The role of ASICs in cerebral ischemia - Zhi-Gang Xiong1 and Tian-Le Xu2
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Focus Article The role of ASICs in cerebral ischemia Zhi-Gang Xiong1∗ and Tian-Le Xu2 Cerebral ischemia is a leading cause of death and long-term disabilities worldwide. Excessive intracellular Ca2+ accumulation in neurons has been considered essential for neuronal injury associated with cerebral ischemia. Although the involvement of glutamate receptors in neuronal Ca2+ accumulation and toxicity has been the subject of intensive investigation, inhibitors for these receptors showed little effect in clinical trials. Thus, additional Ca2+ toxicity pathway(s) must be involved. Acidosis is a common feature in cerebral ischemia and was known to cause brain injury. The mechanisms were, however, unclear. The finding that ASIC1a channels are highly enriched in brain neurons, their activation by ischemic acidosis, and their demonstrated Ca2+ permeability suggested a role for these channels in Ca2+ accumulation and neuronal injury associated with cerebral ischemia. Indeed, a number of studies have now provided solid evidence supporting the involvement of ASIC1a channel activation in ischemic brain injury. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. How to cite this article: WIREs Membr Transp Signal 2012, 1:655–662. doi: 10.1002/wmts.57 INTRODUCTION Although multiple pathways and biochemical changes contribute to ischemic brain injury, exces- I schemic stroke, or cerebral ischemia, is the third most common cause of death in most industrialized countries. Although major advances have occurred sive intracellular Ca2+ accumulation and resultant toxicity has been considered essential in the pathol- ogy of cerebral ischemia.2 In the resting conditions, in the prevention of stroke during the past several free intracellular Ca2+ concentration ([Ca2+ ]i ) in neu- decades, no effective treatment is now available. rons is maintained at nanomolar range. Following Current clinical practices for stroke patients utilize cerebral ischemia, however, [Ca2+ ]i can rise to as thrombolytic agent tissue plasminogen activator (tPA) high as several micromolars. Excessive accumula- to reopen the clotted vessels.1 This approach, tion of Ca2+ in neurons leads to uncontrolled acti- however, has very limited success due to a short vation of various enzymes causing breakdown of therapeutic time window of 3 h and side effect of proteins, lipids, and nucleic acids, and the destruc- intracranial hemorrhage. On the other hand, cell tion of neurons.3–5 In addition, overloading Ca2+ in death is prominent following stroke. Therefore, the mitochondria can cause opening of mitochondria per- need for a continuous search of neuronal damage meability transition pore (PTP), promoting apoptosis mechanisms and effective therapeutic strategies for through release of cytochrome c and activation of neuroprotection remains high. caspases.6 Ca2+ can enter neurons through various path- Conflict of interest: Both authors have no conflict of interest to ways, among which glutamate receptor-gated chan- declare. nels have received the most attention. Unfortunately, ∗ Correspondence to: zxiong@msm.edu clinical trials targeting these channels have shown 1 Neuroscience Institute, Morehouse School of Medicine, Atlanta, little effect in improving the outcome of cerebral GA 30310, USA ischemia.7 Multiple factors may have contributed 2 Neuroscience Division, Department of Biochemistry and Molec- to the failure of the trials. In particular, additional ular Cell Biology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, glutamate-independent Ca2+ entry and toxicity path- China ways must be considered. Volume 1, September/October 2012 © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. 655
Focus Article wires.wiley.com/mts BRAIN ACIDOSIS IN CEREBRAL To provide a link between ASIC1a activation ISCHEMIA and ischemic brain injury, both in vitro neuronal injury and in vivo cerebral ischemia models were Acidosis, a condition characterized by too much acid employed. A brief (1 h) acid incubation, in the pres- in the tissue or body fluid, is one of the most common ence of blockers of glutamate receptors and voltage- pathophysiological changes in the brain associated gated Ca2+ channels, was able to induce substantial with acute neurological conditions such as cerebral neuronal injury measured at 6 h or 24 h after acid ischemia.8,9 In the ischemic core, for example, a rapid treatment. This acid-induced, glutamate-independent drop of pH to 6.5 or lower is frequently observed.10,11 neuronal injury was inhibited by amiloride or PcTX1, The lack of oxygen supply promotes anaerobic supporting the involvement of homomeric ASIC1a glycolysis which leads to increased production of channels. Consistent with an essential role for ASIC1a lactic acid.11 Accumulation of lactic acid, along with subunit in acid injury, neurons cultured from ASIC1 increased production of H+ from ATP hydrolysis, knockout mice were resistant to acid incubation.15,18 and release of H+ from presynaptic terminals,12 Reducing the concentration of extracellular Ca2+ , contributes to the acid buildup in the brain. Acidosis which decreases the driving force for Ca2+ entry, also has long been recognized to aggravate brain injury ameliorated acid injury. To know whether ASIC1a- associated with cerebral ischemia.8,9 However, the mediated injury can also take place in ischemic detailed mechanism(s) remained elusive, although a condition, acid-mediated neuronal injury was stud- number of possibilities have been suggested long ied in the condition of oxygen glucose deprivation before the role of acid-sensing ion channels (ASICs) (OGD). OGD, in the presence of blockers of glu- was recognized.8,13,14 tamate receptors and voltage-gated Ca2+ channels, enhanced the acid-induced neuronal injury which ASIC1a ACTIVATION IS INVOLVED was inhibited by amiloride and PcTX1. Thus, in vitro studies support a role for ASIC1a activation IN ACIDOSIS-MEDIATED ISCHEMIC in acidosis-mediated, Ca2+ -dependent, ischemic neu- BRAIN INJURY ronal injury. Since a recent study showed that PcTX1 On the basis of the evidence that ASIC1a subunits also inhibits heteromeric ASIC1a/ASIC2b channels in are highly expressed in brain neurons, their activa- addition to homomeric ASIC1a channels,19 the poten- tion by pH drops to the level commonly seen in tial contribution of heteromeric ASIC1a/ASIC2b chan- cerebral ischemia, and their permeability to Ca2+ nels to acidosis-mediated neuronal injury cannot be and Na+ , Xiong and colleagues tested the hypoth- excluded. esis that activation of ASIC1a channels is involved Does activation of ASIC1a channels also play a in neuronal Ca2+ accumulation and injury associated role in ischemic brain injury in vivo? To answer this with cerebral ischemia.15 Using patch-clamp recording question, two sets of experiments were performed. and fast-perfusion technique, large inward currents The first experiment examined whether application were recorded in cultured mouse cortical neurons in of ASIC inhibitors reduces ischemic brain injury, and response to rapid perfusion of acidic solutions at pH the second tested whether knockout of the ASIC1 levels relevant to cerebral ischemia. The acid-activated gene renders the animal resistant to cerebral ischemia. currents in cortical neurons were sensitive to non- Rodent model of focal ischemia, by middle cerebral specific ASIC blocker amiloride and partially inhibited artery occlusion (MCAO), was employed for both by ASIC1a-specific inhibitor PcTX1, suggesting that experiments. In rats and mice, intracerebroventricu- the currents were mediated by ASIC1a-containing lar injection of ASIC1a inhibitor PcTX1 reduced the channels. Consistent with the presence of func- infarct volume by up to 60%, measured at 24 h after tional homomeric ASIC1a channels, which are Ca2+ - MCAO.15,20 Similar to the pharmacological blockade, permeable,16 perfusion of acidic solution in these ASIC1 gene knockout provided a comparable degree neurons increased intracellular Ca2+ concentration, of protection against ischemic brain injury.15 Remark- even in the presence of blockers of voltage-gated Ca2+ ably, in contrast to most glutamate antagonists which channels and glutamate receptors. As expected, the have only a short time window of
WIREs Membrane Transport and Signaling Role of ASICs in cerebral ischemia of human brain neurons in culture. Thus, Ca2+ - ischemic conditions and whether the effects of permeable ASIC1a channels represent a promising ASIC1a activation (e.g., membrane depolarization therapeutic target for human cerebral ischemia. and intracellular Ca2+ accumulation) could be long- lasting and detrimental are crucial in determining the pathological functions of these channels. ISCHEMIA-RELATED SIGNALS To this end, Xiong and colleagues first showed ENHANCE THE ACTIVATION OF ASICs that OGD treatment can dramatically potentiate the activity of neuronal ASICs—the amplitude of Even though the results from both in vitro and the acid-activated current was enhanced while the in vivo pharmacological and molecular biological decay of the current was reduced following 1 h interventions clearly supported an important role for OGD.15 The overall outcome of these two effects ASIC1a activation in neuronal injury associated with would be a dramatically increased ASIC-mediated cerebral ischemia, several questions remained to be response, which might be translated into enlarged addressed. and longer-lasting intracellular Ca2+ elevation. What Under in vitro experimental conditions, currents could be the underlying mechanisms responsible for of most ASIC subtypes, particularly the homomeric the changes of electrophysiological property of ASICs ASIC1a channels, decay rapidly in the continuous observed after OGD or ischemia? This question was presence of acidic pH,23 a phenomena of channel not directly answered by the studies of Xiong et al. desensitization. In addition, pre-exposure of these However, later studies by different laboratories have channels to small pH drops (e.g., from 7.4 to provided important missing links. It is now known 7.2) that are insufficient to activate the channel that various ischemia-related signals, for example, also suppresses the channel activity in response to arrachidonic acid, dynorphine, lactate, and spermine, subsequent, large pH drops, a process termed steady- can dramatically enhance the amplitude and/or reduce state desensitization.24,25 Furthermore, it has been the desensitization of ASICs27 (Figure 1). shown that the activities and/or expression of some ion channels could be dramatically down-regulated following the ischemia/hypoxia, as exemplified Arachidonic Acid by N-methyl d-aspartate (NMDA) channels in Arachidonic acid (AA) is a polyunsaturated fatty acid hypoxic turtle brain.26 Thus, whether a significant present in the phospholipids of all cell membranes and amount of ASIC1a current can be activated in one of the most abundant fatty acids in the brain. In Non-ischemic condition Ischemic condition Pre synaptic release Pre synaptic release H+ Lactic acid Ca2+ Na+ Arachidonic acid Glu Ca2+ Glu Dynorphines Glu Na+ Ca2+ Nitric oxide Ca2+ H+ Na+ Protease H+ Ca2+ ASIC 1a GluR Spermine ASIC 1a GluR CaMKII CaMKII Synaptic plasticity Cell death FIGURE 1 | Activation of ASIC1a channels and outcomes in non-ischemic and ischemic conditions. In non-ischemic condition, activation of ASIC1a channels and slight increase of cellular Ca2+ is involved in synaptic plasticity. In ischemic condition, ASIC1a activation is dramatically potentiated by various factors. Increased concentration of H+ per se activates more current. In addition, various ischemia-related signals not only increased the amplitude but also reduced the desensitization of the ASIC responses. Overload of neurons with Ca2+ leads to cell death. Volume 1, September/October 2012 © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. 657
Focus Article wires.wiley.com/mts addition to being involved in cellular signaling as a CaMKII phosphorylation of ASIC1a with KN-93, or lipid second messenger,28 AA plays important roles in mutation of ASIC1a at Ser478 and Ser479, produced pathological conditions including brain ischemia.28,29 neuroprotection. Thus, phosphorylation of ASIC1a by Following brain ischemia, the rise of [Ca2+ ]i leads CaMKII deteriorates ASIC-mediated neuronal injury to activation of phospholipase A2, resulting in in ischemia. increased production of lipid mediators including AA. Although the exact mechanisms are unclear, high concentrations of lipid mediators are known to cause Dynorphins neurotoxicity.28 Dynorphins are endogenous neuropeptides abun- On the basis of demonstrated effects of AA dantly expressed in the central nervous system (CNS). on a variety of voltage-gated and ligand-gated They are involved in a variety of physiologic func- ion channels, for example, potentiation of NMDA tions. Under pathophysiological conditions where channel currents,30 Allen and Attwell tested the effect their levels are substantially elevated, these peptides of AA on ASICs. In rat cerebellar Purkinje cells, bath can be neurotoxic, partially mediated through gluta- perfusion of 5 or 10 μM AA produced a large increase mate receptors.35 Recently, Sherwood and Askwith in the amplitude of the ASIC current. In addition reported that, at high concentrations dynorphins such to potentiating the peak amplitude, AA enhanced as big dynorphin potentiate acid-activated currents in or induced an additional sustained component of mouse cortical neurons and in CHO cells expressing the current.31 In heterologous expression systems, homomeric ASIC1a channels.36 The potentiation of AA potentiates both homomeric ASIC1a and ASIC2a the ASIC1a activity was mediated through a reduction channels.32 Thus, promoting the activation of ASIC1a of the steady-state desensitization of these channels. channels could be one of the mechanisms mediating In the absence of big dynorphine, pre-exposing neu- the neurotoxicity of AA. rons to conditioning pH of 7.0 completely desensitizes the channels, resulting in no responses to subsequent larger decrease in pH (e.g., to 5.0). In the presence of big dynorphine, however, ASIC1a currents were read- CaMKII ily activated. As expected, big dynorphine enhanced Ca2+ /calmodulin (CaM)-dependent protein kinase II ASIC1a-mediated neuronal injury during prolonged (CaMKII) is the most abundant kinase isoform in acidosis. the brain and a major mediator of the function of excitatory glutamate receptors. Influx of intracellular Ca2+ through glutamate receptors triggers an Lactate autophosphorylation of CaMKII and activation of Back in 2001, Immke and McCleskey demonstrated the enzyme. Although activation of CaMKII plays that, in sensory neurons that innervate the heart and a prominent role in synaptic plasticity, increased COS-7 cells transfected with AIC1a channels, addition CaMKII activity has been implicated in the regulation of lactate, at the level seen in ischemia, dramatically of neuronal cell death after cerebral ischemia.33 increased the amplitude of the ASIC current activated Studies by Gao et al. demonstrated a link by a moderate pH drop to ∼7.0.37 The increase of the between CaMKII activation and acidotoxic neuronal current amplitude was accompanied by a reduced death.34 They showed that global ischemia in rats current desensitization. Applications of lactate at results in an increased phosphorylation of ASIC1a pH values that do not activate ASICs caused no at Ser478 and Ser479 by CaMKII. This phosphory- response. Thus, lactate acted by potentiating but not lation sensitizes the channel to low pH, exacerbat- activating the ASICs. The effect of lactate persisted ing cell death by allowing prolonged and increased in excised membrane patches indicating the lack of Ca2+ entry. second messenger involvement. As lactate has the Consistent with the report by Xiong and ability to chelate the divalent cations, which have colleagues,15 Gao and colleagues observed an a modulatory role for various membrane receptors enhancement of ASIC currents by OGD. Inhibition and ion channels,38–40 it was logical to hypothesize of CaMKII with KN-93 or CaMKIINtide abolished that potentiation of the ASIC currents could be due the enhancement of ASIC currents, indicating an to a chelation of Ca2+ and Mg2+ in the solution. involvement of CaMKII. They further demonstrated Indeed, adjusting the concentrations of Ca2+ and an increased phosphorylation of ASIC1a protein Mg2+ eliminated the potentiating effect of lactate.37 after transient global ischemia, which was blocked Similar to the cardiac sensory neurons, potentiation by intracerebroventricular administration of KN-93 of the ASIC current by lactate has been reported in or CaMKIINtide. Pharmacological inhibition of other neurons.31 658 © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. Volume 1, September/October 2012
WIREs Membrane Transport and Signaling Role of ASICs in cerebral ischemia TABLE 1 Ischemia-related Endogenous Modulators Known to Potentiate ASIC-mediated Responses Neurons or ASIC subunit Modulator tested effective Modulation site(s) Functional outcome References Arachidonic acid Cerebellar Purkinje cells Unknown Increased amplitude 32, 60 Sensory neuron Reduced desensitization ASIC1a ASIC3 CaMK II Hippocampal neurons Intracellular Increased amplitude 34 ASIC1a S478 and S479 Increased injury Dynorphine Cortical neurons Extracellular Reduced steady-state desensitization 36 Hippocampal neurons PcTX1 site Increased acid-injury ASIC1a ASIC1b Lactate Sensory neuron, Extracellular Increased amplitude 37, 60 Cerebellar Purkinje neurons Reduced desensitization ASIC1a ASIC3 Nitric oxide DRG neurons Extracellular Increased current amplitude 45, 61 Neuro2A cells Increased acid-injury ASIC1a ASIC1b ASIC2a ASIC3 Protease Hippocampal neurons Extracellular Enhanced current amplitude activated 48 ASIC1a PcTX1 site from a baseline pH of 7.0 Increased recovery from desensitization Spermine Cortical neurons Extracellular Increased amplitude 56, 57 Hippocampal neurons PcTX1 site Reduced desensitization ASIC1a E219 and E242 Reduced steady-state desensitization Increased recovery from desensitization Increased acid-injury Nitric oxide ASICs, probably through oxidization of cysteine Nitric oxide (NO) is an important reactive residues.45 oxygen/nitrogen species which has a variety of physiological and pathological functions.41 During ischemia, intracellular Ca2+ overload leads to Proteases activation of the Ca2+ -dependent neuronal form of Brain ischemia is accompanied by increased protease nitric oxide synthase (nNOS), resulting in an increased activity.46 Following ischemia, blood-derived pro- production of NO.42,43 NO can also be released by teases have access to the interstitial space from a com- activated microglia.44 Excessive NO production is promised blood–brain barrier.46,47 Studies by Poirot known to increase neuronal injury.44 Although the and colleagues demonstrated an ASIC1a-specific mod- formation of a strong oxidant of peroxynitrite is ulation of the ASIC activity by serine proteases.48 likely involved in cell injury, other mechanisms cannot Exposure of cells to trypsin, for example, leads to a be excluded. Cadiou and colleagues reported that decreased ASIC1a current if the channel is activated NO donor S-nitroso-N-acetylpenicillamine (SNAP) by a pH drop from pH 7.4. However, if acidification potentiates ASIC currents in DRG neurons and in occurs from a lower basal pH (e.g., 7.0), a con- CHO cells expressing ASIC subunits. Modulators dition pertinent to brain ischemia, protease exposure of the cGMP/PKG pathway had no effect on the increases, rather than decreases, the ASIC1a activity.48 potentiation, but in excised patches from CHO Further studies demonstrate that trypsin modulates cells expressing ASIC2a, the potentiation could be the ASIC1a function by cleaving this subunit at Arg- reversed by externally applying reducing agents. 145, which is in the N-terminus of the extracellular NO, therefore, has a direct external effect on loop overlapping with the PcTX1 binding site.49 Volume 1, September/October 2012 © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. 659
Focus Article wires.wiley.com/mts Spermine CONCLUSION Spermine is a polyvalent cation involved in var- Stroke or cerebral ischemia is a leading health problem ious physiological processes. High concentration worldwide. Unfortunately, there is still no effec- of spermine can induce neuronal depolarization tive treatment for stroke patients. Searching for and cytoplasmic Ca2+ overload, which may lead new brain injury mechanisms and effective thera- to neuronal damage.50 Following ischemia, the peutic strategies is a major challenge and priority. activity of ornithine decarboxylase (ODC), a rate- Acidosis is a primary feature associated with cere- limiting enzyme responsible for polyamine synthesis is bral ischemia and is known to cause brain injury. enhanced, leading to elevated level of spermine.51 The finding that activation of ASICs contributes Although the modulation of NMDA receptor to acidosis- and ischemia-induced intracellular Ca2+ function52,53 might explain its neurotoxicity, several accumulation and neuronal injury has suggested that studies have yielded inconsistent results.54,55 these channels may represent potential new thera- Babini and colleagues demonstrated that sper- peutic targets for stroke intervention. In additional mine potentiates the activities of ASICs.56 More to developing pharmacological agents directly target- recently, Duan and colleagues showed that extra- ing ASICs, alternative strategies can be considered cellular spermine exacerbated ischemic neuronal by targeting ischemia-related signals known to poten- injury through sensitization of ASIC1a channels to tiate the activity of these channels (Table 1). Alter- acidosis.57 In addition to increasing channel activa- native neuroprotective strategies may also consider tion, spermine reduced channel desensitization and targeting the mechanisms and pathways that control accelerated recovery from desensitization in response the expression level of total protein and/or surface to repeated acid stimulation. Thus, extracellular ASIC1a.58,59 spermine contributes to ischemic neuronal injury, at least in part, by enhancing the activity of ASIC1a channels.57 ACKNOWLEDGMENT The work in Z.G.X.’s lab is supported in part by NIH R01NS047506, R01NS066027, UL1 RR025008, U54 RR026137, AHA 0840132N, and ALZ IIRG-10-173350. REFERENCES 1. Weintraub MI. Thrombolysis (tissue plasminogen acti- traumatic brain injury? Lancet Neurol 2002, 1: vator) in stroke: a medicolegal quagmire. Stroke 2006, 383–386. 37:1917–1922. 8. Siesjo BK, Katsura K, Kristian T. Acidosis-related dam- 2. Choi DW. Calcium-mediated neurotoxicity: relation- age. Adv Neurol 1996, 71:209–233. ship to specific channel types and role in ischemic 9. Tombaugh GC, Sapolsky RM. Evolving concepts damage. Trends Neurosci 1988, 11:465–469. about the role of acidosis in ischemic neuropathology. 3. Lee JM, Zipfel GJ, Choi DW. The changing landscape J Neurochem 1993, 61:793–803. of ischaemic brain injury mechanisms. Nature 1999, 10. Nedergaard M, Kraig RP, Tanabe J, Pulsinelli WA. 399:A7–A14. Dynamics of interstitial and intracellular pH in evolving 4. Simonian NA, Coyle JT. Oxidative stress in neurode- brain infarct. Am J Physiol 1991, 260:R581–R588. generative diseases. Annu Rev Pharmacol Toxicol 1996, 11. Rehncrona S. Brain acidosis. Ann Emerg Med 1985, 36:83–106. 14:770–776. 5. Coyle JT, Puttfarcken P. Oxidative stress, glutamate, 12. Wemmie JA, Price MP, Welsh MJ. Acid-sensing ion and neurodegenerative disorders. Science 1993, 262: channels: advances, questions and therapeutic opportu- 689–695. nities. Trends Neurosci 2006, 29:578–586. 6. Polster BM, Fiskum G. Mitochondrial mechanisms 13. Swanson RA, Farrell K, Simon RP. Acidosis causes of neural cell apoptosis. J Neurochem 2004, 90: failure of astrocyte glutamate uptake during hypoxia. 1281–1289. J Cereb Blood Flow Metab 1995, 15:417–424. 7. Ikonomidou C, Turski L. Why did NMDA recep- 14. McDonald JW, Bhattacharyya T, Sensi SL, Lobner D, tor antagonists fail clinical trials for stroke and Ying HS, Canzoniero LMT, Choi DW. Extracellular 660 © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim. Volume 1, September/October 2012
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