AMDCC Neuropathy Phenotyping Core. Eva Feldman MD, PhD JDRF Center University of Michigan

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1 AMDCC Neuropathy Phenotyping Core Eva Feldman MD, PhD JDRF Center University of Michigan 1

2 Outline Define neuropathy and illustrate phenotyping Summarize current phenotyping efforts Collaborations 2

3 AMDCC Definition of Neuropathy Evidence of clinical loss of sensory function Tail flick and hind paw withdrawal latencies (TF and HP) Electrophysiological evidence of nerve impairment Sensory and motor distal latencies and nerve conduction velocity (NCV) Anatomical evidence of nerve fiber loss Intraepidermal fiber density (IEFD 3

4 Evidence of Clinical Loss of Sensory Function Tail flick and hind paw thermal testing The time from the application of the stimulus to time of withdrawal equals the latency Measured every 12 weeks and at tissue harvest Reliable and reproducible Hind paw latencies correlate well with IEFD Non-invasive 4

5 Tail Flick 5

6 Hind Paw Withdrawal 6

7 Electrophysiological Evidence of Nerve Conductions Nerve Impairment Tail motor distal latency, tail sensory and sciatic motor conduction velocity Sensitive measures of peripheral nerve function Requires anesthesia Performed at 12 weeks post-diabetes and at tissue Harvest 7

8 Tail Distal Motor Latency 8

9 Sciatic Nerve Motor Conduction Velocity 9

10 Anatomical Evidence of Nerve Fiber Loss with Skin Biopsies Intraepidermal Fiber Density PGP9.5 (ubiquitin C-terminal hydrolase) Pan-axonal marker Confocal image capture and analysis Data may be expressed as number of fibers per mm of epidermis or as area of fibers per area epidermis Samples may also be examined for specific neurotransmitters 1

11 Normal Cutaneous Innervation Assessed with Skin Biopsy 11

12 SOD2+/+ Db+ E D Bar = 5 υm 12

13 SOD2+/- Dbdb E D 13

14 Current models uma/cr Every 12 weeks 24 hr urine at 24 wks or end of trial Tail Flick Hind Paw Every 8 weeks NCV Measured 12 and 24 weeks post-diabetes Glom. PAS area Measured at tissue harvest Glom. podocyte Measured at tissue harvest IEFD Measured at tissue harvest Biochemistry Measured at tissue harvest C57BLKS db/db NA X X NA NA X X GCLC +/- db/db high fat diet Ongoing X Ongoing Ongoing Ongoing Ongoing Ongoing GLUT1 tg db/db high fat diet Nphs2 GLUT1 tg C57BLKSdb/db Nphs2 Cre// SOD2 loxp/loxp Nestin Cre// SOD2 loxp/loxp GLUT4 -/- and Nphs2 Cre// GLUT4 loxp/loxp Ongoing X Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing X Ongoing Ongoing Ongoing Ongoing Ongoing X NA NA X Ongoing NA Ongoing X X X Ongoing Ongoing Ongoing Ongoing X X X X X X Ongoing GLUT4 -/- Akita Breeding Breeding Breeding Breeding Breeding Breeding Breeding PDX+/- Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing 14

15 Sensory Measures BKLS Mice 1. TF HP * # 7.5 seconds seconds db+ dbdb. db+ dbdb *P <.1, #P <.1 15

16 Nerve Conduction Velocities BKLS Mice 3 TSNCV 5 TDML * meters/seconds * milliseconds db+ dbdb db+ dbdb SMNCV 5 seconds # *P <.1, #P <.1 1 db+ dbdb 16

17 Sensory Testing GCLC+/+, +/- Db/db Mice TF HP seconds seconds 1 5. wt db+ wt dbdb gclc db+ gclc dbdb wt db+ wt dbdb gclc db+ gclc dbdb No Significant Differences 17

18 Sensory Testing GLUT4-/- C57Bl/6J Mice TF HP seconds seconds wt wt DM ko ko DM. wt wt DM ko ko DM No Significant Differences 18

19 Sensory Tests GLUT1tg C57Bl/6J Mice TF HP seconds 6 4 seconds wt db+ wt dbdb tg db+ tg dbdb wt db+ wt dbdb tg db+ tg dbdb No Significant Differences 19

20 Nerve Conduction Velocity GLUT1tg C57Bl/6J Mice TSNCV TDML 25 6 meters/second milliseconds wt db+ wt dbdb tg db+ tg dbdb SMNCV wt db+ wt dbdb tg db+ tg dbdb 4 meters/second No Significant Differences wt db+ wt dbdb tg db+ tg dbdb 2

21 Sensory Testing Cre//SOD2 loxp/loxp Mice TF HP 1 5 seconds 5 seconds flox flox cre flox flox flox flox cre flox flox No Significant Differences 21

22 Nerve Conduction Velocity Cre//SOD2 loxp/loxp Mice TSNCV TDML 3 3 meters/second 2 1 milliseconds 2 1 flox flox cre flox flox flox flox cre flox flox SMNCV 4 meters/second No Significant Differences flox flox cre flox flox 22

23 Sensory Testing PDX+/+ and +/- Mice 1. TF * 4 HP seconds seconds pdx +/- pdx +/+ pdx +/- pdx +/+ * P <.4 23

24 Nerve Conduction Studies PDX +/+ and +/- Mice TSNCV TDML 3 3 meters/second 2 1 milliseconds 2 1 pdx +/+ pdx +/- pdx +/+ pdx +/- SMNCV 5 * P <.4 meters/second * pdx +/+ pdx +/- 24

25 Intraepidermal Fibers LDLRO and LDLRO ob/ob Mice 25

26 Current models uma/cr Every 12 weeks 24 hr urine at 24 wks or end of trial Tail Flick Hind Paw Every 8 weeks NCV Measured 12 and 24 weeks post-diabetes Glom. PAS area Measured at tissue harvest Glom. podocyte Measured at tissue harvest IEFD Measured at tissue harvest Biochemistry Measured at tissue harvest C57BLKS db/db NA X X NA NA X X GCLC +/- db/db high fat diet Ongoing X Ongoing Ongoing Ongoing Ongoing Ongoing GLUT1 tg db/db high fat diet Nphs2 GLUT1 tg C57BLKSdb/db Nphs2 Cre// SOD2 loxp/loxp Nestin Cre// SOD2 loxp/loxp GLUT4 -/- and Nphs2 Cre// GLUT4 loxp/loxp Ongoing X Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing X Ongoing Ongoing Ongoing Ongoing Ongoing X NA NA X Ongoing NA Ongoing X X X Ongoing Ongoing Ongoing Ongoing X X X X X X Ongoing GLUT4 -/- Akita Breeding Breeding Breeding Breeding Breeding Breeding Breeding PDX+/- Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing 26

27 Collaborations Jan Breslow, Rockefeller University Has sent food pad biopsies to Michigan for IEFD from LDLR mice Completing phenotyping of Pdx mice (very promising model) Firouz Daneshgari, Cleveland Clinic Foundation Measures of bladder elasticity and emptying Plans to examine innervation density similar to foot pad biopsy method Timothy Kern, Case Western Reserve University Sending whole eyes from Michigan and Rockefeller mice Are able to supply eyes after terminal neuropathy phenotyping David Clemmons and Timothy Nichols, University of North Carolina Have sent ankle and hip skin, dorsal root ganglia and sciatic nerves from hypercholesterolemic pigs Continue to encounter some difficulties with IEFD antibody? 27

28 Porcine Skin 28

29 Sensory Testing PDX+/+ and +/- Mice 1. TF * 4 HP seconds seconds pdx +/- pdx +/+ pdx +/- pdx +/+ * P <.4 29

30 Porcine Skin J. Anat. 19:61-611,

31 IEFD Porcine Skin E D 31

32 Outline Respond to EAC comments Define neuropathy and illustrate phenotyping Summarize current phenotyping efforts Highlight key models Collaborations AMDCC Neuropathy Core is fully functional and can perform screening via footpads for IEFD or terminal phenotyping 32

33 IntraEpidermal Fiber Density 33

34 Animal model Background strain current status Phenotyping (begin-end) Consortium collaborators Current Models (page 1) SOD2 +/- STZ C57BL/6J phenotyping complete; no increase in neuropathy or nephropathy 3-2 to 8-3 SOD2 +/- db/db Nphs2 Cre//SOD2 loxp/loxp C57BL/6J C57BL/6J Phenotyping complete; no increase in neuropathy or nephropathy 3-3 to 9-3 phenotyping ongoing; no obvious increase nephropathy 12-3 to 12-4 Vanderbilt ROS Nphs2 Cre//SOD2 loxp/loxp C57BL/6J 129SvJ phenotyping nearing completion; no significant increase nephropathy 1-4 to 12-4 Vanderbilt nestin Cre//SOD2 loxp/loxp C57BL/6J phenotyping ongoing 3-4 to 2-5 Vanderbilt synapsin Cre//SOD2 loxp/loxp C57BL/6J Breeding complicated; phenotyping ongoing 4-4 to 4-5 Vanderbilt Po Cre// SOD2 loxp/loxp C57BL/6J receiving mice On hold 12-4 to 12-5 Vanderbilt GCLC +/- STZ C57BL/6J On hold 6-3 to 5-4 GCLC +/- db/db AR tg//sod2+/- STZ C57BL/6J C57BL/6 phenotyping virtually complete; excellent neuropathy; no increase nephropathy 7-3 to 6-4 phenotyping ongoing; increased neuropathy in diabetics with double mutation 1-4 to 12-4 GCLC +/-//SOD2 +/- STZ C57BL/6 To begin breeding On hold 12-4 to 12-5 signaling fyn -/- fyn -/- STZ fyn -/- C57BL/6J 129SvJ C57BL/6J 129SvJ 129SvJ phenotyping complete severe albuminuria in nondiabetics 6-3 to 8-3 phenotyping completed: increased albuminuria in diabetics with mutation 6-3 to 8-3 rederivation completed; phenotyping ongoing. No albuminuria in nondiabetics 9-3 to 8-4 fyn -/- and +/- STZ 129SvJ phenotyping ongoing 9-3 to 9-4 IRS-1 -/- C57BL/6J Breeding colony On hold? 34

35 Animal model Background strain current status Phenotyping (begin-end) Consortium collaborators Current Models (page 2) GLUT4 -/- STZ C57BL/6J phenotyping complete; increased nephropathy; modest increase neuropathy 11-1 to 5-4 Einstein GLUT4 -/- db/db C57BL/6J On hold 11-3 to 1-4 Einstein Nphs2 Cre //Glut4 loxp/loxp C57BL/6J phenotyping ongoing 4-4 to 12-5 Utah GLUTs GLUT1 tg C57BL/6J phenotyping ongoing; increased glomerulosclerosis in nondiabetics 7-3 to 1-5 Hopkins GLUT1 tg STZ C57BL/6J expanding lines 9-3 to 11-4 Hopkins GLUT1 tg db/db C57BL/6J phenotyping ongoing 1-3 to 1-5 Hopkins Nphs2 GLUT1 tg db/db C57BLKS Transgenic lines with overexpression established; beginning phenotyping 12-4 to 1-5 Hopkins Nestin GLUT1 tg db/db C57BLKS making construct On hold 3-4 to 1-5 Hopkins Nphs2 cre //PPARγ loxp/loxp C57BL/6J uncertain 12-4 to 8-5 UCLA conditional Nphs2 cre C57BL/6J Crossed with other lines breeding stock synapsin cre C57BL/6J crossed with other lines breeding stock nestin cre C57BL/6J crossed with other lines breeding stock db/db C57BL/6J breeding; phenotyping complete 9-3; breeding stock db/db C57BLKS breeding; increased neuropathy 2-4 to 1-4; breeding stock Selenocysteine floxed (trsp) x synapsin cre STZ C57BL/6J breeding 8-4 Selenocysteine floxed (trsp) x podocin cre STZ C57BL/6J breeding 8-4 Koenig (Michigan) Koenig (Michigan) 35

36 Phenotyping: Current Tail Flick Hind Paw Every 8 weeks NCV Measured 12 and 24 weeks post-diabetes IEFD Measured at tissue harvest C57BLKS Animals being added GCLC +/- and +/+ Dbdb and Db+ C57Bl6 Dbdb Breeder Chow nestin Cre// SOD2 LoxP/LoxP synapsin Cre// SOD2 LoxP/LoxP fyn (-/-)(+/-)(+/+) STZ treated and control X X X X X Ongoing 4 animals X (9 animals) Animals Breeding X X (9 animals) X GLUT4 (-/-) (+/+) STZ treated and control X X 36

37 General schema for evaluation STZ 5 mg/kg/day x 5 days Sensory function ±NCVs uma/creat (spot) Sensory function +NCVs uma/creat (24h) blood glc Age (months) BP harvest kidneys, nerves, blood 37

38 Nerve Conduction Velocity GCLC+/+, +/- Db/db Mice TSNCV TDML 3 4 meters/second 2 1 milliseconds wt db+ wt dbdb gclc db+ gclc dbdb wt db+ wt dbdb gclc db+ gclc dbdb SMNCV 5 meters/second No Significant Differences wt db+ wt dbdb gclc db+ gclc dbdb 38

39 C57BlKS * * * P<.1 39

40 C57BlKS : Sensory Tests * # * P<.1 # P <.5 4

41 C57BlKS : Nerve Conductions * * * * P<.1 41