By Makena L. Clive a Dissertation Submitted to Johns Hopkins University in Conformity with the Requirements for the Degree of Do

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By Makena L. Clive a Dissertation Submitted to Johns Hopkins University in Conformity with the Requirements for the Degree of Do UNDERSTANDING SUICIDE BIOMARKER SKA2: DISCOVERY OF A SUICIDE BIOSIGNATURE TO AUGMENT SKA2 SUICIDE PREDICTION AND INVESTIGATING SKA2 REGULATORY MECHANISMS by Makena L. Clive A dissertation submitted to Johns Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy. Baltimore, Maryland May, 2017 © 2017 Makena L. Clive All Rights Reserved Abstract….. Suicide is the 2nd leading cause of death for ages 10-34 in the United States. Suicide rates have risen dramatically since 1999, with an estimated 25 attempts per single completed suicide, calling for increased efforts to improve prevention strategies. Suicide is a state that is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. The spindle and kinetochore associated complex 2 (SKA2) gene was recently discovered as a biomarker of suicide and HPA-axis dysregulation. Genetic and epigenetic variation at rs7208505, a single nucleotide polymorphism located in the 3’ untranslated region of SKA2, interacted with stress/anxiety metrics to predict suicidal behavior. Additionally, SKA2 was downregulated in the brains of suicide decedents. Little is known concerning the regulation and function of SKA2 in regards to HPA-axis dysregulation or suicide. The goal of this dissertation was to improve suicide prevention by enhancing our existing SKA2 suicide prediction model to better identify at-risk individuals, and to increase understanding of underlying suicide biology by investigating the regulation of SKA2. We used a custom bioinformatics approach to derive a DNA methylation biosignature that both interacted with rs7208505 methylation in post mortem prefrontal cortex and predicted suicide attempt in peripheral blood samples. Replacing stress/anxiety metrics in the SKA2 suicide prediction model with this biosignature improved prediction of suicidal behaviors. Additionally, the biosignature showed associations with immune modulation and HPA-axis metrics, suggesting that it may represent a biological state that mediates suicidal behavior. To better understand SKA2 regulation in the context of suicide, we screened various pathway agonists for alterations of SKA2 expression. We observed ii SKA2 downregulation in response to both anoxia and low iron conditions. Knockdown experiments revealed that this regulation was not due to the canonical hypoxia-inducible factor (HIF) pathway. Together, these studies offer an enhanced suicide prediction model and new understanding of underlying biology and molecular mechanisms. This improved suicide prediction model will allow for and enhances ability to identify at-risk individuals and implement interventions to prevent future suicide attempts. With further development, knowledge of SKA2 and other molecular signaling pathways that are involved in HPA- axis dysregulation will allow for development of treatments targeting these pathways. Advisors: Joseph P. Bressler, PhD & Zachary A. Kaminsky, PhD Thesis Readers: John D. Groopman, PhD Peter P. Zandi, PhD Richard S. Lee, PhD Alternates: Winnie Wan-Yee Tang, PhD Sabra L. Klein, PhD iii Acknowledgements The journey through this PhD program has been anything but easy. From late nights studying and endless hours preparing for exams to failed experiments, feelings of inadequacy, and the seemingly constant weight of stress on my shoulders, there were moments that succeeding appeared impossible. Nevertheless, I persisted through these difficulties, borne up by the support of wonderful advisors, colleagues, friends, and family, to which I would be remiss if I did not acknowledge their contributions to my success. First, I would like to offer an enormous thank you to Joseph Bressler. Time and time again, he has gone far above and beyond the call of advisor. I thank him for making himself constantly available to address my endless questions and concerns, introducing me to valuable mentors when experiments exceeded my abilities, and sacrificing his time and sanity to culture cells and conduct experiments in my absence. I’m truly indebted to him for the success of my project and for helping me navigate difficult moments during my time at Hopkins. I would also like to thank Zach Kaminsky for being a wonderful thesis advisor and mentor. I owe many of my skills to his tutelage, including excellent lab technique, performing bioinformatics analysis in R, impeccable efficiency and time management, and the ability to persevere when your experiments seem to be conspiring against your success. And I thank him for providing an excellent example of a dedicated scientist who manages to maintain a work-life balance, which has inspired me to pursue a future career in the sciences. In addition to my wonderful advisors, I’m grateful for the support of lab members past and present. Richard Lee has been incredibly supportive, acting both as a thesis committee member to guide my progress, and as a dear friend, providing stimulating conversation, life advice, delicious lunch outings, and acting as a therapist when frustrations hit their boiling point. Olivia Cox has iv been a good friend, providing words of encouragement and endless hours of entertaining anecdotes. I would also like to thank Ilenna Jones, Tori Brown, and Jerry Guintivano for their assistance with my projects, and to the Mood Disorders Group for their support. I thank John Groopman for participating in my thesis committee and offering words of wisdom on life beyond graduate school. And thank you to my additional thesis readers Peter Zandi, Winnie Tang, and Sabra Klein for donating their time and support. I’m grateful to the EHS Department, students past and present, staff, and faculty for their support, and for providing me with funding throughout my program on the NIEHS T32 Training Grant. Thank you to individuals at KKI who have provided me with help and mentorship: Hernando Lopez-Bertoni, Shuli Xia, and Larry Frelin. I’m extremely grateful for my classmates and dear friends, Meena Aladdin and Suzanne Martos. We laughed together, we cried together (well, mostly Meena), and somehow we all survived the past five years of torture and are only moderately jaded as a result. Their friendship and support mean everything to me, and I wish them both marvelous success in their future careers. I’m also very grateful for the friendship and support of Ben Davis, Cissy Li, Katie Kuhns, Jonathan Coulter, and David and Annaliesa Peterson. Last, but certainly not least, I thank my family for their unwavering support. Thank you to my wonderful parents, Jeff and Sherrie Hinrichs, for their constant backing of my ambitions, and for my siblings Jessica, Bridger, and Matthew for always being there. Thank you to my superb husband, Geoff, for taking me on many adventures, encouraging me to pursue my dreams, and tolerating my PhD-induced insanity for the past five years. And thank you to my catchild, Copernicus, for finding me when I needed him the most. v Table of Contents Abstract….. ......................................................................................................................... ii Acknowledgements ............................................................................................................ iv Table of Contents ............................................................................................................... vi List of Tables ..................................................................................................................... ix List of Figures ..................................................................................................................... x List of Abbreviations ....................................................................................................... xiii 1. INTRODUCTION & BACKGROUND .............................................................................. 1 1.1 Suicide Overview ............................................................................................. 1 1.2 Suicide Biomarkers: HPA-axis Dysregulation ................................................. 4 1.3 SKA2 as a Psychiatric Biomarker .................................................................... 7 1.4 SKA2 Gene Function...................................................................................... 12 2. DISCOVERY AND REPLICATION OF A PERIPHERAL TISSUE DNA METHYLATION BIOSIGNATURE TO AUGMENT A SUICIDE PREDICTION MODEL ........................................ 16 2.1 Abstract ........................................................................................................... 17 2.2 Background ..................................................................................................... 19 2.3 Results ............................................................................................................ 22 2.4 Discussion ....................................................................................................... 28 2.5 Conclusions .................................................................................................... 35 2.6 Materials & Methods ...................................................................................... 36 vi 2.7 Tables and Figures .......................................................................................... 40 2.8 Supplementary Material ................................................................................. 50 3. SUICIDE BIOMARKER GENE SKA2 IS REGULATED BY HIF-INDEPENDENT HYPOXIA PATHWAY ........................................................................................................
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