TOWARD PRECISION MEDICINE : EFFECTS OF THE COMMON VAL66MET BDNF VARIANT IN THE AGING BRAIN AND IMPLICATIONS FOR THE FUTURE OF PARKINSON’S DISEASE THERAPEUTICS

The rs6265 (Val66Met) single nucleotide polymorphism in the gene for brain-derived neurotrophic factor (BDNF) is a common genetic variant that has been shown to alter therapeutic responses in patients with Parkinson’s disease (PD). Possession of the variant Met allele results in decreased activity-dependent release of BDNF by disrupting BDNF transport and sorting into synaptic vesicles. In the experiments detailed in this thesis, I examine the effects of the Val66Met SNP, and its interaction with aging, on therapeutic efficacy and the development of aberrant side-effects following primary dopamine (DA) neuron transplantation, a restorative experimental therapeutic approach for PD that is currently experiencing a robust revitalization following a decade-long worldwide moratorium. In particular, I hypothesized that rs6265-mediated dysfunctional BDNF signaling is an unrecognized contributor to the limited clinical benefit observed in a subpopulation of individuals with PD despite robust survival of grafted DA neurons and extensive integration into the host brain. I also hypothesized that this genetic variant contributes to the development of graft-induced dyskinesias (GID). To test these hypotheses, we generated a novel CRISPR knock-in rat model of the rs6265 BDNF SNP to investigate for the first time the influence of a common genetic polymorphism on graft survival, functional efficacy, and side-effect burden in subjects grafted with embryonic ventral mesencephalic DA neurons. In two sister studies, I compared these primary endpoints between wild-type (Val/Val) rats and those homozygous for the variant Met allele (Met/Met), in both young adult (8 m.o. at grafting) and middle-aged (15 m.o. at grafting) cohorts. In each study, rats were rendered unilaterally parkinsonian with intranigral 6-hydroxydopamine and primed with levodopa (12 mg/kg M-Fr) to induce stable expression of levodopa-induced dyskinesias (LID), the primary behavioral endpoint for assessing graft function. After levodopa priming, rats received an intrastriatal graft of embryonic ventral mesencephalic neurons (200,000 cells in young adult rats, 400,000 cells in middle-aged rats; E14 wild-type donors) or a sham graft. LID were evaluated for 9-10 weeks post-engraftment, and GID were assessed 24-48 hr prior to sacrifice. In young adult graft recipients, this research demonstrates that: 1) Met/Met rats display enhanced graft efficacy and paradoxically enriched graft-derived neurite outgrowth compared to Val/Val rats, and 2) the Met allele is strongly linked to GID development and this behavioral phenotype is correlated with neurochemical signatures of glutamatergic neurotransmission by grafted DA neurons. In middle-aged graft recipients, this research indicates that: 1) behavioral enhancement associated with the Met allele is maintained with advancing age, and 2) advanced age is associated with the induction of GID in rats of both genotypes despite the presence of widespread intrastriatal grafts. In this rapidly evolving era of precision medicine, understanding mechanisms underlying the beneficial versus detrimental impact of the Val66Met polymorphism, and/or its interaction with aging, will aid in the development of safe and optimized therapeutic approaches for remodeling the parkinsonian striatum.