Figure 1 Time-dependent progression of α-synuclein accumulation and aggregation in foetal dopamine nigral grafts. ... Figure 1 Time-dependent progression.

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Figure 1 Time-dependent progression of α-synuclein accumulation and aggregation in foetal dopamine nigral grafts. ... Figure 1 Time-dependent progression of α-synuclein accumulation and aggregation in foetal dopamine nigral grafts. Sections through the graft were stained for Ser129 phospho-synuclein. Scale bar = 100 μm (A–D); 20 μm (a–d). Unless provided in the caption above, the following copyright applies to the content of this slide: © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Brain, awz104, https://doi.org/10.1093/brain/awz104 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 2 Qualitative and quantitative evidence for increased CD45 immunoreactivity was observed in grafted regions of ... Figure 2 Qualitative and quantitative evidence for increased CD45 immunoreactivity was observed in grafted regions of the striatum at all time points examined. Representative low and high power examples are provided from the cases at 18 months (A and B), 4 years (C and D), 14 years (E and F) and 16 years (G and H) after transplantation and (I) an age-matched control. (J) Mean optical density (OD) measures of CD45 immunostaining was calculated for graft regions and comparable regions of the putamen of Parkinson’s disease and controls. Data are presented as mean optical density in grafted versus non-grafted controls (P < 0.0002). Scale bar = 200 µm (A, C, E, G and I); 30 µm (B, D, F, H and inset I). NC = normal control; PD = Parkinson’s disease. Unless provided in the caption above, the following copyright applies to the content of this slide: © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Brain, awz104, https://doi.org/10.1093/brain/awz104 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 3 Low (A) and high power (B) photomicrographs from grafted region of 18 month graft illustrating CD45 ... Figure 3 Low (A) and high power (B) photomicrographs from grafted region of 18 month graft illustrating CD45 immunoreactivity. Intense CD45-labelled inflammatory cells were observed within graft (arrowheads; A). Boxed area in A is enlarged in B showing two types of CD45-positive cells in graft: dark stained round cells with absent processes (arrows; B) associated with blood vessels within the graft, and light stained small cells with present processes (arrowheads; B) distributed either in grafted region or non-grafted putamen. Scale bars = 400 µm (A); 40 µm (B). Unless provided in the caption above, the following copyright applies to the content of this slide: © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Brain, awz104, https://doi.org/10.1093/brain/awz104 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 4 Photomicrographs showing TMEM119 immunoreactivity Figure 4 Photomicrographs showing TMEM119 immunoreactivity. Photomicrographs from grafted regions (A, B, D, F, G, H, J ... Figure 4 Photomicrographs showing TMEM119 immunoreactivity. Photomicrographs from grafted regions (A, B, D, F, G, H, J and K), putamenal area remote from graft deposits (C, F, I and L), Parkinson’s disease control putamen (M), and control (N), illustrating TMEM119 immunoreactivity. The grafted samples were collected from 18 month (A and B), 4 year (D and E), 14 year (G and H), and 16 year (J and K) time points after transplantation. Note that intense TMEM119 labelled microglia were observed within grafts at all time points examined as compared with putamenal area remote from graft deposits and Parkinson’s disease patients who did not undergo a transplant procedure. Scale bar = 100 μm in N (applies to B, C, E, F, H, I, K, L and M); 500 μm in A, D, G and J. Mean optical density (OD) of TMEM119 immunostaining was calculated for graft regions and comparable regions of the putamen of Parkinson’s disease subjects and controls (O). Data are presented as mean optical density versus non-grafted controls (P < 0.05 to P < 0.001). NC = normal control; PD = Parkinson’s disease. Unless provided in the caption above, the following copyright applies to the content of this slide: © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Brain, awz104, https://doi.org/10.1093/brain/awz104 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 5 Photomicrographs showing morphological pattern of TMEM119-labelled microglia. High power photomicrographs ... Figure 5 Photomicrographs showing morphological pattern of TMEM119-labelled microglia. High power photomicrographs from grafted regions (A, C, E and G), putamenal area remote from graft deposits (B, D, F and H), Parkinson’s disease control (I), and normal control (J) illustrating morphological pattern of TMEM119-labelled microglia. The TMEM119-positive microglia inside grafts at all time points examined displayed dense swollen and short processes and enlarged cell bodies with bushy morphology (A, C, E and G). However, in putamen remote from grafts (B, D, F and H) and Parkinson’s disease control (I), TMEM119 labelled small cell bodies and long ramified processes. In age-matched control (J), TMEM-positive microglia exhibited light stained cell bodies and fine ramified processes. Scale bar = 30 μm in J (applies to all). PD = Parkinson’s disease. Unless provided in the caption above, the following copyright applies to the content of this slide: © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Brain, awz104, https://doi.org/10.1093/brain/awz104 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 6 Schematic of the viscous cycle between inflammation and Lewy pathology. Schematic illustration demonstrating ... Figure 6 Schematic of the viscous cycle between inflammation and Lewy pathology. Schematic illustration demonstrating how a variety of factors including the implantation of foreign tissue could cause microglia to become activated and initiate a vicious cycle in which toxic cytokines cause native α-synuclein to misfold, and the uptake of misfolded α-synuclein causes microglia to become activated. In this scenario, microglia become activated and release toxic cytokines, which can metabolize and cleave native α-synuclein causing it to misfold, aggregate, and form pathological inclusions (Lewy pathology). Misfolded α-synuclein can be released from cells and taken up by microglia causing them to become activated with the release of toxic cytokines, thereby perpetuating the vicious cycle. The release of different toxic cytokines from microglia may cause α-synuclein to form and fold differently to cause the known diversity of pathological species of α-synuclein. In addition, cytokine release might affect α-synuclein in nearby cells in a similar manner, thus facilitating the selective spread and propagation of α-synuclein pathology in vulnerable cell populations. This vicious cycle could explain why α-synuclein pathology developed in implanted dopamine neurons in Parkinson’s disease patients, how templating occurs in Parkinson’s disease, and how toxic cytokines may be involved in the spread of α-synuclein pathology. Unless provided in the caption above, the following copyright applies to the content of this slide: © The Author(s) (2019). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Brain, awz104, https://doi.org/10.1093/brain/awz104 The content of this slide may be subject to copyright: please see the slide notes for details.