Tag Archives: CurePSP

Research on quality, accessibility and equity of care

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In 2017, CurePSP created a network of 30 academic medical centers with special expertise in PSP, CBD and MSA.  They’re called the “CurePSP Centers of Care” and are the equivalent of what many other medical non-profits call their “centers of excellence.”  Of the 30 sites, 28 are in the US and 2 in Canada.  Each site is directed by a neurologist specializing either in movement disorders or cognitive/behavioral neurology with a record of excellence and achievement in at least one of the three disorders, and with a certain minimum patient flow, community involvement and availability of other relevant professionals such as physical therapists, speech/swallowing therapists and neuropsychologists.

In 2018 and 2019, its members collaborated on a consensus paper summarizing the latest in the management of PSP and CBD.  It was published in 2020 in an open-access journal, and you can download it here.  It’s written for physicians and other professionals, but the language is accessible to the educated layperson.  You might consider sending copies to your own clinicians.

But that’s old news.  What’s new is that the CoC program has just awarded its first set of grants, totaling $81,000.  The rules are that only CoC sites are eligible to apply and that each project must be a collaboration of at least two sites.  The subject matter has to be the quality, accessibility and equity of care.  It’s not for lab research or drug trials, but each project does have to include some sort of measurable, publishable outcome.

Here are the first year’s grant awardees:

  • The University of Chicago, Northwestern University and Rush University will produce ten live, on-line, hour-long educational sessions for patients and their families and caregivers covering many aspects of PSP, CBD and MSA.  The presentations will be recorded and made available subsequently.  Participants will be tested on the material before and after the sessions.
  • The centers at Johns Hopkins University and at the Harvard-affiliated Massachusetts General Hospital will compare three different methods of improving access to care at their facilities.  They will enroll a total of 30 patients with PSP, CBD or MSA.  Each will receive either an internet-enabled tablet for tele-neurology visits, free transportation to their neurologist’s appointments, or free parking there.  At the start and after six months, the patients and caregivers will complete surveys assessing overall disability, emotional state, stress level, general well-being and level of relevant medical knowledge.
  • The University of Pennsylvania and University of California San Diego centers will assess end-of-life care preferences among White and non-White individuals with PSP, CBD and MSA.  Fifty patients and their caregivers will be invited to participate and ten to 15 are expected to accept.  They will receive a survey called “Attitudes of Older People to End-of-Life Issues” and will participate in hour-long focus groups of two or three patients each.  The analysis will compare White with non-White participants in order to gain insight into racial differences affecting this highly culture-driven set of attitudes.

Not your average set of neurology research projects, right?  I’ll report the results to you in a year.  The Centers of Care plans for another set of projects in late 2023.

Disclosure: I helped organize CurePSP’s Centers of Care program in 2017 and I continue as a member of the CoC’s Steering Committee and as a member of the ad hoc committee evaluating grant applications.    

PSP grants awarded to a new generation

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This week, CurePSP is announcing its semiannual crop of research grants. (Disclosure: I chair CurePSP’s Scientific Advisory Board, which reviews the grant applications and makes funding recommendations to the Board of Directors, of which I’m also a member.) Many granting agencies tend to favor senior researchers on the grounds that they’re known entities with a track record of success. CurePSP, however, has long tended to favor early-career applicants on grounds that they may bring new thinking and energy to the field and that our grant might make the difference in a young research’s choice of diseases to study for decades to come.

There were 22 applications in the current group. We chose to fund 3 early-career applicants – Drs. Bailey, Silva and Olah, all of whom happened to be women, and one world-class, senior guy, Dr. Geschwind. I’ll let the press release speak for itself.

CurePSP funds four new grants to study treatment of prime of life neurodegeneration

Studies at leading institutions may result in therapeutic approaches for PSP, CBD, FTD, and related diseases.

NEW YORK, NY (September 8, 2021) – CurePSP has awarded Venture Grants totaling $320,000 to scientists at Harvard Medical School, Columbia University, UT Southwestern Medical Center, and UCLA. The studies will investigate gene therapy, neuroprotective enzymes, activation of autophagy, and identification of microglia associated with toxic protein accumulation as possible therapeutic agents in the treatment of several neurodegenerative diseases.

Diseases like progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and frontotemporal dementia (FTD) are caused by the toxic accumulation of a naturally resident protein in the brain called tau that leads to destruction of neurons. Symptoms include loss of motor control, behavioral disinhibition, cognitive impairment, and difficulties in swallowing and speech. They are termed “prime of life” neurodegeneration because, unlike commonly occurring Alzheimer’s disease, they frequently strike in middle age. They are currently incurable and largely untreatable.

Dr. Rachel Bailey of the Center for Alzheimer’s and Neurodegenerative Diseases at UT Southwestern Medical Center in Dallas will study gene replacement therapy to combat toxic accumulation of the tau protein. Dr. Bailey will test a way to use a virus to deliver two types of RNA, one to prevent the manufacture of abnormal tau and the other to encode an aggregation-resistant form of tau.

Dr. Daniel H. Geschwind of UCLA’s Department of Neurology and his team will test four new, orally available drugs in mice genetically engineered to produce abnormal tau protein.  The drugs enhance the activity of an enzyme called puromycin-sensitive aminopeptidase, which both cuts up tau protein and enhances the brain cells’ “autophagy” system, which disposes of some types of abnormal proteins, including tau. 

Dr. Maria Catarina Lima da Silva of the Department of Neurology of Massachusetts General Hospital and Harvard Medical School in Boston will, like Dr. Geschwind, investigate small-molecule activators of autophagy to clear toxic protein accumulation in the brain. However, rather than using mice, Dr. Lima da Silva’s approach will utilize neurons grown from stem cells derived from skin biopsies of human patients.  She will study orally-available compounds that activate an enzyme called ULK1, an autophagy enhancer.

Dr. Marta Olah of Columbia University’s department of neurology in New York City will study microglia, the resident immune cells of the brain, which is recent years have been shown to be a major participant in the neurodegenerative process.  Dr. Olah will use a new method to sequence the RNA in individual microglial cells, creating a map of which cells are encoding which proteins in proximity to degenerating neurons.  This could generate new insights into the disease process and new targets for drugs.

CurePSP’s Venture Grants are awarded twice a year. Applications are reviewed and recommended to CurePSP’s board of directors by an independent scientific advisory board. The next application deadline is December 17, 2021.

Drilling into a gene

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So here’s the second of five installments in this fall’s series on CurePSP’s newly funded grants. 

Do you recall that the 2011 publication by CurePSP’s Genetics Corsortium discovered four new places in the genome where a slight variant is associated with slightly greater chance of developing PSP?  The genes containing those variants are cryptically called MAPT, STX6, EIF2AK3 and MOBP.  The first one stands for “microtubule-associated protein tau” and the protein it codes for is, of course, our old frenemy, the tau protein.  Well, when you break the effect down statistically, it turns out that in the MAPT gene, two different variants are each independently associated with increasing PSP risk.  One has been known since 1998 and remained the only known PSP genetic risk factor until 2011.  Its name is the “H1 haplotype.”  (Click on the link for explanatory details. )  The other one, previously unknown, is called only “rs232557.” That variation specifically is the substitution of one “letter” in the genetic code for another, called a single-nucleotide polymorphism, or SNP, pronounced “snip.”  The substitution is probably not itself be the cause of the PSP risk; it’s only a “marker,” a variation that was already present in the MAPT gene in the individual in which the PSP-causing mutation originally occurred. That person then passed both the innocuous old marker variant and the new disease-causing variant together to subsequent generations.  The two stayed together on the chromosome (in this case, chromosome 17) through all those generations because their very close physical proximity means that a break between them during the reproductive process (where sperm cells or ova are made, called “meiosis”) is statistically unlikely. 

Still with me here?  Back to the new grant, where Rueben G. Das, PhD of the University of Pennsylvania proposes to figure out just how the variant revealed by the rs242557 marker increases PSP risk.  We already know that rs242557 is located in an intron of the MAPT (tau) gene.  Introns are long stretches of DNA between the shorter stretches, the exons, which actually encode the structure of proteins.  Introns can do a variety of things, though many of them seem to be just “junk DNA” deactivated by the evolutionary process somewhere between single-celled creatures and ourselves.  But some introns regulate the “expression” of the exons, i.e., the number of RNA molecules the exons produce, which in turn determines the number of molecules of the corresponding protein that the cell makes. 

Introns may also regulate which specific exons in the gene actually get encoded into RNA and which don’t.  That’s relevant for PSP, where nearly all the tau molecules in the neurofibrillary tangles include the product of MAPT’s exon 10, producing “4-repeat” tau.  This contrasts with normal tau in adult human brain, which includes exon 10’s stretch of amino acids on only half of the copies.  The other half are called “3-repeat” tau.

One of Dr. Das’ experiments will simply excise (“knock out”) the variable nucleotide at the rs242557 site.  Others will knock out or change one of the nucleotides nearby.  These experiments will be tried in both mouse and human brain cells.  One of the outcomes the researchers will look for will be the ratio of messenger RNA for the two forms of tau, 3-repeat tau and 4-repear.  A ratio favoring 4-repeat tau would suggest a PSP-causing effect.  Of course, they will also look at the finished tau proteins corresponding to these MAPT gene variants.

Additional readouts will be the messenger RNAs for other genes located in the same general area of chromosome 17 (and their associated proteins) that have bene associated with PSP or Alzheimer’s disease.  Those genes are called NSF, KANSL1, LRR37A and CRHR1.

Dr. Das completed a postdoctoral fellowship (the final stage of training for a lab scientist) at Penn in 2017 under the mentorship of Gerard Schellenberg, PhD, a world authority in the genetics of neurodegenerative disorders.  They continue to work together now that Dr. Das has graduated to Senior Research Investigator at Penn.  Jerry serves on CurePSP Scientific Advisory Board and of course recused himself from the evaluation of this grant application.

Back to science: To create these tiny, targeted changes in the DNA at the rs242557 site, Dr. Das and colleagues will use the new gene-editing technique called CRISPR-Cas9.  Just a month ago, the two scientists most prominent in the development of that technique, Jennifer Doudna and Emmanuelle Charpentier, received the Nobel Prize for that work, which appeared in 2012 and has been called one of the most important advances in biological science in history.   Like many useful techniques in biology and medicine, this one harnesses something from nature, in this case an anti-viral defensive mechanism present in about half of all species of bacteria, an enzyme called CRISPR (clustered regularly-interspaced short palindromic repeats).  The CRISPR protein is coupled with another bacterial protein, Cas9, which can cut DNA.  (“Cas” means CRISPR-associated, and yes, there are at least eight other Cas enzymes.)  The researcher then adds to the complex of CRISPR and Cas9 a stretch of synthetic RNA custom-designed to complement the stretch of DNA targeted for alteration.  That “guide RNA” allows the complex to recognize the DNA site of interest, where the Cas9 proceeds to make a cut. 

If this project is successful and reveals which nearby genes are up- or down-regulated by variants in rs242557, the next steps would be to try to normalize the function of the resulting protein by other means such as conventional drugs. Another approach might reduce the expression of the offending DNA variant by giving an anti-sense oligonucleotide.

This grant is only a one-year project and I’ll report its results once published or otherwise publicly presented.  Stay tuned now for posts on the other new CurePSP grants.

A family matter

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Want to know what’s hot in lab research on PSP?  Or, more accurately, want to know what will be hot in a year or two?  This week, CurePSP will announce its four newest research grant awardees.  Most of the 20 competing applications, a very large crop for CurePSP, were of excellent quality and in a less competitive cycle many of them would have been funded.   A fifth and possibly a sixth application may be funded next month after CurePSP’s leaders have had a chance to discuss the use of a new, unexpected, seven-figure donation.

Since I’m driving this bus, I’ll start with the funded grant I consider the most intriguing, though it’s the smallest of the four.  For two decades, researchers at the University of Southern California have been following a Mexican-American family with PSP in 14 members over three generations.  Two of the 14 have had autopsies confirming the diagnosis.  The inheritance pattern is most likely autosomal dominance (look it up).  There are six living, affected members and another 19 who are at 50% risk because they have an affected parent or sibling.  One of the affected members has had sequencing of the gene that encodes tau (called the MAPT gene).  That revealed no mutations.  Now, John M. Ringman, PhD and his USC colleagues plan to sequence the entire genome of four affected and one unaffected family members.

It’s entirely possible that the result will be a mutation in one of the half dozen or so genes besides MAPT that have already been identified by other methods as conferring a slight risk of developing PSP.  That wouldn’t be so exciting, though it would show that one mutation in that gene suffices to cause the disease while other mutation(s) in the same gene only raise PSP risk slightly.  That would shed light on just how that gene works with respect to PSP.

A more exciting result would be if the culprit gene in this family turns out to be one that has not been previously associated with PSP.  Even though this particular mutation would clearly not be the cause of “regular” PSP, perhaps the protein that this gene encodes will prove to be part of a molecular pathway critical to the pathogenesis of PSP but not yet investigated carefully.  That could point to scads of new treatment targets for drug developers and maybe even a diagnostic test.  Very cool.

I led a project like this on Parkinson’s disease back in the 1980s and 1990s, though we didn’t have whole-genome sequencing then.  I won’t get into the details, but you can read about the big family I found and worked with here, my subsequent clinical analysis of the family here, the report of the culprit gene here, the discovery of its significance to PD in general here, the development of a diagnostic test based on the gene’s product here, the efforts to prevent PD in lab models by reducing the gene’s product here and an initial safety report on a Phase 1 human trial here.  Maybe that’s why I find Dr. Ringman’s little project so intriguing.

More on the other new grantees in the next post.

Your own one- or two-year crystal ball

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You may know that for many years one of my jobs at CurePSP is to chair the grant review. Twice a year we have a deadline for researchers in either academia or the private sector to apply for up to $100,000 for work related to PSP or CBD. It’s very competitive, as we receive about 20-25 applications a year from some top research groups and fund only about 5-7 of them. We welcome purely clinical projects as well as laboratory work. The term of the grants is 1 or 2 years. Here are the 4 successful awardees from our Fall 2019 grant cycle:

Lukasz Joachimiak, The University of Texas Southwestern Medical Center, Dallas: Structural basis for tau strain conformation in CBD and PSP

In the brain, the tau protein can form an altered shape that clumps together in an aggregated form.  This study will isolate the tau protein from healthy, PSP, and CBD patient brain tissues. Specialized research tools will be applied to determine how the abnormally folded shape of tau differs from the tau from healthy brains. Understanding the fine details of how the tau protein changes from a normal shape to the different “bad” forms found in disease will provide the blueprint for designing new methods to detect and prevent these devastating diseases in patients.

David Butler, Neural Stem Cell Institute, Rensselaer, NY: Bifunctional intrabodies to lower tau

The goal of this project is to develop therapeutic agents that will prevent tau accumulation and associated death of brain cells with novel antibody-based reagents (termed intrabodies). Intrabodies are antibodies expressed within brain cells, while antibodies produced by the immune system or administered by vein do not penetrate brain cells.   These antibodies are highly selective for tau, and they have been engineered to target tau for degradation using the cell’s normal clearing process. The study’s central hypothesis is that targeted degradation of tau protein will reduce the amount of tau available to misfold and thus reduce cell death.

J. Mark Cooper, University Hospital, London, UK: The influence of TRIM11 on tau, aggregation, release, and propagation

In 2018 this research group identified the TRIM11 gene as a risk factor for PSP. This study will investigate the effects of a the protein encoded by that gene on toxic tau protein aggregation in the brain. It is believed to play a role in regulating the levels of some proteins within the cell, in particular proteins that may form aggregates. The study will use models of brain cells grown in the laboratory to focus on how changes to TRIM11 influence tau protein regulation, in particular its tendency to aggregate. These findings may help to identify potential therapeutic targets to modify PSP disease progression.

K. Matthew Scaglione, Duke University, Durham, NC: Small-molecule regulation of a protein quality-control E3 to treat PSP

The protein Hsc70 or “CHIP” accelerates the removal of tau from the brain. This project intends to identify compounds that stimulate CHIP functions.  One important such function is as an “E3” enzyme, which is an important part of one of the brain cells’ “garbage disposal” mechanisms called the ubiquitin-proteasome system (UPS).  E3 allows the UPS to recognize specific proteins for appropriate disposal.  Finding new compounds to stimulate this function is an important first step toward developing small (that is, orally dosable) molecules to slow or prevent the progression of PSP and CBD.

(If those descriptions sound like they’re not my own writing style, it because each was provided by the researchers themselves and then edited by me to fit what I think, based on little evidence, to be the technical background of this blog’s readers.)

I’ll update you on the progress of those projects once they’re publicly presented or published over the next 2 or 3 years.

A sidebar about PubMed: If you didn’t already know, you can see these, or any, researchers’ previously published work by typing a name into the search line at PubMed. Enter the last name, then the initials. To narrow it down, add a topic (like tau or neurodegenerative disease). The initial display lists papers satisfying the search terms in reverse chronological order. Clicking on one of them brings up the authors, institutions and a half-page, technical-language summary. There’s always a stack of links to related papers, including subsequent ones that cite it. Clicking an author’s name will produce a list of his/her other publications. Plus, for some articles, the whole text is available via a clickable link, sometimes for free, usually for an exorbitant fee. Have fun!