Francesca Cicchetti

Expanded CAG/CTG repeats cause more than 15 different diseases that all remain without a disease-modifying treatment. Because repeat length accounts for most of the variation in disease severity, contracting CAG/CTG repeats presents an attractive therapeutic avenue. Here, we show that the CRISPR-Cas9 nickase targeted to CAG/CTG repeats leads to efficient repeat contractions in Huntington’s disease (HD) patient–derived neurons and astrocytes and in myotonic dystrophy type 1 patient–derived neurons. The approach was allele selective and free of detectable off-target mutations. Injection of the Cas9 nickase into the striatum of the R6/1 mouse model of HD using adeno-associated viral vectors led to repeat contractions in more than half of striatal neurons. Upon injection, we observed a reduction in the number of inclusion bodies, an improved gene expression profile, and amelioration of locomotion deficits in the open field test. The effects were greater than expected from the contractions induced, suggesting that non–cell autonomous mechanisms may be involved. Our results provide the proof of concept that correction of CAG/CTG repeats can improve HD phenotypes in a mouse disease model.

Brain vascular barriers are dysfunctional in many neurological disorders, including Huntington’s disease (HD), but which vessels are affected and how remains unclear. Using in vivo two-photon microscopy in R6/2 HD-model mice, we reveal a striking divergence in barrier dysfunction. Surface vessels of the blood-cerebrospinal fluid barrier (BCSFB) drive pathology in HD by paracellular leakage, while parenchymal vessels forming the blood-brain barrier (BBB) exhibit increased vesicular transport and adsorptive-mediated transcytosis (AMT), with arterioles representing the most critically impacted vascular segment. The pathology of both barriers was spatially-matched with astrocyte activation pattern localized to affected vessels both in R6/2 mice and in brains of HD patients. Sphingosine-1-phosphate receptor 1 (S1pr1) agonist treatment reversed BCSFB leakage and partially restored BBB function, selectively reducing AMT in arterioles, with no effect in capillaries and venules. These findings redefine HD vascular pathology, demonstrating heterogeneous, vessel-type-specific barrier failure beyond generalized “disruption,” uncovering mechanistic vulnerabilities and the therapeutic potential of S1pr1 modulation.

Purpose: Neutrophil extracellular traps (NETs) are chromatin-based structures decorated with neutrophil enzymes such as elastase and myeloperoxidase (MPO). We previously demonstrated that amyloid fibrils (AFs), regardless of their protein composition, induce NET release in human neutrophils in vitro through a mechanism dependent on reactive oxygen species generated by NADPH oxidase 2 (NOX2). In this study, we investigated whether α-synuclein amyloid fibrils (αSF) induce NET formation in vivo and whether NETs modulate amyloid-associated pathology. Methods: αSF were instilled intratracheally into wild-type (WT) and gp91phox knockout (KO) mice, which lack NOX-2 activity and are unable to form NETs. Both male and female mice were analyzed. Eight hours post-instillation, lungs were assessed for neutrophil infiltration, NET formation (citrullinated histones and myeloperoxidase), amyloid fibril persistence (Congo red staining), and lung mechanics (elastance and resistance). Results: αSF induced robust neutrophil recruitment and lung inflammation in both WT and KO mice. However, NET formation was detected exclusively in WT animals. Congo red–positive amyloid-like structures persisted in KO lungs but were largely absent in WT mice, indicating NET-associated proteolysis promotes fibril clearance. Functionally, αSF impaired lung elastance in both genotypes at early time points. As fibrils were cleared in WT mice, lung function recovered. In contrast, KO animals exhibited persistent fibril deposition and sustained elastance impairment. Additionally, NET structures were observed in post-mortem brain tissue from patients with Parkinson’s disease. Conclusion: These findings demonstrate that NETs act as an innate immune mechanism capable of sensing and degrading amyloid fibrils in vivo, thereby promoting their clearance and preserving tissue function. This mechanism may play a relevant role in modulating amyloid-associated pathology, including in human neurodegenerative diseases such as Parkinson’s disease.

Parkinson’s disease (PD) is a neurodegenerative disorder traditionally characterized by dopaminergic neuron loss in the substantial nigra pars compacta , but peripheral immune dysregulation and blood-brain barrier (BBB) dysfunction have been increasingly implicated in disease etiology. However, how circulating immune cells interact with the human BBB and how these interactions are captured across experimental models remains poorly understood. In particular, human BBB models offer multiple platforms to interrogate these biological questions, with organ-on-chip approaches attracting significant interest. In this context, it is essential to determine whether model architecture influences the assessment of immune-endothelial interactions in PD, and if it may lead to fundamentally different interpretations of immune cell trafficking at the human BBB. Here, we compared peripheral blood mononuclear cells (PBMCs) from control donors or individuals with PD in human induced pluripotent stem cell (iPSC)-derived BBB models to determine how static and dynamic BBB systems influence immune cell behavior. To do so, we leveraged our brain chip platform to establish a model based on expression of the PD-associated SNCA triplication mutation. Using a two-dimensional transwell system and a three-dimensional (3D) microfluidic BBB chip, we evaluated PBMC attachment and transmigration under conditions of PBMC disease status, endothelial genotype associated with SNCA triplication, and exposure to α-synuclein (α-Syn) monomers or preformed fibrils (PFFs). PBMCs from PD donors showed increased baseline reactivity and altered endothelial interactions compared with controls. In transwell models, SNCA triplication increased PBMC attachment and selectively enhanced PD PBMC transmigration, while PFF increased attachment without affecting transmigration. In contrast, in the microfluidic BBB chip, attachment was largely unchanged by endothelial genotype or α-Syn exposure, whereas transmigration increased following α-Syn monomer pre-treatment. Together, PBMC-BBB interactions in PD appear to be shaped by immune cell status, endothelial genotype, and α-Syn exposure, but are strongly influenced by BBB model dimensionality and flow. This study underscores the importance of physiologically relevant multicellular and flow-based BBB systems and provides a human-focused framework for studying peripheral immune cell trafficking across the diseased BBB. These findings also emphasize that biological insights into BBB function are inherently shaped by the experimental model used, underscoring the need for complementary human BBB platforms.

Brain vascular barriers are dysfunctional in many neurological disorders, including Huntington’s disease (HD), but which vessels are affected and how remains unclear. Using in vivo two-photon microscopy in R6/2 HD-model mice, we reveal a striking divergence in barrier dysfunction. Surface vessels of the blood-cerebrospinal fluid barrier (BCSFB) drive pathology by paracellular leakage, while the blood-brain barrier (BBB) of parenchymal arterioles and capillaries exhibited increased vesicular transport and adsorptive-mediated transcytosis (AMT), with arterioles being the most susceptible segment. The pathology of both barriers was congruent with astrocyte activation localized to affected vessels in R6/2 mice, as well as in post-mortem HD human brains. Sphingosine-1-phosphate receptor 1 (S1PR1) agonist treatment rescued BCSFB leakage but only partially restored BBB function, selectively reducing AMT in arterioles, with no effect in capillaries and venules. These findings redefine HD vascular pathology, demonstrating heterogeneous, vessel-type-specific barrier failure beyond generalized “disruption,” uncovering mechanistic vulnerabilities and the therapeutic potential of S1PR1 modulation.

Parkinson’s disease (PD) is a neurodegenerative illness characterized by motor and non-motor features. Hallmarks of the disease include an extensive loss of dopaminergic neurons in the substantia nigra pars compacta, evidence of neuroinflammation, and the accumulation of misfolded proteins leading to the formation of Lewy bodies. While PD etiology is complex and identifying a single disease trigger has been a challenge, accumulating evidence indicates that non-neuronal and peripheral factors may likely contribute to disease onset and progression. The brain is shielded from peripheral factors by the blood-brain barrier (BBB), which tightly controls the entry of systemic molecules and cells from the blood to the brain. The BBB integrates molecular signals originating from the luminal (blood) and abluminal (brain) sides of the endothelial wall, regulating these exchanges. Of particular interest are erythrocytes, which are not only the most abundant cell type in the blood, but they also secrete extracellular vesicles (EVs) that display disease-specific signatures over the course of PD. Erythrocyte-derived EVs (EEVs) could provide a route by which pathological molecular signals travel from the periphery to the central nervous system. The primary objective of this study was to evaluate, in a human-based platform, mechanisms of EEV transport from the blood to the brain under physiological conditions. The secondary objective was to determine the ability of EEVs, generated by erythrocytes of healthy donors or patients, to induce PD-like features. We leveraged two in vitro models of the BBB, the transwell chambers and a microfluidic BBB chip generated using human induced pluripotent stem cells. Our findings suggest that EEVs transcytose from the vascular to the brain compartment of the human BBB model via a caveolin-dependant mechanism. Furthermore, EEVs derived from individuals with PD altered BBB integrity compared to healthy EEV controls, and clinical severity aggravated the loss of barrier integrity and increased EEV extravasation into the brain compartment. PD-derived EEVs reduced ZO-1 and Claudin 5 tight junction levels in BMEC-like cells and induced the selective atrophy of dopaminergic neurons. In contrast, non-dopaminergic neurons were not affected by treatment with PD EEVs. In summary, our data suggest that EEV interactions at the human BBB can be studied using a highly translational human-based brain chip model, and EEV toxicity at the neurovascular unit is exacerbated by disease severity.

Tau is a microtubule protein that is known to be hyperphosphorylated and to aggregate in several chronic neurodegenerative disorders. In many cases, in particular in Alzheimer’s disease, the degree of tau pathology has been demonstrated to correlate with cognitive deficits and/or decline. In Huntington’s disease (HD), a dominantly inherited neurodegenerative disorder, both cognitive impairments and abnormal tau expression have been reported to occur, along with the accumulation of the mutant huntingtin protein. In this respect, tau has been shown to be present in the cerebrospinal fluid of individuals with HD and to increase with disease progression. However, how this relates to changes in tau found in the periphery is largely unknown. In this study, we collected blood samples from patients with HD and isolated multiple blood components including plasma, platelets, and peripheral blood mononuclear cells to measure their tau levels and subsequently correlate these to cognitive impairments and disease stage. Our results suggest that the amount of tau, particularly N-terminal tau (NTA-tau) and total tau (t-tau), is elevated in all assayed blood components and that the quantity of tau within platelets, specifically, is strongly correlated with disease severity.