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Guo J, Min D, Farrell EK, Zhou Y, Faingold CL, Cotten JF, Feng HJ. Enhancing the action of serotonin by three different mechanisms prevents spontaneous seizure-induced mortality in Dravet mice. Epilepsia 2024; 65:1791-1800. [PMID: 38593237 PMCID: PMC11166528 DOI: 10.1111/epi.17966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is an underestimated complication of epilepsy. Previous studies have demonstrated that enhancement of serotonergic neurotransmission suppresses seizure-induced sudden death in evoked seizure models. However, it is unclear whether elevated serotonin (5-HT) function will prevent spontaneous seizure-induced mortality (SSIM), which is characteristic of human SUDEP. We examined the effects of 5-HT-enhancing agents that act by three different pharmacological mechanisms on SSIM in Dravet mice, which exhibit a high incidence of SUDEP, modeling human Dravet syndrome. METHODS Dravet mice of both sexes were evaluated for spontaneous seizure characterization and changes in SSIM incidence induced by agents that enhance 5-HT-mediated neurotransmission. Fluoxetine (a selective 5-HT reuptake inhibitor), fenfluramine (a 5-HT releaser and agonist), SR 57227 (a specific 5-HT3 receptor agonist), or saline (vehicle) was intraperitoneally administered over an 8-day period in Dravet mice, and the effect of these treatments on SSIM was examined. RESULTS Spontaneous seizures in Dravet mice generally progressed from wild running to tonic seizures with or without SSIM. Fluoxetine at 30 mg/kg, but not at 20 or 5 mg/kg, significantly reduced SSIM compared with the vehicle control. Fenfluramine at 1-10 mg/kg, but not .2 mg/kg, fully protected Dravet mice from SSIM, with all mice surviving. Compared with the vehicle control, SR 57227 at 20 mg/kg, but not at 10 or 5 mg/kg, significantly lowered SSIM. The effect of these drugs on SSIM was independent of sex. SIGNIFICANCE Our data demonstrate that elevating serotonergic function by fluoxetine, fenfluramine, or SR 57227 significantly reduces or eliminates SSIM in Dravet mice in a sex-independent manner. These findings suggest that deficits in serotonergic neurotransmission likely play an important role in the pathogenesis of SSIM, and fluoxetine and fenfluramine, which are US Food and Drug Administration-approved medications, may potentially prevent SUDEP in at-risk patients.
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Affiliation(s)
- Jialing Guo
- National Health Commission Key Laboratory of Birth Defect Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Daniel Min
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emory K. Farrell
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yupeng Zhou
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carl L. Faingold
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Joseph F. Cotten
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
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Pan Y, Tan Z, Guo J, Feng HJ. 5-HT receptors exert differential effects on seizure-induced respiratory arrest in DBA/1 mice. PLoS One 2024; 19:e0304601. [PMID: 38820310 PMCID: PMC11142501 DOI: 10.1371/journal.pone.0304601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Abstract
Both clinical and animal studies demonstrated that seizure-induced respiratory arrest (S-IRA) contributes importantly to sudden unexpected death in epilepsy (SUDEP). It has been shown that enhancing serotonin (5-HT) function relieves S-IRA in animal models of SUDEP, including DBA/1 mice. Direct activation of 5-HT3 and 5-HT4 receptors suppresses S-IRA in DBA/1 mice, indicating that these receptors are involved in S-IRA. However, it remains unknown if other subtypes of 5-HT receptors are implicated in S-IRA in DBA/1 mice. In this study, we investigated the action of an agonist of the 5-HT1A (8-OH-DPAT), 5-HT2A (TCB-2), 5-HT2B (BW723C86), 5-HT2C (MK-212), 5-HT6 (WAY-208466) and 5-HT7 (LP-211) receptor on S-IRA in DBA/1 mice. An agonist of the 5-HT receptor or a vehicle was intraperitoneally administered 30 min prior to acoustic simulation, and the effect of each drug/vehicle on the incidence of S-IRA was videotaped for offline analysis. We found that the incidence of S-IRA was significantly reduced by TCB-2 at 10 mg/kg (30%, n = 10; p < 0.01, Fisher's exact test) but was not altered by other agonists compared with the corresponding vehicle controls in DBA/1 mice. Our data demonstrate that 5-HT2A receptors are implicated in S-IRA, and 5-HT1A, 5-HT2B, 5-HT2C, 5-HT6 and 5-HT7 receptors are not involved in S-IRA in DBA/1 mice.
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Affiliation(s)
- Yundan Pan
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Zheren Tan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jialing Guo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- National Health Commission Key Laboratory of Birth Defect Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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Petrucci AN, Jones AR, Kreitlow BL, Buchanan GF. Peri-ictal activation of dorsomedial dorsal raphe serotonin neurons reduces mortality associated with maximal electroshock seizures. Brain Commun 2024; 6:fcae052. [PMID: 38487550 PMCID: PMC10939444 DOI: 10.1093/braincomms/fcae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/13/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
Over one-third of patients with epilepsy will develop refractory epilepsy and continue to experience seizures despite medical treatment. These patients are at the greatest risk for sudden unexpected death in epilepsy. The precise mechanisms underlying sudden unexpected death in epilepsy are unknown, but cardiorespiratory dysfunction and arousal impairment have been implicated. Substantial circumstantial evidence suggests serotonin is relevant to sudden unexpected death in epilepsy as it modulates sleep/wake regulation, breathing and arousal. The dorsal raphe nucleus is a major serotonergic center and a component of the ascending arousal system. Seizures disrupt the firing of dorsal raphe neurons, which may contribute to reduced responsiveness. However, the relevance of the dorsal raphe nucleus and its subnuclei to sudden unexpected death in epilepsy remains unclear. The dorsomedial dorsal raphe may be a salient target due to its role in stress and its connections with structures implicated in sudden unexpected death in epilepsy. We hypothesized that optogenetic activation of dorsomedial dorsal raphe serotonin neurons in TPH2-ChR2-YFP (n = 26) mice and wild-type (n = 27) littermates before induction of a maximal electroshock seizure would reduce mortality. In this study, pre-seizure activation of dorsal raphe nucleus serotonin neurons reduced mortality in TPH2-ChR2-YFP mice with implants aimed at the dorsomedial dorsal raphe. These results implicate the dorsomedial dorsal raphe in this novel circuit influencing seizure-induced mortality. It is our hope that these results and future experiments will define circuit mechanisms that could ultimately reduce sudden unexpected death in epilepsy.
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Affiliation(s)
- Alexandra N Petrucci
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Allysa R Jones
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Benjamin L Kreitlow
- Interdisciplinary Graduate Program in Neuroscience, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Gordon F Buchanan
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Tsytsarev V, Sopova JV, Leonova EI, Inyushin M, Markina AA, Chirinskaite AV, Volnova AB. Neurophotonic methods in approach to in vivo animal epileptic models: Advantages and limitations. Epilepsia 2024; 65:600-614. [PMID: 38115808 PMCID: PMC10948300 DOI: 10.1111/epi.17870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023]
Abstract
Neurophotonic technology is a rapidly growing group of techniques that are based on the interactions of light with natural or genetically modified cells of the neural system. New optical technologies make it possible to considerably extend the tools of neurophysiological research, from the visualization of functional activity changes to control of brain tissue excitability. This opens new perspectives for studying the mechanisms underlying the development of human neurological diseases. Epilepsy is one of the most common brain disorders; it is characterized by recurrent seizures and affects >1% of the world's population. However, how seizures occur, spread, and terminate in a healthy brain is still unclear. Therefore, it is extremely important to develop appropriate models to accurately explore the causal relationship of epileptic activity. The use of neurophotonic technologies in epilepsy research falls into two broad categories: the visualization of neural epileptic activity, and the direct optical influence on neurons to induce or suppress epileptic activity. An optogenetic variant of the classical kindling model of epileptic seizures, in which activatable cells are genetically defined, is called optokindling. Research is also underway concerning the application of neurophotonic techniques for suppressing epileptic activity, aiming to bring these methods into clinical practice. This review aims to systematize and describe new approaches that use combinations of different neurophotonic methods to work with in vivo models of epilepsy. These approaches overcome many of the shortcomings associated with classical animal models of epilepsy and thus increase the effectiveness of developing new diagnostic methods and antiepileptic therapy.
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Affiliation(s)
- Vassiliy Tsytsarev
- University of Maryland School of Medicine, Department of Neurobiology 20 Penn St, HSF-2, 21201 MD, Baltimore, United States
| | - Julia V. Sopova
- Center of Transgenesis and Genome Editing, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Elena I. Leonova
- Center of Transgenesis and Genome Editing, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Mikhail Inyushin
- School of Medicine, Universidad Central del Caribe, Bayamon, PR 00956, USA
| | - Alisa A. Markina
- Institute of Translational Biomedicine, Saint Petersburg State University, St. Petersburg 199034, Russia
| | - Angelina V. Chirinskaite
- Center of Transgenesis and Genome Editing, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna B. Volnova
- Institute of Translational Biomedicine, Saint Petersburg State University, St. Petersburg 199034, Russia
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Misirocchi F, Vaudano AE, Florindo I, Zinno L, Zilioli A, Mannini E, Parrino L, Mutti C. Imaging biomarkers of sleep-related hypermotor epilepsy and sudden unexpected death in epilepsy: a review. Seizure 2024; 114:70-78. [PMID: 38088013 DOI: 10.1016/j.seizure.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024] Open
Abstract
In recent years, imaging has emerged as a promising source of several intriguing biomarkers in epilepsy, due to the impressive growth of imaging technology, supported by methodological advances and integrations of post-processing techniques. Bearing in mind the mutually influencing connection between sleep and epilepsy, we focused on sleep-related hypermotor epilepsy (SHE) and sudden unexpected death in epilepsy (SUDEP), aiming to make order and clarify possible clinical utility of emerging multimodal imaging biomarkers of these two epilepsy-related entities commonly occurring during sleep. Regarding SHE, advanced structural techniques might soon emerge as a promising source of diagnostic and predictive biomarkers, tailoring a targeted therapeutic (surgical) approach for MRI-negative subjects. Functional and metabolic imaging may instead unveil SHE's extensive and night-related altered brain networks, providing insights into distinctions and similarities with non-epileptic sleep phenomena, such as parasomnias. SUDEP is considered a storm that strikes without warning signals, but objective subtle structural and functional alterations in autonomic, cardiorespiratory, and arousal centers are present in patients eventually experiencing SUDEP. These alterations could be seen both as susceptibility and diagnostic biomarkers of the underlying pathological ongoing loop ultimately ending in death. Finally, given that SHE and SUDEP are rare phenomena, most evidence on the topic is derived from small single-center experiences with scarcely comparable results, hampering the possibility of performing any meta-analytic approach. Multicenter, longitudinal, well-designed studies are strongly encouraged.
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Affiliation(s)
| | - Anna Elisabetta Vaudano
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy; Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Florindo
- Neurology Unit, University Hospital of Parma, Parma, Italy
| | - Lucia Zinno
- Neurology Unit, University Hospital of Parma, Parma, Italy
| | | | - Elisa Mannini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Liborio Parrino
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Neurology Unit, University Hospital of Parma, Parma, Italy; Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy.
| | - Carlotta Mutti
- Neurology Unit, University Hospital of Parma, Parma, Italy; Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
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Brodovskaya A, Sun H, Adotevi N, Wenker IC, Mitchell KE, Clements RT, Kapur J. Neuronal plasticity contributes to postictal death. Prog Neurobiol 2023; 231:102531. [PMID: 37778436 PMCID: PMC10842614 DOI: 10.1016/j.pneurobio.2023.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/07/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Repeated generalized tonic-clonic seizures (GTCSs) are the most critical risk factor for sudden unexpected death in epilepsy (SUDEP). GTCSs can cause fatal apnea. We investigated neuronal plasticity mechanisms that precipitate postictal apnea and seizure-induced death. Repeated seizures worsened behavior, precipitated apnea, and enlarged active neuronal circuits, recruiting more neurons in such brainstem nuclei as periaqueductal gray (PAG) and dorsal raphe, indicative of brainstem plasticity. Seizure-activated neurons are more excitable and have enhanced AMPA-mediated excitatory transmission after a seizure. Global deletion of the GluA1 subunit of AMPA receptors abolishes postictal apnea and seizure-induced death. Treatment with a drug that blocks Ca2+-permeable AMPA receptors also renders mice apnea-free with five-fold better survival than untreated mice. Repeated seizures traffic the GluA1 subunit-containing AMPA receptors to synapses, and blocking this mechanism decreases the probability of postictal apnea and seizure-induced death.
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Affiliation(s)
| | - Huayu Sun
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Nadia Adotevi
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA
| | - Ian C Wenker
- Department of Anesthesiology, University of Virginia, Charlottesville, VA 22908, USA
| | - Keri E Mitchell
- Department of Chemistry, University of Virginia, Charlottesville, VA 22908, USA
| | - Rachel T Clements
- Department of Neuroscience, University of Virginia, Charlottesville, VA 22908, USA
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, VA 22908, USA; UVA Brain Institute, University of Virginia, Charlottesville, VA 22908, USA.
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7
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Teran FA, Sainju RK, Bravo E, Wagnon J, Kim Y, Granner A, Gehlbach BK, Richerson GB. Seizures Cause Prolonged Impairment of Ventilation, CO 2 Chemoreception and Thermoregulation. J Neurosci 2023; 43:4959-4971. [PMID: 37160367 PMCID: PMC10324997 DOI: 10.1523/jneurosci.0450-23.2023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) has been linked to respiratory dysfunction, but the mechanisms underlying this association remain unclear. Here we found that both focal and generalized convulsive seizures (GCSs) in epilepsy patients caused a prolonged decrease in the hypercapnic ventilatory response (HCVR; a measure of respiratory CO2 chemoreception). We then studied Scn1a R1407X/+ (Dravet syndrome; DS) and Scn8a N1768D/+ (D/+) mice of both sexes, two models of SUDEP, and found that convulsive seizures caused a postictal decrease in ventilation and severely depressed the HCVR in a subset of animals. Those mice with severe postictal depression of the HCVR also exhibited transient postictal hypothermia. A combination of blunted HCVR and abnormal thermoregulation is known to occur with dysfunction of the serotonin (5-hydroxytryptamine; 5-HT) system in mice. Depleting 5-HT with para-chlorophenylalanine (PCPA) mimicked seizure-induced hypoventilation, partially occluded the postictal decrease in the HCVR, exacerbated hypothermia, and increased postictal mortality in DS mice. Conversely, pretreatment with the 5-HT agonist fenfluramine reduced postictal inhibition of the HCVR and hypothermia. These results are consistent with the previous observation that seizures cause transient impairment of serotonergic neuron function, which would be expected to inhibit the many aspects of respiratory control dependent on 5-HT, including baseline ventilation and the HCVR. These results provide a scientific rationale to investigate the interictal and/or postictal HCVR as noninvasive biomarkers for those at high risk of seizure-induced death, and to prevent SUDEP by enhancing postictal 5-HT tone.SIGNIFICANCE STATEMENT There is increasing evidence that seizure-induced respiratory dysfunction contributes to the pathophysiology of sudden unexpected death in epilepsy (SUDEP). However, the cellular basis of this dysfunction has not been defined. Here, we show that seizures impair CO2 chemoreception in some epilepsy patients. In two mouse models of SUDEP we found that generalized convulsive seizures impaired CO2 chemoreception, and induced hypothermia, two effects reported with serotonergic neuron dysfunction. The defects in chemoreception and thermoregulation were exacerbated by chemical depletion of serotonin and reduced with fenfluramine, suggesting that seizure-induced respiratory dysfunction may be due to impairment of serotonin neuron function. These findings suggest that impaired chemoreception because of transient inhibition of serotonergic neurons may contribute to the pathophysiology of SUDEP.
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Affiliation(s)
- Frida A Teran
- Department of Neurology, University of Iowa, Iowa City, Iowa 52242
- Medical Scientist Training Program, University of Iowa, Iowa City, Iowa 52242
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa 52242
| | - Rup K Sainju
- Department of Neurology, University of Iowa, Iowa City, Iowa 52242
| | - Eduardo Bravo
- Department of Neurology, University of Iowa, Iowa City, Iowa 52242
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa 52242
| | - Jacy Wagnon
- Department of Neuroscience, The Ohio State University, Columbus, Ohio 43210
| | - YuJaung Kim
- Department of Neurology, University of Iowa, Iowa City, Iowa 52242
| | - Alex Granner
- Department of Neurology, University of Iowa, Iowa City, Iowa 52242
| | - Brian K Gehlbach
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242
| | - George B Richerson
- Department of Neurology, University of Iowa, Iowa City, Iowa 52242
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa 52242
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa 52242
- Neurology, Veterans Affairs Medical Center, Iowa City, Iowa 52242
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Celdrán JD, Humphreys L, González D, Soto-Sánchez C, Martínez-Navarrete G, Maldonado I, Gallego I, Villate-Beitia I, Sainz-Ramos M, Puras G, Pedraz JL, Fernández E. Assessment of Different Niosome Formulations for Optogenetic Applications: Morphological and Electrophysiological Effects. Pharmaceutics 2023; 15:1860. [PMID: 37514046 PMCID: PMC10384779 DOI: 10.3390/pharmaceutics15071860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Gene therapy and optogenetics are becoming promising tools for treating several nervous system pathologies. Currently, most of these approaches use viral vectors to transport the genetic material inside the cells, but viruses present some potential risks, such as marked immunogenicity, insertional mutagenesis, and limited insert gene size. In this framework, non-viral nanoparticles, such as niosomes, are emerging as possible alternative tools to deliver genetic material, avoiding the aforementioned problems. To determine their suitability as vectors for optogenetic therapies in this work, we tested three different niosome formulations combined with three optogenetic plasmids in rat cortical neurons in vitro. All niosomes tested successfully expressed optogenetic channels, which were dependent on the ratio of niosome to plasmid, with higher concentrations yielding higher expression rates. However, we found changes in the dendritic morphology and electrophysiological properties of transfected cells, especially when we used higher concentrations of niosomes. Our results highlight the potential use of niosomes for optogenetic applications and suggest that special care must be taken to achieve an optimal balance of niosomes and nucleic acids to achieve the therapeutic effects envisioned by these technologies.
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Affiliation(s)
- José David Celdrán
- Biomedical Neuroengineering, Institute of Bioengineering (IB), University Miguel Hernández (UMH), 03020 Elche, Spain
| | - Lawrence Humphreys
- Biomedical Neuroengineering, Institute of Bioengineering (IB), University Miguel Hernández (UMH), 03020 Elche, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
| | - Desirée González
- Biomedical Neuroengineering, Institute of Bioengineering (IB), University Miguel Hernández (UMH), 03020 Elche, Spain
| | - Cristina Soto-Sánchez
- Biomedical Neuroengineering, Institute of Bioengineering (IB), University Miguel Hernández (UMH), 03020 Elche, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
| | - Gema Martínez-Navarrete
- Biomedical Neuroengineering, Institute of Bioengineering (IB), University Miguel Hernández (UMH), 03020 Elche, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
| | - Iván Maldonado
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- Bioaraba, NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - Idoia Gallego
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- Bioaraba, NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - Ilia Villate-Beitia
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- Bioaraba, NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - Myriam Sainz-Ramos
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- Bioaraba, NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - Gustavo Puras
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- Bioaraba, NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - José Luis Pedraz
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- Bioaraba, NanoBioCel Group, School of Pharmacy, University of the Basque Country (UPV/EHU), 01006 Vitoria-Gasteiz, Spain
| | - Eduardo Fernández
- Biomedical Neuroengineering, Institute of Bioengineering (IB), University Miguel Hernández (UMH), 03020 Elche, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
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Faingold CL, Feng HJ. A unified hypothesis of SUDEP: Seizure-induced respiratory depression induced by adenosine may lead to SUDEP but can be prevented by autoresuscitation and other restorative respiratory response mechanisms mediated by the action of serotonin on the periaqueductal gray. Epilepsia 2023; 64:779-796. [PMID: 36715572 PMCID: PMC10673689 DOI: 10.1111/epi.17521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in people with epilepsy (PWE). Postictal apnea leading to cardiac arrest is the most common sequence of terminal events in witnessed cases of SUDEP, and postconvulsive central apnea has been proposed as a potential biomarker of SUDEP susceptibility. Research in SUDEP animal models has led to the serotonin and adenosine hypotheses of SUDEP. These neurotransmitters influence respiration, seizures, and lethality in animal models of SUDEP, and are implicated in human SUDEP cases. Adenosine released during seizures is proposed to be an important seizure termination mechanism. However, adenosine also depresses respiration, and this effect is mediated, in part, by inhibition of neuronal activity in subcortical structures that modulate respiration, including the periaqueductal gray (PAG). Drugs that enhance the action of adenosine increase postictal death in SUDEP models. Serotonin is also released during seizures, but enhances respiration in response to an elevated carbon dioxide level, which often occurs postictally. This effect of serotonin can potentially compensate, in part, for the adenosine-mediated respiratory depression, acting to facilitate autoresuscitation and other restorative respiratory response mechanisms. A number of drugs that enhance the action of serotonin prevent postictal death in several SUDEP models and reduce postictal respiratory depression in PWE. This effect of serotonergic drugs may be mediated, in part, by actions on brainstem sites that modulate respiration, including the PAG. Enhanced activity in the PAG increases respiration in response to hypoxia and other exigent conditions and can be activated by electrical stimulation. Thus, we propose the unifying hypothesis that seizure-induced adenosine release leads to respiratory depression. This can be reversed by serotonergic action on autoresuscitation and other restorative respiratory responses acting, in part, via the PAG. Therefore, we hypothesize that serotonergic or direct activation of this brainstem site may be a useful approach for SUDEP prevention.
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Affiliation(s)
- Carl L Faingold
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
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10
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Abstract
PURPOSE OF REVIEW Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death in patients with epilepsy. This review highlights the recent literature regarding epidemiology on a global scale, putative mechanisms and thoughts towards intervention and prevention. RECENT FINDINGS Recently, numerous population-based studies have examined the incidence of SUDEP in many countries. Remarkably, incidence is quite consistent across these studies, and is commensurate with the recent estimates of about 1.2 per 1000 patient years. These studies further continue to support that incidence is similar across the ages and that comparable factors portend heightened risk for SUDEP. Fervent research in patients and animal studies continues to hone the understanding of potential mechanisms for SUDEP, especially those regarding seizure-induced respiratory dysregulation. Many of these studies and others have begun to lay out a path towards identification of improved treatment and prevention means. However, continued efforts are needed to educate medical professionals about SUDEP risk and the need to disclose this to patients. SUMMARY SUDEP is a devastating potential outcome of epilepsy. More is continually learned about risk and mechanisms from clinical and preclinical studies. This knowledge can hopefully be leveraged into preventive measures in the near future.
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Affiliation(s)
- Gordon F Buchanan
- Department of Neurology
- Neuroscience Graduate Program
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ana T Novella Maciel
- Department of Neurology
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Universidad Nacional Autónoma de México, Mexico City, México
| | - Matthew J Summerfield
- Neuroscience Graduate Program
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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11
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Wang Y, Xu Q, Yu Q, Gu L, Ma H, Shen Y, Lian X, Shao W, Gu J, Liu L, Zhang H. Protocol for modulation of the serotonergic DR-PBC neural circuit to prevent SUDEP in the acoustic and PTZ-induced DBA/1 mouse models of SUDEP. STAR Protoc 2023; 4:102129. [PMID: 36861823 PMCID: PMC9975696 DOI: 10.1016/j.xpro.2023.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
The dorsal raphe nucleus (DR) and the pre-Bötzinger complex (PBC) may play an important role in regulating seizure-induced respiratory arrest (S-IRA), the main contributor to sudden unexpected death in epilepsy. Here, we describe pharmacological, optogenetic, and retrograde labeling approaches to specifically modulate the DR to PBC serotonergic pathway. We detail steps for implanting optical fibers and viral infusion into DR and PBC regions and optogenetic techniques for exploring the role of 5-hydroxytryptophan (5-HT) neural circuit of DR-PBC in S-IRA. For complete details on the use and execution of this protocol, please refer to Ma et al. (2022).1.
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Affiliation(s)
- YuLing Wang
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Qing Xu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Qian Yu
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - LeYuan Gu
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - HaiXiang Ma
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Yue Shen
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - XiTing Lian
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - WeiHui Shao
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - JiaXuan Gu
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China
| | - Lu Liu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - HongHai Zhang
- Department of Anesthesiology, the Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310006, China.
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12
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Sun X, Lv Y, Lin J. The mechanism of sudden unexpected death in epilepsy: A mini review. Front Neurol 2023; 14:1137182. [PMID: 36815002 PMCID: PMC9939452 DOI: 10.3389/fneur.2023.1137182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is defined as a sudden, unexpected, non-traumatic, non-drowning death in a person with epilepsy. SUDEP is generally considered to result from seizure-related cardiac dysfunction, respiratory depression, autonomic nervous dysfunction, or brain dysfunction. Frequency of generalized tonic clonic seizures (GTCS), prone posture, and refractory epilepsy are considered risk factors. SUDEP has also been associated with inherited cardiac ion channel disease and severe obstructive sleep apnea. Most previous studies of SUDEP mechanisms have focused on cardiac and respiratory dysfunction and imbalance of the neural regulatory system. Cardiac-related mechanisms include reduction in heart rate variability and prolongation of QT interval, which can lead to arrhythmias. Laryngospasm and amygdala activation may cause obstructive and central apnea, respectively. Neural mechanisms include impairment of 5-HT and adenosine neuromodulation. The research to date regarding molecular mechanisms of SUDEP is relatively limited. Most studies have focused on p-glycoprotein, catecholamines, potassium channels, and the renin-angiotensin system, all of which affect cardiac and respiratory function.
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Affiliation(s)
- Xinyi Sun
- School of Basic Medical Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yehui Lv
- School of Basic Medical Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China,Institute of Wound Prevention and Treatment, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Yehui Lv ✉
| | - Jian Lin
- Institute of Wound Prevention and Treatment, Shanghai University of Medicine and Health Sciences, Shanghai, China,Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
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13
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Acute and Repeated Administration of NLX-101, a Selective Serotonin-1A Receptor Biased Agonist, Reduces Audiogenic Seizures in Developing Fmr1 Knockout Mice. Neuroscience 2023; 509:113-124. [PMID: 36410632 DOI: 10.1016/j.neuroscience.2022.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022]
Abstract
Fragile XSyndrome (FXS) is a leading known genetic cause of Autism Spectrum Disorders (ASD) and intellectual disability. A consistent and debilitating phenotype of FXS is sensory hypersensitivity that manifests strongly in the auditory domain and may lead to delayed language and high anxiety. The mouse model of FXS, the Fmr1 KO mouse, also shows auditory hypersensitivity, an extreme form of which is seen as audiogenic seizures (AGS). The midbrain inferior colliculus (IC) is critically involved in generating audiogenic seizures and IC neurons are hyper-responsive to sounds in developing Fmr1 KO mice. Serotonin-1A receptor (5-HT1A) activation reduces IC activity. Therefore, we tested whether 5-HT1A activation is sufficient to reduce audiogenic seizures in Fmr1 KO mice. A selective and post-synaptic 5-HT1A receptor biased agonist, 3-Chloro-4-fluorophenyl-[4-fluoro-4-[[(5-methylpyrimidin-2-ylmethyl)amino]methyl]piperidin-1-yl] methanone (NLX-101, 0.6, 1.2, 1.8 or 2.4 mg/kg, i.p.) was administered to Fmr1 KO mice 15 min before seizure induction. Whereas the 0.6 mg/kg dose was ineffective in reducing seizures, the 1.2, 1.8 and 2.4 mg/kg doses of NLX-101 dramatically reduced seizures and increased mouse survival. Treatment with a combination of NLX-101 and 5-HT1A receptor antagonists prevented the protective effects of NLX-101, indicating that NLX-101 acts selectively through 5-HT1A receptors to reduce audiogenic seizures. NLX-101 (1.8 mg/kg) was still strongly effective in reducing seizures even after repeated administration over 5 days, suggesting an absence of tachyphylaxis to the effects of the compound. Together, these studies point to a promising treatment option targeting post-synaptic 5-HT1A receptors to reduce auditory hypersensitivity in FXS, and potentially across autism spectrum disorders.
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14
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Bauer J, Devinsky O, Rothermel M, Koch H. Autonomic dysfunction in epilepsy mouse models with implications for SUDEP research. Front Neurol 2023; 13:1040648. [PMID: 36686527 PMCID: PMC9853197 DOI: 10.3389/fneur.2022.1040648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Epilepsy has a high prevalence and can severely impair quality of life and increase the risk of premature death. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in drug-resistant epilepsy and most often results from respiratory and cardiac impairments due to brainstem dysfunction. Epileptic activity can spread widely, influencing neuronal activity in regions outside the epileptic network. The brainstem controls cardiorespiratory activity and arousal and reciprocally connects to cortical, diencephalic, and spinal cord areas. Epileptic activity can propagate trans-synaptically or via spreading depression (SD) to alter brainstem functions and cause cardiorespiratory dysfunction. The mechanisms by which seizures propagate to or otherwise impair brainstem function and trigger the cascading effects that cause SUDEP are poorly understood. We review insights from mouse models combined with new techniques to understand the pathophysiology of epilepsy and SUDEP. These techniques include in vivo, ex vivo, invasive and non-invasive methods in anesthetized and awake mice. Optogenetics combined with electrophysiological and optical manipulation and recording methods offer unique opportunities to study neuronal mechanisms under normal conditions, during and after non-fatal seizures, and in SUDEP. These combined approaches can advance our understanding of brainstem pathophysiology associated with seizures and SUDEP and may suggest strategies to prevent SUDEP.
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Affiliation(s)
- Jennifer Bauer
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany,Institute for Physiology and Cell Biology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Orrin Devinsky
- Departments of Neurology, Neurosurgery and Psychiatry, NYU Langone School of Medicine, New York, NY, United States
| | - Markus Rothermel
- Institute for Physiology and Cell Biology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Henner Koch
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany,*Correspondence: Henner Koch ✉
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15
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Zhu L, Chen D, Lin X, Liu L. Gene expression profile for different susceptibilities to sound stimulation: a comparative study on brainstems between two inbred laboratory mouse strains. BMC Genomics 2022; 23:783. [PMID: 36451107 PMCID: PMC9710100 DOI: 10.1186/s12864-022-09016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND DBA/1 mice have a higher susceptibility to generalized audiogenic seizures (AGSz) and seizure-induced respiratory arrest (S-IRA) than C57/BL6 mice. The gene expression profile might be potentially related to this difference. This study aimed to investigate the susceptibility difference in AGSz and S-IRA between DBA/1 and C57BL/6 mice by profiling long noncoding RNAs (lncRNAs) and mRNA expression. METHODS We compared lncRNAs and mRNAs from the brainstem of the two strains with Arraystar Mouse lncRNA Microarray V3.0 (Arraystar, Rockville, MD). Gene Ontology (GO) and pathway analyses were performed to determine the potentially related biological functions and pathways based on differentially expressed mRNAs. qRT-PCR was carried out to validate the results. RESULTS A total of 897 lncRNAs and 438 mRNAs were differentially expressed (fold change ≥2, P < 0.05), of which 192 lncRNAs were upregulated and 705 lncRNAs were downregulated. A total of 138 mRNAs were upregulated, and 300 mRNAs were downregulated. In terms of specific mRNAs, Htr5b, Gabra2, Hspa1b and Gfra1 may be related to AGSz or S-IRA. Additionally, lncRNA Neat1 may participate in the difference in susceptibility. GO and pathway analyses suggested that TGF-β signaling, metabolic process and MHC protein complex could be involved in these differences. Coexpression analysis identified 9 differentially expressed antisense lncRNAs and 115 long intergenic noncoding RNAs (lincRNAs), and 2010012P19Rik and its adjacent RNA Tnfsf12-Tnfsf13 may have participated in S-IRA by regulating sympathetic neuron function. The results of the qRT-PCR of five selected lncRNAs (AK038711, Gm11762, 1500004A13Rik, AA388235 and Neat1) and four selected mRNAs (Hspa1b, Htr5b, Gabra2 and Gfra1) were consistent with those obtained by microarray. CONCLUSION We concluded that TGF-β signaling and metabolic process may contribute to the differential sensitivity to AGSz and S-IRA. Among mRNAs, Htr5b, Gabra2, Hspa1b and Gfra1 could potentially influence the susceptibility. LncRNA Neat1 and 2010012P19Rik may also contribute to the different response to sound stimulation. Further studies should be carried out to explore the underlying functions and mechanisms of differentially expressed RNAs.
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Affiliation(s)
- Lina Zhu
- grid.412901.f0000 0004 1770 1022Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, Chengdu, 610041 Sichuan China
| | - Deng Chen
- grid.412901.f0000 0004 1770 1022Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, Chengdu, 610041 Sichuan China
| | - Xin Lin
- grid.412901.f0000 0004 1770 1022Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, Chengdu, 610041 Sichuan China
| | - Ling Liu
- grid.412901.f0000 0004 1770 1022Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, Chengdu, 610041 Sichuan China
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16
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Leitner DF, Devore S, Laze J, Friedman D, Mills JD, Liu Y, Janitz M, Anink JJ, Baayen JC, Idema S, van Vliet EA, Diehl B, Scott C, Thijs R, Nei M, Askenazi M, Sivathamboo S, O’Brien T, Wisniewski T, Thom M, Aronica E, Boldrini M, Devinsky O. Serotonin receptor expression in hippocampus and temporal cortex of temporal lobe epilepsy patients by postictal generalized electroencephalographic suppression duration. Epilepsia 2022; 63:2925-2936. [PMID: 36053862 PMCID: PMC9669210 DOI: 10.1111/epi.17400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Prolonged postictal generalized electroencephalographic suppression (PGES) is a potential biomarker for sudden unexpected death in epilepsy (SUDEP), which may be associated with dysfunctional autonomic responses and serotonin signaling. To better understand molecular mechanisms, PGES duration was correlated to 5HT1A and 5HT2A receptor protein expression and RNAseq from resected hippocampus and temporal cortex of temporal lobe epilepsy patients with seizures recorded in preoperative evaluation. METHODS Analyses included 36 cases (age = 14-64 years, age at epilepsy onset = 0-51 years, epilepsy duration = 2-53 years, PGES duration = 0-93 s), with 13 cases in all hippocampal analyses. 5HT1A and 5HT2A protein was evaluated by Western blot and histologically in hippocampus (n = 16) and temporal cortex (n = 9). We correlated PGES duration to our previous RNAseq dataset for serotonin receptor expression and signaling pathways, as well as weighted gene correlation network analysis (WGCNA) to identify correlated gene clusters. RESULTS In hippocampus, 5HT2A protein by Western blot positively correlated with PGES duration (p = .0024, R2 = .52), but 5HT1A did not (p = .87, R2 = .0020). In temporal cortex, 5HT1A and 5HT2A had lower expression and did not correlate with PGES duration. Histologically, PGES duration did not correlate with 5HT1A or 5HT2A expression in hippocampal CA4, dentate gyrus, or temporal cortex. RNAseq identified two serotonin receptors with expression that correlated with PGES duration in an exploratory analysis: HTR3B negatively correlated (p = .043, R2 = .26) and HTR4 positively correlated (p = .049, R2 = .25). WGCNA identified four modules correlated with PGES duration, including positive correlation with synaptic transcripts (p = .040, Pearson correlation r = .52), particularly potassium channels (KCNA4, KCNC4, KCNH1, KCNIP4, KCNJ3, KCNJ6, KCNK1). No modules were associated with serotonin receptor signaling. SIGNIFICANCE Higher hippocampal 5HT2A receptor protein and potassium channel transcripts may reflect underlying mechanisms contributing to or resulting from prolonged PGES. Future studies with larger cohorts should assess functional analyses and additional brain regions to elucidate mechanisms underlying PGES and SUDEP risk.
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Affiliation(s)
- Dominique F. Leitner
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Sasha Devore
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Juliana Laze
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - James D. Mills
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | - Yan Liu
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Michael Janitz
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasper J. Anink
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Johannes C. Baayen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Sander Idema
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Erwin A. van Vliet
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Roland Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Maromi Nei
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Manor Askenazi
- Biomedical Hosting LLC, Arlington, MA, USA
- Department of Biochemistry and Molecular Pharmacology, NYU Grossman School of Medicine, New York, NY, USA
| | - Shobi Sivathamboo
- Department of Neuroscience, Alfred Health, Central Clinical School, Melbourne, Victoria, Australia
- Department Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Terence O’Brien
- Department of Neuroscience, Alfred Health, Central Clinical School, Melbourne, Victoria, Australia
- Department Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Thomas Wisniewski
- Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, UK
| | - Eleonora Aronica
- Amsterdam UMC location University of Amsterdam, Department of (Neuro)pathology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Maura Boldrini
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
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17
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Cheng HM, Gao CS, Lou QW, Chen Z, Wang Y. The diverse role of the raphe 5-HTergic systems in epilepsy. Acta Pharmacol Sin 2022; 43:2777-2788. [PMID: 35614227 PMCID: PMC9622810 DOI: 10.1038/s41401-022-00918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
The raphe nuclei comprise nearly all of 5-hydroxytryptaminergic (5-HTergic) neurons in the brain and are widely acknowledged to participate in the modulation of neural excitability. "Excitability-inhibition imbalance" results in a variety of brain disorders, including epilepsy. Epilepsy is a common neurological disorder characterized by hypersynchronous epileptic seizures accompanied by many psychological, social, cognitive consequences. Current antiepileptic drugs and other therapeutics are not ideal to control epilepsy and its comorbidities. Cumulative evidence suggests that the raphe nuclei and 5-HTergic system play an important role in epilepsy and epilepsy-associated comorbidities. Seizure activities propagate to the raphe nuclei and induce various alterations in different subregions of the raphe nuclei at the cellular and molecular levels. Intervention of the activity of raphe nuclei and raphe 5-HTergic system with pharmacological or genetic approaches, deep brain stimulation or optogenetics produces indeed diverse and even contradictory effects on seizure and epilepsy-associated comorbidities in different epilepsy models. Nevertheless, there are still many open questions left, especially regarding to the relationship between 5-HTergic neural circuit and epilepsy. Understanding of 5-HTergic network in a circuit- and molecule-specific way may not only be therapeutically relevant for increasing the drug specificity and precise treatment in epilepsy, but also provide critical hints for other brain disorders with abnormal neural excitability. In this review we focus on the roles of the raphe 5-HTergic system in epilepsy and epilepsy-associated comorbidities. Besides, further perspectives about the complexity and diversity of the raphe nuclei in epilepsy are also addressed.
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Affiliation(s)
- He-Ming Cheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Chen-Shu Gao
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Qiu-Wen Lou
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
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18
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Leitner DF, Kanshin E, Askenazi M, Faustin A, Friedman D, Devore S, Ueberheide B, Wisniewski T, Devinsky O. Raphe and ventrolateral medulla proteomics in epilepsy and sudden unexpected death in epilepsy. Brain Commun 2022; 4:fcac186. [PMID: 35928051 PMCID: PMC9344977 DOI: 10.1093/braincomms/fcac186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/29/2022] [Accepted: 07/11/2022] [Indexed: 12/26/2022] Open
Abstract
Brainstem nuclei dysfunction is implicated in sudden unexpected death in epilepsy. In animal models, deficient serotonergic activity is associated with seizure-induced respiratory arrest. In humans, glia are decreased in the ventrolateral medullary pre-Botzinger complex that modulate respiratory rhythm, as well as in the medial medullary raphe that modulate respiration and arousal. Finally, sudden unexpected death in epilepsy cases have decreased midbrain volume. To understand the potential role of brainstem nuclei in sudden unexpected death in epilepsy, we evaluated molecular signalling pathways using localized proteomics in microdissected midbrain dorsal raphe and medial medullary raphe serotonergic nuclei, as well as the ventrolateral medulla in brain tissue from epilepsy patients who died of sudden unexpected death in epilepsy and other causes in diverse epilepsy syndromes and non-epilepsy control cases (n = 15-16 cases per group/region). Compared with the dorsal raphe of non-epilepsy controls, we identified 89 proteins in non-sudden unexpected death in epilepsy and 219 proteins in sudden unexpected death in epilepsy that were differentially expressed. These proteins were associated with inhibition of EIF2 signalling (P-value of overlap = 1.29 × 10-8, z = -2.00) in non-sudden unexpected death in epilepsy. In sudden unexpected death in epilepsy, there were 10 activated pathways (top pathway: gluconeogenesis I, P-value of overlap = 3.02 × 10-6, z = 2.24) and 1 inhibited pathway (fatty acid beta-oxidation, P-value of overlap = 2.69 × 10-4, z = -2.00). Comparing sudden unexpected death in epilepsy and non-sudden unexpected death in epilepsy, 10 proteins were differentially expressed, but there were no associated signalling pathways. In both medullary regions, few proteins showed significant differences in pairwise comparisons. We identified altered proteins in the raphe and ventrolateral medulla of epilepsy patients, including some differentially expressed in sudden unexpected death in epilepsy cases. Altered signalling pathways in the dorsal raphe of sudden unexpected death in epilepsy indicate a shift in cellular energy production and activation of G-protein signalling, inflammatory response, stress response and neuronal migration/outgrowth. Future studies should assess the brain proteome in relation to additional clinical variables (e.g. recent tonic-clonic seizures) and in more of the reciprocally connected cortical and subcortical regions to better understand the pathophysiology of epilepsy and sudden unexpected death in epilepsy.
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Affiliation(s)
- Dominique F Leitner
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Evgeny Kanshin
- Proteomics Laboratory, Division of Advanced Research Technologies, Grossman
School of Medicine, New York University, 223 East 34th
Street, New York, NY 10016, USA
| | - Manor Askenazi
- Biomedical Hosting LLC, Arlington, MA
02140, USA
- Department of Biochemistry and Molecular Pharmacology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
| | - Arline Faustin
- Center for Cognitive Neurology, Department of Neurology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
- Department of Pathology, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Daniel Friedman
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Sasha Devore
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Beatrix Ueberheide
- Proteomics Laboratory, Division of Advanced Research Technologies, Grossman
School of Medicine, New York University, 223 East 34th
Street, New York, NY 10016, USA
- Department of Biochemistry and Molecular Pharmacology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
- Center for Cognitive Neurology, Department of Neurology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
| | - Thomas Wisniewski
- Center for Cognitive Neurology, Department of Neurology, Grossman School of
Medicine, New York University, 223 East 34th Street, New
York, NY 10016, USA
- Department of Pathology, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
- Department of Psychiatry, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Grossman School of Medicine, New York
University, 223 East 34th Street, New York, NY
10016, USA
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Gu L, Yu Q, Shen Y, Wang Y, Xu Q, Zhang H. The role of monoaminergic neurons in modulating respiration during sleep and the connection with SUDEP. Biomed Pharmacother 2022; 150:112983. [PMID: 35453009 DOI: 10.1016/j.biopha.2022.112983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death among epilepsy patients, occurring even more frequently in cases with anti-epileptic drug resistance. Despite some advancements in characterizing SUDEP, the underlying mechanism remains incompletely understood. This review summarizes the latest advances in our understanding of the pathogenic mechanisms of SUDEP, in order to identify possible targets for the development of new strategies to prevent SUDEP. Based on our previous research along with the current literature, we focus on the role of sleep-disordered breathing (SDB) and its related neural mechanisms to consider the possible roles of monoaminergic neurons in the modulation of respiration during sleep and the occurrence of SUDEP. Overall, this review suggests that targeting the monoaminergic neurons is a promising approach to preventing SUDEP. The proposed roles of SDB and related monoaminergic neural mechanisms in SUDEP provide new insights for explaining the pathogenesis of SUDEP.
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Affiliation(s)
- LeYuan Gu
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Qian Yu
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yue Shen
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - YuLing Wang
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Qing Xu
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - HongHai Zhang
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou 310006, China; Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China; Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310006, China.
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20
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Xia M, Owen B, Chiang J, Levitt A, Preisinger K, Yan WW, Huffman R, Nobis WP. Disruption of Synaptic Transmission in the Bed Nucleus of the Stria Terminalis Reduces Seizure-Induced Death in DBA/1 Mice and Alters Brainstem E/I Balance. ASN Neuro 2022; 14:17590914221103188. [PMID: 35611439 PMCID: PMC9136462 DOI: 10.1177/17590914221103188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in refractory epilepsy patients. Accumulating evidence from recent human studies and animal models suggests that seizure-related respiratory arrest may be important for initiating cardiorespiratory arrest and death. Prior evidence suggests that apnea onset can coincide with seizure spread to the amygdala and that stimulation of the amygdala can reliably induce apneas in epilepsy patients, potentially implicating amygdalar regions in seizure-related respiratory arrest and subsequent postictal hypoventilation and cardiorespiratory death. This study aimed to determine if an extended amygdalar structure, the dorsal bed nucleus of the stria terminalis (dBNST), is involved in seizure-induced respiratory arrest (S-IRA) and death using DBA/1 mice, a mouse strain which has audiogenic seizures (AGS) and a high incidence of postictal respiratory arrest and death. The presence of S-IRA significantly increased c-Fos expression in the dBNST of DBA/1 mice. Furthermore, disruption of synaptic output from the dBNST via viral-induced tetanus neurotoxin (TeNT) significantly improved survival following S-IRA in DBA/1 mice without affecting baseline breathing or hypercapnic (HCVR) and hypoxic ventilatory response (HVR). This disruption in the dBNST resulted in changes to the balance of excitatory/inhibitory (E/I) synaptic events in the downstream brainstem regions of the lateral parabrachial nucleus (PBN) and the periaqueductal gray (PAG). These findings suggest that the dBNST is a potential subcortical forebrain site necessary for the mediation of S-IRA, potentially through its outputs to brainstem respiratory regions.
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Affiliation(s)
| | | | | | | | | | | | | | - William P. Nobis
- Department of Neurology, Vanderbilt University Medical Center, 6130A MRB 3/Bio Sci Building, 465 21st Ave S, Nashville, TN 37235, USA.
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21
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Teran FA, Bravo E, Richerson GB. Sudden unexpected death in epilepsy: Respiratory mechanisms. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:153-176. [PMID: 36031303 PMCID: PMC10191258 DOI: 10.1016/b978-0-323-91532-8.00012-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Epilepsy is one of the most common chronic neurologic diseases, with a prevalence of 1% in the US population. Many people with epilepsy live normal lives, but are at risk of sudden unexpected death in epilepsy (SUDEP). This mysterious comorbidity of epilepsy causes premature death in 17%-50% of those with epilepsy. Most SUDEP occurs after a generalized seizure, and patients are typically found in bed in the prone position. Until recently, it was thought that SUDEP was due to cardiovascular failure, but patients who died while being monitored in hospital epilepsy units revealed that most SUDEP is due to postictal central apnea. Some cases may occur when seizures invade the amygdala and activate projections to the brainstem. Evidence suggests that the pathophysiology is linked to defects in the serotonin system and central CO2 chemoreception, and that there is considerable overlap with mechanisms thought to be involved in sudden infant death syndrome (SIDS). Future work is needed to identify biomarkers for patients at highest risk, improve ascertainment, develop methods to alert caregivers when SUDEP is imminent, and find effective approaches to prevent these fatal events.
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Affiliation(s)
- Frida A Teran
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Medical Scientist Training Program, University of Iowa, Iowa City, IA, United States.
| | - Eduardo Bravo
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - George B Richerson
- Department of Neurology, University of Iowa, Iowa City, IA, United States; Department of Molecular Physiology & Biophysics, University of Iowa, Iowa City, IA, United States
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22
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Gu B, Levine NG, Xu W, Lynch RM, Pardo-Manuel de Villena F, Philpot BD. OUP accepted manuscript. Brain Commun 2022; 4:fcac073. [PMID: 35474855 PMCID: PMC9035525 DOI: 10.1093/braincomms/fcac073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/19/2022] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
Sudden unexpected death in epilepsy is the most catastrophic outcome of epilepsy. Each year there are as many as 1.65 cases of such death for every 1000 individuals with epilepsy. Currently, there are no methods to predict or prevent this tragic event, due in part to a poor understanding of the pathologic cascade that leads to death following seizures. We recently identified enhanced seizure-induced mortality in four inbred strains from the genetically diverse Collaborative Cross mouse population. These mouse models of sudden unexpected death in epilepsy provide a unique tool to systematically examine the physiological alterations during fatal seizures, which can be studied in a controlled environment and with consideration of genetic complexity. Here, we monitored the brain oscillations and heart functions before, during, and after non-fatal and fatal seizures using a flurothyl-induced seizure model in freely moving mice. Compared with mice that survived seizures, non-survivors exhibited significant suppression of brainstem neural oscillations that coincided with cortical epileptic activities and tachycardia during the ictal phase of a fatal seizure. Non-survivors also exhibited suppressed delta (0.5–4 Hz)/gamma (30–200 Hz) phase-amplitude coupling in cortex but not in brainstem. A connectivity analysis revealed elevated synchronization of cortex and brainstem oscillations in the delta band during fatal seizures compared with non-fatal seizures. The dynamic ictal oscillatory and connectivity features of fatal seizures provide insights into sudden unexpected death in epilepsy and may suggest biomarkers and eventual therapeutic targets.
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Affiliation(s)
- Bin Gu
- Department of Neuroscience, Ohio State University, Columbus, OH, USA
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA
- Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
- Correspondence to: Bin Gu, PhD 460 W 12th Avenue, 612 Biomedical Research Tower Columbus, OH 43210, USA E-mail:
| | - Noah G. Levine
- Electrical and Computer Engineering Program, Ohio State University, Columbus, OH, USA
| | - Wenjing Xu
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Physiology and Cell Biology, Ohio State University, Columbus, OH, USA
| | - Rachel M. Lynch
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Fernando Pardo-Manuel de Villena
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Benjamin D. Philpot
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA
- Neuroscience Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
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23
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Yue Q, Cai M, Xiao B, Zhan Q, Zeng C. A High-Tryptophan Diet Reduces Seizure-Induced Respiratory Arrest and Alters the Gut Microbiota in DBA/1 Mice. Front Neurol 2021; 12:762323. [PMID: 34887831 PMCID: PMC8650499 DOI: 10.3389/fneur.2021.762323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background and Aims: Central 5-hydroxytryptamine (5-HT) defects are responsible for the occurrence of sudden unexpected death in epilepsy (SUDEP). The DBA/1 mouse is an animal model of SUDEP since the mouse exhibits audiogenic seizure-induced respiratory arrest (S-IRA). The synthesis of central 5-HT is closely related to the gut microbiota. Moreover, emerging studies suggest a possible role for the microbiota in mitigating seizure likelihood. Based on this, we aimed to explore the effect of a high-tryptophan diet (HTD) on SUDEP as well as the synthesis and metabolism of central 5-HT. Furthermore, we investigated the involvement of the gut microbiota in this process. Methods: All DBA/1 mice were subjected to acoustic stimulation to induce seizures. Only those mice that exhibited S-IRA were randomly assigned to the normal diet (ND) group (n = 39) or HTD group (n = 53). After 1 month of dietary intervention, (1) S-IRA rates were evaluated, (2) the concentrations of 5-HT and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the plasma and brain were determined by ultra-high-pressure liquid chromatography, and (3) the fecal flora biodiversity and species composition were analyzed by 16S rDNA microbiota profiling. Results: The S-IRA rate in DBA/1 mice was significantly reduced in the HTD group compared with that in the control group. HTD increased the levels of 5-HT and 5-HIAA in both the telencephalon and midbrain. HTD significantly elevated the species richness and diversity of the gut microbiota. Moreover, there was a significant difference in the gut microbiota composition between the two groups, and the intestinal flora was dominated by Proteobacteria and Actinobacteria after HTD. Conclusions: HTD is efficient in lowering S-IRA rates and elevating the central 5-HT level in DBA/1 mice. The gut microbiota was altered after HTD intervention. The significant increase in Proteobacteria and Actinobacteria may be related to the SUDEP-protective effect of HTD. Our findings shed light on a candidate choice of dietary prevention for SUDEP.
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Affiliation(s)
- Qiang Yue
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Mingfei Cai
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiong Zhan
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chang Zeng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
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24
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Guo J, Min D, Feng HJ. Genistein, a Natural Isoflavone, Alleviates Seizure-Induced Respiratory Arrest in DBA/1 Mice. Front Neurol 2021; 12:761912. [PMID: 34803895 PMCID: PMC8599950 DOI: 10.3389/fneur.2021.761912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Sudden unexpected death in epilepsy (SUDEP) is a fatal event that ranks second in years of potential life lost among neurological disorders. Seizure-induced respiratory arrest (S-IRA) is the primary instigator leading to death in many SUDEP cases. However, there are currently no effective preventive strategies against S-IRA other than the seizure control. Therefore, it is critical to develop new avenues to prevent SUDEP by investigating the pharmacological interventions of S-IRA. In the present study, we examined the effect of genistein, an isoflavone found in various dietary vegetables, on the incidence of S-IRA in DBA/1 mice. Methods: DBA/1 mice exhibited generalized seizures and S-IRA when subjected to acoustic stimulation. Genistein was intraperitoneally administered alone or in combination with an adrenoceptor antagonist and a serotonin (5-HT) receptor antagonist, respectively. The effects of drug treatments on S-IRA incidence and seizure behaviors were examined. Results: The incidence of S-IRA in DBA/1 mice was significantly reduced 2 h after injection of genistein at 1–90 mg/kg as compared with that in the vehicle control. Genistein could block S-IRA without interfering with any component of seizures, especially at relatively lower dosages. The S-IRA-suppressing effect of genistein was reversed by an α2 adrenoceptor antagonist but was not altered by an α1 antagonist. The inhibitory effect of genistein on S-IRA was not affected by a 5-HT3 or 5-HT2A receptor antagonist. Significance: Our data show that genistein reduces S-IRA incidence and can specifically block S-IRA in DBA/1 mice. Its suppressing effect on S-IRA is dependent on activating α2 adrenoceptors. Our study suggests that genistein, a dietary supplement, is potentially useful to prevent SUDEP in at-risk patients.
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Affiliation(s)
- Jialing Guo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Anesthesia, Harvard Medical School, Boston, MA, United States
| | - Daniel Min
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Anesthesia, Harvard Medical School, Boston, MA, United States
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25
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Wang Y, Huang Y, Bai H, Wang G, Hu X, Kumar S, Min R. Biocompatible and Biodegradable Polymer Optical Fiber for Biomedical Application: A Review. BIOSENSORS 2021; 11:472. [PMID: 34940229 PMCID: PMC8699361 DOI: 10.3390/bios11120472] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/20/2021] [Accepted: 11/20/2021] [Indexed: 05/09/2023]
Abstract
This article discusses recent advances in biocompatible and biodegradable polymer optical fiber (POF) for medical applications. First, the POF material and its optical properties are summarized. Then, several common optical fiber fabrication methods are thoroughly discussed. Following that, clinical applications of biocompatible and biodegradable POFs are discussed, including optogenetics, biosensing, drug delivery, and neural recording. Following that, biomedical applications expanded the specific functionalization of the material or fiber design. Different research or clinical applications necessitate the use of different equipment to achieve the desired results. Finally, the difficulty of implanting flexible fiber varies with its flexibility. We present our article in a clear and logical manner that will be useful to researchers seeking a broad perspective on the proposed topic. Overall, the content provides a comprehensive overview of biocompatible and biodegradable POFs, including previous breakthroughs, as well as recent advancements. Biodegradable optical fibers have numerous applications, opening up new avenues in biomedicine.
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Affiliation(s)
- Yue Wang
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai 519087, China; (Y.W.); (Y.H.)
| | - Yu Huang
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai 519087, China; (Y.W.); (Y.H.)
| | - Hongyi Bai
- College of Electronic Engineering, Heilongjiang University, Harbin 150080, China;
| | - Guoqing Wang
- College of Microelectronics, Shenzhen Institute of Information Technology, Shenzhen 518172, China;
| | - Xuehao Hu
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou 515063, China;
| | - Santosh Kumar
- Shandong Key Laboratory of Optical Communication Science and Technology, School of Physics Science and Information Technology, Liaocheng University, Liaocheng 252059, China;
| | - Rui Min
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University at Zhuhai, Zhuhai 519087, China; (Y.W.); (Y.H.)
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26
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Zhang R, Tan Z, Niu J, Feng HJ. Adrenergic α2 receptors are implicated in seizure-induced respiratory arrest in DBA/1 mice. Life Sci 2021; 284:119912. [PMID: 34461082 PMCID: PMC8484063 DOI: 10.1016/j.lfs.2021.119912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
AIMS Sudden unexpected death in epilepsy (SUDEP) is a serious and underestimated public health burden. Both clinical and animal studies show that seizure-induced respiratory arrest (S-IRA) is the primary cause of death in SUDEP. Our previous studies demonstrated that atomoxetine, a norepinephrine reuptake inhibitor (NRI), suppresses S-IRA in DBA/1 mice, suggesting that noradrenergic neurotransmission modulates S-IRA. However, it remains unclear which adrenoceptors are implicated in S-IRA in DBA/1 mice. MATERIALS AND METHODS Naïve DBA/1 mice exhibit a low incidence of S-IRA, but after primed by acoustic stimulation, they become consistently susceptible to S-IRA. Atomoxetine, adrenoceptor agonists, antagonists or vehicle was intraperitoneally (i.p.) administered alone or in combination, and the effects of drug treatments on S-IRA incidence and seizure behaviors were examined. KEY FINDINGS The incidence of S-IRA in primed DBA/1 mice was significantly reduced by clonidine, an α2 adrenoceptor agonist, as compared with that of the vehicle control. However, compared with the vehicle control, S-IRA was not altered by cirazoline, an α1 agonist. Consistent with previous reports, atomoxetine reduced S-IRA in primed DBA/1 mice. The suppressing effect of atomoxetine on S-IRA was prevented by injection of an α2 adrenoceptor antagonist, yohimbine or atipamezole, but not by prazosin, an α1 antagonist. Administration of α1 or α2 antagonists alone did not promote the incidence of S-IRA in nonprimed DBA/1 mice. SIGNIFICANCE These data demonstrate that noradrenergic neurotransmission modulates S-IRA predominantly via α2 adrenoceptors in DBA/1 mice, indicating that selective activation of α2 adrenoceptors can potentially prevent SUDEP.
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Affiliation(s)
- Rui Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Ningxia Key Laboratory of Cerebrocranial Diseases, Ningxia Medical University, Yinchuan 750004, China
| | - Zheren Tan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jianguo Niu
- Ningxia Key Laboratory of Cerebrocranial Diseases, Ningxia Medical University, Yinchuan 750004, China
| | - Hua-Jun Feng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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27
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Tupal S, Faingold CL. Serotonin 5-HT 4 receptors play a critical role in the action of fenfluramine to block seizure-induced sudden death in a mouse model of SUDEP. Epilepsy Res 2021; 177:106777. [PMID: 34601387 DOI: 10.1016/j.eplepsyres.2021.106777] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/25/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Our previous study showed that the recently approved anticonvulsant drug, fenfluramine, which enhances the release of serotonin (5-hydroxytryptamine, 5-HT) in the brain, prevents seizure-induced respiratory arrest (S-IRA) in the DBA/1 mouse model of sudden unexpected death in epilepsy (SUDEP). The present study examined the role of 5-HT receptor subtypes in mediating the effect of this agent by combined administration of fenfluramine with selective 5-HT receptor antagonists prior to seizure in DBA/1 mice. METHODS Fenfluramine (15 mg/kg, i.p.) was administered to primed DBA/1 mice, and audiogenic seizure (Sz) was induced 16 h later. Thirty min prior to Sz induction a selective antagonist acting on 5-HT1A, 5-HT2, 5-HT3 5-HT4, 5-HT5A, 5-HT6 or 5-HT7 receptors at a sub-toxic dose was administered, and changes in seizure-induced behaviors were evaluated. Follow-up studies examined the effect of administration of a 5-HT4 receptor agonist, BIMU 8, as well as the effect of co-administration of ineffective doses of fenfluramine and BIMU-8 on Sz behaviors. RESULTS The 5-HT4 antagonist (GR125487) was the only 5-HT receptor antagonist that was able to reverse the action of fenfluramine to block Sz and S-IRA. Treatment with the 5-HT4 receptor agonist (BIMU-8), or co-administration of ineffective doses of BIMU-8 and fenfluramine significantly reduced the incidence of S-IRA and tonic Sz in DBA/1 mice. The antagonists for 5-HT3, 5-HT5A 5-HT6, and 5-HT7 receptors did not significantly affect the action of fenfluramine. However, the 5-HT1A and the 5-HT2 antagonists enhanced the anticonvulsant effects of fenfluramine. CONCLUSIONS These findings suggest that the action of fenfluramine to prevent seizure-induced sudden death in DBA/1 mice is mediated primarily by activation of 5-HT4 receptors. These studies are the first to indicate the therapeutic potential of 5-HT4 receptor agonists either alone or in combination with fenfluramine for preventing SUDEP. Enhancement of the anticonvulsant effect of fenfluramine by 5-HT1A and 5-HT2 antagonists may involve presynaptic actions of these antagonists. Thus, the Sz and S-IRA blocking actions of fenfluramine involve complex interactions with several 5-HT receptor subtypes. These data also provide further support for the serotonin hypothesis of SUDEP.
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Affiliation(s)
- Srinivasan Tupal
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Carl L Faingold
- Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, USA.
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28
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Leitner DF, Faustin A, Verducci C, Friedman D, William C, Devore S, Wisniewski T, Devinsky O. Neuropathology in the North American sudden unexpected death in epilepsy registry. Brain Commun 2021; 3:fcab192. [PMID: 34514397 PMCID: PMC8417454 DOI: 10.1093/braincomms/fcab192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
Sudden unexpected death in epilepsy is the leading category of epilepsy-related death and the underlying mechanisms are incompletely understood. Risk factors can include a recent history and high frequency of generalized tonic-clonic seizures, which can depress brain activity postictally, impairing respiration, arousal and protective reflexes. Neuropathological findings in sudden unexpected death in epilepsy cases parallel those in other epilepsy patients, with no implication of novel structures or mechanisms in seizure-related deaths. Few large studies have comprehensively reviewed whole brain examination of such patients. We evaluated 92 North American Sudden unexpected death in epilepsy Registry cases with whole brain neuropathological examination by board-certified neuropathologists blinded to the adjudicated cause of death, with an average of 16 brain regions examined per case. The 92 cases included 61 sudden unexpected death in epilepsy (40 definite, 9 definite plus, 6 probable, 6 possible) and 31 people with epilepsy controls who died from other causes. The mean age at death was 34.4 years and 65.2% (60/92) were male. The average age of death was younger for sudden unexpected death in epilepsy cases than for epilepsy controls (30.0 versus 39.6 years; P = 0.006), and there was no difference in sex distribution respectively (67.3% male versus 64.5%, P = 0.8). Among sudden unexpected death in epilepsy cases, earlier age of epilepsy onset positively correlated with a younger age at death (P = 0.0005) and negatively correlated with epilepsy duration (P = 0.001). Neuropathological findings were identified in 83.7% of the cases in our cohort. The most common findings were dentate gyrus dysgenesis (sudden unexpected death in epilepsy 50.9%, epilepsy controls 54.8%) and focal cortical dysplasia (FCD) (sudden unexpected death in epilepsy 41.8%, epilepsy controls 29.0%). The neuropathological findings in sudden unexpected death in epilepsy paralleled those in epilepsy controls, including the frequency of total neuropathological findings as well as the specific findings in the dentate gyrus, findings pertaining to neurodevelopment (e.g. FCD, heterotopias) and findings in the brainstem (e.g. medullary arcuate or olivary dysgenesis). Thus, like prior studies, we found no neuropathological findings that were more common in sudden unexpected death in epilepsy cases. Future neuropathological studies evaluating larger sudden unexpected death in epilepsy and control cohorts would benefit from inclusion of different epilepsy syndromes with detailed phenotypic information, consensus among pathologists particularly for more subjective findings where observations can be inconsistent, and molecular approaches to identify markers of sudden unexpected death in epilepsy risk or pathogenesis.
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Affiliation(s)
- Dominique F Leitner
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Arline Faustin
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Chloe Verducci
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Friedman
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Christopher William
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
- Department of Pathology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Sasha Devore
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
- Center for Cognitive Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
- Department of Pathology, NYU Langone Health and School of Medicine, New York, NY, USA
- Department of Psychiatry, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurology, NYU Langone Health and School of Medicine, New York, NY, USA
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Chen D, Zhu L, Lin X, Zhou D, Liu L. Dysregulated long noncoding RNAs in the brainstem of the DBA/1 mouse model of SUDEP. BMC Genomics 2021; 22:621. [PMID: 34404356 PMCID: PMC8369804 DOI: 10.1186/s12864-021-07921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/03/2021] [Indexed: 02/08/2023] Open
Abstract
Background Long noncoding RNAs (lncRNAs) play an important role in many neurological diseases. This study aimed to investigate differentially expressed lncRNAs and messenger RNAs (mRNAs) in the susceptibility gaining process of primed DBA/1 mice, a sudden unexpected death in epilepsy (SUDEP) model, to illustrate the potential role of lncRNAs in SUDEP. Methods The Arraystar mouse lncRNA Microarray V3.0 (Arraystar, Rockville, MD) was applied to identify the aberrantly expressed lncRNAs and mRNAs between primed DBA/1 mice and normal controls. The differences were verified by qRT-PCR. We conducted gene ontology (GO), the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and coexpression analyses to explore the possible function of the dysregulated RNAs. Results A total of 502 lncRNAs (126 upregulated and 376 downregulated lncRNAs) and 263 mRNAs (141 upregulated and 122 downregulated mRNAs) were dysregulated with P < 0.05 and a fold change over 1.5, among which Adora3 and Gstt4 were possibly related to SUDEP. GO analysis revealed that chaperone cofactor-dependent protein refolding and misfolded protein binding were among the top ten downregulated terms, which pointed to Hspa1a, Hspa2a and their related lncRNAs. KEGG analysis identified 28 upregulated and 10 downregulated pathways. Coexpression analysis showed fifteen dysregulated long intergenic noncoding RNAs (lincRNAs) and three aberrantly expressed antisense lncRNAs, of which AK012034 and NR_040757 are potentially related to SUDEP by regulating LMNB2 and ITPR1, respectively. Conclusions LncRNAs and their coexpression mRNAs are dysregulated in the priming process of DBA/1 in the brainstem. Some of these mRNAs and lncRNAs may be related to SUDEP, including Adora3, Lmnb2, Hspa1a, Hspa1b, Itrp1, Gstt4 and their related lncRNAs. Further study on the mechanism of lncRNAs in SUDEP is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12864-021-07921-7.
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Affiliation(s)
- Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, 610041, Chengdu, Sichuan, China
| | - Lina Zhu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, 610041, Chengdu, Sichuan, China
| | - Xin Lin
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, 610041, Chengdu, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, 610041, Chengdu, Sichuan, China.
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37 #, 610041, Chengdu, Sichuan, China.
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Marincovich A, Bravo E, Dlouhy B, Richerson GB. Amygdala lesions reduce seizure-induced respiratory arrest in DBA/1 mice. Epilepsy Behav 2021; 121:106440. [PMID: 31399338 PMCID: PMC7474464 DOI: 10.1016/j.yebeh.2019.07.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/06/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in patients with refractory epilepsy. Human studies and animal models suggest that respiratory arrest is the initiating event leading to death in many cases of SUDEP. It has previously been reported that the onset of apnea can coincide with the spread of seizures to the amygdala, and apnea can be reproduced by electrical stimulation of the amygdala. The aim of the current work was to determine if the amygdala is required for seizure-induced respiratory arrest (S-IRA) in a mouse model of SUDEP. Experiments were performed on DBA/1 mice that have audiogenic seizures with a high incidence of fatal postictal respiratory arrest. Electrolytic lesions of the amygdala significantly reduced the incidence of S-IRA without altering seizures, baseline breathing, or the hypercapnic ventilatory response. These results indicate that the amygdala is a critical node in a pathway to the lower brainstem that is needed for seizures to cause respiratory arrest. SIGNIFICANCE STATEMENT: Sudden unexpected death in epilepsy is the most common cause of mortality in patients with refractory epilepsy, and S-IRA is thought to be important in the pathophysiology in many cases. In a patient with epilepsy, the onset of apnea has been shown to coincide with spread of seizures to the amygdala, and in multiple patients, apnea was induced by stimulation of the amygdala. Here, we show that lesions of the amygdala reduced the incidence of S-IRA and death in a mouse model of SUDEP. These results provide evidence that the amygdala may be a critical node in the pathway by which seizures influence the brainstem respiratory network to cause apnea. This article is part of the Special Issue NEWroscience 2018.
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Affiliation(s)
| | - Eduardo Bravo
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - Brian Dlouhy
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA
| | - George B. Richerson
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA,Department of Molecular Physiology & Biophysics, University of Iowa, Iowa City, IA 52242, USA,Neurology Service, Veterans Affairs Medical Center, Iowa City, IA 52242, USA
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31
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Purnell B, Murugan M, Jani R, Boison D. The Good, the Bad, and the Deadly: Adenosinergic Mechanisms Underlying Sudden Unexpected Death in Epilepsy. Front Neurosci 2021; 15:708304. [PMID: 34321997 PMCID: PMC8311182 DOI: 10.3389/fnins.2021.708304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
Adenosine is an inhibitory modulator of neuronal excitability. Neuronal activity results in increased adenosine release, thereby constraining excessive excitation. The exceptionally high neuronal activity of a seizure results in a surge in extracellular adenosine to concentrations many-fold higher than would be observed under normal conditions. In this review, we discuss the multifarious effects of adenosine signaling in the context of epilepsy, with emphasis on sudden unexpected death in epilepsy (SUDEP). We describe and categorize the beneficial, detrimental, and potentially deadly aspects of adenosine signaling. The good or beneficial characteristics of adenosine signaling in the context of seizures include: (1) its direct effect on seizure termination and the prevention of status epilepticus; (2) the vasodilatory effect of adenosine, potentially counteracting postictal vasoconstriction; (3) its neuroprotective effects under hypoxic conditions; and (4) its disease modifying antiepileptogenic effect. The bad or detrimental effects of adenosine signaling include: (1) its capacity to suppress breathing and contribute to peri-ictal respiratory dysfunction; (2) its contribution to postictal generalized EEG suppression (PGES); (3) the prolonged increase in extracellular adenosine following spreading depolarization waves may contribute to postictal neuronal dysfunction; (4) the excitatory effects of A2A receptor activation is thought to exacerbate seizures in some instances; and (5) its potential contributions to sleep alterations in epilepsy. Finally, the adverse effects of adenosine signaling may potentiate a deadly outcome in the form of SUDEP by suppressing breathing and arousal in the postictal period. Evidence from animal models suggests that excessive postictal adenosine signaling contributes to the pathophysiology of SUDEP. The goal of this review is to discuss the beneficial, harmful, and potentially deadly roles that adenosine plays in the context of epilepsy and to identify crucial gaps in knowledge where further investigation is necessary. By better understanding adenosine dynamics, we may gain insights into the treatment of epilepsy and the prevention of SUDEP.
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Affiliation(s)
- Benton Purnell
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Madhuvika Murugan
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Raja Jani
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Detlev Boison
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
- Rutgers Neurosurgery H.O.P.E. Center, Department of Neurosurgery, Rutgers University, New Brunswick, NJ, United States
- Brain Health Institute, Rutgers University, Piscataway, NJ, United States
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Massey CA, Thompson SJ, Ostrom RW, Drabek J, Sveinsson OA, Tomson T, Haas EA, Mena OJ, Goldman AM, Noebels JL. X-linked serotonin 2C receptor is associated with a non-canonical pathway for sudden unexpected death in epilepsy. Brain Commun 2021; 3:fcab149. [PMID: 34396109 PMCID: PMC8361391 DOI: 10.1093/braincomms/fcab149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
Sudden Unexpected Death in Epilepsy is a leading cause of epilepsy-related mortality, and the analysis of mouse Sudden Unexpected Death in Epilepsy models is steadily revealing a spectrum of inherited risk phenotypes based on distinct genetic mechanisms. Serotonin (5-HT) signalling enhances post-ictal cardiorespiratory drive and, when elevated in the brain, reduces death following evoked audiogenic brainstem seizures in inbred mouse models. However, no gene in this pathway has yet been linked to a spontaneous epilepsy phenotype, the defining criterion of Sudden Unexpected Death in Epilepsy. Most monogenic models of Sudden Unexpected Death in Epilepsy invoke a failure of inhibitory synaptic drive as a critical pathogenic step. Accordingly, the G protein-coupled, membrane serotonin receptor 5-HT2C inhibits forebrain and brainstem networks by exciting GABAergic interneurons, and deletion of this gene lowers the threshold for lethal evoked audiogenic seizures. Here, we characterize epileptogenesis throughout the lifespan of mice lacking X-linked, 5-HT2C receptors (loxTB Htr2c). We find that loss of Htr2c generates a complex, adult-onset spontaneous epileptic phenotype with a novel progressive hyperexcitability pattern of absences, non-convulsive, and convulsive behavioural seizures culminating in late onset sudden mortality predominantly in male mice. RNAscope localized Htr2c mRNA in subsets of Gad2+ GABAergic neurons in forebrain and brainstem regions. To evaluate the contribution of 5-HT2C receptor-mediated inhibitory drive, we selectively spared their deletion in GAD2+ GABAergic neurons of pan-deleted loxTB Htr2c mice, yet unexpectedly found no amelioration of survival or epileptic phenotype, indicating that expression of 5-HT2C receptors in GAD2+ inhibitory neurons was not sufficient to prevent hyperexcitability and lethal seizures. Analysis of human Sudden Unexpected Death in Epilepsy and epilepsy genetic databases identified an enrichment of HTR2C non-synonymous variants in Sudden Unexpected Death in Epilepsy cases. Interestingly, while early lethality is not reflected in the mouse model, we also identified variants mainly among male Sudden Infant Death Syndrome patients. Our findings validate HTR2C as a novel, sex-linked candidate gene modifying Sudden Unexpected Death in Epilepsy risk, and demonstrate that the complex epilepsy phenotype does not arise solely from 5-HT2C-mediated synaptic disinhibition. These results strengthen the evidence for the serotonin hypothesis of Sudden Unexpected Death in Epilepsy risk in humans, and advance current efforts to develop gene-guided interventions to mitigate premature mortality in epilepsy.
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Affiliation(s)
- Cory A Massey
- Developmental Neurogenetics Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Samantha J Thompson
- Developmental Neurogenetics Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ryan W Ostrom
- Developmental Neurogenetics Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Janice Drabek
- Developmental Neurogenetics Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Olafur A Sveinsson
- Department of Neurology, National University Hospital of Iceland, 101 Reykjavik, Iceland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 76, Sweden
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 76, Sweden
| | - Elisabeth A Haas
- Department of Pathology, Rady Children’s Hospital-San Diego, San Diego, CA 92123, USA
| | - Othon J Mena
- Medical Examiner Office, Ventura County Health Care Agency, Ventura, CA 93003, USA
| | - Alica M Goldman
- Developmental Neurogenetics Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffrey L Noebels
- Developmental Neurogenetics Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
Bio-photonic devices that utilize the interaction between light and biological substances have been emerging as an important tool for clinical diagnosis and/or therapy. At the same time, implanted biodegradable photonic devices can be disintegrated and resorbed after a predefined operational period, thus avoiding the risk and cost associated with the secondary surgical extraction. In this paper, the recent progress on biodegradable photonics is reviewed, with a focus on material strategies, device architectures and their biomedical applications. We begin with a brief introduction of biodegradable photonics, followed by the material strategies for constructing biodegradable photonic devices. Then, various types of biodegradable photonic devices with different functionalities are described. After that, several demonstration examples for applications in intracranial pressure monitoring, biochemical sensing and drug delivery are presented, revealing the great potential of biodegradable photonics in the monitoring of human health status and the treatment of human diseases. We then conclude with the summary of this field, as well as current challenges and possible future directions.
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Leitner DF, Mills JD, Pires G, Faustin A, Drummond E, Kanshin E, Nayak S, Askenazi M, Verducci C, Chen BJ, Janitz M, Anink JJ, Baayen JC, Idema S, van Vliet EA, Devore S, Friedman D, Diehl B, Scott C, Thijs R, Wisniewski T, Ueberheide B, Thom M, Aronica E, Devinsky O. Proteomics and Transcriptomics of the Hippocampus and Cortex in SUDEP and High-Risk SUDEP Patients. Neurology 2021; 96:e2639-e2652. [PMID: 33910938 PMCID: PMC8205452 DOI: 10.1212/wnl.0000000000011999] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To identify the molecular signaling pathways underlying sudden unexpected death in epilepsy (SUDEP) and high-risk SUDEP compared to control patients with epilepsy. METHODS For proteomics analyses, we evaluated the hippocampus and frontal cortex from microdissected postmortem brain tissue of 12 patients with SUDEP and 14 with non-SUDEP epilepsy. For transcriptomics analyses, we evaluated hippocampus and temporal cortex surgical brain tissue from patients with mesial temporal lobe epilepsy: 6 low-risk and 8 high-risk SUDEP as determined by a short (<50 seconds) or prolonged (≥50 seconds) postictal generalized EEG suppression (PGES) that may indicate severely depressed brain activity impairing respiration, arousal, and protective reflexes. RESULTS In autopsy hippocampus and cortex, we observed no proteomic differences between patients with SUDEP and those with non-SUDEP epilepsy, contrasting with our previously reported robust differences between epilepsy and controls without epilepsy. Transcriptomics in hippocampus and cortex from patients with surgical epilepsy segregated by PGES identified 55 differentially expressed genes (37 protein-coding, 15 long noncoding RNAs, 3 pending) in hippocampus. CONCLUSION The SUDEP proteome and high-risk SUDEP transcriptome were similar to those in other patients with epilepsy in hippocampus and cortex, consistent with diverse epilepsy syndromes and comorbid conditions associated with SUDEP. Studies with larger cohorts and different epilepsy syndromes, as well as additional anatomic regions, may identify molecular mechanisms of SUDEP.
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Affiliation(s)
- Dominique F Leitner
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - James D Mills
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Geoffrey Pires
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Arline Faustin
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Eleanor Drummond
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Evgeny Kanshin
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Shruti Nayak
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Manor Askenazi
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Chloe Verducci
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Bei Jun Chen
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Michael Janitz
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Jasper J Anink
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Johannes C Baayen
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Sander Idema
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Erwin A van Vliet
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Sasha Devore
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Daniel Friedman
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Beate Diehl
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Catherine Scott
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Roland Thijs
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Thomas Wisniewski
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Beatrix Ueberheide
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Maria Thom
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Eleonora Aronica
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
| | - Orrin Devinsky
- From the Comprehensive Epilepsy Center (D.F.L., C.V., S.D., D.F., O.D.), Proteomics Laboratory (E.K., S.N., B.U.), Division of Advanced Research Technologies, and Department of Biochemistry and Molecular Pharmacology (B.U.), NYU School of Medicine; Department of Neurology (D.F.L., G.P., A.F., E.D., S.D., D.F., T.W., B.U., O.D.), Center for Cognitive Neurology (G.P., A.F., E.D., T.W.), Department of Pathology (T.W.), and Department of Psychiatry (T.W.), NYU Langone Health and School of Medicine, New York; Department of (Neuro)Pathology (J.D.M., J.J.A., E.A.v.V., E.A.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef 9, the Netherlands; Alzheimer's and Prion Diseases Team (G.P.), Paris Brain Institute, CNRS, UMR 7225, INSERM 1127, Sorbonne University UM75, Paris, France; Brain & Mind Centre and School of Medical Sciences (E.D.), Faculty of Medicine and Health, University of Sydney, Australia; Biomedical Hosting LLC (M.A.), Arlington, MA; School of Biotechnology and Biomolecular Sciences (B.J.C., M.J.), University of New South Wales, Sydney, Australia; Amsterdam UMC (J.C.B., S.I.), Vrije Universiteit Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, De Boelelaan 1117; Swammerdam Institute for Life Sciences (E.A.v.V.), Center for Neuroscience, University of Amsterdam, the Netherlands; Department of Clinical and Experimental Epilepsy (B.D., C.S., M.T.), University College London Institute of Neurology, UK; and Stichting Epilepsie Instellingen Nederland (R.T., E.A.), Heemstede, the Netherlands
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Cheng H, Qi Y, Lai N, Yang L, Xu C, Wang S, Guo Y, Chen Z, Wang Y. Inhibition of hyperactivity of the dorsal raphe 5-HTergic neurons ameliorates hippocampal seizure. CNS Neurosci Ther 2021; 27:963-972. [PMID: 33955651 PMCID: PMC8265946 DOI: 10.1111/cns.13648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 01/07/2023] Open
Abstract
Aims Epilepsy, frequently comorbid with depression, easily develops drug resistance. Here, we investigated how dorsal raphe (DR) and its 5‐HTergic neurons are implicated in epilepsy. Methods In mouse hippocampal kindling model, using immunochemistry, calcium fiber photometry, and optogenetics, we investigated the causal role of DR 5‐HTergic neurons in seizure of temporal lobe epilepsy (TLE). Further, deep brain stimulation (DBS) of the DR with different frequencies was applied to test its effect on hippocampal seizure and depressive‐like behavior. Results Number of c‐fos+ neurons in the DR and calcium activities of DR 5‐HTergic neurons were both increased during kindling‐induced hippocampal seizures. Optogenetic inhibition, but not activation, of DR 5‐HTergic neurons conspicuously retarded seizure acquisition specially during the late period. For clinical translation, 1‐Hz‐specific, but not 20‐Hz or 100‐Hz, DBS of the DR retarded the acquisition of hippocampal seizure. This therapeutic effect may be mediated by the inhibition of DR 5‐HTergic neurons, as optogenetic activation of DR 5‐HTergic neurons reversed the anti‐seizure effects of 1‐Hz DR DBS. However, DBS treatment had no effect on depressive‐like behavior. Conclusion Inhibition of hyperactivity of DR 5‐HTergic neuron may present promising anti‐seizure effect and the DR may be a potential DBS target for the therapy of TLE.
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Affiliation(s)
- Heming Cheng
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yingbei Qi
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Nanxi Lai
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Lin Yang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China.,Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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36
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Li HL, Deng ZR, Zhang J, Ding CH, Shi XG, Wang L, Chen X, Cao L, Wang Y. Sonographic hypoechogenicity of brainstem raphe nucleus is correlated with electroencephalographic spike frequency in patients with epilepsy. Epilepsy Behav 2021; 117:107884. [PMID: 33714930 DOI: 10.1016/j.yebeh.2021.107884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Brainstem raphe nucleus (BRN) hypoechogenicity in transcranial sonography (TCS) has been demonstrated in patients with major depression, possibly representing a sonographic manifestation of serotonergic dysfunction in depression. Most patients with epilepsy with comorbid depression exhibit hypoechogenic BRN in TCS. However, the role of BRN in the pathogenesis of epilepsy is unclear. This study aimed to evaluate the correlation of BRN echogenicity with epilepsy itself, and the echogenicity of other midbrain structures and the size of lateral ventricle (LV) will also be evaluated in patients with epilepsy. METHODS Thirty-six patients with epilepsy without depression and 37 healthy controls were recruited. Sonographic echogenicity of BRN, caudate nucleus (CN), lentiform nucleus (LN), substantia nigra (SN), and the width of frontal horns of the lateral ventricles (LV) and the third ventricle (TV) were evaluated with TCS. The frequency of interictal epileptiform discharges (IEDs) was assessed with ambulatory electroencephalogram (AEEG). RESULTS Hypoechogenicity of BRN was depicted in 36.1% of patients with epilepsy and 18.9% of controls, showing no significant difference. Patients with epilepsy with BRN hypoechogenicity had higher epileptic discharge index (EDI) than those with normal BRN echogenecity. Especially, higher EDI in patients with BRN hypoechogenicity was observed during the sleep period but not during awake period. The width of TV was significantly larger in patients with epilepsy than that in controls. We did not find any difference between patients with epilepsy and controls in the echogenicity of CN, LN, and SN, as well as in the width of frontal horn of LV. CONCLUSIONS Hypoechogenic BRN is correlated with a high frequency of epileptic discharges in electroencephalogram (EEG), especially during sleep period but not during awake period, indicating that BRN alterations may play a potential role in the pathogenesis of epilepsy in association with sleep cycle.
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Affiliation(s)
- Han-Li Li
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Zi-Ru Deng
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Juan Zhang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Chu-Han Ding
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xue-Gong Shi
- Department of Echocardiography, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Long Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xin Chen
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Li Cao
- Department of Electrocardiogram, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China.
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Abstract
PURPOSE OF REVIEW The serotonergic system is implicated in multiple aspects of epilepsy, including seizure susceptibility, sudden unexpected death in epilepsy (SUDEP), and comorbid depression. Despite the complexity of serotonin's effects on various neuronal networks, ongoing research provides considerable insight into the role of serotonin in human epilepsy. This review explores the potential roles of serotonergic therapies to improve clinical outcomes in epilepsy. RECENT FINDINGS In recent decades, research has markedly increased our knowledge of the diverse effects of serotonin on brain function. Animal models of epilepsy have identified the influence of serotonin on seizure threshold in specific brain regions, serotoninergic augmentation's protective effects on terminal apnea and mortality in SUDEP, and mechanisms underlying behavioral improvement in some models of comorbid depression. Human clinical studies are largely consistent with animal data but the translation into definitive treatment decisions has moved less rapidly. SUMMARY Evidence for serotonergic therapy is promising for improvement in seizure control and prevention of SUDEP. For some epilepsies, such as Dravet syndrome, basic research on serotonin receptor agonists has translated into a positive clinical trial for fenfluramine. The cumulative results of safety and efficacy studies support the routine use of SSRIs for comorbid depression in epilepsy.
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Affiliation(s)
| | | | - Matthew S. Gentry
- Department of Molecular and Cellular Biochemistry, University of Kentucky
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38
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Wengert ER, Wenker IC, Wagner EL, Wagley PK, Gaykema RP, Shin JB, Patel MK. Adrenergic Mechanisms of Audiogenic Seizure-Induced Death in a Mouse Model of SCN8A Encephalopathy. Front Neurosci 2021; 15:581048. [PMID: 33762902 PMCID: PMC7982890 DOI: 10.3389/fnins.2021.581048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death amongst patients whose seizures are not adequately controlled by current therapies. Patients with SCN8A encephalopathy have an elevated risk for SUDEP. While transgenic mouse models have provided insight into the molecular mechanisms of SCN8A encephalopathy etiology, our understanding of seizure-induced death has been hampered by the inability to reliably trigger both seizures and seizure-induced death in these mice. Here, we demonstrate that mice harboring an Scn8a allele with the patient-derived mutation N1768D (D/+) are susceptible to audiogenic seizures and seizure-induced death. In adult D/+ mice, audiogenic seizures are non-fatal and have nearly identical behavioral, electrographical, and cardiorespiratory characteristics as spontaneous seizures. In contrast, at postnatal days 20–21, D/+ mice exhibit the same seizure behavior, but have a significantly higher incidence of seizure-induced death following an audiogenic seizure. Seizure-induced death was prevented by either stimulating breathing via mechanical ventilation or by acute activation of adrenergic receptors. Conversely, in adult D/+ mice inhibition of adrenergic receptors converted normally non-fatal audiogenic seizures into fatal seizures. Taken together, our studies show that in our novel audiogenic seizure-induced death model adrenergic receptor activation is necessary and sufficient for recovery of breathing and prevention of seizure-induced death.
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Affiliation(s)
- Eric R Wengert
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, United States.,Neuroscience Graduate Program, University of Virginia Health System, Charlottesville, VA, United States
| | - Ian C Wenker
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Elizabeth L Wagner
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, VA, United States.,Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Pravin K Wagley
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Ronald P Gaykema
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, United States
| | - Jung-Bum Shin
- Neuroscience Graduate Program, University of Virginia Health System, Charlottesville, VA, United States.,Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Manoj K Patel
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, United States.,Neuroscience Graduate Program, University of Virginia Health System, Charlottesville, VA, United States
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Purnell BS, Petrucci AN, Li R, Buchanan GF. The effect of time-of-day and circadian phase on vulnerability to seizure-induced death in two mouse models. J Physiol 2021; 599:1885-1899. [PMID: 33501667 DOI: 10.1113/jp280856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature death in patients with refractory epilepsy. SUDEP typically occurs during the night, although the reason for this is unclear. We found that, in normally entrained mice, time-of-day alters vulnerability to seizure-induced death. We found that, in free-running mice, circadian phase alters the vulnerability to seizure-induced death. These findings suggest that circadian rhythmicity may be responsible for the increased night-time prevalence of SUDEP ABSTRACT: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related death. SUDEP typically occurs during the night following a seizure. Many aspects of mammalian physiology are regulated by circadian rhythms in ways that might make seizures occuring during the night more dangerous. Using two mouse models of seizure-induced death, we demonstrate that time-of-day and circadian rhythms alter vulnerability to seizure-induced death. We exposed normally entrained DBA/1 mice to a potentially seizure-inducing acoustic stimulus at different times of day and compared the characteristics and outcomes of the seizures. Time-of-day did not alter the probability of a seizure but it did alter the probability of seizure-induced death. To determine whether circadian rhythms alter vulnerability to seizure-induced death, we induced maximal electroshock seizures in free-running C57BL/6J mice at different circadian time points at the same time as measuring breathing via whole body plethysmography. Circadian phase did not affect seizure severity but it did alter postictal respiratory outcomes and the probability of seizure-induced death. By contrast to our expectations, in entrained and free-running mice, vulnerability to seizure-induced death was greatest during the night and subjective night, respectively. These findings suggest that circadian rhythmicity may be responsible for the increased night-time prevalence of SUDEP and that the underlying mechanism is phase conserved between nocturnal and diurnal mammals. All of the seizures in the present study were induced during wakefulness, indicating that the effect of time point on vulnerability to seizure-induced death was not the result of sleep. Understanding why SUDEP occurs more frequently during the night may inform future preventative countermeasures.
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Affiliation(s)
- Benton S Purnell
- Interdisciplinary Graduate Program in Neuroscience, Iowa City, IA, USA.,Iowa Neuroscience Institute, Iowa City, IA, USA.,Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Alexandra N Petrucci
- Interdisciplinary Graduate Program in Neuroscience, Iowa City, IA, USA.,Iowa Neuroscience Institute, Iowa City, IA, USA.,Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Rui Li
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Gordon F Buchanan
- Interdisciplinary Graduate Program in Neuroscience, Iowa City, IA, USA.,Iowa Neuroscience Institute, Iowa City, IA, USA.,Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Shen Y, Ma HX, Lu H, Zhao HT, Sun JL, Cheng Y, Zhang HH. Central deficiency of norepinephrine synthesis and norepinephrinergic neurotransmission contributes to seizure-induced respiratory arrest. Biomed Pharmacother 2021; 133:111024. [PMID: 33232929 DOI: 10.1016/j.biopha.2020.111024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with intractable epilepsy. However, the pathogenesis of SUDEP seems to be poorly understood. Our previous findings showed that the incidence of seizure-induced respiratory arrest (S-IRA) was markedly reduced by atomoxetine in a murine SUDEP model. Because the central norepinephrine α-1 receptor (NEα-1R) plays a vital role in regulating respiratory function, we hypothesized that the suppression of S-IRA by atomoxetine was mediated by NE/NEα-1R interactions that can be reversed by NEα-1R antagonism. We examined whether atomoxetine-mediated suppression of S-IRA evoked by either acoustic stimulation or pentylenetetrazole (PTZ) in DBA/1 mice can be reversed by intraperitoneal (IP) and intracerebroventricular (ICV) administration of prazosin, a selective antagonist of NEα-1R. The content and activity of tyrosine hydroxylase (TH), a rate-limiting enzyme for NE synthesis, in the lower brainstem was measured by ELISA. Electroencephalograms (EEG) were obtained from using the PTZ-evoked SUDEP model. In our models, atomoxetine-mediated suppression of S-IRA evoked by either acoustic stimulation or PTZ was significantly reversed by low doses of IP and ICV prazosin. Neither repetitive acoustic stimulation nor S-IRA reduced TH levels in lower brainstem. However, the enzyme activity of TH levels in lower brainstem was significantly increased by mechanical ventilation with DBA/1 mice, which makes the dying DBA/1 mice suffering from S-IRA and SUDEP recover. EEG data showed that although the protective effect of atomoxetine was reversed by prazosin, neither drug suppressed EEG activity. These data suggest that deficient synthesis of NE and norepinephrinergic neurotransmission contributed to S-IRA and that the NEα-1R is a potential therapeutic target for the prevention of SUDEP.
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Affiliation(s)
- Yue Shen
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China; Department of Anesthesiology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, 310006, China
| | - Hai Xiang Ma
- Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Han Lu
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Ting Zhao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jian Liang Sun
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yuan Cheng
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Hong Hai Zhang
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China; Department of Anesthesiology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, 310006, China; Department of Anesthesiology, The Fourth Clinical School of Medicine, Zhejiang Chinese Medical University, Hangzhou, 310006, China.
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Adhikari Y, Jin X. Intraperitoneal injection of lipopolysaccharide prevents seizure-induced respiratory arrest in a DBA/1 mouse model of SUDEP. Epilepsia Open 2020; 5:386-396. [PMID: 32913947 PMCID: PMC7469803 DOI: 10.1002/epi4.12410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/30/2020] [Accepted: 05/03/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is the cause of premature death of 50% patients with chronic refractory epilepsy. Respiratory failure during seizures is regarded as an important mechanism of SUDEP. Previous studies have shown that abnormal serotonergic neurotransmission is involved in the pathogenesis of seizure-induced respiratory failure, while enhancing serotonergic neurotransmission in the brainstem suppresses it. Because peripheral inflammation is known to enhance serotonergic neuron activation and 5-HT synthesis and release, we investigated the effect of intraperitoneal lipopolysaccharide (LPS)-induced inflammation on the S-IRA susceptibility during audiogenic seizures in DBA/1 mice. METHODS After DBA/1 mice were primed by exposing to sound stimulation for three consecutive days, they were tested for seizure severity and seizure-induced respiratory arrest (S-IRA) induced by sound stimulation under different conditions. We determined the dose and time course of the effects of intraperitoneal administration of LPS on audiogenic seizures and S-IRA. The effects of blocking TLR4 or RAGE receptors and blocking 5-HT receptors on the LPS-induced effect on S-IRA were investigated. Statistical significance was evaluated using the Kruskal-Wallis test. RESULTS Intraperitoneal injection of LPS significantly had dose-dependent effects in reducing the incidence of S-IRA as well as seizure severity in DBA/1 mice. The protective effect of LPS on S-IRA peaked at 8-12 hours after LPS injection and was related to both reducing seizure severity and enhancing autoresuscitation. Blocking TLR4 or RAGE receptor with TAK-242 or FPS-ZM1, respectively, prior to LPS injection attenuated its effects on S-IRA and seizure severity. Injection of a nonselective 5-HT receptor antagonist, cyproheptadine, or a 5-HT3 receptor antagonist, ondansetron, was effective in blocking LPS-induced effect on S-IRA. Immunostaining results showed a significant increase in c-Fos-positive serotonergic neurons in the dorsal raphe. SIGNIFICANCE This is the first study that demonstrates the effect of intraperitoneal LPS injection-induced inflammation on reducing S-IRA susceptibility and provides additional evidence supporting the serotonin hypothesis on SUDEP. Our study suggests that inflammation may enhance brainstem 5-HT neurotransmission to promote autoresuscitation during seizure and prevent SUDEP.
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Affiliation(s)
- Yadav Adhikari
- Spinal Cord and Brain Injury Research GroupStark Neurosciences Research Institute. Indiana University School of MedicineIndianapolisIndianaUSA
| | - Xiaoming Jin
- Department of Anatomy, Cell Biology and PhysiologyStark Neurosciences Research InstituteIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Neurological SurgeryStark Neurosciences Research InstituteIndiana University School of MedicineIndianapolisIndianaUSA
- Spinal Cord and Brain Injury Research GroupStark Neurosciences Research Institute. Indiana University School of MedicineIndianapolisIndianaUSA
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Optical Waveguides and Integrated Optical Devices for Medical Diagnosis, Health Monitoring and Light Therapies. SENSORS 2020; 20:s20143981. [PMID: 32709072 PMCID: PMC7411870 DOI: 10.3390/s20143981] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
Optical waveguides and integrated optical devices are promising solutions for many applications, such as medical diagnosis, health monitoring and light therapies. Despite the many existing reviews focusing on the materials that these devices are made from, a systematic review that relates these devices to the various materials, fabrication processes, sensing methods and medical applications is still seldom seen. This work is intended to link these multidisciplinary fields, and to provide a comprehensive review of the recent advances of these devices. Firstly, the optical and mechanical properties of optical waveguides based on glass, polymers and heterogeneous materials and fabricated via various processes are thoroughly discussed, together with their applications for medical purposes. Then, the fabrication processes and medical implementations of integrated passive and active optical devices with sensing modules are introduced, which can be used in many medical fields such as drug delivery and cardiovascular healthcare. Thirdly, wearable optical sensing devices based on light sensing methods such as colorimetry, fluorescence and luminescence are discussed. Additionally, the wearable optical devices for light therapies are introduced. The review concludes with a comprehensive summary of these optical devices, in terms of their forms, materials, light sources and applications.
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Armstrong JL, Casey AB, Saraf TS, Mukherjee M, Booth RG, Canal CE. ( S)-5-(2'-Fluorophenyl)- N, N-dimethyl-1,2,3,4-tetrahydronaphthalen-2-amine, a Serotonin Receptor Modulator, Possesses Anticonvulsant, Prosocial, and Anxiolytic-like Properties in an Fmr1 Knockout Mouse Model of Fragile X Syndrome and Autism Spectrum Disorder. ACS Pharmacol Transl Sci 2020; 3:509-523. [PMID: 32566916 DOI: 10.1021/acsptsci.9b00101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Indexed: 12/12/2022]
Abstract
Fragile X syndrome (FXS) is a neurodevelopmental disorder characterized by intellectual disabilities and a plethora of neuropsychiatric symptoms. FXS is the leading monogenic cause of autism spectrum disorder (ASD), which is defined clinically by repetitive and/or restrictive patterns of behavior and social communication deficits. Epilepsy and anxiety are also common in FXS and ASD. Serotonergic neurons directly innervate and modulate the activity of neurobiological circuits altered in both disorders, providing a rationale for investigating serotonin receptors (5-HTRs) as targets for FXS and ASD drug discovery. Previously we unveiled an orally active aminotetralin, (S)-5-(2'-fluorophenyl)-N,N-dimethyl-1,2,3,4-tetrahydronaphthalen-2-amine (FPT), that exhibits partial agonist activity at 5-HT1ARs, 5-HT2CRs, and 5-HT7Rs and that reduces repetitive behaviors and increases social approach behavior in wild-type mice. Here we report that in an Fmr1 knockout mouse model of FXS and ASD, FPT is prophylactic for audiogenic seizures. No FPT-treated mice displayed audiogenic seizures, compared to 73% of vehicle-treated mice. FPT also exhibits anxiolytic-like effects in several assays and increases social interactions in both Fmr1 knockout and wild-type mice. Furthermore, FPT increases c-Fos expression in the basolateral amygdala, which is a preclinical effect produced by anxiolytic medications. Receptor pharmacology assays show that FPT binds competitively and possesses rapid association and dissociation kinetics at 5-HT1ARs and 5-HT7Rs, yet has slow association and rapid dissociation kinetics at 5-HT2CRs. Finally, we reassessed and report FPT's affinity and function at 5-HT1ARs, 5-HT2CRs, and 5-HT7Rs. Collectively, these observations provide mounting support for further development of FPT as a pharmacotherapy for common neuropsychiatric symptoms in FXS and ASD.
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Affiliation(s)
- Jessica L Armstrong
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University Health Sciences Center, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
| | - Austen B Casey
- Center for Drug Discovery, Department of Pharmaceutical Sciences, and Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts 02131, United States
| | - Tanishka S Saraf
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University Health Sciences Center, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
| | - Munmun Mukherjee
- Center for Drug Discovery, Department of Pharmaceutical Sciences, and Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts 02131, United States
| | - Raymond G Booth
- Center for Drug Discovery, Department of Pharmaceutical Sciences, and Department of Chemistry and Chemical Biology, Northeastern University, Boston, Massachusetts 02131, United States
| | - Clinton E Canal
- Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University Health Sciences Center, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia 30341, United States
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Xu X, Mee T, Jia X. New era of optogenetics: from the central to peripheral nervous system. Crit Rev Biochem Mol Biol 2020; 55:1-16. [PMID: 32070147 DOI: 10.1080/10409238.2020.1726279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Optogenetics has recently gained recognition as a biological technique to control the activity of cells using light stimulation. Many studies have applied optogenetics to cell lines in the central nervous system because it has the potential to elucidate neural circuits, treat neurological diseases and promote nerve regeneration. There have been fewer studies on the application of optogenetics in the peripheral nervous system. This review introduces the basic principles and approaches of optogenetics and summarizes the physiology and mechanism of opsins and how the technology enables bidirectional control of unique cell lines with superior spatial and temporal accuracy. Further, this review explores and discusses the therapeutic potential for the development of optogenetics and its capacity to revolutionize treatment for refractory epilepsy, depression, pain, and other nervous system disorders, with a focus on neural regeneration, especially in the peripheral nervous system. Additionally, this review synthesizes the latest preclinical research on optogenetic stimulation, including studies on non-human primates, summarizes the challenges, and highlights future perspectives. The potential of optogenetic stimulation to optimize therapy for peripheral nerve injuries (PNIs) is also highlighted. Optogenetic technology has already generated exciting, preliminary evidence, supporting its role in applications to several neurological diseases, including PNIs.
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Affiliation(s)
- Xiang Xu
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Mee
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xiaofeng Jia
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jones JE, Asato MR, Brown MG, Doss JL, Felton EA, Kearney JA, Talos D, Dacks PA, Whittemore V, Poduri A. Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across the Life Span. Epilepsy Curr 2020; 20:31S-39S. [PMID: 31973592 PMCID: PMC7031803 DOI: 10.1177/1535759719895277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epilepsy represents a complex spectrum disorder, with patients sharing seizures as a common symptom and manifesting a broad array of additional clinical phenotypes. To understand this disorder and treat individuals who live with epilepsy, it is important not only to identify pathogenic mechanisms underlying epilepsy but also to understand their relationships with other health-related factors. Benchmarks Area IV focuses on the impact of seizures and their treatment on quality of life, development, cognitive function, and other aspects and comorbidities that often affect individuals with epilepsy. Included in this review is a discussion on sudden unexpected death in epilepsy and other causes of mortality, a major area of research focus with still many unanswered questions. We also draw attention to special populations, such as individuals with nonepileptic seizures and pregnant women and their offspring. In this study, we review the progress made in these areas since the 2016 review of the Benchmarks Area IV and discuss challenges and opportunities for future study.
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Affiliation(s)
- Jana E Jones
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Miya R Asato
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, PA, USA
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Elizabeth A Felton
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Delia Talos
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MA, USA.,Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Ming Q, Ma H, Li J, Yang F, Li J, Liang J, Li D, Lin W. Changes in autonomic nervous function and influencing factors in a rat insular cortex electrical kindling model. Neurosci Lett 2020; 721:134782. [PMID: 31978496 DOI: 10.1016/j.neulet.2020.134782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/26/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
In mammals, the insular cortex plays an important role in autonomic regulation. In patients with insular epilepsy, seizures are always accompanied by autonomic changes. Accordingly, we aimed to establish an electrical kindling model in autonomic-mediating areas of the insular cortex, and to conduct a long-term observation of epileptic genesis in these animals until sudden unexpected death. To establish this model in adult rats, we implanted stimulation electrodes in the granular cell layer of the insular cortex, which controls the heart rate (HR) and respiratory rate (RR). Subsequently, seizure was induced successfully in 92.3 % of the rats, and typical autonomic changes were observed during these seizures. Interestingly, the model was established more easily in older rats, and the rats in which electrical stimulation led to a greater reduction in the HR. Moreover, death occurred in 25 % of the kindled rats. In conclusion, our kindling model demonstrates the ability of insular cortex stimulation to generate epilepsy. Our model thus offers a practical tool for studies of the role of the insular cortex in sudden unexpected death in epilepsy.
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Affiliation(s)
- Qianwen Ming
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Hongtao Ma
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China; Department of Neurological Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA; Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, 215163, China
| | - Jia Li
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Fan Yang
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Jing Li
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China
| | - Jianmin Liang
- Department of Pediatrics, First Hospital of Jilin University, Changchun 130021, China
| | - Dan Li
- Department of Radiology, First Hospital of Jilin University, Changchun 130021, China
| | - Weihong Lin
- Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Changchun 130021, China.
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Abstract
PURPOSE OF REVIEW The current review updates our knowledge regarding sudden unexpected death in epilepsy patient (SUDEP) risks, risk factors, and investigations of putative biomarkers based on suspected mechanisms of SUDEP. RECENT FINDINGS The overall incidence of SUDEP in adults with epilepsy is 1.2/1000 patient-years, with surprisingly comparable figures in children in recently published population-based studies. This risk was found to decrease over time in several cohorts at a rate of -7% per year, for unknown reasons. Well established risk factors include frequency of generalized tonic-clonic seizures, while adding antiepileptic treatment, nocturnal supervision and use of nocturnal listening device appear to be protective. In contrast, recent data failed to demonstrate the predictive value of heart rate variability, periictal cardiorespiratory dysfunction, and postictal generalized electroencephalography suppression. Preliminary findings suggest that brainstem and thalamic atrophy may be associated with a higher risk of SUDEP. Novel experimental and human data support the primary role of generalized tonic-clonic seizure-triggered respiratory dysfunction and the likely contribution of altered brainstem serotoninergic neurotransmission, in SUDEP pathophysiology. SUMMARY Although significant progress has been made during the past year in the understanding of SUDEP mechanisms and investigation of numerous potential biomarkers, we are still missing reliable predictors of SUDEP beyond the well established clinical risk factors.
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Shen J, Li DL, Tan XX, Tao WW, Xie CJ, Shi XG, Wang Y. A transcranial sonography study of brainstem and its association with depression in idiopathic generalized epilepsy with tonic-clonic seizures. Epilepsy Behav 2020; 102:106589. [PMID: 31726317 DOI: 10.1016/j.yebeh.2019.106589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/19/2019] [Accepted: 09/22/2019] [Indexed: 01/18/2023]
Abstract
Brainstem raphe (BR) hypoechogenicity in transcranial sonography (TCS) has been depicted in patients with depression. But, up to date, the association of BR alterations in TCS with depression in patients with epilepsy has never been reported. This study was to investigate the possible role of BR examination via TCS in patients with idiopathic generalized epilepsy with tonic-clonic seizures (IGE-TCS) and depression. Forty-six patients with IGE-TCS and 45 healthy controls were recruited. Echogenicity of the caudate nuclei (CN), lentiform nuclei (LN), substantia nigra (SN), and BR and widths of the lateral ventricle (LV) frontal horns and the third ventricle (TV) were assessed via TCS. The determination of depression was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and depression severity measured by Chinese version Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) and Beck Depression Inventory-II (BDI-II). The width of TV in patients with epilepsy was found significantly larger than that in healthy controls (p = 0.001), but there was no significant difference in TV width between patients with IGE-TCS with and without depression. There were no significant differences between patients with IGE-TCS and healthy controls in LV frontal horn width, as well as in SN, CN, LN, and BR echogenicity. Here, it seems that patients with IGE-TCS were detected with smaller SN echogenic area compared with controls though they had no statistical significance. Patients with IGE-TCS with hypoechogenic BR had significantly higher C-NDDI-E and BDI-II scores than those with normal BR signal, and most patients with IGE-TCS with depression exhibited hypoechogenic BR, but few patients with IGE-TCS without depression exhibited hypoechogenic BR. In conclusion, BR echogenic signal alterations in TCS can be a biomarker for depression in epilepsy, but it might not be associated with epilepsy itself. The alterations of SN echogenic area and TV width in TCS may reflect a potential role of SN and diencephalon structure in the pathogenesis of epilepsy, which needs to be further elucidated.
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Affiliation(s)
- Jie Shen
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Dong-Lin Li
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xiu-Xiu Tan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Wei-Wei Tao
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Cheng-Juan Xie
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xue-Gong Shi
- Department of Echocardiography, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China; Department of Neurology, the Fourth Affiliated Hospital of Anhui Medical University, Huaihai Avenue 100, Hefei 230000, China.
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5-HT neurons and central CO2 chemoreception. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/b978-0-444-64125-0.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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50
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Li R, Buchanan GF. Scurrying to Understand Sudden Expected Death in Epilepsy: Insights From Animal Models. Epilepsy Curr 2019; 19:390-396. [PMID: 31526023 PMCID: PMC6891182 DOI: 10.1177/1535759719874787] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy, accounting for up to 17% of deaths in patients with epilepsy. The pathophysiology of SUDEP has remained unclear, largely because it is unpredictable and commonly unwitnessed. This poses a great challenge to studies in patients. Recently, there has been an increase in animal studies to try to better understand the pathophysiology of SUDEP. In this current review, we focus on developments through seizure-induced death models and the preventative strategies they may reveal.
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Affiliation(s)
- Rui Li
- Department of Neurology, Carver College of Medicine, University of Iowa, IA, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, IA, USA
| | - Gordon F. Buchanan
- Department of Neurology, Carver College of Medicine, University of Iowa, IA, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, IA, USA
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