The amygdala is a chemosensor that detects carbon dioxide and acidosis to elicit fear behavior. Cell. 2009;139:1012-1021. [PMID: 19945383 DOI: 10.1016/j.cell.2009.10.029]

Respiratory and cognitive mediators of treatment change in panic disorder: evidence for intervention specificity

OBJECTIVE

There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this study was to analyze pathways of change in theoretically distinct interventions using longitudinal, moderated mediation analyses.

METHOD

Forty-one patients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of training aimed at altering either respiration (capnometry-assisted respiratory training) or panic-related cognitions (cognitive training). Changes in respiration (PCO₂, respiration rate), symptom appraisal, and a modality-nonspecific mediator (perceived control) were considered as possible mediators.

RESULTS

The reductions in panic symptom severity and panic-related cognitions and the improvements in perceived control were significant and comparable in both treatment groups. Capnometry-assisted respiratory training, but not cognitive training, led to corrections from initially hypocapnic to normocapnic levels. Moderated mediation and temporal analyses suggested that in capnometry-assisted respiratory training, PCO₂ unidirectionally mediated and preceded changes in symptom appraisal and perceived control and was unidirectionally associated with changes in panic symptom severity. In cognitive training, reductions in symptom appraisal were bidirectionally associated with perceived control and panic symptom severity. In addition, perceived control was bidirectionally related to panic symptom severity in both treatment conditions.

CONCLUSION

The findings suggest that reductions in panic symptom severity can be achieved through different pathways, consistent with the underlying models.

Central respiratory chemoreception

By definition central respiratory chemoreceptors (CRCs) are cells that are sensitive to changes in brain PCO(2) or pH and contribute to the stimulation of breathing elicited by hypercapnia or metabolic acidosis. CO(2) most likely works by lowering pH. The pertinent proton receptors have not been identified and may be ion channels. CRCs are probably neurons but may also include acid-sensitive glia and vascular cells that communicate with neurons via paracrine mechanisms. Retrotrapezoid nucleus (RTN) neurons are the most completely characterized CRCs. Their high sensitivity to CO(2) in vivo presumably relies on their intrinsic acid sensitivity, excitatory inputs from the carotid bodies and brain regions such as raphe and hypothalamus, and facilitating influences from neighboring astrocytes. RTN neurons are necessary for the respiratory network to respond to CO(2) during the perinatal period and under anesthesia. In conscious adults, RTN neurons contribute to an unknown degree to the pH-dependent regulation of breathing rate, inspiratory, and expiratory activity. The abnormal prenatal development of RTN neurons probably contributes to the congenital central hypoventilation syndrome. Other CRCs presumably exist, but the supportive evidence is less complete. The proposed locations of these CRCs are the medullary raphe, the nucleus tractus solitarius, the ventrolateral medulla, the fastigial nucleus, and the hypothalamus. Several wake-promoting systems (serotonergic and catecholaminergic neurons, orexinergic neurons) are also putative CRCs. Their contribution to central respiratory chemoreception may be behavior dependent or vary according to the state of vigilance.

Design and screening of ASIC inhibitors based on aromatic diamidines for combating neurological disorders

Acid sensing ion channels (ASICs) are implicated in various brain functions including learning and memory and are involved in a number of neurological disorders such as pain, ischemic stroke, depression, and multiple sclerosis. We have recently defined ASICs as one of receptor targets of aromatic diamidines in neurons. Aromatic diamidines are DNA-binding agents and have long been used in the treatment of leishmaniasis, trypanosomiasis, pneumocystis pneumonia and babesiosis. Moreover, some aromatic diamidines are used as skin-care and baby products and others have potential to suppress tumor growth or to combat malaria. A large number of aromatic diamidines or analogs have been synthesized. Many efforts are being made to optimize the therapeutic spectrum of aromatic diamidines, i.e. to reduce toxicity, increase oral bioavailability and enhance their penetration of the blood-brain barrier. Aromatic diamidines therefore provide a shortcut of screening for selective ASIC inhibitors with therapeutic potential. Intriguingly nafamostat, a protease inhibitor for treating acute pancreatitis, also inhibits ASIC activities. Aromatic diamidines and nafamostat have many similarities although they belong to distinct classes of medicinal agents for curing different diseases. Here we delineate background, clinical application and drug development of aromatic diamidines that could facilitate the screening for selective ASIC inhibitors for research purposes. Further studies may lead to a drug with therapeutic value and extend the therapeutic scope of aromatic diamidines to combat neurological diseases.

Acid-sensing ion channels (ASICs): pharmacology and implication in pain

Tissue acidosis is a common feature of many painful conditions. Protons are indeed among the first factors released by injured tissues, inducing a local pH fall that depolarizes peripheral free terminals of nociceptors and leads to pain. ASICs are excitatory cation channels directly gated by extracellular protons that are expressed in the nervous system. In sensory neurons, they act as "chemo-electrical" transducers and are involved in somatic and visceral nociception. Two highly specific inhibitory peptides isolated from animal venoms have considerably helped in the understanding of the physiological roles of these channels in pain. At the peripheral level, ASIC3 is important for inflammatory pain. Its expression and its activity are potentiated by several pain mediators present in the "inflammatory soup" that sensitize nociceptors. ASICs have also been involved in some aspects of mechanosensation and mechanonociception, notably in the gastrointestinal tract, but the underlying mechanisms remain to be determined. At the central level, ASIC1a is largely expressed in spinal cord neurons where it has been proposed to participate in the processing of noxious stimuli and in central sensitization. Blocking ASIC1a in the spinal cord also produces a potent analgesia in a broad range of pain conditions through activation of the opiate system. Targeting ASIC channels at different levels of the nervous system could therefore be an interesting strategy for the relief of pain.

Central serotonin neurons are required for arousal to CO2

There is a long-standing controversy about the role of serotonin in sleep/wake control, with competing theories that it either promotes sleep or causes arousal. Here, we show that there is a marked increase in wakefulness when all serotonin neurons are genetically deleted in mice hemizygous for ePet1-Cre and homozygous for floxed Lmx1b (Lmx1b(f/f/p)). However, this only occurs at cool ambient temperatures and can be explained by a thermoregulatory defect that leads to an increase in motor activity to generate heat. Because some serotonin neurons are stimulated by CO(2), and serotonin activates thalamocortical networks, we hypothesized that serotonin neurons cause arousal in response to hypercapnia. We found that Lmx1b(f/f/p) mice completely lacked any arousal response to inhalation of 10% CO(2) (with 21% O(2) in balance N(2)) but had normal arousal responses to hypoxia, sound, and air puff. We propose that serotonin neurons mediate the potentially life-saving arousal response to hypercapnia. Impairment of this response may contribute to sudden unexpected death in epilepsy, sudden infant death syndrome, and sleep apnea.

Identifying the Ion Channels Responsible for Signaling Gastro-Intestinal Based Pain

We are normally unaware of the complex signalling events which continuously occur within our internal organs. Most of us only become cognisant when sensations of hunger, fullness, urgency or gas arise. However, for patients with organic and functional bowel disorders pain is an unpleasant and often debilitating reminder. Furthermore, chronic pain still represents a large unmet need for clinical treatment. Consequently, chronic pain has a considerable economic impact on health care systems and the afflicted individuals. In order to address this need we must understand how symptoms are generated within the gut, the molecular pathways responsible for generating these signals and how this process changes in disease states.

Physiological carbon dioxide, bicarbonate, and pH sensing

In biological systems, carbon dioxide exists in equilibrium with bicarbonate and protons. The individual components of this equilibrium (i.e., CO₂, HCO₃⁻, and H(+)), which must be sensed to be able to maintain cellular and organismal pH, also function as signals to modulate multiple physiological functions. Yet, the molecular sensors for CO₂/HCO₃⁻/pH remained unknown until recently. Here, we review recent progress in delineating molecular and cellular mechanisms for sensing CO₂, HCO₃⁻, and pH.

Alterations in subcellular expression of acid-sensing ion channels in the rat forebrain following chronic amphetamine administration

Acid-sensing ion channels (ASICs) are densely expressed in broad areas of mammalian brains and actively modulate synaptic transmission and a variety of neuronal activities. To explore whether ASICs are linked to addictive properties of drugs of abuse, we investigated the effect of the psychostimulant amphetamine on subcellular ASIC expression in the rat forebrain in vivo. Repeated administration of amphetamine (once daily for 7 days, 1.25 mg/kg for days 1/7, 4 mg/kg for days 2-6) induced typical behavioral sensitization. At a 14-day withdrawal period, ASIC1 protein levels were increased in the defined surface and intracellular compartments in the striatum (both caudate putamen and nucleus accumbens) in amphetamine-treated rats relative to saline-treated rats as detected by a surface protein cross-linking assay. ASIC2 proteins, however, remained stable in the striatum. In the medial prefrontal cortex, repeated amphetamine administration had no effect on ASIC1 expression in either the surface or the intracellular pool. However, amphetamine selectively reduced the surface expression of ASIC2 in this region. These data identify ASICs as a sensitive target to repeated stimulant exposure. The region- and compartment-specific regulation of ASIC1 and ASIC2 expression may constitute a key synaptic adaptation in reward circuits critical for psychomotor plasticity.

Two residues in the extracellular domain convert a nonfunctional ASIC1 into a proton-activated channel

Acid-sensing ion channels (ASICs) are proton-activated sodium channels of the nervous system. Mammals express four ASICs, and orthologs of these genes have been found in all chordates examined to date. Despite a high degree of sequence conservation of all ASICs across species, the response to a given increase in external proton concentration varies markedly: from large and slowly inactivating inward currents to no detectable currents. The underlying bases of this functional variability and whether it stems from differences in proton-binding sites or in structures that translate conformational changes have not been determined yet. We show here that the ASIC1 ortholog of an early vertebrate, lamprey ASIC1, does not respond to protons; however, only two amino acid substitutions for the corresponding ones in rat ASIC1, Q77L and T85L, convert lamprey ASIC1 into a highly sensitive proton-activated channel with apparent H(+) affinity of pH(50) 7.2. Addition of C73H increases the magnitude of the currents by fivefold, and W64R confers desensitization similar to that of the mammalian counterpart. Most amino acid substitutions in these four positions increase the rates of opening and closing the pore, whereas only few, namely, the ones in rat ASIC1, slow the rates. The four residues are located in a contiguous segment made by the beta1-beta2-linker, beta1-strand, and the external segment of the first transmembrane helix. We conclude that the segment thus defined modulates the kinetics of opening and closing the pore and that fast kinetics of desensitization rather than lack of acid sensor accounts for the absence of proton-induced currents in the parent lamprey ASIC1.

Structure, function, and pharmacology of acid-sensing ion channels (ASICs): focus on ASIC1a

Acid-sensing ion channels (ASICs) are H(+)-gated Na(+) channels, which are present in most, if not all, neurons. The typical ASIC current is transient and is elicited by a rapid drop in the extracellular pH. In the human genome, four genes for ASICs are present: asic1 - 4. In this review, we will focus on ASIC1a, one of the key subunits in the central nervous system. We will describe the structure of this channel, a topic that has enormously profited from the recent elucidation of the first crystal structure of an ASIC. We will then relate the ASIC1 structure to current models of the gating mechanism of ASICs. Finally, we will review the pharmacology of ASIC1a. Advances in the pharmacological inhibition of individual ASIC currents have greatly contributed to our current knowledge of the functional roles of this channel in physiology, including learning, memory, and fear conditioning, and in pathophysiological states, including the neurodegeneration accompanying stroke, and axonal degeneration in autoimmune inflammation.

Stimulation of TRPC5 cationic channels by low micromolar concentrations of lead ions (Pb2+)

Lead toxicity is long-recognised but continues to be a major public health problem. Its effects are wide-ranging and include induction of hyper-anxiety states. In general it is thought to act by interfering with Ca(2+) signalling but specific targets are not clearly identified. Transient receptor potential canonical 5 (TRPC5) is a Ca(2+)-permeable ion channel that is linked positively to innate fear responses and unusual amongst ion channels in being stimulated by trivalent lanthanides, which include gadolinium. Here we show investigation of the effect of lead, which is a divalent ion (Pb(2+)). Intracellular Ca(2+) and whole-cell patch-clamp recordings were performed on HEK 293 cells conditionally over-expressing TRPC5 or other TRP channels. Extracellular application of Pb(2+) stimulated TRPC5 at concentrations greater than 1 microM. Control cells without TRPC5 showed little or no response to Pb(2+) and expression of other TRP channels (TRPM2 or TRPM3) revealed partial inhibition by 10 microM Pb(2+). The stimulatory effect on TRPC5 depended on an extracellular residue (E543) near the ion pore: similar to gadolinium action, E543Q TRPC5 was resistant to Pb(2+) but showed normal stimulation by the receptor agonist sphingosine-1-phosphate. The study shows that Pb(2+) is a relatively potent stimulator of the TRPC5 channel, generating the hypothesis that a function of the channel is to sense metal ion poisoning.