A patient-derived amyotrophic lateral sclerosis blood-brain barrier model for focused ultrasound-mediated anti-TDP-43 antibody delivery.
Authors: Wasielewska JM, Chaves JCS, Cabral-da-Silva MC, Pecoraro M, Viljoen SJ, Nguyen TH, Bella V, Oikari LE, Ooi L, White AR
Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disorder with minimally effective treatment options. An important hurdle in ALS drug development is the non-invasive therapeutic access to the motor cortex currently limited by the presence of the blood-brain barrier (BBB). Focused ultrasound and microbubble (FUS<sup>+ MB</sup>) treatment is an emerging technology that was successfully used in ALS patients to temporarily open the cortical BBB. However, FUS<sup>+ MB</sup>-mediated drug delivery across ALS patients' BBB has not yet been reported. Similarly, the effects of FUS<sup>+ MB</sup> on human ALS BBB cells remain unexplored. Here we established the first FUS<sup>+ MB</sup>-compatible, fully-human ALS patient-cell-derived BBB model based on induced brain endothelial-like cells (iBECs) to study anti-TDP-43 antibody delivery and FUS<sup>+ MB</sup> bioeffects in vitro. Generated ALS iBECs recapitulated disease-specific hallmarks of BBB pathology, including reduced BBB integrity and permeability, and TDP-43 proteinopathy. The results also identified differences between sporadic ALS and familial (C9orf72 expansion carrying) ALS iBECs reflecting patient heterogeneity associated with disease subgroups. Studies in these models revealed successful ALS iBEC monolayer opening in vitro with no adverse cellular effects of FUS<sup>+ MB</sup> as reflected by lactate dehydrogenase (LDH) release viability assay and the lack of visible monolayer damage or morphology change in FUS<sup>+ MB</sup> treated cells. This was accompanied by the molecular bioeffects of FUS<sup>+ MB</sup> in ALS iBECs including changes in expression of tight and adherens junction markers, and drug transporter and inflammatory mediators, with sporadic and C9orf72 ALS iBECs generating transient specific responses. Additionally, we demonstrated an effective increase in the delivery of anti-TDP-43 antibody with FUS<sup>+ MB</sup> in C9orf72 (2.7-fold) and sporadic (1.9-fold) ALS iBECs providing the first proof-of-concept evidence that FUS<sup>+ MB</sup> can be used to enhance the permeability of large molecule therapeutics across the BBB in a human ALS in vitro model. Together, this study describes the first characterisation of cellular and molecular responses of ALS iBECs to FUS<sup>+ MB</sup> and provides a fully-human platform for FUS<sup>+ MB</sup>-mediated drug delivery screening on an ALS BBB in vitro model.
Introduction
Purpose
Drug delivery with BBB opening
Study Objective
To establish a fully human ALS patient-derived blood–brain barrier model (iBECs) compatible with focused ultrasound and microbubbles to evaluate FUS+MB-mediated delivery of anti-TDP-43 antibodies and associated cellular bioeffects in vitro.
Animal model / Human subject
Human (Homo sapiens) induced brain endothelial-like cells (iBECs) derived from ALS patients, including sporadic ALS and C9orf72 expansion carriers; age None; sex None
Disease model
Amyotrophic lateral sclerosis (ALS)
Targeted brain region(s)
Motor Cortex
Cargo name and characteristics
Anti-TDP-43 antibody (protein; large-molecule therapeutic antibody targeting TDP-43)
Outcomes and Safety
Summary of Outcomes
Focused ultrasound with microbubbles (FUS+MB) applied at clinically relevant parameters transiently opened ALS patient‑derived iBEC monolayers without cytotoxicity, induced transient changes in tight/adherens junction, drug‑transporter and inflammatory gene expression (with different responses in sporadic vs C9orf72 lines), and enhanced anti‑TDP‑43 antibody delivery by 2.7‑fold in C9orf72 and 1.9‑fold in sporadic ALS iBECs; no multiple FUS parameter sets were reported (single clinically relevant FUS+MB condition used).
Safety-related matter
The authors report no adverse cellular effects of FUS+MB in their ALS iBEC in vitro model — no visible monolayer damage or morphology changes and no increase in LDH release (at 30 min and 24 h). They also note prior clinical evidence supporting FUS+MB safety in ALS and that, unlike some animal studies showing neuroinflammation, their human iBECs did not exhibit a profound proinflammatory response.
Brain Region
Ultrasound Parameters
Focal Characteristics
Focal depth: None; Focal length: None; Aperture size: None
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