Son’s Disease Prompts Mom’s Scientific Quest

From the Summer 2015 edition of Vanderbilt Medicine Magazine

Photo by Daniel Dubois
Photo by Daniel Dubois

At age 50, Terry Jo Bichell, a midwife and mother of five with no basic science training, set out to cure Angelman Syndrome.

It wasn’t a mid-life crisis; a fit of reinvention as her four oldest daughters left the house. It was a pure desire to help her son Louie, 16, and the thousands of other children like him who are living with the disorder marked by delayed brain development, lack of speech, uncoordinated motor function, behavior difficulties, seizures and sleep disorders.

“Angelman is caused by just one gene. Why don’t we have a drug that turns on that gene?” Bichell wondered.

“I just didn’t want to sit around complaining about other scientists not doing it. There can’t be anyone more motivated than me, so I should get off the couch and go to school and figure out how to turn on the gene. Why not?”

Sleepless nights
When Louie was born in February 1999, Bichell immediately sensed something was wrong. He wasn’t breast-feeding as well as his four older sisters and wasn’t meeting developmental milestones, except he smiled and laughed earlier than expected. (The syndrome is marked by frequent laughing, smiling and a generally happy demeanor.)

“As a midwife, I couldn’t take no for an answer on the breast-feeding. I had told a thousand other women they could breast-feed and wasn’t going to let my own baby get away with not doing it,” Bichell recalled. “The pediatrician told me he was going to be fine. He was my first boy and they’re different than girls. She said I’m almost 40, maybe I’m more neurotic.”

She and her husband, David Bichell, M.D., now chief of pediatric cardiac surgery at Monroe Carell Jr. Children’s Hospital at Vanderbilt, would often flip through his medical books looking for an answer to Louie’s delays.

When Louie was finally diagnosed with AS around his first birthday, Terry Jo was working in Mexico as a midwife with her mother and four children in tow while David stayed behind to work in San Diego. She walked 2 miles to the closest Internet café and started Googling.

“It was like the door opened. It was like somebody said, ‘OK now you have work to do.’”

She found out the first international Angelman conference was in six weeks in Finland, and recruited her mother to come along to help care for Louie. Like most children with AS, Louie has difficulty sleeping, waking often in the night and still requiring a special adult-sized crib to keep him safe.

“Finland in July is 23 hours of sun, and I have a kid with a sleep disorder. It was ridiculous. In the middle of the night he would be wailing, and I would pace the lobby so my mom could get some sleep,” Bichell recalled.

Also sleepless was Art Beaudet, M.D., the scientist who originally discovered the Angelman gene (or “the Yoda of the 15th chromosome,” as Bichell calls him). They struck up a friendship in the wee hours, and the Bichells began supporting Beaudet’s research to find a way to turn on the paternal gene.

At the conference, Bichell saw that the scientists weren’t really connecting with the families and made it her mission to speed their discoveries from the lab into clinical trials. She became involved with various Angelman groups and supported researchers working in the field.

Angelman Syndrome (AS), named for British pediatrician Harry Angelman who first described the disorder in 1965, occurs in one in every 10,000-20,000 births. It is the medical school textbook example of genomic imprinting, a phenomenon that silences genes from either the mother or father. In the case of AS, the paternal copy of gene UBE3A on chromosome 15 is turned off, and the maternal copy fails to produce the necessary proteins.

“Terry Jo took it by the horns,” David Bichell said. “The interest had been purely scientific—genomic imprinting, isn’t that wacky? They really had blinders to turning that into a treatment. All along she has been pushing their scientific agenda into the clinic. Then carrying the ball all the way down the court, she decided to be more educated and figure it out herself.”

Back to School
Bichell enrolled in the Vanderbilt Brain Institute’s Neuroscience Graduate Program in 2010. She joined the lab of Kevin Haas, M.D., Ph.D., and began looking at the amount of neurotransmitters in the brains of mice with AS. Her mice showed abnormal increases and decreases in neurotransmitters but research colleagues in Memphis found the opposite pattern. There was no explanation for this difference, so Bichell drove to Memphis to make sure they were doing their dissections exactly the same.

“It’s easier for me to find a babysitter at night, so I would put Louie on the bus at 9 in the morning, get to work about 11 and do all my dissections between 5 and 8 in the evening. [The researchers in Memphis] were doing theirs at 9 in the morning,” she said.

Time of day was the only difference, and Bichell latched onto the idea that the biological clock, or circadian rhythm, is important in AS.

Long before her scientific training, Bichell started logging Louie’s sleep patterns and noticed a five-week cycle.

“He would get more and more off over a month’s time, then have a disastrous week and be back to normal. I really wondered if there was something about the gene that he’s missing that functions in the biological clock.”

+ Carl Johnson, Ph.D., and Terry Jo Bichell study circadian rhythm in  Angelman Syndrome.  Photo by Joe Howell.
+
Carl Johnson, Ph.D., and Terry Jo Bichell study circadian rhythm in Angelman Syndrome. Photo by Joe Howell.

More experiments she performed with Carl Johnson, Ph.D., and Shuqun Shi, Ph.D., showed that mice with AS had a 25.5-hour day, and the results were published in February in the journal Current Biology.

These findings could have huge implications for upcoming clinical trials for treatments for AS. There are two known ways to turn on the faulty gene—a brain cancer drug called topotecan and binding a DNA sequence known as an antisense oligonucleaotide—that could potentially reverse the effects of AS. A properly functioning biological clock could be an immediate signal that the treatments are working.

“We’re hoping this circadian knowledge will give the pharmaceutical firms a biomarker. When the gene is turned on, the mice’s clocks are normalized within a day. Anything you can change in a day is a great biomarker,” Bichell said.

“I was so naïve. I thought by the time I finished grad school we’d have that gene turned on. Now that I know more about science, I realize it was crazy! But really I’m behind where I thought the research would be. I really thought we would have it in kids by now.”

The Greater Good
The Angelman community was extremely reluctant to use the word “cure,” but Bichell knew there had to be a drug that would turn on the gene, and eventually decided to find it herself. She’s not at all disappointed other scientists beat her to it.

“There are two drug companies, Isis and Ovid, who say they are starting clinical trials in 2016. There is a cure in sight, and I want to help them get their drugs into kids,” she said.

Today, Louie is an a ninth-grader at Hillsboro High School. He’s a bit of a celebrity among his classmates and their families, and gives exuberant greetings to everyone he meets.

“Louie is a good kid. He’s got a great sense of humor and is very affectionate and super attached to us. He does walk and does feed himself, and he’s better at sleeping now that I know how sensitive he is to light,” Bichell said.

She hopes to finish her Ph.D. this summer and then be involved with clinical trials or help translate scientific information for families and donors. Her husband David is proud of her perseverance.

“There are a thousand points of ‘no’ along this pathway and she’s just pushing them aside. She doesn’t let anything be an obstacle to what is her clear mission,” he said.

“And it’s all with sobering understanding that pretty much everything she’s driving toward may be too late for Louie. But that doesn’t change her resolve. She really is thinking about future kids.”