Inclusive Brain: From Neuronal Doctrine to the Active Milieu

Bioelectronic Medicine: a multidisciplinary roadmap from biophysics to precision therapies

Bioelectronic Medicine stands as an emerging field that rapidly evolves and offers distinctive clinical benefits, alongside unique challenges. It consists of the modulation of the nervous system by precise delivery of electrical current for the treatment of clinical conditions, such as post-stroke movement recovery or drug-resistant disorders. The unquestionable clinical impact of Bioelectronic Medicine is underscored by the successful translation to humans in the last decades, and the long list of preclinical studies. Given the emergency of accelerating the progress in new neuromodulation treatments (i.e., drug-resistant hypertension, autoimmune and degenerative diseases), collaboration between multiple fields is imperative. This work intends to foster multidisciplinary work and bring together different fields to provide the fundamental basis underlying Bioelectronic Medicine. In this review we will go from the biophysics of the cell membrane, which we consider the inner core of neuromodulation, to patient care. We will discuss the recently discovered mechanism of neurotransmission switching and how it will impact neuromodulation design, and we will provide an update on neuronal and glial basis in health and disease. The advances in biomedical technology have facilitated the collection of large amounts of data, thereby introducing new challenges in data analysis. We will discuss the current approaches and challenges in high throughput data analysis, encompassing big data, networks, artificial intelligence, and internet of things. Emphasis will be placed on understanding the electrochemical properties of neural interfaces, along with the integration of biocompatible and reliable materials and compliance with biomedical regulations for translational applications. Preclinical validation is foundational to the translational process, and we will discuss the critical aspects of such animal studies. Finally, we will focus on the patient point-of-care and challenges in neuromodulation as the ultimate goal of bioelectronic medicine. This review is a call to scientists from different fields to work together with a common endeavor: accelerate the decoding and modulation of the nervous system in a new era of therapeutic possibilities.

Sodium homeostasis and signalling: The core and the hub of astrocyte function

Neuronal activity and neurochemical stimulation trigger spatio-temporal changes in the cytoplasmic concentration of Na+ ions in astrocytes. These changes constitute the substrate for Na+ signalling and are fundamental for astrocytic excitability. Astrocytic Na+ signals are generated by Na+ influx through neurotransmitter transporters, with primary contribution of glutamate transporters, and through cationic channels; whereas recovery from Na+ transients is mediated mainly by the plasmalemmal Na+/K+ ATPase. Astrocytic Na+ signals regulate the activity of plasmalemmal transporters critical for homeostatic function of astrocytes, thus providing real-time coordination between neuronal activity and astrocytic support.

Mitochondrial malfunction and atrophy of astrocytes in the aged human cerebral cortex

How aging affects cells of the human brain active milieu remains largely unknown. Here, we analyze astrocytes and neurons in the neocortical tissue of younger (22-50 years) and older (51-72 years) adults. Aging decreases the amount of reduced mitochondrial cytochromes in astrocytes but not neurons. The protein-to-lipid ratio decreases in astrocytes and increases in neurons. Aged astrocytes show morphological atrophy quantified by the decreased length of branches, decreased volume fraction of leaflets, and shrinkage of the anatomical domain. Atrophy correlates with the loss of gap junction coupling between astrocytes and increased input resistance. Aging is accompanied by the upregulation of glial fibrillary acidic protein (GFAP) and downregulation of membrane-cytoskeleton linker ezrin associated with leaflets. No significant changes in neuronal excitability or spontaneous inhibitory postsynaptic signaling is observed. Thus, brain aging is associated with the impaired morphological presence and mitochondrial malfunction of cortical astrocytes, but not neurons.

Activation of Gq-Coupled Receptors in Astrocytes Restores Cognitive Function in Alzheimer's Disease Mice Model

Alzheimer's disease (AD) is one of the most widespread neurodegenerative diseases. Most of the current AD therapeutic developments are directed towards improving neuronal cell function or facilitating Aβ amyloid clearance from the brain. However, some recent evidence suggests that astrocytes may play a significant role in the pathogenesis of AD. In this paper, we evaluated the effects of the optogenetic activation of Gq-coupled exogenous receptors expressed in astrocytes as a possible way of restoring brain function in the AD mouse model. We evaluated the effects of the optogenetic activation of astrocytes on long-term potentiation, spinal morphology and behavioral readouts in 5xFAD mouse model of AD. We determined that in vivo chronic activation of astrocytes resulted in the preservation of spine density, increased mushroom spine survival, and improved performance in cognitive behavioral tests. Furthermore, chronic optogenetic stimulation of astrocytes resulted in the elevation of EAAT-2 glutamate uptake transporter expression, which could be a possible explanation for the observed in vivo neuroprotective effects. The obtained results suggest that the persistent activation of astrocytes may be considered a potential therapeutic approach for the treatment of AD and possibly other neurodegenerative disorders.

Slow ion concentration oscillations and multiple states in neuron-glia interaction-insights gained from reduced mathematical models

When potassium in the extracellular space separating neurons and glia reaches sufficient levels, neurons may fire spontaneous action potentials or even become inactivated due to membrane depolarisation, which, in turn, may lead to increased extracellular potassium levels. Under certain circumstances, this chain of events may trigger periodic bursts of neuronal activity. In the present study, reduced neuron-glia models are applied to explore the relationship between bursting behaviour and ion concentration dynamics. These reduced models are built based on a previously developed neuron-glia model, in which channel-mediated neuronal sodium and potassium currents are replaced by a function of neuronal sodium and extracellular potassium concentrations. Simulated dynamics of the resulting two reduced models display features that are qualitatively similar to those of the existing neuron-glia model. Bifurcation analyses of the reduced models show rich and interesting dynamics that include the existence of Hopf bifurcations between which the models exhibit slow ion concentration oscillations for a wide range of parameter values. The study demonstrates that even very simple models can provide insights of possible relevance to complex phenomena.

Metamodulation of presynaptic NMDA receptors: New perspectives for pharmacological interventions

Metamodulation shifted the scenario of the central neuromodulation from a simplified unimodal model to a multimodal one. It involves different receptors/membrane proteins physically associated or merely colocalized that act in concert to control the neuronal functions influencing each other. Defects or maladaptation of metamodulation would subserve neuropsychiatric disorders or even synaptic adaptations relevant to drug dependence. Therefore, this "vulnerability" represents a main issue to be deeply analyzed to predict its aetiopathogenesis, but also to propose targeted pharmaceutical interventions. The review focusses on presynaptic release-regulating NMDA receptors and on some of the mechanisms of their metamodulation described in the literature. Attention is paid to the interactors, including both ionotropic and metabotropic receptors, transporters and intracellular proteins, which metamodulate their responsiveness in physiological conditions but also undergo adaptation that are relevant to neurological dysfunctions. All these structures are attracting more and more the interest as promising druggable targets for the treatment of NMDAR-related central diseases: these substances would not exert on-off control of the colocalized NMDA receptors (as usually observed with NMDAR full agonists/antagonists), but rather modulate their functions, with the promise of limiting side effects that would favor their translation from preclinic to clinic.

Dissociation Between Neuronal and Astrocytic Calcium Activity in Response to Locomotion in Mice

Locomotion triggers a coordinated response of both neurons and astrocytes in the brain. Here we performed calcium (Ca²⁺) imaging of these two cell types in the somatosensory cortex in head-fixed mice moving on the airlifted platform. Ca²⁺ activity in astrocytes significantly increased during locomotion from a low quiescence level. Ca²⁺ signals first appeared in the distal processes and then propagated to astrocytic somata, where it became significantly larger and exhibited oscillatory behaviour. Thus, astrocytic soma operates as both integrator and amplifier of Ca²⁺ signal. In neurons, Ca²⁺ activity was pronounced in quiescent periods and further increased during locomotion. Neuronal Ca²⁺ concentration ([Ca²⁺]_i) rose almost immediately following the onset of locomotion, whereas astrocytic Ca²⁺ signals lagged by several seconds. Such a long lag suggests that astrocytic [Ca²⁺]_i elevations are unlikely to be triggered by the activity of synapses among local neurons. Ca²⁺ responses to pairs of consecutive episodes of locomotion did not significantly differ in neurons, while were significantly diminished in response to the second locomotion in astrocytes. Such astrocytic refractoriness may arise from distinct mechanisms underlying Ca²⁺ signal generation. In neurons, the bulk of Ca²⁺ enters through the Ca²⁺ channels in the plasma membrane allowing for steady-level Ca²⁺ elevations in repetitive runs. Astrocytic Ca²⁺ responses originate from the intracellular stores, the depletion of which affects subsequent Ca²⁺ signals. Functionally, neuronal Ca²⁺ response reflects sensory input processed by neurons. Astrocytic Ca²⁺ dynamics is likely to provide metabolic and homeostatic support within the brain active milieu.

Central nervous system interaction and crosstalk between nAChRs and other ionotropic and metabotropic neurotransmitter receptors

Neuronal nicotinic acetylcholine receptors (nAChRs) are widely distributed in both the peripheral and the central nervous systems. nAChRs exert a crucial modulatory influence on several brain biological processes; they are involved in a variety of neuronal diseases including Parkinson's disease, Alzheimer's disease, epilepsy, and nicotine addiction. The influence of nAChRs on brain function depends on the activity of other neurotransmitter receptors that co-exist with nAChRs on neurons. In fact, the crosstalk between receptors is an important mechanism of neurotransmission modulation and plasticity. This may be due to converging intracellular pathways but also occurs at the membrane level, because of direct physical interactions between receptors. In this line, this review is dedicated to summarizing how nAChRs and other ionotropic and metabotropic receptors interact and the relevance of nAChRs cross-talks in modulating various neuronal processes ranging from the classical modulation of neurotransmitter release to neuron plasticity and neuroprotection.

Astrocytes in Ageing

Ageing is associated with a morphological and functional decline of astrocytes with a prevalence of morphological atrophy and loss of function. In particular, ageing is manifested by the shrinkage of astrocytic processes: branches and leaflets, which decreases synaptic coverage. Astrocytic dystrophy affects multiple functions astrocytes play in the brain active milieu. In particular, and in combination with an age-dependent decline in the expression of glutamate transporters, astrocytic atrophy translates into deficient glutamate clearance and K⁺ buffering. Decreased astrocyte presence may contribute to age-dependent remodelling of brain extracellular space, hence affecting extrasynaptic signalling. Old astrocytes lose endfeet polarisation of AQP4 water channels, thus limiting the operation of the glymphatic system. In ageing, astrocytes down-regulate their antioxidant capacity leading to decreased neuroprotection. All these changes may contribute to an age-dependent cognitive decline.