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Modelling	Neuropsychiatric	Disorders		
using	in	vitro	models	
Fred	H.	Gage	
Salk	Ins>tute	for	Biological	Studies	
ICOSRO	
3/28/17
Using	human	induced	pluripotent	stem	cells	to	
model	neurological/psychiatric	diseases
LV-SynP-HTG	 Rabies-EnvAΔG-mCherry	
D0	 D7	 D12	
NTP Co-twin SZ
0
2
4
6
8Presynaptic/Postsynaptic
Rabies Virus Tracing
* *
**		
*		
*		
NTP:	Neurotypical	
Co-twin:	Non-affected	siblings	
SZ:	Schizophrenia-affected	siblings
Lineage-specific differentiation
Advantages of Lineage-specific Differentiation

Homogeneity of characteristics

Cell type relevant to the Disease

Characterize developmental features not end point features
Disadvantages of Lineage–specific Differentiation
Wrong choice of Cell type or phenotype
Does not provide adequate circuit properties
Pathobiology	of	SCZ	and	BP	
Prefrontal Cortex and Hippocampus linked to SCZ and BP
Patients exhibit one or all of the following:
•  a reduced volume in non-pyramidal cell layers, including dentate gyrus
•  a reduced number of somatostatin-positive and paravalbumin-positive neurons
•  reduced somal volume of cornu ammonis sector 2/3
The dentate gyrus contributes to the
formation of memories and plays a role in
depression.
Focus on lineage-specific cellular
phenotypes: dentate granule neurons, the
principal cells of the dentate gyrus
Endogenous	Wnt3a	in	early		
hippocampal	paVerning	
Tole	&	Grove	et	al.	J	Neurosci,	2001.	
Mouse	E	10.5	&	E	12.5	
In	situ	hybridizaon:	
Brown-	Wnt3a	exp	
Blue-EphB1	(a,b,c)	
Blue-	beta-tubulin	(d)
Prox1-EGFP/Prox1/Dapi	
Prox1	is	a	specific	marker	for	hippocampal	
DG	granule	neurons
An%-caudalizing		
factors	
Dissociate	
rose6es	
+	FGF2	
Day		0																																														20																												26																								40																																															60	
NPC	differen%a%on		
AA+cAMP+Laminin+	
Wnt3a	+BDNF	
Plate	EBs	 NPC	differen%a%on		
AA+cAMP+Laminin+BDNF	
Differen%a%on	of	human	embryonic	stem	cells	into	
hippocampal	DG	neurons	using	NPCs		
0	
20	
40	
60	
80	
100	
120	
0	 10	 20	 30	 40	
Fold	change	rela%ve	to	control		
Day	of	differen%a%on	
Emx2	
NeuroD1	
Pax6	
0	
5	
10	
15	
20	
25	
30	
35	
40	
45	
0	 10	 20	 30	 40	
Fold	change	rela%ve	to	control	
Days	of	differen%a%on	
TBR1	
DCX	
Foxg1
Human	Prox1-posive	bipolar	granule	neurons	are	spontaneously	acve
Funconal	assay:		
hippocampal	hNPCs	grafed	in	vivo	
50k/ul	
cell	suspension	
Stereotaxic	
injecon	into	
dentate	gyrus	
P14	NOD	SCID	mice	
2-16	wks	in	
vivo	graf
D
A
B
C
Fig. 5
Hilus
GCL
Dapi
GFP/Prox1/Dapi
hNF-M/Dapi
CA3 CA3
Morphometricsofgraftedneurons
Morphometricsofgraftedneurons
120
100
80
60
40
20
0
Soma
Area (µm²)
Dendrite
Length
Total (µm)
0
1
2
3
4
5
6
Segments Tree Number
2wks 6wks
*
**
**
GFP/Dapi
E F
GFP Prox1
HuNu
Transplant of Human iPS cells to adult
NOD/Skid mouse Dentate Gyrus
50ms	
20mV	
25pA	
10s	
10pA	
100ms	
-70mV	
+	CNQX	
A.	 B.	
C.	 D.	
GFP/Prox1/DAPI	50μm	
Fig.	2.	(A)	An	hiPSC-derived	GFP+	neuron	transplanted into the granule cell layer (GCL) of the
mouse DG. (B) Transplanted neurons are active and can generate action potential spikes in
response to somatic current injection. They also functionally integrate into the endogenous
hippocampal network, as evidenced by spontaneous post-synaptic currents (C), and by induced
postsynaptic currents in response to stimulation of upstream presynaptic connections (D). These
responses are attenuated by 10 µM CNQX, indicating that they are mainly generated by
excitatory AMPA receptors.
Human Neurons Functionally Connected in vivo
Basal	Electrophysiology	Unaffected		
in	SCZD	hiPSC	Neurons	
Brennand	et	al	NATURE,	2011	
induced		
Na+/K+	currents	
induced	acon	
potenals	
spontaneous	EPSCs	 spontaneous	IPSCs
Prox1	Granule	Neurons,	Derived	from	Schizophrenics	
	are	less	acve	then	Control	Neurons
Schizophrenia:	a	major	public	health	concern	
"Biological	insights	from	108	schizophrenia-associated	genec	loci."	Nature	511.7510	(2014):	421.
Study	 how	 gene>c	 varia>on	 contributes	 to	 the	 development	 of	 the	
disorder	
Modeling	psychiatric	disorders	in	a	dish	
A	cohort	includes	Monozygoc	twins	that	are	discordant	for	
schizophrenia	(SZ)	and	healthy	control	twins	
Can	we	idenfy	alteraons	that	are	common	to	the	SZ	paents	and	
non-affected	siblings?	
	Can	we	idenfy	alteraons	that	are	specific	to	the	SZ	paents?	
Can	we	idenfy	a	phenotypic	trait	that	is	due	to	a	subset	of	genes?
Hippocampal	paVerned	(hp)NPC	give	rise	to	CA3	
neurons	
Otx=	corcal	hem	marker	 NeuN+	Vglut1=	mature	excitatory	neuron
hpNPC	give	rise	to	hCA3	neurons	
ELAVL2	=	CA3	marker;	not	present	in	DG	
hCA3=	ES/iPS	cell	derived	CA3	neurons		
hDG=	ES/iPS	cell	derived	DG	neurons
hpNPC	give	rise	to	hCA3	neurons	
Selecvely	 Comprehensively
SCGN+	CA3	neurons:	A	novel	subtype	
unique	to	human		
Also	present	in	hCA3	in	vitro
hCA3	neurons	are	funconally	mature	
and	form	synapc	connecons	
Spontaneous	ac%vity	by	MEA	recording	
Rabies	tracing	to	assay	level	
	of	monosynap%c	connec%vity	
DG	neurons	show	v	low	level	of	intrinsic	acvity	and	low	connecvity	(Gothard	2001,	Amaral	
1990)	
Like	in	vivo,	hCA3	neurons	are	disnct	from	hDG	neurons
hCA3	neurons	form	synapc	connecons	with	
hDG	neurons	
Coculture	hCA3	and	hDG	(1:1)	
Rabies	virus	marks	postsynapc	and	presynapc	neurons;		
Grik4	=CA3	marker;	Grik4-GFP	is	specific	for	CA3	
Calb1	=	mature	DG	neurons
DG!CA3	mossy	fiber	circuit	in	vitro	
~400um	
Postsynapc	CA3	neurons	+	rabies	virus
SZ-DG	neurons	show	
aVenuated	
spontaneous	acvity	
Yu	D	et.	al.	2014
SZ-iPSCs	make	CA3	subtypes
SZ-CA3	show	reduced	spontaneous	
acvity	
Co-culture	DG	and	
CA3	neurons	mixed		
Replated	at	3	week	
No	change	in	total	cell	#,	subtype	#,	interneuron	#	suggesng	intrinsic	acvity	deficits	
hpNPC	---------	CA3	neurons
Summary	
•  A	novel	protocol	to	generate	hippocampal	CA3	pyramidal	
neurons	in	vitro	
•  hCA3	neurons	represent	a	novel	human	specific	subtype	and	
demonstrate	pyramidal	neuronal	diversity		
•  CA3	neurons	form	circuitry	with	DG	neurons	in	vitro	
•  Spontaneous	spike	rate	in	CA3	and	DG-CA3	populaon	is	
impaired	in	Schizophrenia
Reprogramming patients in search of Cell autonomous and genetic
mechanism for BP and Li+ responsiveness
4 - phenotypically normal
3 - Li+ responders
3 - Li+ non-responders
Differentiate into
Dentate Granule- Like
Neurons
Modeling	Bipolar	Disease	with	iPSC	derived	Neurons	
Mertens	et	al	Nature	2015
Reprogramming and Differentiation
1- Differentially expressed genes in the BD derived DG neurons (456 genes).
2- Expression of representative genes involved in the PKA/PKC and
AP firing systems revealed by RNA-seq – suggesting Hyper-Excitability
Patch	clamp	
•  Method	invented	late	70’s	by	Erwin	Neher	
and	Bert	Sakmann	,	who	received	a	Nobel	
prize	for	their	work	
•  Allowed	to	record	currents	of	even	single	
ion	channels,	and	the	study	of	the	
involvment	of	ion	channel	in	neuronal	
func%on	
•  Whole	cell	patch	clamp	in	neurons	
marked	by	Prox1::eGFP	lenviral	
vector
Patch clamp recording on Prox1::EGFP-expressing DG neurons (j)
showed spontaneous postsynaptic currents (k) and Na+/K+ currents
Sample trace (s), frequency (t) and mean amplitude (u) of
spontaneous APs.
Hippocampal dentate gyrus granule cells derived from
BD patients show hyper-excitability.
Heatmaps (k) and MA plots (l) showing that Li significantly altered the
gene expression profile of the LR neurons but not the NR neurons:
456 gene significantly changed in Li+ Rs while only 40 genes changed in NRs
Lithium rescues the hyperexcitability in hippocampal neurons
derived from BD patient-iPSCs
hiPS	Derived	Neurons	Show	
Spontaneous	Ca2+	Transients	
Fluo-4AM,	3	month	old	neurons,	real	me	
,Jessica	Jou,	Anthony	Simone,	Diana	Yu
Sample traces (a) and bar graph (b) showing that the Ca2+ transient events
detected with Fluo 4-AM were abolished by TTX.
Somatic Ca2+ imaging analysis reveals hyperactivity in the neural network
formed by the BD iPSC-derived neurons
BD neurons show abnormalities in mitochondrial functions
Sample images of neurons expressing DsRed2-mito and Prox1::EGFP		
Mitochondrial genes changed in
BP Neuronsfl
JC-1 is a cationic dye that can accumulate in energized mitochondria, the
ratio of red to green fluorescence reflects the functional efficiency of
mitochondria
Treatment	of	Li+	NR/BP	paents	
•  Lamotrigine	is	an	oral	drug	that	is	used	
primarily	for	seizures.	It	is	chemically	
unrelated	to	other	an-seizure	drugs.		
•  Lamotrigine	also	is	used	for	prevenng	mood	
episodes	in	individuals	18	years	or	older	with	
BP.	Though	the	mechanism	is	unknown,
Representative traces of APs evoked during 300 ms step-wise
depolarization periods in the normal and NR neurons with and
without 100 µM lamotrigine (LTG) treatment.
Summary
•  BP patient derived hippocampal Dentate Gyrus neurons are
molecularly and functionally hyper-excitability.
•  Li+ can reverse the excitability BUT only in neurons from
patients that responded behavioral to Li+.
•  BP patients have impaired mitochondria, likely required to supply
energy to impaired synapses. This impairment is reversed in Li+
responding patient neurons, but not the NRs. –we do not know if
the energy deficit is primary or secondary to the disease.
Bipolar	iPSCs	
•  Cohort	of	4	control	cell	
lines,	
•  	3	Lithium	responsive	
(LR)		bipolar	paents	
•  3	non-responsive	(NR)	
bipolar	paents	
•  EBV	allows	human	lymphocytes	the	ability	to	proliferate	
indefinitely.	
•  EBV	genes	not	integrated	in	the	derived	iPSCs	
•  Widely	banked	cells	for	studying	human	disease	
Epstein-Barr	Virus	(EBV)	immortalized	lymphocytes
Bipolar	NPCs	and	hippocampal		
DG	granule	cell	neurons	
•  Whole	cell	patch	
clamp	in	neurons	
marked	by	
Prox1::eGFP	lenviral	
vector
Hyper-excitability	and	sustained	ac%vity	
Evoked	Acon	potenals	at	current	clamp	mode,	neurons	3.5	weeks	old	
Evoked	ac%on	poten%als	:		
Current	clamp	mode	
•  Control:21.2±2.4	,	4	cell	lines,	
95	cells	
•  LR:	48±5.5,	3	cell	lines,	84	
cells	
•  NR:	48.7±8.3	,	3	cell	lines,	63	
cells	
p<0.0001	for	LR	neurons	vs.	
control	p=0.0002	for	NR	neurons	
vs.	control	
contr
ol	
LR	 NR	
Spontaneous	ac%vity:	
•  Control:0.24±0.06	Hz	
•  LR:	0.71±0.14	Hz	
•  NR:	0.35±0.08	Hz	
P=0.0005	LR	vs.	control,	p=0.03	LR	vs.	NR,	p=0.0055	
bipolar	vs.	control	
v
Total	evoked	AP	
Spontaneous	ac%vity
Sodium/potassium	currents	
Sodium	
currents	
Fast	potassium	
currents	
Slow	potassium	
currents	
Sodium	to	potassium	
rao	in:	
Voltage	clamp	mode	
25%	increase	in	LR,	not	
significant	
46%	reduced	in	NR,	
p=0.0006	
Spike	shape	
contr
ol	
LR	 NR	
Current	clamp	mode	Special	features	of	each	group	are	preserved	throughout	enre	differenaon	mes
Response	to		chronic	lithium	treatment	
•  An	important	validaon	of	these	neurons	as	model	neurons	for	bipolar	
is	differenal	response	to	neurons	depending	if	the	paent	responded	
to	lithium	treatment		
Total	evoked	
AP	
Total	evoked	
AP
Bioinforma%cs:	Neurons	derived	from	bipolar	pa%ents	divide	into	two	very	
intrinsically	different	groups,	but	is	it	predic%ve	of	drug	response?		
AUC	
0.98
Neurons	from	Bipolar	Disorder	pa%ents	are	characterized	by	
intrinsically	different	sub	popula%ons	of	neurons	
•  LR	neurons	spikes	are	narrow	and	high	amplitude,	
NR	neurons	spikes	are	wide	with	a	low	amplitude,	
and	with	a	more	depolarized	threshold		
•  An	important	feature	is	
shared	by	both	the	bipolar	
disorders	groups:	a	large	fast	
afer-hyperpolarizaon	
(AHP)	
•  This	feature	is	known	from	
fast	spiking	interneurons
Summary	
•  DG	neurons	derived	from	bipolar	paents	are	hyperexcitable	
•  EBV	immortalized	lymphocytes	can	be	well	differenated	into	DG	granule	
neurons,	maintaining	paent	by	paent	differences.	These	cells	are	highly	
banked,	and	their	collecon	induces	minimal	stress	to	the	paent	
•  Bipolar	disorder	neurons	sub-divide	into	subgroups	of	intrinsically	different	
neurons	
•  Predicve	of	the	paent’s	response	to	Li	
•  These	sub	populaons	of	neurons	share	a	feature	of	a	large	fast	Afer-
hyperpolarizaon,	probably	a	main	contributor	to	their	fast,	sustained	spiking	
abilies	
•  A	numerical	model	reproduces	the	experimental	results		
•  Chronic	Li	treatment	reduces	hyperexcitability	in	neurons	derived	from	the	
paents	who	respond	to	Li
Acknowledgments	
Carol	Marche+o	
Shani	Stern	
Lynne	Moore	
Ani	Sarkar	
Meiyan	Wang	
Sara	Linker	
Renata	Santos	
Simon	Schafer	
Patrick	Reed	
Jun	Yao	
Yongsung	Kim	
Rene	Kahn	
Utrect	and	Mt.	
Sinai-	NYC	
John	Kelsoe	
UCSD	
MarEn	Alda,	
Canada	
Anne	Bang,	SBP	
Ruth	Keithley		
Anna	Mendes	
Arianna	Mei	
Isabelle	
Guimont
Lithium	treatment	effects	on	spike	shape	
•  fast	AHP	amplitude	is	
reduced,	and	the	
spike	broadens.		
•  Two	features	which	
contribute	to	reduced	
excitability		
•  fast	AHP	amplitude	is	
reduced	
•  The	threshold	becomes	
less	depolarized	
Fast	
AHP	
Fast	
AHP	
thresh
old	
Spike	
width	
Spike	
width	
thresh
old	
Spike	
height	
Spike	
height	
Input	
conductance	
Input	
conductance
Summary	
•  DG	neurons	derived	from	bipolar	paents	are	hyperexcitable	
•  EBV	immortalized	lymphocytes	can	be	well	differenated	into	
DG	granule	neurons,	maintaining	paent	by	paent	differences.	
These	cells	are	highly	banked,	and	their	collecon	induces	
minimal	stress	to	the	paent	
•  Bipolar	disorder	neurons	sub-divide	into	subgroups	of	
intrinsically	different	neurons	
•  Predicve	of	the	paent’s	response	to	Li	
•  These	sub	populaons	of	neurons	share	a	feature	of	a	large	fast	
Afer-hyperpolarizaon,	probably	a	main	contributor	to	their	
fast,	sustained	spiking	abilies	
•  A	numerical	model	reproduces	the	experimental	results
Next	steps	
•  CA3	and	interneurons	
•  Bipolar	astrocytes	and	co-culturing	
•  Patch-seq
Fred	Gage	
•  Leah	Boyer	
•  Mike	McConnell	
•  Yan	Li	
•  Yangling	Mu	
•  Diana	Yu	
Gong	Chen	
Jonathan	Sebat	
Shane	McCarthy	
Edward	Cook	
Gene	Yeo	
•  Michael	Lovci	
•  Jus%n	Arnold	
Eric	Courchesne	&	ACE	
John	Kelsoe	&	PGBD	
Mark	Lawson	
My	Students:	
• 			Anthony	Simone	
• 			Jessica	Jou		
• 			Chelsea	Gelboin-Burkhart	
• 			Ngoc	Tran	
• 			Sarah	Sangar	
• 			Sam	Larkin	
• 			Lisa	Johnson	
Ed	Callaway		
• 				Nicholas	Wall	
Konrad	Hochedlinger	
Salk	Stem	Cell	Core	
	Travis	Berggeron	
	Margaret	Lutz	
CIRM	Fellow

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