Mantilla, Carlos B.

AbstractCervical spinal cord injury impacts ventilatory and non‐ventilatory functions of the diaphragm muscle (DIAm) and contributes to clinical morbidity and mortality in the afflicted population. Periodically, integrated brainstem neural circuit activity drives the DIAm to generate a markedly augmented effort or sigh—which plays an important role in preventing atelectasis and thus maintaining lung function. Across species, the general pattern of DIAm efforts during a normal sigh is variable in amplitude and the extent of post‐sigh “apnea” (i.e., the post‐sigh inter‐breath interval). This post‐sigh inter‐breath interval acts as a respiratory reset, following the interruption of regular respiratory rhythm by sigh. We examined the impact of upper cervical (C2) spinal cord hemisection (C2SH) on the transdiaphragmatic pressure (Pdi) generated during sighs and the post‐sigh respiratory reset in rats. Sighs were identified in Pdi traces by their characteristic biphasic pattern. We found that C2SH results in a reduction of Pdi during both eupnea and sighs, and a decrease in the immediate post‐sigh breath interval. These results are consistent with partial removal of descending excitatory synaptic inputs to phrenic motor neurons that results from C2SH. Following cervical spinal cord injury, a reduction in the amplitude of Pdi during sighs may compromise the maintenance of normal lung function.

The diaphragm muscle is essential for breathing, and its dysfunctions can be fatal. Many disorders affect the diaphragm, including muscular dystrophies. Despite the clinical relevance of targeting the diaphragm, there have been few studies evaluating diaphragm function following a given experimental treatment, with most of these involving anti-inflammatory drugs or gene therapy. Cell-based therapeutic approaches have shown success promoting muscle regeneration in several mouse models of muscular dystrophy, but these have focused mainly on limb muscles. Here we show that transplantation of as few as 5000 satellite cells directly into the diaphragm results in consistent and robust myofiber engraftment in dystrophin- and fukutin-related protein-mutant dystrophic mice. Transplanted cells also seed the stem cell reservoir, as shown by the presence of donor-derived satellite cells. Force measurements showed enhanced diaphragm strength in engrafted muscles. These findings demonstrate the feasibility of cell transplantation to target the diseased diaphragm and improve its contractility.

Mesoporous silica nanoparticles coated with a lipid bilayer (protocells) are a stable, versatile and biocompatible delivery platform that allows surface engineering to target specific cells and intracellular cargo delivery. The endo‐lysosomal escape of this type of drug carriers is important to enhance the therapeutic efficacy of their cargo. Motoneurons can be specifically targeted by surface‐coating protocells with the subunit B of cholera toxin (CTB‐protocells). The central hypothesis was that CTB‐protocells escape endo‐lysosomal compartments after internalization by motoneurons. In a first study, fixed NSC‐34 motoneuron‐like cells were treated with fluorescently labeled CTB‐protocells (for 1, 3, 6 and 24 hours), immunostained for lysosomes (with anti‐LAMP1) or early endosomes (with anti‐EEA1) and imaged using multicolor confocal microscopy. In a second study, NSC‐34 cells treated with CTB‐protocells and labeled with the acidic vesicle tracker LysoTracker were visualized using time lapse confocal imaging. In these two studies, colocalization of CTB‐protocells with lysosomes or endosomes was analyzed using ImageJ and found to remain less than 20% up to 24 hours. The fraction of CTB‐protocells in endo‐lysosomes increased only slightly between 1 and 24 hours. In a third study, transmission electron microscopy was used to confirm the intracellular localization of CTB‐protocells in NSC‐34 motoneuron‐like cells. CTB‐protocells were visualized in the cytosol and were not detected within larger vacuole compartments after 24‐hour incubation. In conclusion, CTB‐protocells escape lysosomal degradation in motoneurons making them a suitable vehicle to target drug delivery to motoneurons.

Cholera toxin B modified protocells (CTB‐protocells) are a promising, customizable approach for targeting and delivering drugs to motoneurons. Understanding the endocytic mechanism and intracellular fate of CTB‐protocells is essential for safe therapeutic application and cargo delivery efficiency, and also to elucidate characteristics of motoneuron physiology that are not well understood. To assess the energy dependent uptake of CTB‐protocells by motoneurons, intracellular protocell fluorescence was measured at 4°C and 37°C. Confocal analysis demonstrated that after 3 h at 4°C, there is a 40% reduction in CTB‐protocell uptake compared to the uptake observed at 37°C (p<0.001). Pharmacological endocytic pathway inhibitors were used to elucidate the preferential endocytotic mechanism. Results showed that amiloride (macropinocytosis inhibitor) and methyl‐β‐cyclodextrin (inhibitor of cholesterol dependent endocytic processes) significantly reduced the uptake of CTB‐protocells (p<0.001), consistent with endocytosis being dependent on the integrity of lipid rafts. To track intracellular fate, immunofluorescence techniques and live confocal microscopy were used to demonstrate colocalization of CTB‐protocells with lysosomes, endoplasmic reticulum (ER) and Golgi apparatus at 1 h and 3 h. Colocalization of CTB‐protocells with lysosomes was less than 20%. Both, ER and Golgi colocalization increased from ~20 to ~40% in a 2‐h period (from 1 h to 3 h). To evaluate retrograde transport in motoneurons in vivo , CTB‐protocells were intrapleurally injected in rats. Evidence of protocells in phrenic nerve axons measured by protocell fluorescence intensity supported retrograde transport. In conclusion, uptake of CTB‐protocells is energy‐dependent and mediated principally by macropinocytosis. Additionally, CTB‐protocells are able to escape lysosomal degradation, and are trafficked to relevant subcellular compartments after endocytosis.

The diaphragm muscle (DIAm) must be able to generate sufficient forces to sustain ventilatory and non‐ventilatory behaviors throughout the lifespan. Aging‐related decreases in DIAm fiber cross‐sectional area and specific force, i.e., sarcopenia, may impair the ability to generate transdiaphragmatic pressures (Pdi) necessary to accomplish expulsive, non‐ventilatory behaviors essential for airway clearance. We examined the effects of aging on DIAm function in mice at 6, 18, and 24 months of age. At each age, DIAm‐phrenic nerve preparations were used to determine maximal force by ex vivo contractility of the DIAm as well as neuromuscular transmission failure by repetitive nerve and muscle stimulation. By 18 months, animals had reduced Pdi during maximal forces (e.g., during tracheal occlusion) and increased DIAm neuromuscular transmission failure compared to 6 months, but no change in DIAm maximum specific force. By 24 months, Pdi remained reduced during occlusion, DIAm neuromuscular transmission failure remained increased compared to 6 months, and DIAm maximum specific force was decreased compared to both 6 and 18 months. Using this global measure of neuromuscular transmission, it is evident that impaired transmission precedes muscle weakness. Support or Funding Information Supported by R01‐AG044615.

Neuromotor control of respiratory muscles such as the diaphragm muscle (DIAm), the main inspiratory muscle in mammals, is organized around motor units. Motor units comprise a motoneuron and the muscle fibers they innervate. Diversity in the contractile and fatigue properties of DIAm motor units permits generation of the wide range of behaviors necessary to sustain ventilation and maintain airways patent (e.g., sighs, which generate ~70% of maximal force in rats). Descending inputs to phrenic motoneurons innervating the DIAm is thought to be primarily unilateral in rats. After disrupting ipsilateral inputs by unilateral spinal cord hemisection at C2 (C2SH), latent, bilateral projections underlie recovery of ipsilateral DIAm activity. We hypothesized that DIAm EMG activity reflects bilateral descending premotor drive to motoneurons that varies across motor behaviors and conditions (anesthetized vs. awake). Using chronic DIAm EMG recordings in adult male Sprague‐Dawley rats, the bilateral vs. ipsilateral nature of premotor drive for each behavior and condition was evaluated by comparing the impact of C2SH. Three days prior to the C2SH surgery, a pair of DIAm electrodes was implanted bilaterally and DIAm EMG activity was assessed immediately prior to and after C2SH as well as at 3 days post‐C2SH in spontaneously‐breathing awake, restrained animals and following induction of ketamine‐xylazine anesthesia. DIAm EMG recordings comprised ~5 min of eupnea and exposure to hypoxia (10% O 2 )‐hypercapnia (5% CO 2 ). The completeness of C2SH surgery was confirmed by the absence of ipsilateral diaphragm EMG activity during eupnea at the time of C2SH surgery and at 3 days post‐C2SH in anesthetized animals, consistent with previous studies. In addition, histological assessment of disruption of anterolateral white matter tracts was conducted to verify the C2SH injury. Ipsilateral RMS EMG amplitude in anesthetized rats pre‐C2SH was ~30% and 45% of pre‐injury anesthetized sigh levels during eupnea and hypoxia‐hypercapnia, respectively. During awake conditions pre‐C2SH, ipsilateral RMS EMG amplitude was significantly higher (~50%, 70% and 200% of pre injury anesthetized sigh levels during eupnea, hypoxia‐hypercapnia and sighs, respectively). There were no differences across diaphragm muscle sides pre‐C2SH in RMS EMG amplitude. At 3 days post‐C2SH, ipsilateral RMS EMG activity was evident in anesthetized animals during hypoxia‐hypercapnia and sighs (~10% and 50% of pre‐injury anesthetized sigh levels) and in awake animals during eupnea, hypoxia‐hypercapnia and sighs (~25%, 50% and 125% of pre‐injury anesthetized sigh levels, respectively). These findings represent considerable differences in DIAm activity across motor behaviors and anesthetized vs. awake conditions and highlight physiologically‐relevant differences in the relative contribution of ipsilateral vs. bilateral inputs to phrenic motoneurons. Support or Funding Information NIH grant R01 HL96750.

Autophagy is a series of catabolic processes that involves degradation of cytoplasmic components through lysosomal pathways. There is an important balance that must be met, with impaired autophagy contributing to cell dysfunction and excessive autophagy leading to cell death likely via apoptosis. Indeed autophagy is a dynamic multi‐step process that is modulated positively and negatively at several steps. The role of autophagy in aging‐related motoneuron dysfunction or death is not known. Therefore, it is important to differentiate between the accumulation of autophagosomes due to increased induction of autophagy during conditions of cell stress common across aging‐related conditions, and the accumulation of autophagosomes due to inefficient clearance of damaged organelles and other sequestered cargoes, which reflects impairments in autophagy that would lead to cell dysfunction. We hypothesized that with aging, there is autophagy imbalance causing accumulation of autophagosomes and ultimately neuromuscular dysfunction. Male and female mice at 6 and 24 months of age were used to assess markers of autophagy in the spinal cord. Protein expression of autophagy‐related genes LC3A and LC3B increased in the cervical and lumbar spinal cord of old compared to young mice, whereas protein expression of Atg5, Atg7, and Bcn1 did not change with age. Quantitative real‐time RT‐PCR of microdissected phrenic motoneurons showed an increase in LC3 mRNA expression with age. Overall autophagic flux, which assesses inclusion (or exclusion) of cargo within autophagosomes, delivery of cargo to lysosomes, and subsequent breakdown and release of macromolecules back into the cytosol was evaluated using an mCherry‐GFP‐LC3 sensor. This genetic sensor is designed to monitor LC3 flux through autophagy pathways since the GFP signal is sensitive to the acidic/proteolytic conditions of the lysosome lumen, whereas mCherry fluorescence persists under these environments. We used motoneuron‐like NSC‐34 cells transfected with mCherry‐GFP‐LC3 plasmid to detect changes in the autophagic degradation rate in cells treated with tunicamycin (which leads to cell stress via induction of the unfolded protein response). We observed an increase in yellow vesicles indicating an accumulation of autophagosomes due to inefficient clearance of sequestered cargoes. This genetic sensor indicates impaired autophagy flux in motoneurons in conditions of elevated stress likely present in old age. Taken together, these results suggest impaired autophagy in motoneurons, including phrenic motoneurons, with an associated increase in markers of early autophagosome formation (LC3). Support or Funding Information Supported by R01‐AG044615.

Aging‐related changes in lung mechanics of human subjects are characterized by a decrease in resistance and an increase in static compliance (decrease in elastic recoil). Together, these changes result in an increase in residual volume in the absence of an increase in total lung capacity. In C57BL/6x129 mice, it was reported that lung compliance increases with aging while elastic recoil pressure does not change. However, in these studies, “old” mice at 24 months of age were compared to “young” mice at 2 months of age, but at this younger age, alveologenesis is incomplete (completion does not occur until ~6 months of age). Accordingly, it remains to be established if the same aging‐related changes in lung mechanics are observed using fully developed adult C57BL/6x129 mice for comparison. To this end, we compared lung mechanics in C57BL/6x129 mice at 6 months (100% survival, n = 6), 18 months (90% survival, n = 6), and 24 months (75% survival, n = 6) of age. Respiratory system static mechanics (Resistance, R rs ; Compliance, C rs ; Elastance, E rs ) were assessed following tracheal intubation using the FlexiVent. There was a progressive aging‐related decrease in R rs (6 month, 0.47 ± 0.02; 18 month, 0.41 ± 0.02; 24 month, 0.35 ± 0.02 cmH 2 O.s/ml), an increase in C rs (6 month, 0.046 ± 0.002; 18 month, 0.052 ± 0.002; 24 month, 0.062 ± 0.002 ml/cmH 2 O), and a decrease in E rs (6 month, 21.73 ± 1.19; 18 month, 19.30 ± 0.87; 24 month, 16.62 ± 1.25 cmH 2 O/ml). Additionally, lungs were fixed following tracheal instillation of 4% paraformaldehyde at 25 cmH 2 O. Thereafter, lungs were dehydrated, paraffin embedded, sectioned (6 μm thick), and stained (hematoxylin and eosin). Using standard stereological approaches, lung sections were analyzed in a uniform systematic but random fashion to assess alveolar morphology (measurement of average distance between alveolar walls based on mean linear intercept, L m ). There was a progressive aging‐related increase in L m (6 month, 34 ± 2; 18 month, 40 ± 2; 24 month, 45 ± 2 μm) consistent with an aging‐related emphysematous‐like change in lung morphometry. Taken together, these results in appropriately aged C57BL/6x129 mice demonstrate an aging‐related change in lung mechanics and morphometry consistent with what is observed in aging humans. Therefore, the results of the present study confirm the use of rodent models for studying aging‐related changes in lung mechanics and morphometry. Support or Funding Information National Institute of Health grants R01‐AG044615 (CBM & GCS) and T32‐HL105355 (JEE).

Neurotrophic signaling is essential to the maintenance of diaphragm muscle function across the lifespan. With aging, there is an age‐related loss of neurotrophic signaling and a resultant increase in diaphragm muscle denervation and impairment in neuromuscular transmission. We hypothesized that enhancing neurotrophic signaling via the tropomyosin‐related kinase receptor subtype B (TrkB) using the small molecule TrkB agonist 7,8‐dihydroxyflavone (7,8‐DHF) would mitigate age‐related changes in diaphragm neuromuscular transmission and possibly sarcopenia (muscle atrophy and force loss). Adult male TrkB F616A mice (n=32) were randomized to receive 6‐month oral treatment with vehicle (control), 7,8‐DHF, or co‐treatment with 7,8‐DHF and 1NMPP1(a specific inhibitor of TrkB kinase activity in TrkB F616A mice) beginning at 18 and ending at 24 months of age. Mice were analyzed for neuromuscular transmission failure using diaphragm muscle‐phrenic nerve preparations, diaphragm muscle force, and morphologic characteristics of sarcopenia. Chronic 7,8‐DHF treatment did not improve diaphragm neuromuscular function or force (P≥0.25). Co‐treatment with 7,8‐DHF and 1NMPP1 decreased the ratio of the initial nerve stimulation‐derived to initial muscle stimulation‐derived force (~22%) compared to vehicle (p=0.01), consistent with a deleterious effect of inhibiting TrkB kinase activity on aging diaphragm muscle. With age, there was fiber type specific atrophy of type IIa and type IIx and/or IIb diaphragm muscle fibers. There was no evidence of a protective effect of 7,8‐DHF on muscle fiber cross‐sectional area. Taken together, these results support a role for BDNF/TrkB signaling in old age but do not support 7,8‐DHF as a therapeutic agent to mitigate age‐related effects on diaphragm muscle function. Support or Funding Information Supported by R01‐AG044615, T32‐HL105355, and the Mayo Clinic.