The authors thank women who donated their placentas for this study. We also thank the Labor and Delivery Department at OHSU and the Maternal and Fetal Research Team for coordinating the collection of placentas. We are grateful to Eric Wang, Ph.D., and Kelly Kuo, MD for support and help with experimental methods and optimization.
This work was funded by NIH HD076259A (AM) and AHA GRNT29960007 (AM).

Placentae were collected from the Labor and Delivery Unit at University Hospital under a protocol approved by the Institutional Review Board of Oregon Health and Science University in Portland, Oregon, with informed consent from the patients.
1. Collection of Placental Tissue
<ol>
	<li>Preparation 
	NOTE: All equipment that encounters tissue must be sterile.
	<ol>
		<li>Sterilize the dissecting equipment by autoclaving for 60 min at 121 &#176;C.</li>
		<li>Use personal ...

<ol>
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The placenta, responsible for regulating the growth of the fetus, exhibits compromised function in the obese environment6. Despite the high metabolic demands of trophoblasts, placentas with maternal obesity exhibit dysfunctional mitochondrial respiration6,19. Changes in placental metabolism may contribute to the increased incidence of complications and adverse fetal outcomes observed in obese pregnancies3,</sup...

Obesity is an inflammatory state characterized by chronic low-grade inflammation, stemming from excess adipose tissue and nutrient availability. In obesity, proinflammatory cytokines are elevated in metabolic tissues as well as systemically in circulation. A robust body of evidence has shown that TNF&#945; is significantly elevated in the setting of obesity with implications in insulin resistance and metabolic dysfunction1. Activation of TNF&#945; also contributes to disease pathogenesis in conditions such as cancer and autoimmunity, making it an attractive therapeutic target2.
Inflammation in obesity is compounded by pregnancy, also a proinflammatory state3,4. It has been previously shown that placental TNF&#945; content increases with maternal adiposity in pregnancies with female fetuses. Furthermore, TNF&#945; treatment inhibits mitochondrial respiration in female but not male trophoblast cells, suggesting that TNF&#945; is involved in regulating placental metabolism in a sexually dimorphic manner5. Maternal obesity is associated with the increased incidence of a variety of complications during pregnancy, including stillbirth, with male fetuses being the most susceptible3,6,7,8. Due to its key role at the maternal-fetal interface, changes in the functional capacity of the placenta in the obese intrauterine environment in response to inflammatory signaling may play an important role in mediating the outcomes of obese pregnancies.
Cytotrophoblasts and syncytiotrophoblasts in the villous tissue of the placenta are critical for endocrine signaling and nutrient and oxygen exchange between the mother and developing fetus9. Disruptions in the functional capacity of villous cytotrophoblasts (hereafter referred to as trophoblasts) may jeopardize fetal health and development. This protocol describes a method for sampling of villous tissue from the human term placenta by dissecting away the chorionic and basal plates along with an optimized procedure for the isolation of trophoblasts for primary cell culture. This protocol is derived from established methodologies involving enzymatic digestion of villous tissue to release cells from the extracellular matrix followed by differential density centrifugation to isolate trophoblasts10,11,12. This protocol details an approach in which primary trophoblasts from placentas from lean pregnancies are treated with culture media supplemented with TNF&#945; to simulate one component of the inflammatory milieu associated with maternal obesity. Finally, a simple procedure for harvesting total cell lysates from TNF&#945;-treated trophoblasts followed by Western blotting to detect changes in gene expression is described.
While this model does not recapitulate the obesogenic in utero environment in its entirety, it provides a controlled system that allows one to parse out the individual contribution of TNF&#945;-mediated inflammation in the trophoblasts&#39; response to maternal obesity. This model affords both the opportunity to discover or confirm molecular targets directly regulated by TNF&#945; signaling in trophoblasts as well as allows one to test if changes in gene expression patterns observed in vivo in placentas with maternal obesity may be a result of TNF&#945;-mediated inflammation.
The approach described here was implemented to test the effect of TNF&#945;-mediated inflammation on the regulation of autophagy in human trophoblasts. Trophoblasts from obese pregnancies with male fetuses exhibit disrupted autophagic turnover, or autophagosome maturation13. A protein called Rubicon (RUN domain protein Beclin1-interacting and cysteine-rich containing), which is localized to the lysosomes and late endosomes, has been recently described as a &#34;brake&#34; in the autophagic turnover process because it functions as a negative regulator of autophagosome maturation14,15. In fact, Rubicon is a rare example of a protein that restrains autophagy, which makes it a valuable therapeutic target. Very little information is available about the pathophysiological significance of Rubicon, except for its roles in the innate immune response to microbials16,17 and cardiomyocyte protection18. Using the protocol described here, it is found that Rubicon is upregulated in female primary trophoblasts in response to treatment with increasing concentrations of TNF&#945; up to 250 pg/mL. The regulation of Rubicon may play a role in how female fetuses fare better than males in pregnancies with maternal obesity. Recapitulating inflammation associated with maternal obesity ex vivo by exposing human trophoblasts to exogenous TNF&#945; provides a platform to study the impact of the obese intrauterine environment on the regulation of critical pathways in trophoblasts and by extension, placental function.

<table>
	<tbody>
		<tr>
			<td>10X HBSS</td>
			<td>Gibco</td>
			<td>14185-052</td>
			<td></td>
		</tr>
		<tr>
			<td>CaCl2 (anhyd.)</td>
			<td>Sigma-Aldrich</td>
			<td>C1016-100G</td>
			<td></td>
		</tr>
		<tr>
			<td>MgSO4 (anhyd.)</td>
			<td>Sigma-Aldrich</td>
			<td>M7506-500G</td>
			<td></td>
		</tr>
		<tr>
			<td>Hepes</td>
			<td>Fisher Scientific</td>
			<td>BP310-500</td>
			<td></td>
		</tr>
		<tr>
			<td>Trypsin</td>
			<td>Gibco</td>
			<td>15090-046</td>
			<td></td>
		</tr>
		<tr>
			<td>DNAse</td>
			<td>Worthington Biochemical Corp.</td>
			<td>LS002139</td>
			<td></td>
		</tr>
		<tr>
			<td>Protease/Phosphatase inhibitors</td>
			<td>Thermofisher Scientific</td>
			<td>88668</td>
			<td></td>
		</tr>
		<tr>
			<td>Tris HCl</td>
			<td>Invitrogen</td>
			<td>15506-017</td>
			<td></td>
		</tr>
		<tr>
			<td>EDTA</td>
			<td>Invitrogen</td>
			<td>15576-028</td>
			<td></td>
		</tr>
		<tr>
			<td>NaCl</td>
			<td>Sigma-Aldrich</td>
			<td>S7653-1KG</td>
			<td></td>
		</tr>
		<tr>
			<td>SDS</td>
			<td>Fisher Scientific</td>
			<td>BP166-600</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium deoxycholate.</td>
			<td>Fisher Scientific</td>
			<td>AAJ6228822</td>
			<td></td>
		</tr>
		<tr>
			<td>Triton X-100</td>
			<td>Sigma-Aldrich</td>
			<td>X100-500ML</td>
			<td></td>
		</tr>
		<tr>
			<td>Iscove&#8217;s Modified Dulbecco&#8217;s Medium (IMDM)</td>
			<td>Gibco</td>
			<td>12440-046</td>
			<td></td>
		</tr>
		<tr>
			<td>Fetal Bovine Serum (FBS)</td>
			<td>Corning</td>
			<td>35-010-CV</td>
			<td></td>
		</tr>
		<tr>
			<td>Neonatal Calf Serum (NCS)</td>
			<td>Gibco</td>
			<td>26010-074</td>
			<td></td>
		</tr>
		<tr>
			<td>Penicillin/Streptomycin (Pen/Strep)</td>
			<td>Gibco</td>
			<td>15140-122</td>
			<td></td>
		</tr>
		<tr>
			<td>10% Formalin</td>
			<td>Fisher Scientific</td>
			<td>23-427-098</td>
			<td></td>
		</tr>
		<tr>
			<td>DMSO</td>
			<td>Sigma-Aldrich</td>
			<td>D2650-100ML</td>
			<td></td>
		</tr>
		<tr>
			<td>TNF&#945;</td>
			<td>Sigma-Aldrich</td>
			<td>SRP3177-50UG</td>
			<td></td>
		</tr>
		<tr>
			<td>Phosphate Buffered Saline (PBS)</td>
			<td>Gibco</td>
			<td>70013-032</td>
			<td></td>
		</tr>
		<tr>
			<td>K2EDTA vacutainer blood collection tubes</td>
			<td>BD</td>
			<td>366450</td>
			<td></td>
		</tr>
		<tr>
			<td>Percoll (Density Gradient Media, DGM)</td>
			<td>GE Healthcare</td>
			<td>17-0891-01</td>
			<td></td>
		</tr>
		<tr>
			<td>6 well plates</td>
			<td>Corning</td>
			<td>353046</td>
			<td></td>
		</tr>
		<tr>
			<td>Cell strainers</td>
			<td>Fisher Scientific</td>
			<td>22363549</td>
			<td></td>
		</tr>
		<tr>
			<td>Eppendorf Safe-Lock Tubes 2.0 mL, natural</td>
			<td>Fisher Scientific</td>
			<td>22363352</td>
			<td></td>
		</tr>
		<tr>
			<td>Trypan Blue</td>
			<td>Corning</td>
			<td>25-900-Cl</td>
			<td></td>
		</tr>
		<tr>
			<td>Bio-Rad Mini-PROTEAN Tetra System</td>
			<td>Bio-Rad</td>
			<td>1658001FC</td>
			<td></td>
		</tr>
		<tr>
			<td>Bio-Rad Mini Trans-Blot Cell</td>
			<td>Bio-Rad</td>
			<td>1658033</td>
			<td></td>
		</tr>
		<tr>
			<td>TGX FastCast Acrylamide Kit, 12%</td>
			<td>Bio-Rad</td>
			<td>1610175</td>
			<td></td>
		</tr>
		<tr>
			<td>Mini-Protean 3 Multi-Casting Chamber</td>
			<td>Bio-Rad</td>
			<td>1654112</td>
			<td></td>
		</tr>
		<tr>
			<td>4X Laemmli Sample Buffer</td>
			<td>Bio-Rad</td>
			<td>1610747</td>
			<td></td>
		</tr>
		<tr>
			<td>2-Mercaptoethanol</td>
			<td>Sigma-Aldrich</td>
			<td>M3148-100ML</td>
			<td></td>
		</tr>
		<tr>
			<td>Glycine</td>
			<td>Bio-Rad</td>
			<td>1610718</td>
			<td></td>
		</tr>
		<tr>
			<td>Tween-20</td>
			<td>Sigma-Aldrich</td>
			<td>P7949-500ML</td>
			<td></td>
		</tr>
		<tr>
			<td>Instant Nonfat Dry Milk</td>
			<td>Carnation</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Rubicon (D9F7) Rabbit mAb</td>
			<td>Cell Signalling Technology</td>
			<td>8465S</td>
			<td></td>
		</tr>
		<tr>
			<td>Monoclonal Anti-&#946;-Actin antibody produced in mouse</td>
			<td>Sigma-Aldrich</td>
			<td>A2228-100UL</td>
			<td></td>
		</tr>
		<tr>
			<td>Anti-rabbit IgG, HRP-linked Antibody</td>
			<td>Cell Signalling Technology</td>
			<td>7074S</td>
			<td></td>
		</tr>
		<tr>
			<td>Anti-mouse IgG, HRP-linked Antibody</td>
			<td>Cell Signalling Technology</td>
			<td>7076S</td>
			<td></td>
		</tr>
		<tr>
			<td>SuperSignal West Pico PLUS Chemiluminescent Substrate</td>
			<td>Thermo Scientific</td>
			<td>34578</td>
			<td></td>
		</tr>
	</tbody>
</table>

a primary human trophoblast model to study the effect of inflammation associated with maternal obesity on regulation of autophagy in the placenta

Maternal obesity is associated with an increased risk of adverse perinatal outcomes that are likely mediated by compromised placental function that can be attributed to, in part, the dysregulation of autophagy. Aberrant changes in the expression of autophagy regulators in the placentas from obese pregnancies may be regulated by inflammatory processes associated with both obesity and pregnancy. Described here is a protocol for sampling of villous tissue and isolation of villous cytotrophoblasts from the term human placenta for primary cell culture. This is followed by a method for simulating the inflammatory milieu in the obese intrauterine environment by treating primary trophoblasts from lean pregnancies with tumor necrosis factor alpha (TNF&#945;), a proinflammatory cytokine that is elevated in obesity and in pregnancy. Through the implementation of the protocol described here, it is found that exposure to exogenous TNF&#945; regulates the expression of Rubicon, a negative regulator of autophagy, in trophoblasts from lean pregnancies with female fetuses. While a variety of biological factors in the obese intrauterine environment maintain the potential to modulate critical pathways in trophoblasts, this ex vivo system is especially useful for determining if expression patterns observed in vivo in human placentas with maternal obesity are a direct result of TNF&#945; signaling. Ultimately, this approach affords the opportunity to parse out the regulatory and molecular implications of inflammation associated with maternal obesity on autophagy and other critical cellular pathways in trophoblasts that have the potential to impact placental function.

Term human placentas from lean (pre-pregnancy body mass index (BMI) &#60;25) mothers with uncomplicated pregnancies carrying female offspring were collected and sampled within 15 minutes of delivery by cesarean section (no labor). The placentas were examined for the absence of calcifications and typical development: weighing between 300-600 g with the umbilical cord and membranes removed, round in shape, between 15 - 25 cm in diameter, and umbilical cord inserted into the middle of the pl...

Watch this Scientific Journal Video about A Primary Human Trophoblast Model to Study the Effect of Inflammation Associated with Maternal Obesity on Regulation of Autophagy in the Placenta at JoVE.com

A Primary Human Trophoblast Model to Study the Effect of Inflammation Associated with Maternal Obesity on Regulation of Autophagy in the Placenta

Presented here is a protocol for sampling of human placental villous tissue followed by isolation of cytotrophoblasts for primary cell culture. Treatment of trophoblasts with TNF&#945; recapitulates inflammation in the obese intrauterine environment and facilitates the discovery of molecular targets regulated by inflammation in placentas with maternal obesity.

Maternal obesity is associated with an increased risk of adverse perinatal outcomes that are likely mediated by compromised placental function that can be ...

The overall goal of this trophoblast cell culture model is to measure the effect of obesity-related inflammation on the regulation of critical pathways in trophoblasts. The main advantage of this control system is it establish a relationship between TNF alpha mediated inflammation and the gene regulation in placenta in the context of maternal obesity. The main advantage of this experimental system is it establishes relationships between TNF-alpha mediated inflammation and gene regulation in placenta in the context of maternal obesity.Demonstrating the procedure will be Bailey Simon and Matt Bucher, technicians from my lab. Villous tissue should be sampled from the placenta as soon as possible following delivery, preferably in 30 minutes or less. With the chorionic plate facing upwards, use forceps and scissors to excise, at random, two to three full-thickness sections, two to three centimeters in from the periphery of the placenta.Avoid parts of the placenta that appear abnormal. Trim away the chorionic and basal plates and any large blood vessels. Place the resulting villous tissue in warm, complete medium.Within 30 minutes of villous tissue sampling, begin trophoblast isolation. Place each piece of villous tissue in a 50 milliliter conical tube filled with room temperature PBS and gently agitate to release excess blood in the tissue. Decant the PBS and replace with fresh PBS.Repeat the PBS rinse until most of the excess blood is removed. The PBS rinse will be light red or pink when the tissue is thoroughly rinsed. Place the villous tissue in a sterile petri dish and remove as many blood vessels as possible by using a microscope slide to gently scrape off the soft villous tissue from the vessels.Using scissors, finely mince the resulting villous tissue. Transfer the minced villous tissue to a sterile bottle with digestion solution according to the calculated volumes based on the specific activity of trypsin and DNase. Incubate the digestion bottle in a 37 degree Celsius water bath with shaking at 70 rpm for 35 minutes.After 35 minutes, tilt the digestion bottle on its side and allow the undigested pieces of tissue to settle at the bottom of the bottle. Carefully draw up the supernatant with a serological pipette, avoiding the settled tissue. Dispense the supernatant through a 100 micron cell strainer equally between 50 milliliter conical tubes.Start the second digestion by adding digestion solution to the remaining settled tissue and incubating the bottle in the 37 degrees Celsius water bath. Gently layer three to five milliliters of newborn calf serum, or NCS, underneath the strained supernatant from the first digestion by slowly dispensing from a serological pipette at the bottom of the tube. A meniscus between the strained supernatant containing trophoblasts and NCS should be visible.Centrifuge the supernatants over NCS at 1, 250 times g at 20 degrees Celsius for 15 minutes. The resulting pellet will include red blood cells in the lowermost layer, followed by a white layer containing trophoblast cells. In the same way, strain the supernatant from the second and third digestion.Layer NCS underneath the strained supernatant and centrifuge at 1, 250 times g at 20 degrees Celsius for 15 minutes. Once all supernatants have been centrifuged and the NCS and supernatant layers removed, re-suspend each pellet in five milliliters of warm, complete medium and then pool the suspensions. Divide the cell suspension equally between two 50 milliliter conical tubes and centrifuge at 1, 250 times g at 20 degrees Celsius for 15 minutes.Gently remove the supernatant and re-suspend each of the cell pellets in six milliliters of warm, complete medium. To begin this procedure, divide the cell suspension equally between four density gradients by using a transfer pipette to slowly and carefully layer the cell suspension on top of the density gradients. Centrifuge the density gradients at 1, 250 times g at 20 degrees Celsius for 20 minutes with minimum acceleration and deceleration.This should produce distinguishable bands of sedimented cells. Slowly and carefully remove the top layer of density gradient media until the opaque band containing trophoblast cells is reached. Transfer the trophoblast bands into two 50 milliliter conical tubes and fill with warm, complete medium.Gently invert the tubes three to six times to mix and centrifuge at 1, 250 times g at 20 degrees Celsius for 15 minutes. Remove the supernatant and re-suspend each cell pellet in five milliliters of warm, complete medium. Combine the cell suspensions and count viable cells using a hemocytometer and trypan blue.The next step after cell counting is to plate the cells. Plate three million cells per well in each six well plate. Gently rock the plate back and forth and side to side to evenly distribute the cells.Leave the plated cells in the laminar flow vent for approximately 30 minutes to allow the cells to evenly distribute, settle, and begin to adhere to the bottom of the wells. After 30 minutes, place the plates in a 37 degree Celsius incubator with 5%carbon dioxide and 95%humidity. Examine the trophoblasts under a microscope after 24 hours of culture to confirm attachment and proper trophoblast morphology.The cells can be treated after 24 hours of culture. Aspirate the culture media from the cells and replace with two milliliters of TNF alpha supplemented medium per well. Return the plates to the 37 degree Celsius incubator.After 24 hours of TNF alpha exposure, replace the TNF alpha supplemented medium with complete medium. Incubate for another 24 hours. 24 hours after removal of TNF alpha, aspirate media and gently rinse the cells with room temperature PBS.Add directly to each well 80 microliters of ice cold radioimmunoprecipitation assay buffer containing freshly added protease and phosphatase inhibitors. Remove the cells from the plate with a cell scraper. Transfer the cells to a 1.5 milliliter microcentrifuge tube, pooling wells within treatment groups.Ice the cells by vortexing the tubes on high for at least three intervals of 15 seconds. Incubate the cells at four degrees Celsius with rocking for 15 minutes. Vortex the tubes again on high.Centrifuge at 10, 000 times g for five minutes at four degrees Celsius to pellet cellular debris. Transfer the supernatant to a new 1.5 milliliter microcentrifuge tube. Store the cellular protein samples at 80 degrees Celsius until analysis by Western blotting for the protein of interest.After 72 hours of culture, immunocytochemical analysis of cytokeratin 7, shown in red, in primary trophoblasts confirm that the cells underwent syncytialization evidenced by the presence of multi-nucleated cell masses. Furthermore, immunocytochemical analysis of vimentin, also in red, revealed very few contaminating fibroblasts. Nuclear counter-staining is shown in blue in both images.Treatment with TNF alpha up to 250 picograms per milliliter up-regulated rubicon expression. At TNF alpha concentrations greater than 250 picograms per milliliter, rubicon expression levels decreased back toward baseline and even below. Likewise, rubicon is significantly up-regulated in flash frozen villous tissue biopsies from placentas from obese pregnancies with female fetuses compared to lean controls.Once mastered, isolation of trophoblasts from villous tissue can be done in six to seven hours if it is performed properly. While attempting this procedure, it's important to prepare materials and reagents ahead of time so you can work deliberately and efficiently. Following this procedure, other assays, such as those that measure cellular bioenergetics, can be performed to answer additional questions, like does inflammation in the obese intrauterine environment affect the metabolic capacity of trophoblasts?After this development method paved the way for placental researcher to establish the effect of maternal environment on trophoblast function. After watching this video you will have a good understanding of how to isolate trophoblasts from villous tissue for your cell culture experiment and how to determine the effect of TNF alpha mediated inflammation in regulation of critical pathways in the trophoblasts. Don't forget that working with human tissue, cultured cells, DMSO, acrylamide and reducing reagents can be extremely hazardous and precautions, such as wearing proper PPE and using aseptic technique should always be taken while performing this procedure.

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Research

JoVE Journal

Medicine

Biomarkers in an Animal Model for Revealing Neural, Hematologic, and Behavioral Correlates of PTSD

Identification of biomarkers representing the evolution of the pathophysiology of Post Traumatic Stress Disorder (PTSD) is vitally important, not only for objective diagnosis but also for the evaluation of therapeutic efficacy and resilience to trauma. Ongoing research is directed at identifying molecular biomarkers for PTSD, including traumatic stress induced proteins, transcriptomes, genomic variances and genetic modulators, using biologic samples from subjects' blood, saliva, urine, and postmortem brain tissues. However, the correlation of these biomarker molecules in peripheral or postmortem samples to altered brain functions associated with psychiatric symptoms in PTSD remains unresolved. Here, we present an animal model of PTSD in which both peripheral blood and central brain biomarkers, as well as behavioral phenotype, can be collected and measured, thus providing the needed correlation of the central biomarkers of PTSD, which are mechanistic and pathognomonic but cannot be collected from people, with the peripheral biomarkers and behavioral phenotypes, which can.
Our animal model of PTSD employs restraint and tail shocks repeated for three continuous days - the inescapable tail-shock model (ITS) in rats. This ITS model mimics the pathophysiology of PTSD 17, 7, 4, 10. We and others have verified that the ITS model induces behavioral and neurobiological alterations similar to those found in PTSD subjects 17, 7, 10, 9. Specifically, these stressed rats exhibit (1) a delayed and exaggerated startle response appearing several days after stressor cessation, which given the compressed time scale of the rat's life compared to a humans, corresponds to the one to three months delay of symptoms in PTSD patients (DSM-IV-TR PTSD Criterian D/E 13), (2) enhanced plasma corticosterone (CORT) for several days, indicating compromise of the hypothalamopituitary axis (HPA), and (3) retarded body weight gain after stressor cessation, indicating dysfunction of metabolic regulation.
The experimental paradigms employed for this model are: (1) a learned helplessness paradigm in the rat assayed by measurement of acoustic startle response (ASR) and a charting of body mass; (2) microdissection of the rat brain into regions and nuclei; (3) enzyme-linked immunosorbent assay (ELISA) for blood levels of CORT; (4) a gene expression microarray plus related bioinformatics tools 18. This microarray, dubbed rMNChip, focuses on mitochondrial and mitochondria-related nuclear genes in the rat so as to specifically address the neuronal bioenergetics hypothesized to be involved in PTSD.

We describe a rat model of post traumatic stress disorder (PTSD) that reveals the persistent alterations in neuroendocrine function and the delayed long-term, exaggerated fear response, characteristic of PTSD patients. The animal model and methods described here are useful for correlating biomarkers in brain nuclei, which are mechanistic but cannot be measured in patients, with biomarkers in peripheral white blood cells, which can.

Identification of biomarkers representing the evolution of the pathophysiology of Post Traumatic Stress Disorder (PTSD) is vitally important, not only for ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

Human Neuroendocrine Tumor Cell Lines as a Three-Dimensional Model for the Study of Human Neuroendocrine Tumor Therapy

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human malignancies.1 Other than surgery for the minority of patients who present with localized disease, there is little or no survival benefit of systemic therapy. Therefore, there is a great need to better understand the biology of NETs, and in particular define new therapeutic targets for patients with nonresectable or metastatic neuroendocrine tumors. 3D cell culture is becoming a popular method for drug screening due to its relevance in modeling the in vivo tumor tissue organization and microenvironment.2,3 The 3D multicellular spheroids could provide valuable information in a more timely and less expensive manner than directly proceeding from 2D cell culture experiments to animal (murine) models.
To facilitate the discovery of new therapeutics for NET patients, we have developed an in vitro 3D multicellular spheroids model using the human NET cell lines. The NET cells are plated in a non-adhesive agarose-coated 24-well plate and incubated under physiological conditions (5% CO2, 37 &deg;C) with a very slow agitation for 16-24 hr after plating. The cells form multicellular spheroids starting on the 3rd or 4th day. The spheroids become more spherical by the 6th day, at which point the drug treatments are initiated. The efficacy of the drug treatments on the NET spheroids is monitored based on the morphology, shape and size of the spheroids with a phase-contrast light microscope. The size of the spheroids is estimated automatically using a custom-developed MATLAB program based on an active contour algorithm. Further, we demonstrate a simple method to process the HistoGel embedding on these 3D spheroids, allowing the use of standard histological and immunohistochemical techniques. 
This is the first report on generating 3D spheroids using NET cell lines to examine the effect of therapeutic drugs. We have also performed histology on these 3D spheroids, and displayed an example of a single drug's effect on growth and proliferation of the NET spheroids. Our results support that the NET spheroids are valuable for further studies of NET biology and drug development.

We present a simple agarose overlay platform to grow 3D multicellular spheroids using neuroendocrine cancer cell lines. This method provides a very convenient way to examine the effect of therapeutic drugs on the neuroendocrine tumor cells. It could also help us establish human neuroendocrine tumor spheroids for cancer therapy.

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100,&#x200A;000 individuals per year, and they account for 0.5% of all human ...

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As such, primary or &#39;neuronal-like&#39; cell culture systems are commonly utilized. While&#160;these systems are relatively easy to work with, and are useful model systems in which various functional outcomes (such as cell death) can be readily quantified, the examined outcomes and pathways in cultured immature neurons (such as excitotoxicity-mediated cell death pathways) are not necessarily the same as those observed in mature brain, or in intact tissue. Therefore, there is the need to develop models in which cellular mechanisms in mature neural tissue can be examined. We have developed an in vitro technique that can be used to investigate a variety of molecular pathways in intact nervous tissue. The technique described herein utilizes rat cortical tissue, but this technique can be adapted to use tissue from a variety of species (such as mouse, rabbit, guinea pig, and chicken) or brain regions (for example, hippocampus, striatum, etc.). Additionally, a variety of stimulations/treatments can be used (for example, excitotoxic, administration of inhibitors, etc.). In conclusion, the brain slice model described herein can be used to examine a variety of molecular mechanisms involved in excitotoxicity-mediated brain injury.

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

We have developed a brain slice model which can be used to examine molecular mechanisms involved in excitotoxicity-mediated brain injury.&#160;This technique generates viable mature brain tissue and reduces animal numbers required for experimentation, whilst keeping the neuronal circuitry, cellular interactions, and postsynaptic compartments partly intact.

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Phosphorus-31 Magnetic Resonance Spectroscopy: A Tool for Measuring In Vivo Mitochondrial Oxidative Phosphorylation Capacity in Human Skeletal Muscle

Skeletal muscle mitochondrial oxidative phosphorylation (OXPHOS) capacity, which is critically important in health and disease, can be measured in vivo and noninvasively in humans via phosphorus-31 magnetic resonance spectroscopy (31PMRS). However, the approach has not been widely adopted in translational and clinical research, with variations in methodology and limited guidance from the literature. Increased optimization, standardization, and dissemination of methods for in vivo 31PMRS would facilitate the development of targeted therapies to improve OXPHOS capacity and could ultimately favorably impact cardiovascular health. 31PMRS produces a noninvasive, in vivo measure of OXPHOS capacity in human skeletal muscle, as opposed to alternative measures obtained from explanted and potentially altered mitochondria via muscle biopsy. It relies upon only modest additional instrumentation beyond what is already in place on magnetic resonance scanners available for clinical and translational research at most institutions. In this work, we outline a method to measure in vivo skeletal muscle OXPHOS. The technique is demonstrated using a 1.5 Tesla whole-body MR scanner equipped with the suitable hardware and software for 31PMRS, and we explain a simple and robust protocol for in-magnet resistive exercise to rapidly fatigue the quadriceps muscle. Reproducibility and feasibility are demonstrated in volunteers as well as subjects over a wide range of functional capacities.

Phosphorus-31 Magnetic Resonance Spectroscopy: A Tool for Measuring In Vivo Mitochondrial Oxidative Phosphorylation Capacity in Human Skeletal Muscle

This work demonstrates the feasibility of an in vivo phosphorus-31 magnetic resonance spectroscopy (31PMRS) technique to quantify mitochondrial oxidative phosphorylation (OXPHOS) capacity in human skeletal muscle.

Skeletal muscle mitochondrial oxidative phosphorylation (OXPHOS) capacity, which is critically important in health and disease, can be measured in vivo ...

Isometric Contractility Measurement of the Mouse Mesenteric Artery Using Wire Myography

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and drugs. It is widely used in many studies on the physiological functions of vascular smooth muscle, the pathogenesis of vascular diseases such as hypertension, and the development of smooth muscle relaxant drugs. The mouse is a widely used model animal with a large pool of disease models and genetically modified strains. We introduced this method to measure the isometric contraction of mouse mesenteric artery in detail. A 1.4-mm segment of mouse mesenteric resistance artery was isolated and mounted on a myograph chamber by passing two steel wires through its lumen. After equilibration and normalization steps, the vessel segment was potentiated by a high-K+ solution twice prior to the contraction assay. As an example of the application of this method in drug development, we measured the relaxant effect of a novel natural substance, neoliensinine, isolated from a Chinese herb, embryos of the lotus seed (Nelumbo nucifera Gaertn.) on mouse mesenteric arteries. The vessel segments mounted on the myograph chamber were stimulated with a high-K+ solution. When the force tension reached a stable sustained phase, cumulative doses of neoliensinine were added to the chamber. We found that neoliensinine had a dose-dependent relaxant effect on smooth muscle contraction, thus suggesting that it bears potential activity against hypertension. In addition, as the vessel segment can survive at least 4 hours after mounting and maintain contractility induced by the high-K+ solution for many times, we suggest that the wire myograph system may be used for the time-consuming process of drug screening.

The wire myograph technique is used to investigate vascular smooth muscle functions and screen new drugs. We report a detailed protocol for measuring the isometric contractility of the mouse mesenteric artery and for screening new relaxants of vascular smooth muscle.

The wire myograph technique is used to assess the contractility of vascular smooth muscles in response to depolarization, GPCR agonists/inhibitors and ...

Effect of Artificial Tear Formulations on the Metabolic Activity of Human Corneal Epithelial Cells after Exposure to Desiccation

Artificial lipid-containing tear formulations are developed to reduce tear evaporation by the restoration of a deficient tear lipid layer. Artificial tear formulations that prevent cell desiccation will result in ocular surface protection and the maintenance of cell metabolic activity. During dehydration, cells undergo the process of loss of metabolic activity and subsequently cell death. This work describes a method for assessing the efficacy of artificial tear formulations. The metabolic dye (i.e., alamarBlue) changes from a low fluorescent molecule resazurin to a fluorescent molecule resorufin in viable cells. The biological performance of an artificial tear formulation is measured as the ability of the formulation to (a) maintain cell viability and (b) provide cell protection from desiccation. Growth media and saline are used as controls for the cell viability/desiccation tests. Cells are incubated with test solutions for 30 min and then desiccated for 0 or 5 min at 37 &#176;C and 45% relative humidity. Cell metabolic activity after initial exposure and after cell desiccation is then determined. The results show the comparative effects of eye drop formulations on cell metabolic activity and desiccation protection. This method can be used to test dry eye formulations that are designed to treat individuals with evaporative dry eye.

The purpose of this protocol is to evaluate if different artificial tear formulations can protect human corneal epithelial cells from desiccation using an in vitro model. After exposure to artificial tear formulations and desiccation, human corneal epithelial cells are assessed for metabolic activity.

Artificial lipid-containing tear formulations are developed to reduce tear evaporation by the restoration of a deficient tear lipid layer. Artificial tear ...

A Murine Model of Fetal Exposure to Maternal Inflammation to Study the Effects of Acute Chorioamnionitis on Newborn Intestinal Development

Chorioamnionitis is a common precipitant of preterm birth and is associated with many of the morbidities of prematurity, including necrotizing enterocolitis (NEC). However, a mechanistic link between these two conditions remains yet to be discovered. We have adopted a murine model of chorioamnionitis involving lipopolysaccharide (LPS)-induced fetal exposure to maternal inflammation (FEMI). This model of FEMI induces a sterile maternal, placental, and fetal inflammatory cascade, which is also present in many cases of clinical chorioamnionitis. Although models exist that utilize live bacteria and more accurately mimic the pathophysiology of an ascending infection resulting in chorioamnionitis, these methods may cause indirect effects on development of the immature intestinal tract and the associated developing microbiome. Using this protocol, we have demonstrated that LPS-induced FEMI results in a dose-dependent increase in pregnancy loss and preterm birth, as well as disruption of normal intestinal development in offspring. Further, we have demonstrated that FEMI significantly increases intestinal injury and serum cytokines in offspring, while simultaneously decreasing goblet and Paneth cells, both of which provide a first line of innate immunity against intestinal inflammation. Although a similar model of LPS-induced FEMI has been used to model the association between chorioamnionitis and subsequent abnormalities of the central nervous system, to our knowledge, this protocol is the first to attempt to elucidate a mechanistic link between chorioamnionitis and later perturbations in intestinal development as a potential link between chorioamnionitis and NEC.

We developed a model of chorioamnionitis to simulate fetal exposure to maternal inflammation (FEMI) without complications of live organisms to examine the effects of FEMI on development of the offspring&#8217;s intestinal tract. This allows for study of mechanistic causes for development of intestinal injury following chorioamnionitis.

Chorioamnionitis is a common precipitant of preterm birth and is associated with many of the morbidities of prematurity, including necrotizing ...

Design and Development of a Model to Study the Effect of Supplemental Oxygen on the Cystic Fibrosis Airway Microbiome

Airway microbial communities are thought to play an important role in the progression of cystic fibrosis (CF) and other chronic pulmonary diseases. Microbes have traditionally been classified based on their ability to use or tolerate oxygen. Supplemental oxygen is a common medical therapy administered to people with cystic fibrosis (pwCF); however, existing studies on oxygen and the airway microbiome have focused on how hypoxia (low oxygen) rather than hyperoxia (high oxygen) affects the predominantly aerobic and facultative anaerobic lung microbial communities. To address this critical knowledge gap, this protocol was developed using an artificial sputum medium that mimics the composition of sputum from pwCF. The use of filter sterilization, which yields a transparent medium, allows optical methods to follow the growth of single-celled microbes in suspension cultures. To create hyperoxic conditions, this model system takes advantage of established anaerobic culturing techniques to study hyperoxic conditions; instead of removing oxygen, oxygen is added to cultures by daily sparging of serum bottles with a mixture of compressed oxygen and air. Sputum from 50 pwCF underwent daily sparging for a 72-h period to verify the ability of this model to maintain differential oxygen conditions. Shotgun metagenomic sequencing was performed on cultured and uncultured sputum samples from 11 pwCF to verify the ability of this medium to support the growth of commensal and pathogenic microbes commonly found in cystic fibrosis sputum. Growth curves were obtained from 112 isolates obtained from pwCF to verify the ability of this artificial sputum medium to support the growth of common cystic fibrosis pathogens. We find that this model can culture a wide variety of pathogens and commensals in CF sputum, recovers a community highly similar to uncultured sputum under normoxic conditions, and creates different culture phenotypes under varying oxygen conditions. This new approach might lead to a better understanding of unanticipated effects induced by the use of oxygen in pwCF on airway microbial communities and common respiratory pathogens.

The goal of this protocol is to develop a model system for the effect of hyperoxia on cystic fibrosis airway microbial communities. Artificial sputum medium emulates the composition of sputum, and hyperoxic culture conditions model the effects of supplemental oxygen on lung microbial communities.

Airway microbial communities are thought to play an important role in the progression of cystic fibrosis (CF) and other chronic pulmonary diseases. ...