The effects of botulinum toxin on acetylcholine metabolism in mouse brain slices and synaptosomes

Botulinum Neurotoxins in Central Nervous System: An Overview from Animal Models to Human Therapy

Botulinum neurotoxins (BoNTs) are potent inhibitors of synaptic vesicle fusion and transmitter release. The natural target of BoNTs is the peripheral neuromuscular junction (NMJ) where, by blocking the release of acetylcholine (ACh), they functionally denervate muscles and alter muscle tone. This leads them to be an excellent drug for the therapy of muscle hyperactivity disorders, such as dystonia, spasticity, and many other movement disorders. BoNTs are also effective in inhibiting both the release of ACh at sites other than NMJ and the release of neurotransmitters other than ACh. Furthermore, much evidence shows that BoNTs can act not only on the peripheral nervous system (PNS), but also on the central nervous system (CNS). Under this view, central changes may result either from sensory input from the PNS, from retrograde transport of BoNTs, or from direct injection of BoNTs into the CNS. The aim of this review is to give an update on available data, both from animal models or human studies, which suggest or confirm central alterations induced by peripheral or central BoNTs treatment. The data will be discussed with particular attention to the possible therapeutic applications to pathological conditions and degenerative diseases of the CNS.

Pharmacology of botulinum toxin: differences between type A preparations

Different types of botulinum neurotoxin (BoNT) block different proteins of the soluble N-ethylmaleimide sensitive factor attachment protein receptor (SNARE) protein complex within cholinergic nerve terminals, producing blockade of cholinergic neuromuscular and autonomic synapses. Animal studies indicate the longest duration of action for BoNT type A (BoNTA) followed by types B, F, and E. Diffusion to adjacent and remote muscles may be related to protein composition, dilutions, volume, target muscle selection, and injection technique. A review of head-to-head, randomized, controlled trials of BoNTA preparations (Botox and Dysport) suggests that Dysport tends to have higher efficacy, longer duration, and higher frequency of adverse effects. Conversion factors between the preparations varied, however, and remain controversial. In clinical settings, a Botox:Dysport conversion ratio of 1:3 may be appropriate. Animal studies suggest a conversion ratio of 1:2.5-3. When therapeutic effects between these preparations are attempting to be equalized, Dysport seems to produce more adverse effects. In mice, Botox appears to have a better safety margin than Dysport and BoNTB. In rats, diffusion margins are similar for Botox and Dysport. Jitter derived from stimulation single-fiber EMG of injected and remote muscles show no differences between Botox and Dysport. Atrophy of extrafusal muscle fibers of injected and remote muscles do not differ between the BoNTA preparations.

Central effects of botulinum toxin type A: Evidence and supposition

No convincing evidence exists that botulinum toxin type A (BT-A) injected intramuscularly at therapeutic doses in humans acts directly on central nervous system (CNS) structures. Nevertheless, several studies, using various approaches, strongly suggest that BT-A affects the functional organization of the CNS indirectly through peripheral mechanisms. By acting at alpha as well as gamma motor endings, BT-A could alter spindle afferent inflow directed to spinal motoneurons or to the various cortical areas, thereby altering spinal as well as cortical mechanisms. Muscle afferent input is tightly coupled to motor cortical output, so that the afferents from a stretched muscle go to cortical areas where they can excite neurons capable of contracting the same muscle. The BT-A-induced reduction in spindle signals could, therefore, alter the balance between afferent input and motor output, thereby changing cortical excitability.

Toxicity of botulinum neurotoxins in central nervous system of mice

Botulinum neurotoxins (BoNTs) act specifically on cholinergic nerve terminals, where they cause a sustained block of acetylcholine release, and therefore they are powerful tools to study the role of cholinergic neurons in neuronal processes. Peripheral effects of BoNTs are widely documented while central effects have not been studied. Here, we report for the first time on the central toxicity of BoNT serotypes A and B following their direct intracerebroventricular (icv) injection in CD1 mice. The LD50 values were found to be in the range 0.5-1.0 x 10(-6)mg/kg. We recorded the following signs preceding animal death: piloerection and weight decrease appear first, followed by temperature decrease, eyelid closure, loss of sensorimotor reflexes, dehydration, dyspnea. Mice died of heart or respiratory failure. The surviving mice recovered completely within 4-6 days and regained the initial healthy conditions. At sub-lethal doses, the same clinical signs appear in a lighter form and with a longer time course.

Effects of botulinum neurotoxin and Lambert-Eaton myasthenic syndrome IgG at mouse nerve terminals

The interaction between two presynaptically acting agents, Lambert-Eaton myasthenic syndrome (LEMS) immunoglobulin G (IgG) and purified botulinum neurotoxin (BoNT) type A, was studied. Intracellular microelectrode recordings were carried out on mouse muscles after injection with LEMS IgG. BoNT was either injected before recordings were made or applied in vitro. The time course of the in vitro actions of BoNT on miniature end-plate potential and end-plate potential parameters were not affected by pretreatment with LEMS IgG. After in vivo injection of BoNT, end-plate potential quantal content was reduced to less than 2% of control values, whether or not LEMS IgG had also been previously given. Quantitative electron-microscope autoradiographical analysis showed that neither the binding of 125I-BoNT to acceptors on the nerve terminal membrane nor the pattern of its internalisation were affected by pretreatment with LEMS IgG. We conclude that the effects of BoNT are not affected by LEMS IgG, suggesting different presynaptic binding sites for the two agents.

Effects of botulinum A toxin on presynaptic modulation of evoked transmitter release

A possible influence of botulinum A toxin on the modulation of evoked neurotransmitter release was investigated in hippocampus tissue. Rabbit hippocampal slices prelabelled with [3H]noradrenaline ([3H]NA), [3H]5-hydroxytryptamine ([3H]5-HT) or [3H]choline were superfused with physiological medium and were stimulated electrically during superfusion. The evoked release of [3H]NA, [3H]5-HT and [3H]acetylcholine [( 3H]ACh) was inhibited by botulinum A toxin in a concentration- and time-dependent manner. Neither the inhibition of release of [3H]NA and [3H]5-HT by the alpha 2-adrenoceptor agonist clonidine nor facilitation of release in the presence of alpha 2-antagonists were influenced by pretreatment of the tissue with botulinum toxin. The toxin caused no [32P]ADP ribosylation of synaptosomal proteins of hippocampus. The facilitation of the stimulation-induced [3H]NA and [3H]5-HT release by the specific protein kinase C (PKC) activator 4 beta-phorbol-12,13-dibutyrate (PDB) was significantly diminished by botulinum A toxin. These results show that the evoked transmitter release is inhibited by botulinum A toxin by a mechanism which does not involve ADP ribosylation or an interaction with the alpha 2-adrenoceptor mechanism.

Characterization of the inhibitory action of botulinum neurotoxin type A on the release of several transmitters from rat cerebrocortical synaptosomes

Under optimised conditions for intoxication, botulinum neurotoxin type A was shown to inhibit approximately 90% of Ca2+-dependent K+-evoked release of [3H]acetylcholine, [3H]noradrenaline, and [3H]dopamine from rat cerebrocortical synaptosomes; cholinergic terminals were most susceptible. In each case, the dose-response curve for the neurotoxin was extended, with about 50% of evoked release being inhibited at approximately 10 nM whereas 200 nM was required for the maximal blockade. This may suggest some heterogeneity in the release process. The action of the toxin was time and temperature dependent and appeared to involve binding and sequestration steps prior to blockade of release. The neurotoxin failed to exert any effect on synaptosomal integrity or on Ca2+-independent release of the transmitters tested; it produced only minimal changes in neurotransmitter uptake although small secondary effects were detected with cholinergic terminals. Blockade by the neurotoxin of Ca2+-dependent resting release of transmitter was apparent; Sr2+, Ba2+, or high concentrations of Ca2+ restored the resting release of 3H-catecholamine but not [3H]acetylcholine. Interestingly, none of the latter conditions or 4-aminopyridine could reverse the toxin-induced blockade of evoked release. This lack of specificity in its action on synaptosomes, and other published findings, lead to the conclusion that toxin-sensitive component(s) exist in all nerve terminals that are concerned with transmitter release.

Do presynaptic opiate receptors and alpha-adrenoceptors alter acetylcholine release from a sympathetic ganglion by a similar mechanism?

The present experiments tested the possible involvement of a calcium-sensitive mechanism in the alpha-adrenoceptor- and opiate receptor-mediated inhibition of acetylcholine release from the cat superior cervical ganglion. First, the calcium-dependence of evoked acetylcholine release was measured in the presence and absence of the alpha-adrenoceptor agonist noradrenaline or of the opiate receptor agonist [Met5]enkephalin-Arg6-Phe7. When ganglia were perfused with Krebs medium containing [Ca2+] = 2.4, 1.2, 0.6, 0.2 mM, evoked release of acetylcholine was depressed by both agonists and the inhibition increased with reduced levels of extracellular Ca2+; this was especially evident when calcium in the medium was reduced to 0.2 mM. Second, the effects of both noradrenaline and [Met5]enkephalin-Arg6-Phe7 on calcium influx into presynaptic nerve endings was determined by measuring the accumulation of 45Ca into ganglia in the presence and absence of either drug. Both agonists reduced the stimulation-induced increase in 45Ca accumulation. The effect of noradrenaline to reduce calcium influx was blocked by yohimbine or by phentolamine; the effect of [Met5]enkephalin-Arg6-Phe7 to decrease 45Ca accumulation by ganglia was blocked by naloxone. It is concluded that activation of presynaptic opiate receptors and alpha-adrenoceptors in the cat superior cervical ganglion can alter acetylcholine release by a similar mechanism, i.e. to reduce Ca2+ influx during preganglionic nerve stimulation.

Evidence that endogenous catecholamines can regulate acetylcholine release in a sympathetic ganglion

The objective of this study was to test whether activation of alpha-adrenoceptors by endogenously released catecholamines alters the release of acetylcholine (ACh) from the cat superior cervical ganglion. The alpha-adrenoceptor agonists noradrenaline and clonidine depressed evoked ACh release; this effect was concentration-dependent; it was apparent during preganglionic stimulation at 20 Hz, but not so at lower frequencies of stimulation. The inhibitory effect of noradrenaline on evoked ACh release was reversed by yohimbine, by phentolamine and, to a lesser extent, by prazosin. Thus, exogenous amines can depress evoked ACh release by an action on presynaptic alpha-adrenoceptors. To determine if activation of these receptors by endogenous amines inhibits ACh release, we tested whether the alpha-adrenoreceptor antagonists enhance ACh release. Yohimbine and phentolamine increased evoked ACh release during preganglionic stimulation at 20 Hz, but not during stimulation at 5 Hz, suggesting that endogenous, like exogenous, amine can depress evoked ACh release from preganglionic nerve terminals.

Botulinum neurotoxin type B. Its purification, radioiodination and interaction with rat-brain synaptosomal membranes

Neurotoxin from Clostridium botulinum type B was purified to homogeneity by by affinity and ion-exchange chromatography; specific neurotoxicity of this protein (Mr of approximately equal to 155 000) following trypsinisation attained a level of 2 X 10(8) mouse LD50 units/mg protein. 125I-iodination of the toxin to high specific radioactivities (19-63 TBq/mmol) yielded typically greater than 65% of its original toxicity; dodecyl sulphate gel electrophoresis under reducing conditions, after trypsinisation, showed that the larger polypeptide (Mr of approximately equal to 101 000) was labelled preferentially. Saturable binding of the 125I-labelled neurotoxin to rat cerebrocortical synaptosomes was observed and Scatchard analysis showed a low content of acceptors with high affinity (Kd = 0.3-0.5 nM;Bmax approximately equal to 30-60 fmol/mg protein, together with a much larger population of weak-affinity sites. No significant differences in binding affinity were seen in competition experiments using native or fully activated (trypsinized) neurotoxin, indicating that chain cleavage is not essential for acceptor-toxin interaction. Type A botulinum neurotoxin showed a limited capacity to inhibit the synaptosomal binding of labelled type B toxin, even at high concentrations (1 muM), and other neurotoxins were without effect, emphasising the acceptor selectivity. Near-complete loss of specific toxin binding was produced by preincubation of synaptosomes with neuraminidase whereas inhibition of the low-affinity sites with wheat-germ agglutinin was less pronounced; such inactivation was prevented by inclusion of selective inhibitors (2,3-dehydro-2-deoxy-N-acetylneuraminic acid and N-acetylglucosamine, respectively). These observations implicate N-acetylneuraminic acid and, possibly, other sugar moieties as constituents of the toxin acceptors. Trypsinisation of synaptosomes gave incomplete inhibition of binding when assayed with 1 nM or 10 nM 125I-iodinated toxin. Detailed analysis of the actions of neuraminidase, trypsin and heat treatment on the concentration dependence of toxin binding suggest the existence of at least two distinguishable populations of sites that contain N-acetylneuraminic acid, with a protein component being associated with the acceptors of lower affinity. These findings are discussed in relation to those previously reported for type A neurotoxin and to the possible physiological significance of such membrane acceptors.

Depolarization of mouse forebrain minces with veratridine and high K+: failure to stimulate the Ca2+ independent, spontaneous release of acetylcholine from the cytoplasm due to hydrolysis of the acetylcholine stored there

Both high K+ and veratridine, depolarizing agents with different mechanisms of action, lowered the ACh content of the cytoplasmic (S3) fraction of mouse forebrain minces incubated in a Ca2+-free Krebs solution, without stimulating ACh release or altering the level of ACh in the vesicle-bound (P3) fraction. Veratridine increased the level of choline in the P3 fraction by the same amount as it reduced the level of ACh in the S3 fraction, and these changes did not occur in the presence of tetrodotoxin (TTX). Pretreatment of minces in normal Krebs increased the ACh but not the choline content of the S3 fraction. Following this expansion of the S3 ACh content, veratridine caused an even greater loss of S3 ACh, and increased the Ca2+-independent release of ACh slightly. Under these conditions, veratridine also stimulated the Ca2+ independent release of choline, and this increase exceeded that obtained for the Ca2+-independent release of ACh. Preincubation in normal Krebs with paraoxon did not alter the S3 ACh content after 5 min, but raised it by 78% after 30 min. Under the latter conditions of pretreatment, veratridine then stimulated the Ca2+-independent release of ACh even more, but did not stimulate the release of choline. These results suggest that depolarization of brain tissue does not facilitate the Ca2+-independent release of ACh from the cytoplasm because a portion of ACh stored there is hydrolyzed. When the cytoplasmic level of ACh is sufficiently elevated prior to depolarization, then some ACh escapes hydrolysis and is released independently of Ca2+. It is suggested that the depolarization-induced hydrolysis of cytoplasmic ACh may be mediated by an intraterminal form of AChE and may, in addition to the hydrolysis of extracellular ACh, provide substrate for the formation and release of ACh by the vesicle-bound fraction.

Spontaneous release of acetylcholine and acetylhomocholine from mouse forebrain minces: cytoplasmic or vesicular origin

The objective of this study was to determine the subcellular origin of cholinergic transmitter released spontaneously from mouse forebrain minces. To accomplish this objective, minces were pretreated in ionic media and then loaded with [14C]homocholine, an analog of choline, to form the false transmitter [14C]acetylhomocholine [( 14C]AHCh). The ratio of the false transmitter [14C]AHCh to the true transmitter ACh was then used as an index of cholinergic transmitter contents for both the cytoplasmic (S3) and vesicle-bound (P3) fractions. Three different pretreatment procedures were used to cause the following changes in S3 and P3 false to true transmitter ratios prior to spontaneous release: 1) a small increase in the S3 ratio of [14C]AHCh to acetylcholine (ACh) and a large increase in the P3 ratio of [14C] AHCh to ACh; 2) a decrease in the S3 ratio of [14C]AHCh to ACh and an increase in the P3 ratio of [14C]AHCh to ACh; 3) an increase in the P3 ratio of [14C]AHCh to ACh without affecting the S3 ratio of [14C]AHCh to ACh. The influence of each pretreatment on these subcellular ratios was then compared with its influence on the spontaneous release ratio of [14C]AHCh to ACh. In all 3 instances, the influence of pretreatment on the ratio of spontaneously released false and true cholinergic transmitters from minces coincided with the effect of pretreatment on the pre-release ratio of false to true transmitter in the S3 fraction. These results suggest that much of the cholinergic transmitter which is spontaneously released from mouse forebrain occurs from the cytroplasmic fraction.

Botulinum toxin type A: kinetics of calcium dependent paralysis of the neuromuscular junction and antagonism by drugs and animal toxins

The effect of botulinum Toxin (BoTx), which blocks the mechanism of release of acetylcholine at neuromuscular junctions and induces paralysis of muscles stimulated by nerves, is known to be Ca2+-dependent. Amplitude of muscular contractions evoked by nerve impulse was studied in BoTx poisoned preparations. The present report notes that an increase in Ca2+ concentration in vitro delays paralysis of muscular contractions of the frog evoked by nerve impulse. The restorative effect of different drugs on this paralysis has been tested: 4-aminopyridine, ATXII (toxin isolated and purified from the sea anemone Anemonia sulcata tentacles) and a crude venom isolated from the scorpion Androctonus australis antagonize the BotX induced paralysis at physiological concentrations of Ca2+ (Cao2+ = 2 mM), whereas the restorative effect observed with tetra-ethylammonium or guanidine occurs at higher concentrations of Ca2+ (Cao2+ = 4 mM), as in mammals. ATXII restores in vivo the activity of a BoTx paralysed muscle of guinea pig and this effect is more efficient if the interval between the injection of BoTx and ATXII is shortened. These results on the frog and guinea pig are in agreement with those obtained on other biological preparations by several investigators. Moreover it is suggested that the antagonism of BoTx induced paralysis is a consequence of the increase in Ca2+ at the nerve ending. The efficiency of 4-aminopyridine and animal toxins is explained by an action on the nerve ending, by increasing Ca2+ from an interval compartment of the cell, whereas antagonism produced by guanidine and tetraethylammonium involves uptake of Ca2+ from the external medium. The bathing medium must be at a higher concentration of Ca2+ than usual. This explains the differences in antagonism obtained by these drugs and toxins in vitro and in vivo.

Localization of sites for 125I-labelled botulinum neurotoxin at murine neuromuscular junction and its binding to rat brain synaptosomes

Botulinum neurotoxin, purified to homogeneity from Clostridium botulinum (Type A), was found to be highly neurotoxic (greater than 8 X 10(7) mouse LD50/mg protein). Labelling of this pure neurotoxin with 125I-iodine to high specific radioactivity was achieved without appreciable loss of biological activity. This was used to demonstrate saturable binding sites for this toxin at the neuromuscular junction, following in vivo administration into mice. A demonstrable inhibitory effect of the neurotoxin on release of acetylcholine from rat cerebrocortical synaptosomes indicates that it affects synapses in the central nervous system. Kinetic studies on the binding of 125I-labelled neurotoxin to brain synaptosomes yielded an association rate constant of 2.3 x 10(5)M-1s-1; dissociation plots were biphasic and the predominant species showed a rate constant of 1.2 X 10(-4)s-1. The saturable binding component is heat-sensitive and inactivated by trypsin. Preliminary studies showed that botulinum neurotoxin associates with plasma membrane fractions of synaptosomes and that binding does not result in any gross structural changes, at least in the majority of the toxin molecules.

Binding to mouse brain synaptosomes of Clostridium botulinum type E derivative toxin before and after tryptic activation

Clostridium botulinum type E125 I-labelled derivative toxin, both the partially active (intact) and the fully active (nicked) forms, bound to mouse brain synaptosomes. They gave the same KD and Bmax values in binding to synaptosomes, although the nicked form possessed a mouse lethal potency about 30 times higher than that of the intact form. These results may indicate that the binding site of the derivative toxin is not modified by tryptic activation and that the binding to synaptosomes is independent of the blockade of acetylcholine release.

Tetanus toxin and botulinum A toxin inhibit acetylcholine release from but not calcium uptake into brain tissue

Slices or particles from rat forebrain cortex were preloaded with [3H]choline, and the release of [3H]acetylcholine was evoked with potassium ions in a superfusion system. Release depended on the presence of calcium. 1. Incubation of the preloaded tissue preparation for 2 h with tetanus or botulinum A toxin did not change the [3H]acetylcholine content or the ratio [3H]acetylcholine/[3H]choline. Tetanus toxin diminished, dependent on dose and time, the release of [3H]acetylcholine evoked by 25 mM K+. It was about ten times more potent than botulinum A toxin. The effect of botulinum toxin was due to its neurotoxin content. Raising the potassium concentration partially overcame the inhibition by the toxins. Hemicholinium-3, applied to preloaded slices, left the subsequent [3H]acetylcholine release unchanged. Pretreatment of particles with neuraminidase diminished the content of long-chain gangliosides to the detection limit. Such particles remained fully sensitive to tetanus toxin, and at least partially sensitive to botulinum A toxin. 2. The potassium or sea anemone toxin II stimulated uptake of 45Ca2+ into cortex synaptosomes or particles was not inhibited by either toxin. Both toxins appear to impede the Ca2+-dependent mobilization of an easily releasable acetylcholine pool, without inhibiting the transmembranal calcium fluxes.

High affinity choline transport and acetylCoA production in brain and their roles in the regulation of acetylcholine synthesis

This review describes recent advances made in the understanding of the regulation of acetylcholine synthesis in brain with regard to the availability of its two precursors, choline and acetylCoA. Choline availability appears to be regulated by the high affinity choline transport system. Investigations of the localization and inhibition of this system are reviewed. Procedures for measuring high affinity choline transport and their shortcomings are described. The kinetics and effects of previous in vivo and in vitro treatments on high affinity choline transport are reviewed. Kinetic and direct coupling of the transport and acetylation of choline are discussed. Recent investigations of the source of acetylCoA used for the synthesis of acetylcholine are reviewed. Three sources of acetylCoA have recently received support: citrate conversion catalyzed by citrate lyase, direct release of acetylCoA from mitochondria following its synthesis from pyruvate catalyzed by pyruvate dehydrogenase, and production of acetylCoA by cytoplasmic pyruvate dehydrogenase. Investigations indicating that acetylCoA availability may limit acetylcholine synthesis are reviewed. A model for the regulation of acetylcholine synthesis which incorporates most of the reviewed material is presented.