Background
Tuberous sclerosis complex (TSC) is a rare multi-system monogenic hamartomatous disorder, which is caused by mutations inactivating the
TSC1 (hamartin) or
TSC2 (tuberin) genes. TSC is characterized by benign tumors in multiple organs, including the brain, kidneys, heart and eyes [
1]. Over 90% of TSC patients develop epilepsy, and around 50% present with neuropsychiatric problems, such as intellectual disability (50%) [
2,
3], autism spectrum disorder (ASD) (17–68%), schizophrenia (10–30%) and anxiety disorders (40%) [
4], which account for most of the mortality and morbidity [
5].
At the molecular level, both
Tsc1 and
Tsc2 protein products form hetero-dimers which inhibit the GTP-binding protein RHEB (Ras homolog enriched in the brain). Consequently, mutations within either
Tsc1 or
Tsc2 lead to increased levels of activated RHEB [
6], which causes hyperactivation of mammalian target of rapamycin (mTOR) signaling, a constitutive phosphorylation of eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1) and activation of ribosomal protein S6 through S6K1 phosphorylation [
7,
8]. The net effect is enhanced protein translation, cell proliferation and growth [
9]. Notably, increased mTOR signaling and subsequent changes in global protein synthesis are shared molecular mechanisms of several rare neurodevelopmental disorders with an increased prevalence of ASD, such as fragile X syndrome (FXS) [
10].
The hyperactivation of mTOR induced by
Tsc1 and
Tsc2 heterozygosity can be inhibited by mTOR inhibitors, such as the macrolide rapamycin. Rapamycin is an immunosuppressant, which is widely prescribed to prevent rejection in organ transplantation and exerts anti-tumor properties [
11‐
13]. Rapamycin binds FK-binding protein 12 (FKBP12), and as a complex, rapamycin-FKBP12 directly binds to the mTOR complex 1 (mTORC1), thus reducing phosphorylation of downstream mTOR targets [
14,
15]. Rapamycin and other mTOR inhibitors have been shown to be efficacious in the treatment of several TSC-associated tumors as well as seizures [
16‐
19] and may ameliorate the symptoms of neurodevelopmental disorders in adults [
20,
21]. In TSC mouse models, rapamycin limits tumor growth [
22,
23], reduces neuropathology and ameliorates epileptic seizures as well as learning deficits [
24‐
26]. It was recently reported that rapamycin normalizes social interaction deficits relevant to core disabilities associated with ASD in both
Tsc1
+/− and
Tsc2
+/− mice [
27].
Here, we investigated the
Tsc1
+/− mouse model, which exhibits haploinsufficiency for the
Tsc1 gene, in an attempt to identify molecular changes associated with the neuropsychiatric phenotype of TSC patients [
5]. In this mouse model, the typical human cerebral pathology of spontaneous seizures, cerebral lesions and giant dysmorphic cells could not been detected using immuno-cytochemistry and high resolution magnetic resonance imaging, respectively [
28]. Furthermore, spine number and dendritic branching are normal [
28]. However, the
Tsc1
+/−
mouse shows prominent behavioural deficits which mimic core symptoms of ASD and other neuropsychiatric disorders [
28].
Tsc1
+/− mice show hippocampal learning deficits using the Morris water maze test and contextual fear conditioning, as well as social deficits indicated by reduced social interaction and nest building [
28]. Consequently, the
Tsc1
+/− mouse is a suitable model to investigate aspects of the molecular pathology associated with neuropsychiatric spectrum disorders, especially in relation to ASD and intellectual disability. In this study, we attempted to identify changes in molecular pathways in the frontal cortex and hippocampus of the
Tsc1
+/− mouse model using a mass spectrometry-based proteomics approach. We also investigated protein changes associated with rapamycin treatment. Findings from this study could aid in the identification of novel drug targets for the treatment of cognitive, social and psychiatric symptoms in ASD.
Discussion
The pathogenesis of psychiatric disorders such as ASD remains elusive, and there is accumulating evidence that several neuronal circuits and pathways are affected. This is especially true for the social, cognitive and neuropsychiatric symptoms associated with these disorders. In an attempt to gain further insight into these pathways, this study combines unbiased and targeted proteomic approaches to investigate the hippocampus and frontal cortex of a mouse model of TSC, which is one of the most frequent causes of syndromic ASD [
44]. The investigated
Tsc1
+/− mouse model exhibits social and cognitive deficits, which are core behavioural symptoms of ASD in humans [
45] and other relevant rodent models [
46], without any obvious brain pathology (such as tumors or epilepsy). This makes the
Tsc1
+/− mouse an excellent model of pharmacologically treatable ASD. A previous study has demonstrated the effectiveness of rapamycin to normalize reciprocal social interactions in this model [
27]. The aim of the present study was to investigate proteins and pathways affected by rapamycin treatment, which could support drug discovery efforts and in turn the development of improved treatments for TSC, ASD and possibly other neuropsychiatric disorders.
Proteomic profiling of the frontal cortex and hippocampus brain tissue in this study identified and quantified a large number of significantly changed proteins in the Tsc1
+/− mouse model. Differentially expressed proteins and altered molecular pathways were identified and selected candidate proteins were validated using SRM as a highly quantitative method. In a second stage, proteomic analysis of rapamycin treatment effects were investigated to identify down-stream effects of mTOR-pathway inhibition in the hope to gain new insights into the molecular underpinnings of social impairments in ASD and other psychiatric disorders.
We were able to show that myelin proteins and the translational machinery, specifically several ribosomal subunits, were significantly altered in
Tsc1
+/− mice treated with rapamycin. Our findings of lower ribosomal subunit abundances are consistent with a rapamycin-induced downregulation of ribosomal biogenesis [
47]. Regarding the effects on myelination, previous research has linked the mTOR pathway to oligodendrocyte differentiation and axonogenesis [
48]. Oligodendrocytes produce myelin, and this is specifically regulated at the late progenitor to immature oligodendrocyte transition stage (as shown by changes in expression of the myelin marker proteins MYPR and MBP). We identified an increase in myelin proteins in the
Tsc1
+/− mouse, but not in Wt mice. A recent study has shown that ablation of TSC1 is associated with oligodendrocyte-specific over-activation and subsequent hypomyelination [
49]. An increase in myelin proteins in the
Tsc1
+/− mouse brain may be due to the globally enhanced (Table
1) protein translation and cell proliferation in the context of mTOR hyperactivation. An increase in cell growth and proliferation could interfere with oligodendrocyte maturation and thus result in incomplete myelination as seen in some demyelinating diseases, such as multiple sclerosis [
50].
MYPR and MBP as well as TSN-2 were amongst the altered myelin proteins. These proteins play an important role in oligodendrocyte differentiation during development. Furthermore, in vitro studies have shown that MBP mRNA and protein expression are significantly decreased by mTOR inhibition [
48,
51]. Inhibiting mTOR in oligodendrocyte precursor cell/dorsal root ganglion co-cultures potently abrogated oligodendrocyte differentiation and reduced numbers of myelin segments. Disorganized and structurally compromised axons with poor myelination have already been found in TSC patients, and this may at least to some extent explain the behavioural and cognitive deficits associated with the disorder [
52]. Impaired adult myelination has been shown in the prefrontal cortex of socially isolated mice [
53]. Importantly, changes in oligodendrocyte function and myelination abnormalities are amongst the most consistent hallmarks of psychiatric pathology in post-mortem brain studies. Changes were reported for schizophrenia, bipolar disorder, depression and ASD [
36,
54‐
58]. In wildtype mice, rapamycin treatment led to a reduction of myelin and myelin protein expression [
59,
60]. This is consistent with our findings, where rapamycin affects both wildtype (reduced) and mutant myelin (increased) protein expression.
Interestingly, several proteins that we found altered in the
Tsc1
+/− mouse model were reversed by rapamycin treatment. One of these proteins, a glycine receptor subunit, which abundance was decreased in the mutant and normalized by rapamycin treatment, could be a potential drug target for novel treatments of ASD and schizophrenia-spectrum disorders. The glycine receptor co-localizes with GABA
A receptors on hippocampal neurons [
61]. A microdeletion at Xq22.2 implicates GLRA4 to be involved in intellectual disability and behavioural problems [
62]. In a case report, glycine receptor antibodies could be detected in a patient with treatment-resistant focal epilepsy, tantrums, clumsiness and impaired speech [
63] and in patients with progressive encephalomyelitis with rigidity and myoclonus stiff person syndrome [
64]. Treatments targeting the glycine transporter are under investigation as novel treatment approaches for schizophrenia [
65].
Other altered proteins, which are normalized by rapamycin treatment, included the calcium-dependent secretion activator 1 (CAPS1) (decreased in
Tsc1
+/− and normalized by rapamycin), two guanine metabolism associated proteins (guanine deaminase and PDE6B; both increased in
Tsc1
+/− and normalized by rapamycin) and the vesicle-fusing ATPase NSF (increased in
Tsc1
+/−, normalized by rapamycin), a molecular component of the exocytosis machinery [
66], which is required for membrane fusion [
67] and regulates the disassembly of SNARE complexes on early endosomes [
68]. The NSF gene has also been linked with cocaine dependence [
69] and schizophrenia [
36,
70]. Direct interactions with cell surface receptors such as AMPA receptors [
71,
72], β2-adrenergic receptors [
73], dopaminergic receptors [
74] and the adrenomedulin receptor [
75] have been reported. Interestingly, a coordinated action of NSF and PKC regulates GABA
B receptor signaling efficiency [
76]. PKCG was found to be strongly downregulated by rapamycin treatment in this study and is known to be involved in the regulation of the neuronal receptors GLUR4 and NMDAR1 [
77]. It binds and phosphorylates the GLUR4 glutamate receptor and regulates its function by increasing membrane-associated GRIA4 expression [
78]. Several preclinical and clinical trials have investigated mGLUR antagonists for the treatment of social deficits in ASD [
78,
79] and ASD associated with FXS [
80,
81] and PKCG inhibitors could represent a novel treatment strategy to ameliorate cognitive and social deficits. Notably, Ketamine, which is thought to exert antidepressant action through modulation of mTOR pathway activity [
82], potentiates persistent learning and memory impairment through the PKCG-ERK signaling pathway [
83].
Another protein strongly downregulated following rapamycin treatment is the anaphase promoting complex S7 (APC7), which is a cell cycle-regulated E3 ubiquitin ligase controlling progression through mitosis and the G1 phase of the cell cycle. The control of APC7 through rapamycin might be a major breakpoint in cell proliferation. Rapamycin has already been shown to also downregulate the expression of the APC/C inhibitor Emi1 [
84].
Copine 6, which we found upregulated in the hippocampus of
Tsc1
+/− compared to wildtype mice, is a calcium-dependent regulator of the actin cytoskeleton in neuronal spines and negatively regulates spine maturation during neuronal development [
85]. Changes in copine 6 expression may be involved in neurodevelopmental disorders, as deformed dendritic spines and changes in spine density are hallmarks of many neurodevelopmental conditions, such as Down’s syndrome [
86,
87] and FXS [
88]. Interestingly, hippocampi from patients suffering from uncontrolled epileptic seizures, typically a problem in tuberous sclerosis patients, exhibit a decrease in spine density [
89]. We also found that MAP2, a dendritic spine marker, was increased by
Tsc1 heterozygocity and decreased by rapamycin treatment.
Interestingly, over twice as many significantly changed proteins were identified in the
Tsc1
+/− hippocampus as compared to control animals following rapamycin treatment (Fig.
1c; 231 vs. 106 changed proteins, respectively). TSC1 mutations are linked to numerous changes in biochemical processes, including cell cycle regulation, translational control and metabolism which are linked to mTOR pathway hyperactivation. It can be speculated that rapamycin-related inhibition of the mTORC1 complex results in TSC genotype-dependent adaptations in a wide range of molecular pathways. These adaptations could be indirectly involved in the therapeutic effect of rapamycin. A further explanation for the enhanced rapamycin treatment effect in the Tsc1
+−/ mice is selective vulnerability. Mutant mice might be more susceptible to the treatment as mTOR hyperactivation modulated similar downstream molecular pathways during neurodevelopment as are affected by the rapamycin-induced mTOR hypoactivation.