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Optogenetically transduced human ES cell-derived neural progenitors and their neuronal progenies: Phenotypic characterization and responses to optical stimulation
Authors: Jiwon Ryu aff001; Philippe F. Y. Vincent aff002; Nikolaos K. Ziogas aff001; Leyan Xu aff001; Shirin Sadeghpour aff001; John Curtin aff001; Athanasios S. Alexandris aff001; Nicholas Stewart aff001; Richard Sima aff002; Sascha du Lac aff002; Elisabeth Glowatzki aff002; Vassilis E. Koliatsos aff001
Authors place of work: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff001; Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff002; Division of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff003; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff004
Published in the journal: PLoS ONE 14(11)
Category: Research Article
doi: https://doi.org/10.1371/journal.pone.0224846Summary
Optogenetically engineered human neural progenitors (hNPs) are viewed as promising tools in regenerative neuroscience because they allow the testing of the ability of hNPs to integrate within nervous system of an appropriate host not only structurally, but also functionally based on the responses of their differentiated progenies to light. Here, we transduced H9 embryonic stem cell-derived hNPs with a lentivirus harboring human channelrhodopsin (hChR2) and differentiated them into a forebrain lineage. We extensively characterized the fate and optogenetic functionality of hChR2-hNPs in vitro with electrophysiology and immunocytochemistry. We also explored whether the in vivo phenotype of ChR2-hNPs conforms to in vitro observations by grafting them into the frontal neocortex of rodents and analyzing their survival and neuronal differentiation. Human ChR2-hNPs acquired neuronal phenotypes (TUJ1, MAP2, SMI-312, and synapsin 1 immunoreactivity) in vitro after an average of 70 days of coculturing with CD1 astrocytes and progressively displayed both inhibitory and excitatory neurotransmitter signatures by immunocytochemistry and whole-cell patch clamp recording. Three months after transplantation into motor cortex of naïve or injured mice, 60–70% of hChR2-hNPs at the transplantation site expressed TUJ1 and had neuronal cytologies, whereas 60% of cells also expressed ChR2. Transplant-derived neurons extended axons through major commissural and descending tracts and issued synaptophysin+ terminals in the claustrum, endopiriform area, and corresponding insular and piriform cortices. There was no apparent difference in engraftment, differentiation, or connectivity patterns between injured and sham subjects. Same trends were observed in a second rodent host, i.e. rat, where we employed longer survival times and found that the majority of grafted hChR2-hNPs differentiated into GABAergic neurons that established dense terminal fields and innervated mostly dendritic profiles in host cortical neurons. In physiological experiments, human ChR2+ neurons in culture generated spontaneous action potentials (APs) 100–170 days into differentiation and their firing activity was consistently driven by optical stimulation. Stimulation generated glutamatergic and GABAergic postsynaptic activity in neighboring ChR2- cells, evidence that hChR2-hNP-derived neurons had established functional synaptic connections with other neurons in culture. Light stimulation of hChR2-hNP transplants in vivo generated complicated results, in part because of the variable response of the transplants themselves. Our findings show that we can successfully derive hNPs with optogenetic properties that are fully transferrable to their differentiated neuronal progenies. We also show that these progenies have substantial neurotransmitter plasticity in vitro, whereas in vivo they mostly differentiate into inhibitory GABAergic neurons. Furthermore, neurons derived from hNPs have the capacity of establishing functional synapses with postsynaptic neurons in vitro, but this outcome is technically challenging to explore in vivo. We propose that optogenetically endowed hNPs hold great promise as tools to explore de novo circuit formation in the brain and, in the future, perhaps launch a new generation of neuromodulatory therapies.
Keywords:
Cell differentiation – Neurons – Transplantation immunology – Yellow fluorescent protein – Light pulses – Axons – Astrocytes – Neuronal differentiation
Introduction
Regenerative medicine relies heavily on animal models of disease and on preclinical optimization of regenerative therapies, including therapies based on stem cells and their derivatives [1]. In neurology, the consideration of stem-cell based regenerative strategies is founded on a series of successful preclinical transplantation studies showing that exogenous neural stem cells (NSCs) derived from embryonic neural tissue, embryonic stem (ES) cells, or induced pluripotent stem cells (iPSCs) can successfully engraft, differentiate, and integrate into the preformed adult nervous system [2–10] in a manner largely corresponding to their constitutive differentiation program. The demonstration of structurally mature synapses from stem cell transplants that contact host neurons in the brain and spinal cord [5, 7, 10–12] raises the question whether newly formed synapses are not only structurally complete, but also physiologically active. Functionality of regenerated synapses is important not only for the purpose of conveying system-specific information, but perhaps also for facilitating transsynaptic trophic support [13–15].
Human ES cell-derived neural progenitors (NPs) and iPSCs have been induced to a large number of neuronal or glial fates and have been used in preclinical therapies for various neurological diseases, especially stroke [16–18], neurodegenerative diseases like Parkinson’s and Huntington’s disease and Amyotrophic lateral sclerosis [8, 10, 11, 19–21], and spinal cord injury [22, 23]. Traumatic brain injury (TBI), another common problem with 2–3 million new cases requiring medical attention annually, is often associated with chronic encephalopathies that have no effective treatments and a disappointing record of universally negative clinical trials [24]. In all the above conditions there is widespread disconnection or degradation of brain circuits. Therefore, a key translational issue is whether stem cells and their derivatives can help support or regenerate parts of damaged circuitry. One way to achieve this goal is to transplant NPs with pre-established neuronal differentiation potential and to monitor their circuit-generating effects with physiological strategies. One strategy is the transplantation of optogenetically competent NPs after transduction with channelrhodopsin (ChR2) genes and then monitoring of their ability to form physiologically active circuits with light stimulation. However, despite attempts to create stable ChR2 human ES cell lines to prevent variable transduction and expression efficiency in ES cell-derived neurons, to date, it has been difficult to establish and successfully maintain such lines.
Here we used a non-clonal strategy to generate optogenetically competent human ChR2 (hChR2)-expressing human NPs (hNPs) that we extensively characterized in vitro and then tested their differentiation fate in vivo after transplantation into the adult rodent CNS (frontal neocortex). We found that these cells differentiate into mature neurons that stably express the optogene and, when transplanted into the cortex of mice and rats, they survive and differentiate into mature neurons with GABAergic phenotypes that innervate proximal and remote limbic, paralimbic and neocortical sites. In physiological experiments in vitro (light stimulation of hChR2-hNP-derived neurons), these nerve cells can elicit glutamatergic and GABAergic postsynaptic activity in neighboring neurons via newly matured synapses.
Materials and methods
Derivation of hNPs
Because cerebral cortex is highly accessible to transplantation and commonly implicated in disease, including TBI, our differentiation strategy was designed such as to introduce a forebrain fate bias to cells destined for transplantation. Therefore, H9 stem cells were differentiated into forebrain-specific hNPs by inhibiting bone morphogenetic protein (BMP)-mediated Spinal Muscular Atrophy and Mothers Against Decapentaplegic (SMAD) signaling with dorsomorphin and also epithelial-to-mesenchymal transition with the TGFβ kinase/activin receptor like kinase (ALK)-5 inhibitor A-83-01 (targeting TGF-β type I receptor ALK5, Activin/Nodal receptor ALK4, and nodal receptor ALK7) [25, 26]. Cells were maintained as colonies on mouse embryonic fibroblast (MEF) plates [27, 28] and lifted with collagenase treatment (37°C, 1 hour) to generate embryoid bodies (EB) on Day 0. Embryoid bodies were fed daily with EB medium containing DMEM/F12, 20% KOSR, 2mM L-glutamine, 0.1mM NEM-NEAA, 100μM 2-mercaptoethanol, 2μM dorsomorphin and 2μM A-83 for 4 days and then human NP medium (DMEM/F12, 1× N2, 0.1mM NEM-NEAA, 2μg/mL heparin, 2μM cyclopamine) from day 5 to 21 every two days. On day 7, EBs were plated on Matrigel coated plates and the resulting rosettes were collected manually with pipette on day 22 to generate neurospheres in human NP medium. To expand NPs, spheres were digested with accutase and 1–2 million cells were plated on matrigel-coated 35mm dishes and fed with NP expansion medium containing DMEM/F12, 1× N2, 1× B27 and 20ng/mL FGF2. Cells were characterized at different stages of differentiation with immunocytochemistry (ICC) for OCT4, nestin, PAX6, FOXG1, HB9, TUJ1, MAP2 and SMI-312.
Transduction of human NPs with lentivirus harboring hSyn-hChR2
Our early attempts to establish a stable hChR2 transgenic human embryonic stem cell (hES) clonal line to avoid variable transduction and expression efficiency was hampered by problems in stable transgene expression despite the presence of the transgenes hChR2 and YFP in the genomic DNA (S1 Fig and S1 Table). After differentiation of H9 cells to NPs and neurons, transgene expression was not detectable; varying neural differentiation methods. Therefore, we decided to transduce cells at the NP stage of differentiation. Neural progenitor cells (2 million) were plated on a matrigel-coated 35mm dish on day 34. Two days after plating, cells were treated with polybrene (6 μg/mL) in NP expansion medium at 37°C for 15min. Lentivirus harboring hSyn-hChR2(H134R)-eYFP-WPRE was added to each well at moi 0 or 13 and incubated at 37°C for 24 hours. The virus medium was replaced with new NP expansion media (NPEM; DMEM/F12, N2, B27, 20ng/mL FGF2) on the next day and live cell images of NPs or neurons expressing hChR2 were acquired 4–5 days after transduction using a Nikon TS 100 fluorescence inverted microscope (Nikon Instruments Inc., Melville, NY) with a Digital Sight DS Fi1 CCD camera (Nikon Instruments Inc., Melville, NY).
Differentiation to neurons with forebrain signatures
Human ChR2-NPs used for transplantation at day 41 were subjected to further in vitro differentiation to neurons with a forebrain phenotype, essentially as described in Wen et al, 2014 [26]. Neural progenitors were plated on matrigel-, laminin - or PDL/laminin-coated chambers (ibidi USA Inc., Madison, Wisconsin; 8 well, 80841) or 12 mm coverslips (Bellco Glass Inc., Vineland, NJ; 1943-10012A or Corning, Corning, NY; Biocoat 354087) for further forebrain-specific differentiation on day 41 and were fed with neural differentiation media (NDM) containing Neurobasal medium, 2mM L-glutamine, 1× B27, 10ng/mL BDNF and 10ng/mL GDNF every 2–3 days [26]. Neurons were characterized by immunocytochemistry for NP markers (PAX6, FOXG1, BRN2, and TBR1), neuronal markers (TUJ1, MAP2, SMI-312, Synapsin 1, GAD1, vGLUT1/2 and vGAT) and astrocytic markers (GFAP) as described [27, 28]. Donkey anti-rabbit or mouse IgG-Alexa-Fluor 488, 555, 655, donkey anti-chicken IgY-Alexa-Fluor 488 and donkey anti-mouse IgG-Cy3 were used as secondary antibodies at concentrations of 1 : 500–1 : 1000.
Mouse primary astrocyte preparation for co-culture with hNPs and neurons
Primary astrocytes were prepared from P2-P3 CD1 mouse brains as described [29]. Twenty-to-forty thousand astrocytes were plated on 12 mm coverslips coated with poly-D-lysine (PDL) and laminin a week before hNP plating and fed with astrocyte progenitor medium containing DMEM (Invitrogen, Carlsbad, CA, 10569), FBS-HI (Invitrogen, 10082) and penicillin/streptomycin (Invitrogen, 15140). Twenty to eighty thousand hNPs (day 41–50) were plated on the coverslips and fed with NDM every 2–3 days to promote neuronal differentiation for electrophysiology. Human ChR2-neurons expressing YFP were used for in vitro optogenetic stimulation and testing of their response to light at a 485 nm wavelength.
Whole-cell patch clamp recordings and data analysis
Cultured neurons were placed in a recording chamber under a Zeiss Axioskop 2 FS plus or a Nikon A1R-MP upright microscope and visualized with a 40× water immersion objective. Cells were perfused at a rate of 1mL/min with an extracellular solution containing (in mM): 140 NaCl, 3 KCl, 2 CaCl2, 1 MgCl2, 15 HEPES, 23 glucose, pH 7.4 (NaOH), 300 mOsm. For some experiments, 250 nM TTX citrate (Tocris, Minneapolis, MN) was added to the extracellular solution to block voltage-gated sodium channels. Borosilicate patch pipettes with 1 mm outside diameter (WPI, Sarasota, FL) were pulled using a multistep horizontal puller P87 (Sutter Instrument, Novato, CA) and fire polished with a micro forge MF-200 (WPI) to achieve pipette resistances ranging from 4 to 5 MΩ. Patch pipettes were filled with an intracellular solution containing (in mM): 121 K-gluconate, 22 KCl, 10 HEPES, 10 EGTA, 4 Mg-ATP, pH 7.2 (KOH), 290 mOsm. All recordings were performed at room temperature (21–24°C).
Data were either collected using pClamp10.6 software with a Multiclamp 700B amplifier (Molecular Devices, Sunnyvale, CA) or using patchmaster controlling a double EPC10 Heka amplifier (Heka Elektronik, Germany). The signal was low-pass filtered at 10 kHz and digitized at 20 kHz with a Digidata 1550A (Molecular Devices). Only recordings with series resistances (Rs) < 25 MΩ and leak currents < 200 pA were considered for analysis, without compensating for Rs errors. In voltage clamp mode, holding voltage potentials were corrected for liquid junction potentials (11 mV).
Data were analyzed using Clampfit 10.6 (Molecular Devices), MiniAnalysis (Synaptosoft, Fort Lee, NJ) and Origin 9.1 (OriginLab, Northampton, MA). Statistical testing was performed with Origin 9.1 software. When comparing two independent samples, an unpaired student t-test was used. In the case of two dependent samples, a paired student t-test was used. Where more than two groups were compared, ANOVA was used. The limit of significance was set at p < 0.05.
In vitro optical stimulation
Channelrhodopsin activation was achieved with a custom LED device including an optic fiber cable mounted on a 485 nm blue LED (Cree Lighting Inc., Durham, NC) connected to a SLB-1200-1 universal LED driver (Mightex, Pleasanton, CA). The end of the optic fiber cable was placed a few millimeters away from the cells with a MP-285 micromanipulator (Sutter Instrument, Novato, CA). Light intensity was calibrated at 0.38 mW/mm2 using a PM20A optical power meter (Thorlabs, Newton, NJ). Light pulses were Transistor-Transistor Logic (TTL) triggered with pClamp10.6 software using the analog-input of the LED driver. For some sets of experiments, channelrhodopsin was stimulated using a Spectra X (Lumencor, Beaverton, USA) directly coupled to the epifluorescent port of the Nikon A1R-MP microscope. Light pulses were TTL triggered with patchmaster software.
Transplantation of hChR2-hNPs in the frontal cortex of mice and rats
Fourteen-to-fifteen-week old male athymic nude mice (Hsd:Athymic Nude-Foxn1nu; Envigo, Indianapolis, IN) and 12 weeks old athymic nude rats (Crl:NIH-Foxn1rnu) were the subjects of transplantation experiments that were carried out according to protocols approved by the Animal Care and Use Committee of the Johns Hopkins Medical Institutions. Immunodeficient rodents allow for a better engraftment and survival of human cells compared to immunocompetent animals treated with immunosuppressants [30]. Transplantation was performed using gas anesthesia (isoflurane:oxygen:nitrous oxide = 1 : 33 : 66) and aseptic methods. In mice, we explored the survival and differentiation of both transduced and nontransduced transplanted hNPs in naïve or injured animals (transduced NP, n = 45; nontransduced NP, n = 4). For injury, we used the impact acceleration method [31] that produces diffuse trauma, with impact set at 40 × 1m [32]. A hundred thousand hNPs were transplanted next to the corpus callosum using pulled beveled glass micropipettes with tip diameters of 50–100μm controlled by a Nanoinjector device (World Precision Instruments, Sarasota, FL) [5, 7, 9, 28]. Stereotaxic coordinates were 0.7 mm anterior to bregma, 1.5 mm lateral to midline and 2 mm ventral to pia. Prior to transplantation, day 41 hNP cells had been dissociated with accutase (Invitrogen) and resuspended in NP expansion media (DMEM/F12, N2, B27, 20ng/mL FGF2) at a concentration of 100,000 per μL. Injured subjects were grafted one week after injury, i.e. time point that appears to optimize survival and differentiation [9, 10]. Animals were allowed to survive for 2–4 months, i.e. a period sufficient to ascertain the success of engraftment and differentiation, including the stable expression of hChR2 in vivo. Similarly, naïve athymic rats (uninjured, n = 9) were injected with 50K-100K of hChR2-hNPs into layers 2–3 of the motor cortex (1 mm anterior to bregma, 2.5 mm lateral to midline and 1 mm ventral to pia) using 5 μL Hamilton syringe. Rats were allowed to survive for 9 months before analyzed.
Histology, immunohistochemistry and microscopy
Brain tissues were prepared from animals perfused transcardially with 4% phosphate-buffered paraformaldehyde as described [5]. The survival and fate of hNP grafts were assessed with avidin-biotin complex-based peroxidase immunohistochemistry (IHC) and dual-label fluorescent IHC in serial coronal sections (40μm) through the brain as described previously [5, 11, 33]. Human NP survival was studied with human-specific nuclei (HuNu) or human-specific cytoplasm (SC121) antibody using immunoperoxidase or immunofluorescence labeling. Differentiation was studied with dual-label immunofluorescence combining antibodies against HuNu or SC121 with antibodies against the neural and glial markers doublecortin, TUJ1, PDGFRα, GFAP, MAP2, and synaptophysin, vGAT, vGLUT1, vGLUT2, GAD1, gamma aminobutyric acid (GABA), oligodendrocyte transcription factor 2 (Olig2), myelin basic protein (MBP), 2',3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase); the mesodermal lineage marker BMP4 or antibodies against YFP; the immediate early gene transcription marker c-FOS as a marker of neuronal activation; and the nuclear epitope Ki67 present in all phases of cell cycle except G0 as a marker of dividing neurons [2, 5, 10, 11]. Information for all antibodies is listed in S2 Table. For immunofluorescence, brains were first incubated in the primary antibodies overnight at 4°C, and then incubated in donkey/goat anti-rabbit IgG conjugated to Alexa-Fluor 488, 546 or 647 (1 : 300, Invitrogen, Carlsbad, CA), donkey/goat anti-mouse IgG conjugated to Cy3 (1 : 200; Jackson ImmunoResearch, West Grove, PA) or Alexa-Fluor 488, goat anti-guinea pig IgG Alexa Fluor 568 (Abcam, Cambridge, MA) and donkey/goat anti-chicken IgY conjugated to Alexa-Fluor 488 (1 : 300, Invitrogen, Carlsbad, CA) for 2 hours at 4°C. Brains were then counterstained with the fluorescent DNA dye 4′,6-diamidino-2-phenylindole (DAPI), and then mounted and coverslipped. For the immunoperoxidase-DAB method, after the primary antibody reaction (4°C, overnight), sections were incubated with biotinylated donkey antimouse IgG (1 : 200; Jackson ImmunoResearch, West Grove, PA) (room temperature, 2 hours), then treated with avidin-HRP and developed in DAB (Vectastain Elite ABC Kit, Vector Laboratories Inc., Burlingame, CA). Stained brain sections were imaged on a Zeiss Axiophot microscope equipped for epifluorescence or a Zeiss LSM 710 confocal microscope, or Leica SP8 confocal microscope with MetaXpress high-content analysis software (Molecular Devices, CA, USA) or Leica Application Suite X (Leica microsystem, Inc, IL). Adobe Photoshop 9.0 software (Adobe Systems, San Jose, CA) and Image J (Fiji distribution) and Imaris 9.0 (Bitplane Inc, Concord, MA) was used for image processing and montaging.
Stereological estimates of transplanted hChR2-hNP survival and differentiation
In mice transplanted with ChR2-hNPs, SC121-, YFP-, HuNu - and TUJ1-immunoreactive cells were counted through the site of the main transplant and sites of leakage in the ventricle or surface of the brain (pia) on systematically sampled sections (every 6th of a coronal brain series) using ImageJ software (V. 1.44p, NIH, USA). Counting frame was set at 250×250μm per image. The percentage of eYFP+SC121+ or TUJ1+ HuNu+ cells was calculated by dividing the number of cells with the total of SC121+ or HuNu+ cell profiles, respectively.
Student's t-tests were performed to compare between densities of TUJ1+ human-derived cells in cortex between transduced and nontransduced NPs at the main transplantation site. One-way analysis of variance (ANOVA) followed by Tukey's post-hoc test was also used to compare the effect of engraftment site (main transplant, pia, ventricles) on NP differentiation based on TUJ1 phenotype (TUJ1+HuNu+ cells divided by the total of HuNu+ cells). Statistical analyses were performed with STATISTICA 8.0 software (StatSoft Inc., Tulsa, OK).
Results
Embryonic stem cell differentiation to hNPs with forebrain fate preference
Embryonic stem cells were first differentiated to cortical-fate hNPs (Figs 1 and 2). Cells grown as colonies on MEF feeder cell layers were detached by collagenase on day 0 to make EBs (Figs 2 and 3) and fed with EB medium daily for 4 days in an ultra-low attachment plate. Embryoid bodies were initially treated with the AMP-activated protein kinase (AMPK) inhibitor dorsormorphin and the ALK inhibitor A-83-1. On day 5, medium was switched to NP-induction medium that was changed every 2 days to day 21. To pattern cells to forebrain fates, we added heparin for the activation of wnt signaling [34, 35] and cyclopamine for inhibition of SHH signaling [36, 37]. On day 7, EBs were seen to be attached to Matrigel-coated plates and, on the next day (day 8), neural rosette structures started to appear on attached colonies (Fig 3C). On day 22, rosettes were lifted to generate neurospheres in NP medium (Fig 3F) and then neurospheres were dissociated into single cells with accutase and 1–2 million cells were plated in NP expansion medium on Matrigel-coated wells on day 23 (Fig 3G and 3F) for cell expansion.
Fig. 1. General schema of hES cell differentiation. Optogenetically engineered human neural precursors were differentiated into neurons with forebrain fate preference. The functionality of derived neurons was measured by their light-responsive action potentials and synaptic activity in vitro and the induction of the immediate early gene c-FOS in host neurons in vivo. Fig. 2. Induction and differentiation protocol used to generate hNPs from H9 hES cells and to further advance them to a cortical neuronal fate. ES, embryonic stem cell; KOSR, KnockOut™ Serum Replacement; NEAA, non-essential amino acids; 2-ME, 2-mercaptoethanol; EB, embryoid body; NP, neural progenitors; FGF, fibroblast growth factor 2; BDNF, brain-derived neurotrophic factor; GDNF, glial cell-derived neurotrophic factor. Fig. 3. Critical steps in neural differentiation of human ES cells (Day 0) to NPs (Day 25). On Day 0, H9 ES cell colonies (A) were detached using collagenase to form embryoid bodies (B; EBs on Day 2) that were further cultured in EB media with dorsomorphin and A-83. Beginning at day 4, medium was changed to the one promoting NP cell differentiation that was used to feed every other day to Day 22. On Day 7, EBs were attached to matrigel-coated plate; neural rosette structures were evident at day 8 (C) and became prominent on day 11 (D-E). On day 22, colonies with rosettes were detached manually to form neurospheres (F). On day 23, neurospheres were dissociated into single cells with accutase, plated on matrigel-coated plate, and fed with NP expansion media till they became confluent (G-H). Cells were passed every 4–5 days. Days 36 NPs were used for viral transduction and Day 41 NPs for transplantation. Scale bars: A-C, F, 500μm; D and G-H, 200μm; E, 100μm. To examine the progressive differentiation of hNPs in vitro, on day 23, cells were also plated on coverslips or a plastic surface coated with Matrigel or PDL and laminin at various densities and fed with neural differentiation media every 2–3 days for immunocytochemistry. Consistent with the forebrain neural differentiation method used here [26], the majority of NPs were FOXG1 positive on day 13 (Fig 4A); by day 28, they lost Oct4 expression (data not shown) but were nestin as well as PAX6 positive (Fig 4B and 4C) and many displayed early neuronal phenotypes (Fig 4D). By day 41, we observed further differentiation to MAP2+ and SMI-312+ neurons (Fig 4E and 4F).
Fig. 4. Characterization of H9-derived hNPs by immunocytochemistry at an early stage. Neuronal progenitors were plated on matrigel-coated ibidi chambers or PDL/Laminin coated-12 mm coverslips on day 23. Cells were fed with NDM every 2 days. At Days 13–28, most H9-derived cells expressed the primary progenitor and telencephalon marker FOXG1 (A) and the neural stem cell markers nestin (B) and PAX6 (C); cells immunoreactive for the stem cell marker Oct4 were rare (data not shown). On Day 41 (E-F), some cells were TUJ1, MAP2 and SMI-312 positive but vGAT, vGLUT1 and synapsin 1 signals were absent (data not shown). Scale bars: A, 25μm; B-D and F, 100μm; E, 50μm. Human NP transduction with hChR2-eYFP-harboring lentivirus; establishment of mature neuronal phenotypes of hChR2-hNPs in vitro
At day 35, some batches of hNPs were transduced with lentivirus at moi of 13 for 24 hours in the presence of polybrene. After transduction, we continued differentiation on PDL - and laminin-coated 12mm coverslips pre-plated with CD1 mouse astrocytes a week prior. Human ChR2 gene expression was detected 4–7 days after transduction (Fig 5A–5C). Confocal microscopy shows that hChR2 protein was localized preferentially at the cell membrane (Fig 5D–5F). Co-culturing hNPs with astrocytes reduced aggregation and inhibition of neuronal maturation that is common when cells are differentiated in NDM long term and led to the appearance of nicely separated mature neurons suitable for phenotypic characterization by microscopy and electrophysiology (Fig 6A). By day 90, neurons co-cultured with astrocytes were seen to express mature neuronal markers including MAP2, SMI-312, synapsin 1 (Fig 6B–6D), and also neurotransmitter markers consistent with inhibitory or excitatory neurotransmission i.e. vGLUT1 for glutamatergic neurotransmission and vGAT for inhibitory GABAergic or glycinergic neurotransmission (Fig 6E and 6F). These neurotransmitter markers display vesicular immunoreactivity (Fig 6E and 6F) and colocalize with the endogenous ChR2-YFP (S2 Fig).
Fig. 5. Expression and localization of hChR2 in H9-derived hNPs. Panels A-C depict typical neurons at various days of maturation in vitro: H9 hNPs, photographed here on day 47 in culture, had been transduced on Day 34 by lentivirus carrying hChR2 at moi 13. Human ChR2-YFP expression started to appear two-four days after transduction and progressively spread over the perikaryon and processes of maturing neurons. Panels D-F demonstrate the fine localization of hChR2 (YFP fluorescence), predominantly to the membranes of representative transduced nerve cells (arrows), seven days after transduction, by confocal microscopy. Scale bars: A-C, 100μm; D-F, 50μm. Fig. 6. Characterization of hNP-derived neurons co-cultured with mouse astrocytes by immunocytochemistry at an advanced stage (Days 97 and 116). The use of the co-culture system with CD1 astrocytes (A) greatly reduces aggregation and promotes neuronal differentiation in the form of nicely separated mature neurons expressing advanced neuronal signatures such as phosphorylated neurofilaments M and H (B: SMI312 immunoreactivity), MAP2 (C), and SYN1 (D, in conjunction with MAP2). Neurotransmitter markers consistent with excitatory or inhibitory neurotransmission such as vGLUT1 and vGAT are also abundantly expressed in these cultures (E and F). Note the vesicular nature of vGLUT1 and vGAT immunoreactivity. Scale bars: 100μm. Next we determined whether hCHR2-expressing nerve cells displayed electrophysiological features of functional neurons and if they formed functional synapses in vitro. Human ChR2+ cells were kept in co-culture with mouse astrocytes and were identified in the recording dish by their fluorescence (S3A Fig). At 6 weeks into co-culturing (corresponding to day 82) hNP-derived neurons were still immature with depolarized resting membrane potentials and weak membrane depolarization in response to optic stimulation. However, at 8–11 weeks, 14 to 17-week old hChR2+ neurons were mature enough to allow for the detection of action potentials (APs) and optic responsiveness. Sodium and potassium ion channels were identified in the current voltage relation (S3B Fig), and in current clamp mode, spontaneous action potentials (APs) were recorded (S3C Fig).
Because immunocytochemical experiments showed excitatory and inhibitory synaptic markers in hNP-derived neurons by day 90, we proceeded to test the presence of functional inhibitory and excitatory synapses with patch clamp recordings from hChR2- neurons between day 90 and day 167. Seventy eight % of recorded neurons (36/46) displayed spontaneous excitatory synaptic currents (EPSCs) (Fig 7). Twenty nine neurons were tested for their transmitter identity, using pharmacology and excitatory postsynaptic current (EPSC) waveform analysis. Fourteen % of neurons (4/29) received uniformly glutamatergic transmission, as their spontaneous EPSCs were completely blocked by 50 μM CNQX, a glutamate receptor blocker specific for AMPA and kainate, but not NMDA receptors (Fig 7A). The blocking effect of CNQX was reversed during washout in 1 out of 4 cells. Excitatory postsynaptic currents were short, as it is typical for AMPA receptor currents. The peak of the distribution for decay time constants was 2.4 ± 1.3 ms (n = 23) (Fig 7A´ and 7B). Seventeen % of neurons (5/29) received uniformly GABAergic transmission, as their spontaneous EPSCs were completely blocked by 20 μM bicuculline, a GABA-A receptor blocker (Fig 7C). The GABAergic block was reversed during washout in 2 out 5 cells. Compared to glutamatergic EPSCs, bicuculline-sensitive EPSCs displayed slower waveforms. The peak of the distribution for decay time constants was 13.1 ± 4.9 ms (n = 24) (Fig 7C´ and 7D). Finally, 69% of cells (20/29) showed mixed synaptic events that were sensitive to either CNQX or to bicuculline block (Fig 7E). For these recordings, the decay time constant distributions displayed two components, representing the faster and slower kinetics (arrow) of the respective glutamatergic and GABAergic EPSCs (Fig 7F). When adding CNQX, fast synaptic events were abolished (Fig 7G), leaving the component that represents the slower kinetics (arrow) of the GABAergic events (n = 3) (Fig 7G). Spontaneous synaptic currents were also recorded from hChR2+ neurons in 6 of 8 cells tested. Four recordings had enough EPSCs to be analyzed, and two showed purely glutamatergic and the other two showed purely GABAergic synaptic transmission (data not shown).
Fig. 7. Human NPs display glutamatergic and GABAergic spontaneous synaptic transmission in vitro (Days 90–167). Voltage clamp recordings of spontaneous synaptic currents from ChR2- neurons. Holding potential -90 mV; at room temperature. (A) Example recording showing that in this cell, spontaneous synaptic currents are completely and reversibly blocked by 50 μM CNQX, a glutamate receptor blocker. (Aʹ) Top left panel shows a superimposed view of synaptic events from recording in A at an enlarged time scale (gray traces, n = 122 events). Average trace is shown in black. Bottom right panel shows an example of one postsynaptic event. Red line indicates monoexponential fit used to calculate the decay time constant. (B) Distribution of decay time constants for the recording shown in A, with a peak of the distribution at 0.79 ms. (C) Example recording showing that in this cell, spontaneous synaptic currents are completely and reversibly blocked by 20 μM Bicuculline, a GABA-A receptor blocker. (C´) Postsynaptic events from recording in C (n = 131 events, gray lines) were superimposed and averaged (black trace, top left). Bottom right panel shows an example of one postsynaptic current with monoexponential fit of decay time constant. (D) Distribution of decay time constants of the recording shown in C, with a peak of the distribution at 15 ms. Note that events at these inhibitory synapses appear as excitatory postsynaptic currents in this type of recording, as the reversal potential of chloride has been changed in the artificial in vitro recording environment. (E) Example recording showing a mix of glutamatergic and GABAergic synaptic events during spontaneous activity. In this cell, CNQX only partially abolished postsynaptic events (middle trace). The remaining events are blocked by bicuculline (bottom trace). (F) Distribution of decay time constants of postsynaptic events from the control trace before drug application in E shows a distribution with two peaks, at 1.6 ms and 8.5 ms (arrow). (G) Distribution of decay time constants of postsynaptic events during CNQX application for the recording shown in the middle trace in E. Note that compared to the distribution in F, the peak at 1.6 ms is abolished in CNQX (red dotted line); therefore it is representing the glutamatergic postsynaptic events. The blue line represents the events that are not blocked by CNQX, but sensitive to bicuculline, and therefore GABAergic. The arrow points to the same peak as in F, now appearing larger due to rescaling. Overall, these results suggest that in vitro, ChR2- and ChR2+ hNPs mature properly into neurons that form a functional network with both excitatory and inhibitory synapses in vitro.
In vivo plasticity of hChR2-hNPs: survival and differentiation in mice and rats
Both transduced and non-transduced hNPs were transplanted into the deep sensorimotor cortex (M1-S1) of naïve or injured mice and naïve rats. Mouse and rat material had some key differences. Mice had deeper injections into motor cortex and were allowed to survive only 3 months, to generate observations on the early differentiation of the graft. Rats were intended for optogenetic stimulation experiments in vivo because their larger brain size allows for a better spatial separation of transplant site, i.e. the direct target of optic stimulation, and terminal fields of transplant-derived neurons. Also, to readily access and stimulate the transplants from the surface of the brain, and because of the exponential attenuation of energy as the light travels through deeper parts of the brain, we targeted grafting to layers 1–3 of motor cortex. Furthermore, to allow for a full maturation of synapses of hNP-derived neurons, we extended survival time to 9 months, in keeping with our previous observations on the synaptic maturation of NP grafts in the brain [5].
In mice, graft survival was excellent (Figs 8 and 9). Viral hChR2 transduction and the presence or absence of IA injury had no apparent impact on the fate of transplanted hNPs. Twenty % of hNPs at the transplantation site were positive for the mitotic marker Ki67, indication of an ongoing proliferative potential of the transplant; all such cells were located in neuroepithelial rosettes that were still visible at the transplantation sites. On dual fluorescence preparations for human markers and markers of neural differentiation we found that 63% (44–96%) of SC121+ cells and 66% (57–72%) of HuNu+ cells expressed TUJ1, a type III β-tubulin epitope that marks neurons from an early stage (Fig 8A). There was some penetration of hNP-derived cells with neuronal features in the halo around the transplants, but no evidence of long-distance migration of SC121+ (transplant-derived) cells. Even when hNPs were inadvertently engrafted in the ventricle or leaked over pia, neuronal differentiation rate was high at 57% (45–74%). Less than 5% of transplanted cells were immunoreactive for the astrocytic marker GFAP, the early oligodendrocytic marker PDGFRα or the mesenchymal marker BMP4. In transplants of transduced hNPs (hChR2-hNPs), we found that 62% (60–90%) of transplant-derived neuronal cells expressed hChR2-YFP signal (Fig 8B). In areas of dense human synaptophysin (hSYP)+ boutons we occasionally found GABA immunoreactivity manifesting as punctate perikaryal and perhaps also neuropil staining; transplants were not immunoreactive for vGLUT1 (data not shown).
Fig. 8. Series of confocal images indicating the differentiation of transplant-derived cells into early neurons with hChR2 expression. (A) These four panels indicate that a large percentage of transplant-derived HuNu+ cells (green) are also immunoreactive with antibodies against class III β-tubulin epitope TUJ1 (red). Blue nuclei are stained with DAPI. (B) These panels indicate that the majority of transplant-derived epitope SC121+ positive cells (red) also fluoresce in the green spectrum, which is indication of hChR2 expression. Cell nuclei are stained with DAPI (blue). Scale bars: 200μm. Fig. 9. Neuronal differentiation of ChR2-transduced and non-transduced hNP transplants and pathfinding of axons from their neuronal progenies two months after transplantation (mice). (A) These four panels are from representative cases visualized with IHC for the human-cell specific epitope SC121 and illustrate a consistent engraftment of hNPs in the primary motor area at a coronal level corresponding to caudal septum. Transplant engages deep cortical layers, medial corpus callosum, and dorsal neostriatum. In most cases, the transplantation needle track is also evident. Panels also show that SC121+ transplant-derived axons project along the fibers of corpus callosum and exit at the level of claustrum. Transplants in #21 and #22 contain transduced hNPs, whereas in #12 and #15 contain non-transduced cells. All cases are from injured mice. (B-D) SC121 immunohistochemical preparations illustrating the propensity of transplant-derived axons to exit the lateral corpus callosum at the level of the claustrum and then course in deep insular/piriform cortex. Case 15 involves non-transduced NPs. There is a striking concentration of axons at the claustrum, and an occasional further advancement towards the insular and piriform cortex. In some cases, bundles of axons extend all the way to layer II of piriform/insular cortex (B), commonly following a course oblique or vertical to the plane of view (C). Panel D shows that axon bundles branch into numerous single axons with boutons (arrows) in the deep insular/piriform cortex (Case 22, transduced NPs). (E-H) These human synaptophysin-immunostained preparations show the formation of early synaptic fields by transplant-derived neurons. Low-level synaptophysin expression often extends from the site of the transplant all the way to the lateral corpus callosum and insular/piriform area, with an apparent terminal field at the claustrum/piriform cortex (E). With higher magnification, terminal field contains putative synaptic boutons (F; photograph is taken from the claustral/piriform area indicated with asterisk on panel E). Bundles of axons that course obliquely or vertically to the coronal plane as in panels C-D also express diffuse synaptophysin immunoreactivity (G; bundles are indicated with arrows). Synaptophysin+ boutons surround such bundles (H; panel is a magnification of area indicated with an asterisk on panel G). M1, primary motor cortex M2, secondary motor cortex; S1, primary somatosensory cortex; cl, claustrum; ep, endopiriform nucleus; pir, piriform cortex; SYP, synaptophysin. Scale bars: A, 800μm; B-C, 200μm; D, 30μm; E, 400μm; F-H, 20μm; G, 100μm. Transplants from hChR2-hNP injections formed in cortical layers 5/6 and the adjacent corpus callosum (Fig 9A). Neuronal cells differentiated from transplanted hNPs extended axons primarily along the corpus callosum, mainly on the ipsilateral but to some extent also the contralateral side (Fig 9A). Axons were also seen in the cingulum, internal capsule and fornix. Invariably, callosal axons exited the external capsule at the dorsal claustrum and then bundled in cylindrical structures that appeared to course in the mediolateral and then caudally in the anteroposterior axis; some of these tubes reached piriform cortex (Fig 9B–9C). These structures have a complex 3D configuration and branch off to individual axons with bouton-like synaptic structures (Fig 9D). Human synaptophysin IHC confirms the synaptic maturation potential of the hNP transplants and reveals terminal fields in claustrum (Fig 9E and 9F) and in deep insular/piriform cortex (Fig 9G and 9H). In some cases we also saw terminal fields in nearby neocortical and cingulate areas.
In rats, because of the longer survival times, emphasis was on terminal fields and neurotransmitter differentiation. Brain tissues were analyzed with IHC for: the localization and differentiation of grafted cells (HuNu, SC121, or TUJ1 immunoreactivity); expression of hChR2 (YFP immunoreactivity); and the presence and distribution of human synapses (human-specific synaptophysin immunoreactivity). In all cases, we found an extensive differentiation of transplanted cells into neurons (Fig 10A and S4 Fig). We rarely saw SC121+ or hChR2+ neurons in the halo around the border of the graft and we saw no such neurons in remote sites, a pattern indicating lack of migration. Human NP-derived neurons inside the transplant projected axons outside its boundaries and established dense terminal fields of hChR2+ axons and terminals in cingulate and motor cortices (Fig 10B), whereas many axons entered the corpus callosum. Two independent markers of transplant-derived axons and terminals, i.e. human ChR2 and hSYP expression, colocalized extensively in host terminal fields; human ChR2 (marked by YFP immunoreactivity) was preferentially expressed in axons and axon bundles, whereas human synaptophysin was abundant in axons but also terminal boutons attached to YFP+ structures (Fig 10C and S5 Fig). The majority of transplant-derived synapses were in contact with host dendritic profiles (Fig 10D). In an initial characterization of the neurotransmitter phenotype of the differentiated transplant, we found intense vGAT and very low vGLUT1 immunoreactivity in the transplant, evidence for a predominantly GABAergic differentiation of the graft (Fig 11A and 11B and S6 Fig). Many transplant-derived terminals in the host (in motor and cingulate cortex) were also positive for GABAergic markers such as vGAT (Fig 11C and 11C´ and S7 Fig) and GAD1 (Fig 11D and 11D´) whereas we found no colocalization of human synaptophysin with glutamatergic markers, i.e. vGLUT1/2 (Fig 11E and 11E´) with high-resolution confocal microscopy. Some large axons in the vicinity of the graft (Fig 12 and S8 Fig) and smaller axons in terminal fields in the motor and cingulate cortices (Fig 13) were myelinated, but most graft-derived axons were unmyelinated. Oligodendrocytes differentiating from the hNP graft did not migrate far away from the transplant site (S9 Fig), suggesting that the myelination of transplant-derived axons in terminal fields could not be attributed to these fellow oligodendrocytes. Indeed, in host cortex, we found SC121- oligodendrocytes contacting human axons with classical ensheathing configurations (Fig 14). Inside transplants or at their border, double labeling with MBP and SC121 occasionally showed punctate SC121 immunostaining in myelin sheaths, although most sheaths were SC121 negative. At the transplant border, occasional SC121+ oligodendrocytes were seen to contact transplant-derived axons, although some contacted axons were SC121 negative (S10 Fig).
Fig. 10. Differentiation of hChR2-hNP transplants in rat motor cortex and patterns of innervation of host neurons. Fig. 11. Partial characterization of neurotransmitter identity of differentiated hChR2-hNP transplants and their terminals in host brain. (A-B) These are dually immunostained preparations for YFP (hChR2 marker to label the transplant and transplant-derived structures) and either vGAT, a presynaptic marker of GABAergic neurotransmission (A) or vGLUT1, a presynaptic marker of glutamatergic neurotransmission (B). Color panels show both transplant and neurotransmission marker immunoreactivities, whereas black and white panels underneath the color ones illustrate transplant and neurotransmitter markers separately. Note the dense GABAergic neurotransmission in the graft (orange neuropil in A) as contrasted with the very low glutamate marker immunoreactivity (B). (C-E´) Representative images illustrating the GABAergic or glutamatergic differentiation of transplant-derived human synaptophysin+ (hSYP+) terminals in rat motor cortex. Differentiation was assessed with IHC for GABAergic markers such as vGAT (C-C´) or GAD1 (D-D´) and glutamatergic markers such as a mixture of antibodies for vGLUT 1 and 2 (vGLUT) (E-E´). Images in C-C´ are taken at a lower magnification than D-E´. There are multiple vGAT+ or GAD1+ transplant-derived hSYP+ terminals (yellow color), most of them on non-identifiable host structures, probably dendrites (asterisks in C-C´) but quite a few also on somata (double asterisk on C´ as part of a basket-type GABAergic innervation of a rat cortical neuron; arrows on D-D´). At the contrary, we were not able to find any colocalization of vGLUT in hSYP+ terminals (D-D´); even when there is double labeling as in E´, the relationship is that of juxtaposition, not colocalization. Asterisks on E-E´ are unlabeled rat (host) structures, probably dendrites. Scale bars: A-B, 100μm; C-E, 10μm. Fig. 12. Myelinated human axons in dually immunostained preparations with YFP antibodies (for hChR2+ axons) MBP (for myelin) through the border of a transplant. Single optical sections are taken with a confocal microscope. Human ChR2-hNP-derived axons are in green and myelin in red. At least a third of these axons is myelinated. Inset on top right is a 3D rendition of profile 1 in main frame from z-stack. Insets on bottom left are optical sections of profiles 3–5. Note the non-continuous myelination in the form of serial MBP+ “cuffs”. Graft is on the left. Rat corpus callosum is on top right. Scale bar: 10μm. Fig. 13. Myelinated human axons deeply into host cortex. Fig. 14. An example of ensheathing-type contacts made between a transplant-derived axon and several host-derived (rat) oligodendrocytic processes in host cingulate cortex. Maximum projection confocal image was captured from a section triply immunostained for YFP for transplant-derived axons (green), CNPase for oligodendrocytes (red) and SC121 for transplant-derived cells (white). (Top panel). Although four oligodendrocyte cell bodies are identified (asterisks), it appears that many of the contacts are made by the centrally located cell. None of the red oligodendrocyte profiles was double labeled with SC121, indication that they were of host origin (the lack of SC121 immunostaining of the central profile is shown in inset, against the SC121 immunoreactivity of the human axon). For the sake of conveying a sharper color, white was omitted from the panel. Examples of ensheathing contacts are indicated with numbers 1–4. (Bottom panels). Here we performed 3D reconstructions of ensheathing profiles 1–4 to show the detailed configuration of the human axon and the host oligodendrocytic processes enveloping it. Ensheathing profile 3 has unusual morphology, but this may be related to the immaturity of the process. Scale bars: Top panel, 20 μm; insets, 5μm; bottom panels, 1μm. Optical stimulation experiments: responses of hChR2-hNP-derived neurons to light
Before starting optogenetic stimulation experiments with hChR2+ neurons, we first ensured that CHR2 expression did not affect their neuronal properties. We found that membrane input resistance, AP firing rate, AP threshold and AP half width, were not statistically different between cells with and without CHR2 expression (S3C and S3D Fig), suggesting that ChR2 expression does not affect the electrical properties of hNP-derived neurons.
For optical stimulation, hChR2-expressing neurons were exposed to 10-pulse stimulations with 485 nm light, 5 ms each, at different pulse rates. Ten-pulse protocols were applied 5 times, every 4 seconds, and responses were averaged for analysis. In voltage clamp, such pulse trains activated inward currents at every individual stimulus, however, the inward current amplitude decreased during the 10-pulse stimulation, more prominently at higher stimulation rates (Fig 15A–15C). In voltage clamp, light-activated inward currents were not affected by TTX (n = 3, data not shown), assuring that these currents were caused by ChR stimulation. In current clamp, pulse trains activated TTX-sensitive APs (Fig 15D–15F). The AP amplitude decreased during 10-pulse stimulation, more prominently at higher stimulation rates. Additionally, at higher stimulation rates, the success rate of AP activation was reduced (Fig 15F–15G), as indicated by arrows in Fig 15F. To test the efficiency of a single long pulse compared to pulsed stimulation, a 2.5 s long light pulse was applied (Fig 15H and 15I). Compared to spontaneous firing before optical stimulation, single pulse stimulation increased AP firing rates significantly, about 5-fold (Fig 15I). However, during stimulation, AP amplitudes decreased to ~ 60%, and firing rates adapted.
Fig. 15. Electrophysiological recordings and optogenetic light stimulation of hChR2-hNP-derived neurons differentiated in vitro. (A-C) Representative voltage clamp traces in response to blue light stimulation (485 nm) at 5 Hz (A), 10 Hz (B) and 20 Hz (C) obtained in hChR2-hNP-derived neurons. The amplitude of the 1st pulse response was similar at each tested stimulation rate (for example, 269.8 ± 42.2 pA at 5 Hz). However, response amplitudes decreased during the 10-pulse stimulation, by a total of 29–36% (from 1st to 10th pulse), with an increasing level of adaptation at higher stimulation rates (asterisks). (D-F) Representative current clamp traces in response to a train of light stimulation at 5 Hz (D), 10 Hz (E) and 20 Hz (F). Before light exposure, the membrane potential was preset to -55 mV by current injection. When TTX is added to the extracellular solution AP generation is blocked (E´). (G) Comparison of spiking fidelity in response to different rates of 10-pulse optogenetic stimulations. (H) During a single 2.5s-long light stimulation, the AP firing rate initially increases and then adapts. (I) During a 2.5 s-long single light stimulation (+light), AP firing rate significantly increased from 0.7 ± 0.2/s (-light) to 3.6 ± 0.6/s (n = 10; p < 0.001, paired t-test). These data show that optogenetic train stimulation efficiently induces AP firing in hChR2+ neurons, and that train stimulation at higher rates and with longer pulses may become less effective.
Optical stimulation experiments: light activation of hChR2-hNP-derived neurons drive postsynaptic activity in vitro
Next, we investigated whether light activation of hChR2+ neurons can drive postsynaptic activity in co-cultured hChR2- neurons. Human ChR2+ neurons were stimulated with a 10s blue light pulse while recording from a co-cultured hChR2- neurons (Fig 16A and 16B). Fourteen % of recorded cells (8/56) displayed an increased rate of postsynaptic events in response to light stimulation (Fig 16B and 16C). From a spontaneous rate of 2.2 ± 2.4 events per second, during light stimulation, the rate of postsynaptic events increased about 4-fold, to 8.9 ± 8.4 events per second (n = 8; p < 0.05, paired t-test) (Fig 16C, black lines). The combined application of CNQX and Bicuculline reversibly blocked both spontaneous and light stimulated synaptic activity (Fig 16B), suggesting that the light stimulated events were generated by light stimulation of the presynaptic hChR2+ neurons. Additionally, recordings with light stimulation were also performed directly from hChR2+ neurons. As expected, these cells responded with an inward ChR2 current directly to the light stimulation, as shown in the previous figure (Fig 15A). In 18% of the hChR2+ neurons (3/16), from a spontaneous rate of 1.6 ± 0.6 events/s, during light stimulation, the rate of postsynaptic events increased about 4-fold, to 6.0 ± 0.5 events/s (n = 3) (Fig 16C, green lines). Again, postsynaptic events were abolished by application of CNQX/Bicuculline (data not shown).
Fig. 16. Light stimulation of hChR2-hNP-derived neurons triggers postsynaptic events in ChR2- and ChR2+ neurons. (A) Confocal image showing ChR2+ neurons (green) in co-culture with ChR2- neurons after 119 days in vitro. (B) Example of a voltage clamp recording from a ChR2- neurons in co-culture with ChR2+ neurons; same cell as shown to be recorded in A. In response to light stimulation (blue bar), a slow inward current and synaptic events were triggered in control conditions (top trace). Inset shows an extended time scale of the recording time. The postsynaptic responses were blocked by the presence of CNQX and bicuculine suggesting that they were due to light stimulation of presynaptic hChR2+ neurons. (C) Synaptic rate before and during light stimulation plotted for individual recordings of ChR2- neurons (n = 8) and ChR2+ neurons (n = 3). Solid black squares represent mean of combined ChR2- and ChR2+ neurons, respectively (mean ± SD). For ChR2- neurons, the synaptic rate increased about 4-fold during light stimulation, from 2.2 ± 2.4 to 8.9 ± 8.4 events/s (n = 8; p < 0.05, paired t-test). In vivo stimulation of transplants in rats was inconclusive. When we stimulated these transplants with light pulses of 20 Hz for 15 minutes using a custom LED device 1 mm distance from the surface of the brain right above the exposed transplantation site and analyzed tissues through the level of the transplant for c-FOS immunoreactivity one hour later, results were mixed. The expression of c-FOS in transplants was variable and did not allow the detection of an obvious effect of light stimulation in the host. For example, we saw non-stimulated transplants with high c-FOS immunoreactivity and stimulated transplants with no c-FOS immunoreactivity (S11–S13 Figs). Upon closer look we found that, in stimulated transplants, immunoreactive nuclei were uncommon in areas with dense synaptic activity (S14 Fig), a finding consistent with local inhibitory neurotransmission.
Overall, these results suggest that optical stimulation of hChR2+ neurons in vitro can evoke postsynaptic events in co-cultured hChR2- and hChR2+ neurons via established functional synapses.
Discussion
The present study demonstrates the successful generation of optogenetically competent hNPs suitable for transplantation, the stable expression of the optogene down to their neuronal progenies, and the responsivity of such progenies to light. With the method we employed here, hNPs were transduced at an advanced stage of differentiation, a strategy ensuring sustained transduction through the course of the neural lineage and the future expression of hChR2 and reporter (YFP) transgenes under synapsin promoter. These optogenetically competent hNPs were fully differentiable into mature, light-responsive neurons, with both excitatory and inhibitory phenotypes in vitro but evolved predominantly into inhibitory GABAergic profiles after grafting in vivo, where they established dense terminal fields. Human ChR2-hNP derived neurons were able to generate postsynaptic responses in vitro, although demonstrating such effects in vivo is technically challenging and would require additional efforts.
Since optogenetics have been introduced as a methodology in the neurosciences in 2005 [38], a variety of neural cells have been transduced by lentivirus or AAV and then transplanted into animal models for the purpose of exploring connectivity and function or correcting disease-related phenotypes. Examples include ES - and IPS-cell-derived NSCs, NPs or neurons from human [16, 39–46] or mouse [47, 48], and neurons directly converted from fibroblasts [49]. In the majority of these studies, outcomes of interest (especially physiological) were assessed on ex vivo slices [39, 41–46, 48, 49], although a few studies attempted to examine select structural and functional outcomes in vivo [16, 39–41, 47]. These in vivo studies involved transplantation in models of disease including temporal lobe epilepsy (TLE), peripheral paralysis and stroke [16, 41, 47], but some work explored the formation of connections [40]. Compared to our experiments here, Byers and colleagues used iPSCs for ChR2-YFP transduction and FACS-sorted ChR2-YFP-iPSCs were differentiated to NSCs which they allowed to differentiate for close to a year after graft in the striatum of female nude rats [40]. Although only 15% of grafted ChR2+ NPs differentiated into neurons and terminal fields were sparse in their hands, they found fMRI responses to light stimulation both locally (striatum) and distally (apparently not consistent with the known projections of the rat striatum) [40]. These problems may suggest epigenetic modification and silencing of ChR2-YFP expression in the process of differentiation from ES cells to NPs. Altogether, testing optogenetic efficiency in vivo has been extremely difficult and our unsuccessful in vivo efforts summarized four paragraphs below bear testament to the difficulty of the task.
One of the challenges in this study was our difficulty in generating stable, optogenetically competent hNP cell lines by cloning at the hES stage because of problems with gene expression. This problem is consistent with the experience of Weick and colleagues who found that the expression of ChR2 transgene in their ChR2-hESC line was low and ChR2-mediated currents were relatively small at 12 weeks in vitro compared to transiently transduced NPs [45]. In further communication with the authors, we learned that ChR2 expression using this line was unreliable, possibly because of dilution of expression during expansion of hES cells and epigenetic modification during neural differentiation (Zhang SC, personal communication). The paucity of studies where investigators employed clonal optogenetically competent cell lines [40, 44, 45] and apparent challenges with differentiation and integration after transplantation may be an indication of problems with stable gene expression over successive generations of cells. Here, these challenges were obviated by employing transduction at a later stage (hNP stage). In the future, this problem may be resolved by knock-in gene editing of ES cells by CRISPR to target the optogene to specific DNA location and minimize gene silencing. Another issue is the determination of the hNP stage at which transplantation will reliably result in the desired neuronal outcome. In the present study this was not such a big problem but, as we have indicated in our previous work [5], non-clonal hNPs are best monitored with immunophenotyping by flow cytometry in order to establish a stage in culture that maximizes differentiation efficiency in vivo. For example, relatively late hNPs with TnTx+nestin+ phenotype, but not earlier ones with CD15+TnTx- signatures, are more likely to generate predominantly neuronal transplants [5].
Human NPs generated in this paper were cued into a forebrain fate choice because of the anticipated transplantation into cortical sites. Regardless of the genuine “forebrain” signature of thus generated neurons, hChR2-hNP-generated nerve cells express both excitatory and inhibitory neurotransmitter markers that render them extremely useful as tools to ascertain the functionality of in vivo generated circuits after transplantation. Our in vitro experiments show that hChR2+ neurons can be activated by light but still display some immature features, as indicated by their depolarized resting membrane potential. This can be partially explained by the fact that electrophysiological recordings have been performed at room temperature, where kinetics and conductances of ion channels are reduced compared to body temperature, rendering neurons less excitable [50, 51]. This condition may explain why the success rate of AP activation is significantly reduced during light train stimulation above 10 Hz. Our in vitro experiments also show that light stimulation of hChR2-hNP-derived neurons can generate synaptic activity in neighboring non-ChR2 hNP cells, providing evidence that hNP-derived neurons establish functional synaptic connections with other neurons in culture. Upon light stimulation, we found both glutamatergic and GABAergic postsynaptic activity. These results are consistent with previous ex vivo work on slices prepared from brains transplanted with ChR2-engineered hNPs showing the generation of both excitatory and inhibitory post-synaptic currents in ChR2- neurons after light stimulation [45, 52, 53].
Our in vivo findings in mice indicate a prodigious differentiation of hChR2-hNPs into neuronal cells, with less of a presence of astrocytes, oligodendrocytes or other cells, at least at 2–4 months post-transplantation. At this time point, there are still mitotic neuroepithelial profiles at the transplantation site and about a fifth of cells still undergo mitotic divisions. Indeed, it appears that most hChR2-hNP transplant-derived cells that do not express neuronal markers are dividing neuroepithelial cells. It is possible that such dividing progenitors may give rise to non-neuronal cells at later time points and it is highly likely that they are plastic enough to generate non-neuronal cells, e.g. astrocytes, if injected into white matter, as we have seen previously. Continued mitotic activity and ongoing expansion of the transplant was also observed in our previous work in the brain and spinal cord [5, 10] at 3 months, but subsided at 6 months. Based on this earlier work, early neuronal differentiation to a TUJ1+ phenotype was achieved by 3 months [5, 10], a pattern consistent with the high rates of neuronal profiles encountered in the present study. Although pathfinding of newly generated axons along callosal trajectories has been observed in the case of hNP transplants in cortex [36, 54], a very interesting finding in our experiments in mice featured by deeper cortical grafts is the consistent exit of axons tracking in the corpus callosum at the level of the external capsule into the territory of claustrum and the endopiriform area when the hNPs were transplanted in and around the corpus callosum. Such axons seem to establish synaptic fields in the claustrum, but they continue to pathfind and distribute terminals, seemingly lateral - or caudal-ward in piriform and insular regions. The presence or absence of the ChR2 transgene or experimental history (naïve versus TBI) did not appear to play significant roles in the pathfinding profile of transplanted cells. In concert, preparing hNPs in the way described here is very effective in biasing these cells to early neuronal fates with pathfinding and synapse-forming capabilities within cortical-limbic circuitries, though it is possible that remaining populations of dividing neuroepithelial cells may give rise to non-neuronal cells at later time points.
In rats, perhaps due to the longer time of graft maturation (9 instead of 2–4 months), transplants were generally more differentiated, with very few neuroepithelial formations. Using smaller numbers of cells typically helps with tumorigenicity in long-term survival animals according to our previous investigation [5] but here we opted for higher numbers because it was the first time with this cell preparation and our primary goal was to ensure survival. Neuronal differentiation was remarkable. However, there were places with adipocytic differentiation more superficially, where grafting was in close proximity to the pia, and there were patches of astrocytic and some oligodendrocytic differentiation associated with the neuronal components of the transplants. Terminal fields were established primarily in the adjacent motor and cingulate cortices, a pattern that is different than grafts in mice and may correspond to the more superficial location of the rat grafts away from the corpus callosum. This is most probably a site-specific rather than a species-specific diversion, since grafts injected deeply in rat neocortex are known to also enter the corpus callosum and form terminal fields in the claustrum and adjacent areas [40]. We also found that some large axons near the graft and smaller axons at the terminal fields were myelinated, in part by host oligodendrocytes. The latter serves as yet another indication of integration of transplant-derived axons with host tissue (rat neocortex). Although some graft-derived Olig2+ oligodendrocytes were seen to contact both human and some host axons at the border of the graft, this was a rather rare phenomenon, perhaps because hNPs used for grafting here were cued to neuronal fates and any oligodendrocytes derived from such grafts might have been at a relatively immature state of differentiation. Our observation that, in contrast to the host, we rarely found human CNPase+ oligodendrocytes in transplants, is also supportive of the latter idea.
Neurons in ChR2-hNP transplants are predominantly GABAergic. The differentiation of NP grafts in important ways recapitulates neural development and GABA is the earliest neurotransmitter in CNS development, especially cortex, with widely ranging effects from progenitor proliferation to the migration and maturation of newborn neurons [55]. The fact that ChR2-hNPs were cued to forebrain/cortical fates may have contributed to this phenotypic outcome which is also consistent with previous work from our lab showing that human NSC-derived neurons may have a generic propensity to develop GABAergic phenotypes in vivo [7, 10]. The subtype of GABAergic neurons into which ChR2-hNPs differentiate is an important issue that is beyond the scope of this paper.
At least based on c-FOS induction in transplant as well as host cortical neurons, the effects of optical stimulation were inconclusive. The predominantly inhibitory differentiation of hChR2 may be partially to blame: turning on GABAergic neurons obviously inhibits downstream neuronal targets and the extensive connections between interneurons and projection neurons within the cortical circuity but also the extensive interconnectivity between differentiated neurons within the transplant itself may have caused complex transsynaptic effects leading to downstream inhibition as well as excitation. Other challenges include the degree to which the light penetrated enough into the transplant to stimulate an adequate number of hChR2+ neurons and the potential subthreshold input of transplant-derived neurons on individual cortical neurons of the host. On the other hand, we found that a consistent response to optogenetic stimulation was increase in respiratory rate (Ziogas NK and Sima R, personal observations). This anecdotal observation may be related to the dense terminal fields of differentiated grafts in cingulate cortex, a paralimbic cortical region who has well known associations with breathing and respiratory drive [56–59]. Based on the survey of our material, we hypothesize that there are at least three types of c-FOS immunoreactivity inside the transplants: first, the primarily stimulated hChR2+ neurons that do not happen to be inhibited by concomitantly stimulated, differentiated neighbors; second, hChR2+ or hChR2- cells innervated by inhibitory neurons that are themselves inhibited within local GABAergic circuits that abound in densely differentiated portions of transplants; third, immature cells with persisting mitotic activity in which c-FOS is activated in a tonic fashion that has nothing to do with light stimulation. This level of complexity makes the use of optogenetically endowed grafts as physiological means to modulate CNS circuits extremely difficult at this stage. One solution might be to use smaller grafts, for example with 30,000 hNPs or less [5] and place them within clearly defined pathways with relatively simple neurotransmitter signatures, for example in the putamen or globus pallidus in order to modulate cortico-striato-thalamic activity in models of movement disorders.
Despite challenges in characterizing optical stimulation effects in vivo, these experiments show that we now possess the basic methods to test the functional integration of neural stem cells of various origins into host neural systems with optogenetics. Experiments in vitro and ex vivo have been more successful than in vivo work. Still, showing that we can drive neural systems and affect function or behavior in vivo would be critical prior to considering potential clinical applications. Such applications may come in various forms, including novel neuromodulatory treatments with optogenetically drivable, strategically placed transplants which could modulate host neural circuits at the millisecond scale. Our work is generally supportive of this potential and also points to specific challenges and problems that would need to be tackled in the immediate future.
Supporting information
S1 Fig [tif]
Genomic DNA PCR amplification of hChR2 and YFP segments of H9 pLenti-EYFP-hChR2 clones.S2 Fig [tif]
Co-localization of mature neuronal markers with hChR2-YFP in hChR2-hNP-derived neurons co-cultured with astrocytes.S3 Fig [a]
ChR2 expression in hChR2-hNP-derived neurons does not change their biophysical properties.S4 Fig [a]
Further support for hChR2-hNP transplant differentiation in rat motor cortex.S5 Fig [1]
Detail of terminal field of hChR2-hNP-derived neurons (located in the transplant) in cingulate cortex.S6 Fig [a]
Phenotypic disposition of hChR2-hNP transplant with respect to inhibitory (GABA) or excitatory (glutamate) neurotransmission.S7 Fig [tif]
Colocalization of a marker of GABAergic terminals, vGAT, in transplant-derived hSYP terminals in rat motor cortex.S9 Fig [human]
Triply immunostained preparations with various combinations of antibodies against YFP (for hChR2 axons), MBP (for myelin), Olig2 (for oligodendrocytes) and SC121 (for human graft identity) through the border of a transplant or through the adjacent motor cortex.S10 Fig [green]
A triply immunostained preparation with antibodies against YFP (for hChR2 axons), MBP (for myelin) and SC121 (for human graft identity) through the border of a transplant.S11 Fig [red]
An example of c-FOS activity in a stimulated hChR2-hNP transplant (Case R3): This is a c-FOS active graft, with uneven differentiation, one hour after stimulation.S12 Fig [red]
Another examples of c-FOS activity in a stimulated hChR2-hNP transplant (Case R4): This is a c-FOS inactive graft, with very good homogeneous differentiation, one hour after stimulation.S13 Fig [tif]
An example of c-FOS activity in an unstimulated hChR2-hNP transplants (Case R5): This is a c-FOS active graft, with uneven differentiation.S1 Table [pdf]
Primers used for genomic DNA PCR to detect integrated channelrhodopsin (ChR2) and YFP genes.S2 Table [docx]
Antibodies used in research related to this paper.
Zdroje
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- The role of stigma in the acceptance and disclosure of HIV among recently diagnosed men who have sex with men in Australia: A qualitative study
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- The mutational landscape of quinolone resistance in Escherichia coli
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- Development of a novel automatable fabrication method based on electrospinning co electrospraying for rotator cuff augmentation patches
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- Respiratory health and inflammatory markers - Exposure to respirable dust and quartz and chemical binders in Swedish iron foundries
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- Bioinformatic analysis of a novel Echinococcus granulosus nuclear receptor with two DNA binding domains
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- Involvement of extracellular vesicles in the macrophage-tumor cell communication in head and neck squamous cell carcinoma
- Comparison of Humphrey Field Analyzer and imo visual field test results in patients with glaucoma and pseudo-fixation loss
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- The clinicopathological significance of Thrombospondin-4 expression in the tumor microenvironment of gastric cancer
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- Effects of Debaryomyces hansenii treatment on intestinal mucosa microecology in mice with antibiotic-associated diarrhea
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- Evolution of high tooth replacement rates in theropod dinosaurs
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- Investigating reindeer pastoralism and exploitation of high mountain zones in northern Mongolia through ice patch archaeology
- Diversity pattern of Plasmodium knowlesi merozoite surface protein 4 (MSP4) in natural population of Malaysia
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- “What gets measured better gets done better”: The landscape of validation of global maternal and newborn health indicators through key informant interviews
- Contactless monitoring of heart and respiratory rate in anesthetized pigs using infrared thermography
- Molecular characterisation of genital human papillomavirus among women in Southwestern, Nigeria
- The impact of “male clinics” on health-seeking behaviors of adult men in rural Kenya
- Gene expression microarray public dataset reanalysis in chronic obstructive pulmonary disease
- Utility of the new cobas HCV test for viral load monitoring during direct-acting antiviral therapy
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- Effects of an incremental theory of personality intervention on the reciprocity between bullying and cyberbullying victimization and perpetration in adolescents
- The clot thickens: Autologous and allogeneic fibrin sealants are mechanically equivalent in an ex vivo model of cartilage repair
- Reproducibility, stability, and accuracy of microbial profiles by fecal sample collection method in three distinct populations
- Cooperation with autonomous machines through culture and emotion
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- A global overview of cassava genetic diversity
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- From waste to food: Optimising the breakdown of oil palm waste to provide substrate for insects farmed as animal feed
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- Comparative efficacy of tenofovir and entecavir in nucleos(t)ide analogue-naive chronic hepatitis B: A systematic review and meta-analysis
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- Evaluation of comprehensive improvement for mild and moderate soil salinization in arid zone
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- Magnitude and associated factors of postpartum depression among women in Nekemte town, East Wollega zone, west Ethiopia, 2019: A community-based study
- Comparison of continuous wave and cold lateral condensation filling techniques in 3D printed simulated C-shape canals instrumented with Reciproc Blue or Hyflex EDM
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- Characterization of two thermophilic cellulases from Talaromyces leycettanus JCM12802 and their synergistic action on cellulose hydrolysis
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- Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson's disease: A systematic review
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- Investigation of biochemical and physiological parameters of the newborn Saiga antelope (Saiga tatarica) in Gansu Province, China
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- Perception of potential harm and benefits of HIV vaccine trial participation: A qualitative study from urban Tanzania
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- Deep brain stimulation restores the glutamatergic and GABAergic synaptic transmission and plasticity to normal levels in kindled rats
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- Cranberry extracts promote growth of Bacteroidaceae and decrease abundance of Enterobacteriaceae in a human gut simulator model
- Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study
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- Optogenetically transduced human ES cell-derived neural progenitors and their neuronal progenies: Phenotypic characterization and responses to optical stimulation
- Ion torrent high throughput mitochondrial genome sequencing (HTMGS)
- Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data
- Acute Influenza A virus outbreak in an enzootic infected sow herd: Impact on viral dynamics, genetic and antigenic variability and effect of maternally derived antibodies and vaccination
- Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon
- Home-cage monitoring ascertains signatures of ictal and interictal behavior in mouse models of generalized seizures
- CRISPR/Cas9 gene editing in the West Nile Virus vector, Culex quinquefasciatus Say
- Genetic susceptibility to angiotensin-converting enzyme-inhibitor induced angioedema: A systematic review and evaluation of methodological approaches
- Proton pump inhibitor use increases the risk of peritonitis in peritoneal dialysis patients
- Comparative distribution of extended-spectrum beta-lactamase–producing Escherichia coli from urine infections and environmental waters
- Sex differences in thigh muscle volumes, sprint performance and mechanical properties in national-level sprinters
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- Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies
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- The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes
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- Affective disorders in the elderly in different European countries: Results from the MentDis_ICF65+ study
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- Maternal stress in Shank3ex4-9 mice increases pup-directed care and alters brain white matter in male offspring
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- Exploiting open source 3D printer architecture for laboratory robotics to automate high-throughput time-lapse imaging for analytical microbiology
- Long non-coding RNAs and latent HIV – A search for novel targets for latency reversal
- Clinical characteristics of neonatal fulminant necrotizing enterocolitis in a tertiary Children's hospital in the last 10 years
- Effects of neuromuscular electrical stimulation training on muscle size in collegiate track and field athletes
- Adaptive fuzzy flow rate control considering multifractal traffic modeling and 5G communications
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- A smart tele-cytology point-of-care platform for oral cancer screening
- Vasopressin SNP pain factors and stress in sickle cell disease
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- Microbial metabolisms in an abyssal ferromanganese crust from the Takuyo-Daigo Seamount as revealed by metagenomics
- Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017
- The impact of short-term machine perfusion on the risk of cancer recurrence after rat liver transplantation with donors after circulatory death
- Proteomic profiling of the thrombin-activated canine platelet secretome (CAPS)
- Blood metal levels and serum testosterone concentrations in male and female children and adolescents: NHANES 2011–2012
- The effects of prolonged single night session of videogaming on sleep and declarative memory
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- Mapping developmental QTL for plant height in soybean [Glycine max (L.) Merr.] using a four-way recombinant inbred line population
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- Positive selection and precipitation effects on the mitochondrial NADH dehydrogenase subunit 6 gene in brown hares (Lepus europaeus) under a phylogeographic perspective
- Evaluation of Minimum Inhibitory Concentrations for 154 Mycoplasma synoviae isolates from Italy collected during 2012-2017
- Enhancement of antibiotics antimicrobial activity due to the silver nanoparticles impact on the cell membrane
- Correction: Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored
- Correction: Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa
- Knowledge-based best of breed approach for automated detection of clinical events based on German free text digital hospital discharge letters
- Importance of thorough tissue and cellular level characterization of targeted drugs in the evaluation of pharmacodynamic effects
- Integrated value-chain and risk assessment of Pig-Related Zoonoses in Ghana
- Failed sperm retrieval from severely oligospermic or non-obstructive azoospermic patients on oocyte retrieval day: Emergent oocyte cryopreservation is a feasible strategy
- Cassava yield traits predicted by genomic selection methods
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- Pig farmers’ willingness to pay for management strategies to reduce aggression between pigs
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- Diagnostic value of ASVS for insulinoma localization: A systematic review and meta-analysis
- Newly educated care managers’ experiences of providing care for persons with stress-related mental disorders in the clinical primary care context
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- An analytical model to minimize the latency in healthcare internet-of-things in fog computing environment
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- Assessment of energy expenditure during high intensity cycling and running using a heart rate and activity monitor in young active adults
- Evaluating rectal swab collection method for gut microbiome analysis in the common marmoset (Callithrix jacchus)
- Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study
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- The calcium sensor OsCBL1 modulates nitrate signaling to regulate seedling growth in rice
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- Mathematical determination of the HIV-1 matrix shell structure and its impact on the biology of HIV-1
- Contingent negative variation during a modified cueing task in simulated driving
- CAMDI interacts with the human memory-associated protein KIBRA and regulates AMPAR cell surface expression and cognition
- Effect of feeding patterns on growth and nutritional status of children aged 0-24 months: A Chinese cohort study
- A fecal sequel: Testing the limits of a genetic assay for bat species identification
- Measuring the impact of chronic conditions and associated multimorbidity on health-related quality of life in the general population in Hong Kong SAR, China: A cross-sectional study
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- Correction: Resistance profile of the HIV-1 maturation inhibitor GSK3532795 in vitro and in a clinical study
- New formulation of the Gompertz equation to describe the kinetics of untreated tumors
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- Minimal genetic differentiation of the malaria vector Nyssorhynchus darlingi associated with forest cover level in Amazonian Brazil
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- A case study of the use of verbal reports for talent identification purposes in soccer: A Messi affair!
- Transgenerational deep sequencing revealed hypermethylation of hippocampal mGluR1 gene with altered mRNA expression of mGluR5 and mGluR3 associated with behavioral changes in Sprague Dawley rats with history of prolonged febrile seizure
- Obesity is associated with an impaired survival in lymphoma patients undergoing autologous stem cell transplantation
- Periodontal disease: Repercussions in pregnant woman and newborn health—A cohort study
- Origins of Chinese reindeer (Rangifer tarandus) based on mitochondrial DNA analyses
- Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis
- How effective are films in inducing positive and negative emotional states? A meta-analysis
- 3D nanostructural characterisation of grain boundaries in atom probe data utilising machine learning methods
- An outbreak of tuberculosis in a middle school in Henan, China: Epidemiology and risk factors
- Initial clinical radiological findings and staging to predict prognosis of primary hepatic angiosarcoma: A retrospective analysis
- A new early Eocene deperetellid tapiroid illuminates the origin of Deperetellidae and the pattern of premolar molarization in Perissodactyla
- Longevity and marginal bone loss of narrow-diameter implants supporting single crowns: A systematic review
- Impact of UVC-sustained recirculating air filtration on airborne bacteria and dust in a pig facility
- Cold-related Florida manatee mortality in relation to air and water temperatures
- Conceptual fluency in inductive reasoning
- Clinical outcomes and treatment patterns among Medicare patients with nonvalvular atrial fibrillation (NVAF) and chronic kidney disease
- Improvements in the learnability of smartphone haptic interfaces for visually impaired users
- Role of the malic enzyme in metabolism of the halotolerant methanotroph Methylotuvimicrobium alcaliphilum 20Z
- Cyclic loading test study on a new cast-in-situ insulated sandwich concrete wall
- Natural compounds as angiogenic enzyme thymidine phosphorylase inhibitors: In vitro biochemical inhibition, mechanistic, and in silico modeling studies
- Analysis of virulence potential of Escherichia coli O145 isolated from cattle feces and hide samples based on whole genome sequencing
- Pre-clinical medical student reflections on implicit bias: Implications for learning and teaching
- Prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients
- Determinants of preterm birth among mothers who gave birth at public hospitals in the Amhara region, Ethiopia: A case-control study
- Real-world evidence of the effectiveness of ombitasvir-paritaprevir/r ± dasabuvir ± ribavirin in patients monoinfected with chronic hepatitis C or coinfected with human immunodeficiency virus-1 in Spain
- Unique transcriptomic landscapes identified in idiopathic spontaneous and infection related preterm births compared to normal term births
- Restrained expansion of the recall germinal center response as biomarker of protection for influenza vaccination in mice
- Arabidopsis TRM5 encodes a nuclear-localised bifunctional tRNA guanine and inosine-N1-methyltransferase that is important for growth
- Achievement of weight loss in patients with overweight during dietetic treatment in primary health care
- Autophagy deficiency exacerbates colitis through excessive oxidative stress and MAPK signaling pathway activation
- The impacts of parity on lung function data (LFD) of healthy females aged 40 years and more issued from an upper middle income country (Algeria): A comparative study
- Reorganization of spatial configurations in visual working memory: A matter of set size?
- Unravelling travellers’ route choice behaviour at full-scale urban network by focusing on representative OD pairs in computer experiments
- Evaluating the higher-order structure of the Profile of Emotional Competence (PEC): Confirmatory factor analysis and Bayesian structural equation modeling
- HIV prevalence and correlated factors among male clients of female sex workers in a border region of China
- Next generation sequencing and RNA-seq characterization of adipose tissue in the Nile crocodile (Crocodylus niloticus) in South Africa: Possible mechanism(s) of pathogenesis and pathophysiology of pansteatitis
- Association between advanced maternal age and maternal and neonatal morbidity: A cross-sectional study on a Spanish population
- Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians
- Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project
- Friends with benefits: The effects of vegetative shading on plant survival in a green roof environment
- Comparison of the fecal, cecal, and mucus microbiome in male and female mice after TNBS-induced colitis
- Identifying candidate diagnostic markers for early stage of non-small cell lung cancer
- Complex alternative splicing of human Endonuclease V mRNA, but evidence for only a single protein isoform
- Correction: KML001 Induces Apoptosis and Autophagic Cell Death in Prostate Cancer Cells via Oxidative Stress Pathway
- Unique developmental trajectories of risk behaviors in adolescence and associated outcomes in young adulthood
- Enhanced fibrinolysis detection in a natural occurring canine model with intracavitary effusions: Comparison and degree of agreement between thromboelastometry and FDPs, D-dimer and fibrinogen concentrations
- Overexpression of Saussurea involucrata dehydrin gene SiDHN promotes cold and drought tolerance in transgenic tomato plants
- Foxtail millet (Setaria italica (L.) P. Beauv) CIPKs are responsive to ABA and abiotic stresses
- Autonomous drone hunter operating by deep learning and all-onboard computations in GPS-denied environments
- Heterogeneity Diffusion Imaging of gliomas: Initial experience and validation
- Frequency cluster formation and slow oscillations in neural populations with plasticity
- DHP23002 as a next generation oral paclitaxel formulation for pancreatic cancer therapy
- Diagnostic accuracy of SOX11 immunohistochemistry in mantle cell lymphoma: A meta-analysis
- Analytical solution to swing equations in power grids
- Pathways to conspiracy: The social and linguistic precursors of involvement in Reddit’s conspiracy theory forum
- Spatiotemporally random and diverse grid cell spike patterns contribute to the transformation of grid cell to place cell in a neural network model
- Empathic concern and personal distress depend on situational but not dispositional factors
- Who is more susceptible to job stressors and resources? Sensory-processing sensitivity as a personal resource and vulnerability factor
- Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
- A substitution mutation in a conserved domain of mammalian acetate-dependent acetyl CoA synthetase 2 results in destabilized protein and impaired HIF-2 signaling
- One step at a time: Physical activity is linked to positive interpretations of ambiguity
- Calreticulin regulates vascular endothelial growth factor-A mRNA stability in gastric cancer cells
- Evaluation of various methods of selection of B. subtilis strains capable of secreting surface-active compounds
- Association between US Pharmacopeia (USP) monograph standards, generic entry and prescription drug costs
- Molecular characterisation of the synovial fluid microbiome in rheumatoid arthritis patients and healthy control subjects
- On sorption hysteresis in wood: Separating hysteresis in cell wall water and capillary water in the full moisture range
- Inbreeding, Allee effects and stochasticity might be sufficient to account for Neanderthal extinction
- Reliability and construct validity of the stepping-forward affordance perception test for fall risk assessment in community-dwelling older adults
- Socioeconomic determinants of nutritional status among ‘Baiga’ tribal children In Balaghat district of Madhya Pradesh: A qualitative study
- Study on characteristics of fire plume in building facade window under lateral blow
- ‘When you talk to someone in a bad way or always put her under pressure, it is actually worse than beating her’: Conceptions and experiences of emotional intimate partner violence in Rwanda and South Africa
- Effects of 6-mercaptopurine in pressure overload induced right heart failure
- The association between haemoglobin levels in the first 20 weeks of pregnancy and pregnancy outcomes
- Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study
- Factors associated with persistently high-cost health care utilization for musculoskeletal pain
- Nitrogen and chlorophyll status determination in durum wheat as influenced by fertilization and soil management: Preliminary results
- Effect of repeated in vivo microCT imaging on the properties of the mouse tibia
- Coupling environment and physiology to predict effects of climate change on the taxonomic and functional diversity of fish assemblages in the Murray-Darling Basin, Australia
- Hematology and plasma biochemistries in the Blanding’s turtle (Emydoidea blandingii) in Lake County, Illinois
- CRISPR-Cas influences the acquisition of antibiotic resistance in Klebsiella pneumoniae
- Phosphorylation-dependent activity-based conformational changes in P21-activated kinase family members and screening of novel ATP competitive inhibitors
- Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis
- Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study
- Imported severe malaria and risk factors for intensive care: A single-centre retrospective analysis
- Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes
- Low-latency single channel real-time neural spike sorting system based on template matching
- Quantifying the scale effect in geospatial big data using semi-variograms
- Paper-and-pencil versus computerized administration mode: Comparison of data quality and risk behavior prevalence estimates in the European school Survey Project on Alcohol and other Drugs (ESPAD)
- Regression adjusted colocalisation colour mapping (RACC): A novel biological visual analysis method for qualitative colocalisation analysis of 3D fluorescence micrographs
- Ostrich eggshell bead diameter in the Holocene: Regional variation with the spread of herding in eastern and southern Africa
- Spatial and temporal variations in female size at maturity of a Southern Rock Lobster (Jasus edwardsii) population: A likely response to climate change
- Inactive USP14 and inactive UCHL5 cause accumulation of distinct ubiquitinated proteins in mammalian cells
- Training rhesus macaques to take daily oral antiretroviral therapy for preclinical evaluation of HIV prevention and treatment strategies
- Left ventricular structural and functional changes in Friedreich ataxia – Relationship with body size, sex, age and genetic severity
- Magnitude and factors associated with anemia among pregnant women attending antenatal care in Bench Maji, Keffa and Sheka zones of public hospitals, Southwest, Ethiopia, 2018: A cross -sectional study
- Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review
- Hydrogen sulphide-induced hypometabolism in human-sized porcine kidneys
- Correction: Comparison of the molecular properties of retinitis pigmentosa P23H and N15S amino acid replacements in rhodopsin
- Retraction: Regulation of gastric smooth muscle contraction via Ca2+-dependent and Ca2+-independent actin polymerization
- Evaluation of neutral oral contrast agents for assessment of the small bowel at abdominal staging CT
- Blood type and breed-associated differences in cell marker expression on equine bone marrow-derived mesenchymal stem cells including major histocompatibility complex class II antigen expression
- Induced abortion and future use of IVF treatment; A nationwide register study
- Psychosocial determinants of sustained maternal functional impairment: Longitudinal findings from a pregnancy-birth cohort study in rural Pakistan
- Measurement of finger joint angle using stretchable carbon nanotube strain sensor
- Determinants of mortality among patients with drug-resistant tuberculosis in northern Nigeria
- Drugs modulating stochastic gene expression affect the erythroid differentiation process
- Efficacy of UB0316, a multi-strain probiotic formulation in patients with type 2 diabetes mellitus: A double blind, randomized, placebo controlled study
- Prognostic value of des-γ-carboxy prothrombin in patients with hepatocellular carcinoma treated with transarterial chemotherapy: A systematic review and meta-analysis
- Avermectin induces the oxidative stress, genotoxicity, and immunological responses in the Chinese Mitten Crab, Eriocheir sinensis
- Antibiotic use in mandarin production (Citrus reticulata Blanco) in major mandarin-producing areas in Thailand: A survey assessment
- Application of CPI cutoff value based on parentage testing of duos and trios typed by four autosomal kits
- Correction: Good and Bad in the Hands of Politicians: Spontaneous Gestures during Positive and Negative Speech
- Adolescents with worse levels of oral health literacy have more cavitated carious lesions
- Effective methods for the inactivation of Francisella tularensis
- Detection of early-stage Alzheimer’s pathology using blood-based autoantibody biomarkers in elderly hip fracture repair patients
- Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease
- Analysis of HER2 genomic binding in breast cancer cells identifies a global role in direct gene regulation
- Population productivity of shovelnose rays: Inferring the potential for recovery
- Correction: Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era
- Effects of tetracycline on myocardial infarct size in obese rats with chemically-induced colitis
- Mineral absorption is an enriched pathway in a brain region of restless legs syndrome patients with reduced MEIS1 expression
- Changes in weight and body composition across five years at university: A prospective observational study
- Adeno-associated virus-mediated expression of human butyrylcholinesterase to treat organophosphate poisoning
- Effects of insulin signaling on mouse taste cell proliferation
- Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya
- TAP: A static analysis model for PHP vulnerabilities based on token and deep learning technology
- Cost-effectiveness of QuantiFERON-TB Gold In-Tube versus tuberculin skin test for diagnosis and treatment of Latent Tuberculosis Infection in primary health care workers in Brazil
- Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial
- Changes over time in creatinine clearance and comparison of emergent adverse events for HIV-positive adults receiving standard doses (300 mg/day) of lamivudine-containing antiretroviral therapy with baseline creatinine clearance of 30–49 vs ≥50 mL/min
- Population dynamics of foxes during restricted-area culling in Britain: Advancing understanding through state-space modelling of culling records
- Impacts of experimental advisory exit speed sign on traffic speeds for freeway exit ramp
- In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium
- Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia
- Delivering genes across the blood-brain barrier: LY6A, a novel cellular receptor for AAV-PHP.B capsids
- Correction: Using remote sensing to detect whale strandings in remote areas: The case of sei whales mass mortality in Chilean Patagonia
- Comparison of the inoculum size effects of antibiotics on IMP-6 β-lactamase-producing Enterobacteriaceae co-harboring plasmid-mediated quinolone resistance genes
- Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma
- Non-invasive in vivo imaging of UCP1 expression in live mice via near-infrared fluorescent protein iRFP720
- Overexpression of pink1 or parkin in indirect flight muscles promotes mitochondrial proteostasis and extends lifespan in Drosophila melanogaster
- Fiber stiffness, pore size and adhesion control migratory phenotype of MDA-MB-231 cells in collagen gels
- Comparison of two experimental ARDS models in pigs using electrical impedance tomography
- Are primary school children attending full-day school still engaged in sports clubs?
- Stroke risks in women with dysmenorrhea by age and stroke subtype
- Changes in patterns of mortality rates and years of life lost due to firearms in the United States, 1999 to 2016: A joinpoint analysis
- In vitro modeling of Batrachochytrium dendrobatidis infection of the amphibian skin
- Development and validation of LC-MS/MS method for imatinib and norimatinib monitoring by finger-prick DBS in gastrointestinal stromal tumor patients
- Correction: Habitat disturbance and the organization of bacterial communities in Neotropical hematophagous arthropods
- Characterisation of early metazoan secretion through associated signal peptidase complex subunits, prohormone convertases and carboxypeptidases of the marine sponge (Amphimedon queenslandica)
- Time trends between 2002 and 2017 in correlates of self-reported sitting time in European adults
- Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis
- Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes
- Correction: Antimicrobial resistance genotypes and phenotypes of Campylobacter jejuni isolated in Italy from humans, birds from wild and urban habitats, and poultry
- Correction: Mental health and quality of life outcomes in family members of patients with chronic critical illness admitted to the intensive care units of two Brazilian hospitals serving the extremes of the socioeconomic spectrum
- Correction: Establishing an infrastructure for collaboration in primate cognition research
- Correction: The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review
- Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting
- Comparison of potential drug-drug interactions with metabolic syndrome medications detected by two databases
- The Polish version of the Cultural Intelligence Scale: Assessment of its reliability and validity among healthcare professionals and medical faculty students
- Selection of optimal reference genes for qRT-PCR analysis of shoot development and graviresponse in prostrate and erect chrysanthemums
- Metastasis risk prediction model in osteosarcoma using metabolic imaging phenotypes: A multivariable radiomics model
- Defining hospital community benefit activities using Delphi technique: A comparison between China and the United States
- Establishment of the experimental procedure for prediction of conjugation capacity in mutant UGT1A1
- A robust multi-objective optimization framework to capture both cellular and intercellular properties in cardiac cellular model tuning: Analyzing different regions of membrane resistance profile in parameter fitting
- Sea star wasting disease demography and etiology in the brooding sea star Leptasterias spp.
- Diagnostic plasma miRNA-profiles for ovarian cancer in patients with pelvic mass
- Genetic diversity and drug resistance of HIV-1 among infected pregnant women newly diagnosed in Luanda, Angola
- I’ve been robbed! – Can changes in floral traits discourage bee pollination?
- Visualising statistical models using dynamic nomograms
- Assessing the capacity of Malawi’s district and central hospitals to manage traumatic diaphyseal femoral fractures in adults
- Diagnostic performance of basal cortisol level at 0900-1300h in adrenal insufficiency
- The Mastery Rubric for Bioinformatics: A tool to support design and evaluation of career-spanning education and training
- Microdissection and whole chromosome painting confirm karyotype transformation in cryptic species of the Lariophagus distinguendus (Förster, 1841) complex (Hymenoptera: Pteromalidae)
- Quality of Kangaroo Mother Care services in Ethiopia: Implications for policy and practice
- Gemcitabine potentiates the anti-tumour effect of radiation on medullary thyroid cancer
- iTRAQ-based high-throughput proteomics analysis reveals alterations of plasma proteins in patients infected with human bocavirus
- The detection of a non-anemophilous plant species using airborne eDNA
- Perception and control of low cable operation forces in voluntary closing body-powered upper-limb prostheses
- Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis
- Randomized methods to characterize large-scale vortical flow networks
- Disentangling the coexistence strategies of mud-daubing wasp species through trophic analysis in oases of Baja California peninsula
- Front-of-pack nutritional labels: Understanding by low- and middle-income Mexican consumers
- Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support
- Pathways to antibiotics in Bangladesh: A qualitative study investigating how and when households access medicine including antibiotics for humans or animals when they are ill
- DOC export is exceeded by C fixation in May Creek: A late-successional watershed of the Copper River Basin, Alaska
- Behavioral observation of prosocial behavior and social initiative is related to preschoolers’ psychopathological symptoms
- Evaluating the impact of citations of articles based on knowledge flow patterns hidden in the citations
- Correction: Economic sanctions and academia: Overlooked impact and long-term consequences
- Correction: A novel association between relaxin receptor polymorphism and hematopoietic stem cell yield after mobilization
- Expression of Concern: Cooperativity of Oncogenic K-Ras and Downregulated p16/INK4A in Human Pancreatic Tumorigenesis
- Price dispersion of generic medications
- Sex differences in body composition but not neuromuscular function following long-term, doxycycline-induced reduction in circulating levels of myostatin in mice
- The emotion regulation effect of cognitive control is related to depressive state through the mediation of rumination: An ERP study
- Comparison of SMS-EPI and 3D-EPI at 7T in an fMRI localizer study with matched spatiotemporal resolution and homogenized excitation profiles
- Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method
- Correction: Combining biophysical parameters, spectral indices and multivariate hyperspectral models for estimating yield and water productivity of spring wheat across different agronomic practices
- Correction: Flowers as viral hot spots: Honey bees (Apis mellifera) unevenly deposit viruses across plant species
- 'Small small quarrels bring about happiness or love in the relationships’: Exploring community perceptions and gendered norms contributing to male perpetrated intimate partner violence in the Central Region of Ghana
- The performance of practitioners conducting facial comparisons on images of children across age
- Increased amounts and stability of telomeric repeat-containing RNA (TERRA) following DNA damage induced by etoposide
- Patients with limitation or withdrawal of life supporting care admitted in a medico-surgical intermediate care unit: Prevalence, description and outcome over a six-month period
- Correction: Diverse radiofrequency sensitivity and radiofrequency effects of mobile or cordless phone near fields exposure in Drosophila melanogaster
- Predicting the performance of TV series through textual and network analysis: The case of Big Bang Theory
- Risk of temperature, humidity and concentrations of air pollutants on the hospitalization of AECOPD
- Mixed methods grant applications in the health sciences: An analysis of reviewer comments
- Renal abnormalities among children with sickle cell conditions in highly resource-limited setting in Ghana
- Size matters: How reaching and vergence movements are influenced by the familiar size of stereoscopically presented objects
- Willingness to receive institutional and community-based eldercare among the rural elderly in China
- An improved deep learning method for predicting DNA-binding proteins based on contextual features in amino acid sequences
- Beyond executive functions, creativity skills benefit academic outcomes: Insights from Montessori education
- A LAMP assay for the rapid and robust assessment of Wolbachia infection in Aedes aegypti under field and laboratory conditions
- Nonarteritic anterior ischemic optic neuropathy is associated with cerebral small vessel disease
- Fiber-tract localized diffusion coefficients highlight patterns of white matter disruption induced by proximity to glioma
- The fight against polio through the NO-DO newsreels during the Francoism period in Spain
- Ocean sound levels in the northeast Pacific recorded from an autonomous underwater glider
- Cost-consequence analysis of influenza vaccination among the staff of a large teaching hospital in Rome, Italy: A pilot study
- The relationship among the progression of inflammation in umbilical cord, fetal inflammatory response, early-onset neonatal sepsis, and chorioamnionitis
- How medical professional students view older people with dementia: Implications for education and practice
- An enhanced nonparametric EWMA sign control chart using sequential mechanism
- Land use change, carbon stocks and tree species diversity in green spaces of a secondary city in Myanmar, Pyin Oo Lwin
- Is there a difference in women’s experiences of care with medication vs. manual vacuum aspiration abortions? Determinants of person-centered care for abortion services
- Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort
- Adsorption of oxytetracycline on kaolinite
- Interdisciplinary stratified care for low back pain: A qualitative study on the acceptability, potential facilitators and barriers to implementation
- The role of resource transfer in positive, non-additive litter decomposition
- The impact of language on the interpretation of resuscitation clinical care plans by doctors. A mixed methods study
- Quantum dots reveal heterogeneous membrane diffusivity and dynamic surface density polarization of dopamine transporter
- Genomic analysis of Shiga toxin-producing Escherichia coli from patients and asymptomatic food handlers in Japan
- The heavy metals lead and cadmium are cytotoxic to human bone osteoblasts via induction of redox stress
- Anatomical, taxonomic, and phylogenetic reappraisal of a poorly known ghost knifefish, Tembeassu marauna (Ostariophysi: Gymnotiformes), using X-ray microcomputed tomography
- Matrix-assisted laser desorption/ionization time of flight mass spectrometry identification of Vibrio (Listonella) anguillarum isolated from sea bass and sea bream
- Recommendations of older adults on how to use the PROM ‘TOPICS-MDS’ in healthcare conversations: A Delphi study
- The winner takes it all—Competitiveness of single nodes in globalized supply networks
- Hamsters in the city: A study on the behaviour of a population of common hamsters (Cricetus cricetus) in urban environment
- Correction: Liquid biopsies for omics-based analysis in sentinel mussels
- Size matters! Association between journal size and longitudinal variability of the Journal Impact Factor
- Drug resistance and epidemiology characteristics of multidrug-resistant tuberculosis patients in 17 provinces of China
- A model-based framework for chronic hepatitis C prevalence estimation
- Adding rewards to regulation: The impacts of watershed conservation on land cover and household wellbeing in Moyobamba, Peru
- Clinical determinants of social media use in individuals with schizophrenia
- Arsenic and nutrient absorption characteristics and antioxidant response in different leaves of two ryegrass (Lolium perenne) species under arsenic stress
- An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi
- A single plasmid based CRISPR interference in Synechocystis 6803 – A proof of concept
- Structural vulnerability to narcotics-driven firearm violence: An ethnographic and epidemiological study of Philadelphia’s Puerto Rican inner-city
- Temporal trends in intracerebral hemorrhage: Evidence from the Austrian Stroke Unit Registry
- Prevalence and risk factors for multi-drug resistant Escherichia coli among poultry workers in the Federal Capital Territory, Abuja, Nigeria
- Prediction of disease-related metabolites using bi-random walks
- Clinical use, efficacy, and durability of maraviroc for antiretroviral therapy in routine care: A European survey
- Biomarker discovery in inflammatory bowel diseases using network-based feature selection
- The Cinderella Complex: Word embeddings reveal gender stereotypes in movies and books
- Exoproteome profiling of Trypanosoma cruzi during amastigogenesis early stages
- Reproducible phenotype alteration due to prolonged cooling of the pupae of Polyommatus icarus butterflies
- Nutritional treatment with an immune-modulating enteral formula alleviates 5-fluorouracil-induced adverse effects in rats
- Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands
- Systematic review of the accuracy of plasma preparation tubes for HIV viral load testing
- Circadian clock regulates the shape and content of dendritic spines in mouse barrel cortex
- “Anybody can make kids; it takes a real man to look after your kids”: Aboriginal men’s discourse on parenting
- Correction: A 1D computer model of the arterial circulation in horses: An important resource for studying global interactions between heart and vessels under normal and pathological conditions
- Maternal interpregnancy weight change and premature birth: Findings from an English population-based cohort study
- Correction: Identifying performance benchmarks and determinants for reproductive performance and calf survival using a longitudinal field study of cow-calf herds in western Canada
- Prognostic value of the model for end-stage liver disease excluding INR score (MELD-XI) in patients with adult congenital heart disease
- Treatment of Urethral Pain Syndrome (UPS) in Sweden
- Migration and political polarization in the U.S.: An analysis of the county-level migration network
- Epidemiology and complications of late-onset sepsis: an Italian area-based study
- The relationship between women’s experience of intimate partner violence and other socio-demographic factors, and under-5 children’s health in South Africa
- Association between trunk and gluteus muscle size and long jump performance
- Multimorbidity and complex multimorbidity in Brazilian rural workers
- Correction: Interspecific Phylogenic Relationships within Genus Melilotus Based on Nuclear and Chloroplast DNA
- Insulin-like growth factor (IGF)-II- mediated fibrosis in pathogenic lung conditions
- Wolf diet and prey selection in the South-Eastern Carpathian Mountains, Romania
- In vitro activity of aryl-thiazole derivatives against Schistosoma mansoni schistosomula and adult worms
- Sample size issues in multilevel logistic regression models
- Seed germination ecology of Ageratum houstonianum: A major invasive weed in Nepal
- Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting
- Pharmacologic management of HCV treatment in patients with HCV monoinfection vs. HIV/HCV coinfection: Does coinfection really matter?
- The association between cigarette smoking and serum thyroid stimulating hormone, thyroid peroxidase antibodies and thyroglobulin antibodies levels in Chinese residents: A cross-sectional study in 10 cities
- Mouse movement measures enhance the stop-signal task in adult ADHD assessment
- Ecosystem functioning in urban grasslands: The role of biodiversity, plant invasions and urbanization
- Correction: KETOS: Clinical decision support and machine learning as a service – A training and deployment platform based on Docker, OMOP-CDM, and FHIR Web Services
- Does craniofacial morphology affect third molars impaction? Results from a population-based study in northeastern Germany
- Hyperconnectivity during screen-based stories listening is associated with lower narrative comprehension in preschool children exposed to screens vs dialogic reading: An EEG study
- Weight loss is associated with improved quality of life among rural women completers of a web-based lifestyle intervention
- Long-term high-grain diet altered the ruminal pH, fermentation, and composition and functions of the rumen bacterial community, leading to enhanced lactic acid production in Japanese Black beef cattle during fattening
- Beyond detoxification: Pleiotropic functions of multiple glutathione S-transferase isoforms protect mice against a toxic electrophile
- Golgi reassembly and stacking protein 65 downregulation is required for the anti-cancer effect of dihydromyricetin on human ovarian cancer cells
- SSR marker development in Clerodendrum trichotomum using transcriptome sequencing
- Risk factors for the carriage of Streptococcus infantarius subspecies infantarius isolated from African fermented dairy products
- Development of an intervention tool for precision oral self-care: Personalized and evidence-based practice for patients with periodontal disease
- Personal values in adolescence and psychological distress in adults: A cross-sectional study based on a retrospective recall
- Overactive bladder and bladder pain syndrome/interstitial cystitis in primary Sjögren’s syndrome patients: A nationwide population-based study
- Clinical utility of combined preimplantation genetic testing methods in couples at risk of passing on beta thalassemia/hemoglobin E disease: A retrospective review from a single center
- Hip stress distribution - Predictor of dislocation in hip arthroplasties. A retrospective study of 149 arthroplasties
- Mortality, morbidity, and cardiac surgery in Injection Drug Use (IDU)-associated versus non-IDU infective endocarditis: The need to expand substance use disorder treatment and harm reduction services
- Pup mortality in New Zealand sea lions (Phocarctos hookeri) at Enderby Island, Auckland Islands, 2013-18
- In vitro endothelial cell migration from limbal edge-modified Quarter-DMEK grafts
- Liquid Chromatography/Mass Spectrometry based serum metabolomics study on recurrent abortion women with antiphospholipid syndrome
- Gut carriage of antimicrobial resistance genes among young children in urban Maputo, Mozambique: Associations with enteric pathogen carriage and environmental risk factors
- Prepubertal nutrition alters Leydig cell functional capacity and timing of puberty
- Reliability of the Swedish version of the Evidence-Based Practice Attitude Scale assessing physiotherapist’s attitudes to implementation of evidence-based practice
- Mitochondrial alarmins are tissue mediators of ventilator-induced lung injury and ARDS
- Complete Chloroplast Genomes of Vachellia nilotica and Senegalia senegal: Comparative Genomics and Phylogenomic Placement in a New Generic System
- Retraction: Over-Expression of Superoxide Dismutase Ameliorates Cr(VI) Induced Adverse Effects via Modulating Cellular Immune System of Drosophila melanogaster
- Effect of pre-season training phase on anthropometric, hormonal and fitness parameters in young soccer players
- Exosomes from conditioned media of bone marrow-derived mesenchymal stem cells promote bone regeneration by enhancing angiogenesis
- Outcome of patients with heart failure after transcatheter aortic valve implantation
- Fatty acid profile of Romanian’s common bean (Phaseolus vulgaris L.) lipid fractions and their complexation ability by β-cyclodextrin
- Appropriate empirical antibiotic therapy and mortality: Conflicting data explained by residual confounding
- Treatment of corneal endothelial damage in a rabbit model with a bioengineered graft using human decellularized corneal lamina and cultured human corneal endothelium
- Telbivudine on IgG-associated hypergammaglobulinemia and TGF-β1 hyperactivity in hepatitis B virus-related liver cirrhosis
- Correction: Axial variation of deoxyhemoglobin density as a source of the low-frequency time lag structure in blood oxygenation level-dependent signals
- Correction: Mobile health-based physical activity intervention for individuals with spinal cord injury in the community: A pilot study
- Retraction: Placental expression of CD100, CD72 and CD45 is dysregulated in human miscarriage
- Correction: Use of IoT sensing and occupant surveys for determining the resilience of buildings to forest fire generated PM2.5
- Correction: The modulation of facial mimicry by attachment tendencies and their underlying affiliation motives in 3-year-olds: An EMG study
- Correction: Cognitive impairment in multiple sclerosis: An exploratory analysis of environmental and lifestyle risk factors
- Discovering novel disease comorbidities using electronic medical records
- Glutathione contributes to efficient post-Golgi trafficking of incoming HPV16 genome
- Epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus isolates colonizing pigs with different exposure to antibiotics
- Social information use in adolescents: The impact of adults, peers and household composition
- Public practices on antibiotic use: A cross-sectional study among Qatar University students and their family members
- Effects of Topper Training on psychosocial problems, self-esteem, and peer victimisation in Dutch children: A randomised trial
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- Correction: Fast, quantitative, murine cardiac 19F MRI/MRS of PFCE-labeled progenitor stem cells and macrophages at 9.4T
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- Correction: People making deontological judgments in the Trapdoor dilemma are perceived to be more prosocial in economic games than they actually are
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- Correction: An international randomised placebo-controlled trial of a four-component combination pill (“polypill”) in people with raised cardiovascular risk
- Correction: Evaluation of lung toxicity risk with computed tomography ventilation image for thoracic cancer patients
- Retraction: Pathological Roles of Interleukin-22 in the Development of Recurrent Hepatitis C after Liver Transplantation
- Correction: Elevational Distribution and Ecology of Small Mammals on Tanzania's Second Highest Mountain
- Correction: Decreased breast cancer-specific mortality risk in patients with a history of thyroid cancer
- Correction: Fecal microbiota dysbiosis in macaques and humans within a shared environment
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