Refine
Document Type
- Doctoral Thesis (9)
Has Fulltext
- yes (9)
Is part of the Bibliography
- no (9)
Keywords
- Bewegungsstörung (1)
- Checkpoint Inhibitor (1)
- Idiopathische Dystonie (1)
- Neurotoxicity (1)
- Relaxometrie (1)
- Volumetrie (1)
- mPFC (1)
- quantitative MRT (1)
Institute
- Medizin (5)
- Biowissenschaften (4)
Cancer therapies have experienced significant advances in recent years. While conventional cytotoxic chemotherapy has long been the cornerstone for the treatment of many tumor entities, uprising immunotherapies have revolutionized the therapeutic landscape. Among them, immune checkpoint inhibitors (ICIs) with their demonstrated increased overall survival rates and response rates in cancer patients are now FDA-approved for metastatic melanoma and multiple other malignancies. Despite their clinical benefit in cancer therapies, ICIs can induce unique autoimmune-like toxicities known as immune-related adverse events (irAEs), which can involve any organ system including the nervous system. Although neurotoxicities are rare complications of ICI therapy they are often severe and can lead to long-term disability or even death if left untreated.
Neurological irAEs exhibit a broad spectrum of clinical presentations affecting the entire nervous system. Diagnosing neurological irAEs is often challenging as symptoms and laboratory findings can be uncharacteristic for common neurological disorders and clinical experience with ICI-mediated toxicities is still limited. In light of expanding clinical indications for ICIs, physicians will encounter ICI-mediated neurotoxicities more frequently. Thus, thorough characterizations of the diverse set of neurological irAEs are essential for optimal patient care, the prevention of severe ICI-mediated complications, and the development of diagnostic and therapeutic algorithms. This work portrays the clinical presentation, management and outcome of neurological irAEs following ICI therapies.
Patients with neurotoxicities related to ICIs who presented at the Yale New Haven Hospital between January 2014 and June 2018 were retrospectively identified from the quality control database. A comprehensive chart review was performed and data regarding patient demographics, medical history, ICI regimen and neurotoxicity were recorded. In total, 18 patients with neurological irAEs following ICI therapy for melanoma, small cell lung cancer, non-small cell lung cancer, and Merkel-cell carcinoma were identified. Neurotoxicities included central nervous system disorders comprising central demyelinating disorder,autoimmune encephalitis predominantly affecting the grey matter, and aseptic meningitis. Peripheral nervous system toxicities included sensorimotor polyneuropathy and myasthenia gravis. Cases of hypophysitis were also recorded. Time to onset of neurological irAEs ranged from 1 to72 weeks with a median of five weeks. In all patients ICIs were held and steroids initiated. Additional immunomodulatory therapies were required in nine patients. Sixteen of 18 patients showed neurological improvement. Fourteen patients had highgrade neurotoxicity (grade 3-4), six of whom deceased due to cancer progression, while none of the low-grade neurotoxicity patients (grade 1-2) died. High-grade neurotoxicity was identified as a negative prognostic marker for overall survival (p = 0.046).
This work shows that neurotoxicities present early-onset, rapidly progressive complications of ICIs with a broad spectrum of clinical phenotypes affecting the central nervous system, peripheral nervous system, and neuroendocrine system. A high index of caution for neurological irAEs is warranted throughout ICI therapy as timely diagnosis and management can reduce morbidity and mortality. Randomized clinical trials are needed to develop standardized diagnostic and therapeutic algorithms of ICI-induced neurotoxicities.
The prefrontal cortex (PFC) is considered the cognitive center of the mammalian brain. It is involved in a variety of cognitive functions such as decision making, working memory, goal-directed behavior, processing of emotions, flexible action selection, attention, and others (Fuster, 2015). In rodents, these functions are associated with the medial prefrontal cortex (mPFC). Experiments in mice and rats have shown that neurons in the mPFC are necessary for successful performance of many cognitive tasks. Moreover, measurements of neural activity in the mPFC show excitation or inhibition in different cells in relation to specific aspects of the tasks to be solved. To date, however, it is largely unknown whether prefrontal neurons are stably activated during the same behaviors within a task and whether similar aspects are represented by the same neurons in different tasks. In addition, it is unclear how specifically neurons are activated, for example, whether cells that are activated in response to reward are activated in a different task without reward in a different situation or remain inactive. To address these questions, we recorded the same neurons in the mPFC of mice over the course of several weeks while the animals performed various behaviors.
To do this, we expressed GCaMP6 in pyramidal neurons in the mPFC of mice. A small lens was implanted in the same location and a miniature microscope ("miniscope") was used to record neural activity. Later the extracted neurons got aligned based on their shape and position across multiple days and sessions. The mice performed five different behavioral tests while neural activity was measured: A spatial working memory test in a T-maze, exploration of the elevated plus maze (EPM), a novel object recognition (NO) test including free open field (OF) exploration, a social interaction (SI) test and discriminatory auditory fear conditioning (FC). Each task was repeated at least twice to check for stable task encoding across sessions. Behavioral performance and neural correlates to specific task events were similar to earlier studies across all tasks. We utilized generalized linear models (GLM) to determine which behavioral variables most strongly influence neural activity in the mPFC. The position of the mouse in the environment was found to explain most of the variance in neural activity, together with movement speed they were the strongest predictors of neural activity across all tasks. Reward time points in the working memory test, the conditioned stimulus after fear conditioning, or head direction in general were also strongly encoded in the mPFC.
Many of the recorded neurons showed a stable spatial activity profile across multiple sessions of the same task. Similarly, cells that coded for position in one task tended to code for position in other tasks. Not only did the same cells code for position across multiple tasks, but cells also coded for movement speed and head direction. This indicates that at least these general behavioral variables are each represented by the same neurons in the mPFC. Interestingly, the stability of position or speed coding did not depend on the time between two sessions, but only on whether it was within the same or across different tasks. Within the same task, stability was slightly higher than across different tasks.
To find out whether task-specific behavioral aspects were also stably encoded in the mPFC, difference scores as the difference in neural activity between two task aspects like left- and right-choice trials or exposed and enclosed locations were calculated. Many cells encoded these aspects stably across different sessions of each task. Both the left-right differences in the different phases of the working memory test, the open-closed-arm differences in the elevated plus maze, the different activity between center and corners in the open field, the social target-object differences in the social interaction test, and the differences between the two tones during fear conditioning were all stably encoded across the population of mPFC cells. Only the distinction between the novel and the familiar object during object recognition was not stably encoded, but also the preference for the novel object was not present in the second session of novel object exploration.
There was also an overlap in coding for different aspects within a task across multiple sessions. For example, cells stably encoded left-right differences in the T-maze between different sessions as a function of walking direction across different phases of working memory, an aspect that we could already show within one session (Vogel, Hahn et al., 2022). During fear conditioning, the same cells showed a discrimination between CS+ and CS- that also responded to the start of CS+.
Consistency in the neurons activity across different tasks was also found, but only between tasks with similar demands, the elevated plus-maze and free exploration of the open field. Cells that were more active in the open arms also showed more activity in the center of the open field and vice versa. This could be an indicator that the cells were coding for anxiety or exposure across those tasks, indicating that neurons in the mPFC also stably encode general task aspects independent of the specific environment. However, it remains unclear what exactly these neurons encode; in the case of a general fear signal, one would also expect activation during fear conditioning which could not be found.
Overall, we found that neurons in the mPFC of mice encoded multiple general behavioral variables across multiple tasks and task-specific variables were encoded stably within each of the tested tasks. However, we found little task-specific variables that were systematically encoded by the same neurons with the exception being the elevated plus-maze and open field exploration, two tasks with similar features.
Tinnitus is a symptom experienced by most people at least once in their lifetime. In most documented cases, a new onset of chronic tinnitus can be chronologically correlated with hearing loss. However, tinnitus can also occur in people with (apparently) normal hearing and remains without a traceable preceding cause. Despite the frequency of occurrence of tinnitus, the pathophysiological mechanisms are still not fully understood. A currently proposed hypothesis focuses on a "hidden" hearing loss called synaptopathy as a pathomechanism of tinnitus in normal hearing subjects. In the present study, the objective was to test whether finestructure audiometry or measurement of otoacoustic emissions can reveal possibly overlooked hearing impairment in presumed normalhearing individuals with chronic tinnitus. Thus, a hearing loss not audiologically detectable by the usual methods would supplement or replace the presumed synaptopathic pathomechanism. Another objective was to attempt to replicate the existing findings of another research group on synaptopathy as cause for tinnitus in normal hearing people. Schaette and McAlpine (2011) were able to demonstrate a significant difference in wave I amplitudes between groups of normal hearing subjects with and without chronic tinnitus by deriving clickevoked auditory brainstem potentials, thus supporting the hypothesis of synaptopathy18.
For the present study, a cohort of normal-hearing subjects consisting of a group of tinnitus subjects (N = 15) and a control group (N = 14) was tested. Manual puretone audiometry with 11 test frequencies was conducted to determine hearing performance. Inclusion criteria were defined as air conducted hearing thresholds of 10 dB HL or lower. A deviation at a test frequency of 15 dB HL or less was tolerated. Data of tinnitus characteristics, such as pitch and intensity, were collected by presentation and matching of comparative tones, quality and subjective disturbance by questionnaire. Furthermore, data was obtained from both test groups by Békésy gliding frequency audiometry (794 test frequencies), as well as DPOAE measurement (36 test frequencies) and auditory brainstem response (ABR) audiometry (derivation of early auditory evoked potentials). The results showed a correlation of the determined tinnitus comparison pitch with the frequency location of the largest deviation (impairment) from the normal hearing curve in the Békésy gliding frequency audiometry (p = 0.032). All further analyses of the finestructure hearing curve (steepness of hearing loss, slope, number of hearing loss dips) showed no statistically significant relationship between the morphology of the fine-structure hearing curve and tinnitus characteristics. Finestructure measurement revealed areas of hearing loss that were not mapped in manual puretone audiometry. These "undetected" hearing losses would have led to the exclusion of 12 of 29 subjects (41.4 %) if the finestructure hearing curve had been used as an inclusion criterion. A direct comparison of the mean finestructure hearing curves of both test groups showed a statistically significant better mean hearing performance of the tinnitus group (p < 0.05) in 3 different test frequency ranges (1.5 kHz, 3 kHz, 7 kHz) with a maximum of 4 dB HL. Analy-sis of the mean amplitudes of wave I of the ABRs showed, contrary to expectation, a weak trend toward higher amplitudes in the tinnitus group (p = 0.06). According to Schaette and McAlpine (2011), synaptopathy pathogenesis should have resulted in an opposite trend, i.e., a decrease in wave I amplitude in the tinnitus group. As a secondary finding, a weak trend between wave I amplitude and subjectively perceived disturbance of tinnitus was demonstrated (p = 0.06). Statistical analysis of the parameters determined from the DPOAE measurements did not reveal any significant differences between the tinnitus group and control group. Direct comparison of the DPOAE and finestructure hearing curves, revealed a significant difference in the differences of the frequencyspecific measurements around 2.4 kHz (p = 0.007).
The results of the study suggest that in previous studies with supposedly normal hearing tinnitus subjects there were unrecognized hearing losses that either went unrecognized by the screening by manual puretone audiometry, or subjects with previously aboveaverage hearing experienced a subtle spontaneous decrease in their hearing as tinnitus pathogenesis. This assumption is also supported by the fact that there is a significant correlation between the frequency range of the greatest hearing loss in the finestructure hearing curves and the tinnitus frequency.
The suspected pathomechanism of synaptopathy in "normal hearing" subjects with tinnitus could not be confirmed. The correlation between wave I amplitudes and subjectively perceived disturbance by tinnitus, indicated by the data of this study, should be investigated in more detail in future studies. Further research with more accurate measurement methods and larger subject groups is needed to clarify the hypothesis "Genesis of chronic subjective tinnitus without hearing loss".
Inhibition of midbrain dopamine (DA) neurons codes for negative reward prediction errors, and causally affects conditioning learning. DA neurons located in the ventral tegmental area (VTA) display two-fold longer rebound delays from hyperpolarizing inhibition in comparison to those in the substantia nigra (SN). This difference has been linked to the slow inactivation of Kv4.3-mediated A-type currents (IA). One known suppressor of Kv4.3 inactivation is a splice variant of potassium channel interacting protein 4 (KChIP4), KChIP4a, which has a unique potassium channel inactivation suppressor domain (KISD) that is coded within exon 3 of the KChIP4 gene. Previous ex vivo experiments from our lab showed that the constitutive knockout of KChIP4 (KChIP4 KO) removes the slow inactivation of IA in VTA DA neurons, with marginal effects on SN DA neurons. KChIP4 KO also increased firing pauses in response to phasic hyperpolarization in these neurons. Here I show, using extracellular recordings combined with juxtacellular labeling in anesthetized mice, that KChIP4 KO also selectively changes the number and duration spontaneous firing pauses by VTA DA neurons in vivo. Pauses were quantified with two different statistical methods, including one developed in house. No other firing parameter was affected, including mean frequency and bursting, and the activity of SN DA neurons was untouched, suggesting that KChIP4 gene products have a highly specific effect on VTA DA neuron responses to inhibitory input.
Following up on this result, I developed a new mouse line (KChIP4 Ex3d) where the KISD-coding exon 3 of KChIP4 is selectively excised by cre-recombinase expressed under the dopamine transporter (DAT) promoter, therefore disrupting the expression of KChIP4a only in midbrain DA neurons. I show that these mice have a highly selective behavioral phenotype, displaying a drastic acceleration in extinction learning, but no changes in acquisition learning, in comparison to control littermates. Computational fitting of the behavioral data with a modified Rescorla-Wagner model confirmed that this phenotype is congruent with a selective increase in learning from negative prediction errors. KChIP4 Ex3d also had normal open field exploration, novel object preference, hole board exploration and spontaneous alternation in a plus maze, indicating that exploratory drive, responses to novelty, anxiety, locomotion and working memory were not affected by the genetic manipulation. Furthermore semi-quantitative IHC revealed that KChIP4 Ex3d mice have increased Kv4.3 expression in TH+ neurons, suggesting that the absence of KChIP4a increases the binding of other KChIP variants, which known to increase surface expression of Kv4 channels.
Furthermore, in the course of my experimental study I identified that the most used mouse line where cre-recombinase is expressed under the DAT promoter (DAT-cre KI) has a different behavioral phenotype during conditioning in relation to WT littermate controls. These animals displayed increased responding during the initial trials of acquisition and delayed response latency extinction, consistent with an increase in motivation, which is in line with a decrease in DAT function.
I propose a working model where the disruption of KChIP4a expression in DA neurons leads to an increase in binding of other KChIP variants to Kv4.3 subunits, promoting their increased surface expression and increasing IA current density; this then increases firing pauses in response to synaptic inhibition, which in behaving animals translates to an increase in negative prediction error-based learning.
Fokale idiopathische Dystonien stellen die häufigste Dystonieform im Erwachse-nenalter dar. Die Pathophysiologie dieser Erkrankungsgruppe ist weitestgehend unverstanden, wobei die Basalganglien, der Thalamus und das Cerebellum eine zentrale Rolle in der Genese dystoner Bewegungen zu spielen scheinen. Unklar ist, ob Patienten mit fokaler idiopathischer Dystonie mikrostrukturelle Verände-rungen in den oben genannten Arealen aufweisen, die das Störungsbild bedingen könnten.
In dieser Arbeit wurde mittels Methoden der quantitativen Magnetresonanztomographie (qMRT) der Versuch unternommen, Änderungen von Struktur und Eigenschaften des Hirngewebes bei idiopathischen Dystonien im Vergleich zu einer gesunden Kontrollkohorte zu identifizieren. Vorangegangen bildgebende Studien erbrachten bislang widersprüchliche Ergebnisse. Insbesondere der Frage nach möglichen Veränderungen des Eisengehaltes sollte mittels Messung der T2*-Re-laxationszeit nachgegangen werden. Weiterhin wurden Areale der motorischen Kontrolle (Basalganglien, Thalamus, Cerebellum und zerebraler Kortex) auf mög-liche Volumenveränderungen untersucht.
Insgesamt wurden 30 Patienten mit fokaler idiopathischer Dystonie sowie 30 alters- und geschlechtsgematchte Kontrollprobanden mittels multimodaler qMRT untersucht und Parameterkarten für die T1- und T2/T2*-Relaxationszeiten sowie der Protonendichte berechnet. Die Parameterkarten wurden sowohl voxelweise als auch regionenbasiert mit der Frage nach Dystonie-spezifischen Veränderungen statistisch ausgewertet. Zusätzlich erfolgte eine Subgruppenanalyse der ge-nannten Parameter von 17 Patienten mit zervikaler Dystonie im Vergleich zu ei-ner verkleinerten Kontrollgruppe.
Für keinen der untersuchten qMRT-Parameter konnte in der voxelweisen oder der regionenbasierten Analyse signifikante Gruppenunterschiede zwischen Patienten mit fokaler idiopathischer Dystonie und gesunden Kontrollprobanden nachgewiesen werden (p ≥ 0,05). Auch unterschieden sich die untersuchten Hirnregionen nicht hinsichtlich ihres Volumens (p ≥ 0,31). Ebenfalls ausschließlich negative Ergebnisse ergab die Subgruppenanalyse für Patienten mit zervikaler Dystonie (Gewebeparameter p ≥ 0,05, Volumen p ≥ 0,21).
Somit fanden sich entgegen der ursprünglichen Hypothese keine mittels qMRT detektierbaren krankheitsspezifischen mikrostrukturellen Gewebeveränderungen bei Patienten mit fokaler idiopathischer Dystonie. Unter Berücksichtigung der me-thodischen Limitationen und der kleinen Fallzahl ergaben sich keine Hinweise auf Dystonie-assoziierte neurodegenerative Prozesse, erhöhte Eisenablagerungen, Demyelinisierung oder Veränderungen des Wassergehaltes. Die Ergebnisse dieser Studie sind kompatibel mit der Sichtweise, dass idiopathische Dystonien am ehesten aufgrund einer reinen neurofunktionellen Netzwerkstörung der Ba-salganglien und deren kortikalen sowie cerebellären Projektionsareale entstehen. Hierbei ist zu berücksichtigen, dass sehr kleine, feingewebliche Veränderungen, die unterhalb des Auflösungsvermögens der hier verwendeten Bildge-bungsmethode liegen, nicht sicher ausgeschlossen werden können. Weitere quantitativ histologische Untersuchungen in Kombination mit quantitativ bildgebenden Verfahren werden benötigt, um die Pathophysiologie dieser Erkrankungsgruppe besser verstehen zu können.
The midbrain DA system comprising dopamine (DA) neurons of the substantia nigra (SN) and the ventral tegmental area (VTA) is involved in various brain functions, including voluntary movement and the encoding and prediction of behaviorally relevant stimuli. In Parkinsonʼs disease (PD), a progressive degeneration of particularly vulnerable SN DA neurons causes a progressive DA depletion of striatal projection sites. As a consequence, motor symptoms such as tremor, hypokinesia and rigidity appear once about 50 % to 70 % of SN DA neurons have been lost. Under physiological conditions, SN DA neurons can encode behaviorally salient events and coordinated movements through tonic and phasic activity and correlated striatal DA release. Burst-activity mediates a phasic, supralinear rise of striatal DA levels and allows to activate coordinated movements via modulation of corticostriatal signals.
In the present dissertation project, pathophysiological adaptations of surviving SN DA neurons after a partial degeneration of the nigrostiatal system have been studied using a 6-hydroxydopamine mouse model of PD. Combining in vivo retrograde tracing techniques with in vitro whole-cell patch-clamp recordings, multifluorescent immunolabeling and confocal microscopy allowed an unambiguous correlation of electrophysiological phenotypes, anatomical positions and neurochemical phenotypes of recorded neurons on a single-cell level. In vitro, neuronal activity of SN DA neurons is characterized by spontaneous, slow pacemaker activity of 1 to 10 Hz and a high degree of spike-timing precision. In vitro current-clamp recordings of surviving SN DA neurons using acute brain slice preparations after a partial, PD-like degeneration of the nigrostriatal DA system showed a significant perturbation of spontaneous pacemaker activity, mirrored by a decreased spike-timing precision compared to controls. Selective pharmacology and whole-cell voltage-clamp recordings served to identify calciumactivated SK channels as molecular effectors of a perturbated pacemaker activity of surviving SN DA neurons. SK channels and have been shown to critically contribute to the spike-timing precision of SN DA neurons. Consistently, in vitro current-clamp recordings after pharmacological blockade of SK channels in vitro caused a significant decrease of spike-timing precision, occluding previously observed differences between surviving SN DA neurons and controls.In addition to in vitro patch-clamp recordings, extracellular single-unit recordings in anaesthetized animals in vivo served to study surviving SN DA neurons embedded in an intact neuronal network after a partial, PD-like degeneration of the nigrostriatal DA system. Combining in vivo single-unit recordings, juxtacellular neurobiotin labeling and multifluorescent immunohistochemistry allowed to directly correlate electrophysiological and neurochemical phenotypes as well as anatomical positions on a single-cell level. In vivo, surviving SN DA neurons showed a significant decrease of spike-timing precision as reflected by an increased irregularity and an augmented burst activity compared to controls.
The present dissertation project provided a unique combination of a neurotoxicological PD mouse model, retrograde tracing techniques and in vitro as well as in vivo electrophysiologiy, allowing to unambiguously correlate electrophysiological adaptations, projection-specific anatomical positions and neurochemical phenotypes of SN DA neurons after a partial degeneration of the nigrostriatal system. Surviving SN DA neurons exhibited a significant deficit of SK channel activity after a partial degeneration of the nigrostriatal DA system. In consequence of a diminished SK channel activity observed in vitro, surviving SN DA neurons exhibited and enhanced burst activity in vivo, providing a plausible mechanism to compensate a striatal DA depletion.
An exciting in vivo function of ATP-sensitive potassium channels in substantia nigra dopamine neurons Ð Implications for burst firing and novelty coding ÐPhasic burst activity is a key feature of dopamine (DA) midbrain neurons. This particular pattern of excitation of DA neurons occurs via a synaptically triggered transition from low-frequency background spiking to transient high-frequency discharges. Burst-firing mediated phasic DA release is critical for flexible switching of behavioural strategies in response to unexpected rewards, novelty and other salient stimuli. However, the cellular and molecular bases of burst signalling in distinct DA subpopulations of the substantia nigra (SN) or the ventral tegmental area (VTA) are unknown.
DA neuron excitability is controlled by synaptic network inputs, neurotransmitter receptors and ion channels, which generate action potentials and determine frequency and pattern of electrical activity in a complex interplay. ATP-sensitive potassium (K-ATP) channels are widely expressed throughout the brain, where in most cases they are believed to act as metabolically-controlled 'excitation brakes' by matching excitability to cellular energy states. However, their precise physiological in vivo function in DA neurons remains elusive.
To study burst firing and the underlying ionic mechanisms with single cell resolution, in vivo single-unit recordings were combined with juxtacellular neurobiotin labelling as well as immunohistochemical and anatomical identification of individual DA neurons. In vivo recordings were performed in adult isoflurane-anaesthetised wildtype (WT) and global K-ATP channel knockout mice, lacking the pore forming Kir6.2 subunit (Kir6.2-/-). In addition, DA cell-selective functional silencing of K-ATP channel activity in vivo was established using virus-mediated expression of dominant-negative Kir6.2 subunits. Careful control experiments ruled out any significant contributions from nonDA neurons as transduction was effectively limited to SN DA neurons rather than affecting those cells that innervate them. Virus-based K-ATP channel silencing in combination with juxtacellular recording and labelling was achieved to define the electrophysiological phenotype of individually identified, virally-transduced DA neurons in vivo.
Single-unit recordings revealed that K-ATP channels Ð in contrast to their conventional hyperpolarising role Ð in a subpopulation of DA neurons located in the medial SN (m-SN) act as cell-type selective gates for excitatory burst firing in vivo. The percentage of spikes in bursts was threefold reduced in Kir6.2-/- compared to WT mice. Classification of firing patterns based on visual inspection of autocorrelation histograms and on a newly developed spike-train-model confirmed the dramatic shift from phasic burst to tonic single-spike oscillatory firing in Kir6.2-/-. This significant decrease of burstiness was selective for m-SN DA neurons and was not exhibited by DA cells in the lateral SN or VTA. Virus-based K-ATP channel silencing in vivo unequivocally demonstrated that the activity of postsynaptic K-ATP channels was sufficient to disrupt bursting in m-SN DA neuron subtypes. Patch-clamp recordings in brain slices indicated an essential role of K-ATP channels for NMDA-mediated in vitro bursting. In accordance with previous studies in DA midbrain neurons, NMDA receptor stimulation triggered burst-like firing in m-SN DA cells in vitro, but only when K-ATP channels were co-activated in these neurons.
K-ATP channel-gated burst firing in m-SN DA neurons might be functionally relevant in awake, freely moving mice. To explore the behavioural consequences of SN DA neuron subtype-selective K-ATP channel suppression, spontaneous open field (OF) behaviour of mice with bilateral K-ATP silencing across the whole SN (medial + lateral) or in only the lateral SN was tested. Analysis of WT and global Kir6.2-/- mice showed reduced exploratory locomotor activity of Kir6.2-/- in a novel OF environment. Remarkably, K-ATP channel silencing in m-SN DA neurons phenocopied this novelty-exploration deficit, indicating that K-ATP channel-gated burst firing in medial but not lateral SN DA neurons is crucial for WT-like novelty-dependent exploratory behaviour.
In summary, a novel role of K-ATP channels in promoting the excitatory switch from tonic to phasic firing in vivo in a cell-type specific manner was discovered. The present PhD thesis provides several important insights into the pivotal function of K-ATP channels in medial SN DA cells, which project to the dorsomedial striatum, for burst firing and its important consequences for context-dependent exploratory behaviour.
In collaboration with two other research groups transcriptional up-regulation of K-ATP channel and NMDA receptor subunits and high levels of in vivo burst firing were detected in surviving SN DA neurons from Parkinson's disease (PD) patients Ð providing a potential link of K-ATP channel activity to neurodegenerative pathomechanisms of PD. Using high-resolution fMRI imaging another study in humans has recently identified distinct DA midbrain regions that are preferentially activated by either reward or novelty. Taken together, these human data and the results of the present PhD thesis suggest that burst-gating K-ATP channel function in SN DA neurons impacts on phenotypes in disease as well as in health.
Hintergrund: Die leichte kognitive Störung (engl. Mild cognitive impariment, MCI) ist ein wichtiges nicht-motorisches Symptom der Parkinson-Krankheit (PD) und ein Hochrisiko-Zustand für die Entwicklung einer Parkinson-Demenz (PDD).
Die Etablierung von Biomarkern für ein MCI bei PD-Patienten (PD-MCI) könnte sowohl die Diagnosestellung als auch das Therapiemonitoring verbessern.
Ziel: Es ist bekannt, dass PDD-Patienten im Vergleich zu PD-Patienten ohne kognitive Beeinträchtigung (engl. PD normal cognition, PD-NC) in der strukturellen Magnetresonanztomographie (MRT) eine ausgeprägte kortikale und subkortikale Hirnatrophie aufweisen. Die Datenlage für Patienten mit PD-MCI ist deutlich heterogener, zudem wurden bisher vor allem de novo-Patienten untersucht. Mittels longitudinaler struktureller MRT soll in dieser multizentrischen Studie herausgefunden werden, ob der beginnende kognitive Abbau von Parkinson-Patienten im mittleren Krankheitsstadium ebenfalls mit Volumenänderungen kritischer Hirnstrukturen assoziiert ist. Die Hypothese ist, dass Patienten mit PD-MCI sich durch eine reduzierte mittlere kortikale Dicke sowie durch die Atrophie des Hippocampus und ggf. weiterer subkortikaler Strukturen von PD-NC-Patienten und von gesunden Kontrollen (engl. healthy controls, HC) unterscheiden.
Methode: 59 Patienten mit PD-NC, 49 Patienten mit PD-MCI sowie 59 HC erhielten zu Beginn der Studie und nach 12 Monaten eine ausführliche neuropsychologische Testung und eine strukturelle MRT-Untersuchung. Die MRT-Daten wurden mit der Freesurfer-Software automatisiert segmentiert, die mittlere kortikale Dicke sowie subkortikale Volumina und deren Atrophieraten berechnet und Gruppenvergleiche angestellt.
Ergebnisse: Verglichen mit HC zeigte sich bei Patienten mit PD-MCI eine signifikant geringere mittlere kortikale Dicke sowie ein reduziertes Volumen des linken Thalamus, des Hippocampus und des Nucleus caudatus. Zwischen Patienten mit PD-MCI und PD-NC fanden sich dagegen keine signifikanten Volumenunterschiede. Für kognitiv beeinträchtigte PD-Patienten zeigte sich über 12 Monate eine signifikant höhere Atrophierate des rechten Thalamus, sowohl verglichen mit kognitiv unauffälligen PD-Patienten als auch verglichen mit HC.
Für alle anderen untersuchten Strukturen unterschieden sich die Atrophieraten zwischen allen drei Gruppen nicht signifikant.
Schlussfolgerung: PD-MCI ist im mittleren Stadium der Parkinson-Krankheit mit einer reduzierten kortikalen Dicke sowie einer die Altersnorm überschreitenden Atrophie des Thalamus, des Hippocampus und des Striatums assoziiert.
Aufgrund der geringen Volumenunterschiede zwischen den einzelnen Gruppen und der hohen interindividuellen Variabilität ist die Sensitivität der Methode allerdings nicht ausreichend, um MR-basiert zwischen Parkinson-Patienten mit MCI und solchen mit normaler Kognition zu unterscheiden.
as Locus coeruleus-noradrenerge System ist die primäre Quelle für zentrales corticales und subcorticales Noradrenalin. Die noradrenergen Projektionen des LC sind an der Modulation einer Vielzahl von funktionellen zentralen Abläufen beteiligt, u.a. an Aufmerksamkeitsprozessen, der Vermittlung von Stress und der Schlaf-Wach-Koordination, aber auch an der Koordination spezifischerer kognitiver Funktionen im Rahmen von Belohnungs-orientiertem Verhalten.
Die im Rahmen der vorliegenden Arbeit im anatomisch-topographischen Teil durchgeführten Experimente belegen eine dichte noradrenerge Innervation des präfrontalen Cortex, des dorsalen und ventralen Hippocampus, und des Kleinhirns durch Neurone des Locus coeruleus. Innerhalb des LC sind die nach präfrontal und hippocampal projizierenden Neurone vorwiegend im dorsalen Anschnitt über die gesamte rostro-caudale Achse zu finden. Der Anteil ipsilateral gelabelter Zellen überwiegt deutlich. Coeruleocerebelläre Neurone sind innerhalb des LC sowohl in den dorsalen als auch ventralen Abschnitten, ebenfalls über die gesamte rostro-caudale Achse, zu finden. Der Anteil kontralateral gelabelter Zellen ist relativ höher als bei den anderen Projektionen.
Die im ersten elektrophysiologischen Teil der Arbeit durchgeführten Experimente belegen ein in den Grundeigenschaften ähnliches Feuerungsmuster selektiv identifizierter coeruleo-präfrontaler und coeruleo-hippocampaler Nervenzellen. Einzelne Aktionspotential-Parameter waren signifikant unterschiedlich, hinweisend auf unterschiedliche hyperpolarisierende Ströme in beiden Populationen. Eine Überprüfung des a2-Autorezeptor-Status im zweiten elektrophysiologischen Teil der Arbeit ergab ein fehlendes Ansprechen der coeruleo-präfrontalen Neurone auf a2-Blockade (im Gegensatz zu den coeruleo-hippocampalen Neuronen); dieser Befund ist vereinbar am ehesten mit fehlenden oder funktionell down-regulierten a2-Rezeptoren selektiv in nach präfrontal projizierenden Neuronen des Locus coeruleus. Hierbei handelt es sich um einen in der Literatur nicht vorbeschriebenen Befund.