molecules and factors involved in these immune-triggered mechanisms remain largely unexplored. Lately, accumulating evidence has shown the presence of extracellular α-Syn both in its aggregated and monomeric forms in cerebrospinal fluid and blood plasma. However, the effect of extracellular α-Syn on cellular activation and immune mediators, as well as the impact of familial PD-linked α-Syn mutants on this stimulation, are still largely unknown. METHODS AND FINDINGS: In this work, we have compared the activation profiles of non-aggregated, extracellular wild-type and PD-linked mutant α-Syn variants on primary glial and microglial cell cultures. After stimulation of cells with α-Syn, we measured the release of Th1- and Th2- type cytokines as well as IP-10/CXCL10, RANTES/CCL5, MCP-1/CCL2 and MIP-1α/CCL3 chemokines. Contrary to what had been observed using cell lines or for the case of aggregated α-Syn, we found strong differences in the immune response generated by wild-type α-Syn and the familial PD mutants (A30P, E46K and A53T). CONCLUSIONS: These findings might contribute to explain the differences in the onset and progression of this highly debilitating disease, which could be of value in the development of rational approaches towards effective control of immune responses that are associated with PD.
BACKGROUND:Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized pathologically by the presence in the brain of intracellular protein inclusions highly enriched in aggregated alpha-synuclein (α-Syn). Although it has been established that progression of the disease is accompanied by sustained activation of microglia, the underlying molecules and factors involved in these immune-triggered mechanisms remain largely unexplored. Lately, accumulating evidence has shown the presence of extracellular α-Syn both in its aggregated and monomeric forms in cerebrospinal fluid and blood plasma. However, the effect of extracellular α-Syn on cellular activation and immune mediators, as well as the impact of familial PD-linked α-Syn mutants on this stimulation, are still largely unknown. METHODS AND FINDINGS: In this work, we have compared the activation profiles of non-aggregated, extracellular wild-type and PD-linked mutant α-Syn variants on primary glial and microglial cell cultures. After stimulation of cells with α-Syn, we measured the release of Th1- and Th2- type cytokines as well as IP-10/CXCL10, RANTES/CCL5, MCP-1/CCL2 and MIP-1α/CCL3 chemokines. Contrary to what had been observed using cell lines or for the case of aggregated α-Syn, we found strong differences in the immune response generated by wild-type α-Syn and the familial PD mutants (A30P, E46K and A53T). CONCLUSIONS: These findings might contribute to explain the differences in the onset and progression of this highly debilitating disease, which could be of value in the development of rational approaches towards effective control of immune responses that are associated with PD.
Parkinson's disease (PD) is the second most common neurodegenerative
disorder, after Alzheimer's disease. It is characterized pathologically by
the presence of deposits of aggregated α-synuclein (α-Syn) in
intracellular inclusions, known as Lewy bodies, in the substantia nigra pars
compacta (SN) of the brain [1], [2], and
by the loss of dopaminergic neurons [3], [4]. There is considerable
evidence indicating a role of α-Syn in the etiology of PD, in which the
conversion of α-Syn from soluble monomers to aggregated amyloid-like
insoluble forms is a key event in PD pathogenesis [5]. However, the cellular
and molecular mechanisms underlying the pathological actions of α-Syn are
still not completely understood. Traditionally, α-Syn has been viewed as an
exclusively intracellular, cytoplasmic protein which is highly expressed in
dopaminergic neuronal cells. Lately, accumulating evidence showing the uptake of
extracellular α-Syn by glia and neurons via endocytosis [6], [7], the
release and exocytosis of α-Syn to the medium [8], [9], and the presence of
α-Syn in cerebrospinal fluid [10], [11] and blood [11] both
in its aggregated and non-aggregated forms has pointed at the importance of studying
the effects of extracellular α-Syn on surrounding cells in the brain.Alpha-Syn is a 140-amino acid protein that is highly enriched in presynaptic neuronal
terminals, in particular in the neocortex, hippocampus, and SN [12], as well as within
astrocytes and oligodendroglia [13], [14]. The
physiological role of α-Syn is still being established, but its interaction
with pre-synaptic membranes suggests that one function may be the regulation of
synaptic vesicle pools, including control of dopamine levels [15]. Alpha-Syn belongs to
the group of proteins described as natively unfolded [16], meaning that it does
not adopt a well-defined globular structure, but instead a broad ensemble of
dynamically interacting and largely disordered conformations [17], [18]. Three missense
mutations, A53T, A30P and E46K, as well as multiple copies of wild-type (Wt)
α-Syn, are linked to hereditary, early-onset PD [19]–[22].
In vitro studies have shown that the ensemble of α-Syn
conformers is perturbed by the mutations [23], at least in the
cases of A30P and A53T studied. Presumably as a result of the differences in their
structural, biophysical and biochemical characteristics, the various mutants have
been reported to have different cytotoxic effects, and this cytotoxicity to be
mediated by different pathways (reviewed in [24]). Nevertheless, the
factors contributing to both familial and sporadic cases of PD are not understood in
any detail.Even though the central nervous system (CNS) has been traditionally seen as an
immune-privileged organ, it has become increasingly evident that inflammation is
actively involved in the pathogenesis of various degenerative diseases including
multiple sclerosis, Alzheimer's disease and PD (reviewed in [25]). Indeed,
accumulating evidence indicates that the onset and progression of PD is accompanied
by a robust and highly localized inflammatory response mediated by reactive
astrocytes and activated microglia in affected areas in the brain of PDpatients
[26]–[30]. Whether microglial
activation protects or exacerbates neuronal loss is currently the subject of debate
[31]–[34].
Significantly, a link was established a few years ago between extracellular,
aggregated α-Syn and activation of microglia [35] leading to dopaminergic
neurotoxicity, and a few recent in vivo studies have shown that
microglial activation and neurodegeneration can be directly caused by α-Syn
overexpression [36]–[40]. Even though evidence has
accumulated pointing at the importance of the immunological features of
α-Syn related to the pathogenesis of Parkinson's disease (reviewed
in [2],
[41]), the effects of extracellular α-Syn on the
cellular and molecular components of the immune system linked to PD pathology [42], remain
largely unexplored.Up to this point, research on α-Syn-mediated cell response has focused
primarily on the effects of aggregated α-Syn on neuroinflammation [43] or on
activation of microglia [24], [35], [44]–[46]. In turn, most of
these studies have focused on nitrated α-Syn [43], [45], [46], assuming that
extracellular α-Syn has been modified in a similar manner to α-Syn
found in Lewy bodies [47], [48] −a typically pro-oxidative
environment− an assumption that is still uncertain [42] and might not be valid for
secreted α-Syn. Moreover, it has been recently shown that non-aggregated,
exogenous α-Syn can regulate the key brain cytoactive molecules matrix
metalloproteinase-9 and tissue plasminogen activator in glial cells [49], [50], and
induces higher TNF-α, IL-1β and ROS release levels than aggregated
α-Syn in microglia [50]. Furthermore, it has also been observed that, in
contrast to the aggregated form, monomeric α-Syn enhances microglial
phagocytosis [51]. These results and other recent findings point at the
importance of exploring the effects on the immune response of
non-aggregated/monomeric as well as aggregated extracellular α-Syn. Despite
the fact that some investigations in this direction have been done using monocytic
cell lines [52], human astrocytes [53], or microglia [37], nothing
has been reported about the cytokine expression profile of primary microglial cells
induced by non-aggregated α-Syn, under conditions where the aggregation
state of the protein has been characterized. Likewise, apart from a recent article
focusing on the pro-inflammatory effects of an α-Syn double mutant which
does not exist in nature [54], a comparative study of wild-type α-Syn
and pathologically relevant α-Syn mutants is still lacking. Moreover, so far
there are no data available on key chemokines that might control the differential
homing and activation of T cell subsets, monocytes and glial cells in this context.In this work, we have compared the activation profile of non-aggregated,
extracellular Wt α-Syn and its PD-linked variants, by measuring the release
of key interleukins and chemokines in glial cells. Our findings demonstrate
significant differences in the immune response profiling of Wt α-Syn and
PD-related mutants that might indicate the existence of different pathways towards
PD onset and progression.
Results and Discussion
Characterization of α-Synuclein preparations
It is known that α-Syn has a tendency to self-assemble under certain
conditions to form dimers [55], [56] and higher order
oligomeric species in addition to amyloid-like fibrils [57]. In order to
assess the purity and oligomerization state of the α-Syn preparations
used in this study, we subjected the purified Wt and mutant α-Syn
protein variants to electrophoretic analysis (
). As expected from additional analysis by mass spectrometry (not shown),
each of the four α-Syn preparations migrated as a single, well defined
band corresponding to ca. 14.5 kDa as analysed by SDS-PAGE (
). However, when the samples were subjected to native PAGE (
), they migrated as less defined bands of ca. 110–120 kDa, as
found previously for monomeric α-Syn a natively unfolded protein with a
large charge/mass ratio under these conditions [58]. Finally, the
rather smeared bands corresponding to ca. 50–60 kDa observed by Blue
Native PAGE (BN-PAGE) (
), in which proteins migrate solely as a function of their apparent mass
[59], indicates that the α-Syn preparations
are monomeric. Taken together, our data demonstrate a well defined monomeric
state for the functional characterization of immune-elicited reponses by the
α-Syn protein variants. In order to analyse the oligomeric state of
α-Syn present in the cell cultures after 20 hours, a specific and
sensitive ELISA assay [60] was used. As can be observed, a low amount of
α-Syn oligomers were formed by the end of the incubation step with
cells, with ≤4.3% of oligomers relative to the initially added
α-Syn (
). In addition, in order to assess the total amount of α-Syn
still present in the medium by the end of the incubation step with cells, a
time-course quantification of α-Syn in the culture supernatants was
performed after 1, 6 and 20 hours (
). We found that after 20 hours, the α-Syn content was still ca.
60% of the exogenously added amount.
Figure 1
Determination of the purity, oligomeric state and cytotoxic effects
of preparations of α-synucleins.
(A) SDS-PAGE electrophoresis and (B) native
PAGE electrophoresis of wild type (Wt) and mutant (A53T, A30P and E46K)
α-Syn preparations; (C) BN-PAGE of wild type (Wt)
and mutant (A53T, A30P and E46K) α-Syn preparations;
(D) α-Syn oligomer content after 20 hr incubation
with cells (on a protomer basis), relative to the initial amount of
exogenously added α-Syn, as determined by sandwich ELISA.
(E) LDH release in mixed glial cultures following
incubation for 20 hours with the highest concentration of α-Syn
used in our experiments, i.e. 5 µg/ml. MG132, a proteasome
inhibitor, was used at 6 µM as a control. Values are means
from triplicate measurements.
Determination of the purity, oligomeric state and cytotoxic effects
of preparations of α-synucleins.
(A) SDS-PAGE electrophoresis and (B) native
PAGE electrophoresis of wild type (Wt) and mutant (A53T, A30P and E46K)
α-Syn preparations; (C) BN-PAGE of wild type (Wt)
and mutant (A53T, A30P and E46K) α-Syn preparations;
(D) α-Syn oligomer content after 20 hr incubation
with cells (on a protomer basis), relative to the initial amount of
exogenously added α-Syn, as determined by sandwich ELISA.
(E) LDH release in mixed glial cultures following
incubation for 20 hours with the highest concentration of α-Syn
used in our experiments, i.e. 5 µg/ml. MG132, a proteasome
inhibitor, was used at 6 µM as a control. Values are means
from triplicate measurements.In order to assess the level of cytotoxicity induced by α-Syn at the
concentrations used in this study, we next performed lactate dehydrogenase (LDH)
release assays with microglial cells. After incubating primary mixed cultures
for 20 hours with the α-Syn variants at 5 µg/ml (the highest
concentrations used in this work), the cytotoxicity levels displayed by all four
α-Syn variants were found to be very low (≤8%) and
similar to basal control levels (
). Therefore, it can be concluded that the parameters measured in this
study after α-Syn treatment of cell cultures are not linked to
alterations in cellular viability and therefore represent a specific
α-Syn immune mediated-response.
Characterization of primary microglial cultures
Microglial cells were purified from long-term cultures of neonatal mouse brains
as described in the Materials and Methods
section. The purity of the isolated microglial fraction was evaluated by two
independent approaches. First, immunofluorescence procedures were used as shown
in
, where the absence of contaminating macroglial cells after purification
was confirmed since less than 1% of the total cells stained
positively for GFAP, an intermediate filament specifically expressed in
macroglial cells (
). As a positive control, most of the cells detached by trypsinization of
the long-term cultures from neonatal mouse brains –expected to be
macroglia– were found to be strongly immunostained for GFAP (not
shown). As a second measure of the purity of microglial cell cultures, the
majority of cells were found to express the pan haematopoietic lineage marker
CD45 (
), the monocyte-macrophage marker CD11b (
), and the mature macrophage markers CD68 and F4/80 (
,
respectively). In addition, quantitative RT-PCR was employed to amplify
specifically the GFAP and CD11b genes (
), and the results indicate no detectable mRNA expression of the GFAP
macroglial marker, and a clear up-regulation of the microglia-specific CD11b
gene expression after stimulation by lipopolyssacharide (LPS). Taken together,
the cell marker profiles observed confirms the high purity of the microglial
cultures and hence to the reliability of the results obtained using our purified
microglial cell culture model.
Figure 2
Evaluation of the purity of isolated microglial cell fractions.
Immunofluorescence characterization of purified microglial cell cultures
for the specific macroglial lineage marker GFAP (A), the
pan haematopoietic lineage marker CD45 (B), and the mature
macrophages markers CD11b (C), CD68 (D), and
F4/80 (E). Nuclei are counterstained in blue with Hoechst
33342. Scale bar: 100 µm. mRNA expression (qRT-PCR) from
isolated microglial preparations after no stimulation (control) or after
stimulation with 1 µg/ml LPS for 20 hours (F).
Specific primers for amplifying the GFAP and CD11b genes were used.
Evaluation of the purity of isolated microglial cell fractions.
Immunofluorescence characterization of purified microglial cell cultures
for the specific macroglial lineage marker GFAP (A), the
pan haematopoietic lineage marker CD45 (B), and the mature
macrophages markers CD11b (C), CD68 (D), and
F4/80 (E). Nuclei are counterstained in blue with Hoechst
33342. Scale bar: 100 µm. mRNA expression (qRT-PCR) from
isolated microglial preparations after no stimulation (control) or after
stimulation with 1 µg/ml LPS for 20 hours (F).
Specific primers for amplifying the GFAP and CD11b genes were used.
Pro-inflammatory response of α-Syn-stimulated glia and microglia
In the normal CNS, brain tissue provides an immunosuppressive environment, which
seems to be important for the proper function of the CNS. Under circumstances
that cause disruption of this environment, including chronic inflammatory
conditions in neurodegenerative diseases, a variety of immune regulatory and
inflammatory mediators can be activated [25]. Although various
types of cells have been identified as sources of cytokines in the CNS,
microglia appear to be a principal source of pro-inflammatory and immune
regulatory cytokines [25], [61]. In order to
explore the immunological properties of extracellular, non-aggregated
α-Syn, as well as to evaluate the importance of the cellular context in
this process, we measured by ELISA the release of a series of key cytokines
after incubation for 20 hours of mouse primary cultures of mixed glia and
isolated microglia, with exogenously added Wt α-Syn or the early onset
PD-linked α-Syn variants A30P, E46K, and A53T (at 0.2, 1 or 5
µg/ml).First, we assayed the release of IL-6, TNF-α, IFN-γ and
IL-1β, four key pro-inflammatory cytokines (
and
). Wild-type α-Syn moderately stimulated the release of IL-6 in
mixed glial cultures (
), but contrary to findings for aggregated
Wt α-Syn [62], this effect was hardly detectable on
isolated microglia (
). And in contrast to the comparable IL-6
response observed for the four α-Syn variants reported in a study using
the human U-373 MG astrocytoma cell line [53], we found
remarkable differences in their behaviour, notably a very strong IL-6-mediated
pro-inflammatory response induced by the A30P and E46K variants after
stimulation of both mixed glial and microglial cultures. These differences could
be explained by the nature of the cell line used by Klegeris and coworkers.
Alternatively, given that astrocytes are the most abundant glial cell population
of the CNS participating in local innate immune responses; this result could be
consistent with our finding of less marked differences (
) between the α-Syn variants in mixed glial cultures. The A53T
variant, however, caused a weak but significant increase in IL-6 levels on total
glia but not on isolated microglia, similar to Wt α-Syn but even less
prominent. In the case of TNF-α and IFN-γ levels measured in
microglial cultures, only stimulation with A30P produced a significant increase
(
), partially coinciding with the IL-6 observed profile. Therefore, A30P
and E46K appear to drive IL-6, TNF-α, and IFN-γ cytokine
secretion in the context of PD-affected glia.
Figure 3
Pro-inflammatory interleukin profile of α-Syn-stimulated
primary mixed glial and isolated microglial cultures.
IL-6 (A) and IL-1β (B) release was
measured by ELISA in culture supernantants of mixed glia (left) and
microglia (right) after a 20-hour treatment with monomeric Wt or mutant
α-Syn variants or lipopolysaccharide (LPS). Values are mean
± S.E.M. (n = 4). *
P<0.05, ** P<0.01,
*** P<0.001. The results shown are
representative of two or three independent experiments with microglia
and mixed glial cultures, respectively.
Pro-inflammatory interleukin profile of α-Syn-stimulated
primary mixed glial and isolated microglial cultures.
IL-6 (A) and IL-1β (B) release was
measured by ELISA in culture supernantants of mixed glia (left) and
microglia (right) after a 20-hour treatment with monomeric Wt or mutant
α-Syn variants or lipopolysaccharide (LPS). Values are mean
± S.E.M. (n = 4). *
P<0.05, ** P<0.01,
*** P<0.001. The results shown are
representative of two or three independent experiments with microglia
and mixed glial cultures, respectively.When we assayed the levels of IL-1β from mixed glial cultures (
), only the A30P and E46K α-Syn variants showed a
significant stimulatory effect. Interestingly, when tested on isolated
microglial cells, while A30P did not cause a significant rise in IL-1β
levels relative to the control, Wt α-Syn −in agreement with a
previous report of mRNA levels in a comparable experiment design [37]− and especially E46K, showed a very
significant increase in cytokine release (
). Taken
together, these results suggest that A30P and E46K, as opposed to either Wt
α-Syn or the A53T variant, induce a pro-inflammatory response in glia.
Remarkably, only two of the three PD-linked variants of α-synuclein were
IL-1β inducers in primary glia, and contrary to expectations from
previous studies performed using cell line cultures and other studies involving
modified α-synuclein species, our results show that the A53T
α-Syn variant has instead a very modest activity in regulating the
innate immune response by primary glia and microglia. These findings indicate
the need for further detailed studies on the role of the glia in early PD onset
before detailed conclusions as to the role of the latter in PD can be drawn.Previously, the available data had shown that the A30P and A53T α-Syn
variants, but not the Wt and the E46K forms, efficiently induced the release of
IL-1β when added to THP-1 macrophage cell line cultures [52]
and that all the α-Syn variants were able to increase IL-1β
secretion in THP-1 cells only when co-treatments with INF-γ were
included, suggesting a pro-inflammatory response in already immune-primed THP-1
cells [52]. Our data, obtained with primary microglial
cultures, indicate a very different behaviour. Thus, Wt and E46K α-Syn
in our study appear to be pro-inflammatory in primary microglia, while the A30P
and A53T variants seem to be unable to produce a significant response. These
differential responses of these two studies point at the importance of the
differentiation/maturation status of the primary microglia, which suggests that
there could be multiple subtle but important differences in immune responses
during the establishment of PD. It is interesting that these differences were
only revealed in primary settings that were not over-primed, as was the case of
IFN-γ treated THP-1 cells.The observed effects on IL-1β secretion by primary glia and microglia are
of particular interest considering the emerging role of an adaptive immune
response in PD, in particular by CD4+ T cells [63].
Given IL-1's known effects to promote T cells responses, our findings
on IL-1β regulation by α-Syn variants in innate immunocompetent
cells require further attention in view of the potential effects of the latter
in mediating immune tolerance and T effector responses.
IL-10 regulation by α-Syn-stimulated glia and microglia
Although most studies in the past have focused on microglial production of
pro-inflammatory cytokines, a large body of evidence has supported the notion
that microglia also produce cytokines with anti-inflammatory or regulatory
activities [25]. Indeed, a strong induction of IL-10
−recognized as an anti-inflammatory cytokine− had been
observed for microglial cells stimulated with nitrated, aggregated Wt
α-Syn [62]. We therefore investigated the effects of
non-aggregated and unmodified α-Syn on glial secretion of IL-10
−a Th2 immunoregulator− which reduces cytokine production by
Th1 cells (
). Our results show that only the A30P variant produced a significant
increase in IL-10 levels in mixed glial cells (top panel) whilst, on the
contrary, the A53T variant caused a significant reduction of IL-10 basal levels,
also observed in microglia, likely suggesting a lack of microglial response, a
differential uptake by microglia, or an effect of the uptaken α-Syn on
the endogenous IL-10 when A53T is present. In this sense, it has been reported a
link between α-Syn and the microglial activation features [64],
including phagocytic ability.
Figure 4
Immunoregulatory effect of α-Syn-stimulation in primary mixed
glial and isolated microglial cultures.
IL-10 release was measured by ELISA in supernatants of
α-Syn-stimulated mixed-glial cultures (top) and microglia
(bottom) after a 20-hour treatment with monomeric Wt or mutant
α-Syn variants, or lipopolysaccharide (LPS). Values are mean
± S.E.M. (n = 4). *
P<0.05, ** P<0.01,
*** P<0.001. The results shown are
representative of two or three independent experiments with microglia
and mixed glial cultures, respectively.
Immunoregulatory effect of α-Syn-stimulation in primary mixed
glial and isolated microglial cultures.
IL-10 release was measured by ELISA in supernatants of
α-Syn-stimulated mixed-glial cultures (top) and microglia
(bottom) after a 20-hour treatment with monomeric Wt or mutant
α-Syn variants, or lipopolysaccharide (LPS). Values are mean
± S.E.M. (n = 4). *
P<0.05, ** P<0.01,
*** P<0.001. The results shown are
representative of two or three independent experiments with microglia
and mixed glial cultures, respectively.In microglial cells, on the other hand, only the E46K variant produced an
increase in IL-10 levels as compared to the control (bottom panel). These
results might suggest that microglial cells, in order to produce
α-Syn-driven endogenous IL-10, require both IL-6 and IL-1β
secretion. In this sense, while Wt α-Syn increased only IL-1β
production in microglial cells, A30P increased only the IL-6 production. These
facts could reflect the requirement of a doubly activated state of the microglia
for IL-10 production. Although the general mechanism that generate IL-10
production within the CNS during neuroinflammation is still not well enough
understood, our results support a role for α-Syn in the modulation of
the microglial phenotype as suggested by Austin and collaborators [64].
Chemokine release profiles by α-Syn-stimulated glia and microglia
Chemokines are involved in a wide variety of disorders in the CNS and their
actions contribute to reactive glial changes and neuronal injury in
neuroinflammatory conditions [65]–[67]. We therefore sought
to determine the chemokine release profiles of glial and microglial cells
induced by non-aggregated Wt and PD-linked α-Syn variants. In
particular, we assayed the release of IP-10/CXCL10, RANTES/CCL5, MCP-1/CCL2 and
MIP-1α/CCL3 chemokines (
).
Figure 5
Chemokine release profile of α-Syn-stimulated primary mixed
glial cultures and isolated microglia cultures.
IP-10 (A), RANTES (B), MCP-1 (C),
and MIP-1α (D) were measured in supernantants of
mixed-glial cultures (left) and microglia (right) after a 20-hour
treatment with monomeric Wt or mutant α-Syn variants, or
lipopolysaccharide (LPS). All chemokines were assayed by ELISA as
described in Materials and Methods.
Values are mean ± S.E.M.
(n = 2). * P<0.05,
** P<0.01. The results shown are representative
of two and three independent experiments with microglia and mixed glial
cultures, respectively.
Chemokine release profile of α-Syn-stimulated primary mixed
glial cultures and isolated microglia cultures.
IP-10 (A), RANTES (B), MCP-1 (C),
and MIP-1α (D) were measured in supernantants of
mixed-glial cultures (left) and microglia (right) after a 20-hour
treatment with monomeric Wt or mutant α-Syn variants, or
lipopolysaccharide (LPS). All chemokines were assayed by ELISA as
described in Materials and Methods.
Values are mean ± S.E.M.
(n = 2). * P<0.05,
** P<0.01. The results shown are representative
of two and three independent experiments with microglia and mixed glial
cultures, respectively.The regulation by α-Syn of IP-10/CXCL10 in CNS cells has not been
previously reported. In addition, the only data available regarding RANTES/CCL5
levels in PD are from a transgenic rat model for A53T α-Syn [38], or
from sera and thus relate to peripheral dysregulation in the cytokine network
associated with PDpatients [68]–[70], and although no
information is given on the genetic background of these PDpatients, these
studies reported increased levels of circulating RANTES/CCL5. Our results show
large and comparable effects for A30P and E46K variants on IP-10/CXCL10 and
RANTES/CCL5 release, both by mixed glial cultures and by microglia (
). Remarkably, neither Wt nor A53T in both glial
cultures and microglia produced a relevant increase in IP-10/CXCL10 or
RANTES/CCL5 secretion, the latter result in agreement with the one reported for
the striatum and SN in the (A53T) rat model [38]. These data suggest
a specific role for A30P and E46K α-Syn variants associated with
enhancement of Th1-cell recruitment, activation, and effector potential.Besides their role as chemoattractants, IP-10/CXCL10 and RANTES/CCL5 are known to
induce T-cell proliferation and cytokine production [71], suggesting a role
for A30P and E46K α-Syn variants beyond purely innate pro-inflammatory
responses. In this sense, IP-10/CXCL10 is pivotal in generating antigen-specific
T-cells [71]. As the possible roles of adaptive immune
responses in PD is gaining increasing attention [72], [73],
our data should contribute to a better understanding of the differential immune
responses exerted by the different α-Syn variants in terms of augmented
microglia and macrophage recruitment and/or activation. The strong
pro-inflammatory species (IL-1β, IL-6, IP-10/CXCL10, and RANTES/CCL5)
whose release the A30P and E46K variants seem to promote in the CNS could lead
to augmented macrophage recruitment and/or activation. This view is supported by
the observation of upregulation of MCP-1/CCL2 and MIP-1α/CCL3 by A30P
and E46K (
). Interestingly, the large effects observed for
A30P and E46K were much more pronounced in microglia, indicating a
context-dependent stimulation mechanism. Further studies to asses the extent to
which peripheral inflammation may amplify the neuroinflammation contributing to
PD are needed, but our results raise the possibility of the need for a more
personalised manipulation of the different PD situations in terms of
immunosupressory treatments and/or immunomodulatory therapeutic approaches.Previously, in addition to increased levels of TNF-α, IL-6, and
INF-γ, stimulation of microglia with nitrated, aggregated α-Syn
had been shown to enhance the secretion of MCP-1/CCL2 [46], [62].
In this work, we also found significantly higher levels of MCP-1/CCL2 induced by
non-aggregated Wt α-Syn, as well as a similar MCP-1 release profile in
mixed glial cultures for Wt α-Syn and its A30P and E46K variants, while
A53T caused no detectable chemokine release (
).In summary, stimulation of total glia and microglia with A30P and E46K variants
show large increases of IP-10/CXCL10, RANTES/CCL5, MCP-1/CCL2 and
MIP-1α/CCL3 levels. Wt α-Syn, however, only induced the release
of MCP-1/CCL2 and MIP-1α/CCL3, but not in isolated microglia, suggesting
potential differential effects of Wt α-Syn and its variants on Th1/Th2
activation and/or recruitment, and a more prominent effect for A30P and E46K
α-Syn variants in adaptive immune responses in PD.
Effect of non-aggregated α-Syn stimulation on microglial phagocytosis
Phagocytosis is believed to be involved in steady-state tissue homeostasis, via
the clearance of apoptotic cells, and the promotion of tissue repair and
resolution of the wound [66], [74]. These aspects are
related to the ‘alternative activation’ and acquired
deactivation of the microglia, as a counter phenotype to the
‘classically activated’, pro-inflammatory, microglia [74].
Therefore, in order to assess the role of Wt α-Syn and the PD-linked
variants on phagocytosis, we used fluorescein-conjugated tracker microparticles
for measuring the phagocytosis capacity of differentially activated primary
microglial cells (
).
Figure 6
Effect of α-Syn-stimulation on microglial phagocytosis.
(A) After treatment of the primary microglial cell cultures
with α-Syn (1 µg/ml) for 20 hours, cells were
incubated with fluorescent microspheres for 1 hour. After fixing the
cells, phagocytosis was assessed by fluorescence microscopy analysis.
The phagocytic index was calculated by dividing the fluorescence from
the phagocytosed microspheres by the total number of cells in the
images. Four images were analysed for each sample in each experiment,
and the results shown are representative of three independent
experiments. A.U.: arbitrary units. (Representative microscopy images
used to determine the phagocityc activity of microglial cultures
stimulated with Wt (top) an A30P (centre) α-Syn, or non
stimulated microglial cells (bottom). From left to right, green
fluorescent microspheres, Hoechst-stained cells, and cells as observed
in the absence of fluorescence. Scale bar: 50 µM.
Effect of α-Syn-stimulation on microglial phagocytosis.
(A) After treatment of the primary microglial cell cultures
with α-Syn (1 µg/ml) for 20 hours, cells were
incubated with fluorescent microspheres for 1 hour. After fixing the
cells, phagocytosis was assessed by fluorescence microscopy analysis.
The phagocytic index was calculated by dividing the fluorescence from
the phagocytosed microspheres by the total number of cells in the
images. Four images were analysed for each sample in each experiment,
and the results shown are representative of three independent
experiments. A.U.: arbitrary units. (Representative microscopy images
used to determine the phagocityc activity of microglial cultures
stimulated with Wt (top) an A30P (centre) α-Syn, or non
stimulated microglial cells (bottom). From left to right, green
fluorescent microspheres, Hoechst-stained cells, and cells as observed
in the absence of fluorescence. Scale bar: 50 µM.It has been previously reported that monomeric Wt α-Syn enhances
phagocytosis of a microglial cell line [51], and indeed, our
results show that Wt and A53T α-Syn promote phagocytosis of microglial
cells (
), while the opposite effect was observed for cell cultures stimulated by
the A30P and E46K α-Syn variants (
).
Interestingly, the phagocytic capacity measured for the stimulated microglia was
observed to be inversely correlated to the IL-6 release levels induced by the
different α-Syn variants (
). Our findings point to induction of differential microglial phenotypes
by α-Syn variants. Thus, A53T α-Syn, which was not associated
with a robust pro-inflammatory activity, produced an increase in the phagocytic
capacity that could reflect an alternative activation state of the microglia, as
observed with CNS damage [61]. However, Wt α-Syn, which was
associated with a moderate proinflammatory response in our model, promoted
phagocytosis in microglia, indicating a combination of alternative and classical
activation states, a scenario that has been related to chronic inflammatory
processes such as those observed in Alzheimer's disease [74]. On
the other hand, the A30P and E46K variants of α-Syn induced a strong
pro-inflammatory response, combined with reduced phagocytic capacity, reflecting
a classical activation state, which is clearly associated with the most
cytotoxic situation.Taken together, our results suggest that extracellular, non-aggregated Wt
α-Syn produces a moderate to low pro-inflammatory response in glia,
together with a reduction of the immunoregulatory response, and a moderate
stimulation of Th1 chemokine secretion. The A30P and E46K pathological variants,
on the other hand, can induce strong pro-inflammatory and immunoregulatory
responses, together with marked increases in chemokine release levels, both in
total glia and microglia. This exacerbated native immune response generated by
these two α-Syn variants might explain the earlier onset and more rapid
evolution of these two genetic forms of PD as compared to the sporadic variety.
Intriguingly, our results from the pathologically-linked A53T variant, apart
from a weak effect on IL-6 levels, did not provoke a significant native immune
response. This finding suggests that there are other mechanisms of
neurodegeneration that can contribute to the pathogenesis of PD, perhaps
involving adaptive immune responses that might be promoted specifically by the
A53T variant.In comparison to the classical sporadic form of PD, the clinical phenotypes
associated with mutations in α-Syn are characterized by an earlier
disease onset but a reduced prevalence of tremor [75]–[79]. Studies that help to correlate the different
α-Syn variants with the mechanism of neurodegeneration, and ultimately
with disease progression, are therefore of considerable importance. However, we
should be cautious about preclinical studies in animal models relating to
translational research, as immune responses might vary between mice and human
systems [80]. Equally important is to mention the lack of
physiologically oriented studies employing human primary microglia, rather than
immortalised cell lines. In this context, our results on the effects on glial
native immunity exerted by extracellular, non-aggregated Wt α-Syn and
the various familial PD-linked variants could be of value in the development of
rational approaches towards effective control of immune responses that are
associated with PD.
Materials and Methods
α-synuclein overexpression, purification, and preparation
Human wild-type α-Syn and the A30P, E46K and A53T mutants were
overexpressed in E. coli BL21(DE3) cells using plasmid pT7-7
and purified as described previously [81] with minor
modifications, as follows. After cell transformation, BL21(DE3)-competent cells
were grown in LB in the presence of ampicillin (100 µg/ml). Protein
expression was induced with 1 mM IPTG, and cells were harvested by
centrifugation at 3,500 g after shaking at 37°Cfor 4 hours. The cell
pellet was resuspended in 10 mM Tris–HCl (pH 8.0), 1 mM EDTA, and
EDTA-free protein inhibitor cocktail (Roche Diagnostics, Burgess Hill, UK), and
lysed by multiple freeze–thaw cycles and sonication. The cell
suspension was boiled for 20 min and centrifuged at 20,000 g. Streptomycin
sulphate was added to the supernatant to a final concentration of 10 mg/ml and
the mixture was stirred for 15 min at 4°C. After centrifugation at
13,500 rpm, the supernatant was collected and ammonium sulphate was added (to
0.36 g/ml). The solution was stirred for 30 min at 4°C and centrifuged
again at 13,500 rpm. The pellet was resuspended in 25 mM Tris–HCl (pH
7.7), and loaded onto an HQ/M-column on a BioCAD (Applied Biosystems, Foster
City, USA) workstation. The synuclein proteins were eluted at ca. 300 mM NaCl
with a salt gradient from 0 mM to 600 mM NaCl. The pure α-Syn fractions
were pooled together and dialyzed extensively at 4°C against water.
Protein purities were >95% as determined by SDS-PAGE, and
molecular masses were confirmed by electrospray mass spectrometry.In order to get rid of any possible bound contaminants, the purified proteins
were subjected to denaturation with 6 M urea in 20 mM Tris/HCl (pH 8.0) for 1
hour at room temperature and subsequently dialyzed at 4°C against 20 mM
Tris/HCl (pH 8.0) containing 3 M, 1.5 M, 0.75 M, and 0.375 M urea, and finally
against water. Afterwards, the protein preparations were concentrated by
centrifugation using a 10 k Amicon Ultra-Centrifugal Filter Device (Millipore
Iberica, Madrid, Spain), and passed under sterile conditions through a
0.22-µm filter, and stored at −80°C.
PAGE electrophoresis analyses of the α-Syn preparations
Ten µg of protein were loaded onto a 15% SDS-PAGE gel (the
loading buffer containing 0.1 M DTT), or 25 µg onto a
4–12% gradient Tris-glycine native PAGE gel (Lonza Group,
Basel, Switzerland), and subjected to electrophoresis at 200 V. Gels were
stained with Blue Silver [82], and destained with water. For Blue-Native
PAGE (BN-PAGE), samples were prepared according to the protocol described
previously for purified samples [83] with some modifications. Briefly, 12
µg of protein for experimental samples and 20 µg for protein
markers were loaded on a continuous 15% poly-acrylamide gel.
Ovalbumin and bovineserum albumin (Sigma-Aldrich, St. Louis, USA) were used as
protein markers for native PAGE and BN-PAGE assays. After electrophoresis, gels
were destained in a solution of 50% methanol and 10%
acetic acid until the bands were clearly visible.
Time-course determination of total α-Syn and oligomer content in the
medium after incubation with cells
For a quantitative assessment of the oligomeric content of culture supernatants,
a specific sandwich ELISA assay [60] and a calibration
curve with oligomers of an α-Syn variant carrying six point mutations
(V63A, T64S, N65H, V66L, V71F, T72S), were used. Such oligomers were prepared as
follows: a 700 µM solution in PBS of the mutant α-Syn was
incubated overnight at RT, and subjected to centrifugation with a 100 kDa
cut-off centrifugal filter (Millipore #UFC510024). The resulting retentate was
rinsed with 150 µl of cold PBS and subjected to centrifugation as
before. This procedure was repeated three more times, in order to eliminate the
non-oligomerized protein. The oligomeric nature of the prepared α-Syn
fraction was confirmed by native PAGE and Western blot (not shown), and the
α-synuclein protomer concentration was determined with the BCA assay kit
(Pierce, Rockford, USA.).Quantification of total α-Syn species in culture supernatants after 0, 1,
6 and 20 hours of incubation with cells at 37°C was performed by ELISA.
Briefly: individual wells of 96-well ELISA plates were coated with 100
µl of cell-free culture supernatants. Plates were incubated at
37°C for 2 hours and washed with 0.5% Tween20/PBS, pH 7.2
(PBST). Plates were blocked with 200 µl of 1% BSA in PBS
and incubation at 37°C for 1 hour. After washing with PBST, 100
µl/well of a 1 µg/ml biotinylated anti-α-Syn 211
mouse mAb [Santa Cruz Biotechnology, Santa Cruz, USA; biotinylated as
previously described [60] diluted in 1% BSA in PBS were
added and plates were incubated at 37°C for 1 hour. After washing with
PBST, 100 µl/well of 1∶5000 dilution of ExtrAvidin-alkaline
phosphatase (Sigma-Aldrich, St. Louis, USA) in 1% BSA in PBS were
added, and plates were incubated at 37°C for 30 min. After washing with
PST, 100 µl/well of pNPP substrate (Sigma, St. Louis, USA) were added,
and absorbance at 405 nm was measured within 30 minutes.
Cell cultures
Mixed glial cultures were prepared from the cerebral cortices of 1–3
days-old C57BL/6 mice (University of Seville Animal Core Facility, Seville,
Spain) according to previously described methods [33] with some
modifications. After mechanical, trypsin-mediated (BioWhittaker, Verviers,
Belgium) dissociation, followed by filtration in DMEM-F12 with 10%
inactivated FBS (BioWhittaker, Verviers, Belgium), cells were cultured at
37°C onto 12-well plates treated with poly-D-lysine (Sigma-Aldrich, St.
Louis, USA). After 2 days, half of the volume of culture medium was carefully
changed, and completely changed after 4 days of culture. Cells were used for
stimulation or microglial isolation at day 18–22 of culture.Microglial isolation was carried out according to previously described methods
[84] with some modifications. The supernatant was
removed and the wells were washed with DMEM-F12 without inactivated FBS; this
conditioned medium was stored to be used later. Cells were incubated for
30–45 min with DMEM-F12/trypsin 0.25% solution at
37°C and complete medium was added to inactivate trypsin and the
supernatant containing microglial cells collected. Conditioned medium was added
to attached microglia; the following day the medium was changed for normal
medium, and microglial cultures were stimulated after 5 days post isolation.
Immunofluorescence analysis
Purified microglia were characterized by immunocytochemistry on the basis of
their expression of the pan haematopoietic marker CD45 and of the
monocyte/macrophage markers CD11b, F4/80 and CD68. Additionally, the absence of
Glial Fibrillary Acidic Protein (GFAP)-positive astrocytes in purified
microglial cell cultures was also established. By contrast, trypsin-detached
cells, largely astrocytes but containing some microglial cells, were plated back
into 12-multiwell tissue culture plates and immunocytochemically processed as
mentioned above.For detection of CD45, CD11b and CD68 cell-surface antigens, cells were fixed for
10 min at room temperature (RT) in PBS containing 4%
paraformaldehyde, washed twice in PBS and finally blocked overnight at
4°C in PBS containing 3% bovineserum albumin (BSA). The
cells were then incubated for 1 hour at 4°C with a fluorescein
isothiocyanate (FITC)-conjugated rat anti-mouseCD45 monoclonal antibody
(Leukocyte Common Antigen, Ly-5, clone 30-F11, BD Pharmingen, Franklin Lakes,
USA) and a FITC-conjugated rat anti-mouseCD11b monoclonal antibody (clone
M1/70, BD Pharmingen, Franklin Lakes, USA). Cells were exposed to primary rat
anti-mouseF4/80 monoclonal antibodies (clone Cl:A3-1, Serotec, Oxford, UK) for
1 hour at RT at a final dilution of 1∶100 in PBS. For detection of
CD68 and GFAP intracellular antigens, 4% PFA-fixed cells were
permeabilized and blocked overnight at 4°C in PBS containing
3% BSA and 0.5% of the permeabilizing detergent
Triton-X-100. The following day, cells were incubated for 1 hour at 4°C
in PBS containing a dilution of 1∶100 rat anti-mouse monoclonal CD68
antibodies (clone FA-11, Serotec, Oxford, UK) and a 1∶300 dilution of
anti-GFAPmouse monoclonal antibodies (clone G-A-5, Sigma-Aldrich, Saint Louis,
USA). Labelling with F4/80 and CD68 primary antibodies was detected from
fluorescence measurements after incubating cells for 30 min at RT in PBS
containing 1∶100 diluted FITC-conjugated goat anti-rat IgG secondary
antibodies (Jackson ImmunoResearch, West Grove, USA). For GFAP detection, an
Alexa Fluor 488 nm goat anti-mouse IgG secondary antibody solution (Invitrogen,
Paisley, UK) was added for 30 min at RT at a final dilution of 1∶300
in PBS. Immunofluorescence images were captured with an inverted fluorescence
microscope Olympus IX71 using the digital image processing softwares DP
Controller and DP Manager (Olympus Europa, Hamburg, Germany).
Phagocytosis assays
FluoresbriteTM carboxylate 0.75 µ microspheres
(2.64% Solid-Latex; Polysciences Inc, Warrington, USA) were used as
fluorescein-conjugated tracker microparticles for measuring the phagocytosis
capacity of differentially activated microglial cells. One hour before starting
the phagocytosis assay, fluorescent microspheres (1.08×1011
particles/ml) were mixed at a ratio of 1 µl/20 µl
inactivated FBS (BioWhittaker, Verviers, Belgium) and incubated for 1 hour at
37°C in order to opsonise fully the carboxylate groups. The mixture of
microspheres and FBS was then resuspended in fresh DMEM-F12 medium
(BioWhittaker, Verviers, Belgium), with L-glutamine and P/S antibiotics
supplements to obtain normal 10% FBS-supplemented media containing
5.4×108 microspheres/ml.After removal of 400 µl of supernantant from the
α-Syn-stimulated microglial cell cultures, a volume of 150 µl
of resuspended microspheres was added to each well to obtain a final
concentration of 1.08×108 particles/ml. The particles were
then homogenously distributed throughout each well by gentle movements of the
plate and incubated for 1 hour at 37°C. The medium containing
non-phagocytosed microspheres was then removed and the cells were washed with
PBS prior to their fixation with 4% paraformaldehyde in PBS for 30
min at 4°C. One ml of PBS containing the nuclear fluorescent dye Hoechst
33342 (1 µg/ml) was then added to the cells, and the plates were
stored at 4°C for a minimum of 24 hours before being analyzed.
Determination of the phagocytic index
For each cell culture condition, the phagocytic capacity of microglial cells was
determined by analysing fluorescent images of phagocytosed FITC-labelled
microspheres and by staining cell nuclei with Hoechst 33342. An Olympus IX71
fluorescence microscope equipped with the digital image processing softwares
DPController and DPManager (Olympus Europa, Hamburg, Germany) was used.For each random field, a mean phagocytic index was calculated by determining the
intensity of specific green and blue fluorescence emissions with digital imaging
analysis software MetaMorph (MDS Analytical Technologies, Toronto, Canada).
Specific green fluorescence emitted by FITC-microspheres was determined by
subtracting the mean background fluorescence calculated from three different
areas of the image where no cells were present, from the overall mean green
fluorescence of the entire image. Specific blue emitted nuclear fluorescence was
then calculated in a similar manner. The phagocytic index corresponds to the
specific green/blue ratio. The mean phagocytic index was calculated from 4
random fields of cells (>100 cells) and was considered as a
representative value of the phagocytic capacity of the microglial cells, as
previously determined for mouse peritoneal macrophages within normal media for
24 hours with 1 µl/ml of lipopolysacharide (LPS).
qRT-PCR
Expression of GFAP and CD11b was determined by using a two-step quantitative
real-time PCR. Total RNA from two microglial culture wells, one without
treatment and one treated with LPS for 16 hours, was extracted using the RNeasy
Micro Kit (Qiagen GmbH, Hilden, Germany) according to the
manufacturer's protocol. One µg of RNA was
reverse-transcribed using the Quantitect Reverse Transcription kit (Qiagen GmbH,
Hilden, Germany) according to the manufacturer's protocol. qPCR was
performed with SYBR® Premix EX TaqTM (Perfect Real Time) (Takara Bio
Inc., Otsu, Shiga, Japan) on an ABI Prism 7500 Real Time PCR System. Primers
used were: HPRT_For: 5′-GTAATGATCAGTCAACGGGGGAC-3′,
HPRT_Rev: 5′-CCAGCAAGCTTGCAACCTTAACCA-3′;
GFAP_For: 5′-ATCGAGATCGCCACCTACAG-3′, GFAP_Rev:
5′-CTCACATCACCACGTCCTTG-3′; CD11b_For:
5′-CAGATCAACAATGTGACCGTATGG-3′,
CD11b_Rev: 5′-CATCATGTCCTTGTACTGCCGC-3′). Multiple
transcripts were analyzed simultaneously for 40 cycles using an optimized
qRT-PCR thermal profile. Changes in gene expression were determined using the
2−ΔΔCt method with normalization to
endogenous hypoxanthinephophoribosyltransferase (HPRT) control.
Cytotoxicity assays
The cytotoxic effect of the α-Syn variants under study was evaluated from
the extent of LDH release with by using the LDH Cytoxicity Detection Kit (Roche,
Basel, Switzerland) in MGC, following stimulation with the maximum concentration
of wild-type α-Syn, its mutants or LPS (Sigma-Aldrich, St. Louis, USA),
used in the present experiments (5 µg/ml for α-synuclein
samples and 1 µg/ml for LPS). The limiting value in each case was
determined using 6 µM MG132 (Sigma-Aldrich, St. Louis, USA), which is
known to be lethal for cells at the concentration used, again using the
manufacturer's protocol.
Cytokine release measurements
Glial mixed cultures and isolated microglial cultures were stimulated with Wt
α-Syn and its mutational variants at different concentrations (5
µg/ml and 1 µg/ml for MGC and 1 µg/ml and 0.2
µg/ml for MiG) for 20 hours. LPS at a concentration of 1
µg/ml, and culture medium alone were used as positive and negative
controls, respectively. Culture supernatants were harvested and centrifuged at
700 g for 5 min. and cell-cleared supernatants were recovered and stored at
−80°C before cytokine measurement. IL-6, IL-1β,
TNF-α, IFN-γ and IL-10 levels were assayed using MouseIL-6/IL-1β/TNF-α/IFN-γ/IL-10 BD OptEIA ELISA set (BD
Biosciences, Madrid, Spain) according to the manufacturer's protocol.
Chemokine levels in the culture supernatants were determined by a specific
sandwich ELISA by using capture/biotinylated detection antibodies obtained from
Peprotech (London, UK) according to the manufacturer's recommendations.
Cytokine profiles shown are representative of three independent experiments.
Ethics statement
All animals were handled in strict accordance with good animal practice as
defined by the relevant national/EU guidelines and the CEA-CABIMER Experimental
Animal Committee, and all animal work was approved by the appropriate committee
(file CEA-2010-14).
Data analysis
All values are expressed as mean ± S.E.M. Statistical significance
(Student's test, two-tailed) was evaluated using SPSS Statistics 17.0
(IBM Company, Chicago, USA).Time-course quantitation of total α-Syn in cell culture supernatants.
Total α-Syn content measured by direct ELISA in culture supernatants
recovered after addition of wild-type α-Syn to mixed glial cultures
and incubation for 0, 1, 6 and 20 hours at 37°C.(0.06 MB TIF)Click here for additional data file.
TNF-α and IFN-γ release profile of α-Syn-stimulated primary microglial cultures.
TNF-α (A) and IFN-γ (B) levels were measured by ELISA in
culture supernantants of microglia after a 20-hour treatment with
exogeneously added α-Syn variants, or lipopolysaccharide (LPS).
Values are mean ± S.E.M.
(n = 3). The results shown are
representative of two independent experiments.(0.13 MB TIF)Click here for additional data file.
Authors: Omar M A El-Agnaf; Sultan A Salem; Katerina E Paleologou; Leanne J Cooper; Nigel J Fullwood; Mark J Gibson; Martin D Curran; Jennifer A Court; David M A Mann; Shu-ichi Ikeda; Mark R Cookson; John Hardy; David Allsop Journal: FASEB J Date: 2003-08-15 Impact factor: 5.191
Authors: Xianwu Li; Eiron Cudaback; Richard M Breyer; Kathleen S Montine; C Dirk Keene; Thomas J Montine Journal: FASEB J Date: 2012-04-12 Impact factor: 5.191
Authors: Lama M Chahine; Judy Qiang; Emily Ashbridge; James Minger; Dora Yearout; Stacy Horn; Amy Colcher; Howard I Hurtig; Virginia M-Y Lee; Vivianna M Van Deerlin; James B Leverenz; Andrew D Siderowf; John Q Trojanowski; Cyrus P Zabetian; Alice Chen-Plotkin Journal: JAMA Neurol Date: 2013-07 Impact factor: 18.302