Reduced Retinal Function in the Absence of Na(v)1.6

Cisplatin-Induced Toxic Optic Neuropathy in a Patient With Hodgkin's Lymphoma

Hodgkin's lymphoma (HL) is commonly treated with multi-agent chemotherapy, with cisplatin being a key component due to its effectiveness in inducing DNA crosslinking and causing cancer cell death. Despite its therapeutic benefits, cisplatin can lead to serious ocular complications, including a rare but severe condition known as cisplatin-induced toxic optic neuropathy. This condition, while uncommon, has the potential to cause significant and irreversible visual impairment, particularly in pediatric patients, even when cisplatin is administered at standard therapeutic doses. The lack of specific guidelines for ocular monitoring during cisplatin therapy exacerbates the challenge of managing this complication, highlighting the importance of monitoring, early detection and intervention. This case report describes a 16-year-old male pediatric patient with stage IVA HL who was admitted for dexamethasone, high-dose cytarabine, and platinum (DHAP) chemotherapy to treat relapsed disease. He developed sudden, painless bilateral vision loss three days after the discontinuation of the DHAP regimen, which had been stopped due to tumor lysis syndrome and acute kidney failure. The patient presented with severely reduced visual acuity and optic disc swelling in both eyes. Despite receiving high-dose intravenous methylprednisolone, visual improvement was minimal. Unfortunately, the patient did not survive due to disease progression. This case report emphasizes the critical need for careful ocular monitoring and the prompt involvement of ophthalmologists to manage and prevent severe and irreversible ocular complications associated with cisplatin therapy.

Voltage-gated sodium channel-dependent retroaxonal modulation of photoreceptor function during post-natal development in mice

Juvenile (postnatal day 16) mice lacking Na_v 1.6 channels (null-mutant Scn8a^dmu ) have reduced photoreceptor function, which is unexpected given that Na_v channels have not been detected in mouse photoreceptors and do not contribute appreciably to photoreceptor function in adults. We demonstrate that acute block of Na_v channels with intravitreal TTX in juvenile (P16) wild-type mice has no effect on photoreceptor function. However, reduced light activity by prolonged dark adaptation from P8 caused significant reduction in photoreceptor function at P16. Injecting TTX into the retrobulbar space at P16 to specifically block Na_v channels in the optic nerve also caused a reduction in photoreceptor function comparable to that seen at P16 in null-mutant Scn8a mice. In both P16 null-mutant Scn8a^dmu and retrobulbar TTX-injected wild-type mice, photoreceptor function was restored following intravitreal injection of the TrkB receptor agonist 7,8-dihydroxyflavone, linking Na_v -dependent retrograde transport to TrkB-dependent neurotrophic factor production pathways as a modulatory influence of photoreceptor function at P16. We also found that in Scn8a^dmu mice, photoreceptor function recovers by P22-25 despite more precarious general health of the animal. Retrobulbar injection of TTX in the wild type still reduced the photoreceptor response at this age but to a lesser extent, suggesting that Na_v -dependent modulation of photoreceptor function is largely transient, peaking soon after eye opening. Together, these results suggest that the general photosensitivity of the retina is modulated following eye opening by retrograde transport through activity-dependent retinal ganglion cell axonal signaling targeting TrkB receptors.

Voltage- and calcium-gated ion channels of neurons in the vertebrate retina

In this review, we summarize studies investigating the types and distribution of voltage- and calcium-gated ion channels in the different classes of retinal neurons: rods, cones, horizontal cells, bipolar cells, amacrine cells, interplexiform cells, and ganglion cells. We discuss differences among cell subtypes within these major cell classes, as well as differences among species, and consider how different ion channels shape the responses of different neurons. For example, even though second-order bipolar and horizontal cells do not typically generate fast sodium-dependent action potentials, many of these cells nevertheless possess fast sodium currents that can enhance their kinetic response capabilities. Ca2+ channel activity can also shape response kinetics as well as regulating synaptic release. The L-type Ca2+ channel subtype, CaV1.4, expressed in photoreceptor cells exhibits specific properties matching the particular needs of these cells such as limited inactivation which allows sustained channel activity and maintained synaptic release in darkness. The particular properties of K+ and Cl- channels in different retinal neurons shape resting membrane potentials, response kinetics and spiking behavior. A remaining challenge is to characterize the specific distributions of ion channels in the more than 100 individual cell types that have been identified in the retina and to describe how these particular ion channels sculpt neuronal responses to assist in the processing of visual information by the retina.

Short Communication: Contribution of Voltage-Gated Sodium Channels to the Rabbit Cone Electroretinograms

PURPOSE

Although the rabbit eye is of a similar size to the human eye, our limited understanding of the differences in retinal physiology to other species hinders its use in retinal research. The role of voltage-gated sodium channels (Nav) in the propagation of excitatory potentials along bipolar cells remains unclear, as conflicting data have been reported in the rabbit. The present study assesses the relative contributions of Nav to the scotopic and photopic flash ERGs as well as the wavelength-dependence of Nav blockade on the rabbit flicker ERG.

MATERIALS AND METHODS

Tetrodotoxin (TTX, 1 μM) was injected into the vitreous cavity of Chinchilla bastard rabbits. Scotopic ERGs were evoked by white flashes ranging from 10(-5) to 10 cds m(-2), photopic ERGs on a background of 25 cdm(-2) using flash intensities of 0.032-25 cds m(-2). Flicker ERGs (3-50 Hz) were elicited by blue, green and yellow stimuli at 2.34 cds m(-2) on a white background of 30 cdm(-2).

RESULTS

The a- and b-waves of the scotopic ERG were unaffected by intravitreal injection of the Nav blocker TTX. In contrast, the b-wave, but not the a-wave, of the photopic ERG was selectively blocked by TTX. The reduction by TTX of the flicker ERG was greater for blue than for green and yellow stimuli.

DISCUSSION

The data suggest that Nav selectively contribute to the generation of the photopic b-wave in the rabbit, indicating that they play an important role in the propagation of excitatory signals on bipolar cells in the cone, but not rod pathways. Importantly, the present study resolves conflicting previous reports into the role of Nav in the retinal function of the rabbit.

Structural basis for the modulation of the neuronal voltage-gated sodium channel NaV1.6 by calmodulin

The neuronal-voltage gated sodium channel (VGSC), Na(V)1.6, plays an important role in propagating action potentials along myelinated axons. Calmodulin (CaM) is known to modulate the inactivation kinetics of Na(V)1.6 by interacting with its IQ motif. Here we report the crystal structure of apo-CaM:Na(V)1.6IQ motif, along with functional studies. The IQ motif of Na(V)1.6 adopts an α-helical conformation in its interaction with the C-lobe of CaM. CaM uses different residues to interact with Na(V)1.6IQ motif depending on the presence or absence of Ca²⁺. Three residues from Na(V)1.6, Arg1902, Tyr1904 and Arg1905 were identified as the key common interacting residues in both the presence and absence of Ca²⁺. Substitution of Arg1902 and Tyr1904 with alanine showed a reduced rate of Na(V)1.6 inactivation in electrophysiological experiments in vivo. Compared with other CaM:Na(V) complexes, our results reveal a different mode of interaction for CaM:Na(V)1.6 and provides structural insight into the isoform-specific modulation of VGSCs.