Mice
Female C57BL/6 C3H (B6C3) mice at 2 months of age purchased from Charles River were used for the experiments in Figures 1–3. Thy1:SNCA/Snca–/– mice were generated in the Center for Neurodegenerative Disease Research (CNDR) by crossing Thy1:SNCA mouse line 61 37 on a DBA background with Snca–/– mice on a B6C3 background. Because the transgene is inserted in the X chromosome, only male Thy1:SNCA/Snca–/– mice were used for this study. To generate male Thy1:SNCA/Snca–/– mice, female Thy1:SNCA/Snca–/– mice were crossed with male Snca–/– mice. Male Thy1:SNCA/Snca–/– mice and male B6C3 mice as WT mice at 2–3 months of age were used for the experiments in Figures 4–7. Mice were housed in a temperature-controlled room under a 12-hour light/dark cycle with free access to food and water. All animal procedures were approved by the University of Pennsylvania Institutional Animal Care and Use Committee and conformed to the National Institute of Health Guide for Care and Use of Laboratory Animals.
Primary Hippocampal Neuron Cultures
Primary mouse neurons were prepared from the hippocampus of embryonic day E16–E18 CD1 mouse embryos as described previously 12. Dissociated hippocampal neurons were plated at 100,000 cells/well (24-well plate) or 17,500 cells/well (96-well plate) in neuron media (Neurobasal medium, Thermo Fisher #21103049) supplemented with B27 (Thermo Fisher #17504044), 2 mM GlutaMax (Thermo Fisher #35050061), and 100 U/ml penicillin/streptomycin (Thermo Fisher #15140122).
Human patient samples
Detailed clinical characteristics (disease duration, age at death, site of onset, etc.) were ascertained from an integrated neurodegenerative disease database in CNDR at the University of Pennsylvania. Frozen and paraffinized postmortem brain samples were obtained from patient brain donors who underwent autopsy at CNDR between 2002 and 2018. More details on these patients are found in Table S1. All procedures were performed in accordance with local institutional review board guidelines. Written informed consent for autopsy and analysis of tissue sample data was obtained either from patients themselves or their next of kin.
Biochemical extraction of sarkosyl-insoluble αSyn from human and mouse brains
Biochemical brain extraction was conducted as described previously with minor modifications 32. All human brain tissues were obtained from the CNDR brain bank 42. Fontal cortex tissues with a high burden of αSyn pathology from patients with AD, PDD, and DLB were identified by postmortem neuropathological examination 5. Biochemical extraction of human brains was performed as described previously 32. In brief, 5–10 g of frontal cortical gray matter was homogenized in five volumes (w/v) of 1% (v/v) Triton X-100-containing high-salt (HS) buffer (50 mM Tris–HCl pH 7.4, 750 mM NaCl, 10 mM NaF, 5 mM ethylenediaminetetraacetic acid [EDTA]) with protease and protein phosphatase inhibitors, incubated on ice for 20 min, and centrifuged at 180,000 ´ g for 30 min. The pellets were then re-extracted with five volumes of 1% (v/v) Triton X-100-containing HS buffer, followed by sequential extraction with five volumes of HS buffer with 30% (w/v) sucrose for myelin floatation. The pellets were then re-suspended and homogenized in 2% (w/v) sarkosyl-containing HS buffer, rotated at room temperature for 1 h or at 4 °C overnight and centrifuged at 180,000 ´ g for 30 min. The resulting sarkosyl-insoluble pellets were washed once with Dulbecco’s PBS (DPBS, Corning #21-031-CV) and re-suspended in DPBS by sonication (QSonica Microson XL-2000; 60 pulses, setting 2, 0.5 s per pulse). This suspension termed the “sarkosyl-insoluble fraction” or “brain lysate” contained pathological αSyn referred to as “LB-αSyn” and was used for the experiments. Mouse brain extraction was performed with the same protocol for human brain extraction except that only one round of extraction with 1% Triton X-100-containing HS buffer was performed (Figure S8A). The Triton X-100-soluble fraction was used for the experiments in Figure S6B. The concentrations of αSyn in the sarkosyl-insoluble fractions were determined by sandwich ELISA (see ‘Sandwich ELISA’), and the protein concentrations were examined by bicinchoninic acid (BCA) assay (Tables S2 and S3).
Sandwich ELISA
Sandwich ELISA was conducted as described previously 32. To measure the concentration of αSyn in brain lysates, 384-well Nunc Maxisorp clear plates were coated with 100 ng (30 μl per well) of an anti-human αSyn antibody Syn9027 (CNDR) in sodium carbonate buffer, pH 9.6 and incubated overnight at 4 °C. The plates were washed 4 times with PBS containing 1% (v/v) Tween 20 (PBS-T), and blocked using Block Ace solution (AbD Serotec) overnight at 4 °C. Brain lysates were sonicated with a Diagenode Biorupter sonicator (20 min, 30 s on, 30 s off, 10 °C, high setting), serially diluted in PBS and added to each well. The plates were incubated overnight at 4 °C. The recombinant human αSyn monomer and hPFF were used as standards. The plates were then washed with PBS-T and an anti-human αSyn antibody MJFR1 (Abcam #ab138501, 1:1000) or an anti-human αSyn antibody HuA (CNDR, 1:2000) was added to each well and incubated at 4 °C overnight. After washing, a secondary antibody conjugated with horse radish peroxidase (Cell Signaling Technology #7074, 1:10000) was added to the plates followed by incubation for 1 hr at 37 °C. Following another wash, the plates were developed for 10–15 min using 1-Step Ultra TMB-ELISA substrate solution (Thermo Fisher Scientific #37574, 30 μl per well), the reaction was quenched using 10% phosphoric acid and plates were read at 450 nm on a Molecular Devices Spectramax M5 plate reader.
Recombinant αSyn purification and in vitro PFF generation
Purification of recombinant human αSyn and generation of hPFF was conducted as described previously 43. The pRK172 plasmid containing a full-length human αSyn gene was transformed into BL21 (DE3) RIL-competent E. coli (Agilent Technologies #230245). A single colony from the transformed bacteria was expanded in Terrific Broth (12 g/l of Bacto-tryptone, 24 g/l of yeast extract 4% (v/v) glycerol, 17 mM KH2PO4 and 72 mM K2HPO4) with ampicillin. Bacterial pellets from the growth were sonicated, and the sample was boiled to precipitate undesired proteins. The supernatant was dialyzed with 10 mM Tris, pH 7.6, 50 mM NaCl, 1 mM EDTA overnight. Protein was filtered with a 0.22 μm filter and concentrated using Amicon Ultra-15 centrifugal filters (Millipore Sigma #UFC901008). Protein was then loaded onto a Superdex 200 column and 1 ml fractions were collected. Fractions were run on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and stained with Coomassie blue to select fractions that were highly enriched in αSyn. These fractions were combined and dialyzed in 10 mM Tris, pH 7.6, 50 mM NaCl, 1 mM EDTA overnight. Dialyzed fractions were applied to a HiTrap Q HP anion-exchange column (GE Healthcare #17115301) and run using a linear gradient from 25 mM NaCl to 1 M NaCl. Collected fractions were run on SDS-PAGE and stained with Coomassie blue. Fractions that were highly enriched in αSyn were collected and dialyzed with DPBS. Protein was filtered through a 0.22 μm filter and concentrated to 5 mg/ml (αSyn) with Amicon Ultra-15 centrifugal filters. αSyn monomer was aliquoted and frozen at −80°C. For preparation of PFF, αSyn monomer was shaken at 1,000 rpm for 7 d. Conversion to PFF was validated by sedimentation at 100,000 ´ g for 60 min and by Thioflavin S staining.
In vitro amplification of LB-αSyn from brain lysates
LB-αSyn amplification was performed as described previously with minor modifications 32. LB-αSyn from brain lysates of patients pathologically confirmed with AD, PDD, or DLB was sonicated with a Diagenode Biorupter sonicator (20 min, 30 s on, 30 s off, 10 °C, high setting). The amplification reaction was set up with 5% LB-αSyn (calculated based on sandwich ELISA), 95% human αSyn monomer, and DPBS (pH 7.4, without Mg2+ and Ca2+) at the final αSyn concentration of 200 or 400 ng/µl. The solution was incubated at 37 °C with constant agitation at 1,000 rpm for 14 d. The resulting material (ampLB) was transduced into mouse primary hippocampal neurons to verify the success of amplification of LB-αSyn.
αSyn transduction into mouse primary neurons
αSyn transduction into mouse primary hippocampal neurons was performed as described previously 32. hPFF, LB-αSyn, ampLB, and αSyn aggregates extracted from Thy1:SNCA/Snca–/– mouse brains were diluted in DPBS and sonicated with a Diagenode Biorupter sonicator (20 min, 30 s on, 30 s off, 10 °C, high setting). Neurons were then treated with noted dose of the αSyn preparations at 7 d in vitro (DIV), fixed and immunostained at 14 d post-treatment (21 DIV). The amount of αSyn transduced in Figures 1F, S1, and S6C was 25 ng/well. For the treatment with αSyn aggregates extracted from Thy1:SNCA/Snca–/– mouse brains in Figure 7B, the brain lysates containing 25 ng of αSyn or up to 6.4 μg of total protein per well were transduced to avoid significant toxicity of contaminants for cultured neurons 32. The resulting amounts of αSyn were 2.4 ng/well (Thy1:SNCA/Snca–/– mice without αSyn pathology), 19 ng/well (ampLB-injected Thy1:SNCA/Snca–/– mice), and 25 ng/well (hPFF-injected Thy1:SNCA/Snca–/– mice and Thy1:SNCA/Snca–/– mice with spontaneous αSyn pathology).
Immunocytochemistry and quantification of neuron pathology
Immunocytochemistry and quantification of pSyn-positive neuronal pathology was performed as described previously 32. Mouse primary neurons cultured in 96 wells were washed with PBS once and fixed at DIV 21 with 4% (w/v) PFA, 4% (w/v) sucrose, and 1% (v/v) Triton X-100 in PBS. After PBS washes, cells were blocked with 3% (w/v) bovine serum albumin (BSA), 5% (w/v) fetal bovine serum in DPBS for 1 h at room temperature, then incubated with an anti-pSyn antibody 81A (CNDR, 1:5000) and an anti-microtubule associated protein 2 (MAP2) antibody #17028 (CNDR, 1:3000) at 4 °C overnight. The cells were washed 5 times with PBS and incubated with secondary antibodies conjugated with Alexa fluor 488 or 594 (Molecular Probes, 1:1000) for 2 h at room temperature. After washing with PBS, the cells were incubated in DAPI solution (ThermoFisher #D21490, 1:10,000 in PBS) after staining with secondary antibodies and the plates were sealed with adhesive covers. The 96 well plates were scanned with an In Cell Analyzer 2200 (GE Healthcare) with a 10 × or 40 × objective and analyzed using the accompanying software (In Cell Toolbox Analyzer). Quantitation of total 81A signal and the amount of somatic 81A signal was calculated using Cell Profiler ver. 3.1.9 (The Broad Institute). The fraction of somatic inclusions was calculated as the 81A signal intensity (density times area) of somatic objects divided by the total 81A signal intensity. Data are reported as the average of 3 replicate wells for each treatment sample.
Western blotting
Protein concentrations of samples were determined with a BCA assay kit (Fisher #23223 and 23224) using BSA as a standard (Thermo Fisher #23210). Samples were normalized for total protein content and boiled with SDS-sample buffer for 10 min. Samples (10 μg total protein) were separated on 12.5% SDS-polyacrylamide gels and transferred onto 0.2 μm nitrocellulose membranes. For the samples digested by PK, NuPAGE Novex 12% Bis–Tris gels (Invitrogen) were used. The membranes were fixed with 4% (w/v) paraformaldehyde in tris buffered saline (TBS) for 30 min to prevent detachment of αSyn from the blotted membranes. Ponceau staining was performed to visualize the protein transferred to the membranes. After blocked in 5% (w/v) non-fat milk in TBS for 30 min, the membranes were probed at 4 °C overnight with following primary antibodies: an anti-human αSyn antibody HuA (CNDR, 1:500–3000), an anti-pSyn antibody 81A (CNDR, 1:5000), an anti-human αSyn-specific antibody LB509 (CNDR, 1:100), an anti-mouse αSyn-specific antibody D37A6 (Cell signaling #4179, 1:1000), an anti-αSyn antibody Syn1 (BD transduction #610787, 1:500–1000), and an anti-pSyn antibody EP1536Y (abcam #ab51253, 1:5000). Primary antibodies were detected using IRDye 800 (Li-Cor #925-32210) and IRDye 680 (Li-Cor #925-68071) labeled secondary antibodies, scanned on a Li-Cor Odyssey Imaging System and analyzed using Image Studio software (Li-Cor Biosciences). Densitometric analyses were performed using ImageJ (NIH).
Immunodepletion of αSyn from brain lysate
An anti-human αSyn monoclonal antibody 9027 was covalently conjugated to Dynabeads M-280, tosylactivated (Invitrogen #14204) per the manufacturer’s instructions. Immunodepletion of αSyn was performed by incubating diluted AD1 brain lysate (10 ng/μl of αSyn, 50 μl total dose) with anti-αSyn antibody–bead complexes containing 68 μg of the antibody at 37 °C for 1 h with constant rotation. The immunodepleted fraction was separated from the antibody–bead complex using a magnet. Mock immunodepletion was performed using the equal amount of a control mouse IgG antibody (Jackson Immuno Research). The brain lysate immunodepleted with the anti-αSyn antibody and the control antibody were used for western blot analysis. The αSyn-depleted brain lysate (2.5 μl) mixed with hPFFs (500 ng) was used for mouse brain injection. Diluted AD1 brain lysate (10 ng/μl of αSyn, 2.5 μl total dose) and amplified LB-αSyn generated from AD1 brain lysate (200 ng/μl of αSyn, 2.5 μl total dose) were used for injection as comparisons. Those three injection materials contained almost the same contaminants.
Partial PK digestion of αSyn aggregates in brain lysate
Sarkosyl-insoluble fractions from LBD brains and Thy1:SNCA/Snca–/– mouse brains were prepared by biochemical brain extraction. For partial PK digestion, 50 ng of αSyn from each sample was sonicated with a Diagenode Biorupter sonicator (20 min, 30 s on, 30 s off, 10 °C, high setting) and mixed with 0.2 μg of PK in DPBS to a final volume of 50 μl and incubated at 37 °C for 1, 5, 15, and 30 min. The reaction was stopped with 1 mM PMSF. The samples were boiled with SDS-sample buffer for 10 min and resolved on NuPAGE Novex 12% Bis–Tris gels (Invitrogen). Transferred nitrocellulose membranes were probed with an anti-human αSyn antibody HuA (CNDR, 1:500) and an anti-αSyn antibody Syn1 (BD transduction #610787, 1:500).
Stereotaxic inoculation of mouse brains
Stereotaxic surgery was performed as described previously with minor modifications 13. Mice anesthetized with ketamine–xylazine–acepromazine underwent stereotaxic injection. A 30-gauge syringe was used for brain lysate injection, and a 33-gauge syringe was used for hPFF- and ampLB-injection. For pathological analysis in Figures 1–3, WT mice received a unilateral injection of 2.5 μl of hPFF (200 ng/μl or 2 µg/μl of αSyn, 500 ng or 5 µg total dose) or ampLB (200 ng/μl of αSyn, 500 ng total dose) into the dorsal striatum (coordinates: 0.2 mm relative to bregma; 2.0 mm from midline; –3.2 mm beneath the skull surface). For biochemical analysis in Figure S3, WT mice received a bilateral injection of 2.5 μl of ampLB (400 ng/μl of αSyn, 1 µg total dose) into the dorsal striatum. For pathological, behavioral, and biochemical analysis in Figures 4–7, Thy1:SNCA/Snca–/– and WT mice received a unilateral injection of 2.5 μl of hPFF (400 ng/μl of αSyn, 1 µg total dose), ampLB (400 ng/μl of αSyn, 1 µg total dose), or PBS into the dorsal hippocampus (coordinates: –2.5 mm relative to bregma; 2.0 mm from midline; –2.4 mm beneath the skull surface). The mice were sacrificed at indicated timepoints and were subjected to histological and biochemical analyses.
Immunohistochemical analysis of injected mouse brains
Mice were deeply anesthetized with ketamine–xylazine–acepromazine. Following intracardial perfusion with PBS, mice were perfused with 15 ml of fixative containing 4% (w/v) PFA in PBS. The brains were collected and immersed in 4% (w/v) PFA in PBS at 4 °C overnight. The brains were embedded in paraffin and then sectioned with a thickness of 6 μm. For immunohistochemical analyses, the sections were incubated at 4°C for 2 d with following primary antibodies: an anti-pSyn antibody EP1536Y (Abcam #ab51253, 1:20000), an anti-TH antibody (Sigma-Aldrich #T2928, 1:10000), an anti-NeuN antibody (Sigma-Aldrich #MAB377, 1:2000), an anti-GFAP antibody 2.2B10 (CNDR, 1:5000), and an anti-Iba1 antibody (Wako #019-19741, 1:2000). Biotinylated secondary antibodies (Vector laboratories) were used for generating diaminobenzidine reaction product, and nuclei were counterstained with hematoxylin.
To quantify the amount of αSyn pathology, every 20th paraffin section throughout the brains was stained with an anti-pSyn antibody EP1536Y, and pSyn-positive neuronal somatic inclusions with visible nuclei were manually counted. To assess distribution and severity of αSyn pathology, semi-quantitative analyses were performed for pSyn-positive pathology on the five coronal sections (2.80, 0.26, −1.58, −2.92, and −4.04 mm relative to bregma), and color coded onto heat maps (Figures 1C, 1G, 2E, 4C, 5D, 5G, and S5A). The extent of αSyn pathology was graded as 0–3 (0, no pathology; 0.5, mild; 1, moderate; 2, severe; 3, very severe) based on the criteria described previously 44, and averaged across samples for each brain region. To quantitatively assess distribution of pSyn-positive area, each brain region shown in Figure S5B was measured using QuPath software 45. The proportion of pSyn-positive area was averaged across samples for each brain region, and color coded onto heat maps (Figures 2F and S5C). Primary component analysis of distribution of pSyn-positive pathology was performed using GraphPad Prism Software, Version 9.
To assess dopaminergic neuron loss in the SNpc, every 20th section was stained with an anti-TH antibody throughout the SNpc. The numbers of TH-positive cells with visible nuclei were manually counted. To assess neuron loss and glial activation in the ventral DG, sections at −3.52 mm relative to bregma were stained with anti-NeuN, GFAP, and Iba1 antibodies. The numbers of NeuN-positive neurons were automatically counted and the GFAP- and Iba1-positive area was measured using QuPath software. Sections were examined with a BX43 microscope (Olympus) or a Pannoramic 250 (3DHISTECH) scanner.
For immunofluorescence, the sections were incubated at 4°C for 2 d with following primary antibodies: an anti-pSyn antibody EP1536Y (Abcam #ab51253, 1:5000), an anti-pSyn antibody 81A (CNDR, 1:2000), an anti-pSyn antibody #64 (Wako #015-25191, 1:2000), anti-TH antibody (Sigma-Aldrich #T2928, 1:2000), an anti-Olig2 antibody (Millipore #AB9610, 1:500), an anti-GFAP antibody 2.2B10 (CNDR, 1:2000), an anti-Iba1 antibody (Wako #019-19741, 1:1000), and an anti-phosphorylated neurofilament antibody TA51 (CNDR, 1:500). Fluorescent dye-conjugated secondary antibodies (Vector laboratories) were used, and nuclei were stained with DAPI. Sections were examined with an Eclipse Ni microscope (Nikon) or a TCS SP8 WLL Confocal with STED 3X (Leica).
Immunoelectron microscopy
Preparative procedures for pre-embedding immunoelectron microscopy have been described in detail elsewhere 46. Mice were deeply anesthetized with ketamine–xylazine–acepromazine. Following intracardial perfusion with 0.1 M phosphate buffer (PB) (pH 7.2), mice were perfused with 30 ml of fixative containing 4% (w/v) PFA and 0.05% (w/v) glutaraldehyde in 0.1 M PB. The brains were removed from the skull immediately after perfusion, post-fixed in 4% (w/v) PFA overnight at 4 °C and coronally sectioned at 50 μm by a vibratome (VT1200S; Leica). Sections were pre-incubated for 30 min in PBS containing 20% (v/v) normal donkey serum (Jackson ImmunoResearch Laboratories), 0.3% (v/v) Photo-flo 600 (Kodak), incubated overnight at 4 °C with 13 μg/ml anti-pSyn rabbit antibody EP1536Y (Abcam #ab51253) in PBS containing 2% (v/v) normal donkey serum and 0.3% (v/v) Photo-flo 600, and then washed twice with PBS. Subsequently, after incubation overnight at 4 °C with 1/100-diluted gold-conjugated anti-rabbit IgG goat antibody (Ultra-small Gold Reagent) in PBS containing 2% (v/v) normal donkey serum and 0.3% (v/v) Photo-flo 600, the sections were post-fixed with 1% (w/v) glutaraldehyde in 0.1 M PB for 10 min. After washes with distilled water, gold particles were developed with a silver enhancement kit (R-GENT SE-EM). The sections were then washed with 0.1 M PB, placed for 40 min in 0.1 M PB containing 1% (w/v) osmium tetroxide, counterstained for 30 min with 1% (w/v) uranyl acetate, dehydrated, and flat-embedded in epoxy resin (Luveak 812; Nacalai Tesque). After polymerization of the resin, approximately 70-nm-thick ultrathin sections were cut with an ultramicrotome (UC6; Leica), stained briefly with 1% (w/v) uranyl acetate and 1% (w/v) lead citrate, and observed with an electron microscope (HT7700; Hitachi).
Behavioral analysis
WT mice injected with PBS, Thy1:SNCA/Snca–/– mice injected with PBS, and Thy1:SNCA/Snca–/– mice injected with ampLB were subjected to behavioral tests from 6 to 8MPI. Before every test, the mice were habituated to the experimental environment for more than 30 min. Samples that encountered technical problems were removed from the analyses.
Open field
Mice were placed at the center of the field inside an open field apparatus (36 × 36 cm) and allowed to move freely for 15 min. The distance traveled and time spent in the center area (18 × 18 cm) were recorded using video tracking software EthoVision XT 15 (Noldus).
Y-maze
Mice were placed at the end of one arm of the Y-maze apparatus (San Diego Instruments) and allowed to move freely for 5 min. The distance traveled and series of arm entries were recorded using video tracking software EthoVision XT 15 (Noldus). An alternation was defined as entries into all three arms on consecutive occasions. The number of maximum alternations was therefore the total number of arm entries minus two, and the percentage of alternations was calculated.
Barnes maze
The Barnes maze test was conducted on a white circular surface with 20 holes equally spaced along the perimeter (Figure S6F). For acquisition trials, a shelter was placed under one of the holes, i.e. the “target hole”. Mice were placed in the center and allowed to move freely up to 3 min. The latency to reach the target, numbers of holes visited other than the target, and distance traveled were recorded using video tracking software EthoVision XT 15 (Noldus). Mice were subjected to acquisition trials twice a day for 7 d, and then to probe tests 24 h and 10 d after the last acquisition trial. In the probe tests without the shelter, mice were placed in the center and allowed to move freely for 3 min. The time spent around each hole, numbers of visiting each hole, and distance traveled were recorded. “Target zone” were defined as the target hole plus the 2 holes on either side of the target hole.
Contextual fear conditioning
Conditioning and test sessions were performed in a standard operant chamber (Med Associates) equipped with a tone generator and house light. Mice were handled for habituation in front of the apparatus for 2 min per day for 3 d. On day 0, conditioning was performed (Figure S6G). Mice were placed in a test chamber inside a sound-attenuated cabinet and allowed to explore freely for 150 s. A white noise, which is conditioned stimulus, was presented for 30 s, followed by a foot shock (2 s, 1 mA) serving as unconditioned stimulus. On day 1 and 10, contextual fear memory and auditory-cued fear memory tests were performed. For the contextual fear memory test, mice were placed in the same chamber in the same context as the conditioning, and immobile time and distance traveled were recorded for 5 min. For the auditory-cued fear memory test, mice were placed in a different chamber in a different context from the conditioning. Mice were allowed to move freely for 2.5 min, and then the white noise was presented for 2.5 min. Immobile time and distance traveled were recorded automatically.
Quantification and statistical analyses
Numbers of samples or animals analyzed in each experiment, statistical analysis performed, as well as p values for all results are described in the figure legends. For all the in vivo and in vitro experiments, “n” represents the number of animals and replicates, respectively. An F test, a Brown–Forsythe test, or a Bartlett's test was performed to evaluate the differences in variances. An unpaired, two-tailed Student’s t-test, a two-tailed paired test, or a Mann–Whitney test was used to determine statistical significance between two groups. One- or two-way Analysis of Variance (ANOVA) with a Dunnett’s, Tukey’s, or Sidak’s multiple comparison test was used to determine statistical significance among three or more groups. A linear regression model was used to test the correlation between two variables. A Fisher’s exact test was used to analyze contingency table data. Statistical calculations were performed with GraphPad Prism Software, Version 9. Differences with p values of less than 0.05 were considered significant. Statistically significant comparisons in each figure are indicated with asterisks, *p < 0.05, **p < 0.01, ***p < 0.001, and ****p < 0.0001. Data are presented as mean ± SEM.