The patient met the criteria for AD as recommended by the National Institute on Aging-Alzheimer's Association [6] and the normal elderly subject fulfilled the criteria of a normal elderly control as defined by Christensen [7]. We performed detailed neuropsychological tests, MRI, [18F]-Florbetaben or [11C]-Pittsburgh compound B (PIB) amyloid PET scans, and blood draw for iPSC generation from each participant. The Institutional review board of CHA University (1044308-201612-BR-031-02), Samsung Medical Center (2013-03-087), and Asan Medical Center (2015-0699) approved the study protocol, and informed written consent was obtained from each participant. All methods were performed in accordance with the relevant guidelines and regulations.

Mononuclear cells (MNCs) were isolated freshly from the peripheral blood of the AD patient and normal subject using the Ficoll-Paque™ PLUS method (GE Healthcare, USA). Isolated peripheral-derived MNCs (PBMCs) were cultured for 4 days in MNC media containing 50 ng/ml interleukin-6 (IL-6), 50 ng/ml stem cell factor (SCF), 10 ng/ml thrombopoietin (TPO), 20 ng/ml Flt3 ligand (Flt-3L), 20 ng/ml interleukin-3 (IL-3), and 10 ng/ml granulocyte colony-stimulating factor (G-CSF) (all from WAKO, Japan) in StemFit AK03 medium (kindly provided by Ajinomoto, Japan). The MNCs were then infected with SeVdp (KOSM) 302L at MOI of 3~10 [8] and transferred into 6-well dishes coated with iMatrix-511 (Matrixome, Japan). From the next day, 500 ul of StemFit AK03 medium was added every day for 4 days, after which the medium was fully changed every other day until iPSC-like colonies emerged. Sub-culturing and expansion of the cells was then undertaken until the generated iPSCs became stable for characterization and storage, normally at passage 10.

Karyotyping was performed using a GTG-banding analysis (Korea Research of Animal Chromosomes, Korea). The iPSC pellets were incubated in lysis buffer containing 100 mM Tris-HCl (pH 8.0), 50 mM EDTA, 0.2% SDS, 200 mM NACL and 200 ug/ml Proteinase K for 3 hr at 55℃. Genomic DNA was isolated by isopropyl alcohol precipitation, followed by a 70% ethanol washing step. Genotyping of the PS1-E120K single nucleotide mutation was performed by PCR amplification of isolated iPSC genomic DNA, followed by DNA sequencing (Cosmo Genetech, Korea). The PS1 gene was amplified by PCR using the following primers (forward primer: GTA GAA TCT ATA CCC CAT TC; reverse primer: TCA CCT TAT AGC ACC TGT AT).

Total RNAs were manually isolated using the TRIzol reagent (Life Technologies) lysis and isopropyl alcohol precipitation. Complementary DNAs (cDNAs) were synthesized using the cDNA synthesis Kit (Cosmo Genetech, Korea). RT-PCR amplification was done in a final volume of 20 ul containing 200 ng/ul cDNA for each sample. Primers were used as follows: GAPDH (forward primer: TGA CCA CAG TCC ATG CCA TCA CTG C; reverse primer: GTC ATA CCA GGA AAT GAG CTT GAC A); OCT4 (forward primer: CTG AAG CAG AAG AGG ATC AC; reverse primer: GAC CAC ATC CTT CTC GAG CC); NANOG (forward primer: TTC TTG ACT GGG ACC TTG TC; reverse primer: GCT TGC CTT GCT TTG AAG CA); SOX2 (forward primer: GCT GCA AAA GAG AAC ACC AA; reverse primer: CTT CCT GCA AAG CTC CTA CC); LIN28 (forward primer: CAC CAT GGG CTC CGT GTC CAA CCA GCA G; reverse primer: TCA ATT CTG TGC CTC CGG GAG CAG GGT AGG). Q-PCR analysis was performed using TB Green™ Premix Ex Taq™ (TaKaRa) with 100 ng/ul cDNA for each sample. Primers were used as follows: PSEN1 (forward primer: ACA GAG TTA CCT GCA CCG TTG T; reverse primer: GCT ATA AGG TCA TCC ATG CCT G); DRP1 (forward primer: ATG TTG CAT CTG GAG GTG GT; reverse primer: CGT GAA CCT GCT AGA TGT GC); Fis1 (forward primer: CAG TTT GAG TAC GCC TGG TG; reverse primer: CCG GCT CAA GGA ATA CGA GA); Mfn1 (forward primer: CTG GCT GTC TTG TAC GTG TG; reverse primer: CAA GGT GAA TGA GCG GCT TT); Mfn2 (forward primer: GAC CCC GTT ACC ACA GAA GA; reverse primer: GCT CTG GGA CAA AGT TCT GC).

After total RNA isolation and cDNA synthesis, Sendai virus detection RT-PCR was performed using a final volume of 20 ul with a 200 ng/ul concentration for each sample. Primers were used as follows: SeVdp NP (forward primer: AGA CCC TAA GAG GAC GAA GAC AGA; reverse primer: ACT CCC ATG GCG TAA CTC CAT AG) for detecting the nucleoprotein (NP) of Sendai virus vector (SeVdp) [9].

After genomic DNA isolation as described above, we detected the mycoplasma contamination in cell culture using the PCR-based e-Myco™ VALiD Mycoplasma detection Kit (iNtRON, Korea). PCR was done using a final volume of 20 ul containing 100 ng/ul of each sample [9,10].

Human iPSCs were harvested using a 0.5% TrypLE Select (ThermoFisher) treatment and used for embryoid body (EB) formation. Detached cells were transferred into 96-well Nunclon™ Sphera™ Microplate (ThermoFisher) that includes DMEM/F12 medium containing 20% Knockout serum replacement (KSR; Life Technology), 0.1 M nonessential amino acids (NEAA), 0.1 M 2-mercaptoethanol (Life Technologies) and 0.1 antibiotic-antimycotic solutions (ThermoFisher). The medium was changed every other day and the EBs were plated onto 0.2% gelatin-coated glass coverslips at day 8. EBs were then allowed to differentiate spontaneously for an additional 8 days.

For the cortical neuronal differentiation, iPSCs were dissociated into single cells and quickly re-aggregated in a 96-well Nunclon™ Sphera™ Microplate (ThermoFisher). The EBs were cultured in DMEM/F12 containing 20% knockout serum replacement (KSR), 0.1 M nonessential amino acids (NEAA), 0.1 M 2-mercaptoethanol, 0.1% antibiotic-antimycotic solutions (all from ThermoFisher), 10 uM SB431542 (Reagent Direct) and 10 uM LDN 193189 (Reagent Direct) for neural induction for 8 days. These neural induced EBs were dissociated using Accutase™ (Stem Cell Technologies) and were seeded onto 15 ug/ml poly-L-ornithine (Sigma) and 5 ug/ml laminin (Sigma)-coated dishes. Once neural precursor cells (NPCs) were formed, they were cultured in DMEM/F12 media containing 0.1 M nonessential amino acids (NEAA), 0.1 M 2-mercaptoethanol, 0.1 antibiotic-antimycotic solutions, 1% D-Glucose (Life Technologies), 1% B27 supplement without vitamin A (all from ThermoFisher), 200 mM L-Glutamine (Sigma), and 20 ng/ml basic fibroblast growth factor (bFGF; PeproTech Korea). Finally, NPCs were differentiated into cortical neurons for 10 weeks in Neurobasal A medium containing 1% B27 supplement without vitamin A, 1x Glutamax (all from ThermoFisher), 10 ng/ml brain-derived neurotrophic factor (BDNF), 10 ng/ml glial cell-derived neurotrophic factor (GDNF), 10 ng/ml nurotrophin-3 (NT3) (all from PeproTech Korea) on PLO/laminin-coated dishes [10].

The cells were fixed with 4% paraformaldehyde (PFA) for 15 min at room temperature (RT). Fixed cells were permeabilized and washed with TPBS containing 0.1% TritonX-100 (Sigma) in phosphate-buffered saline (PBS) and blocked with 5% normal horse serum (Vector Labs) for 30 min at RT. Afterwards, they were incubated with primary antibodies in blocking solution overnight with gentle rocking at 4℃. After washing three times with TPBS, they were incubated with secondary antibodies (ThermoFisher) for 90 min at RT, and then were counterstained using DAPI for 15 min. All fluorescence images were captured by confocal microscopy (TCSSP5II, Leica). The following primary antibodies were used: anti-OCT4 (1:200, Santa Cruz), anti-SOX2 (1:200, Millipore), anti-NANOG (1:200, R&D Systems), anti-SSEA-4 (1:100, Developmental Studies Hybridoma Bank)), anti-TRA-1-81 (1:100, CHEMICON), Tuj1 anti-tubulin beta III isoform (1:200, Millipore), anti-SMA (1:100, DAKO); anti-AFP (1:100, DAKO), anti-Nestin (1:200, R&D Systems), anti-Musashi (1:200, Millipore), anti-Map2 (1:200, Millipore), anti-TBR1 (1:100, Abcam), anti-CTIP2 (1:100, Abcam), 6E10 anti-Amyloid β (1:500, Covance), AT8 anti-p-tau (1:1000, ThermoFisher), anti-ChAT (1:200, Millipore) and anti-LC3B (1:500, Cell Signaling).

Conditioned media (CM) were collected from cultured neuronal cells (1×10⁵) at 48 hours after the last medium change from 6 and 10 weeks of differentiation. The pellets of iPSC-derived neurons were resuspended in RIPA buffer (Biosesang) containing protease inhibitors (ThermoFisher) and phosphatase inhibitors (ThermoFisher). Then they were chilled on ice for 30 min and sonicated. The supernatants were collected after centrifugation at 13,000 rpm for 30 min to remove membrane lipids. Protein concentration was determined using a BCA Protein Assay Kit (ThermoFisher). Intracellular Aβ₄₂ and Aβ₄₀ were measured in a total of 1 µg proteins from 10 week-differentiated neurons. Aβ₄₀ and Aβ₄₂ levels were measured using the human Aβ₄₀ and Aβ₄₂ ELISA Kit according to the manufacture's instruction (IBL). ELISA plate reader (BioTek) was used to quantify Aβ₄₀ and Aβ₄₂ levels.

Cultured neurons in 6-well plates were harvested at 10 weeks of differentiation as cell pellets and were resuspended in RIPA buffer (BIOSESANG) containing protease inhibitors (ThermoFisher) and phosphatase inhibitors (ThermoFisher). They were then chilled on ice for 30 min and sonicated. The supernatants were collected after centrifugation at 13,000 rpm for 30 min to remove membrane lipids. Protein concentration was determined using a BCA Protein Assay Kit (ThermoFisher), and 25 ug of protein for each sample was electrophoresed on 8% or 12% gels. The separated samples were transferred onto a PVDF membrane and incubated with target antibodies. Protein bands were visualized by Immobilon Western (Millipore) and were detected using Chemi-Doc (Bio-Rad). The following primary antibodies were used: Tau5 anti-tau (1:1,000, ThermoFisher), AT8 anti-p-tau (1:1,000, ThermoFisher), anti-OPA1 (1:1,000, Santa Cruz), anti-Mfn1 (1:1,000, Abcam), anti-Mfn2 (1:1,000, Cell Signaling), anti-Drp1 (1:1,000, Cell Signaling), anti-Fis1 (1:1,000, Santa Cruz), anti-Ub (1:4,000, Santa Cruz), anti-LC3B (1:1,000, Cell Signaling), anti-LAMP2 (1:1,000, Santa Cruz), anti-Beclin1 (1:1,000, Cell Signaling), p62 anti-SQSTM1 (1:1,000, Santa Cruz), 4G8 anti-APP (1:500, Covance), anti-p-Drp1 (Ser637, 1:1000, Cell Signaling) and anti-β-actin (1:10000, Santa Cruz).

For autophagy flux assay, we treated cells with 10 uM chloroquine (CQ) for 12 h, a compound known to interference the lysosomal function [11]. After 12 h, we used the CytoID® Green Autophagy Detection Kit (Enzo Life Sciences Inc., Cat. No, ENZ-51031-K200) to detect the autophagic vesicles in live cells. Induction of autophagic flux can be visualized by enhanced accumulation of autophagic vesicles when lysosomal function is inhibited. CytoID green was co-stained with DAPI and the fluorescence images were captured using a confocal microscopy (TCSSP5II, Leica). The quantification for the number and size of autophgic vesicles were performed using Image J (particle analysis plugin).

All statistical analyses were performed using a one-factor analysis of variance (ANOVA) followed by a Fisher's LSD (Least Significant Difference) using the Statistical Analysis System (Enterprise 4.1, SAS Korea, Seoul, Korea). Significance was accepted at the 95% probability level. Data in graphs are presented as mean±SEM. p-value<0.05 (^*), p-value<0.01 (^**) and p-value<0.001 (^***).

The patient was a 38-year-old woman who visited the outpatient clinic of Samsung Medical Center, Seoul, Korea. She had progressive memory impairment over a course of five years, which eventually resulted in disturbance of her daily life. She had 16 years of education and had no history of medical illness. A mildly spastic gait was noticed by her husband 6 months prior to presentation. Neurological examination revealed cerebellar dysfunction, including limb and truncal ataxia, dysdiadochokinesia, cerebellar dysarthria, and ocular abnormalities, such as overshooting saccades and saccadic intrusions during smooth pursuit eye movements. She also had bilateral spasticity in her legs and bradykinesia in both upper extremities. She demonstrated global cognitive problems with deficits in verbal and visual memory, language, and visuospatial functions with relative sparing of attention and frontal-executive function (Table 1).

The patient had a family history of dementia and ataxia (Fig. 1A). Her grandmother (I:2 in Fig. 1A) had developed a late-onset dementia during the seventh decade of life and died ten years after the diagnosis. Her cousin (III:2 in Fig. 1A) was diagnosed with late-onset cerebellar ataxia at the age of 54 and died at 62 years of age due to aspiration pneumonia without evidence of cognitive impairment. Brain MR images of her cousin (III:2) demonstrated severe cerebellar atrophy (Fig. 1B) without prominent atrophy of the medial temporal lobes. Brain MRI of our patient revealed generalized cortical atrophy along with atrophy in the bilateral medial temporal lobes and cerebellum (Fig. 1C). Laboratory studies of the patient, including 24-hour urine copper levels were unremarkable. Given the tentative diagnosis of dementia associated with a familial cerebellar ataxia, genetic evaluations for spinocerebellar ataxia (SCA, 1, 2, 3, 6, 7, 8, 12, 17, 27), dentatorubral-pallidoluysian atrophy (DRPLA), and late-onset Friedreich's ataxia (Frataxin gene) were performed and shown to be negative. Huntingtin gene test was negative. Given the diagnosis of early onset dementia with spastic paraparesis, a genetic work-up for a Presenilin mutation was performed [12], and a mutation in the PSEN1 gene (a transition from G (358^th codon) to A, resulting in a change from glutamate to lysine at codon 120 (Glu120Lys; PS1-E120K)) was detected. For the control iPSC generation, blood samples were obtained from a cognitively normal elderly man aged 72, who fulfilled the criteria for being a normal elderly person [7].

Pittsburgh compound-B (PiB) positron emission tomography (PET) imaging of the patient revealed a deposition of Aβ in the striatum as well as in the bilateral frontal lobes, posterior cingulate cortices, and precuneus (Fig. 1D). These PiB-PET image findings of the patient are compatible with previous reports of familial AD with spastic paraparesis caused by PSEN1 mutations [13,14]. The PiB-PET images of our patient did not reveal amyloid deposition in the cerebellum as shown in some previous studies [13,15]. The MRI and ¹⁸F-Florbetaben amyloid PET images of the normal elderly subject were in normal range.

Isolated MNCs were reprogrammed using Sendai virus vector (SeVdp) which expresses four reprogramming factors (OCT3/4, SOX2, cMYC, and KLF4) [9]. In our iPSC generation procedure, we normally pick more than three individual clones and select the best growing clone among them for further analyses, including neuronal differentiation experiments. Although the effects of PS1-E120K mutation on Aβ deposition have been studied in the brains of familial AD patients previously [16,17], the pathological features of the patients are less known at cellular levels. For this reason, we generated an iPSC line from AD patient carrying a mutation for PS1-E120K using iPSC technology for the first time. Control and PS1-E120K mutation iPSC lines exhibited the typical expression of undifferentiated pluripotent stem cell markers, such as OCT4, SOX2, SSEA4 and TRA-1-81 (Fig. 2A, B). Genotyping of the established iPSC lines was confirmed using a conventional sequencing method (Fig. 2C). The differentiation potential of iPSC lines was assessed in vitro by three-germ layer marker expression (Fig. 2D). Control and PS1-E120K mutation iPSC lines did not carry a SeV integration (Fig. 2E) and were not contaminated by mycoplasma (Fig. 2F, G).

To characterize the cortical neurons derived from each iPSC line, we developed a modified cortical neuron differentiation protocol, based on previously published procedures (Fig. 3A) [10]. Differentiated cells expressed general neuronal markers (i.e., Tuj1 and Map2), cholinergic marker (i.e., ChAT), as well as cortical neuron markers (i.e., TBR1 and CTIP2; Fig. 3B, C). We observed high levels of neuronal differentiation in our experiments, and the following is the relative percentage of each neuronal cell type (control vs. PS1-E120K iPSC-derived neurons): TUJ1 (86.79%±3.37 vs. 82.41%±4.42) MAP2 (80.24%±2.47 vs. 80.45%±1.81), TBR1 (61.29%±2.23 vs. 64.69%±3.47) and CTIP2 (59.65%±3.28 vs. 49.40%±6.73). Among them, the percentage of TBR1/CTIP-double positive neurons were relatively high (58.02%±4.43 vs. 48.41%±6.93), indicating our cortical neuron differentiation was efficient. We also observed high levels of ChAT, a marker for cholinergic neurons (74.25%±6.69 vs. 81.20%±2.23). In most cases, no significant differences in the neuronal differentiation propensity was seen between control and PS1-E120K iPSC lines (Fig. 3D). In addition, there was no significant difference of PSEN1 gene expression in iPSC and iPSC-derived neurons (data not shown). Moreover, no significant difference in features associated with aging was observed between the two iPSC lines (i.e., PS1-E120K iPSC from the 38 year-old AD patient vs. control iPSC from the 72 year-old normal elderly subject).

To analyze the functional aspects of familial AD (PS1-E120K), we investigated Aβ secretion in the conditioned medium (CM) from the iPSC-derived neurons at 6 weeks and 10 weeks after differentiation. We measured Aβ₄₀ and Aβ₄₂ levels 48 hr after the last medium change. Strikingly, PS1-E120K iPSC-derived neurons exhibited a dramatic increase in Aβ₄₂ levels (over 2-fold) compared with the control iPSC-derived neurons at both 6 weeks and 10 weeks after differentiation (Fig. 4A). However, no difference in Aβ₄₀ levels was detected (Fig. 4B). Importantly, the ratio of Aβ₄₂/Aβ₄₀ was significantly increased (over 2-fold) in PS1-E120K iPSC-derived neurons (Fig. 4C) compared with the control iPSC-derived line. Furthermore, intracellular Aβ₄₂ levels and the ratio of Aβ₄₂/Aβ₄₀ was also significantly increased in PS1-E120K iPSC-derived neurons (Fig. 4D~F). We also observed a marked increase in APP expression levels in PS1-E120K iPSC-derived neurons (Fig. 4H and I). To detect the Aβ deposits, iPSC-derived neurons were stained with the anti-Aβ antibody 6E10 and 4G8 at 10 weeks of differentiation. Using a confocal microscopy we found a distinctive increase of extracellular Aβ deposits in PS1-E120K iPSC-derived neurons compared with the control iPSC-derived neurons (Fig. 4G, H). Given the difference in ages when the blood was drawn to generate both iPSC-derived neurons, the current findings suggest that the accumulation of Aβ protein can be driven by the PS1-E120K mutation beyond the effect of aging.

Tau protein normally exists as a soluble form in axons. However, as it becomes hyperphosphorylated, as in AD, it accumulates in dendrites and cell bodies [16,17]. To analyze the phosphorylated tau (p-tau) levels in the iPSC-derived neurons, we performed western blot analyses using antibodies against AT180 (phosphorylated at Thr231), p-Tau (phosphorylated at Ser400, Thr403/Ser404), and Tau5 (total tau). Then, we found that there exist multi-bands indicative of fractions in AT8, AT180 and p-Tau and the protein expression of each was strongly increased in the PS1-E120K iPSC-derived neurons compared with the control lines (Fig. 5A~F). These findings are in line with previous studies demonstrating that brain tissues from AD patients with severe Braak stages [18,19] and neural cells with PSEN1 and APP mutation showed multiple bands of p-tau (>50 kDa) compared with the controls [20]. We also found that there was an increase of total tau (Tau5) levels, which likely correlates with a robust increase in the aggregated tau fractions [20].

As we found the increase of fragmented tau in our PS1-E120K iPSC-derived neurons at 10 weeks of differentiation, we conducted tau ELISA to detect soluble tau using conditioned medium. We found that PS1-E120K patient exhibited significant increases in soluble tau both at 6 and 10 weeks of differentiation (data not shown). To further investigate this p-tau accumulation at the cellular level, we performed immunocytochemical analysis using an antibody against AT8 and found that, unlike in the control iPSC-derived neurons, AT8 expression in the PS1-E120K iPSC-derived neurons was localized to the cell bodies (Fig. 5G~J). Taken together, these results show that there are high levels of p-tau (AT8) which localizes to the cell bodies in the PS1-E120K iPSC-derived neurons, compared with the control iPSC-derived neurons.

Mitochondrial dysfunction is a prominent feature in AD [22,23]. Recent studies have reported that extracellular Aβ and phosphorylated tau could be attributed to the impaired balance of mitochondrial fission and fusion [6,24]. To investigate whether mitochondria fission and fusion was impaired in our PS1-E120K iPSC-derived neurons, we measured the expression levels of mitochondria fission-related proteins, Drp1 (dynamin-related protein 1), p-Drp1 (for the detection of inhibitory phosphorylation of Drp1 at Ser637) and Fis1 (mitochondrial fission 1 protein); and fusion-related protein OPA1 (optic atrophy 1 gene protein), Mfn1 (membrane proteins mitofusin 1) and Mfn2 (membrane proteins mitofusin 2). Western blot analysis revealed a significant increase of Drp1 expression, a decrease of inhibitory p-Drp1 (Ser637) as well as the ratio of p-Drp1 (Ser637)/Drp1 and a slight increase of Fis1 in the PS1-E120K group compared with the control group (Fig. 6A~D). Furthermore, we found that the expression of OPA1, Mfn1 and Mfn2 was dramatically reduced in PS1-E120K group when compared with the control group (Fig. 6A, E, F and G). Q-PCR analyses revealed dramatic increases of fission-related gene (DRP1) expression and decrease of fusion-related gene (Mfn1) expression in the PS1-E12K iPSC-derived neurons compared with the control neurons (Fig. 6J and K). In addition, mitophagy-related proteins PINK1 and PARKIN showed dramatic increase in the PS1-E120K cells compared with the control lines (Fig. 6A, H and I). These results strongly suggest that PSEN1 mutation may result in impaired mitochondrial fission and fusion.

Defective autophagy function is known also to occur in AD which correlates with the presence of neuritic plaques and filamentous tau [25,26]. It was previously shown that PS1 is necessary for the degradation of abnormal proteins using autophagylysosome system [27]. To investigate this further in our neurons, we measured the expression levels of autophagy-related proteins, including Ubiquitin (Ub), p62 (SQSTM1, sequestosome 1; cargo protein marker), Beclin1 (autophagosome membrane formation-related protein), LC3b (light chain 3; autophagosome formation marker) and LAMP2 (lysosome-associated membrane proteins). Western blot analysis revealed that the expression levels of Ub and LC3b-II (active form of LC3b), but not p62, were significantly increased in PS1-E120K iPSC-derived neurons (Fig. 6L, M and P). To further investigate LC3B expression at the cellular level, we performed immunocytochemical analysis and found that PS1-E120K iPSC-derived neurons exhibit a dramatic increase of LC3b in the periphery of soma area, compared with the control group (Fig. 6R). In contrast, the chaperone-mediated autophagosome and lysosome membrane marker, LAMP2 showed a dramatic decrease in the PS1-E120K iPSC-derived neurons (Fig. 6L and Q). To further investigate the dysfunctioning autophagy, we performed autophagy flux assay with treatment of 10 uM chloroquine (CQ), a compound known to interfere with the lysosomal function. Autophagy flux assay showed a significant increase in LC3B-II expression after the CQ treatment in the PS1-E120K iPSC-derived NPC compared to the control (Fig. 6S). In addition, we performed the live cell staining with CytoID. In line with previous findings, the PS1-E120K iPSC-derived NPCs exhibited dramatic increases in the number of autophagic vesicles compared with the control cells (Fig. 6 T~P). Taken together, these results strongly suggest that PSEN1 mutation alters autophagic activity and lysosomal expression in the differentiated neurons.