Justin Michael A. Naniong

Peripheral neurons have an intrinsic capacity for repair, albeit still challenging. How the nervous system responds to the cellular stress imposed by nerve injury and adjunct therapies impacts axon regeneration and functional outcomes. Here, we summarize some of the key primarily axonal and neuronal adaptive stress responses and mechanisms that underlie the ability of peripheral neurons to regenerate an axon. This includes activation of the unfolded protein response and endoplasmic reticulum membrane-associated molecules, namely Luman/CREB3, a transmembrane basic leucine zipper transcription factor that regulates the encoding of beneficial adaptive stress responses that drive the ability of an injured sensory neuron to regenerate their axon. We also highlight an emerging novel non-invasive strategy, therapeutic acute intermittent hypoxia, that imposes a level of beneficial adaptive stress that can alter gene programs induced by the injury to enhance regeneration in a manner akin to the more invasive yet highly effective electrical nerve stimulation. The ability to manipulate and significantly elevate the intrinsic adaptive stress/repair responses of injured peripheral neurons holds therapeutic promise, with accumulating evidence supporting its clinical use.

Misfolded protein accumulation in demyelinating disorders or injury can trigger internal endoplasmic reticulum (ER) stress alleviation mechanisms, namely the unfolded protein response (UPR) and cholesterol biosynthesis pathways. Here we demonstrate that the ER stress-associated transcription factor Luman/CREB3, herein called Luman, shown to drive axon regeneration by UPR-dependent regulation of adaptive low-level stress, also positively regulates rat Schwann cell (SC) survival, myelination, the UPR, and cholesterol production in vitro . siRNA knockdown of SC Luman expression decreased SC viability and increased apoptosis 48 hours post-transfection. Dorsal root ganglion (DRG) neuron/SC co-cultures where SCs overexpressed Luman exhibited increased myelination. Simulation of unstressed, mild and moderate ER stress by tunicamycin-mediated UPR induction in SCs, allowed examination of Luman on expression of known UPR regulators, including Xbp1, Xbp1s , CHOP, and pIRE1. They collectively demonstrate a cytoprotective role for Luman under manageable ER stress. Total cholesterol levels and sterol precursor Srebf1 expression, key to myelination, also decreased following Luman knockdown. Finally, levels of mature brain-derived neurotrophic factor (mBDNF), a positive regulator of myelination and also regulated by the UPR, decreased with Luman knockdown. In contrast, pro-apoptotic BDNF precursor (proBDNF) levels increased in Luman-deficient SCs at higher ER stress levels, indicating that any protection Luman confers at moderate ER stress levels is lost upon its reduced expression. In conclusion, a connection between Luman and adaptive beneficial ER stress pathways linked to survival and myelination capacity in SCs exists. These Luman-driven cytoprotective mechanisms including survival and myelination open avenues for targeting this pathway in nerve trauma and myelinating disorders.

Multiple interrelated pathways contribute to the pathogenesis of preeclampsia, and variants in susceptibility genes may play a role among Filipinos, an ethnically distinct group with high prevalence of the disease. The objective of this study was to examine the association between variants in maternal candidate genes and the development of preeclampsia in a Philippine population. A case-control study involving 29 single nucleotide polymorphisms (SNPs) in 21 candidate genes was conducted in 150 patients with preeclampsia (cases) and 175 women with uncomplicated normal pregnancies (controls). Genotyping for the GRK4 and DRD1 gene variants was carried out using the TaqMan Assay, and all other variants were assayed using the Sequenom MassARRAY Iplex Platform. PLINK was used for SNP association testing. Multilocus association analysis was performed using multifactor dimensionality reduction (MDR) analysis. Among the clinical factors, older age (P < 1 × 10–4), higher BMI (P < 1 × 10–4), having a new partner (P = 0.006), and increased time interval from previous pregnancy (P = 0.018) associated with preeclampsia. The MDR algorithm identified the genetic variant ACVR2A rs1014064 as interacting with age and BMI in association with preeclampsia among Filipino women. The MDR algorithm identified an interaction between age, BMI and ACVR2A rs1014064, indicating that context among genetic variants and demographic/clinical factors may be crucial to understanding the pathogenesis of preeclampsia among Filipino women.

The vascular endothelial growth factor (VEGF) family is important for establishing normal pregnancy, and related single nucleotide polymorphisms (SNPs) are implicated in abnormal placentation and preeclampsia. We evaluated the association between preeclampsia and several VEGF SNPs among Filipinos, an ethnically distinct group with high prevalence of preeclampsia. The genotypes and allelic variants were determined in a case–control study (191 controls and 165 preeclampsia patients) through SNP analysis of VEGF-A (rs2010963, rs3025039) and VEGF-C (rs7664413) and their corresponding receptors VEGFR1 (rs722503, rs12584067, rs7335588) and VEGFR3 (rs307826) from venous blood DNA. VEGF-A rs3025039 C allele has been shown to associate with preeclampsia (odds ratio of 1.648 (1.03–2.62)), while the T allele bestowed an additive effect for the maintenance of normal, uncomplicated pregnancy and against the development of preeclampsia (odds ratio of 0.62 (0.39–0.98)). VEGFR1 rs722503 is associated with preeclampsia occurring at or after the age of 40 years. The results showed that genetic variability of VEGF-A and VEGFR1 are important in the etiology of preeclampsia among Filipinos.