GABAA receptor-mediated seizure liabilities: a mixed-methods screening approach

Background and PurposeMany psychotherapeutic drugs, including clozapine, display polypharmacology and act on GABAA receptors. Patients with schizophrenia show alterations in function, structure and molecular composition of the hippocampus, and a recent study demonstrated aberrant levels of hippocampal α5 subunit‐containing GABAA receptors. The purpose of this study is to investigate the effects of tricyclic compounds on α5 subunit‐containing receptor subtypes.Experimental ApproachFunctional studies of effects by seven antipsychotic and antidepressant medications were performed in several GABAA receptor subtypes by two‐electrode voltage‐clamp electrophysiology using Xenopus laevis oocytes. Computational structural analysis was employed to design mutated constructs of the α5 subunit, probing a novel binding site. Radioligand displacement data complemented the functional and mutational findings.Key ResultsThe antipsychotic drugs clozapine and chlorpromazine exerted functional inhibition on multiple GABAA receptor subtypes, including those containing α5‐subunits. Based on a chlorpromazine binding site observed in a GABA‐gated bacterial homologue, we identified a novel site in α5 GABAA receptor subunits and demonstrate differential usage of this and the orthosteric sites by these ligands.Conclusion and ImplicationsDespite high molecular and functional similarities among the tested ligands, they reduce GABA currents by differential usage of allosteric and orthosteric sites. The chlorpromazine site we describe here is a new potential target for optimizing antipsychotic medications with beneficial polypharmacology. Further studies in defined subtypes are needed to substantiate mechanistic links between the therapeutic effects of clozapine and its action on certain GABAA receptor subtypes.

The GABAA receptor is a ligand-gated ion channel of the Cys-loop family that includes the nicotinic acetylcholine, 5-HT3 and strychnine-sensitive glycine receptors. GABAA receptor-mediated inhibition within the CNS occurs by fast synaptic transmission, sustained tonic inhibition and temporally intermediate events that have been termed 'GABAA, slow' [45]. GABAA receptors exist as pentamers of 4TM subunits that form an intrinsic anion selective channel. Sequences of six α, three β, three γ, one δ, three ρ, one ε, one π and one θ GABAA receptor subunits have been reported in mammals [281, 237, 238, 288]. The π-subunit is restricted to reproductive tissue. Alternatively spliced versions of many subunits exist (e.g. α4- and α6- (both not functional) α5-, β2-, β3- and γ2), along with RNA editing of the α3 subunit [71]. The three ρ-subunits, (ρ1-3) function as either homo- or hetero-oligomeric assemblies [365, 50]. Receptors formed from ρ-subunits, because of their distinctive pharmacology that includes insensitivity to bicuculline, benzodiazepines and barbiturates, have sometimes been termed GABAC receptors [365], but they are classified as GABAA receptors by NC-IUPHAR on the basis of structural and functional criteria [16, 237, 238].Many GABAA receptor subtypes contain α-, β- and γ-subunits with the likely stoichiometry 2α.2β.1γ [170, 237]. It is thought that the majority of GABAA receptors harbour a single type of α- and β -subunit variant. The α1β2γ2 hetero-oligomer constitutes the largest population of GABAA receptors in the CNS, followed by the α2β3γ2 and α3β3γ2 isoforms. Receptors that incorporate the α4- α5-or α6-subunit, or the β1-, γ1-, γ3-, δ-, ε- and θ-subunits, are less numerous, but they may nonetheless serve important functions. For example, extrasynaptically located receptors that contain α6- and δ-subunits in cerebellar granule cells, or an α4- and δ-subunit in dentate gyrus granule cells and thalamic neurones, mediate a tonic current that is important for neuronal excitability in response to ambient concentrations of GABA [211, 275, 84, 19, 293]. GABA binding occurs at the β+/α- subunit interface and the homologous γ+/α- subunits interface creates the benzodiazepine site. A second site for benzodiazepine binding has recently been postulated to occur at the α+/β- interface ([257]; reviewed by [287]). The particular α-and γ-subunit isoforms exhibit marked effects on recognition and/or efficacy at the benzodiazepine site. Thus, receptors incorporating either α4- or α6-subunits are not recognised by ‘classical’ benzodiazepines, such as flunitrazepam (but see [362]). The trafficking, cell surface expression, internalisation and function of GABAA receptors and their subunits are discussed in detail in several recent reviews [52, 141, 190, 322] but one point worthy of note is that receptors incorporating the γ2 subunit (except when associated with α5) cluster at the postsynaptic membrane (but may distribute dynamically between synaptic and extrasynaptic locations), whereas those incorporating the δ subunit appear to be exclusively extrasynaptic. NC-IUPHAR [16, 237, 3, 2] class the GABAA receptors according to their subunit structure, pharmacology and receptor function. Currently, eleven native GABAA receptors are classed as conclusively identified (i.e., α1β2γ2, α2βγ2, α3βγ2, α4βγ2, α4β2δ, α4β3δ, α5βγ2, α6βγ2, α6β2δ, α6β3δ and ρ) with further receptor isoforms occurring with high probability, or only tentatively [237, 238]. It is beyond the scope of this Guide to discuss the pharmacology of individual GABAA receptor isoforms in detail; such information can be gleaned in the reviews [16, 96, 170, 175, 144, 281, 218, 237, 238, 284, 9, 10]. Agents that discriminate between α-subunit isoforms are noted in the table and additional agents that demonstrate selectivity between receptor isoforms, for example via β-subunit selectivity, are indicated in the text below. The distinctive agonist and antagonist pharmacology of ρ receptors is summarised in the table and additional aspects are reviewed in [365, 50, 146, 225].Several high-resolution cryo-electron microscopy structures have been described in which the full-length human α1β3γ2L GABAA receptor in lipid nanodiscs is bound to the channel-blocker picrotoxin, the competitive antagonist bicuculline, the agonist GABA (γ-aminobutyric acid), and the classical benzodiazepines alprazolam and diazepam [200].

Allosteric modulation of GABAA receptors via multiple drug-binding sites.

Neuronal activity and its influence on developmentally regulated GABA A receptor expression in cultured mouse cerebellar granule cells

GABAA receptors are ligand-gated chloride ion channels composed of five subunits that can be opened by GABA, and modulated by multiple drugs, some of utmost clinical importance. GABAA receptors occur in the nervous system as well as in peripheral tissues where their function is largely unknown. The existence of multiple GABAA receptor subtypes with distinct subunit composition leads to multiple homologous binding sites with different degrees of similarity. Crystal structures of proteins homologous to GABAA receptors and of a GABAA receptor subtype, combined with homology modeling studies, have provided insights into the possible location of drug interaction sites. Some of these sites have been confirmed by experimental studies. For many receptor ligands, however, binding sites are not yet known. Here we will briefly review the function of distinct types of GABAA receptors and provide structural insights and experimental evidence on binding sites for ligands that could be of considerable clinical interest.

Functional and computational studies reveal that the allosteric inhibition mechanism is conserved between glutamate and neutral amino acid transporters of the SLC1 family, and identify a novel allosteric inhibitor.

γ-Aminobutyric acid (GABA) is the most prevalent inhibitory neurotransmitter in the mammalian brain, and it may play an important role in sleep regulation. The effects of GABA are mediated by activation of two classes of receptors, i.e. GABAA and GABAB receptors. GABAA receptors are assumed to have a pentameric glycoprotein structure, composed of different polypeptide subunits and, as a result, are highly heterogeneous. The GABAA1a receptor subclass (previously termed the benzodiazepine BDZ1 receptor) represents approximately half of all GABAA receptors. BDZ hypnotics exert their sleep-inducing action by increasing the GABAA receptor—mediated chloride ion (Cl−) current. Possibly due to their nonspecific effect at the different subtypes of GABAA receptors, these drugs can also induce daytime sedation, anterograde amnesia and rebound insomnia. Additionally, they affect the sleep EEG in a specific manner (the so-called ‘spectral GABA-BDZ signature’), and may lead to tolerance and dependence. Given the drawbacks of BDZs, newer compounds with a preferential selectivity for GABAA1a receptors were developed. It was hoped that they would have fewer adverse effects than nonspecific BDZs. The available data, however, do not support the notion that the pharmacodynamics of these newer agents result in markedly different clinical effects compared with the BDZ hypnotics. As with the BDZs, the pharmacokinetics are clinically more important than the pharmacodynamics. It is concluded that there are no major differences in hypnotic efficacy and safety between the newer, selective GABAA1a receptor agonists and the classical, nonselective BDZs.

Medroxyprogesterone acetate (MPA) is a progestin widely used in humans as hormone replacement therapy and at other indications. Many progestin metabolites, as the progesterone metabolite allopregnanolone, have GABAA-receptor modulatory effects and are known to affect memory, learning, appetite, and mood. In women, 4 years chronic treatment with MPA doubles the frequency of dementia and in rats, MPA causes cognitive impairment related to the GABAergic system. Activation of the membrane bound GABAA receptor results in a chloride ion flux that can be studied by whole-cell patch-clamp electrophysiological recordings. The purpose of this study was to clarify the modulatory effects of MPA and specific MPA metabolites, with structures like known GABAA-receptor modulators, on different GABAA-receptor subtypes. An additional aim was to verify the results as steroid effects on GABA response in single cells taken from rat hypothalamus. HEK-293 cell-lines permanently expressing the recombinant human GABAA-receptor subtype α1β2γ2L or α5β3γ2L or α2β3γ2S were created. The MPA metabolites 3α5α-MPA,3β5α-MPA and 3β5β-MPA were synthesised and purified for electrophysiological patch-clamp measurements with a Dynaflow system. The effects of MPA and tetrahydrodeoxycorticosterone were also studied. None of the studied MPA metabolites affected the responses mediated by α1β2γ2L or α5β3γ2L GABAA receptors. Contrary, MPA clearly acted both as a positive modulator and as a direct activator of the α5β3γ2L and α2β3γ2S GABAA receptors. However, in concentrations up to 10 μM, MPA was inactive at the α1β2γ2L GABAA receptor. In the patch-clamp recordings from dissociated cells of the preoptic area in rats, MPA increased the amplitude of responses to GABA. In addition, MPA alone without added GABA, evoked a current response. In conclusion, MPA acts as a positive modulator of specific GABAA receptor subtypes expressed in HEK cells and at native GABA receptors in single cells from the hypothalamic preoptic area.

GABAA receptors mediate most of the fast inhibitory transmission in the CNS. They form heteromeric complexes assembled from a large family of subunit genes. The existence of multiple GABAA receptor subtypes differing in subunit composition, localization and functional properties underlies their role for fine-tuning of neuronal circuits and genesis of network oscillations. The differential regulation of GABAA receptor subtypes represents a major facet of homeostatic synaptic plasticity and contributes to the excitation/inhibition (E/I) balance under physiological conditions and upon pathological challenges. The purpose of this review is to discuss recent findings highlighting the significance of GABAA receptor heterogeneity for the concept of E/I balance and its relevance for epilepsy. Specifically, we address the following issues: (1) role for tonic inhibition, mediated by extrasynaptic GABAA receptors, for controlling neuronal excitability; (2) significance of chloride ion transport for maintenance of the E/I balance in adult brain; and (3) molecular mechanisms underlying GABAA receptor regulation (trafficking, posttranslational modification, gene transcription) that are important for homoeostatic plasticity. Finally, the relevance of these findings is discussed in light of the involvement of GABAA receptors in epileptic disorders, based on recent experimental studies of temporal lobe epilepsy (TLE) and absence seizures and on the identification of mutations in GABAA receptor subunit genes underlying familial forms of epilepsy.

Dynamic modulation of ion channel expression, localization, and/or function drives plasticity in intrinsic neuronal excitability. Voltage-gated Kv2.1 potassium channels are constitutively maintained in a highly phosphorylated state in neurons. Increased neuronal activity triggers rapid calcineurin-dependent dephosphorylation, loss of channel clustering, and hyperpolarizing shifts in voltage-dependent activation that homeostatically suppress neuronal excitability. These changes are reversible, such that rephosphorylation occurs after removal of excitatory stimuli. Here, we show that cyclin-dependent kinase 5 (CDK5), a Pro-directed Ser/Thr protein kinase, directly phosphorylates Kv2.1, and determines the constitutive level of Kv2.1 phosphorylation, the rapid increase in Kv2.1 phosphorylation upon acute blockade of neuronal activity, and the recovery of Kv2.1 phosphorylation after stimulus-induced dephosphorylation. We also demonstrate that although the phosphorylation state of Kv2.1 is also shaped by the activity of the PP1 protein phosphatase, the regulation of Kv2.1 phosphorylation by CDK5 is not mediated through the previously described regulation of PP1 activity by CDK5. Together, these studies support a novel role for CDK5 in regulating Kv2.1 channels through direct phosphorylation.

Anthropogenic releases of plastics, persistent organic pollutants (POPs), and heavy metals can impact the environment, including aquatic ecosystems. Nanoplastics (NPs) have recently emerged as pervasive environmental pollutants that have the ability to adsorb POPs and can cause stress in organisms. Among POPs, DDT and its metabolites are ubiquitous environmental pollutants due to their long persistence. Despite the discontinued use of DDT in Europe, DDT and its metabolites (primarily p,p′-DDE) are still found at detectable levels in fish feed used in salmon aquaculture. Our study aimed to look at the individual and combined toxicity of NPs (50 mg/L polystyrene) and DDE (100 μg/L) using zebrafish larvae as a model. We found no significant morphological, cardiac, respiratory, or behavioural changes in zebrafish larvae exposed to NPs alone. Conversely, morphological, cardiac and respiratory alterations were observed in zebrafish larvae exposed to DDE and NPs + DDE. Interestingly, behavioural changes were only observed in zebrafish larvae exposed to NPs + DDE. These findings were supported by RNA-seq results, which showed that some cardiac, vascular, and immunogenic pathways were downregulated only in zebrafish larvae exposed to NPs + DDE. In summary, we found an enhanced toxicological impact of DDE when combined with NPs.

We have previously shown that extracellular protons inhibit recombinant and native GABA(A) receptors. In this report, we studied the site(s) and mechanism by which protons modulate the GABA(A) receptor. Whole cell GABA-activated currents were recorded from human embryonic kidney (HEK) 293 cells expressing recombinant alpha1beta2gamma2 GABA(A) receptors. Protons competitively inhibited the response to GABA and bicuculline. In contrast, change in pH did not influence direct gating of the channel by pentobarbital, and it did not influence spontaneous channel openings in alpha1(L264T)beta2gamma2 receptors, suggesting pH does not modulate channel activity by affecting the channel gating process directly. To test the hypothesis that protons modulate GABA(A) receptors at the ligand binding site, we systemically mutated N-terminal residues known to be involved in GABA binding and assessed effects of pH on these mutant receptors. Site-specific mutation of beta2 Y205 to F or alpha1 F64 to A, both of which are known to influence GABA binding, significantly reduced pH sensitivity of the GABA response. These mutations did not affect Zn(2+) sensitivity, suggesting that H(+) and Zn(2+) do not share a common site of action. Additional experiments further tested this possibility. Treatment with the histidine-modifying reagent diethylpyrocarbonate (DEPC) reduced Zn(2+)-mediated inhibition of GABA(A) receptors but had no effect on proton-induced inhibition of GABA currents. In addition, mutation of residues known to be involved in Zn(2+) modulation had no effect on pH modulation of GABA(A) receptors. Our results support the hypothesis that protons inhibit GABA(A) receptor function by direct or allosteric interaction with the GABA binding site. In addition, the sites of action of H(+) and Zn(2+) in GABA(A) receptors are distinct.

IntroductionDepression is a serious CNS-related disease that may require long-term treatment. Postpartum depression is a critical medical condition that affects the mother, as well as has a short and long-term impact on the growth of the infant. There is an urgent medical need to develop new treatments for these diseases. GABAA receptor is a cell membrane receptor in the brain that responds to the neurotransmitter gamma-aminobutyric acid (GABA). It is a ligand-gated ion channel and help maintain the balance between excitation and inhibition in the central nervous system, by reducing the likelihood of neuronal firing. It is proven that positive allosteric modulation of GABAA receptor has the potential to treat postpartum depression and major depression disorder.ObjectivesTo discover a pre-clinical compound that meets our targeted product profile, i.e., good potency, orally bioavailable, in vivo efficacy in animal disease models, a good safety profile, etc. The compound was to be advanced into clinical development.MethodsWith the help of CADD and AIDD, we have discovered lead molecules that bound to GABAA receptor. Structural optimization of these molecules led to the discovery of a potent GABAA receptor positive allosteric modulator as our pre-clinical candidate (PCC) compound with excellent pharmacokinetic properties and efficacy in a variety of animal models. Safety studies showed that the compound has a good safety profile.ResultsWe have discovered a positive allosteric GABAA modulator, KH607, with high potency against all three subtypes of GABAA receptors, especially the α5β3γ2 subtype. PK studies showed that the compound had high oral bioavailability in mice, rats, dogs, and monkeys, ranging from 60% to 125%. KH607 effectively penetrates the blood-brain barrier. In anxiety and depression animal modes, KH607 showed anti-anxiety and antidepressant efficacy through oral administration at a dosage of 0.3 mg/Kg to 1.0 mg/Kg. The phase 1 clinical trial up to 40 mg qd dosage orally in human showed that KH607 was well-tolerated with no severe adverse events (AEs) and low discontinuation rate. The PK result demonstrated good pharmacokinetic characteristics and a linear correlation between dosage and exposure.ConclusionsPPD and MDD are serious CNS-related diseases that need new treatments. Our newly discovered compound, KH607 is a potent GABAA receptor positive allosteric modulator. Pre-clinical studies showed significant efficacy to improve anxiety and depression-like behaviors in a variety of animal models. The compound has an acceptable safety profile for the development as an anti-depressive drug. Therefore, it was advanced to human clinical studies. A phase 1 clinical trial in human was completed. Phase II clinical studies are currently ongoing. We expect that the compound to be developed as a new treatment to address the unmet medical needs for PPD and MDD patients.Disclosure of InterestNone Declared

P.1.c.039 Increased midbrain dopaminergic firing by the competitive N-methyl-D-aspartate receptor antagonist SDZ 220–581

Pulsed Electron Spin Resonance Resolves the Coordination Site of Cu 2+ Ions in α1-Glycine Receptor