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Automated Immunohistochemical Analysis of the Orbitofrontal Cortex in Patients with Schizophrenia, Bipolar Disorder and Major Depressive Disorder

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Automated Immunohistochemical Analysis of the Orbitofrontal Cortex in Patients with Schizophrenia, Bipolar Disorder and Major Depressive Disorder Automated Immunohistochemical Analysis of the Orbitofrontal Cortex in Patients with Schizophrenia, Bipolar Disorder and Major Depressive Disorder by Kathleen Trought A thesis submitted in conformity with the requirements for the degree of Master of Science Institute of Medical Science University of Toronto © Copyright by Kathleen Trought (2017) Automated Immunohistochemical Analysis of the Orbitofrontal Cortex in Patients with Schizophrenia, Bipolar Disorder and Major Depressive Disorder Kathleen Trought Master of Science Institute of Medical Science University of Toronto 2017 Abstract Previous studies have found evidence for orbitofrontal cortex (OFC) pathology in major depressive disorder (MDD), bipolar disorder (BP) and to a lesser extent schizophrenia (SCZ). However, given that the OFC is a large heterogeneous area, it is difficult to assess how findings from small subareas translate to the entire region. The aim of this thesis is to analyze the entire OFC in patients with MDD, BP and SCZ. Using a novel approach with layer-specific immunohistochemical markers and an automated counting protocol, we were able to analyze the cortical width, cell density, cell area and distance from pia in the entire OFC of 60 post-mortem brain samples (15 control, 15 MDD, 15 BP, 15 SCZ). We did not find strongly significant differences between patients and control subjects. Our findings suggest that inconsistencies in the literature may arise from sampling only small areas of the cortex in a limited number of subjects. ii Acknowledgments I would like to thank my supervisor and mentor Dr. Albert Wong for his continuous support, guidance and encouragement throughout the completion of this degree. I greatly appreciate his mentorship over the past two years and his constant support in helping me to achieve my future goals. I would also like to thank my committee members Dr. Sheena Josselyn and Dr. Jeff Daskalakis for supporting me throughout my degree and providing me with guidance. There are several individuals who have helped me a tremendous amount throughout this project and I want to express my sincerest gratitude. Firstly, thank you to both the present and former members of the Wong lab for all of their support and assistance: Mohamad Abbass, Donald Wang, Frankie Lee, James Samson, John Zawadzki, Jialun Chen and Meng Xi Yu. Thank you to Paul Paroutis from the Imaging Facility at the Hospital for Sick Children. I would also like to extend my gratitude to Dr. Maree Webster, the Stanley Research Laboratory and Brain Collection and all of the individuals who generously donated their organs for research. Finally, I am extremely thankful for my family and close friends who have continuously supported and encouraged me. iii Contributions Mohamad Abbass and Dr. Albert Wong conceived and planned the study when Mohamad analyzed the anterior cingulate cortex (Abbass, 2014). Myself and Dr. Wong planned the OFC study and made changes to the protocol when needed. Myself, Mohamad Abbass and Dr. Albert Wong conceived and planned the method validation. Dr. Albert Wong contributed to the interpretation of the results. Jialun Chen assisted with the staining of the tissue. Mohamad Abbass developed the protocol for ImageJ, which was adapted for the purpose of the OFC study. Anton Semechko developed the MATLAB algorithm, which was used to calculate cortex width, cell density, cell area and distance from pia. Dr. Maree Webster and the Stanley Medical Research Institute provided us with the cortical samples. iv Table of Contents Title Page i Abstract ii Acknowledgments iii Contributions iv Table of Contents v List of Tables viii List of Figures ix List of Appendices xii List of Abbreviations xiii Chapter 1: Introduction and Literature Review 1 1.1 Cerebral Cortex 1 1.1.1 Overview 1 1.1.2 Neurons in the Neocortex 2 1.1.2.1 Pyramidal Neurons 2 1.1.2.2 Non-Pyramidal Neurons 4 1.1.3 Cytoarchitecture 5 1.2 Cortical Development 6 1.2.1 Development of the Human Centreal Nervous System 6 1.2.2 Corticogenesis 7 1.2.3 Cell-Fate Determination 9 1.2.4 Neuron Migration 15 1.2.4.1 Radial Migration 15 1.2.4.2 Tangential Migration 17 1.3 Orbitofrontal Cortex 18 1.3.1 Orbitofrontal Cortex Anatomy 18 1.3.2 Orbitofrontal Cortex Function 22 1.4 Psychiatric Disorders 23 v 1.4.1 Schizophrenia 23 1.4.1.1 Neurodevelopmental Hypothesis of Schizophrenia 24 1.4.1.2 Neurochemical Pathologies 25 1.4.1.3 Gross Anatomical Pathologies 26 1.4.1.4 Histological Pathologies 28 1.4.1.5 Genetic and Molecular Pathologies 29 1.4.1.6 Orbitofrontal Cortex in Schizophrenia 31 1.4.2 Bipolar Disorder 33 1.4.2.1 Orbitofrontal Cortex in Bipolar Disorder 33 1.4.3 Major Depressive Disorder 34 1.4.3.1 Orbitofrontal Cortex in Major Depressive Disorder 35 1.4.4 Cytoarchitecture of the Orbitofronal Cortex in Psychiatric Disorders 36 Chapter 2: Research Aims and Hypotheses 38 Chapter 3: Methods 41 3.1 Tissue Samples 41 3.2 Immunohistochemistry 42 3.3 Image Analysis 43 3.3.1 Microscopy - Zeiss Epifluorescence Microscope 43 3.3.2 Regional and Laminar Delineation 43 3.3.3 Automatic Cell Segmentation 46 3.3.4 Automatic Data Generation 47 3.3.4.1 Cortex Width 49 3.3.4.2 Cell Density 49 3.3.4.3 Cell Area 51 3.3.4.4 Distance From Pia 51 3.4 Statistical Analysis 52 3.5 Method Validation 53 3.5.1 Tissue Samples 53 3.5.2 Staining 53 3.5.2.1 Cresyl Violet (Nissl) Staining 53 3.5.2.2 Anti-CUX2 and Anti-NeuN 54 vi 3.5.2.3 Anti-ZNF312 and Anti-NeuN 54 3.5.3 Image Analysis 55 3.5.4 Statistical Analysis 56 Chapter 4: Results 57 4.1 Method Validation 57 4.1.1 Automated Versus Manual Counts 57 4.1.2 Nissl Stain 58 4.1.3 Neuronal Nuclear Antigen (NeuN) 59 4.2 Pearson's Correlation 61 4.3 Brodmann Area 47l 62 4.4 Brodmann Area 47m 68 4.5 Entire Orbitofrontal Cortex 73 Chapter 5: Discussion 78 5.1 Labeled Cell Population 78 5.2 Method Validation 81 5.3 Summary of Findings 83 5.4 Schizophrenia 85 5.5 Bipolar Disorder 88 5.6 Major Depressive Disorder 91 5.7 Significance 95 5.8 Limitations 96 5.9 Conclusion 98 Chapter 6: Future Directions 101 Chapter 7: References 104 Chapter 8: Appendix 126 vii List of Tables Table 1. Embryonic zones of the human cerebral cortex. 8 Table 2. Demographic information of the Neuropathology Consortium 41 of the Stanley Medical Research Institute. Table 3. Automated counts of DAPI, CUX2, ZNF312, CUX2+ve/ 57 DAPI+ve and ZNF312+ve/DAPI+ve cells are similar to manual counts. Table 4. Cortical thickness measurements are similar between Nissl 58 and immunohistochemically stained slides. Table 5. Summary of findings. 81 viii List of Figures Figure 1. Corticogenesis in the human brain. 10 Figure 2. Neocortical projection neurons are generated in an “inside-out” 12 fashion by progenitor cells. Figure 3. Three sulcogyral patterns in the orbitofrontal cortex of the 20 human brain. Figure 4. BAs 47 and 11 in the OFC based on gross anatomical landmarks. 21 Figure 5. A model of the orbitofrontal cortex function. 23 Figure 6. Gray-scale images of CUX2, ZNF312 and DAPI and an 43 overlapped artificially coloured image. Figure 7. Regional and laminar delineation of the orbitofrontal cortex. 44 Figure 8. Cortical layers delineated based on cytoarchitectonic criteria. 45 Figure 9. Automatic cell segmentation using ImageJ for (A) CUX2, 47 (B) ZNF312, and (C) DAPI. Figure 10. The five images that are input into MATLAB and the resulting 48 image. Figure 11. Delaunay Triangulation. 52 Figure 12. Nissl stain of the orbitofrontal cortex. 56 Figure 13. The percentage of CUX2 cells that are co-stained with NeuN 59 is 82.82%. Figure 14. The percentage of ZNF312 cells that are co-stained with NeuN 60 is 72.34% Figure 15. Trend for an increased thickness of layer V in SCZ in BA47l. 63 ix Figure 16. Decreased relative density of ZNF312 cells in layer V in BP, 64 MDD and SCZ in BA47l. Figure 17. Decreased relative density of CUX2 cells in layer V in BP, 65 and MDD in BA47l. Figure 18. Trend for an increase in the relative density of CUX2+ve/ 66 ZNF312-ve cells in layer I and decrease in layer IV in MDD in BA47l. Figure 19. No significant differences in ZNF312 cell size in BA47l. 67 Figure 20. No significant differences in relative distance from pia in BA47l. 67 Figure 21. Trend for an increased thickness of layer IV in MDD in BA47m. 68 Figure 22. Trend for a decrease in the relative density of ZNF312 cells 69 in layer VI in MDD in BA47m. Figure 23. Trend for an increase in the absolute density of CUX2 cells in 70 layer I and II and decrease in the relative density in layer V and VI in MDD in BA47m. Figure 24. Trend for an increase in the absolute and relative density of 71 CUX2+ve/ZNF312-ve cells in layer I in MDD in BA47m. Figure 25. No significant differences in ZNF312 cell size in BA47m. 72 Figure 26. No significant differences in relative distance from pia in BA47m. 72 Figure 27. Trend for an increased thickness of layer IV in SCZ in the 73 entire OFC. Figure 28. Trend for a decrease in the relative density of ZNF312 cells in 74 layer IV in SCZ, layer V and VI in MDD and layer VI in BP in the entire OFC.
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