Glutamate and calcium dyshomeostasis have been documented in Alzheimer’s disease, however it has been difficult to determine whether or not calcium and glutamate phenotypes precede amyloid and tau phenotypes in humans. To address this question in a 2D human cell model of early stages of the disease, this study aimed to generate iPSC-derived neurons from FAD patients, isogenic controls and healthy controls and measure Ca2+ responses following application of glutamate, NMDA, AMPA and kainate. The results obtained in this study showed that day 35 FAD iPSC-derived neurons did not demonstrate evidence of AD-associated Aβ and tau pathology and yet displayed altered Ca2+ responses. Neurons from FAD patients had elevated Ca2+ responses to both glutamate and AMPA, but not to kainate and NMDA, when compared to their isogenic controls. Together, the data suggest that mutations in PSEN1 cause increased Ca2+ responses to AMPA as an early phenotype of AD.
4.1. FAD Neurons Lacking Aβ and Tau Pathology Show Elevated Ca2+ Responses to Glutamate and AMPA Compared to Isogenic Controls
In AD, cortical brain regions are severely affected by both Aβ and tau pathology and eventually, neuronal loss. Hence, cortical glutamatergic neurons represent an appropriate model to study FAD neuronal calcium responses to excitatory stimuli.
In this study iPSC-derived neurons were differentiated for a total of 35 days. Changes in cell morphology from iPSCs into neurons and expression of the fluorescent reporter GFP (co-expressed with NGN2) could be observed from day 1 of neuronal differentiation. Immunocytochemistry results from this study confirmed the cell cultures generated expressed the neuronal marker MAP2, while no cells positive for the astrocytic marker GFAP were observed.
The presence of amyloid-β plaques and neurofibrillary tangles in human
post mortem brain tissue provide the criteria for the neuropathologic diagnosis of AD [
51]. Both plasma and cerebral spinal fluid levels of Aβ are decreased in AD and are inversely associated with plaque burden [
42,
43]. Since Aβ plaques cannot be formed in 2D neuronal cultures due to the frequent media changes, the levels of Aβ peptides released into the cell medium are commonly used as a measurement of Aβ pathology. Several long-term 2D cell culture models of AD have detected elevated Aβ42/Aβ40 ratios [
36,
46,
47,
48,
49] or increased secreted Aβ42 in the media [
46], while others have found no differences [
36]. This discrepancy may be explained by the use of different protocols to generate neuronal subtypes or by the length of time that neurons are cultured / matured for. Another important contributing factor is the use of cell lines harbouring different FAD mutations or sporadic AD lines bearing different genetic risk factors, and their comparison with either healthy or isogenic controls. Statistical analysis of Aβ42 levels for day 35 iPSC-derived neurons generated for this work showed FAD2 neurons had higher levels of Aβ42 than a healthy control line HC2 but, critically, was not statistically different from its isogenic control IC2. Since healthy controls have an entirely different genome to a familial disease cell line, differences found between these cells may be biased by factors other than the disease-associated mutation and therefore, complicate interpretation of the results. Isogenic controls, on the other hand, should have the same genome as their parental cell line, except for the disease-causing mutation that is reverted to WT, making it a more useful comparison to understand the contribution of specific mutations to disease phenotypes. Thus, we expect to observe differences in responses between unrelated lines. Nevertheless, the inclusion of additional healthy controls is helpful to assess variations in responses.
The microtubule associated protein tau is enriched in axons of mature neurons, however in pathological conditions such as AD, it is hyperphosphorylated and accumulates in the cell soma and dendrites, where it forms insoluble aggregates and neurofibrillary tangles. A total of 59 tau phosphorylation sites have been detected in human
post mortem brain tissue of AD patients [
52,
53], and serine 404 (p-Tau S404) is considered one of the first epitopes to be phosphorylated in the disease (Mondragón-Rodríguez et al., 2014). Tau phosphorylation at different epitopes has been previously replicated in cell models of AD, including p-Tau S404 [
47], hence its inclusion as a measurement for early stages of tau pathology. However, statistical analysis revealed no significant differences in the levels of p-Tau S404 between FAD and control cell lines in day 35 neurons. Although a combination of factors, such as lipid metabolism, endocytosis and the immune response contribute to pathologic tau accumulation [
54], elevated Aβ levels is also believed to accelerate tau pathology [
55]. Given an Aβ pathology phenotype at this stage of neuronal maturation was not observed in the FAD neurons, this may explain the absence of a tau phenotype as well. Therefore, neither Aβ accumulation nor increased tau phosphorylation were detected in day 35 FAD iPSC-derived neurons in this study. Thus, this model permits the study of early FAD phenotypes associated with
PSEN1 mutations in human cells.
Another phenotype of AD is neuronal hyperexcitability (increased excitability), which is thought to precede neuronal hypoexcitability (reduced excitability) and cell death [
32]. This elevated neuronal activity is thought to promote neurodegeneration in specific neurons [
30] and correlates with cognitive decline. Numerous abnormalities have been suggested to contribute to the change in neuronal excitability, including calcium and glutamate dyshomeostasis [
32]. To understand whether there is a calcium phenotype and how neurons respond to excitatory stimuli in early FAD neurons, the experiments aimed to measure neuronal calcium signals after treatment with glutamate and the ionotropic glutamate receptor agonists, NMDA, AMPA and kainate. Analysis of the maximum amplitude of the calcium response to each drug revealed FAD neurons had significantly higher calcium responses to both glutamate and AMPA, compared to their isogenic controls. No significant differences were observed between disease and isogenic controls following treatment with NMDA or kainate. Both Aβ and tau contribute to calcium dyshomeostasis and AMPAR trafficking dysfunction, resulting in a reduction in AMPAR expression and function and defective synaptic plasticity (reviewed in Guntupalli et al., 2016; Jurado, 2018). Nevertheless, the data identified an aberrant calcium signalling phenotype that appears to occur independently of Aβ or tau phenotypes. Conseuently, in the absence of evidence for Aβ and early phosphorylated tau S404 changes, alternative mechanisms need to be considered.
4.2. Aberrant Ca2+ Signalling of FAD Neurons Occurs Independently of Changes in GluA1 and GluA2 Protein Expression
Whilst the data failed to demonstrate alterations in GluA1 and GluA2 protein levels in FAD compared to isogenic control neurons, there were some increases in
GRIA1,
GRIA2 and
GRIA4 at the mRNA level. The transcriptional regulatory mechanisms were not assessed since the transcriptional up-regulation did not lead to concomitant increases in protein levels. However, it is possible that
GRIA mRNA alterations were mediated by alterations in Notch-1 or related pathways, since Notch-1 was found to be reduced in FAD neurons, including in neurons bearing these same mutations [
58]. AMPAR are tetrameric assemblies of GluA1-GluA4 subunits that permit Na
+ and Ca
2+ influx into the cells. Ca
2+-permeable AMPAR are important for long term potentiation (LTP) induction and long-term memory formation [
59]. The permeability of AMPARs to Ca
2+ depends on subunit composition and GluA2 subunit permeability to Ca
2+ is regulated by RNA editing. The post-transcriptional modification of
GRIA2 RNA from a codon encoding glutamine (Q) to a codon encoding arginine (R) renders this subunit impermeable to Ca
2+. Thus, AMPARs lacking GluA2 or containing the unedited version of GluA2 are Ca
2+ permeable [
60]. The unedited
GRIA2 mRNA has very low expression in the adult human brain, comprising less than 10% of
GRIA2 in the white matter, and less than 1% in the grey matter [
61]. In spite of its low expression, unedited GluA2 can contribute to synaptic plasticity and excitotoxic neuronal cell death (reviewed in Wright & Vissel, 2012). Interestingly, lower RNA editing of GluA2 has been reported in AD brains [
63,
64,
65]. Although RT-qPCR of
GRIA2 performed in this study is insufficient to discern edited from unedited
GRIA2, previous studies have employed different strategies, such as restriction enzyme digestion and Sanger sequencing of PCR products [
66,
67], to quantify unedited
GRIA2 mRNA. Future work utilising these assays could inform whether changes in the amount of edited or unedited
GRIA2 occurs in FAD neurons.
The expression of AMPAR subunits varies across regions of the mammalian brain. In murine hippocampal synapses, the majority of AMPARs are comprised of GluA1/2 subunits, followed by a smaller fraction of GluA2/3 heterodimers [
68,
69]. In the adult rat cortex GluA1 is the predominant subunit (~45% of total AMPAR), followed by GluA2 (21%) and GluA3 (27%), and very low levels of GluA4 (less than 6%) [
13]. Several studies have shown GluA1 and GluA2 protein expression is decreased in AD
post mortem brain tissue (summarised in Askenazi et al., 2023). Lower expression of GluA1 has been reported in the frontal cortex [
70,
71,
72] and cerebellum [
73] of AD brains, while no differences were observed in the temporal cortex, compared to healthy individuals [
59], suggesting there is a brain region-specific phenotype. Regarding GluA2, this AMPAR subunit has been the most extensively studied in AD. A recent compilation of 38 proteomic studies of AD reported a total of 12 studies where GluA2 protein expression was reduced in the frontal, entorhinal and parahippocampal cortex, as well as the hippocampus and precuneus brain regions of AD brains [
29]. Most of the studies (7 out of 12) found these changes in the frontal cortex. Nonetheless, contrasting results have been reported by a couple of studies that detected an upregulation of GluA2 protein expression in the temporal cortex and hippocampus of AD patients [
59,
74]. The work conducted by Barbour and colleagues [
59] is the only study to examine GluA2 expression in the temporal cortex, indicating GluA2 could be differentially regulated in specific brain regions, however more studies analysing this area of the brain are required to confirm these results. While Stepler et al. [
75] found decreased levels of GluA2 in tissue homogenates of whole hippocampus, Yeung et al. [
74] found GluA2 expression was elevated in a subregion of the hippocampus, the stratum moleculare layer of the dentate gyrus, but no significant changes were detected in the stratum granulosum and hilus areas of the dentate gyrus, or in any of the CA1, CA2 or CA3 regions of the hippocampus. Also, no changes were observed in the superior temporal gyrus, subiculum and entorhinal cortex of AD versus control donors. Thus, a potential explanation for these discrepancies is that GluA2 expression is differentially altered in specific subregions of the hippocampus. Furthermore, although the
post mortem brain tissue used by Yeung et al. [
74] was obtained from a brain bank located in New Zealand, the ethnicity of their cohort was not specified. In contrast, Stepler et al. [
75] analysed brains from African American and non-Hispanic White individuals and identified 185 proteins differentially expressed in these two groups. African American and Hispanic populations have greater risk of developing AD and non-AD dementia than non-Hispanic White adults, however these groups are commonly under-represented in proteomic studies of AD. Even though GluA4 was not differentially expressed between the two ethnicity groups included in this study, these results highlight the need for more research including ethnically diverse cohorts. This will allow for a better understanding of variabilities in disease-associated phenotypes amongst different populations so that future therapies can target various ethnic groups.
Overall, the work of Askenazi et al. (2023), compiling studies on AD proteome alterations, postulates expression of GluA1 and GluA2 is reduced in later stages of AD. Interestingly, this phenotype is not observed in studies of the early stages of the disease, including our study, in which western blot analysis showed no changes in total cell protein expression of GluA1 and GluA2. Since the AD model presented here represents an early stage of the disease, preceding Aβ and tau phenotypes, it can be speculated that abnormalities in AMPAR protein levels have not yet developed at this stage.
In this study, protein expression of GluA3 and GluA4 in iPSC-derived neurons was not analysed but changes in their expression have been reported in AD
post mortem brain tissue. GluA3 and GluA4 follow a similar pattern of protein expression as those observed for GluA1 and GluA2. Even though no changes were detected in early stages of the disease, lower levels of GluA3 were found in the hippocampus, precuneus, frontal and entorhinal cortex of late stages of AD pathology (Askenazi et al., 2023). Despite the low number of studies on GluA4, decreased expression of this subunit has been reported in the frontal and entorhinal cortex of advanced stages of AD [
76,
77]. Thus, future work measuring GluA3 and GluA4 protein levels in day 35 iPSC-derived neurons is required to fully characterize protein expression of AMPAR subunits in this model. In summary,
post mortem brain tissue of AD patients show reduced AMPAR expression, but these changes are only observed in the late/end stages of the disease. Likewise, the results from this study found no differences in total protein levels of GluA1 and GluA2 subunits in FAD iPSC-derived neurons representing early stages of pathology, compared to isogenic controls. This suggests the mechanism leading to changes in how FAD neurons respond to AMPA, compared to controls, is not explained by alterations in total cellular protein expression of these two subunits. Nonetheless, analysis of total cellular protein expression may mask changes in protein expression in specific cellular compartments. The expression of AMPARs in the plasma membrane, specifically, is crucial for receptor function and can be regulated through post-translational modifications. Reversible post-translational modifications, such as phosphorylation, palmitoylation and ubiquitination, affect receptor subunit exocytosis, endocytosis, degradation and gating [
78]. Phosphorylation of GluA1 regulates synaptic plasticity by potentiating AMPAR responses to glutamate [
79] and increasing channel conductance [
80] and open probability [
81]. While phosphorylation of GluA1 at epitopes S818, S831 and S845 promote synaptic insertion of AMPAR and dephosphorylation causes endocytosis, dephosphorylation of GluA1 S567 increases receptor expression at the synapse [
78]. GluA2 phosphorylation, on the other hand, is required for AMPAR internalisation in the CA1 region of the hippocampus both in vitro and in vivo [
82,
83].
Ubiquitination comprises the attachment of a single ubiquitin or polymeric ubiquitin chains to lysine residues of a substrate protein [
84]. All AMPAR subunits can undergo ubiquitination when treated with AMPA [
85]. This post-translational modification is calcium dependent [
85,
86] and only occurs in receptors present in the plasma membrane [
85]. The ubiquitination of AMPAR signals for lysosomal [
86,
87] or proteasomal degradation [
88] of this receptor and most studies report it also regulates endocytosis [
86,
88,
89]. Importantly, ubiquitination of AMPAR also modulates synaptic transmission [
86,
88,
89,
90]. In rat neuronal cultures, AMPA treatment increases the number of internalized GluA1. This phenotype is abolished in GluA1 mutant lacking ubiquitination sites. Instead, mutant GluA1 shows reduced GluA1 degradation and internalization and increased GluA1 expression at the cell surface [
86,
88]. Finally, human
post mortem brain tissue of AD patients showed increased expression of ubiquitinated GluA1 protein, suggesting ubiquitination of AMPAR subunits may play an important role in modulating plasma membrane expression and function. Proteins can also be modified by being covalently bound to lipids, such as fatty acids. This process is termed fatty acylation and includes the post-translational modification palmitoylation, which is the addition of the 16-carbon saturated fatty acid palmitate to one or more intracellular cysteine residues of target proteins. All 4 AMPAR subunits can be palmitoylated and they are differentially regulated depending on the site of palmitoylation [
91]. In HEK293T cells and primary cortical neurons, palmitoylation of cysteines in the transmembrane domain 2 of GluA1 or GluA2 accumulates these subunits in the Golgi and reduces their surface expression. C-terminal palmitoylation of AMPAR, on the other hand, does not influence steady-state surface expression of this receptor but increases its internalization after NMDA or AMPA stimulation [
91,
92]. A knock-in GluA1 C811 palmitoylation-deficient mouse model (GluA1C811S) showed elevated expression of GluA1 in the cortex [
93]. Altogether, these studies demonstrate that various post-translational changes to AMPARs influence their trafficking and consequent membrane expression and receptor function. Hence, future work needs to be conducted to measure the expression of all AMPAR subunits intracellularly and in the plasma membrane and to measure post-translational changes that may regulate their trafficking to and from the membrane.
Apart from AMPAR regulation via post-translational modifications, the composition of the lipid membrane, where AMPARs are embedded, provides another layer of ion channel modulation. Presynaptic and postsynaptic membranes are enriched in cholesterol, a sterol lipid that has been linked to AD. Although cholesterol does not affect AMPA binding to its receptor [
94], it can still modulate AMPAR activity. Analysis of intracellular calcium levels in cultures of rat hippocampal neurons demonstrated cholesterol depletion decreased AMPAR-mediated calcium influx [
95]. In rat hippocampal slices, cholesterol depletion reduced both the amplitude of AMPAR-mediated excitatory postsynaptic currents (EPSCs) [
96] and basal synaptic transmission [
95]. Using the same model, it was shown that AMPA treatment potentiated basal synaptic transmission in both normal and in cholesterol-depleted conditions. However, in the absence of cholesterol, this potentiation lasted for a shorter period and the responses to AMPA were not fully abolished after washing out the drug, as was the case for control slices [
95]. Nevertheless, contrasting results were found in rat cerebellar granule cells and mouse cortical neurons, where cholesterol depletion reduced NMDA-evoked currents but had no effect on AMPAR-mediated currents [
97,
98]. This divergence could possibly be explained by the different cell types analysed, concentration and duration of the stimulus, or the AMPAR agonist utilized by each study. Hence, further investigation is required to understand the effect of neuronal membrane cholesterol content in AMPAR function.
The poly-unsaturated fatty acid arachidonic acid (AA) has also been implicated in neuronal excitability. Mouse brain slices expressing human APP (hAPP) showed higher surface expression of GluA1 and GluA2 subunits of AMPARs when treated with AA, which resulted in increased neuronal activity. AA is generated from the hydrolysis of phospholipids by phospholipase-A2 (PLA
2), an enzyme that was hyperphosphorylated in hAPP animals, suggesting elevated activation [
99]. To confirm this hypothesis, the authors blocked PLA
2 activity, which prevented the increase in AMPAR protein expression, as well as neuronal hyperactivity. PLA
2 further acts in synaptic transmission by increasing AMPA affinity and binding to its receptor [
100] and modulating AMPAR phosphorylation [
101]. In rat brain slices, inhibition of calcium-independent PLA
2 increased GluA1 phosphorylation at residue S831, while inhibition of calcium-dependent PLA
2 enhanced phosphorylation of GluA2/3 at S880/891 [
101]. Although the authors did not investigate the impact of AMPAR phosphorylation in neuronal activity, it is possible that it could affect AMPAR trafficking and expression.