Electrical prodromals of spreading depression void Grafstein’s potassium hypothesis

The Critical Role of Spreading Depolarizations in Early Brain Injury: Consensus and Contention

BACKGROUND

When a patient arrives in the emergency department following a stroke, a traumatic brain injury, or sudden cardiac arrest, there is no therapeutic drug available to help protect their jeopardized neurons. One crucial reason is that we have not identified the molecular mechanisms leading to electrical failure, neuronal swelling, and blood vessel constriction in newly injured gray matter. All three result from a process termed spreading depolarization (SD). Because we only partially understand SD, we lack molecular targets and biomarkers to help neurons survive after losing their blood flow and then undergoing recurrent SD.

METHODS

In this review, we introduce SD as a single or recurring event, generated in gray matter following lost blood flow, which compromises the Na⁺/K⁺ pump. Electrical recovery from each SD event requires so much energy that neurons often die over minutes and hours following initial injury, independent of extracellular glutamate.

RESULTS

We discuss how SD has been investigated with various pitfalls in numerous experimental preparations, how overtaxing the Na⁺/K⁺ ATPase elicits SD. Elevated K⁺ or glutamate are unlikely natural activators of SD. We then turn to the properties of SD itself, focusing on its initiation and propagation as well as on computer modeling.

CONCLUSIONS

Finally, we summarize points of consensus and contention among the authors as well as where SD research may be heading. In an accompanying review, we critique the role of the glutamate excitotoxicity theory, how it has shaped SD research, and its questionable importance to the study of early brain injury as compared with SD theory.

Effects of Glia in a Triphasic Continuum Model of Cortical Spreading Depression

Cortical spreading depression (SD) is a spreading disruption in brain ionic homeostasis during which neurons experience complete and prolonged depolarizations. SD is generally believed to be the physiological substrate of migraine aura and is associated with many other brain pathologies. Here, we perform simulations with a model of SD treating brain tissue as a triphasic continuum of neurons, glia and the extracellular space. A thermodynamically consistent incorporation of the major biophysical effects, including ionic electrodiffusion and osmotic water flow, allows for the computation of important physiological variables including the extracellular voltage (DC) shift. A systematic parameter study reveals that glia can act as both a disperser and buffer of potassium in SD propagation. Furthermore, we show that the timing of the DC shift with respect to extracellular [Formula: see text] rise is highly dependent on glial parameters, a result with implications for the identification of the propagating mechanism of SD.

Diffusing substances during spreading depolarization: analytical expressions for propagation speed, triggering, and concentration time courses

Spreading depolarization (SD) is an important phenomenon in stroke and migraine. However, the processes underlying the propagation of SD are still poorly understood, and an elementary model that is both physiological and quantitative is lacking. We show that, during the onset and propagation of SD, the concentration time courses of excitatory substances such as potassium and glutamate can be described with a reaction-diffusion equation. This equation contains four physiological parameters: (1) a concentration threshold for excitation; (2) a release rate; (3) a removal rate; and (4) an effective diffusion constant. Solving this equation yields expressions for the propagation velocity, concentration time courses, and the minimum stimulus that can trigger SD. This framework allows for analyzing experimental results in terms of these four parameters. The derived time courses are validated with measurements of potassium in rat brain tissue.

Enhanced excitatory transmission at cortical synapses as the basis for facilitated spreading depression in Ca(v)2.1 knockin migraine mice

Migraine is a common disabling brain disorder. A subtype of migraine with aura (familial hemiplegic migraine type 1: FHM1) is caused by mutations in Ca(V)2.1 (P/Q-type) Ca(2+) channels. Knockin mice carrying a FHM1 mutation show increased neuronal P/Q-type current and facilitation of induction and propagation of cortical spreading depression (CSD), the phenomenon that underlies migraine aura and may activate migraine headache mechanisms. We studied cortical neurotransmission in neuronal microcultures and brain slices of FHM1 mice. We show gain of function of excitatory neurotransmission due to increased action-potential-evoked Ca(2+) influx and increased probability of glutamate release at pyramidal cell synapses but unaltered inhibitory neurotransmission at fast-spiking interneuron synapses. Using an in vitro model of CSD, we show a causative link between enhanced glutamate release and CSD facilitation. The synapse-specific effect of FHM1 mutations points to disruption of excitation-inhibition balance and neuronal hyperactivity as the basis for episodic vulnerability to CSD ignition in migraine.

Controlling the onset of traveling pulses in excitable media by nonlocal spatial coupling and time-delayed feedback

The onset of pulse propagation is studied in a reaction-diffusion (RD) model with control by augmented transmission capability that is provided either along nonlocal spatial coupling or by time-delayed feedback. We show that traveling pulses occur primarily as solutions to the RD equations, while augmented transmission changes excitability. For certain ranges of the parameter settings, defined as weak susceptibility and moderate control, respectively, the hybrid model can be mapped to the original RD model. This results in an effective change in RD parameters controlled by augmented transmission. Outside moderate control parameter settings new patterns are obtained, for example, stepwise propagation due to delay-induced oscillations. Augmented transmission constitutes a signaling system complementary to the classical RD mechanism of pattern formation. Our hybrid model combines the two major signaling systems in the brain, namely, volume transmission and synaptic transmission. Our results provide insights into the spread and control of pathological pulses in the brain.

The role of extracellular potassium dynamics in the different stages of ictal bursting and spreading depression: a computational study

Experimental evidences point out the participation of nonsynaptic mechanisms (e.g., fluctuations in extracellular ions) in epileptiform bursting and spreading depression (SD). During these abnormal oscillatory patterns, it is observed an increase of extracellular potassium concentration [K(+)](o) and a decrease of extracellular calcium concentration [Ca(2+)](o) which raises the neuronal excitability. However, whether the high [K(+)](o) triggers and propagates these abnormal neuronal activities or plays a secondary role into this process is unclear. To better understand the influence of extracellular potassium dynamics in these oscillatory patterns, the experimental conditions of high [K(+)](o) and zero [Ca(2+)](o) were replicated in an extended Golomb model where we added important regulatory mechanisms of ion concentration as Na(+)-K(+) pump, ion diffusion and glial buffering. Within these conditions, simulations of the cell model exhibit seizure-like discharges (ictal bursting). The SD was elicited by the interruption of the Na(+)-K(+) pump activity, mimicking the effect of cellular hypoxia (an experimental protocol to elicit SD, the hypoxia-induced SD). We used the bifurcation theory and the fast-slow method to analyze the interference of K(+) dynamics in the cellular excitability. This analysis indicates that the system loses its stability at a high [K(+)](o), transiting to an elevated state of neuronal excitability. Effects of high [K(+)](o) are observed in different stages of ictal bursting and SD. In the initial stage, the increase of [K(+)](o) creates favorable conditions to trigger both oscillatory patterns. During the neuronal activity, a continuous growth of [K(+)](o) by outward K(+) flow depresses K(+) currents in a positive feedback way. At the last stage, due to the depression of K(+) currents, the Na(+)-K(+) pump is the main mechanism in the end of neuronal activity. Thus, this work suggests that [K(+)](o) dynamics may play a fundamental role in these abnormal oscillatory patterns.

A role for glutamate and glia in the fast network oscillations preceding spreading depression

The mechanism of the propagation of spreading depression is unclear. Classical theories proposed a self-maintained cycle fed by elevated potassium and/or glutamate in the extracellular space. Earlier we found in vivo a characteristic oscillatory field activity that is synchronous in a strip of tissue ahead of the oncoming wave of neuron depolarization and that occurs before the extracellular potassium level begins to rise [Herreras O, Largo C, Ibarz JM, Somjen GG, Marrín del Río R (1994) Role of neuronal synchronizing mechanisms in the propagation of spreading depression in the in vivo hippocampus. J Neurosci 14:7087-7098]. We investigated here the possible participation of glutamate and the role of glia in the prodromal field oscillations using extra and intracellular recordings and pharmacological manipulations in rat hippocampal slices. As earlier shown in vivo, field oscillations propagated ahead of the negative potential shift covering distances of up to 1 mm. The oscillatory prodromals were initially subthreshold but then each wave became crowned by a population spike. The frequency of the oscillatory prodromals was variable among slices (80-115 Hz), but constant in individual slices. The blockade of ionotropic glutamate receptors decreased the frequency of prodromal oscillations, retarded spreading depression propagation, and shortened the duration of depolarization. Blocking the glutamate membrane transport increased the oscillatory frequency. The selective metabolic poisoning of astrocytes led to gradual disorganization of prodromal oscillations whose frequency first increased and then decreased. Also, the amplitude of the population spikes within the burst diminished as individual cells fired fewer action potentials, although still phase-locked with population spikes. The effects of glial metabolic impairment were observed within the period when neuron electrical properties were still normal, and were blocked by glutamate receptor antagonists. These data suggest that glutamate released from glial cells and possibly also from neurons has a role in the generation of oscillations and neuron firing synchronization that precede the spreading depression-related depolarization, but additional mechanisms are required to fully explain the onset and propagation of spreading depression.