Ahmad Seif Kanaan1,2, Alfred Anwander1, Riccardo Metere1, Andreas Schäfer3, Torsten Schlumm1, Jamie Near4, Berkin Bilgic5, Kirsten Müller-Vahl2, and Harald Möller1
1Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany, 2Department of Psychiatry, Hannover Medical School, Hannover, Germany, 3Siemens Healthcare, Erlangen, Germany, 4Douglas Mental Health Institute, McGill University, Montreal, QC, Canada, 5Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
Synopsis
We employ a genetic-imaging approach to examine the
underlying genetic basis of magnetic susceptibility reductions at a major locus
of pathophysiology in Gilles de la Tourette syndrome (GTS). Voxel-wise
statistical differences of motor-striatal susceptibility exhibited significant associations
with the expression profile of iron-related gene-sets extracted from the Allen
Human Brain Atlas, thus suggesting that the
expression of iron-related genes coincides with patterns of
susceptibility reductions in GTS. This work supports previous studies relating
magnetic susceptibility to brain iron and provides an example of an analytic
strategy in which valuable insights can be gleaned by exploring associations
between gene-expression and image-derived phenotypes.
Introduction
Gilles de la Tourette syndrome (GTS) is a neuropsychiatric movement
disorder characterized by tics with reported abnormalities in the
neurotransmission of dopamine, GABA and glutamate (1, 2). Given that iron plays an
integral role in varied biochemical processes involved in neurotransmitter
synthesis and transport (3), we hypothesized that iron
exhibits a role in GTS pathophysiology. Utilizing Quantitative Susceptibility
Mapping (QSM) as a surrogate measure of iron, we showed that GTS patients
exhibit magnetic susceptibility reductions in subcortical regions implicated in
disease pathophysiology (Fig. 1) (4). To explore the underlying
genetic basis of these reductions, we employed an imaging-genetic approach to
assess relationships between voxel-wise, nucleus specific, susceptibility differences
with the default expression profile of iron-related gene-sets extracted from
the Allen Human Brain Atlas (AHBA) (5). Given
that genetic transcriptional profiles are known to exhibit distinct expression
patterns in the brain, we aimed to investigate spatially specific relationships
exhibited between susceptibility and gene expression patterns to glean further
insights into pathophysiological mechanisms of iron-related changes. To
explore the relevance of these reductions to the clinical population, we
additionally employed a machine learning approach to investigate associations
with clinical symptomatology.Methods
QSM and
MP2RAGE data
were acquired from 28 GTS patients and 26 age/gender matched healthy controls
on a 3T Siemens MAGNETOM Verio using a 32-channel head coil. A 10ml blood
sample was collected from each subject for the quantitation of serum Ferritin,
in addition to a comprehensive clinical assessment battery.
Susceptibility-weighted data were acquired using FLASH (TR=30ms; TE=17ms;
flip-angle=13°; 0.8mm isotropic nominal resolution).
High-quality phase maps were reconstructed using data-driven coil combination (6) and QSM images were computed using the SDI
approach (7) with referencing to lateral ventricle CSF
(8). To investigate associations between
magnetic susceptibility and clinical symptoms, we first decomposed the clinical
data into a set of clinical scores using Principal Component Analysis (PCA). To interrogate genetic mechanisms that may drive abnormalities
in iron levels, we employed a cross-correlation approach to examine the
relationship between susceptibility differences with gene expression profiles
extracted from the AHBA. Voxel-wise
susceptibility difference statistical maps were calculated via nonparametric
permutation testing while accounting for age, gender and image quality
(FSL-randomise, 10,000 permutations). Transcriptional levels of genes
incorporated within four iron-related gene sets (iron-homeostasis, iron-deficiency; iron transport and uptake and
Iron-storage (9, 10)) were then extracted from loci of pathophysiology at specific
coordinates sampled in the AHBA. For each gene-set, principal components were
extracted and cross-correlated to statistical values of striatal susceptibility
differences in same coordinate space (MNI). To evaluate whether the observed
correlations were significant, a permutation-based approach was implemented in
which the null distribution was constructed using a re-sampling based approach (10,000
permutations).
For each permutation, Pearson correlation was calculated between
magnetic susceptibility differences and the average gene-expression value of
random set of genes with an equal size to the gene set of interest (alpha level
of 0.05).Results
The correlation matrix between all the acquired
clinical variables revealed sufficient complementary for data-reduction using
PCA (Fig 2A). PCA yielded a set 4 components explaining 77% of the variance
that were interpreted as representing scores for (i) depression/anxiety; (ii)
motor-tics, (iii) obsessions/compulsions, (iv) attention-deficits/hyperactivity
(Fig. 2B). Regression analysis between the motor-tic score and surrogate
measures of iron revealed a trend with serum ferritin levels and a significant
negative association with striatal susceptibility (Fig. 2C). Driven by these
results, iron-related gene expression profiles were extracted within three functionally distinct sub-territories of
the striatum (motor, associative, limbic) and cross-correlated with statistical
maps of magnetic susceptibility reductions at the same coordinates. Permutation
based inference revealed significant positive associations between striatal-motor
susceptibility and the principal components of the iron-related gene-sets (Fig.
3). Inspection of associations between the mean expression profile of the
iron-related gene-sets and magnetic susceptibility statistical values, revealed
similar findings. These results indicate
that iron-related abnormalities in the motor sub-division of the striatum
exhibit a major role in the pathophysiology of GTS.Discussion
We demonstrate a link between magnetic susceptibility
reductions and default expression profiles of iron-related genes within a major
locus of pathophysiology in GTS. These findings suggest that the expression
profiles of iron-related genes coincide with patterns of susceptibility reductions
in patients with GTS, thus providing a link between disrupted iron homeostasis
and GTS pathophysiology. This work supports previous studies relating magnetic
susceptibility to brain iron and provides an example of an analytic strategy in
which valuable insights on disease pathophysiology can be achieved by exploring
associations between genetic transcriptional profiles and image derived phenotypes.Acknowledgements
This work was
funded by the FP7 Marie Curie Actions of the European Commission (“TS-EUROTRAIN
FP7-PEOPLE-2012-ITN, Grant No. 316978”) and,
in part, by the Helmholtz Alliance “ICEMED: Imaging and Curing
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