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Table 1
Results from an automated biological process over-representation analysis in the AD brain
Up-regulated (1572/6265; 25.1%) EASE N/M/B Down-regulated (1126/6265; 18.0%) EASE N/M/B
Regulation of transcription
(269/792; 34%)
0.0000 21/38/41 Energy pathways (57/151; 37.7%) 0.0000 15/15/69
Cell proliferation (210/666; 31.5%) 0.0001 23/43/35 ATP biosynthesis (16/23; 69.6%) 0.0000 18/9/73
Oncogenesis (24/47; 51.1%) 0.0003 21/39/39 Synaptic transmission (49/143; 34.3%) 0.0000 9/30/61
Protein a.a. phosphorylation
(104/310; 33.5%)
0.0006 23/30/47 Coenzyme biosynthesis (20/40; 50%) 0.0000 15/15/69
Transition metal ion homeostasis
(10/16; 62.5%)
0.0076 18/45/36 Cation transport (60/197; 30.5%) 0.0000 13/18/69
Positive reg. cell prolif.
(25/62; 40.3%)
0.0119 18/68/14 Protein folding (30/86; 34.9%) 0.0003 32/11/57
Establishment. . . chromatin arch.
(34/94; 36.2%)
0.0186 25/43/33 Tricarboxylic acid cycle
(12/22; 54.5%)
0.0006 27/27/47
Nucleosome assembly (13/27; 48.1%) 0.0219 11/56/33 Glycolysis (14/29; 48.3%) 0.0007 6/18/76
Histogenesis and organogenesis
(22/57; 38.6%)
0.0319 22/17/61 Neurogenesis (64/244; 26.2%) 0.0011 19/27/53
Cell adhesion (94/314; 29.9%) 0.0346 19/46/35 Amino acid catabolism (13/30; 43.3%) 0.0038 33/0/67
Development (235/850; 27.6%) 0.0425 21/42/37 Ubiquitin-dep. protein catab.
(27/87; 31%)
0.0043 48/13/39
Complement activation\, classical
(9/18; 50%)
0.0576 10/40/50 Secretion (14/37; 37.8%) 0.0095 0/35/65
Negative reg. cell prolif. (28/83; 33.7%) 0.0762 09/50/41 Protein transport (66/288; 22.9%) 0.0245 26/25/49
Isoprenoid metabolism (6/10; 60%) 0.0789 00/83/17 Neurotransmitter metabolism (6/11; 54.5%) 0.0329 17/17/67
Apoptosis (72/255; 29.5%) 0.0818 13/32/55 Axon guidance (8/19; 42.1%) 0.0404 27/9/64
Defense response (102/360; 28.3%) 0.1010 15/57/28 Calcium ion transport (11/32; 34.4%) 0.0482 7/7/87
Lipid metabolism (82/288; 28.5%) 0.1250 15/47/38 Microtubule-based process (20/73; 27.4%) 0.0538 11/21/68
Biological process categories signicantly over-represented by up-regulated (left) and down-regulated (right) Alzheimers disease-dependent genes (ADGs) ( p < 0.15;
EASE score) are shown. Similar categories are excluded to reduce redundancy. After each category description (in parentheses) is the fraction and percentage of
signicant/total gene associations with that category. The ratios for total identied up- and down-regulated genes are shown in the headings. EASE, modied Fishers
exact test p-value; N/M/B, percentage of genes included in category because they were signicant by NFT correlation (N), MMSE correlation (M) or both (B). (Reprinted
from Proceedings of the National Academy of Sciences; the complete list of ADGs is given alphabetically in web Table 5 of Blalock et al., 2004.)
It is important to note that these increasingly rened approaches for the detection of co-
regulation and of pathway or functional class involvement (e.g., Pavlidis et al., 2004), are
rapidly advancing microarray research from an early developmental stage in which it
primarily yielded unprocessed lists of genes to a newand sophisticated level fromwhich
it can provide insights into dynamic alterations in complex biological systems and
functions. This advancement in co-regulation analysis clearly will be a key element in
redressing the problems of evaluating functional relevance. Additionally, another valuable
approach to functional relevance appears to be that of correlation with functional
endpoints, a strategy that we have implemented extensively as summarized below.
4. Correlations for functional relevance
As discussed, co-regulation provides insights into altered categories/pathways, thereby
aiding functional interpretation. Nonetheless, the functional implications of changes in
many identied genes, or even pathways, may not be apparent in a given study. Thus, one of
the major problems facing microarray studies is howto evaluate the functional relevance of
any specic gene that may be on a long list of genes identied by the analysis. Obviously,
the gold standard for establishing causative relevance is an intervention study. However,
while correlation of course cannot establish causation, what is less well recognized is that
correlation is a key prediction of a causative relationship; that is, two causally related
variables should co-vary. Therefore, since it is not feasible to perform intervention studies
for each gene that may be found to change (particularly in well-powered studies, e.g.,
Blalock et al., 2004), nding genes that change in correlation with key functional endpoints
is a next best strategy (Fig. 4). This approach allows substantial narrowing of potential
candidate genes for intervention studies, as any that are not consistently correlated with
function are much less likely to be directly relevant.
In our studies of aging-related and neurodegenerative processes, we have, as noted, used
large samples of independent subjects, excised regions of interest, and used a separate
microarray chip for each subject, to counter problems associated with multiple testing,
types I and II error, tissue heterogeneity and inter-subject variability. In addition, we have
applied the strategy of correlating microarray changes with behavioral/functional outcome
markers to strengthen the interpretation of transcriptional prole alterations specically
associated with the condition under investigation. In our study of Alzheimers disease in
post mortem tissue (Blalock et al., 2004), for example, we correlated expression of each of
thousands of genes with two established markers of AD, the Mini-Mental Status Exam and
a neurobrillary tangle index (see Fig. 4); and in a study of normal aging in rats (Blalock
et al., 2003), we correlated gene expression with behavioral tests of cognitive function (see
Fig. 1 in Blalock et al., 2003). It is important to emphasize that the processes under study
generally are graded and variable, and consequently, even within a single age group, there
are variations among individuals. In the aging study, some aged animals performed as well
as their younger counterparts, while in the AD study, some subjects with the same clinical
diagnosis varied considerably in pathological markers. These correlative approaches have
allowed identication not simply of genes that change with brain aging or AD, but more
importantly, of those that change in relation to functional decline. Together, the results have
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 490
provided new clues and generated new models of the functional pathogenesis of AD and
brain aging (see below).
5. Reproducibility of ndings across studies
The next section briey considers and compares the microarray studies performed to
date on aging brain in humans and animals, as well as AD models and human AD brain
tissue. As is apparent from the preceding discussion, microarray studies vary dramatically
in platforms, sample sizes, identication algorithms and statistical approaches, and studies
in the brain aging and AD elds are no exception. Furthermore, studies in this eld vary
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 491
Fig. 4. Gene identication through correlation. For each gene, expression intensity is plotted on the y-axis, and
MMSE (A left and C left) or neurobrillary tangle (NFT) (B right and D right) scores are plotted on the x-axis; R
2
value, p-value (Pearsons test), linear t (black line) and 95% condence intervals (dashed lines) are also shown.
The MMSE scale is reversed, so that AD severity increases to the right on all x-axes. (A and B) Genes for which
expression levels were up-regulated with AD, identied by negative or positive correlation with MMSE (A) or
NFT (B) scores, respectively. (C and D) Genes for which expression levels were down-regulated with AD,
identied by positive or negative correlation with MMSE (C) or NFT (D), respectively. (Reprinted from
Proceedings of the National Academy of Sciences; Blalock et al., 2004.)
considerably in the models used and the brain regions studied. Given this variability, it
might be expected that the results fromthese studies also vary substantially, and in fact, this
is clearly the case.
As discussed above, reliability (reproducibility) of ndings across studies is a hallmark
of true positives. That is, the probability of the same false positive result occurring by
chance in two separate tests is quite low, reecting the product of p-value probabilities
found on both tests (e.g., 0.05 0.05 = 0.0025). In addition, comparing results from two
similar microarray studies can determine whether the rate of replication (i.e., overlapping
positive results) is greater than might be expected by chance, and therefore, facilitate
interpretation of whether a common underlying process is generating the true positive gene
changes. A greater-than chance rate of replication can be determined, for example, by
the binomial test, comparing the degree of overlap in the two studies to that expected by
chance alone (e.g., Fig. 5). Thus, replication in two tests provides enhanced statistical
condence in scientic inferences.
Nonetheless, failure to repeat a signicant expression change does not necessarily imply
that the gene alteration observed in the rst study was a false positive. There can, of course,
be many other reasons for such discrepancies, including, importantly, a false negative
result in one of the studies. Because of concerns about the numerous false positives
generated by multiple comparisons in microarray studies, investigators often use stringent
criteria for gene identication (i.e., for determining that a genes expression has changed).
While this approach reduces false positives, it conversely increases false negative error.
The latter is compounded by the low group ns commonly employed in microarray studies,
which yield low statistical power with high false negatives. However, even when power is
reasonably high (e.g., 0.7), there is a strong chance of a false negative result and
accordingly, the chance of replicating a true positive effect in two independent studies (e.g.,
0.7 0.7 = 0.49) may not be better than 50%. In addition, cellular heterogeneity, regional
localization or model specicity of changes, microarray platform sensitivity, experimental
design, and a priori assumptions by researchers may all contribute variability and account
for different results among studies.
In light of the many causes of potential disagreements in ndings across studies, as
well as the difculty in evaluating the basis for such disagreements, replication in two
independent studies confers added condence in the overlapping positive results. And
although a smaller number of gene changes agree than disagree between studies to date,
the smaller agreeing set can likely be viewed as a robust and reliable set of biomarkers
for brain aging or AD. Consequently, in the next section, we summarize results and
analyze the overlap of gene changes between our studies and the multiple and diverse
other studies of brain aging and AD. For several reasons, we used our own recent works
as references against which to compare the other studies, including that we have
conducted large and relatively similar microarray studies in hippocampus of both
normally aging rats (Blalock et al., 2003) and AD subjects (Blalock et al., 2004). Our
studies also were well-powered (ns of 29 and 31, respectively), and our total numbers of
signicant genes (348 in aging, 3413 in AD on a larger chip) much exceeded expected
false positives (99 and 967, respectively). From these total numbers of observed
positives, we determined which were also identied in at least one other study of aging
or AD/AD models.
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 492
The degree of overlap with other studies and the conditions for each study are shown in
Table 2. Note that many genes identied in other studies were not even rated present on our
chips (because of different patterns of expression in different species, platforms and brain
regions as well as varying criteria for absence calls). Note also that for those genes that
were common, the highest proportions of overlap (replication) were found between our
studies and those with the largest sample sizes (even when comparing disparate models),
presumably because of the fewer false negatives expected in higher-powered studies.
Specic genes that overlapped between our studies and at least one other are described
below. Although these are relatively short lists considering the total positives identied, the
genes on the lists can be viewed as including a high proportion of true positives, for reasons
noted above.
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 493
Fig. 5. Binomial analysis of overlapping positives in two studies. Comparison of genes found to change
(positives) both as a function of aging (Ag) in Blalock et al. (2003) and in response to calcineurin (CaN)
overexpression in Norris et al. (2005). Binomial analysis revealed a degree of overlap of positives signicantly
greater than expected by chance for genes found to agree in direction in the two studies (i.e., calcineurin Up/Ag
Up, red circle; calcineurin Down/Ag Down, green circle). Values for binomial probabilities of deviation from
expected overlap are plotted on the x-axis (converted to standard deviations). Frequencies of the probabilities for
different degrees of deviation are plotted on the y-axis. In contrast, note the relative under-representation of genes
found to disagree in direction in the two studies (i.e., calcineurin Up/Ag Down, pink; calcineurin Down/Ag Up,
blue). The high degree of overlap suggests that aging and CaN may activate related pathways. (Reprinted with
permission from Journal for Neuroscience; Norris et al., 2005.) Similar overlap analyses can be used to compare
two studies on the same subject (e.g., microarray studies from different labs on post mortem ADtissue) in order to
assess statistical reliability of positive results (see text). (For interpretation of the references to colour in this gure
legend, the reader is referred to the web version of the article.)
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Table 2
Agreeing/overlapping transcriptional alterations across studies
Reference Species Platform Tissue Design # Genes changed # Also present
in Blalock
et al. (2003)
% Agree
" #
Comparison of aging studies (vs. Blalock et al., 2003)
Blalock et al. (2003) Rat Affymetrix Hip CA1 n = 910/group,
1 array/animal
348 348 (178"/170#)
1. Jiang et al. (2001) Mouse Affymetrix Cortex n = 3/group,
pooled, 1 array/
group
97 38 (201/184) 25 11
2. Lee et al. (2000) Mouse Affymetrix Neocortex n = 3/group, 1
array/animal
186 73 (39"/34#) 31 0
3. Lu et al. (2004) Human Affymetrix Frontal cortex n = 30, 1 array/
subject
320* 119 (64"/55#) 33 7
# Also present
in Blalock
et al. (2004)
Comparison of AD/AD models (vs. Blalock et al., 2004)
Human AD
Blalock et al.
(2004)
Human Affymetrix CA1 tissue n = 31, 1 array
per subject
3414 3413
(1977"/1436#)
4. Colangelo et al.
(2002)
Human Affymetrix CA1 tissue n = 6/group,
pooled, 1 array/group
38 34 (17"/17#) 29 29
5. Ginsberg et al.
(2000)
Human Spotted CA1 neurons n = 20/group, pooled,
4 arrays/group
isolated neurons
32 26 (26#) 35
6. Loring et al.
(2001)
Human Spotted Cing. ctx/amygdala n = 69/group, 1
array/subject
106* 88 (41"/47#) 27 49
7. Mufson et al.
(2002)
Human Nylon Nucleus basalis n = 610/group 12 8 (1"/7#) 100 14
8. Pasinetti (2001) Human Spotted Supratemporal
gyrus
n = 56/group,
pooled, 1 array/group
18 13 (13#) 54
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Reference Species Platform Tissue Design # Genes changed # Also present
in Blalock
et al. (2004)
% Agree
" #
9. Yao et al. (2003) Human Affymetrix Superior
frontal gyrus
n = 56/group, 1
array/subject
5 4 (4#) 50
AD models
10. Beglopoulos et al.
(2004)
Mouse Affymetrix Cortex n = 1/group, 1
array/group
56* 34 (21"/13#) 5 8
11. Dickey et al.
(2003)
Mouse Spotted Ctx and hip vs. cblm,
strtm and brstm
n = 4/group, 1
array/animal
43 18 (11"/7#) 100 57
12. Lee et al. (2004) Mouse Spotted Amygdala n = 5/group, pooled,
1 array/group
21 19 (8"/11#) 0 2
13. Mirnics et al.
(2003)
Mouse Affymetrix Brain n = 6/group, 1
array/animal
124* 59 (20"/39#) 70 56
14. Mirnics et al.
(2005)
Mouse Affymetrix Ctx and hip n = 45/group, 1
array/animal
57* 43 (24"/19#) 33 21
15. Reddy et al.
(2004)
Mouse Spotted Cortex n = 5/group,
pooled, 4 arrays/group
240* 169 (63"/106#) 16 24
Platform: Microarray design used in study. Tissue abbreviations: Hip, hippocampus; CA1, cornu ammonis 1 region of hippocampus; cing., cingulate; ctx, cortex; cblm,
cerebellum; strtm, striatum; brstm, brainstem. # Genes changed: number of genes reported to change by authors (* includes only mRNA transcripts annotated with gene
symbols); # also present in Blalock et al. (2003, 2004): the total number reported to change by respective authors that also were rated present and annotated in the Blalock
et al. (2003, 2004) studies (and showing the direction of change indicated in the authors work); % agree: the percentage of total genes found both in the respective
authors work and in the Blalock et al. (2003, 2004) studies that are both signicant (positive) and agree in direction. Boldface indicates a signicantly higher percent of
genes agree between the two studies than would be expected by chance (signicant over-representation, p < 0.05, by the binomial test). Based on the percent of positive
genes found among all tested in Blalock et al. (2003, 2004), the expected probability in the binomial test (Fig. 5) for overlap/agreement was 10% for aging comparisons
with Blalock et al. (2003) (references 13), and 19.9 and 14.5% for up- and down-regulated genes, respectively, in the AD comparisons with Blalock et al. (2004)
(references 415). Note: Many of the AD model mice differ importantly in the nature of their transgenic engineering.
Table 2 (Continued)
6. Overview and overlap of microarray studies on brain aging and aging-related
disease
6.1. Mammalian models of brain aging (Table 3)
As seen in Tables 2 and 3, most microarray studies (as other studies) of brain aging have
been performed in rodent models. Essentially all have found a clear increase in the
expression of genes related to inammatory, oxidative and glial processes (Lee et al., 2000;
Jiang et al., 2001; Blalock et al., 2003). Increases in glial and/or inammatory markers
have been seen in many conventional non-microarray studies as well (Rogers et al., 1996;
Murray and Lynch, 1998; Buttereld et al., 1999; Bickford et al., 2000; Calingasan and
Gibson, 2000; Andreasson et al., 2001; Mrak and Grifn, 2001; Nicolle et al., 2001; Wang
et al., 2001; Finch et al., 2002; Gemma et al., 2002; Wyss-Coray and Mucke, 2002; Wenk
et al., 2003), and therefore, their detection in microarray studies can perhaps be viewed as a
kind of positive control, validating microarray technology. And, in fact, such changes may
represent low hanging fruit for microarray analysis in that up-regulated genes in this
category make up the great majority of identied genes that overlapped across studies
(Table 3). This overlap appears to reect both strong expression and relatively ubiquitous
aging changes across brain regions and models. Interestingly, the highest overlap of our rat
aging study (Blalock et al., 2003) was with the human tissue study of normal aging
(Table 2, Lu et al., 2004), which had similar sample size to ours. Of course, many changes
may not be as strong or ubiquitous as inammatory responses, and therefore, their
detection may require greater biological replication (to increase statistical power) and more
selective brain tissue isolation and preparation (to reduce cellular heterogeneity) (Becker,
2002; Ginsberg et al., 2000).
In our microarray-based study on brain aging in a rat model (Blalock et al., 2003), we
focused on the CA1 region of the hippocampus, an area long implicated in aging-related
cognitive decline (Landeld and Pitler, 1984; Disterhoft et al., 1993; Thibault et al.,
1998). Each animals CA1 region was hybridized to a separate microarray and three age
groups (young, mid-aged and aged) were used-to assess (roughly) at which point along
the age-course transcriptional alterations began to occur. Further, each animals
performance on two hippocampally dependent tasks (Spatial Water Maze and Object
Memory Task) was assessed prior to euthanasia. Analysis was performed using formal
statistical tests after results had been ltered for absence calls and non-annotated
transcripts. Absence call ltering resulted in a marked improvement in the expected
false discovery rate of our data set. This is not unexpected as the expression values for
probe sets rated absent by the Microarray Suite algorithms (MAS4 and MAS5) are
considered by the manufacturer to be too volatile for analysis (Affymetrix, 2001).
Transcriptional changes were identied at two levels; rst, by whether the genes
expression differed signicantly across age (tested with one-way ANOVA) and second,
in a subset, by whether it also correlated (by Pearsons test) signicantly with cognitive
performance. Functional grouping analysis was performed using literature searches and
supported through automated Gene Ontology assignments. Genes that met criteria for
both aging dependence and functional correlation were identied as aging and cognition
related genes (ACRGs).
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 496
As noted, our studies were in agreement with many others regarding altered expression
of molecules related to inammatory responses, oxidative stress, glial activation and
mitochondrial dysfunction. Many of these molecules are reected in Table 3. In addition,
this well-powered study yielded many ACRGs that were not detected in other studies. From
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 497
Table 3
Agreement (overlap) of gene transcription changes in the brain with aging
Gene References
Up-regulated with age (Blalock et al., 2003)
Apod Apolipoprotein D 2,3
Cast Calpastatin 3
Cd9 CD9 antigen 2
Cgef2 cAMP-regulated guanine nucleotide exchange factor II 3
Cryab Crystallin, alpha B 2
Csrpi Cysteine and glycine-rich protein 1 3
Ctsd Cathepsin D 2
Dck Deoxycytidine kinase 1
Ddr1 Discoidin domain receptor family, member 1 3
Erbb3 V-erb-b2 erythroblastic leukemia viral oncogene homolog 3 3
Fah Fumarylacetoacetate hydrolase 1
Fgfr2 Fibroblast growth factor receptor 2 3
Gatm Glycine amidinotransferase 3
Gfap Glial brillary acidic protein 2,3
Gna15 Guanine nucleotide binding protein, alpha 15 2
Hbb Hemoglobin beta chain complex 3
Hcrtr2 Hypocretin (orexin) receptor 2 3
Klk6 Kallikrein 6 1
Lamp2 Lysosomal membrane glycoprotein 2 3
Lcat Lecithin cholesterol acyltransferase 2
Mag Myelin-associated glycoprotein 2
Mog Myelin oligodendrocyte glycoprotein 2
Msn Moesin 3
Nfe2l2 NF-E2-related factor 2 3
Pmp22 Peripheral myelin protein 22 3
S100b S100 protein, beta polypeptide 3
Seppi Selenoprotein P, plasma, 1 1,3
Tgfbr2 Transforming growth factor, beta receptor II 3
Tmp21 Integral membrane protein Tmp21-I (p23) 3
Vamp1vesi Vesicle-associated membrane protein (synaptobrevin 2) 2
Vegf Vascular endothelial growth factor form 3 2,3
Vim Vimentin 1,2,3
Down-regulated with age (Blalock et al., 2003)
Ap2m1 Adaptor-related protein complex 2, mu 1 subunit 1
Ca4 Carbonic anhydrase 4 3
Calb1calbi Calbindin 1 3
Coro1a Coronin-1A 3
Gad1 Glutamate decarboxylase 1 3
Pfn1 Prolin 1 1
Genes that changed in both Blalock et al. (2003) and at least one other mammalian brain aging study. References:
references with similar ndings: 1, Jiang et al. (2001); 2, Lee et al. (2000); 3, Lu et al. (2004).
the categories of these ACRGs we were able to identify several novel processes not
previously closely associated with brain aging, such as down-regulated structural synaptic
plasticity, activity regulated signaling and transcription factors, as well as up-regulated
myelin turnover, cholesterol synthesis/transport, protein processing and some signal
transduction, among others. These results, combined with the prior results fromour lab and
others, led us to suggest a new, more comprehensive model of functional brain aging
(Fig. 6), in which altered Ca
2+
signaling leads to decreased neuronal signaling, in turn
reducing biosynthesis and metabolism in neurons, down-regulating synaptic plasticity and
inducing axonal regression. Axonal regression then triggers demyelination, producing
myelin fragments that activate microglia to induce an inammatory response. In parallel,
activated microglia exacerbate the demyelinating response by attacking oligodendrocytes,
which respond with remyelinating programs (e.g., cholesterol synthesis) in a compensatory
fashion. Further, microglia cause a feed-forward increase in inammatory response,
increasing antigen presentation and causing altered glial metabolism, astrocytic
hypertrophy and destabilized extracellular matrix.
This model of course, is only one of several possible cascades that might t the data.
However, it illustrates how the broader overviews of dynamic changes in multiple
pathways now being provided by microarray research are beginning to generate more
comprehensive and presumably, more realistic models for experimental testing. Thus, the
smaller set of gene changes replicated in other studies (Table 3) provided evidence of
reliability, whereas the larger set of gene changes not found in other studies (but whose
reliability is nevertheless based on statistical analysis in a well-powered study) provided
new insights necessary for a novel comprehensive model. Notably, we have recently
replicated many of our ndings on novel ACRGs in another well-powered study of
hippocampal aging in rats (in preparation).
6.2. Human AD (Table 4)
Many of the same principles apply in studies of AD as in the aging studies summarized
above. AD has been remarkably resistant to analysis at the molecular level, possibly
because of the high degree of complex interactions that may exist between cell-types in the
affected brain tissue. While several microarray studies of post mortem AD brain tissue
have been conducted, it is important to note the limitations that differences in experimental
design may have on interpretation. Studies can be divided into three basic designs; those
comparing (1) AD-affected versus AD-resistant brain tissues within subjects, (2) AD-
affected brain structures across AD patients and age-matched controls (Pasinetti, 2001;
Colangelo et al., 2002; Mufson et al., 2002; Yao et al., 2003) or (3) some combination of
affected and unaffected tissue across AD patients and age-matched controls (Ginsberg
et al., 2000; Loring et al., 2001). The within-subject design is powerful because single
subjects can serve as their own controls, helping to reduce the contribution of inter-subject
variability. However, results in such designs may also be inuenced by changes unique to
a potential interaction between the effects of AD and a specic brain region. In addition,
relatively few studies (Pasinetti, 2001; Blalock et al., 2004) have looked at early stages of
ADwith microarrays. Because these early-stage changes presumably are more subtle, it is
likely that such studies need good statistical power (achieved through increased n and/or
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 498
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 499
Fig. 6. Integrative model of brain aging. Numbers represent one putative sequence of events consistent with
ndings on aging-dependent hippocampal genomic changes correlated with cognitive dysfunction. Arrows
indicate hypothesized causal interactions for the inammatory cascade component. Altered Ca
2+
and synaptic
signaling (1) in neurons (N) reduce neural activity responses, which then activate genomic alterations that down-
regulate activity-dependent signaling pathways (2) and induce general neuronal, metabolic and biosynthetic
involution (3a and b). These involutional changes induce other transcriptional alterations that down-regulate the
capacity for neurite outgrowth, synaptogenesis, and maintenance of extracellular structure (4). The weakening of
extracellular structure and axonal regression trigger an initial demyelination process (5) that in turn activates
remyelinating programs and associated cholesterol biosynthesis/transport (6a) in oligodendrocytes (O). Con-
currently, myelin fragments are endocytosed by glia and degraded to antigenic epitopes that stimulate innate
autoimmunity and antigen presentation (6b) in microglia (M). These autoimmune responses then activate a glial-
mediated inammatory cascade (7) in microglia (M) and astrocytes (A), associated with altered glial metabolism
(8a) and glucose uptake from capillaries (C), and astrocytic hypertrophy (8b). The increasing inammatory and
glial activation induce additional extracellular matrix transformation and neuronal erosion (9) and exacerbate
demyelination. The accumulating inammatory damage (7) and extracellular changes (9) eventually interact with
decreased neuronal activity (1) and synaptic plasticity (4) to impair cognition and increase neuronal vulnerability
(bottom). (Reprinted with permission from Journal of Neuroscience; Blalock et al., 2003.)
decreased variability) to facilitate detection of incipient changes (e.g., Blalock et al.,
2004).
To identify both early and severe AD changes, we selected a correlative algorithm and a
single subject per array design and correlated each genes expression against a
neuropathologic and a cognitive index of AD pathology. The CA1 region was excised
for microarray analysis from all AD or control subjects (through the Alzheimers Disease
Research Center at the University of Kentucky, Sanders-Brown Center on Aging), each of
whom had received a battery of cognitive tests, including the Mini-Mental Status Exam
(MMSE), and had received post mortem quantication scores for amyloid plaque, diffuse
amyloid and neurobrillary tangle (NFT) density. We used MMSE as a measure of cognitive
function and NFTas a measure of pathology against which each gene was correlated across
subjects (the steps of the full microarray analysis algorithm are summarized in Fig. 2).
Despite the important differences in analytical and design approaches (in addition to the
other important differences between studies, such as array platform and pooling issues),
comparisons of these studies to our own (Tables 2 and 4) again revealed overlapping sets of
genes that can be interpreted as containing a relatively higher proportion of true positives. It
should be noted that, for purposes of comparisons across studies (see below), we used our
results for the changes seen overall across all stages of AD, rather than the smaller set of
results for changes found in the incipient/control correlations (because most other AD
microarray studies examined cases of advanced rather than incipient changes).
Interestingly, in contrast to the normal aging study (Table 3), there was greater agreement
among down-regulated than among up-regulated transcripts (Table 4), including overlap
among many transcripts whose protein products are associated with neuronal function,
suggesting that genomic changes reecting neuronal decline may be a common and clear
hallmark of severe AD. As expected from the large differences between study designs, and
from the aging study, many more gene expression changes in our AD study did not overlap
than agreed with other microarray studies (Tables 2 and 4).
As noted, in this study we additionally identied a subset of transcriptional changes that
were also correlated with AD markers in the very early or incipient stages of AD. Changes
in the incipient stages of AD could provide important clues on the pathogenesis of the
disorder, as well as serve as valuable biomarkers or targets for clinical intervention as new
therapeutic agents are developed. Gene expression correlates of incipient AD revealed an
intriguing alteration in the hippocampal transcriptional prole, including an up-regulation
of messages functioning as transcription factors and tumor suppressors (Blalock et al.,
2004). Based on these ndings, we proposed a model in which alterations in axons or their
myelin sheaths initially stimulate growth and remyelination responses in localized
oligodendrocytes. The oligodendrocytes, in turn, secrete growth factors that have local
autocrine/paracrine stimulatory effects, stimulating oligodendrocytic progenitor cells and
also causing compensatory cell-specic tumor suppressor responses in neurons and
astrocytes. These compensatory responses lead to protein aggregation, affect axonal
myelin interactions, and result in NFTs. As the NFT density increases, wider extracellular
matrix, amyloid precursor protein and inammatory changes may be triggered that impact
cognition. This model could help to explain why AD pathogenesis appears to travel
along myelinated axons fromthe entorhinal cortex to hippocampus and neocortex (Hyman,
1997; Braak and Braak, 1998), leaving NFTs and plaques in its wake.
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 500
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 501
Table 4
Agreement (overlap) of gene transcription changes in the human brain with AD
Symbol References
Up-regulated with AD (Blalock et al., 2004)
Add3 Adducin 3 (gamma) 6
Ccl20 Chemokine (CC motif) ligand 20 4
Cdk2Ap1 Cdk2-associated protein 1 6
Cebpd CCAAT/enhancer binding protein (C/EBP), delta 4
Ftl Ferritin, light polypeptide 6
Gak Cycling associated kinase 6
Gja1 Gap junction protein, alpha 1, 43 kDa (connexin 43) 6
Gsta1 Glutathione S-transferase A1 6
Igfbp5 Insulin-like growth factor binding protein 5 6
Il1A Interleukin 1A 4
Nfkb1 Nuclear factor of kappa light polypeptide in B-cells 1 (p105) 4
Pabc1 Poly(A) binding protein, cytoplasmic 1 6
Thg-1 TSC-22-like 6
Tjp2 Tight junction protein 2 6
Tnfaip2 Tumor necrosis factor, alpha-induced protein 2 4
Tob2 Transducer of ErbB-2 6
Tpd52 Tumor protein D52 6
Down-regulated with AD (Blalock et al., 2004)
Chl1 Cell adhesion molecule with homology to L1CAM 6
Cox4L1 Cytochrome c oxidase subunit IV isoform 1 6
Cspg5 Chondroitin sulfate proteoglycan 5 (neuroglycan C) 4
Ddx1 Dead box 1 6
Dscr1L1 Down syndrome critical region gene 1-like 1 6
Ensa Alpha endosulne 6
Fkbp4 FK506 binding protein 4 6
Glrx Glutaredoxin (thioltransferase) 5
Got1 Glutamic-oxaloacetic transaminase 1, soluble 6,8
Gria1 Glutamate receptor, ionotropic, AMPA 1 5
Gria2 Glutamate receptor, ionotropic, AMPA 2 5
6Itpr1 Inositol triphosphate receptor, type 1 6
Kcnb2 Shaker K+ Channel, beta 2 6
Lmo4 Lim domain only 4 6
Lss Lanosterol synthase 6
Map2K1 Mitogen activated protein kinase kinase 1 6
6Mapk1 Mitogen activated protein kinase 1 5,6
Mlf2 Myeloid leukemia factor 2 6
Mdh1 Malate dehydrogenase 1, NAD (soluble) 8
Nars Asparaginyl-tRNA synthetase 6
Ne Neurolament light chain; neuron specic structural protein 4
Nell2 Nel (chicken)-line 2 8
Oxct 3-Oxoacid CoA transferase 6,8
Pgrmd Progesterone receptor membrane component 1 6
Ppp2Ca Protein phosphatase 2, catalytic subunit alpha 5,6
Psma5 Proteasome (prosome, macropain) subunit, alpha type, 5 6
6Psmd1 Proteasome (prosome, macropain) 26S subunit, non-ATPase, 1 6
Rpip8 Rap2 interacting protein 8 6
Rtn1 Reticulon 1 8
Slc25A6 Mitochondrial ADP/ADT translocator, member 6 6
6.3. Animal models of AD (Table 5)
We also compared gene expression proles in our study against those reported in
studies of brain tissue in selected AD models. Initially, we expected to nd a relatively
small degree of overlap considering that the AD models only simulate some aspects of
the human condition. Surprisingly, more genes showed overlapping responses (Tables 2
and 5) than in the human comparison (Table 4). Despite this overlap, there obviously are
many notable differences between human AD and the mouse models including type and
presence of genetic manipulation, time and severity of onset of pathologic and/or
cognitive changes, and species-related differences. Thus, the aspects of gene expression
proles that overlap may be particularly robust. In this section we discuss signicant
overlaps between our work in human AD brain (Blalock et al., 2004) and studies using
animal models of AD.
Double transgenic presenilin1 (PS1)/amyloid precursor protein (APP) mice (Borchelt
et al., 1997) show many characteristics similar to those seen in the human AD population,
such as cognitive decits (Richards et al., 2003), age-dependent accumulation of
pathological markers (Holcomb et al., 1998), and a similar distribution of markers across
hippocampus and cortex (Gordon et al., 2002). Microarray analyses of amyloid bearing
(versus amyloid free) regions of the brains of PS1/APP mice (Dickey et al., 2003) found
up-regulation that overlapped with human AD (Table 5) for inammatory markers (C4a/
C4b and Hspca), lysozomal enzymes (Npc1 and Ctss), and transcription machinery/
regulators (Madh5, Sp100, Rrm2 and Sfrs10), as well as for Cbs (involved in homocysteine
transulferation) and Gadd45B, a negative regulator of cell growth. Interestingly,
overlapping down-regulation was found exclusively for synaptic/intracellular signaling
molecules (Camk2a, Clstn1, Gria1 and Syn47).
Mutated presenilins have been implicated in some forms of Familial Alzheimers
disease. However, the relative activity of these mutated enzymes is not well understood and
may involve both increased and decreased function in different pathways and brain
structures (reviewed in Mirnics et al., 2005). Using a model in which normally functioning
PS1 is knocked out, Mirnics et al. (2003) assessed possible loss of function transcriptional
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 502
Table 4 (Continued )
Symbol References
Slit2 Slit homolog 2 (Drosophila) 4
Snca Synuclein, alpha (non A4 component of amyloid precursor) 5
6Stat1 Signal transducer and activator of transcription 1, 91 kDa 4
Stx1A Syntaxin 1A (brain) 9
Syn1 Synapsin I 4,5
Syn2 Synapsin II 8
Syt1 Synaptotagmin I 5,7,9
Tpi1 Triosephosphate isomerase 1 6
Tubb2 Tubulin, beta, 2 5
Uchl1 Ubiquitin carboxyl terminal esterase L1 8
Genes that changed in Blalock et al. (2004) and at least one other human AD post mortem brain tissue study.
References: references with similar ndings: 4, Colangelo et al. (2002); 5, Ginsberg et al. (2000); 6, Loring et al.
(2001); 7, Mufson et al. (2002); 8, Pasinetti (2001); 9, Yao et al. (2003).
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Table 5
Agreement (overlap) of gene transcription changes between AD and selected AD models
Symbol References Symbol References
Up-regulated with AD (Blalock et al., 2004) Down-regulated with AD (Blalock et al., 2004)
Aebp1 AE binding protein 1 14 Aldoc Aldolase C,
fructose-bisphosphate
15
Appbp2 Amyloid beta precursor
protein binding protein 2
15 Ap2M1 Adaptor-related protein
complex 2, mu 1 subunit
15
Birc4 Baculoviral IAP
repeat-containing 4
13 Arf1 ADP-ribosylation factor 1 15
Bub1 BUB1 budding uninhibited
by benzimidazoles 1 homolog
13 Atp6Ip1 ATPase, H + transporting,
lysosomal interacting protein 1
15
C4A Complement component 4A 11 Atp6V0C ATPase, H + transporting,
lysosomal 16 kDa, V0 subunit C
15
C4B Complement component 4B 11 Atp6V1C1 ATPase, H + transporting,
V1 subunit C, isoform 1
15
Ca1 Carbonic anhydrase I 13 Bat3 HLA-B associated transcript 3 15
Cbs Cystathionine-beta-synthase 11 Bsg Basigin (OK blood group) 15
Cd68 CD68 antigen 14 Camk2A Ca
2+
/CaM dependent
protein kinase Iia
11
Cdc2L2 Cell division cycle 2-like 2 15 Cap Adenylyl cyclase-associated
protein
14
Csh1 Chorionic somatomammotropin
hormone 1
15 Cct3 Chaperonin containing TCP1,
subunit 3 (gamma)
15
Ctss Cathepsin S 11 Chl1 Cell adhesion molecule with
homology toL1CAM
13
Eno1 Enolase 1 alpha 13 Ckb Creatine kinase, brain 15
Epm2A Epilepsy, progressive
myoclonus type 2, Lafora
disease (laforin)
14 Clcn3 Chloride channel 3 13
Exo1 Exonuclease 1 15 Clstn1 Calsyntenin 1 11
Fzd9 Frizzled homolog 9
(Drosophila)
14 Cox4I1 Cytochrome c oxidase
subunit IV isoform 1
15
Gadd45B Growth arrest and
DNA-damage-inducible, beta
10,11 Cox7A2L Cytochrome c oxidase
subunit VIIa polypeptide 2 like
15
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4 Table 5 (Continued )
Symbol References Symbol References
Gfap Glial brillary acidic protein 10,13 Crnkl1 Crn, crooked neck-like
1 (Drosophila)
12
Gja1 Gap junction protein, alpha 1,
43 kDa (connexin 43)
13 Cs Citrate synthase 15
Gpi Glucose phosphate isomerase 10 Dpysl4 Dihydropyrimidinase-like 4 13
Gpx5 Glutathione peroxidase 5 13 Gad1 Glutamate decarboxylase
1 (brain, 67 kDa)
13
Hmox1 Heme oxygenase (decycling) 1 15 Glul Glutamate-ammonia ligase
(glutamine synthase)
15
Hspca Heat shock 90 kDa
protein 1, alpha
11 Gnb1 G protein, beta polypeptide 1 15
Itgb5 Integrin, beta 5 15 Gng3 G protein gamma 3 15
Jag1 Jagged 1 (Alagille syndrome) 14 Got2 Glutamic-oxaloacetictransaminase
2, mitochondrial
15
Lats1 LATS, large tumor suppressor,
homolog 1 (Drosophila)
13 Gria1 Glutamate receptor, ionotropic,
AMPA 1
11
Madh5 MAD, mothers against
decapentaplegic homolog 5
11 Hyou1 Hypoxia up-regulated 1 14
Man2B1 Mannosidase, alpha,
class 2B, member 1
13 Ina Internexin neuronal intermediate
lament protein, alpha
13
Mkrn1 Makorin, ring nger protein, 1 10 Kcnab2 Potassium voltage-gated channel,
shaker beta 2
10
Mtf1 Metal-regulatory transcription
factor 1
15 Kl Klotho 12
Nap1L1 Nucleosome assembly
protein 1, like 1
15 Lxn Latexin protein 13
Npc1 Niemann-pick disease,
type C1
11 Mapre3 Microtubule-associated protein,
RP/EB family 3
13
Npc2 Niemann-pick disease, type C2 13 Mapt Microtubule-associated protein tau 13
Nr4A1 Nuclear receptor subfamily 4,
group A, member 1
14 Meg3 Maternally expressed 3 13
Plagl1 Pleiomorphic adenoma gene-like 1 14 Mgst3 Microsomal glutathione
S-transferase 3
13
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Table 5 (Continued )
Symbol References Symbol References
Prelp Proline arginine-rich end
leucine-rich repeat protein
15 Ne Neurolament, light polypeptide
68 kDa
13
Prkcl1 Protein kinase C-like 1 13 Oaz2 Ornithine decarboxylase
antizyme 2
15
Pura Purine-rich element binding
protein A
15 Pcp4 Purkinjecell protein 4 13
Rrm2 Ribonucleotide reductase
M2 polypeptide
11 Pea 15 Phosphoprotein enriched in
astrocytes 15
13,15
Sdc1 Syndecan 1 13 Pias1 Protein inhibitor of activated
STAT, 1
15
Serpini2 Neuroserpin 10 Pnoc Prepronociceptin 13
Sfrs10 Splicing factor,
arginine/serine-rich 10
11 Psa Phosphoserine aminotransferase 13
Sp100 Nuclear antigen Sp100 11 Psmb4 Proteasome subunit, beta 4 15
Sspn Sarcospan
(Kras oncogene-associated gene)
10 Ptprz1 Protein tyrosine phosphatase,
receptor-type Z1
13
Tf Transferring 13 Ptx3 Pentaxin-related gene, rapidly
induced by IL-1 beta
13
Thra Thyroid hormone
receptor, alpha
14 Sgne1 Secretory granule, neuroendocrine
protein 1 (7B2 protein)
14
Tnxb Tenascin XB 13 Slc6A1 Neurotransmitter transporter,
GABA
13
Snap25 Synaptosomal-associated
protein, 25 kDa
13
Sncg Synuclein, gamma 13
Stmn3 Stathmin-like 3 15
Syn47 Homer, neuronal immediate
early gene, 1B
11
Tal1 T-cell acute lymphocytic
leukemia 1
13
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6
Table 5 (Continued )
Symbol References Symbol References
Tm4Sf2 Transmembrane 4 superfamily
member 2
13
Trpc1 Transient receptor potential cation
channel, subfamily C, member 1
14
Ube2H Ubiquitin-conjugating enzyme E2H 15
Uqcrc1 Ubiquinol-cytochrome c reductase
core protein I
15
Ywhaz Tyrosine 3-monooxygenase
act. prot. zeta
15
Genes that changed in both Blalock et al. (2004) and at least one microarray study of brain tissue in an animal model of AD. References: references with similar ndings:
10, Beglopoulos et al. (2004); 11, Dickey et al. (2003); 12, Lee et al. (2004); 13, Mirnics et al. (2003); 14, Mirnics et al. (2005); 15, Reddy et al. (2004).
alterations associated with PS1 ablation and found up-regulation overlapping with human
AD (Table 5) for expression of: negative regulators of cell growth (Birc4, Bub1, Eno1,
Lats1, Tf and Tnxb), intra- and inter-cellular signaling molecules (Gja1 and Prkcl1),
lysozomal enzymes (Man2b1 and Npc2), Ca1, a carbonic anhydrase whose dysfunction is
thought to play a role in AD and aging (reviewed in Sun and Alkon, 2002), Gfap, a marker
for astroglia, Gpx5, a glutathione peroxidase with anti-oxidant properties and Sdc1, a cell-
surface proteoglycan important for cytoskeletal structure. These authors also found
overlapping down-regulation for expression of: neuronal signaling molecules (Clcn3,
Gad1, Pnoc, Psa, Slc6a1 and Snap25), extracellular matrix/cytoskeletal elements (Chl1,
Ina, Mapre3, Mapt, the principle protein product associated with NFTs, Ne and Sncg),
negative regulators of inammation (Pea15, also decreased in APP transgenic mice, Ptx3,
Tal1 and Tm4sf2), regulators of neuronal growth (Dpysl4 and Ptprz1), Lxn, a
carboxypeptidase inhibitor that also serves as a marker of excitatory neurons in cortex
(Job and Tan, 2003), Meg3, an untranslated RNA that may function directly as a tumor
suppressor, Mgst3, which also functions as a glutathione peroxidase and may have anti-
oxidant properties and Pcp4 (Pep-19), which may play a role in sequestering calcineurin
(Slemmon et al., 2000).
APP transgenic mice do not show the neuronal cell loss seen in AD (Stein and Johnson,
2002), but do demonstrate decits in hippocampal-dependent behavioral tasks (Westerman
et al., 2002). Reddy et al. (2004) used microarrays to examine transcriptional proles in the
frontal cortex of APP transgenic mice. Interestingly, signicantly overlapping changes
with human AD (Table 5) were found only for down-regulated genes, including those
related to energy transduction (Aldoc, Ckb, Cox4i1, Cox7a2l, Cs, Got2, Oaz2 and Uqcrc1),
G-protein signaling (Gnb1 and Gng3), protein degradation (Psmb4 and Ube2h), vesicle/
golgi trafcking (Ap2m1, Arf1, Atp6ip1, Atp6V0C and Atp6V1C1), Bat3, a protein of
unknown function coded from the MHC region of the genome, Bsg, a type I membrane
protein whose activity promotes both neurite formation and outgrowth of astrocytic
processes, Cct3, a molecular chaperone, Glul, an enzyme that catalyzes the reversible
conversion of glutamate to glutamine, Pea15, a negative regulator of inammation (also
decreased in PS1 knock out study), Pias1, a transcriptional co-regulator, Stmn3, one of the
neuronal growth associated proteins that may serve as a marker for synaptic plasticity
(Mori and Morii, 2002) and Ywhaz, an adaptor protein that participates in multiple
signaling pathways.
Overall, many of these changes, particularly down-regulated genes associated with
neuron structure and synaptic activity, suggest disorganization of the synaptic structure of
extant neurons or loss of neurons (in the case of PS1 knockouts and APP/PS1 transgenic
animals). The dysfunction in the neuronal compartment is apparently accompanied by glial
activation and inammatory processes, as these markers were also replicated in mouse
models and human AD. Many of these changes also have been observed using non-
microarray based technology and, therefore, the overlapping ndings reviewed here further
strengthen use of animal models to approximate many aspects of AD. Finally, as mentioned
in Section 5, statistically signicant overlapping results do not provide a list of the only true
positive genes that may be common across studies, but rather serve as a stochastic
bellwether, indicating that, at least in part, two phenomena share similar transcriptional
proles.
E.M. Blalock et al. / Ageing Research Reviews 4 (2005) 481512 507
7. Summary and conclusions
In this article, we have considered some of the critical aspects of bioinformatics
problems facing studies employing microarray technology. We also summarized a multi-
pronged strategy we have developed to address, in part, some of these problems. This
strategy comprises the management of multiple comparisons via pre-test ltering, the
application of formal statistical testing of each transcript, use of well-powered sample
sizes to reduce false negatives and improve false discovery rate for identied transcripts,
as well as a one-subject-per-chip experimental design, and the statistical correlation of
individual expression changes with functional endpoints (Blalock et al., 2003, 2004). In
addition, we have briey reviewed the overlap and differences among some recent
ndings on brain aging/AD obtained by ourselves and others using microarray
technology. Together, these results suggest that recent advances in harnessing the raw
analytic power of microarray technology are ushering in a new research era in which it
will be possible to develop more realistic and comprehensive models of dynamically
complex processes, such as aging, disease and systems-level brain functions, than have
previously been feasible.
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