1. Introduction
Autism spectrum disorder (ASD) is a neurobehavioral disorder manifested by persistent deficits in the two core domains of social interaction and communication, and fixed interests and repetitive behavior, along with developmental delay [
1,
2,
3]. The prevalence of ASD, which is higher in males, is about 1% [
3]. As of today, there are no biochemical or molecular markers that predict a diagnosis of ASD. Both genetics and environmental exposures, or potential interactions of the two, are postulated to cause ASD [
1,
2,
3,
4].
Valproic acid (VPA) is one of the most potent animal and human teratogens. Exposure to VPA during the first trimester of pregnancy is associated with significantly increased risks of major and minor congenital malformations, including neural tube defects (NTDs), limb defects, cardiovascular abnormalities, and cleft palate [
5,
6,
7]. In animals, VPA causes dose-related teratogenic effects in all species investigated, including mice, rats, rabbits, and monkeys; these include skeletal malformations, and cardiac and craniofacial defects [
8,
9,
10,
11,
12]. In rodents, exposure to a single dose of 500–600 mg of VPA on embryonic day 12, after the critical period of organogenesis, is associated mainly with an increased risk of autistic-like behavior [
4,
13,
14,
15].
Christianson et al. [
16] first reported in 1994 that VPA intake during pregnancy leads to a significant increase in the rate of ASD in the offspring. Typical neurobehavioral symptoms of ASD can be detected in rodents exposed to VPA during pregnancy [
13]. The association between VPA use in pregnancy and ASD, and the possibility to evaluate the behavioral changes by standard tests led to the development of experimental ASD models in rodents by VPA administered in high doses during different stages of pregnancy, or early postnatally [
3,
4,
12,
17].
The mechanism by which VPA causes ASD is not completely understood. Various studies showed that VPA may affect the neuronal system in different ways [
18,
19,
20]. Kataoka et al. [
18] showed that the exposure of mice to VPA at gestation day (GD) 12.5 caused a transient hyperacetylation of the histones H3 and H4 in the embryonic brain right after exposure, due to histone deacetylase inhibition. The offspring exhibited social interaction deficits, anxiety, and learning difficulties equivalent to findings among human ASD. Decreased neocortical neuronal density was observed in pathological studies.
VPA triggers increased oxidative stress, which may cause oxidative damage to lipids, DNA, and proteins [
12,
21,
22,
23]. Indeed, treatment of VPA-exposed dams with high doses of folic acid and vitamin E (antioxidants) and the methyl donor methionine ameliorated or prevented most VPA-induced damage [
17,
24].
The rapid increase in ASD rates in the last years has led to the hypothesis that ASD may also result from environmental perturbations that lead to epigenetic changes. Choi et al. [
25] found that mice prenatally exposed to VPA who developed ASD in F1 also transferred some of the behavioral changes to the F2 and F3 generations, supporting the hypothesis that VPA induced epigenetic changes.
In pregnant rats, co administration of VPA (300 mg/kg/day on days 8, 9, and 10 of the pregnancy) and S-adenosyl methionine (SAMe) (10 mg/kg/day, on days 1–10 of the pregnancy) did not reduce the rate of fetal malformations associated with VPA exposure during pregnancy [
26]. However, in our previous studies, we examined 60-day-old mice exposed to VPA on postnatal day 4 with co-administration of SAMe and found that SAMe significantly improved ASD-like behavior and reduced the brain’s oxidative stress induced by VPA [
17]. Thus, treatment with SAMe can improve the behavioral abnormalities that result from the VPA-induced changes in the brain while it has no effect on the congenital anomalies. These and other findings indicated that VPA-induced autistic-like features accrue by different mechanisms than VPA-associated neural tube defects (NTDs) and other malformations. We also recently found that VPA induced in the brain changes in the expression of several genes associated with neurological development and inflammation; most of these changes were reversed by concomitant SAMe supplementation [
27]. Postnatal administration of SAMe alone did not induce any changes in gene expression in the brain.
Post-translational histone modifications may modify gene expression regulation by controlling DNA accessibility to transcription factors. Tung et al. found that the exposure of dams to VPA at GD 9 resulted in a significant increase in histone acetylation in the offspring homogenate, which peaked 3 h after VPA exposure and was accompanied by an increase in histone methylation at histone H3 lysine 4 (H3K4) and a decrease in histone methylation at histone H3 lysine 9 (H3K9). Immunohistochemical staining performed on the embryos 3 h post exposure showed increased staining for the acetylated histone H3, particularly in the neuroepithelium and mesenchyme, as well as some increased staining in the heart and somites. VPA did not induce any significant changes in global or CpG island methylation at 1, 3, 6, and 24 h after VPA exposure, regardless of the presence of NTD at the 24-h time point [
28].
Downregulation of several genes, including the methyl-CpG-binding protein 2 (MeCP2) gene, was found by Kim et al. among male rat offspring prenatally exposed to VPA [
29].
S- adenosyl methinone (SAMe) is the principal methyl donor present in all living organisms and it is involved in multiple biochemical reactions. SAMe is critical for the regulation of cell growth, differentiation, function, and biosynthesis of hormones and neurotransmitters [
30]. SAMe has also been shown to reduce oxidative stress [
31,
32,
33,
34]. Villalobos et al. [
31] showed that SAMe modulates the cellular oxidative status, mainly by inhibiting lipid peroxidation and enhancing the glutathione system in the brain of a rat model of brain ischemia-reperfusion. Due to its important metabolic functions, especially in cellular trans-methylation pathways in the brain, SAMe is currently used as a food additive and as an adjunct treatment of several psychiatric and neurodegenerative diseases of the brain, such as depression, schizophrenia, and Alzheimer’s disease, with promising results [
35,
36]. The daily doses may range from 400–1200 mg (i.e., 8–20 mg/Kg body weight). Very few studies have examined the effect of SAMe treatment during pregnancy. Most of them focused on the efficacy of SAMe for the treatment of intrahepatic cholestasis of pregnancy (obstetric cholestasis), a common liver disorder specific to pregnancy, characterized by maternal pruritus and increased serum bile acid concentrations [
37,
38,
39,
40,
41,
42]. Most of these studies did not report on the neonatal outcome, except for preterm labor and a low Apgar score. One study carried out on an infant followed up to three months of age reported normal development [
38]. Importantly, these clinical trials used intravenous injection of 800 to over 1000 mg/day of SAMe for a period between 14 and 20 days, during the third trimester of pregnancy [
37,
38,
39,
40,
41,
42], suggesting that SAMe is safe in the third trimester because no maternal or fetal adverse effects have been reported. On the other hand, the effectivity and the safety of SAMe administration during organogenesis were apparently not studied.
In the present study, we exposed the offspring of ICR mice to VPA on GD 12, with SAMe administered during days 12–14 of gestation or with a combination of VPA and SAMe. Our aim was to evaluate the offspring on post-natal day (PND)1 for the expression of genes related to physiology and pathology in the brain and to assess the gender specificity of these effects. We hypothesized that the VPA-exposed offspring, which could potentially develop ASD-like behavior, would exhibit increased brain oxidative stress and gene expression changes in the brain driven by epigenetic changes. We also hypothesized that due to the susceptibility of the embryo and fetus to epigenetic modulation, SAMe would induce significant changes in gene expression unrelated to VPA as well as interact with the effects of VPA on gene expression when combined with VPA. We hypothesize that these changes in gene expression underlie the mechanisms involved in VPA-triggered autism and its prevention with SAMe that we previously described.
We focused on the frontal half of the brain of PND1 mice because this part contains both the prefrontal cortex, which was found to be affected by postnatal VPA administration in our previous study, and the hippocampus, in which neuronal size abnormalities were found in ASD patients [
43].
Furthermore, structural and genetic changes were also reported in these regions in mice with autistic-like behavior [
44,
45].
2. Results
There were no signs of toxicity or abnormal behavior in both VPA-treated and SAMe-treated dams, and all animals similarly gained weight during gestation. There was no significant effect of the VPA administration or of the administration of VPA plus SAMe on the litter average, or on the body weight of offspring. SAMe administration did not change the litter size (
Table 1) but slightly and insignificantly reduced the weight of the offspring on PND1 (1.48g vs. 1.74 in the controls,
p = 0.10). We did not find any external malformations in the offspring in any of the groups. The weight gain of the offspring during the first 30 postnatal days was similar in all groups (
Figure 1A–C)
There were no differences in the developmental milestones between the control and SAMe-treated animals until the age of one month (Weinstein-Fudim L et al. [
46]).
Similar to our previous findings of sex-specific VPA-induced differences in gene expression in adult mice [
46], we found that newborn mice prenatally treated with SAMe demonstrated significant sex differences in the expression of genes in the brain, thus the data were analyzed for males and for females separately.
2.1. SAMe Administration
SAMe administration induced significant changes in the expression of many genes in both females and males. Changes in 112 genes overlapped in both sexes while many changes were sex specific. In females, SAMe significantly changed (
p < 0.05) the expression of 170 additional genes, of which 56 of them were changed by more than 50% and 15 genes were changed by more than 100%. All genes that were significantly changed by 100% or more were upregulated (
Table 2). In males, we had only two samples for the NanoString analysis of this group. However, since the data in both brains showed little variance, we decided to include them in the study. SAMe significantly changed the expression of 31 additional genes, 9 of which were changed by more than 50% but none were changed with more than 100%. Hence, they are not further described here (
Figure 2).
Table 3 describes the genes whose expression was similarly changed in both genders. The expression of 112 genes was significantly changed in both genders, 25 genes changed by more than 50% with 23/25 changing in the same direction, 15 were upregulated, and 7 were downregulated. Eleven genes were upregulated by more than 100% in males and in females, except nostrin, which was changed by more than 100% in males and by 91% in females (
Table 3).
2.2. Mouse Neonates Prenatally Treated with VPA and SAMe
Most of the genes that were changed by SAMe administration in males and in females were normalized to control levels by co-administration of single dose of VPA. Only four genes in males and one gene in females remained statistically significantly different from controls after treatment with VPA before SAMe administration (
Table 4).
The expression of Prkcg (protein kinase C, gamma) and Vegf-a (vascular endothelial growth factor A) in males and Slc2a1 (solute carrier family 2 member 1) in females was significantly changed by SAMe administration. The co-administration of VPA did not affect the expression of Prkcg but downregulated the expression of Vegf-a and Slc2a1 to almost normal levels.
2.3. Comparison of Gene Expression Changes in Mouse Neonates Treated with VPA Versus those Treated with VPA + SAMe
In males, we found no changes in gene expression between the VPA and VPA + SAMe groups. In females, the expression of two genes was changed in the VPA+SAMe group in comparison to VPA. Axin2 (adj. p value= 0.01168), where the expression was also changed by SAMe alone and Desmin (Des, adj. p value= 0.05593). However, the levels of both genes were similar to their expression in the controls.
2.4. IPA Analysis
In males, the Ingenuity Pathway Analysis (IPA) analysis revealed a significant overexpression of genes associated with the VEGF pathway (
Figure 3A,B). This pathway is proposed to have a significant role in tumor-derived VEGF-induced angiogenesis. In females, overexpression of the VEGF pathway was observed in fewer genes compared to males. VEGF angiogenesis was also overexpressed (in both genders). Specific genes changed in both genders are also detailed in
Table 3.
The difference between
Figure 3A,B is in the intensity of the colors, which show the level of the expression of a specific gene. For clarity, the data are shown in
Table 5 (males) and
Table 6 (females).
In males, the expression of 13 of 26 genes in the VEGF pathway was changed significantly after SAMe administration (pink), most of which were upregulated, as reported in
Table 5 and
Figure 3.
In females, only nine genes in this pathway were altered, as reported in
Table 6.
In males, the z score of the VEGF pathway was statistically significant, meaning that the pathway was upregulated as predicted; in females, the pathway did not have a significant direction.
Anther pathway significantly activated in males with a positive Z score was the Interlukin8 signaling pathway. In females, the most significant canonical pathways are Cyclic adenosine monophosphate (cAMP)-mediated signaling and melatonin signaling pathways, with significant negative Z scores, predicting inhibited upstream regulators.
Figure 4. Heat maps in the different groups:
Figure 4A,B represent heat maps of the mRNA levels of the genes involved in neuropathological pathways in the frontal half of the brain. For each gene, the expression was normalized to the geometrical mean of seven housekeeping genes and the negative and positive technical controls. Each vertical column represents one animal belonging to the SAMe treatment group or control group indicated in the upper panel while each horizontal lane represents the normalized mRNA counts for one gene. The colors represent the expression of each gene among the different treated animals (red and blue represent strong and weak expression, respectively). As observed, there were many genes whose expression was significantly changed by SAMe in comparison to the controls. More of these genes were up- or downregulated in females compared to males.
Figure 5. Result of the MA plot showing a log two-fold change in the different genes studied in SAMe-treated versus control mice in both genders. More genes were up- or downregulated in females compared to males. In both genders, most of the genes whose expression was changed by SAMe were upregulated.
2.5. VPA Administration
Prenatal VPA exposure of the newborn mice did not induce any significant changes in gene expression of the frontal half of the brain (
Figure 6A,B). As the treated mice were not followed to adulthood, since the gene expression of neonates obviously requires the sacrifice of animals, we could not determine whether these specific animals would have developed ASD-like behavioral changes. However, many studies have shown that prenatal administration of VPA to mice induced autistic-like behavior [
4,
13,
14,
15].
Figure 6 A,B show the effect of VPA administration during pregnancy on gene expression in female and male newborn mice.
Figure 7A,B show the effect of the combined VPA and SAMe administration during pregnancy on gene expression in female and male newborn mice.
4. Materials and Methods
4.1. Animals
On GD12, 12 ICR-CD1 pregnant female mice were injected subcutaneously with a single injection of either 600 mg/kg of valproic acid sodium salt (VPA; Sigma) in saline solution or with normal saline (NS). Each of these two groups (VPA and NS treated) were further subdivided into two groups: One group received 30mg/kg of SAMe (which is 2–3 times the human dose) by intraoral gavage once daily for 3 days starting on the day of VPA injection, and the other group similarly received phosphate-buffered saline.
On postnatal day 1 (PND 1), the pups were weighted and euthanized, and the frontal half of the brain was removed for the different studies.
The offspring of similarly treated mice were also followed until the age of one month with weighing and examination for the development of reflexes, and appearance of postnatal developmental milestones, including muscular strength, coordination, eye opening, surface righting, cliff aversion, rooting, forelimb grasp, auditory startle, ear twitch, and open field traversal tests as described by Hill et al. [
87]. In this group, only physical sex determination was done; therefore, assessment in the first 2 weeks was on both genders as one group.
Animals were handled according to the NIH specifications with the approval of the committee for experimentation on animals of the Hebrew University Jerusalem, Israel.
Sex determination study for the newborn mice: We assessed the gender of each one of the day 1 pups by PCR using specimens obtained from their liver by the method described by McFarlene [
88] and by us [
89].
4.2. DNA Extraction for Sex Determination
Pieces of liver were placed in 100 μL of Extracta DNA Pref for PCR (Quanta biosciences), which allows rapid extraction of DNA that can be used directly in PCR reactions, eliminating the need for purification steps. Samples were heated at 95 °C for 30 min, cooled to room temperature, and dissolved by 100 μL of stabilizing buffer (safe stopping point). Then. 1.5 μL of each sample were added directly to a 25-μL PCR reaction.
PCR Reaction
To identify genes for the sex determination of newborn mice, we used two types of genes: The pseudo-autosomal genes Xlr and Sly (Xlr –x chromosome linked lymphocyte regulated complex, NM_011725 localized on the X and y chromosomes; Sly- Sycp3 -like Y-linked, BC049626 that regulates genes involved in chromatin remodeling and sperm differentiation), and Zfy, a gene on the Y chromosome that encodes a zinc-finger DNA binding protein. Each DNA extract was used in a PCR reaction with specific primer pairs for Sly/Xlr and Zfy genes, as stated below.
Primer sequences for the Xlr Sly and Zfy genes were obtained from McFarlane et al. (2013).
PCR Reactions: Genomic DNA was amplified with the following primer pairs:
Sly/Xlr _F, 5ʹ-GATGATTTGAGTGGAAATGTGAGGTA-3ʹ;
Sly/Xlr _R, 5ʹ-CTTATGTTTATAGGCATGCACCATGTA-3ʹ;
Zfy_F, 5ʹ-GAC TAGACATGTCTTAACATCTGTCC-3ʹ;
Zfy_R, 5ʹ-CC T A TTGC ATGGACTGCAGCTTATG-3ʹ
PCR reactions were performed in a final volume of 25 μL with 10µl AccuStart ll GelTrack PCR SuperMix that contained Taq DNA polymerase, Deoxynucleoside triphosphates (dNTPs) and electrophoresis tracking dyes (Quanta biosciences), 2 μL of forward primer, 2 μL of reverse primer (primers concentration: 10 pmol/µL), 9.5 µL of nuclease-free water, and 1.5 µL of sample, and the following PCR parameters: Initial denaturation at 95 °C for 5 min, 35 cycles with 95 °C for 30 s, 60 °C for 40 s, 72 °C for 30 s followed by final elongation at 72 °C for 5 min. PCR products were electrophoresed together with a DNA ladder (100 bp, Bio-lab) on 1% agarose gels and visualized with ethidium bromide under UV-illumination.
4.3. RNA Extraction and Gene Expression Analysis of the Brain
While looking at the upper surface of the cerebrum and cerebellum, we performed a coronal cut in the brain, exactly in the middle, removing the frontal half of the brain for our studies. The dissection was similar in all specimens (and was done by the same person, LW). Total RNA was extracted from the frontal half of the brains using the RNA/DNA/protein purification plus kit (47700; Norgen) according to the manufacturer’s protocol as described by us previously [
15]. RNA was quantified using absorbance at 260 nm.
Gene expression analysis was performed on 18 samples, 4–5 pups in each group (excluding the saline+SAMe male group, with only 2 samples), using the NanoString nCounter system, which provides a simple way to profile specific nucleic acid molecules in a complex mixture. The system is based on direct digital detection of mRNA molecules utilizing target-specific color-coded probe pairs that can hybridize directly to target molecules. The expression level of mRNA molecules is measured by counting the number of times the barcode for that molecule is detected by a digital analyzer. It does not require the conversion of mRNA to cDNA by reverse transcription or the amplification of the resulting cDNA by PCR. The system does not need amplification and is sensitive enough to detect low-abundance molecules.
The data is expressed by the number of mRNA molecules in 100 ng/uL of RNA. It can simultaneously quantify up to 800 different interesting targets in a single reaction, making it ideal for miRNA profiling and targeted mRNA expression analysis [
90]. We used the Mouse Neuropathology Panel, which includes 770 genes covering pathways involved in neurophysiology, neurodegeneration, and other nervous system diseases, and 10 internal reference genes for data normalization.
4.4. Statistical Analysis
NanoString analysis was performed on 3–5 samples from each group and each gender. In males, we had only two samples from the SAMe-treated group, hence, although reported, we note the limitation of the small sample.
Gene expression data were analyzed by the R package DESeq2, v1.22.1, Bioconductor [
91]. Since samples were measured in two batches, the statistical model included both the treatment and the batch. After normalization by the internal reference genes, the Wald test was used to compare the different conditions, using default parameters, including the significance threshold of the Benjamini–Hochberg false discovery rate (FDR) (p adj) of less than 0.1. Further filtering of significant genes required a change in the expression of at least 50% relative to the control group.
Enriched canonical pathways of the significantly differentially expressed genes (FDR < 0.1) were identified using QIAGEN’s Ingenuity® Pathway Analysis (QIAGEN Inc.,
https://www.qiagenbioinformatics.com/products/ingenuity-pathway-analysis). All 770 genes of the Mouse Neuropathology Panel were taken as the background in the calculation. The scores were calculated by the right-tailed Fisher’s exact test. The scores derived from
p-values indicate the likelihood of supplied genes belonging to a network versus those obtained by chance. A consistency score (Z-score) > 2 or < −2 indicates with ≥99% confidence that a supplied gene network was not generated by chance alone. Enrichment of “canonical pathways” and “up-stream regulators” with a Z-score > 2 or < −2 were considered for analysis.
Gene ontology for functional enrichment of pathways (KEGG) was performed for genes that were found to be significantly altered by VPA using DAVID bioinformatics resources 6.8. The total list of 770 genes related to neuropathology that were tested in the array were used as the background reference for the enrichment analysis. GO Biological Process (BP) enrichment was performed using the whole 770 genes of the nanostring neuropathology panel as a background (generated by running the function enrichGO in ClusterProfiler R package). No GO BP nor IPA canonical function passed Padj < 0.05.