Digital endpoints in clinical trials of Alzheimer's disease and other neurodegenerative diseases: challenges and opportunities

Alzheimer's disease (AD) and other neurodegenerative diseases such as Parkinson's disease (PD) and Huntington's disease (HD) are associated with progressive cognitive, motor, affective and consequently functional decline considerably affecting Activities of Daily Living (ADL) and quality of life. Standard assessments, such as questionnaires and interviews, cognitive testing, and mobility assessments, lack sensitivity, especially in early stages of neurodegenerative diseases and in the disease progression, and have therefore a limited utility as outcome measurements in clinical trials. Major advances in the last decade in digital technologies have opened a window of opportunity to introduce digital endpoints into clinical trials that can reform the assessment and tracking of neurodegenerative symptoms. The Innovative Health Initiative (IMI)-funded projects RADAR-AD (Remote assessment of disease and relapse-Alzheimer's disease), IDEA-FAST (Identifying digital endpoints to assess fatigue, sleep and ADL in neurodegenerative disorders and immune-mediated inflammatory diseases) and Mobilise-D (Connecting digital mobility assessment to clinical outcomes for regulatory and clinical endorsement) aim to identify digital endpoints relevant for neurodegenerative diseases that provide reliable, objective, and sensitive evaluation of disability and health-related quality of life. In this article, we will draw from the findings and experiences of the different IMI projects in discussing (1) the value of remote technologies to assess neurodegenerative diseases; (2) feasibility, acceptability and usability of digital assessments; (3) challenges related to the use of digital tools; (4) public involvement and the implementation of patient advisory boards; (5) regulatory learnings; and (6) the significance of inter-project exchange and data- and algorithm-sharing.

Description of the Method for Evaluating Digital Endpoints in Alzheimer Disease Study: Protocol for an Exploratory, Cross-sectional Study

Background

More sensitive and less burdensome efficacy end points are urgently needed to improve the effectiveness of clinical drug development for Alzheimer disease (AD). Although conventional end points lack sensitivity, digital technologies hold promise for amplifying the detection of treatment signals and capturing cognitive anomalies at earlier disease stages. Using digital technologies and combining several test modalities allow for the collection of richer information about cognitive and functional status, which is not ascertainable via conventional paper-and-pencil tests.

Objective

This study aimed to assess the psychometric properties, operational feasibility, and patient acceptance of 10 promising technologies that are to be used as efficacy end points to measure cognition in future clinical drug trials.

Methods

The Method for Evaluating Digital Endpoints in Alzheimer Disease study is an exploratory, cross-sectional, noninterventional study that will evaluate 10 digital technologies’ ability to accurately classify participants into 4 cohorts according to the severity of cognitive impairment and dementia. Moreover, this study will assess the psychometric properties of each of the tested digital technologies, including the acceptable range to assess ceiling and floor effects, concurrent validity to correlate digital outcome measures to traditional paper-and-pencil tests in AD, reliability to compare test and retest, and responsiveness to evaluate the sensitivity to change in a mild cognitive challenge model. This study included 50 eligible male and female participants (aged between 60 and 80 years), of whom 13 (26%) were amyloid-negative, cognitively healthy participants (controls); 12 (24%) were amyloid-positive, cognitively healthy participants (presymptomatic); 13 (26%) had mild cognitive impairment (predementia); and 12 (24%) had mild AD (mild dementia). This study involved 4 in-clinic visits. During the initial visit, all participants completed all conventional paper-and-pencil assessments. During the following 3 visits, the participants underwent a series of novel digital assessments.

Results

Participant recruitment and data collection began in June 2020 and continued until June 2021. Hence, the data collection occurred during the COVID-19 pandemic (SARS-CoV-2 virus pandemic). Data were successfully collected from all digital technologies to evaluate statistical and operational performance and patient acceptance. This paper reports the baseline demographics and characteristics of the population studied as well as the study's progress during the pandemic.

Conclusions

This study was designed to generate feasibility insights and validation data to help advance novel digital technologies in clinical drug development. The learnings from this study will help guide future methods for assessing novel digital technologies and inform clinical drug trials in early AD, aiming to enhance clinical end point strategies with digital technologies.

International Registered Report Identifier (IRRID)

DERR1-10.2196/35442

Remote monitoring technologies in Alzheimer's disease: design of the RADAR-AD study

Background

Functional decline in Alzheimer’s disease (AD) is typically measured using single-time point subjective rating scales, which rely on direct observation or (caregiver) recall. Remote monitoring technologies (RMTs), such as smartphone applications, wearables, and home-based sensors, can change these periodic subjective assessments to more frequent, or even continuous, objective monitoring. The aim of the RADAR-AD study is to assess the accuracy and validity of RMTs in measuring functional decline in a real-world environment across preclinical-to-moderate stages of AD compared to standard clinical rating scales.

Methods

This study includes three tiers. For the main study, we will include participants (n = 220) with preclinical AD, prodromal AD, mild-to-moderate AD, and healthy controls, classified by MMSE and CDR score, from clinical sites equally distributed over 13 European countries. Participants will undergo extensive neuropsychological testing and physical examination. The RMT assessments, performed over an 8-week period, include walk tests, financial management tasks, an augmented reality game, two activity trackers, and two smartphone applications installed on the participants’ phone. In the first sub-study, fixed sensors will be installed in the homes of a representative sub-sample of 40 participants. In the second sub-study, 10 participants will stay in a smart home for 1 week.

The primary outcome of this study is the difference in functional domain profiles assessed using RMTs between the four study groups. The four participant groups will be compared for each RMT outcome measure separately. Each RMT outcome will be compared to a standard clinical test which measures the same functional or cognitive domain. Finally, multivariate prediction models will be developed. Data collection and privacy are important aspects of the project, which will be managed using the RADAR-base data platform running on specifically designed biomedical research computing infrastructure.

Results

First results are expected to be disseminated in 2022.

Conclusion

Our study is well placed to evaluate the clinical utility of RMT assessments. Leveraging modern-day technology may deliver new and improved methods for accurately monitoring functional decline in all stages of AD. It is greatly anticipated that these methods could lead to objective and real-life functional endpoints with increased sensitivity to pharmacological agent signal detection.

A New Perspective in the Field of Cardiac Safety Testing through the Comprehensive In Vitro Proarrhythmia Assay Paradigm

For the past decade, cardiac safety screening to evaluate the propensity of drugs to produce QT interval prolongation and Torsades de Pointes (TdP) arrhythmia has been conducted according to ICH S7B and ICH E14 guidelines. Central to the existing approach are hERG channel assays and in vivo QT measurements. Although effective, the present paradigm carries a risk of unnecessary compound attrition and high cost, especially when considering costly thorough QT (TQT) studies conducted later in drug development. The C: omprehensive I: n Vitro P: roarrhythmia A: ssay (CiPA) initiative is a public-private collaboration with the aim of updating the existing cardiac safety testing paradigm to better evaluate arrhythmia risk and remove the need for TQT studies. It is hoped that CiPA will produce a standardized ion channel assay approach, incorporating defined tests against major cardiac ion channels, the results of which then inform evaluation of proarrhythmic actions in silico, using human ventricular action potential reconstructions. Results are then to be confirmed using human (stem cell-derived) cardiomyocytes. This perspective article reviews the rationale, progress of, and challenges for the CiPA initiative, if this new paradigm is to replace existing practice and, in time, lead to improved and widely accepted cardiac safety testing guidelines.

Role of mitochondria in Ca(2+) homeostasis of mouse pancreatic acinar cells

The effects of mitochondrial Ca(2+) uptake on cytosolic Ca(2+) concentration ([Ca(2+)](c)) were investigated in mouse pancreatic acinar cells using cytosolic and/or mitochondrial Ca(2+) indicators. When calcium stores of the endoplasmic reticulum (ER) were emptied by prolonged incubation with thapsigargin (Tg) and acetylcholine (ACh), small amounts of calcium could be released into the cytosol (Delta[Ca(2+)](c)=46 +/- 6 nM, n=13) by applying mitochondrial inhibitors (combination of rotenone (R) and oligomycin (O)). However, applications of R/O, soon after the peak of Tg/Ach-induced Ca(2+) transient, produced a larger cytosolic calcium elevation (Delta[Ca(2+)](c)=84 +/- 6 nM, n=9), this corresponds to an increase in the total mitochondrial calcium concentration ([Ca(2+)](m)) by approximately 0.4 mM. In cells pre-treated with R/O or Ru360 (a specific blocker of mitochondrial Ca(2+) uniporter), the decay time-constant of the Tg/ACh-induced Ca(2+) response was prolonged by approximately 40 and 80%, respectively. Tests with the mitochondrial Ca(2+) indicator rhod-2 revealed large increases in [Ca(2+)](m) in response to Tg/ACh applications; this mitochondrial uptake was blocked by Ru360. In cells pre-treated with Ru360, 10nM ACh elicited large global increases in [Ca(2+)](c), compared to control cells in which ACh-induced Ca(2+) signals were localised in the apical region. We conclude that mitochondria are active elements of cellular Ca(2+) homeostasis in pancreatic acinar cells and directly modulate both local and global calcium signals induced by agonists.

Correlation of NADH and Ca2+ signals in mouse pancreatic acinar cells

Relationships between calcium signals and NADH responses were investigated in pancreatic acinar cells stimulated with calcium-releasing secretagogues. Cytosolic calcium signals were studied using Fura Red or calcium-sensitive Cl(-) current. Mitochondrial calcium was measured using Rhod-2. The highest levels of NADH autofluorescence were found around the secretory granule region. Stimulation of cells with physiological doses of cholecystokinin (CCK) triggered slow oscillations of NADH autofluorescence. NADH oscillations were clearly resolved in the mitochondrial clusters around secretory granules. Very fast apical calcium signals induced by acetylcholine (ACh) produced no detectable changes in NADH; slightly more extended apical (or preferentially apical) calcium transients triggered clear NADH responses. Triple combined recordings of cytosolic calcium, mitochondrial calcium and NADH revealed the sequence of development of individual signals: an increase in cytosolic calcium was accompanied by a slower mitochondrial calcium response followed by a delayed increase in NADH fluorescence. Recovery of cytosolic calcium was faster than recovery of mitochondrial calcium. NADH recovery occurred at elevated mitochondrial calcium levels. During the transient cytosolic calcium oscillations induced by intermediate doses of ACh, there was an initial increase in NADH fluorescence following the first calcium transient; each of the subsequent calcium responses produced biphasic NADH changes comprising an initial small decline followed by restoration to an elevated calcium level. During the higher-frequency sinusoidal calcium oscillations induced by higher doses of ACh, NADH responses fused into a smooth rise followed by a slow decline. Supramaximal doses of ACh and CCK produced single large NADH transients.

Perinuclear, perigranular and sub-plasmalemmal mitochondria have distinct functions in the regulation of cellular calcium transport

We have identified three distinct groups of mitochondria in normal living pancreatic acinar cells, located (i) in the peripheral basolateral region close to the plasma membrane, (ii) around the nucleus and (iii) in the periphery of the granular region separating the granules from the basolateral area. Three-dimensional reconstruction of confocal slices showed that the perigranular mitochondria form a barrier surrounding the whole of the granular region. Cytosolic Ca(2+) oscillations initiated in the granular area triggered mitochondrial Ca(2+) uptake mainly in the perigranular area. The most intensive uptake occurred in the mitochondria close to the apical plasma membrane. Store-operated Ca(2+) influx through the basolateral membrane caused preferential Ca(2+) uptake into sub-plasmalemmal mitochondria. The perinuclear mitochondria were activated specifically by local uncaging of Ca(2+) in the nucleus. These mitochondria could isolate nuclear and cytosolic Ca(2+) signalling. Photobleaching experiments indicated that different groups of mitochondria were not luminally connected. The three mitochondrial groups are activated independently by specific spatiotemporal patterns of cytosolic Ca(2+) signals and can therefore participate in the local regulation of Ca(2+) homeostasis and energy supply.

Calcium-dependent enzyme activation and vacuole formation in the apical granular region of pancreatic acinar cells

The pancreatic acinar cell produces powerful digestive enzymes packaged in zymogen granules in the apical pole. Ca(2+) signals elicited by acetylcholine or cholecystokinin (CCK) initiate enzyme secretion by exocytosis through the apical membrane. Intracellular enzyme activation is normally kept to a minimum, but in the often-fatal human disease acute pancreatitis, autodigestion occurs. How the enzymes become inappropriately activated is unknown. We monitored the cytosolic Ca(2+) concentration ([Ca(2+)](i)), intracellular trypsin activation, and its localization in isolated living cells with specific fluorescent probes and studied intracellular vacuole formation by electron microscopy as well as quantitative image analysis (light microscopy). A physiological CCK level (10 pM) eliciting regular Ca(2+) spiking did not evoke intracellular trypsin activation or vacuole formation. However, stimulation with 10 nM CCK, evoking a sustained rise in [Ca(2+)](i), induced pronounced trypsin activation and extensive vacuole formation, both localized in the apical pole. Both processes were abolished by preventing abnormal [Ca(2+)](i) elevation, either by preincubation with the specific Ca(2+) chelator 1, 2-bis(O-aminophenoxy)ethane-N,N-N',N'-tetraacetic acid (BAPTA) or by removal of external Ca(2+). CCK hyperstimulation evokes intracellular trypsin activation and vacuole formation in the apical granular pole. Both of these processes are mediated by an abnormal sustained rise in [Ca(2+)](i).

Experimental study showing a diminished cytosolic antioxidative capacity in kidneys of aged rats

In response to the rising demand for renal transplantations, more and more marginal (e.g. older) organs are being transplanted with the result of decreasing graft survival rates. Ischemia-reperfusion injury via oxidative stress is thought to be the main pathogenetic factor for this phenomenon. The cytosolic antioxidative capacity (CAC; expressed as superoxide anion radical scavenging capacity and quantified as the amount of cytosol (=ID(50)), which scavenges 50% of superoxide anions generated by a defined xanthine oxidase activity in vitro) and the catalase activity were therefore quantified in renal tissues of young (10 weeks) and older (40 and 60 weeks) Wistar rats and compared to each other. CAC with an ID(50) of 0.064 microl in 10-week-old rats was significantly higher than in older rats (0.152 microl in 40- and 0.100 microl in 60-week-old rats; p < 0.01). The catalase activity in 10-week-old rats was 18, 200 +/- 3,500 U/g w/w and 18,900 +/- 850 U/g w/w in 40-week-old rats. In 60-week-old rats, however, catalase activity was found to be significantly less (7,500 +/- 175 U/g w/w; p < 0.01). In conclusion, the aforementioned significant decrease of the cytosolic antioxidative capacity of kidneys in older rats should be the rationale for extensive cytoprotective, antioxidative treatment trials especially after renal transplantation from aged donors.

Release of monoamines and nitric oxide is involved in the modulation of hyperpolarization-activated inward current during acute thalamic hypoxia

Using slices of the dorsal lateral geniculate nucleus, it has been shown that, in the presence of excitatory and inhibitory amino acid antagonists, brief periods of hypoxia (3-4 min of 95% N(2)/5% CO(2)) induce in thalamocortical neurons an increase in instantaneous input conductance (G(N)) accompanied by an inward shift in baseline holding current (I(BH)). These effects have been suggested to be mediated, at least in part, by a positive shift in the voltage-dependence of the hyperpolarization-activated, mixed Na(+)/K(+) current (I(h)) and a change in its activation kinetics which transforms it into an almost instantaneously activated current. In this study, using the whole-cell patch-clamp technique, the contribution of an increased Ca(2+)-dependent transmitter release to the hypoxic response of thalamocortical neurons was further investigated using (i) blockers of calcineurin, a Ca(2+)/calmodulin-activated phosphatase that selectively regulates Ca(2+)-dependent release, and (ii) antagonists of neurotransmitters that are known to modulate I(h). Thalamocortical neurons (n = 23) recorded with electrodes filled with calcineurin autoinhibitory fragment (30-250 microM), a membrane impermeable blocker of calcinuerin, showed no difference either in resting, or in the hypoxia-induced changes in, G(N), I(BH) and I(h), when compared to thalamocortical cells patched with electrodes that did not contain calcineurin autoinhibitory fragment. In contrast, in 18 of these neurons recorded with calcineurin autoinhibitory fragment-filled electrodes, bath application either of cyclosporin-A (20 microM) or tacrolimus (50-100 microM), two membrane permeable blockers of calcineurin, abolished the effects of hypoxia on G(N), I(BH), and I(h). Separate application of noradrenaline, serotonin, histamine and nitric oxide antagonists produced only a small depression of the hypoxic response, while concomitant bath application of these antagonists decreased the hypoxia-induced changes in G(N) and I(BH) by 55 and 42%, respectively (n = 12). Concomitant bath application of 8-bromo-adenosine-3'5'-cyclicmonophosphate and 8-bromo-guanosine-3'5'-cyclicmonophosphate (both 1mM), which are known to mediate the action of these transmitters on I(h), increased G(N) (40%), decreased I(h) time-constant of activation (30%) and significantly occluded (50%) the hypoxia-induced effect on G(N) and I(BH). Thalamocortical neurons (n = 6) patched with electrodes filled with 8-bromo-adenosine-3'5'-cyclicmonophosphate and 8-bromo-guanosine-3'5'-cyclicmonophosphate (both 1 mM) showed a larger G(N) than the one recorded with the standard internal solution, and a significant depression of the hypoxia-induced changes in G(N) and I(BH). These results indicate that during acute thalamic hypoxia an increased release of noradrenaline, serotonin, histamine and nitric oxide is responsible for transforming I(h) into an instantaneously activating current via cyclic AMP- and cyclic GMP-mediated mechanisms.

Potassium conductance causing hyperpolarization of CA1 hippocampal neurons during hypoxia

In experiments on slices (from 100- to 150-g Sprague-Dawley rats) kept at 33 degreesC, we studied the effects of brief hypoxia (2-3 min) on CA1 neurons. In whole cell recordings from submerged slices, with electrodes containing only KMeSO4 and N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid, and in the presence of kynurenate and bicuculline (to minimize transmitter actions), hypoxia produced the following changes: under current clamp, 36 cells were hyperpolarized by 2.7 +/- 0.5 (SE) mV and their input resistance (Rin) fell by 23 +/- 2.7%; in 30 cells under voltage clamp, membrane current increased by 114 +/- 22.3 pA and input conductance (Gin) by 4.9 +/- 0.9 nS. These effects are much greater than those seen previously with K gluconate whole cell electrodes, but only half those seen with "sharp" electrodes. The hypoxic hyperpolarizations (or outward currents) were not reduced by intracellular ATP (1-5 mM) or bath-applied glyburide (10 microM): therefore they are unlikely to be mediated by conventional ATP-sensitive K channels. On the other hand, their depression by internally applied ethylene glycol-bis-(beta-aminoethyl ether)-N,N, N',N'-tetraacetic acid (1.1 and 11 mM) and especially 1, 2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (11-33 mM) indicated a significant involvement of Ca-dependent K (KCa) channels. The beta-adrenergic agonist isoprenaline (10 microM) reduced hypoxic hyperpolarizations and decreases in Rin (n = 4) (and in another 11 cells corresponding changes in Gin); and comparable but more variable effects were produced by internally applied 3':5'-adenosine cyclic monophosphate (cAMP, 1 mM, n = 6) and bath-applied 8-bromo-cAMP (n = 8). Thus afterhyperpolarization-type KCa channels probably take part in the hypoxic response. A major involvement of G proteins is indicated by the near total suppression of the hypoxic response by guanosine 5'-O-(3-thiotriphosphate) (0. 1-0.3 mM, n = 23) and especially guanosine 5'-O-(2-thiodiphosphate) (0.3 mM, n = 26), both applied internally. The adenosine antagonist 8-(p-sulfophenyl)theophylline (10-50 microM) significantly reduced hypoxic hyperpolarizations and outward currents in whole cell recordings (with KMeSO4 electrodes) from submerged slices but not in intracellular recordings (with KCl electrodes) from slices kept at gas/saline interface. In further intracellular recordings, antagonists of gamma-aminobutyric acid-B or serotonin receptors also had no clear effect. In conclusion, these G-protein-dependent hyperpolarizing changes produced in CA1 neurons by hypoxia are probably initiated by Ca2+ release from internal stores stimulated by enhanced glycolysis and a variable synergistic action of adenosine.

Response of thalamocortical neurons to hypoxia: a whole-cell patch-clamp study

The effect of hypoxia (3-4 min of 95% N2, 5% CO2) on thalamocortical (TC) neurons was investigated using the whole-cell patch-clamp technique in rat dorsal lateral geniculate nucleus slices kept submerged at 32 degreesC. The predominant feature of the response of TC neurons to hypoxia was an increase in input conductance (DeltaGN = 117 +/- 15%, n = 33) that was accompanied by an inward shift in baseline holding current (IBH) at -65 and -57 mV (DeltaIBH = -45 +/- 6 pA, n = 18, and -25 +/- 8 pA, n = 33, respectively) but not at -40 mV. The hypoxia-induced increase in GN (as well as the shift in IBH) was abolished by procedures that are known to block Ih, i.e., bath application of 4-(N-ethyl-N-phenylamino)-1, 2-dimethyl-6-(methylamino)-pyrimidinium chloride (100-300 microM) (DeltaGN = 5 +/- 13%, n = 11) and CsCl (2-3 mM) (DeltaGN = 16 +/- 16%, n = 5), or low [Na+]o (DeltaGN = 10 +/- 10%, n = 5), whereas bath application of BaCl2 (0.1-2.0 mM) had no significant effect (DeltaGN = 128 +/- 14%, n = 8). The hypoxic response was also abolished in low [Ca+2]o (DeltaGN = 25 +/- 16%, DeltaIBH = -6 +/- 8 pA, n = 13), but was unaffected by recording with electrodes containing EGTA (10 mM), BAPTA (10-30 mM), Cs+, or Cl-, as well as in the presence of external tetraethylammonium and 4-aminopyridine. Furthermore, preincubation of the slices with botulinum toxin A (100 nM), which is known to reduce Ca2+-dependent transmitter release, blocked the hypoxic response (DeltaGN = -3 +/- 15%, DeltaIBH = 10 +/- 5 pA, n = 4). We suggest that a positive shift in the voltage-dependence of Ih and a change in its activation kinetics, which transforms it into a fast activating current, may be responsible for the hypoxia-induced changes in GN and IBH, probably via an increase in Ca+2-dependent transmitter release.

On the action of the anti-absence drug ethosuximide in the rat and cat thalamus

The action of ethosuximide (ETX) on Na+, K+, and Ca2+ currents and on tonic and burst-firing patterns was investigated in rat and cat thalamic neurons in vitro by using patch and sharp microelectrode recordings. In thalamocortical (TC) neurons of the rat dorsal lateral geniculate nucleus (LGN), ETX (0.75-1 mM) decreased the noninactivating Na+ current, INaP, by 60% but had no effect on the transient Na+ current. In TC neurons of the rat and cat LGN, the whole-cell transient outward current was not affected by ETX (up to 1 mM), but the sustained outward current was decreased by 39% at 20 mV in the presence of ETX (0.25-0.5 mM): this reduction was not observed in a low Ca2+ (0.5 mM) and high Mg2+ (8 mM) medium or in the presence of Ni2+ (1 mM) and Cd2+ (100 microM). In addition, ETX (up to 1 mM) had no effect on the low-threshold Ca2+ current, IT, of TC neurons of the rat ventrobasal (VB) thalamus and LGN and in neurons of the rat nucleus reticularis thalami nor on the high-threshold Ca2+ current in TC neurons of the rat LGN. Sharp microelectrode recordings in TC neurons of the rat and cat LGN and VB showed that ETX did not change the resting membrane potential but increased the apparent input resistance at potentials greater than -60 mV, resulting in an increase in tonic firing. In contrast, ETX decreased the number of action potentials in the burst evoked by a low-threshold Ca2+ potential. The frequency of the remaining action potentials in a burst also was decreased, whereas the latency of the first action potential was increased. Similar effects were observed on the burst firing evoked during intrinsic delta oscillations. These results indicate an action of ETX on INaP and on the Ca2+-activated K+ current, which explains the decrease in burst firing and the increase in tonic firing, and, together with the lack of action on low- and high-threshold Ca2+ currents, the results cast doubts on the hypothesis that a reduction of IT in thalamic neurons underlies the therapeutic action of this anti-absence medicine.

Monitoring cellular edema at single-neuron level by electrical resistance measurements

Electrical resistance measurements have been used for investigating extracellular volume fraction (EVF) of brain tissue. Conventional techniques using multiple metal electrodes are limited in their spatial resolution, and thus not suitable for detecting local EVF changes at cellular level. We used a multibarrelled glass microelectrode to monitor cellular swelling locally at single-neuron level. The microelectrode was placed in CA1 region of the rat hippocampus, in situ. A constant current pulse was applied between one of the barrels and a reference electrode placed in the neck. The resultant voltage drop, which was directly proportional to the resistance of the immediate environment surrounding the tip of the microelectrode, was recorded through another barrel. A third barrel was used for iontophoretic injection of N-methyl-D-aspartate (NMDA) for inducing local cellular edema. The effect of diffuse edema induced by bilateral carotid artery ligation on EVF was also investigated. NMDA application increased the local tissue resistance by 2.0-, and ischemia, by 3.4-folds. We conclude that the method described can detect changes in EVF of minute volumes of brain tissue, and is suitable for monitoring very local effects of drugs or changes in the metabolism on cell volume.

Extrasynaptic glutamate spillover in the hippocampus: dependence on temperature and the role of active glutamate uptake

At excitatory synapses on CA1 pyramidal cells of the hippocampus, a larger quantal content is sensed by N-methyl-D-aspartic acid receptors (NMDARs) than by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs). A novel explanation for this discrepancy is that glutamate released from terminals presynaptic to one cell can diffuse to and activate NMDARs, but not AMPARs, on a neighboring cell. If this occurs in the living brain, it could invalidate the view that glutamatergic synapses function as private communication channels between neurons. Here, we show that the discrepancy in quantal content mediated by the two receptors is greatly decreased at physiological temperature, compared with conventional recording conditions. This effect of temperature is not due to changes in release probability or uncovering of latent AMPARs. It is, however, partially reversed by the glutamate uptake inhibitor dihydrokainate. The results suggest that glutamate transporters play a critical role in limiting the extrasynaptic diffusion of glutamate, thereby minimizing cross-talk between neighboring excitatory synapses.

LTP of AMPA and NMDA receptor-mediated signals: evidence for presynaptic expression and extrasynaptic glutamate spill-over

We have addressed the expression of long-term potentiation (LTP) in hippocampal CA1 by comparing AMPA and NMDA receptor-(AMPAR- and NMDAR-) mediated postsynaptic signals. We find that potentiation of NMDAR-mediated signals accompanies LTP of AMPAR-mediated signals, and is associated with a change in variability implying an increase in quantal content. Further, tetanic LTP of NMDAR-mediated signals can be elicited when LTP of AMPAR-mediated signals is prevented. We propose that LTP is mainly expressed presynaptically, and that, while AMPARs respond only to glutamate from immediately apposed terminals, NMDARs also sense glutamate released from terminals presynaptic to neighboring cells. We also find that tetanic LTP increases the rate of depression of NMDAR-mediated signals by the use-dependent blocker MK-801, implying an increase in the glutamate release probability. These findings argue for a presynaptic contribution to LTP and for extrasynaptic spill-over of glutamate onto NMDARs.

Is activation of metabotropic glutamate receptors responsible for acute hyposic changes in hippocampal neurons?

In whole-cell recordings from CA1 neurons in slices from rats, the mGLUR agonist (+/-)-1-aminocyclopentane-trans-1,3-dicarboxylic acid (ACPD; 10 microM) had a depolarizing action on most cells, associated with an increase in input resistance and suppression of afterhyperpolarizations. Under voltage-clamp, there were corresponding changes in membrane current and conductance; in the presence of ACPD, the slow voltage-dependent outward current recorded at approximately -25 mV was smaller and was more clearly depressed by hypoxia. Neither ACPD nor mGLUR antagonists, L(+)-2-amino-3-phosphonoproprionic acid (L-AP3; 1 mM) and (+)-alpha-methyl-4-carboxyphenyl-glycine (MCPG; 0.5 mM), reduced the hyperpolarization or outward current (or the associated changes in input resistance or conductance) induced by 2 min of hypoxia. Early inward currents, corresponding to the early, transient depolarizing effect of hypoxia, wer also not significantly depressed by either MCPG or L-AP3. The hypoxic responses of CA1 neurons in slices are therefore unlikely to be caused mainly be glutamate release and activation of mGLURs.

Tolbutamide blocks Ca(2+)- and voltage-dependent K+ currents of hippocampal Ca1 neurons

In current-clamp recordings with KMeSO4 electrodes (either whole-cell or intracellular), though tolbutamide (0.5-1 mM) did not change the resting potential, it increased both input resistance (by 12 +/- 3.8%) and spontaneous firing, and spikes were evoked by smaller depolarizing pulses. Tolbutamide reduced in a dose-dependent manner both components of post-burst afterhyperpolarizations: IC50 was 0.15 mM for medium afterhyperpolarizations and 0.33 mM for slow afterhyperpolarizations. In whole-cell recordings under voltage-clamp, 0.5-1 mM tolbutamide depressed slow outward currents by 65 +/- 5.3%. The tolbutamide-sensitive current was Ca(2+)-dependent-tolbutamide being ineffective in Mn2+, low Ca(2+)-containing medium-though tolbutamide did not significantly depress high voltage-activated Ca2+ currents. Tolbutamide reduced C-type outward currents by 45 +/- 5.9% and M-type current inward relaxations by 41 +/- 12.9%, as well as Q-type current inward relaxations by 22 +/- 5.7%. Glyburide (10 microM) did not depress afterhyperpolarizations or outward currents, even in recordings with electrodes containing 1 mM guanosine diphosphate. We conclude that the most prominent effects of 0.5-1 mM tolbutamide on CA1 neurons are caused by suppression of Ca(2+)-and voltage-dependent outward currents, including IAHP, IC and IM.

Effects of cerebral ischemia on N-methyl-D-aspartate and dihydropyridine-sensitive calcium currents. An electrophysiological study in the rat hippocampus in situ

BACKGROUND AND PURPOSE

During cerebral ischemia, both promoting and limiting factors are present for activation of the N-methyl-D-aspartate (NMDA) receptor ion channel and the dihydropyridine (DHP)-sensitive Ca2+ channels. We investigated the activity of these channels during ischemia and reperfusion in the rat hippocampus in situ.

METHODS

Reversible ischemia was induced by bilateral carotid artery ligation. NMDA and BAY K8644 were applied by iontophoresis or pneumatic ejection, and extracellular field potential and resistance changes were recorded from the CA1 region of the rat hippocampus. Resting membrane potentials of the CA1 neurons were also recorded.

RESULTS

DC potential shifts produced by NMDA and BAY K8644 were reduced when ischemia depressed the evoked activity more than 50%. They disappeared on total failure of synaptic transmission and recovered during reperfusion. When the evoked activity was depressed less than 50%, DC shifts were greater than their preischemic values; however, BAY K8644-induced potentiation did not reach statistical significance. CA1 neurons were depolarized during ischemia.

CONCLUSIONS

These data suggest that ischemia severe enough to cause transmission failure inactivates NMDA and DHP-sensitive Ca2+ currents. During less intense ischemia and reperfusion, NMDA and DHP-sensitive Ca2+ channels are functional, and their overactivation may lead to neurotoxicity.

Nitric oxide tonically depresses a voltage- and Ca-dependent outward current in hippocampal slices

In whole-cell recordings from CA1 neurons, net outward currents (at ca. -20 mV, from VH ca. -50 mV) were 40-50% depressed by sodium nitroprusside (100-500 microM) or L-arginine (L-ARG; 50-200 microM), but not by D-arginine (100 microM). The NO synthase inhibitor N omega-nitro-L-arginine methyl ester (L-NAME; 200 microM) restored the L-ARG-depressed current to ca. 80% of control. In naive cells, L-NAME increased outward currents by 45 +/- 12.6%; the enhanced currents were then reduced by adding L-ARG (200-400 microM). The NO-sensitive current is Ca-dependent, because L-NAME and L-ARG were ineffective in Mn/low Ca medium or when electrodes contained 2.2 mM EGTA. Since high voltage-activated Ca-currents were unaltered by L-NAME, we conclude that NO tonically enhances excitability in slices by depressing a voltage- and calcium-dependent (IK(Ca)-type) outward current.

Actions of diazoxide on CA1 neurons in hippocampal slices from rats

Membrane effects of diazoxide (DZX) were examined in CA1 pyramidal neurons, mainly by whole-cell recording in slices kept at 33 degrees C (from Sprague-Dawley rats). Bath applications of DZX (0.65 mM) did not significantly change the resting input conductance; but instantaneous inward rectification was reduced by 47 +/- 14% (near -110 mV). There was a similar depression of a large, sustained voltage-dependent outward current (by 44 +/- 11% near 0 mV). A nearly identical reduction of the outward current recorded in a Ca current suppressing medium (but not in 30 mM tetraethylammonium) indicated that the DZX-sensitive current includes the delayed rectifier. In Mn, low-Ca medium containing tetraethylammonium and carbachol, DZX potentiated (by 43 +/- 12%) the D-type slowly decaying outward current seen after hyperpolarizing pulses at a holding potential of approximately -50 mV. DZX abolished or depressed slow inward currents, such as the tetrodotoxin-sensitive persistent Na current, high voltage activated Ca currents (IC50 = 0.47 mM), and the Q current. In 6 of 13 cells recorded with electrodes containing either guanosine or adenosine diphosphate, DZX potentiated the voltage-dependent outward current, but input conductances were reduced. In conclusion, although there was little indication that it activates classical KATP channels in CA1 neurons, DZX strongly depresses several voltage-dependent, slowly inactivating outward and inward currents, which are important modulators of cell excitability.

Nitric oxide may be a mediator of effects of prolonged but not brief anoxia in CA1 neurons in slices

As a known vasodilator, nitric oxide (NO) probably acts by hyperpolarizing smooth muscle by increasing K conductance (GK). Therefore NO could mediate the anoxic hyperpolarizations of brain neurons that are also mediated by GK. We investigated this question by recording from CA1 neurons in submerged hippocampal slices (from rats), kept at 33 degrees C. Incubation with the NO synthase inhibitor N omega-nitro-L-arginine methyl ester (L-NAME; 200 microM) had no significant effect on CA1 population spikes (delta = 2.5%, SEM +/- 3.1%, n = 7) or on the time course of their suppression by brief exposure to anoxia (2-3 min). In intracellular recordings, L-NAME did not change the resting membrane potential or input resistance (n = 10). In the presence of L-NAME, anoxic changes were not significantly different: the cells were hyperpolarized by 6.4 +/- 0.74 mV (6.3 +/- 0.82 mV for controls) and their resistance decreased by 16 +/- 3.2% (18 +/- 1.4% for controls, n = 10). In whole-cell recordings from another 15 cells (clamped at approximately -50 mV, near resting level), L-NAME also had no consistent effect on input conductase (GN) or holding current (IH); and the anoxic increased in GN were unchanged (44 +/- 12% before and 48 +/- 20% after, for n = 10). Thus NO does not appear to be a significant element in the mechanism of membrane and synaptic changes during brief anoxia in CA1 neurons in slices.(ABSTRACT TRUNCATED AT 250 WORDS)

Tolbutamide suppresses slow and medium afterhyperpolarization in hippocampal slices

Afterhyperpolarizations (AHPs) were recorded (in whole-cell mode, with KMeSO4-containing electrodes) after multiple spikes evoked with 200 ms current pulses. Bath applications of tolbutamide (0.5-1 mM) to 12 CA1 neurones nearly abolished the medium and slow component of AHPs. Thus the AHPs generated by 7-8 spikes (mostly) were reduced by 82.6 +/- 5.2% (s.e.m.) at the initial peak (mAHP) and by 85.0 +/- 5.8% 1 s later (sAHP). Glibenclamide (10 microM) had no comparable blocking effect. The previous finding that tolbutamide (but not glibenclamide) selectively suppresses the anoxic hyperpolarization of CA1 neurones is therefore consistent with the idea that the anoxic hyperpolarization is mediated by Ca-dependent (especially AHP-type) K channels.

Actions of cromakalim on outward currents of CA1 neurones in hippocampal slices

1. Membrane effects of cromakalim (Crom; 50-300 microM) were examined in CA1 neurones recorded mainly by intracellular, single-electrode voltage-clamping in slices (from Sprague-Dawley rats) kept in an interface chamber at 33 degrees C. 2. In 14 cells held at -63 +/- 3.5 mV, in the presence of tetrodotoxin, kynurenic acid and (in most cases) bicuculline, bath applied Crom produced no consistent change in holding current (-59 +/- 66 pA) or input conductance (GN) (-3.9 +/- 5.2%). 3. Overall there were no significant changes in instantaneous inward rectification or in Q-current inward relaxations. 4. In 18 out of 22 cells, outward currents, evoked by 0.5 s pulses to voltages > -50 and < -20 mV, were depressed by Crom (by 42 +/- 11%, for n = 22). Because this effect was consistently seen in Ca current-blocking media, containing either Mn and low Ca, or Cd (and also carbachol), the K channels depressed by Crom were probably of the delayed rectifier (IDR) type. 5. The Crom-control difference current (ICrom), obtained with slow depolarizing ramps, had a biphasic character, inward in the voltage (V) range > -50 < -20 mV (where outward currents are depressed by Crom) and tending outward for V > or = -20 mV. 6. In 10 out of 11 cells, Crom potentiated a D-like, slowly-inactivating outward current (by 88 +/- 31%, for n = 11). 7 The effects of Crom and of 2 min periods of anoxia were compared in 12 cells: unlike anoxia, Cromproduced no consistent increases in GN; the currents evoked in the same cells by anoxia differed significantly from those evoked by Crom (by 150 +/- 60 pA); the directions of current changes induced byCrom and anoxia respectively were not significantly correlated. Crom strongly depressed anoxic outward currents (by 80 +/- 12%, n = 4).8 Some Crom-induced effects (increases in D-like current and the outward current elicited at V>- 20 mV) were always reversed by tolbutamide (1 mM), but much less consistently by glibenclamide(10-30 microM).9 In conclusion, the effects of Crom, recorded with intracellular electrodes in CA1 neurones in slices,show little resemblance to the effects of activation of ATP-sensitive K channels.

Guanosine diphosphate is required for activation of a glyburide, ATP and cromakalim-sensitive outward current in rat hippocampal neurones

Voltage-dependent outward currents were examined in CA1 neurones by whole-cell recording in slices. Nine cells were recorded with the 'standard' internal solution (KMeSO4, HEPES, EGTA, CaCl2, and MgCl2) and held a potential (-54 +/- 3 mV) at which there was no significant outward current. Cromakalim (CROM, 100 microM) reduced both input conductance (GN) (by 14 +/- 4%) and outward currents, evoked over a wide range of potentials by brief depolarizing pulses: at -4.0 +/- 3.0 mV, currents diminished by 30 +/- 10%. When 1 mM GDP was added to the standard internal solution, there was a significant outward current at approximately -54 mV; and CROM greatly increased outward currents near -4.0 mV (by 99 +/- 26.4%, n = 10). The enhanced outward currents were reduced by CROM washout (in two cells) and by 10 microM glyburide (GLYB, in four cells). When six other cells were recorded with electrodes containing both ATP (5 mM) and GDP (1 mM), there was no net outward current at approximately -54 mV and CROM reduced outward currents (at approximately 0 mV, by 37.5 +/- 10.9%). We conclude that GDP in hippocampal neurones appears to activate an ATP- and GLYB-sensitive outward current, which is much potentiated by CROM.

Diazoxide suppresses slowly-inactivating outward and inward currents in CA1 hippocampal neurones

Diazoxide (DZX) opens ATP-sensitive K (KATP) channels in muscle and other cells. In whole-cell voltage-clamp recordings in slices, in the presence of kynurenate and bicuculline to minimize indirect effects, DZX (0.65 mM) did not increase input conductance; but it sharply reduced persistent inward and outward currents. An inward current (peak near -20 mV) was especially clear in the presence of K channel blockers; was fully evident in Ca-channel blocking medium; but was abolished by tetrodotoxin. The main direct effects of DZX on these neurones are thus mediated not by activation of KATP channels, but rather by modulation of voltage-dependent channels, including a TTX-sensitive persistent NA current and possibly a Ca current.

Glycine is required for NMDA receptor activation: electrophysiological evidence from intact rat hippocampus

Fimbrial/commissural stimulation evokes a prolonged negative field potential in stratum radiatum of CA1 region of the rat hippocampus, in situ, upon activation of N-methyl-D-aspartate (NMDA) receptors. This activity can be induced by iontophoresis of NMDLA (50 nA) or glycine (50-100 nA) during low-frequency stimulation. 7-Cl-Kynurenate (10-30 nA) fully antagonized the NMDA receptor-mediated negative wave induced not only by glycine (N = 3) but also by NMDLA (N = 9), suggesting that activation of NMDA receptors is not possible without glycine binding. 7-Cl-Kynurenate also depressed the extracellular negative d.c. potential shifts appearing during iontophoresis of NMDLA. Stimulation with brief, high-frequency trains evoked a negative wave of 2.1 +/- 0.2 mV and 176 +/- 4 ms (N = 20) on the hippocampal field response following the last stimulus. Ketamine (100-200 nA, N = 6) and MK-801 (50-200 nA, N = 7) blocked the negative wave by 74 +/- 13 and 62 +/- 8%, respectively, while glycine (100 nA) potentiated it by 35 +/- 2% (N = 6), indicating that it had a component mediated by NMDA receptors. 7-Cl-Kynurenate (100 nA) antagonized this activity at a comparable rate to the NMDA receptor antagonists (67 +/- 8%, N = 4). A similar negative wave of 0.9 +/- 0.2 mV and 41 +/- 3 ms (N = 12) was evoked in hippocampal slices by high-frequency orthodromic stimulation. Potentiation of this activity upon lowering Mg2+ in ACSF from 1.3 to 0.5 mM further supported that it had an NMDA-mediated component.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrophysiological evidence for activation of NMDA receptors and its antagonism by MK-801 in cerebral ischemia

We studied the effects of iontophoretically administered MK-801 (50-150 nA) on ischemic changes on the CA1 hippocampal field potential. Twenty rats under urethane anesthesia, of which the hippocampal field response was depressed or lost upon ligation of the carotid arteries, were used. MK-801 applications starting before carotid ligation, decreased the depression of the field response in 8 of 11 trials. MK-801 was applied after the appearance of ischemic changes and partly restored the deteriorated hippocampal field potential in 16 of 34 penetrations. MK-801 was ineffective in preventing or restoring the severely depressed or lost evoked activity. During ischemia a DC potential shift of -32.6 +/- 3.7 mV (n = 10) was recorded. MK-801 reduced the amplitude of the DC potential shift by 50% when applied before (n = 6) or after (n = 4) the initiation of ischemia. Activation of N-methyl-D-aspartate (NMDA) receptors by glutamate or N-methyl-DL-aspartate (NMDLA) induces a slow negative wave on the field response. During ischemia a similar negative wave spontaneously appeared in 9 trials and was also induced with low currents (5-10 nA) of NMDLA which were insufficient to evoke the NMDA-mediated wave before ischemia. These data provide electrophysiological evidence that NMDA receptors are activated during ischemia and MK-801 reduces ischemia neuronal dysfunction.

Glutamate and glycine induce a negative wave on hippocampal field response through NMDA receptors

In rats under urethane anesthesia, iontophoresis of large amounts (30-300 nA) of glutamate in the hippocampus induced a negative wave on the field potential evoked by stimulation of fimbria/commissura or perforant pathway. The amplitudes of the negative waves ranged between 0.2 and 9.8 mV and their mean duration was 341 +/- 12 ms. This activity was antagonized by iontophoresis of N-methyl-D-aspartate (NMDA) antagonists: Mg2+ (80-100 nA), ketamine (50-150 nA), MK-801 (50-150 nA) and by systemic ketamine (5 mg/kg, i.v.) administration. Iontophoresis of N-methyl-DL-aspartate (NMDLA) (20-40 nA) and glycine (25-100 nA) also elicited a negative wave which was blocked by NMDA antagonists. The negative waves were induced in all hippocampal layers except the dentate hilus by glutamate, NMDLA and glycine. Pyramidal regions were found to be as sensitive as dendritic layers; the mean amplitudes of glutamate-induced negative waves on the field response were 4.1 +/- 0.6 and 4.2 +/- 0.5 mV for CA1 stratum pyramidale and radiatum, respectively. These data suggest that large amounts of glutamate activate NMDA receptor/ion channels causing appearance of a long-lasting negative wave on the hippocampal field response. The data also demonstrate that glycine leads to a significant participation of NMDA receptors during glutamatergic transmission which is largely mediated through non-NMDA receptors.