Laurent Vinay

Down-regulation of the potassium-chloride cotransporter KCC2 contributes to spasticity after spinal cord injury

Hyperexcitability of spinal reflexes and reduced synaptic inhibition are commonly associated with spasticity after spinal cord injury (SCI). In adults, the activation of γ-aminobutyric acidA (GABAA) and glycine receptors inhibits neurons as a result of low intracellular chloride (Cl−) concentration, which is maintained by the potassium-chloride cotransporter KCC2 (encoded by Slc12a5). We show that KCC2 is downregulated after SCI in rats, particularly in motoneuron membranes, thereby depolarizing the Cl− equilibrium potential and reducing the strength of postsynaptic inhibition. Blocking KCC2 in intact rats reduces the rate-dependent depression (RDD) of the Hoffmann reflex, as is observed in spasticity. RDD is also decreased in KCC2-deficient mice and in intact rats after intrathecal brain-derived neurotrophic factor (BDNF) injection, which downregulates KCC2. The early decrease in KCC2 after SCI is prevented by sequestering BDNF at the time of SCI. Conversely, after SCI, BDNF upregulates KCC2 and restores RDD. Our results open new perspectives for the development of therapeutic strategies to alleviate spasticity.

Perinatal development of lumbar motoneurons and their inputs in the rat.

The rat is quite immature at birth and a rapid maturation of motor behavior takes place during the first 2 postnatal weeks. Lumbar motoneurons undergo a rapid development during this period. The last week before birth represents the initial stages of motoneuron differentiation, including regulation of the number of cells and the arrival of segmental and first supraspinal afferents. At birth, motoneurons are electrically coupled and receive both appropriate and inappropriate connections from the periphery; the control from supraspinal structures is weak and exerted mainly through polysynaptic connections. During the 1st postnatal week, inappropriate sensori-motor contacts and electrical coupling disappear, the supraspinal control increases gradually and myelin formation is responsible for an increased conduction velocity in both descending and motor axons. Both N-methyl-D-aspartate (NMDA) and non-NMDA receptors are transiently overexpressed in the neonatal spinal cord. The contribution of non-NMDA receptors to excitatory amino acid transmission increases with age. Activation of gamma-aminobutyric acid(A) and glycine receptors leads to membrane depolarization in embryonic motoneurons but to hyperpolarization in older motoneurons. The firing properties of motoneurons change with development: they are capable of more repetitive firing at the end of the 1st postnatal week than before birth. However, maturation does not proceed simultaneously in the motor pools innervating antagonistic muscles; for instance, the development of repetitive firing of ankle extensor motoneurons lags behind that of flexor motoneurons. The spontaneous embryonic and neonatal network-driven activity, detected at the levels of motoneurons and primary afferent terminals, may play a role in neuronal maturation and in the formation and refinement of sensorimotor connections.

Refuting the challenges of the developmental shift of polarity of GABA actions: GABA more exciting than ever!

During brain development, there is a progressive reduction of intracellular chloride associated with a shift in GABA polarity: GABA depolarizes and occasionally excites immature neurons, subsequently hyperpolarizing them at later stages of development. This sequence, which has been observed in a wide range of animal species, brain structures and preparations, is thought to play an important role in activity-dependent formation and modulation of functional circuits. This sequence has also been considerably reinforced recently with new data pointing to an evolutionary preserved rule. In a recent “Hypothesis and Theory Article,” the excitatory action of GABA in early brain development is suggested to be “an experimental artefact” (Bregestovski and Bernard, 2012). The authors suggest that the excitatory action of GABA is due to an inadequate/insufficient energy supply in glucose-perfused slices and/or to the damage produced by the slicing procedure. However, these observations have been repeatedly contradicted by many groups and are inconsistent with a large body of evidence including the fact that the developmental shift is neither restricted to slices nor to rodents. We summarize the overwhelming evidence in support of both excitatory GABA during development, and the implications this has in developmental neurobiology.

Activation of 5-HT2A receptors upregulates the function of the neuronal K-Cl cotransporter KCC2

In healthy adults, activation of γ-aminobutyric acid (GABA)A and glycine receptors inhibits neurons as a result of low intracellular chloride concentration ([Cl–]i), which is maintained by the potassium-chloride cotransporter KCC2. A reduction of KCC2 expression or function is implicated in the pathogenesis of several neurological disorders, including spasticity and chronic pain following spinal cord injury (SCI). Given the critical role of KCC2 in regulating the strength and robustness of inhibition, identifying tools that may increase KCC2 function and, hence, restore endogenous inhibition in pathological conditions is of particular importance. We show that activation of 5-hydroxytryptamine (5-HT) type 2A receptors to serotonin hyperpolarizes the reversal potential of inhibitory postsynaptic potentials (IPSPs), EIPSP, in spinal motoneurons, increases the cell membrane expression of KCC2 and both restores endogenous inhibition and reduces spasticity after SCI in rats. Up-regulation of KCC2 function by targeting 5-HT2A receptors, therefore, has therapeutic potential in the treatment of neurological disorders involving altered chloride homeostasis. However, these receptors have been implicated in several psychiatric disorders, and their effects on pain processing are controversial, highlighting the need to further investigate the potential systemic effects of specific 5-HT2AR agonists, such as (4-bromo-3,6-dimethoxybenzocyclobuten-1-yl)methylamine hydrobromide (TCB-2).

Role of gravity in the development of posture and locomotion in the neonatal rat

This report describes the early motor behaviour in the neonatal rat in relation with the maturation of sensory and motor elements of the central nervous system (CNS). The role of vestibular information during the week before (E14-21) and the 2 weeks after (P0-15) birth will be considered. There is a rostro-caudal gradient in the maturation of posture and locomotion with a control of the head and forelimbs during the first postnatal week and then a sudden acceleration in the functional maturation of the hindlimb. At birth, the neonatal rat is blinded and deaf; despite the immaturity of the other sensory systems, the animal uses its olfactory system to find the mother nipple. Vestibular development takes place between E8 and P15. Most descending pathways from the brainstem start to reach the lumbar enlargement of the spinal cord a few days before birth (reticulo-, vestibulospinal pathways as well as the serotonergic and noradrenergic projections); their development is not completed until the end of the second postnatal week. At birth, in an in vitro preparation, a locomotor activity can be evoked by perfusing excitatory amino acids and serotonin over the lumbar region. The descending pathways which trigger the activity of the CPG are also partly functional. At the same age both air stepping and swimming can be induced. Complex locomotion such as walking, trotting and galloping start later because it requires the maturation of the vestibular system, descending pathways and postural reflex regulation. The period around birth is critical to properly define how the vestibular information is essential for the structuring of the motor behaviour. Different types of experiments (hypergravity, microgravity) are planned to test this hypothesis.

Serotonin refines the locomotor-related alternations in the in vitro neonatal rat spinal cord.

Serotonergic projections from raphe nuclei arrive in the lumbar enlargement of the spinal cord during the late fetal period in the rat, a time window during which the locomotor‐related left/right and flexor/extensor coordinations switch from synchrony to alternation. The goal of the present study was to investigate the role played by serotonin (5‐HT) in modulating the left/right and flexor/extensor alternations. Fictive locomotion was induced by bath application of N‐methyl‐d,l‐aspartate (NMA) in the in vitro neonatal rat spinal cord preparation. By means of cross‐correlation analysis we demonstrate that 5‐HT, when added to NMA, improves left/right and flexor/extensor (recorded from the 3rd and 5th lumbar ventral roots, respectively) alternations. This effect was partly reproduced by activation of 5‐HT2A/2C receptors. We then tested the contribution of endogenous 5‐HT to NMA‐induced fictive locomotion. Reducing the functional importance of endogenous 5‐HT, either by inhibiting its synthesis with daily injections of p‐chloro‐phenylalanine (PCPA), starting on the day of birth, or by application of ketanserin (a 5‐HT2 receptor antagonist) or SB269970 (a 5‐HT7 receptor antagonist), disorganized the NMA‐induced locomotor pattern. This pattern was restored in PCPA‐treated animals by adding 5‐HT to the bath. Blocking 5‐HT7 receptors disorganized the locomotor‐like rhythm even in the absence of electrical activity in the brain stem, suggesting that NMA applied to the spinal cord does not cause 5‐HT release by activating a spino‐raphe–spinal loop. These results demonstrate that 5‐HT is critical in improving the locomotor‐related alternations in the neonatal rat.

Dual personality of GABA/glycine-mediated depolarizations in immature spinal cord

The inhibitory action of glycine and GABA in adult neurons consists of both shunting incoming excitations and moving the membrane potential away from the action potential (AP) threshold. By contrast, in immature neurons, inhibitory postsynaptic potentials (IPSPs) are depolarizing; it is generally accepted that, despite their depolarizing action, these IPSPs are inhibitory because of the shunting action of the Cl− conductance increase. Here we investigated the integration of depolarizing IPSPs (dIPSPs) with excitatory inputs in the neonatal rodent spinal cord by means of both intracellular recordings from lumbar motoneurons and a simulation using the compartment model program “Neuron.” We show that the ability of IPSPs to suppress suprathreshold excitatory events depends on ECl and the location of inhibitory synapses. The depolarization outlasts the conductance changes and spreads electrotonically in the somatodendritic tree, whereas the shunting effect is restricted and local. As a consequence, dIPSPs facilitated AP generation by subthreshold excitatory events in the late phase of the response. The window of facilitation became wider as ECl was more depolarized and started earlier as inhibitory synapses were moved away from the excitatory input. GAD65/67 immunohistochemistry demonstrated the existence of distal inhibitory synapses on motoneurons in the neonatal rodent spinal cord. This study demonstrates that small dIPSPs can either inhibit or facilitate excitatory inputs depending on timing and location. Our results raise the possibility that inhibitory synapses exert a facilitatory action on distant excitatory inputs and slight changes of ECl may have important consequences for network processing.

The maturation of locomotor networks.

In both vertebrates and invertebrates, the elaboration of locomotion, and its neural control by the central nervous system, are extremely flexible. This is due not only to the network properties of relevant sets of central neurons, but also to the active participation of mutually co-operative central and peripheral loops of neural projections and activity. In this chapter, we describe experiments in which the above concepts have been advanced by comparing locomotor properties in the adult vs. neonatal rat preparation. Data obtained from the in vivo vs. in vitro preparation, and swimming vs. walking behavior, suggest that the locomotor pattern progressively exhibited after birth corresponds to successive steps in the maturation of locomotor networks. Our work emphasises that during the late pre- and early postnatal period, three distinct neural entities--segmental sensory input, descending pathways, and motoneurons--play a key role in the maturation of locomotion and its neural control. We propose that the neonatal rat preparation is an excellent model for studying the conversion from immature to adult locomotion. Some neural controls are more clearly demonstrable in the developing animal preparation than in the adult because the latter exhibits an array of complex and redundant adaptive mechanisms.

Strategies to restore motor functions after spinal cord injury

This review presents recent advances in the development of strategies to restore posture and locomotion after spinal cord injury (SCI). A set of strategies focusing on the lesion site includes prevention of secondary damages, promotion of axonal sprouting/regeneration, and replacement of lost cells. Other strategies focus on spinal central pattern generators (CPGs). Training promotes functional recovery by enhancing the plasticity of CPGs and these sublesional networks can be reactivated by means of pharmacological or electrical stimulation. It is now clear that substantial functional recovery will require a combination of strategies adapted to each phase following SCI. Finally, improvements in the understanding of the mechanisms underlying spasticity may lead to new treatments of this disabling complication affecting patients with SCI.

Developmental up-regulation of the potassium–chloride cotransporter type 2 in the rat lumbar spinal cord

The classical GABA/glycine hyperpolarizing inhibition is not observed in the immature spinal cord. GABA(A) and glycine receptors are anions channels and the efficacy of inhibitory transmission in the spinal cord is largely determined by the gradient between intracellular and extracellular chloride concentrations. The concentration of intracellular chloride in neurons is mainly regulated by two cation-chloride cotransporters, the potassium-chloride cotransporter 2 (KCC2) and the sodium-potassium-chloride co-transporter 1 (NKCC1). In this study, we measured the reversal potential of IPSPs (E(IPSP)) of lumbar motoneurons during the first postnatal week and we investigated the expression of KCC2 and NKCC1 in the ventral horn of the spinal cord from the embryonic day 17 to the postnatal day 20 in the rat. Our results suggest that the negative shift of E(IPSP) from above to below the resting membrane potential occurs during the first postnatal week when the expression of KCC2 increases significantly and the expression of NKCC1 decreases. KCC2 immunolabeling surrounded motoneurons, presumably in the plasma membrane and NKCC1 immunolabeling appeared outside this KCC2-labeled fine strip. Taken together, the present results indicate that maturation of chloride homeostasis is not completed at birth in the rat and that the upregulation of KCC2 plays a key role in the shift from depolarizing to hyperpolarizing IPSPs.