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Copyright © 2011 Cognizant Communication Corporation
CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
DOI: 10.3727/096368911X600957
CCTT--00551111 AAcccceepptteedd 88//2299//22001111 ffoorr ppuubblliiccaattiioonn iinn ““CCeellll TTrraannssppllaannttaattiioonn””
Altered oxygen metabolism associated to neurogenesis of induced pluripotent stem
cells derived from a schizophrenic patient
Authors and Affiliations
Bruna da Silveira Paulsen1*, Renata de Moraes Maciel1*, Antonio Galina2, Mariana
Souza da Silveira3, Cleide dos Santos Souza1, Hannah Drummond1, Ernesto Nascimento
Pozzatto1, Hamilton Silva Junior1, Leonardo Chicaybam4, Raffael Massuda5, Pedro
Setti-Perdigão9, Martin Bonamino4, Paulo Silva Belmonte-de-Abreu5, Newton
Gonçalves Castro9, Helena Brentani6,7,8, Stevens Kastrup Rehen1#
1Laboratório Nacional de Células–Tronco Embrionárias, Instituto de Ciências
Biomédicas, UFRJ, Rio de Janeiro, RJ, 21941-913, Brazil; 2Laboratório de
Bioenergética e Fisiologia Mitocondrial, Instituto de Bioquímica Médica, UFRJ, Rio de
Janeiro, RJ, 21941-590, Brazil; 3Laboratório de Neurogênese, Instituto de Biofisica
Carlos Chagas Filho, UFRJ, Rio de Janeiro, RJ, 21941-902, Brazil; 4Divisão de
Medicina Experimental, Instituto Nacional de Câncer, Rio de Janeiro, RJ, 20231-050,
Brazil; 5Departamento de Psiquiatria, Faculdade de Medicina, Universidade Federal do
Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil; 6Departamento de Psiquiatria,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, 05403-010, Brazil;
7Instituto Nacional de Psiquiatria do Desenvolvimento, Faculdade de Medicina,
Universidade de São Paulo, São Paulo, SP, 05403-010, Brazil; 8Laboratório de
Investigação Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo,
SP, 05403-010, Brazil; 9Laboratório de Farmacologia Molecular, Instituto de Ciências
Biomédicas, UFRJ, Rio de Janeiro, RJ, 21941-902, Brazil.
*These authors provided equal contribution to this work.
Copyright © 2011 Cognizant Communication Corporation
CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
#Address correspondence to Stevens K. Rehen, National Laboratory for Embryonic
Stem Cell Research, UFRJ, Hospital Universitário Clementino Fraga Filho – HUCFF,
Rua Rodolpho Paulo Rocco, 255 - 4º andar – CEPEDIP - Cidade Universitária Rio de
Janeiro – RJ, Brasil. Phone: + 55 21 2562 2928; E-mail: srehen@lance-ufrj.org
ABSTRACT
Schizophrenia has been defined as a neurodevelopmental disease that causes changes in
the process of thoughts, perceptions and emotions, usually leading to a mental
deterioration and affective blunting. Studies have shown altered cell respiration and
oxidative stress response in schizophrenia; however, most of the knowledge has been
acquired from post-mortem brains analyses or from non-neural cells. Here we describe
that neural cells, derived from induced pluripotent stem cells generated from skin
fibroblasts of a schizophrenic patient, presented a 2-fold increase in extra-mitochondrial
oxygen consumption as well as elevated levels of reactive oxygen species (ROS), when
compared to controls. This difference in ROS levels was reverted by the mood stabilizer
valproic acid. Our model shows evidence that metabolic changes occurring during
neurogenesis are associated with schizophrenia, contributing to a better understanding
of the development of the disease and highlighting potential targets for treatment and
drug screening.
Key words: Schizophrenia; Oxygen Metabolism; Induced Pluripotent Stem Cells; ROS
production
Running head: ROS associated to neurogenesis in schizophrenia
Copyright © 2011 Cognizant Communication Corporation
CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
INTRODUCTION
Schizophrenia is characterized by both positive and negative symptoms, such as
auditory hallucinations, paranoid delusions and social impairment. The disability of
schizophrenia is largely due to cognitive deficits, such as lack of attention and working
memory. Usually, first symptoms are identified in the adolescence or in early adulthood
and after that, the disease enters into a chronic evolution, regardless of culture, social
class, racial group and gender (31).
Brain mitochondria play a key role in neuroenergetics, as they are essentials regulators
of intracellular Ca2+ and reactive oxygen species (ROS) homeostasis, as well as of the
glutamate-lactate metabolism. Therefore, an imbalance between mitochondrial and non-
mitochondrial ROS production (12,25,37), in addition to impaired levels of antioxidant
defenses, may lead to altered intracellular signaling radicals or oxidative stress,
conditions that have been associated with neurodysfunction (20,38,40,47). In fact, a
large number of studies have shown affected efficiency of oxidative phosphorylation
and ROS levels in some psychiatric diseases such as schizophrenia (11). On the other
hand, even though it is not known whether schizophrenia involves ROS overproduction
by non-mitochondrial sources, an impaired oxidative stress response has been
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CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
associated with the disorder for a long time (21), in which changes in glutathione (GSH)
synthesis were reported, as well as polymorphisms in key enzyme genes (22,44,49).
Much of the knowledge about schizophrenia biology is the result of analyses in post-
mortem brains, which are not always preserved under ideal conditions (35) and are
usually a representation of the final stage of the disease, not providing proper clues
about its development. In order to overcome these limitations, others have used non-
neural cells as a model for studying schizophrenia; however, it is not clear how
informative these cells are for understanding the onset of the disease (36).
Since schizophrenia has been proposed as a neurodevelopmental disorder (27), the
generation of a new model by reprogramming somatic cells into induced pluripotent
stem (iPS) cells has the advantage of enabling the study of neurogenesis and early
phenotypic changes associated to the mental illness, avoiding interferences such as
therapeutic treatment.
Understanding the role of oxygen metabolism, both in diseased brain and throughout
development, is of critical importance to elucidate pathophysiological mechanisms in
psychiatric disorders. Taking all this into account, we decided to explore oxygen
consumption and ROS levels changes in neural cells derived from reprogrammed
fibroblasts obtained from a schizophrenic patient.
In the current study, we successfully generated two clones of iPS cells from skin
fibroblasts of one patient with schizophrenia. When compared to controls, neural
precursor cells derived from these two independent schizophrenic iPS clones showed
altered extra-mitochondrial oxygen consumption associated with an increase in the
levels of ROS, which was reverted by the use of valproic acid (VPA). Using the iPS
Copyright © 2011 Cognizant Communication Corporation
CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
model, our results provide the first evidence of a developmental metabolic alteration in
schizophrenia, which can be reverted by pharmacological intervention.
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CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
MATERIAL AND METHODS
Schizophrenic patient
The patient with DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders)
diagnosis of schizophrenia was recruited from the outpatient clinic (Schizophrenia
Program) at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
Psychiatric diagnosis was defined after a comprehensive assessment, including clinical
interview, application of the Structured Clinical Interview for DSM-IV-Axis I Disorders
(SCID-I), and Operational Criteria (OPCRIT), based on medical history, interview with
caregivers and clinical examination. The patient is a 48 year-old woman considered as
Clozapine-resistant. Skin tissue for use in reprogramming experiments was obtained
after patient and caregivers signed an informed consent approved by the HCPA
Institutional Review Board (IRB00000921). Data was analyzed anonymously and all
clinical investigations were conducted according to the principles expressed in the
Declaration of Helsinki.
Derivation of primary human fibroblast from schizophrenic patient
Skin fibroblasts from schizophrenic patient were obtained after patient and caregivers
signed an informed consent approved by the Ethics Committee of the Institution
(Institutional Review Board). Using sterile technique, a 10-mm full-thickness skin cut
biopsy was taken from the neck surface of the patient by a plastic surgeon. The biopsy
was cut into 2x2 mm pieces. The pieces were plated in a T75 bottle and maintained in 2
mL of DMEM/F12 supplemented with 10 % fetal bovine serum (FBS) and 20 µg/mL
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ciprofloxacin. After fibroblast migration (10–14 days), cells were detached using
TrypLETM Express (Invitrogen) and maintained in DMEM/F12 medium supplemented
with 10 % FBS without antibiotics. Age-matched male control fibroblasts were obtained
from a commercial source (Excellion, Brazil).
Cell culture H9 female human embryonic stem (ES) cells and iPS cells were cultured on Matrigel
(BD Biosciences) -coated plates in mTeSR™1 (StemCell Technologies). All splits were
performed mechanically as colonies clumps. To form embryoid bodies (EBs), confluent
undifferentiated iPS cells were treated with accutase (Millipore), scrapped out and
transferred to 60 mm, non-adherent dishes in DMEM/F12 medium supplemented by
15% of knockout serum replacement (KSR; Invitrogen), 1% nonessential amino acid
solution (Invitrogen), 2mM L-glutamine (Invitrogen), 0.1mM β-mercaptoethanol
(Invitrogen), 40μg/mL gentamicin sulfate (Schering-Plough).
iPS cell generation
The pMX-based retroviral vectors encoding human Octamer binding transcription factor
4 [Oct4], (sex determining region Y) box 2 [Sox2], Krüppel-like factor 4 [Klf4] and c-
Myc cDNAs (48) were prepared as described previously by Paulsen and coworkers
(41). For generation of iPS cells, human primary fibroblasts were transduced overnight
with equal amounts of concentrated supernatants containing each of the four
retroviruses, supplemented with 8 g/mL polybrene. Twenty-four hours after
transduction, virus-containing medium was replaced with the second round of
supernatant. Two days after transduction, 50 g/mL of L-Ascorbic Acid (USB
Corporation) were added to cultures, as described by Esteban and coworkers (17). Six
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days after transduction cells were replated (5x104 cells per 6-well plate) on mitotically
inactivated mouse embryonic fibroblasts (MEFs). In the following day, medium was
replaced by mTeSR™1 and changed every day. Eight days after transduction, 1 mM of
valproic acid (VPA, Sigma) was added to the medium for another seven days. About
twenty days after transduction, colonies were picked up and transferred to 6-well plates
coated with Matrigel in mTeSRTM1. Pluripotent-like colonies were selected based on
morphological criteria, and pluripotency was verified by RT-PCR analyses and
immunostaining assays using OCT3/4 (Santa Cruz Biotechnology; mouse, 1:100),
stage-specific embryonic antigen 4 (SSEA4; Chemicon; mouse, 1:100), TRA-1-60
(Chemicon; mouse, 1:100) and TRA-1-81 (Chemicon; mouse, 1:100) primary
antibodies.
The cell lines derived in this work, as well as controls, are available in the cell bank of
the National Laboratory for Embryonic Stem Cell Research at Federal University of Rio
de Janeiro, LaNCE-RJ (Brazil).
RNA isolation and PCR analysis
Total RNA was isolated using the Trizol reagent (Invitrogen) and digested with DNase I
using DNA-freeTM Kit (Applied Biosystems), following manufacturer’s instructions.
Complementary DNA was generated from 1 g total RNA using High Capacity RNA-
to-cDNA Kit (Applied Biosystems), according to manufacturer’s recommendations.
Reverse transcription (RT)–PCR was performed using specific primer sequences (Table
S1). Each RT-PCR reaction was carried out for 35 cycles in a reaction mixture
containing 1U Taq DNA Polymerase (NB Science), 1 X Taq DNA Polymerase Buffer
containing 25 mM MgCl2 (NB Science), 500 nM of each primer (Forward and Reverse),
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200 M dNTP mixture containing the four deoxyribonucleotides (dATP, dCTP, DTTP,
dGTP) and 1 L of cDNA.
Neural differentiation of iPS cells
Generation of neural precursor cells (NPCs) was performed using retinoic acid (RA) as
previously described (3), and immunological analyses were done using primary
antibodies for Nestin (Chemicon; mouse, 1:100), III-tubulin (Sigma; mouse, 1:100)
and NeuN (Chemicon; mouse, 1:100).
High-resolution respirometry
Oxygen consumption was measured by high-resolution respirometry using the
OROBOROS Oxygraph 2k at 37 °C with chamber volumes set at 2 mL. DatLab
software (Oroboros Instruments, Innsbruck, Austria) was used for data acquisition and
analysis. Human fibroblasts, iPS cells and NPCs were enzymatically harvested,
centrifuged and resuspended in serum free DMEM. Cell routine respiration, which is
defined as respiration in cell-culture medium without additional substrates or effectors,
was determined under baseline conditions for 10-15 minutes. After observing routine
respiration, ATP synthase was inhibited by oligomycin (2 g/mL). Oxygen
consumption coupled to ATP synthesis by oxidative phosphorylation was derived from
the difference between routine respiration and oligomycin-resistant respiration. To
uncouple oxidative phosphorylation, stepwise titration of FCCP (carbonyl cyanide p-
trifluoromethoxyphenylhydrazone) was used in the range of 100-700 nM. After FCCP
titration, the electron transport chain of oxidative phosphorylation was stopped/blocked
by Antimycin A (1 g/mL) and/or KCN (0.5 mM) and the oxygen flow rate detected in
this condition was defined as extra-mitochondrial oxygen consumption.
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Reactive oxygen species (ROS) production
Formation of intracellular ROS was measured by incubating NPC-Control (NPCs from
a control patient) and NPC-SZP (NPCs from a schizophrenic patient) in the presence of
5-(and-6)-carboxy-2`,7`-dichlorodihydrofluorescein diacetate (CM-H2-DCFDA,
Molecular Probes). Control groups included cells without VPA treatment. VPA
treatment was performed by adding 1 mM of valproic acid to medium for 24 h. After
that, medium was replaced by fresh DMEM/F12 supplemented with 2 mM CM-H2-
DCFDA. Cells were incubated for 40 min at 37 °C and 5% CO2, and randomly chosen
fields were examined under a Zeiss Axio Observer.Z1 inverted microscope, equipped
with a 20X objective lens and an AxioCam MRm camera at a fixed exposure time. Five
independent fields were counted for each experimental condition, which was carried out
in triplicate.
Electrophysiology
Voltage-activated currents and synaptic activity were measured after further culturing
NPC-Control and NPC-SZP neural tube-like structures onto 5 μg/mL laminin and 15
μg/mL poly L-ornithine-coated tissue culture dishes in Neurobasal medium (Invitrogen)
supplemented with 1X B27 (Invitrogen) and 1X N2 (Invitrogen) for 20 days. Whole-
cell membrane currents were recorded at a membrane holding potential of –70 mV with
an EPC-7 (List, Germany) patch-clamp system. Currents were low-pass filtered at 3
kHz and digitized with a LabMaster interface under the control of pClamp software
(Axon Instruments, USA). The standard extracellular solution was 165 mM NaCl, 5
mM KCl, 2 mM CaCl2, 10 mM D-glucose, 5 mM HEPES, and ~2 mM NaOH, pH 7.34.
This solution replaced the culture medium approximately 20 minutes before the
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recordings and was continuously perfused at a rate of ~1 mL/min throughout the
experiments. Patch micropipettes were made from borosilicate glass capillaries (WPI,
USA) in a P-97 horizontal puller (Sutter Instruments, USA). The intracellular solution
was 80 mM CsCl, 80 mM CsF, 10 mM EGTA, 10 mM HEPES, and ~26 mM CsOH, pH
7.3. The filled patch microelectrodes had resistances of 2 to 5 MΩ in the bath; the
access resistance was left uncompensated. Approximately 2 minutes after achieving the
whole-cell configuration, voltage sensitive sodium currents were evoked by 50 ms-
depolarizing square pulses ranging from –40 mV to +10 mV from a holding potential of
–70 mV. Leak currents were subtracted by a fractional method (P/N) using four scaled
hyperpolarizing subpulses. Immediately after this pulse, 3-minute recordings of the
spontaneous activity were made for each cell. Recordings were made at room
temperature (~23°C).
Statistical Analyses
Statistical analyses were performed with GraphPad Prism 5 and validated by applying
Student’s t tests to compare two groups individually, or One-Way ANOVA followed by
Newman-Keuls post-test to compare more than two groups. Confidence intervals were
defined at 95% confidence level (p<0.05 was considered to be statistically
significant).RESULTS
Characterization of iPS cells generated from fibroblasts of a patient with schizophrenia
Skin fibroblasts obtained from one patient with schizophrenia and one control with
similar age (Fig. 1A, B) were reprogrammed through retroviral transduction. Two SZP
iPS clones (SZP-C11 and SZP-C2) (Fig. 1B; Fig. S1A, B, respectively) and one control
iPS clone (Fig. 1A) were manually selected based on their human ES cells-like
morphology. Both clones from the schizophrenic patient presented similar results
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regarding all the analyses. Data presented here refers to SZP-C11, while data from SZP-
C2 can be found at the supplemental material. All iPS clones used had similar rates of
growth and stable karyotypes with 46 chromosomes (data not shown). Analysis by RT-
PCR demonstrated that both iPS-Control and iPS-SZPs cells present similar expression
of pluripotency markers compared to one of the most widely used human embryonic
stem (hES) cells lines, H9 (Fig. 1C) (19). Pluripotency markers were also verified by
immunostaining for OCT3/4, SSEA4, Tra-1-60 and Tra-1-81 (Fig. 1D, E).
Since teratoma formation is not required for iPS cells in vitro applications (16), and in
this work we intended to use those cells as a tool for studying schizophrenia-associated
events during neurogenesis, we adopted differentiation of the selected iPS cells into
embryoid bodies (EBs), which were similar to those generated from H9 cells (data not
shown), and also toward early neuroectoderm, mesoderm, and endoderm, to allow
assessment of their differentiation capacity (Fig. 1F-H). Moreover, iPS cells were able
to differentiate into spontaneously beating cells in vitro (data not shown) or, when co-
cultured with the mouse bone marrow derived stromal PA6 cell line, into neural cells
expressing the dopaminergic neuron marker tyrosine hydroxylase (TH) as well as other
neuronal markers (Fig. S2).
Direct differentiation of iPS cells into neural precursor cells
To induce iPS cells to direct neural differentiation, we performed an adaptation of
Baharvand and coworkers protocol (3) (Fig. 2A). During the first stage of the neural
induction, the cells underwent drastic morphological changes. During the second stage,
rosettes and neural tube-like structures (Fig. S3, left panels) were noticed amongst
differentiating cells. The emergence of neural processes could be observed at the final
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stage of differentiation, in both iPS-Control and iPS-SZP cells (Fig. S3, right panels).
By the end of 18 days of differentiation, we obtained a population of neural precursor
cells (NPCs) that similarly expressed the neuronal marker gene nestin in both NPC-
Control (51.9 ± 4.3%) and NPC-SZP (53.7 ± 2.8%). Other neuronal marker genes were
expressed by these cells such as βIII-Tubulin and NeuN [neuronal nuclei] (Fig. 2B; Fig.
S1E), as well as aromatic amino acid decarboxylase [AADC] and dopamine transporter
[DAT] (dopaminergic neurons), choline acetyltransferase [ChAT] (cholinergic neurons)
and LIM homeobox transcription factor 1, beta [LMX1B] (serotonergic neurons) were
evidenced by RT-PCR analysis (Fig. 2C; Fig. S1H). Furthermore, after more 20 days in
culture, both NPC-Control and NPC-SZP expressed functional voltage activated
channels and formed functional synapses, as indicated by the presence of spontaneous
postsynaptic currents (Fig. 3). No apparent changes in neuronal differentiation or
expression of neuronal marker genes were observed amongst the experimental groups.
Changes in endogenous oxygen consumption are only observed in SZP neural precursor
cells but not in fibroblasts or iPS cells
Endogenous oxygen consumption is a result of two main components of O2 sink
systems: mitochondria and extra-mitochondrial oxidases (28). Total cellular oxygen
flow parameters were assessed in fibroblasts, iPS cells and NPCs from control and
schizophrenic individual by using high-resolution respirometry (Fig. 4; Fig. S4).
Respiratory control ratios were determined from titrations with the FoF1-ATP synthase
specific inhibitor, oligomycin, and the oxidative phosphorylation uncoupler, FCCP (Fig.
4A-C). These ratios yield important information regarding control of electron flux
through respiratory chain by the FoF1-ATP synthase, and also about maximal respiratory
capacity of mitochondrial electron transfer system (ETS) per cell. Oligomycin-inhibited
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respiration represents O2 consumption coupled to ATP synthesis (Fig. 4D). When the
proton ionophore FCCP is added to cells, it dissipates the proton gradient, and
mitochondrial oxygen flow is settled to a maximal rate (Fig. 4). It was observed that
routine, oligomycin-insensitive and maximal ETS respiration (FCCP-treated) were
much higher in fibroblasts than in iPS cells and NPCs (Fig. 4A-C). In addition, the
portion of respiration coupled to ATP synthesis was five to eight times higher in
fibroblasts than in iPS cells and NPCs, but no significant difference was observed
amongst all cell types when Control and SZP were compared (Fig. 4D). Analysis of the
same parameters in embryonic stem cells, H9, place them on a similar zone to iPS cells
and NPCs, displaying much lower rates than those detected in fibroblasts (Fig. 4B). The
slight difference observed between respiration parameters level of H9 and iPS cells lines
is consistent with other recently described metabolic differences between these two
types of pluripotent stem cells (50). Remarkably, after differentiation, all respiration
parameters (routine, oligomycin- and FCCP-treated rates) were down-regulated
exclusively in NPC-Control cells (Fig. 4C, black bars), while in NPC-SZP they
remained similar to those observed for iPS cells (Fig. 4C, grey bars).
In accordance with previous observations (26), fibroblasts derived from both control
and schizophrenic patient present over 80% of oxygen consumption attributed to
mitochondrial respiration, as shown when antimycin A or KCN-insensitive values are
compared to routine O2 flow in these cells (Fig. 4A, E). On the other hand, our results
show that, in iPS cells and NPCs, the main O2 consumption fraction is extra-
mitochondrial (Fig. 4B, C, E; Fig. S4A, C). The new finding consists in the fact that
fibroblasts from Control and SZP, as well as iPS cells from theses two groups, present
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no difference in extra-mitochondrial O2 consumption, while NPC-SZP shows 2-fold
higher levels than NPC-Control (Fig. 4E).
NPCs from schizophrenic patient present higher ROS levels, which is reverted by
valproic acid
Then, we analyzed whether the mood stabilizer VPA could interfere in two oxidative
activities: (i) extra-mitochondrial O2 consumption (Fig. 5A) and (ii) ROS levels (Fig.
5B, C). After VPA treatment, both NPC-Control and NPC-SZP presented a 2 to 3-fold
increase in extra-mitochondrial O2 flow. This result raised the possibility that there
could be an increase in ROS accumulation in cells mediated by oxidases activity
(1,23,42,52). In order to evaluate ROS levels, the ROS-sensitive fluorescent probe CM-
H2-DCFDA was used (Fig. 5B, C). It was observed that ROS detection was more than
2-fold higher in NPC-SZP than NPC-Control, in accordance to the extra-mitochondrial
O2 consumption pattern. However, although VPA treatment enhanced extra-
mitochondrial O2 consumption, this was not followed by ROS increase (Fig. 5),
suggesting that ROS levels detected in response to VPA might be determined by a
balance between ROS generation and antioxidant defenses. In fact, after VPA treatment,
we observed that NPC-SZP ROS levels were reduced to NPC-Control levels (Fig 5C).
DISCUSSION
Due to difficulties in obtaining biopsies of the central nervous system, the study of
neuropathological abnormalities in patients, especially during the early stages of the
disease, has long been halted. Moreover, there is speculation regarding the credibility of
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data obtained from adult patients, that could reflect effects of secondary cause (i.e.
constant use of a drug) rather than a disease phenotype (35).
Because iPS cells have a genetic background similar to that of the original donor cell
and are capable of generating all cell types, including neural cells, they appear as an
attractive model for the study of neuropathologies (4,32). It also facilitates
characterization of specific changes that might occur during nervous system
development (33). The potential of iPS cells to generate models of neurodegenerative
diseases has been successfully demonstrated by reprogramming of somatic cells from a
single patient with amyotrophic lateral sclerosis (13), one patient with spinal muscular
atrophy (15), one patient with Leucine-rich repeat kinase 2 (LRRK2) mutation of
Parkinson’s disease (39), one patient with X-linked chronic granulomatous disease (X-
CGD) (54), and four patients with Rett Syndrome (34).
However, modeling a multifactorial disorder, such as schizophrenia, is an enormous
challenge to the iPS cells field. Schizophrenia, for example, is a consequence of many
different combinations of gene malfunction and also the influence of environmental
factors (27). Because cellular and molecular mechanisms underlying the disease state
remain unclear, schizophrenia innovative models (i.e. iPS cells) are required as a
complementation to current models, such as post-mortem brains and animals (7).
Recently, fibroblasts from two schizophrenic patients with a mutation in DISC1
(Disrupted in schizophrenia 1) were reprogrammed into iPS cells without any specific
phenotype being described in vitro (10). In spite of being considered a risk factor for
developing schizophrenia, little is known about how DISC1 contributes to a spectrum of
the mental disorder (10). Furthermore, since schizophrenia is now considered a
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neurodevelopmental disorder, specific phenotypes associated with the disease in vitro
may only be revealed after the onset of neurogenesis, as described here.
Moreover, after reprogramming iPS cell from fibroblasts of four schizophrenic patients,
Brennand et al reported changes in gene expression of many components of the cyclic
AMP and WNT signaling pathways and also identified neuronal phenotypes associated
with the mental disorder, such as reduced neuronal connectivity, decreased neurite
number, post synaptic density protein 95 (PSD95)-protein levels and glutamate receptor
expression (7).
Here, we described a novel and different approach to the elucidation of changes in
respiration and ROS production in a patient with schizophrenia. We further show that
neurons derived from a schizophrenic patient developed electrophysiological properties
in vitro similar to those of mature neurons, as recently reported (7). In addition, we also
show that synaptic connections are formed amongst neurons from SZP without the
support of exogenous glial cells or co-cultured neurons. Therefore, one can envisage the
development of networked derived cell systems, which might better model the
complexities of schizophrenia. Since we could recapitulate at least some cellular aspects
of the disorder, our methodology may lead to the development of screening assays of
new compounds capable of modulating these aspects of schizophrenia pathophysiology.
However, as discussed by Brennand et al., due to sample size, our findings are
necessarily preliminary.
Increasing evidence indicates that schizophrenia may encompass a combination of many
different disorders with different outcomes, caused by distinct lesions that contribute to
the final clinical scenario (27,31). Therefore, it is worth mentioning that the expectation
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for the next decade is turned towards development of personalized approach to
treatment and prevention, aiming more accurate diagnosis and pathophysiologic
understanding based on individual risk detection (27). In this context, iPS cells seem to
be a valuable tool.
The use of oxygen consumption as an index of oxidative metabolism has been applied
for decades and revealed important mechanisms and enzyme activities related either to
redox or bioenergetic metabolisms (24,28,43).
Although there are consistent reports in which specific alterations in mitochondrial
physiology are described as a factor that contributes for the onset of psychiatric
disorders, including schizophrenia (5,11), the original causal relationship between the
disease and mitochondrial dysfunction has not been clearly identified.
Here the analysis of oxygen flow, which includes both mitochondrial and extra-
mitochondrial consumption rates, showed there was no detectable distinction in all
respiratory coupling states analyzed using oligomycin and FCCP, either in fibroblasts or
iPS cells from both Control and SZP. This observation supports the notion that
phenotypic differences between Control and SZP are not seen in non-disease-specific
cell types. The fact that routine, ATP-coupled or maximal ETS respirations rates are all
lower in iPS cells than in fibroblasts is in accordance with previous observations
demonstrating that mitochondria energy supply is lower in stem cells, in which
glycolysis assumes the spare energetic role (8,9,18). However, the novelty is that all the
above-mentioned respiration parameters are decreased in NPC-Control without loss of
the amount of ATP-coupled respiration. We described that these differences were
related to extra-mitochondrial oxygen consumption.
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Alterations observed in oxygen consumption of schizophrenic patient-derived cells
cannot be attributed to improper integration of the vectors in the genome since both SZP
clones (C2 and C11) presented similar results (see supplemental data).
One possibility for the total extra-mitochondrial O2 flow decrease observed in NPC-
Control is that cells undergoing differentiation have to reset their ROS levels for novel
signaling programs, as suggested for other cell types (30,43).
In contrast, oxygen flow in NPC-SZP remains similar to iPS-SZP levels (about 2-fold
higher than NPC-Control), which correlates to higher ROS levels. Some reports have
attributed to nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) a
relevant role in oxygen consumption and ROS generation in various cell types,
including hematopoietic and neural stem cells (30,43). Signaling roles for NOX-
produced ROS were also recently proposed (30), but other oxidases cannot be excluded.
The fact that NPC-SZP present higher levels of ROS in comparison with NPC-Control
could be related not only to an aberrant production of ROS, but also, to an impaired
regulation of antioxidant responses. In fact, it has been previously suggested that ROS
imbalance might be relevant to schizophrenia pathophysiology (6,14).
More interesting is the new finding that this neuroenergetic failure in NPC-SZP
(increased ROS production) might have emerged during neural differentiation and can
be attenuated pharmacologically.
Comparing oxygen consumption in response to VPA treatment to ROS levels, it
becomes clear that antioxidant responses are critically affected under these conditions.
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CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
In fact, VPA and other mood stabilizers were previously shown to interfere in pathways
able to revert oxidative stress (2,51).
The way in which VPA interacts with its cellular targets is still not fully understood.
However, evidences suggest that the mechanism of mood-stabilizing action of VPA
comprises acute effects due to the enhancement of gamma-aminobutyric acidergic
(GABAergic) transmission, followed by a variety of longer-term effects caused by
changes in gene expression, mediated in one hand by the glycogen synthase kinase
(GSK)-3 and/or inositol monophosphatase (IMPase) cascades (46), and in the other by
histone deacetylases inhibition. These changes in the expression of multiple genes are
involved in transcription regulation, cell survival, ion homeostasis, cytoskeletal
modifications and signal transduction (45). Besides that, it has been long established
that VPA protects against oxidative stress (29).
The effect of VPA in our model, reverting the schizophrenic-specific neuronal
phenotype in culture, may serve as a proof of principle for future high-throughput
screening of different drugs, including other epigenetic modifiers with similar effects as
VPA.
High-throughput screening technology using iPS cells is a novel alternative to current
drug discovery and toxicological tests, as it promotes the improvement of drug selection
and decreases costs and time of drug development. However, to validate this model,
further understanding and technology development are required to confirm that iPS cells
would be able to recapitulate such a complicated system, as the human organism.
Furthermore, quality criteria have to be monitored during reprogramming process in
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CT‐0511 Cell Transplantation Epub; submitted 04/11/2011, provisional acceptance 08/15/2011
order to certify the biologic relevance of iPS cell system for solving specific
toxicological questions (53).
In conclusion, the application of this approach of generating neural cells from iPS of a
schizophrenic patient revealed metabolic changes during neurogenesis, which might not
only contribute to the development of the disease but also represent an important target
for treatment.
SUPPLEMENTAL DATA can be downloaded from the link http://www.lance‐
ufrj.org/supplemental‐data‐schizophrenia‐2011‐cell‐transplantation‐9182736455.html.
ACKNOWLEDGEMENTS: We thank Dr. Aline Marie Fernandes for assistance with the
biopsies, Paulo André Nóbrega Marinho for assistance with cell cultures, Sylvie
Devalle for manuscript editing, Ismael Gomes and Sandra Pellegrini for technical
assistance. This work was supported by Fundação Carlos Chagas Filho de Amparo a
Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de
Desenvolvimento Científico e Tecnológico (CNPq), Instituto Nacional de Ciência e
Tecnologia (INCTC), Instituto do Milênio – Terapia Gênica (CNPq), Instituto Nacional
do Câncer (INCA) and INCT for Excitotoxicity and Neuroprotection/CNPq.
Authors declare no conflicts of interest.
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FIGURE LEGENDS
Figure 1. Reprogrammed induced pluripotent stem (iPS) cells are generated from
fibroblasts after biopsy. (A, B) Representative images of selected colonies with
embryonic stem (ES)-cell-like morphology derived from control and schizophrenic
(SZP) fibroblasts, respectively. (C) Expression of ES cell-marker transcripts in the iPS
clones in comparison to H9, a human embryonic stem cell line. (D) RT-PCR analysis
shows that iPS from both control and SZP patient express markers from the three germ
layer. (E, F) As shown by immunocytochemistry, control (E) and SZP patient iPS (F)
express pluripotency markers. Nuclei were stained with DAPI (blue). (G, H) Embryoid
bodies (EBs) from control and SZP iPS cells, respectively. Scale bars, 50 m.
GAPDH = Glyceraldehyde 3-phosphate dehydrogenase; OCT3/4 = octamer-binding
transcription factor 3/4; SOX2 = (sex determining region Y)-box 2; KLF4 = Krüppel-
like factor 4; DPPA2 = developmental pluripotency associated 2; ESG1 = Embryonic
stem cell-specific gene; FGF4 = fibroblast growth factor 4; GDF3 = Growth
differentiation factor-3; TERT = telomerase reverse transcriptase; REX1 = RNA
exonuclease 1; -RT = no reverse transcriptase; AFP = alpha fetoprotein; FOXA2 =
forkhead box A2; CK8 = cytokeratin 8; MSX1 = muscle segment homeobox 1; GFAP =
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glial fibrillary acidic protein; MAP2 = microtubule associated protein 2; PAX6a =
paired box gene 6a.
Figure 2. iPS cells differentiate into neural precursor cells (NPCs). (A) Schematic view
of the protocol used for differentiation. (B) Control and SZP iPS cells express the
neuroectodermal marker Nestin, and generate III-Tubulin and NeuN positive neural
cells after eighteen days of differentiation. Nuclei were stained with DAPI (blue). Scale
bars, 50 m. (C) RT-PCR showing that NPCs express neurochemical neuron markers.
RA= retinoic acid; AADC= aromatic amino acid decarboxylase; DAT = dopamine
transporter; ChAT = choline acetyltransferase; LMX1b = LIM homeobox transcription
factor 1, beta.
Figure 3. NPC-Control and NPC-SZP develop mature neuronal electrophysiological
properties after 20 days in culture. (A) Sample traces showing spontaneous postsynaptic
currents recorded at –70 mV in each group. (B) Averaged traces from five
representative synaptic currents from one cell in each case. (C) Voltage-activated
currents elicited by depolarizing pulses ranging from –40 mV to +10 mV in 10 mV
steps from a holding potential of –70 mV. Similar results were obtained from four
Control and four SZP neurons.
Figure 4. Neural precursor cells (NPCs) from the schizophrenic patient consume more
oxygen than control. (A, B, C) Different respiration conditions in fibroblasts (A), iPS /
H9 (B) and NPC (C) cells from Control (black bars) and SZP patient (gray bars). (D)
Respiration coupled to ATP synthesis in fibroblasts (Fib), iPS, NPCs and H9. (E) Extra-
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mitochondrial oxygen consumption. Bars represent mean ± s.e.m. (n=3 * p<0.01, **
p<0.001, with respect to NPC-Control). FCCP = carbonyl cyanide p-
trifluoromethoxyphenylhydrazone).
Figure 5. NPC-SZP generates more reactive oxygen species (ROS) than NPC-Control
and valproic acid (VPA) treatment reverts this condition. (A) Extra-mitochondrial
respiration on VPA treated and non-treated NPCs. (B) Fluorescence microscopy of
ROS derived from NPC-Control and NPC-SZP cells probed with 5-(and-6)-carboxy-
2`,7`-dichlorodihydrofluorescein diacetate (CM-H2-DCFDA), Scale bar, 100 m. (C)
Reactive oxygen species generation of VPA-treated and non-treated NPC-Control and
NPC-SZP. Bars represent mean ± s.e.m. (n=3,* p<0.05, ** p<0.001, with respect to
NPC-Control or as indicated by black lines).
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Figure 1:
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Figure 2:
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Figure 3:
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Figure 4:
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Figure 5:
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