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Erschienen in: Experimental Brain Research 1/2004

01.09.2004 | Research Article

Abnormal Purkinje cell activity in vivo in experimental allergic encephalomyelitis

verfasst von: Carl Y. Saab, Matthew J. Craner, Yuko Kataoka, Stephen G. Waxman

Erschienen in: Experimental Brain Research | Ausgabe 1/2004

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Abstract

Cerebellar deficits in multiple sclerosis (MS) tend to persist and can produce significant disability. Although the pathophysiological basis for these deficits is not clear, it was recently reported that the expression of the sensory neuron-specific sodium channel Nav1.8 (which is not normally expressed within the cerebellum) is aberrantly upregulated within Purkinje cells in experimental allergic encephalomyelitis (EAE) and in human MS. The expression of Nav1.8 in cultured Purkinje cells has been shown to alter the activity pattern of these cells in vitro by decreasing the number of spikes per conglomerate action potential and by contributing to the production of sustained, pacemaker-like activity upon depolarization, suggesting the hypothesis that, in pathophysiological situations where Nav1.8 is upregulated within Purkinje cells, the pattern of activity in these cells will be altered. In the present study, we examined this hypothesis in vivo in mice with EAE. Our results demonstrate a reduction in the number of secondary spikes per complex spike and irregularity in the temporal organization of secondary spikes in Purkinje cells from mice with EAE in which Nav1.8 is upregulated. We also observed abnormal bursting activity in Purkinje cells from mice with EAE, which was not observed in control animals. These results demonstrate functional changes in Purkinje cells in vivo within their native cerebellar environment in EAE, a model of MS, and support the hypothesis that misexpression of Nav1.8 can contribute to cerebellar deficits in neuroinflammatory disorders by altering the pattern of electrical activity within the cerebellum.
Literatur
Zurück zum Zitat Akopian AN, Sivilotti L, Wood JN (1996) A tetrodotoxin-resistant voltage-gated sodium channel expressed by sensory neurons. Nature 379:257–262PubMed Akopian AN, Sivilotti L, Wood JN (1996) A tetrodotoxin-resistant voltage-gated sodium channel expressed by sensory neurons. Nature 379:257–262PubMed
Zurück zum Zitat Amor S, Groome N, Linington C, Morris MM, Dornmair K, Gardinier MV, Matthieu JM, Baker D (1994) Identification of epitopes of myelin oligodendrocyte glycoprotein for the induction of experimental allergic encephalomyelitis in SJL and Biozzi AB/H mice. J Immunol 153:4349–4356PubMed Amor S, Groome N, Linington C, Morris MM, Dornmair K, Gardinier MV, Matthieu JM, Baker D (1994) Identification of epitopes of myelin oligodendrocyte glycoprotein for the induction of experimental allergic encephalomyelitis in SJL and Biozzi AB/H mice. J Immunol 153:4349–4356PubMed
Zurück zum Zitat Armstrong DM, Rawson JA (1979) Activity patterns of cerebellar cortical neurones and climbing fibre afferents in the awake cat. J Physiol 289:425–448PubMed Armstrong DM, Rawson JA (1979) Activity patterns of cerebellar cortical neurones and climbing fibre afferents in the awake cat. J Physiol 289:425–448PubMed
Zurück zum Zitat Black JA, Fjell J, Dib-Hajj S, Duncan ID, O’Connor LT, Fried K, Gladwell Z, Tate S, Waxman SG (1999) Abnormal expression of SNS/PN3 sodium channel in cerebellar Purkinje cells following loss of myelin in the taiep rat. Neuroreport 10:913–918PubMed Black JA, Fjell J, Dib-Hajj S, Duncan ID, O’Connor LT, Fried K, Gladwell Z, Tate S, Waxman SG (1999) Abnormal expression of SNS/PN3 sodium channel in cerebellar Purkinje cells following loss of myelin in the taiep rat. Neuroreport 10:913–918PubMed
Zurück zum Zitat Black JA, Dib-Hajj S, Baker D, Newcombe J, Cuzner ML, Waxman SG (2000) Sensory neuron-specific sodium channel SNS is abnormally expressed in the brains of mice with experimental allergic encephalomyelitis and humans with multiple sclerosis. Proc Natl Acad Sci U S A 97:11598–11602CrossRefPubMed Black JA, Dib-Hajj S, Baker D, Newcombe J, Cuzner ML, Waxman SG (2000) Sensory neuron-specific sodium channel SNS is abnormally expressed in the brains of mice with experimental allergic encephalomyelitis and humans with multiple sclerosis. Proc Natl Acad Sci U S A 97:11598–11602CrossRefPubMed
Zurück zum Zitat Craner MJ, Lo AC, Black JA, Baker D, Newcombe J, Cuzner ML, Waxman SG (2003a) Annexin II/p11 is up-regulated in Purkinje cells in EAE and MS. Neuroreport 14:555–558CrossRefPubMed Craner MJ, Lo AC, Black JA, Baker D, Newcombe J, Cuzner ML, Waxman SG (2003a) Annexin II/p11 is up-regulated in Purkinje cells in EAE and MS. Neuroreport 14:555–558CrossRefPubMed
Zurück zum Zitat Craner MJ, Lo AC, Black JA, Waxman SG (2003b) Abnormal sodium channel distribution in optic nerve axons in a model of inflammatory demyelination. Brain 126:1552–1561CrossRefPubMed Craner MJ, Lo AC, Black JA, Waxman SG (2003b) Abnormal sodium channel distribution in optic nerve axons in a model of inflammatory demyelination. Brain 126:1552–1561CrossRefPubMed
Zurück zum Zitat Craner MJ, Lo AC, Kataoka Y, Lo AC, Black JA, Baker D, Waxman SG (2003c) Temporal course of upregulation of Nav1.8 in Purkinje neurons parallels the progression of clinical deficit in EAE. J Neuropathol Exp Neurol 62:968–975PubMed Craner MJ, Lo AC, Kataoka Y, Lo AC, Black JA, Baker D, Waxman SG (2003c) Temporal course of upregulation of Nav1.8 in Purkinje neurons parallels the progression of clinical deficit in EAE. J Neuropathol Exp Neurol 62:968–975PubMed
Zurück zum Zitat Davie CA, Barker GJ, Webb S, Tofts PS, Thompson AJ, Harding AE, McDonald WI, Miller DH (1995) Persistent functional deficit in multiple sclerosis and autosomal dominant cerebellar ataxia is associated with axon loss. Brain 118:1583–1592PubMed Davie CA, Barker GJ, Webb S, Tofts PS, Thompson AJ, Harding AE, McDonald WI, Miller DH (1995) Persistent functional deficit in multiple sclerosis and autosomal dominant cerebellar ataxia is associated with axon loss. Brain 118:1583–1592PubMed
Zurück zum Zitat De Zeeuw C, Simpson J, Hoogenraad C, Galjart N, Koekkoek S, Ruigrok T (1998) Microcircuitry and function of the inferior olive. Trends Neurosci 29:391–400 De Zeeuw C, Simpson J, Hoogenraad C, Galjart N, Koekkoek S, Ruigrok T (1998) Microcircuitry and function of the inferior olive. Trends Neurosci 29:391–400
Zurück zum Zitat Dib-Hajj SD, Ishikawa K, Cummins TR, Waxman SG (1997) Insertion of a SNS-specific tetrapeptide in S3-S4 linker of D4 accelerates recovery from inactivation skeletal muscle voltage-gated Na channel mu1 in HEK293 cells. FEBS Lett 416:11–14CrossRefPubMed Dib-Hajj SD, Ishikawa K, Cummins TR, Waxman SG (1997) Insertion of a SNS-specific tetrapeptide in S3-S4 linker of D4 accelerates recovery from inactivation skeletal muscle voltage-gated Na channel mu1 in HEK293 cells. FEBS Lett 416:11–14CrossRefPubMed
Zurück zum Zitat Eccles JC, Llinas R, Sasaki K (1966a) Parallel fibre stimulation and the responses induced thereby in the Purkinje cells of the cerebellum. Exp Brain Res 1:17–39PubMed Eccles JC, Llinas R, Sasaki K (1966a) Parallel fibre stimulation and the responses induced thereby in the Purkinje cells of the cerebellum. Exp Brain Res 1:17–39PubMed
Zurück zum Zitat Eccles JC, Llinas R, Sasaki K (1966b) The excitatory synaptic action of climbing fibres on the Purkinje cells of the cerebellum. J Physiol 182:268–296PubMed Eccles JC, Llinas R, Sasaki K (1966b) The excitatory synaptic action of climbing fibres on the Purkinje cells of the cerebellum. J Physiol 182:268–296PubMed
Zurück zum Zitat Eccles JC, Llinas R, Sasaki K (1966c) Intracellularly recorded responses of the cerebellar Purkinje cells. Exp Brain Res 1:161–183PubMed Eccles JC, Llinas R, Sasaki K (1966c) Intracellularly recorded responses of the cerebellar Purkinje cells. Exp Brain Res 1:161–183PubMed
Zurück zum Zitat Eccles JC, Ito M, Szentágothai J (1967) The cerebellum as a neuronal machine. Springer, New York Eccles JC, Ito M, Szentágothai J (1967) The cerebellum as a neuronal machine. Springer, New York
Zurück zum Zitat Elliott AA, Elliott JR (1993) Characterization of TTX-sensitive and TTX-resistant sodium currents in small cells from adult rat dorsal root ganglia. J Physiol 463:39–56PubMed Elliott AA, Elliott JR (1993) Characterization of TTX-sensitive and TTX-resistant sodium currents in small cells from adult rat dorsal root ganglia. J Physiol 463:39–56PubMed
Zurück zum Zitat Felts PA, Yokoyama S, Dib-Hajj S, Black JA, Waxman SG (1997) Sodium channel alpha-subunit mRNAs I, II, III, NaG, Na6 and hNE (PN1): different expression patterns in developing rat nervous system. Mol Brain Res 45:71–82CrossRefPubMed Felts PA, Yokoyama S, Dib-Hajj S, Black JA, Waxman SG (1997) Sodium channel alpha-subunit mRNAs I, II, III, NaG, Na6 and hNE (PN1): different expression patterns in developing rat nervous system. Mol Brain Res 45:71–82CrossRefPubMed
Zurück zum Zitat Ferguson B, Matyszak MK, Esiri MM, Perry VH (1997) Axonal damage in acute multiple sclerosis lesions. Brain 120:393–399CrossRefPubMed Ferguson B, Matyszak MK, Esiri MM, Perry VH (1997) Axonal damage in acute multiple sclerosis lesions. Brain 120:393–399CrossRefPubMed
Zurück zum Zitat Goldowitz D, Hamre K (1998) The cells and molecules that make a cerebellum. Trends Neurosci 21:375–382 Goldowitz D, Hamre K (1998) The cells and molecules that make a cerebellum. Trends Neurosci 21:375–382
Zurück zum Zitat Granit R, Phillips CG (1956) Excitatory and inhibitory processes acting upon individual Purkinje cells of the cerebellum in cats. J Physiol 133:520–547PubMed Granit R, Phillips CG (1956) Excitatory and inhibitory processes acting upon individual Purkinje cells of the cerebellum in cats. J Physiol 133:520–547PubMed
Zurück zum Zitat Greenlee JE, Burns JB, Rose JW, Jaeckle KA, Clawson S (1995) Uptake of systemically administered human anticerebellar antibody by rat Purkinje cells following blood-brain barrier disruption. Acta Neuropathol (Berl) 89:341–345 Greenlee JE, Burns JB, Rose JW, Jaeckle KA, Clawson S (1995) Uptake of systemically administered human anticerebellar antibody by rat Purkinje cells following blood-brain barrier disruption. Acta Neuropathol (Berl) 89:341–345
Zurück zum Zitat Ito M (2001) Cerebellar long-term depression: characterization, signal transduction, and functional roles. Physiol Rev 81:1143–1195PubMed Ito M (2001) Cerebellar long-term depression: characterization, signal transduction, and functional roles. Physiol Rev 81:1143–1195PubMed
Zurück zum Zitat Ito M, Simson JI (1971) Discharges in Purkinje cell axons during climbing fiber activation. Brain Res 31:215–219CrossRefPubMed Ito M, Simson JI (1971) Discharges in Purkinje cell axons during climbing fiber activation. Brain Res 31:215–219CrossRefPubMed
Zurück zum Zitat Kohrman DC, Smith MR, Goldin AL, Harris J, Meisler MH (1996) A missense mutation in the sodium channel Scn8a is responsible for cerebellar ataxia in the mouse mutant jolting. J Neurosci 16:5993–9599PubMed Kohrman DC, Smith MR, Goldin AL, Harris J, Meisler MH (1996) A missense mutation in the sodium channel Scn8a is responsible for cerebellar ataxia in the mouse mutant jolting. J Neurosci 16:5993–9599PubMed
Zurück zum Zitat Llinas R, Sugimori M (1980a) Electrophysiological properties of in vitro Purkinje cell somata in mammalian cerebellar slices. J Physiol 305:171–195PubMed Llinas R, Sugimori M (1980a) Electrophysiological properties of in vitro Purkinje cell somata in mammalian cerebellar slices. J Physiol 305:171–195PubMed
Zurück zum Zitat Llinas R, Sugimori M (1980b) Electrophysiological properties of in vitro Purkinje cell dendrites in mammalian cerebellar slices. J Physiol 305:197–213PubMed Llinas R, Sugimori M (1980b) Electrophysiological properties of in vitro Purkinje cell dendrites in mammalian cerebellar slices. J Physiol 305:197–213PubMed
Zurück zum Zitat Matthews WB, Compston A, Allen IV, Martyn CN (1991) McAlpine’s multiple sclerosis, 2nd edn. Churchill Livingstone, Edinburgh Matthews WB, Compston A, Allen IV, Martyn CN (1991) McAlpine’s multiple sclerosis, 2nd edn. Churchill Livingstone, Edinburgh
Zurück zum Zitat Nataf S, Naveilhan P, Sindji L, Darcy F, Brachet P, Montero-Menei CN (1998) Low affinity NGF receptor expression in the central nervous system during experimental allergic encephalomyelitis. J Neurosci Res 52:83–92CrossRefPubMed Nataf S, Naveilhan P, Sindji L, Darcy F, Brachet P, Montero-Menei CN (1998) Low affinity NGF receptor expression in the central nervous system during experimental allergic encephalomyelitis. J Neurosci Res 52:83–92CrossRefPubMed
Zurück zum Zitat Okuse K, Malik-Hall M, Baker MD, Poon WY, Kong H, Chao MV, Wood JN (2002) Annexin II light chain regulates sensory neuron-specific sodium channel expression. Nature 417:653–656CrossRefPubMed Okuse K, Malik-Hall M, Baker MD, Poon WY, Kong H, Chao MV, Wood JN (2002) Annexin II light chain regulates sensory neuron-specific sodium channel expression. Nature 417:653–656CrossRefPubMed
Zurück zum Zitat Paxinos G, Franklin KBJ (2001) The mouse atlas in stereotaxic coordinates, 2nd edn. Academic Press, San Diego Paxinos G, Franklin KBJ (2001) The mouse atlas in stereotaxic coordinates, 2nd edn. Academic Press, San Diego
Zurück zum Zitat Raman IM, Sprunger LK, Meisler MH, Bean BP (1997) Altered subthreshold sodium currents and disrupted firing patterns in Purkinje neurons of Scn8a mutant mice. Neuron 19:881–891PubMed Raman IM, Sprunger LK, Meisler MH, Bean BP (1997) Altered subthreshold sodium currents and disrupted firing patterns in Purkinje neurons of Scn8a mutant mice. Neuron 19:881–891PubMed
Zurück zum Zitat Renganathan M, Cummins TR, Waxman SG (2001) Contribution of Nav1.8 sodium channels to action potential electrogenesis in DRG. J Neurophysiol 86:629–640PubMed Renganathan M, Cummins TR, Waxman SG (2001) Contribution of Nav1.8 sodium channels to action potential electrogenesis in DRG. J Neurophysiol 86:629–640PubMed
Zurück zum Zitat Renganathan M, Gelderblom M, Black JA, Waxman SG (2003) Expression of Nav1.8 sodium channels perturbs the firing patterns of cerebellar Purkinje cells. Brain Res 959:235–242CrossRefPubMed Renganathan M, Gelderblom M, Black JA, Waxman SG (2003) Expression of Nav1.8 sodium channels perturbs the firing patterns of cerebellar Purkinje cells. Brain Res 959:235–242CrossRefPubMed
Zurück zum Zitat Saab CY, Willis WD (2001) Nociceptive visceral stimulation modulates the activity of cerebellar Purkinje cells. Exp Brain Res 140:122–126PubMed Saab CY, Willis WD (2001) Nociceptive visceral stimulation modulates the activity of cerebellar Purkinje cells. Exp Brain Res 140:122–126PubMed
Zurück zum Zitat Saab CY, Willis WD (2003) The cerebellum: organization, functions and its role in nociception. Brain Res Rev 42:85–95CrossRefPubMed Saab CY, Willis WD (2003) The cerebellum: organization, functions and its role in nociception. Brain Res Rev 42:85–95CrossRefPubMed
Zurück zum Zitat Saab CY, Kawasaki M, Al-Chaer ED, Willis WD (2001) Cerebellar cortical stimulation increases spinal visceral nociceptive responses. J Neurophysiol 85:2359–2363PubMed Saab CY, Kawasaki M, Al-Chaer ED, Willis WD (2001) Cerebellar cortical stimulation increases spinal visceral nociceptive responses. J Neurophysiol 85:2359–2363PubMed
Zurück zum Zitat Sangameswaran L, Delgado SG, Fish LM, Koch BD, Jakeman LB, Stewart GR, Sze P, Hunter JC, Eglen RM, Herman RC (1996) Structure and function of a novel voltage-gated, tetrodotoxin-resistant sodium channel specific to sensory neurons. J Biol Chem 271:5953–5956CrossRefPubMed Sangameswaran L, Delgado SG, Fish LM, Koch BD, Jakeman LB, Stewart GR, Sze P, Hunter JC, Eglen RM, Herman RC (1996) Structure and function of a novel voltage-gated, tetrodotoxin-resistant sodium channel specific to sensory neurons. J Biol Chem 271:5953–5956CrossRefPubMed
Zurück zum Zitat Schild JH, Kunze DL (1997) Experimental and modeling study of Na+ current heterogeneity in rat nodose neurons and its impact on neuronal discharge. J Neurophysiol 78:3198–3209PubMed Schild JH, Kunze DL (1997) Experimental and modeling study of Na+ current heterogeneity in rat nodose neurons and its impact on neuronal discharge. J Neurophysiol 78:3198–3209PubMed
Zurück zum Zitat Schmolesky MT, Weber JT, De Zeeuw CI, Hansel C (2002) The making of a complex spike: ionic composition and plasticity. Ann N Y Acad Sci 978:359–390PubMed Schmolesky MT, Weber JT, De Zeeuw CI, Hansel C (2002) The making of a complex spike: ionic composition and plasticity. Ann N Y Acad Sci 978:359–390PubMed
Zurück zum Zitat Smith MR, Goldin AL (1999) A mutation that causes ataxia shifts the voltage-dependence of the Scn8a sodium channel. Neuroreport 10:3027–3031PubMed Smith MR, Goldin AL (1999) A mutation that causes ataxia shifts the voltage-dependence of the Scn8a sodium channel. Neuroreport 10:3027–3031PubMed
Zurück zum Zitat Thach WT Jr (1967) Somatosensory receptive fields of single units in cat cerebellar cortex. J Neurophysiol 30:675–696PubMed Thach WT Jr (1967) Somatosensory receptive fields of single units in cat cerebellar cortex. J Neurophysiol 30:675–696PubMed
Zurück zum Zitat Thach WT (1968) Discharge of Purkinje and cerebellar nuclear neurons during rapidly alternating arm movements in the monkey. J Neurophysiol 31:785–797PubMed Thach WT (1968) Discharge of Purkinje and cerebellar nuclear neurons during rapidly alternating arm movements in the monkey. J Neurophysiol 31:785–797PubMed
Zurück zum Zitat Thach WT (1970) Discharge of cerebellar neurons related to two maintained postures and two prompt movements. II. Purkinje cell output and input. J Neurophysiol 33:537–547PubMed Thach WT (1970) Discharge of cerebellar neurons related to two maintained postures and two prompt movements. II. Purkinje cell output and input. J Neurophysiol 33:537–547PubMed
Zurück zum Zitat Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L (1998) Axonal transection in the lesions of multiple sclerosis. N Engl J Med 338:278–285CrossRefPubMed Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L (1998) Axonal transection in the lesions of multiple sclerosis. N Engl J Med 338:278–285CrossRefPubMed
Zurück zum Zitat van Kan PL, Gibson AR, Houk JC (1993) Movement-related inputs to intermediate cerebellum of the monkey. J Neurophysiol 69:74–94PubMed van Kan PL, Gibson AR, Houk JC (1993) Movement-related inputs to intermediate cerebellum of the monkey. J Neurophysiol 69:74–94PubMed
Zurück zum Zitat Vega-Saenz de Miera EC, Rudy B, Sugimori M, Llinas R (1997) Molecular characterization of the sodium channel subunits expressed in mammalian cerebellar Purkinje cells. Proc Natl Acad Sci U S A 94:7059–7064 Vega-Saenz de Miera EC, Rudy B, Sugimori M, Llinas R (1997) Molecular characterization of the sodium channel subunits expressed in mammalian cerebellar Purkinje cells. Proc Natl Acad Sci U S A 94:7059–7064
Zurück zum Zitat Waxman SG (1998) Demyelinating diseases—new pathological insights, new therapeutic targets. N Engl J Med 338:323–325CrossRefPubMed Waxman SG (1998) Demyelinating diseases—new pathological insights, new therapeutic targets. N Engl J Med 338:323–325CrossRefPubMed
Zurück zum Zitat Weinshenker BG, Rice GP, Noseworthy JH, Carriere W, Baskerville J, Ebers GC (1991) The natural history of multiple sclerosis: a geographically based study. 4. Applications to planning and interpretation of clinical therapeutic trials. Brain 114:1057–1067PubMed Weinshenker BG, Rice GP, Noseworthy JH, Carriere W, Baskerville J, Ebers GC (1991) The natural history of multiple sclerosis: a geographically based study. 4. Applications to planning and interpretation of clinical therapeutic trials. Brain 114:1057–1067PubMed
Metadaten
Titel
Abnormal Purkinje cell activity in vivo in experimental allergic encephalomyelitis
verfasst von
Carl Y. Saab
Matthew J. Craner
Yuko Kataoka
Stephen G. Waxman
Publikationsdatum
01.09.2004
Erschienen in
Experimental Brain Research / Ausgabe 1/2004
Print ISSN: 0014-4819
Elektronische ISSN: 1432-1106
DOI
https://doi.org/10.1007/s00221-004-1867-4

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