Understanding how mutations affect diseases such as diabetes

Natália Ružičková Institute of Science and Technology Austria

PhD student Natália Ružičková

Many statistical models and algorithms scientists use can be imagined as a “black box.” These powerful models give accurate predictions, but their internal workings are not easily understood. In an era dominated by deep learning, where an ever-increasing amount of data can be processed, Natália Ružičková, a physicist and PhD student at the Institute of Science and Technology Austria (ISTA), chose to take a step back at least in the context of genomic data analysis.

Ružičková, along with recent ISTA graduate Michal Hledík and Professor Gašper Tkačik, has proposed a model to analyze polygenic diseases—conditions where multiple regions of the genome contribute to dysfunction. This model also aids in understanding the role of these identified genomic regions in developing these diseases. Their research provides valuable findings by integrating advanced genome analysis with fundamental biological insights. The results have been published in the Proceedings of the National Academy of Sciences (PNAS).

Decoding the human genome

In 1990, the Human Genome Project was launched to decode human DNA fully—the genetic blueprint that defines humanity. By 2003, the project was completed, leading to numerous scientific, medical, and technological breakthroughs. By deciphering the human genetic code, scientists aimed to learn more about diseases linked to specific mutations and variations in this genetic map. The human genome comprises approximately 20,000 genes and even more base pairs, which are the letters of the blueprint. This complexity made ample statistical power essential, resulting in the development of “genome-wide association studies” (GWAS).

GWAS approach the issue by identifying genetic variants potentially linked to organismal traits such as height. Notably, they also include the propensity for various diseases. The underlying statistical principle is relatively straightforward: participants are divided into two groups—healthy and sick individuals. Their DNA is then analyzed to detect variations—changes in their genome—that are more prominent in those affected by the disease.  

An interplay of genes

When genome-wide association studies emerged, scientists expected to find just a few mutations in known genes linked to a disease that would explain the difference between healthy and sick individuals. The truth, however, is much more complicated. “Sometimes, hundreds or thousands of mutations are linked to a specific disease,” says Miss Ružičková. “It was a surprising revelation and conflicted with our understanding of biology.”

Each individual mutation contributes only minimally to the risk of developing a disease. However, when combined, these mutations can provide a better—though not complete—understanding of why some individuals develop the disease. Such diseases are known as “polygenic.” For instance, type 2 diabetes is considered polygenic because it cannot be attributed to a single gene; rather, it involves hundreds of mutations. Some of these mutations influence insulin production, insulin action, or glucose metabolism, while many others are found in genomic regions that have not been previously linked to diabetes or have unknown biological functions.

The omnigenic model

In 2017, Evan A. Boyle and colleagues from Stanford University proposed a new conceptual framework called the “omnigenic model.” They proposed an explanation for why so many genes contribute to diseases: cells possess regulatory networks that link genes with diverse functions.

“Since genes are interconnected, a mutation in one gene can impact others, as the mutational effect spreads through the regulatory network,” Ružičková explains. Due to these networks, many genes in the regulatory system contribute to a disease. However, until now, this model has not been formulated mathematically and has remained a conceptual hypothesis that was difficult to test. In their latest paper, Ružičková and her colleagues introduce a new mathematical formalization based on the omnigenic model named the “quantitative omnigenic model” (QOM).

Combining statistics and biology

To demonstrate the new model’s potential, they needed to apply the framework to a well-characterized biological system. They chose the typical lab yeast model Saccharomyces cerevisiae, better known as the brewer’s yeast or the baker’s yeast. It is a single-cell eukaryote, meaning its cell structure is similar to that of complex organisms such as humans. “In yeast, we have a fairly good understanding of how regulatory networks that interconnect genes are structured,” Miss Ružičková says.

Using their model, the scientists predicted gene expression levels—the intensity of gene activity, indicating how much information from the DNA is actively utilized—and how mutations spread through the yeast’s regulatory network. The predictions were highly efficient: The model identified the relevant genes and could clearly pinpoint which mutation most likely contributed to a specific outcome.

The puzzle pieces of polygenic diseases

The scientists’ goal was not to outdo the standard GWAS in prediction performance but rather to go in a different direction by making the model interpretable. Whereas a standard GWAS model works as a “black box,” offering a statistical account of how frequently a particular mutation is linked to a disease, the new model also provides a chain-of-events causal mechanism for how that mutation may lead to disease.

In medicine, understanding the biological context and such causal pathways has huge implications for finding new therapeutic options. Although the model is far from any medical application, it shows potential, especially for learning more about polygenic diseases. “If you have enough knowledge about the regulatory networks, you could also build similar models for other organisms. We looked at the gene expression in yeast, which is just the first step and proof of principle. Now that we understand what is possible, one can start thinking about applications to human genetics,” says Miss Ružičková.

“Human mini-brains” reveal autism biology

“Human mini-brains” reveal autism biology and potential treatments

A cerebral organoid showing rosettes (or whirls) of newly developing and migrating new neurons (shown in purplish-red). Credit Scripps Research

Researchers at Scripps Research have created personalized “mini-brains” (or organoids) from stem cells derived from patients with a rare and severe form of autism spectrum disorder and intellectual disability. These lab-grown organoids have enabled the team to gain deeper insights into how a specific genetic mutation contributes to autism spectrum disorder. Additionally, they found that an experimental drug called NitroSynapsin can reverse some brain dysfunction associated with autism in these models.

“Our research demonstrates how a genetic mutation linked to autism disrupts the normal balance of brain cells during development,” says Stuart A. Lipton, MD, PhD, Step Family Foundation Endowed Professor and co-director of the Neurodegeneration New Medicines Center at Scripps Research. However, we have also found potential ways to address this imbalance later in life.”

Learning from patients

Autism is a neurological and developmental disorder that impacts social interactions and communication and leads to repetitive interests and behaviours. The exact causes of autism are still not fully understood; various genetic variants have been linked to the disorder, but each accounts for only a small percentage of cases. For many years, research on autism has focused on creating models of the disorder in mice or examining isolated human brain cells. However, neither of these methods accurately captures the complexity of an interconnected human brain.

Lipton and his colleagues studied MEF2C haploinsufficiency syndrome (MHS), a rare and severe form of autism and intellectual disability caused by a genetic variation in the MEF2C gene. They isolated skin cells from patients with MHS and applied modern stem cell biology techniques to transform these cells into human stem cells. Subsequently, they grew them into small, millimetre-sized “mini-brain” organoids, allowing the researchers to investigate how the various types of brain cells interact with one another.

“We were able to replicate key features of patients’ brains to study their electrical activity and other properties,” says Lipton. “We even invited children into the lab to see their own mini-brains, which was an emotional experience for both the kids and their families.”

In healthy human brains and brain organoids, neural stem cells develop into nerve cells, or neurons, which communicate messages throughout the brain. They also differentiate into various types of glial cells, which support neurons and play important roles in signalling and immune function. A healthy brain maintains a balance between excitatory neurons, which enhance electrical signalling, and inhibitory neurons, which suppress it. Autism is associated with an imbalance between these types of neurons, often resulting in excessive excitation.

In the organoids created from cells of children with MHS, researchers found that neural stem cells more frequently developed into glial cells, resulting in a higher proportion of glial cells compared to neurons. Notably, the MHS organoids had fewer inhibitory neurons than normal, leading to excessive electrical signaling in these mini-brains, similar to what is observed in many human brains affected by autism.

A role for microRNA

When Lipton’s group probed exactly how MEF2C mutations could lead to this imbalance between cell types, they found nearly 200 genes directly controlled by the MEF2C gene. Three of these genes stood out—rather than encoding DNA that led to messenger (m)RNA and then protein expression, they encoded genes for microRNA molecules.

MicroRNAs (miRNAs) are small RNA molecules that bind to DNA to control gene expression rather than producing proteins themselves. This month, two scientists won the 2024 Nobel Prize in Physiology or Medicine for their work describing the discovery of miRNA molecules and how they can impact cell development and behaviour.

“In our study, a few specific miRNAs appear to be important in telling developing brain cells whether to become glial cells, excitatory neurons, or inhibitory neurons,” says Lipton. “Mutations in MEFC2 alter the expression of these miRNAs which, in turn, prevent the developing brain from making proper nerve cells and proper connections or synapses between nerve cells.”

Lipton’s group found that early-developing brain cells from patients with MHS have lower levels of three specific miRNAs. When the researchers added extra copies of these miRNA molecules to the patient-derived brain organoids, the mini-brains developed more normally, with a standard balance of neurons and glial cells.

A potential treatment

Since autism is generally not diagnosed during fetal brain development, treatments that aim to alter initial development—such as correcting a mutated gene or adding miRNA molecules to stop the imbalance of cell types—are not currently feasible. However, even after development, Lipton was already developing another drug that could help promote the balance between excitatory and inhibitory neurons.

Lipton’s group recently tested a drug they invented and patented called NitroSynapsin (also known as EM-036) for its ability to restore brain connections in “mini-brains” derived from cells affected by Alzheimer’s disease.

In the new paper, they tested whether the drug could also help treat the MHS form of autism. Using the patient-derived brain organoids, Lipton and his colleagues showed that in fully developed brain organoids that had an imbalance between cell types, NitroSynapsin could partially correct the imbalance, preventing the hyperexcitability of the neurons and restoring excitatory/inhibitory balance in the mini-brain. This also protects nerve cell connections or synapses.

More work is needed to show whether the drug improves the symptoms of patients with MHS or influences other types of autism spectrum disorder that are not caused by mutations in the MEF2C gene. Lipton hypothesizes this could be the case since MEF2C is known to influence many other genes associated with autism.

“We are continuing to test this drug in animal models to get it into people soon,” says Lipton. “This is an exciting step in that direction.”

Researchers explore new methods for quantifying chronic pain in women

Measuring pain

Over 70% of chronic pain cases are women. Effective treatment of pain has been hampered by an entirely subjective protocol for measuring pain severity, with variation introduced in patient assessments and physician biases. Credit Arocamora, CC BY-SA 4.0

Chronic pain affects millions of people, with women experiencing more severe and frequent pain than men. Over 70% of chronic pain cases involve women. However, measuring and managing pain remains a complex challenge. There is currently no objective method to quantify pain, which makes it difficult to tailor treatments effectively. Additionally, there are significant variations in how patients experience pain and how physicians respond. A new research initiative aims to address these issues.

Tufts University, in collaboration with external partners, has been selected by the Advanced Research Projects Agency for Health (ARPA-H) as an award recipient for the Sprint for Women’s Health. This initiative aims to develop new technologies for quantitatively measuring pain in patients, to improve care and accelerate the development of new treatments. The team will receive $3.03 million in funding over the next two years.

Various factors, such as inflammation, damaged nerves, or conditions like fibromyalgia, can cause chronic pain. Each of these causes may require a different treatment approach. Regardless of its origin, pain is highly subjective and can be influenced by psychological, social, and other factors. While elite athletes and soldiers often train to tolerate high levels of pain, individual reactions to pain can vary significantly among those who experience it.

Standard practice in assessing pain in the clinical setting is entirely subjective—something most of us have experienced if asked to measure it on a chart using smiling to frowning emoticons.

Subjectivity in assessing pain is not just on the patient’s side. Bias also occurs on the treatment side, with some minority groups being undertreated for managing pain compared to the general population.

“Having an objective, quantitative tool to assess pain will help eliminate subjective variables and provide a more rational basis for treatment,” said Sameer Sonkusale, a professor of electrical and computer engineering at the Tufts School of Engineering and the principal investigator on the project. The project includes collaborators from the Uniformed Services University of Health Sciences (USU), The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), and Northwestern Medicine.

The research team plans to screen more than 30 biomarkers, including stress hormones, inflammation markers, and neurotransmitters in the interstitial fluid that circulates between skin cells. Additionally, they will monitor physiological responses such as fluctuations in heart rate, galvanic skin response, and breathing patterns.

These biomarkers were identified in earlier studies as linked to a patient’s experience of pain, but this is the first effort to create a composite panel of markers to generate a quantitative score for pain.

The biomarker data will be merged with answers to pain questionnaires collected from women at several sites, including the Defense and Veterans Center for Integrative Pain Management and Northwestern Medicine. Shuchin Aeron, an electrical and computer engineering associate professor at Tufts, will apply artificial intelligence and machine learning to combine these factors into an objective and quantitative pain score.

The researchers will narrow the panel to five or more of the most reliable pain-linked biomarkers. These biomarkers can be monitored on a portable, wearable device for clinical site and remote pain assessment. The results would instantly be reported to the physician or the patient on a smartwatch or ring.

The availability of such devices would not only improve pain management. Still, it could also accelerate the development of new drugs and treatments, which could benefit from an objective measure of their effectiveness.

“While pain reporting is subjective and dependent on many extraneous factors, for the same pain level, the measurable physiological markers and signals are expected to be similar from one individual to the next,” said Sonkusale. “Considering an observed gender bias in the prevalence and approach to treatment of chronic pain, this technology addresses a large unmet medical need for women, creating a path to more effective pain management.”

“It has been extremely challenging to objectively quantify nociplastic pain—the type of pain involving nervous system sensitization in conditions like fibromyalgia that are quite common in women. This study could provide a way to objectively quantify pain in a way that will greatly help their treatment,” said Steven P Cohen, Edmond I Eger Professor of Anesthesiology and Pain Medicine at Northwestern Medicine.

Study identifies natural compound to treat MS

Spinal fluid and multiple sclerosis

Scientists have identified a natural compound that halts the process involved in the progression of certain forms of cancer and demyelinating conditions — those that damage the sheath, known as myelin, that surrounds neurons — such as multiple sclerosis.

A study published today in the Journal of Biological Chemistry identified a plant-derived flavonoid known as sulfuretin, which has been found to inhibit the activity of an enzyme associated with multiple sclerosis (MS) and cancer. This discovery was made in cell tests conducted at Oregon Health & Science University. The next step is to evaluate the compound in animal models to determine its effectiveness and any potential side effects in treating cancer and neurodegenerative conditions like MS.

“We think this is a drug that could impact many different areas,” said Larry Sherman, Ph.D., professor in the Division of Neuroscience at OHSU’s Oregon National Primate Research Center.

The researchers found that sulfuretin, along with a pair of synthetic compounds that were also tested in live cells, inhibited the activity of a particular type of enzyme known as a hyaluronidase,  which naturally degrades hyaluronic acid. That’s important because when hyaluronic acid is broken down into fragments, it is known to cause problems in at least two ways:

  • Forestalls myelin repair: It prevents the maturation of oligodendrocytes, which are cells that produce myelin. Myelin is the protective sheath covering each nerve cell’s axon — the threadlike portion of a cell that transmits electrical signals between cells. Damage to myelin is associated with MS, stroke, brain injuries and certain forms of dementia. In addition, delay in myelination can affect infants born prematurely, leading to brain damage or cerebral palsy.
  • Allows cancer cells to proliferate: In cancerous tumours, hyaluronidase activity can allow cancer cells to proliferate unchecked by normal cellular death. “Now we have an inhibitor that could actually stop that,” said Sherman, who is also a professor of cell, developmental and cancer biology in the OHSU School of Medicine.

The new research focuses on inhibiting a specific type of hyaluronidase, known as cell migration-inducing and hyaluronan-binding protein (CEMIP).

In addition to MS and cancer, CEMIP is implicated in a range of disorders, including osteoarthritis, skin infections, brain injury caused by heavy alcohol use and possibly other neurodevelopment disorders, including Alzheimer’s disease. The study indicates its activity appears to be inhibited by sulfuretin.

Molecules in flowers

The discovery came after years of undergraduates painstakingly screening plant compounds in the lab of co-author Angela Hoffman, PhD, a longtime and now-retired professor of chemistry at the University of Portland.

“Over the years, her students have been grinding up these flowers, extracting molecules and testing to see if any of them blocked hyaluronidase activity,” Sherman said. “Finally, a couple of years ago, they found a promising compound.”

Alec Peters, a graduate student in Sherman’s lab at OHSU, found that this compound blocked CEMIP activity in a tumour cell line and in oligodendrocyte progenitor cells. Oligodendrocytes generate myelin.

Hoffman, a nun and chemistry professor who earlier this year retired from the University of Portland after 35 years to lead her convent, began collaborating with Sherman a decade ago. Over that time, she said, hundreds of undergraduate students worked on breaking down dozens of plants to their molecular essence and then testing to see whether any of the compounds worked to neutralize CEMIP.

The new publication validates the students’ diligent work over many years, she said.

Study finds intense exercise may suppress appetite in healthy humans

What is moderate and vigorous exercise?

A rigorous workout suppresses hunger more than moderate exercise in healthy adults, with females potentially more affected, according to a small study published in the Journal of the Endocrine Society.

The study investigates how exercise intensity affects ghrelin levels and appetite in men and women. Ghrelin, known as the “hunger hormone,” is linked to feelings of hunger.

“We discovered that high-intensity exercise reduces ghrelin levels more effectively than moderate-intensity exercise,” said lead author Kara Anderson, Ph.D., from the University of Virginia and the University of Virginia Health System in Charlottesville, Virginia. “Additionally, we found that individuals felt ‘less hungry’ after high-intensity exercise compared to when they engaged in moderate-intensity exercise.”

Ghrelin circulates in acylated (AG) and deacylated (DAG) forms, which are known to affect appetite. The study noted that data on the impact of exercise intensity on AG and DAG levels and their effects on appetite is sparse and primarily limited to males.

To address this shortfall, the study examined eight males and six females. Participants fasted overnight and then completed exercises of varying intensity levels, determined by blood lactate measurements, followed by self-reported measurements of appetite.

The study noted that females had higher levels of total ghrelin at baseline compared with males. However, only females demonstrated “significantly reduced AG” following the intense exercise.

“We found that moderate intensity either did not change ghrelin levels or led to a net increase,” the study noted. These findings suggest that exercise above the lactate threshold “may be necessary to elicit a suppression in ghrelin.”

Researchers also acknowledged that more work is needed to determine the extent to which exercise’s effects differ by sex.

Ghrelin has been shown to have wide-ranging biological effects in areas including energy balance, appetite, glucose homeostasis, immune function, sleep, and memory.

“Exercise should be thought of as a ‘drug,’ where the ‘dose’ should be customized based on an individual’s personal goals,” Anderson said. “Our research suggests that high-intensity exercise may be important for appetite suppression, which can be particularly useful as part of a weight loss program.”