Localization of efferent neurotransmitters in the inner ear of the homozygous Bronx waltzer mutant mouse

A preliminary trial of botulinum toxin type A in patients with vestibular migraine: A longitudinal fMRI study

Objective

This study aims to investigate the efficacy of botulinum toxin type A (BTX-A) in the prophylactic management of vestibular migraine (VM) and to determine whether this treatment modulates intrinsic functional brain network.

Methods

Vestibular migraine patients (n = 20, mean age 45.4 years) who were resistant to conventional prophylactic therapies had BTX-A injection and rs-fMRI before and 2 months after the injection. We also measured the changes in the frequency of vertigo and migraine attacks, symptomatic functional disability scores, and neuropsychiatric inventories.

Results

After BTX-A injection, the mean monthly frequencies of migraine and vertigo episodes decreased significantly compared with the baseline (p < 0.01, paired t-test). The Headache Impact Test-6 score and the Migraine Disability Assessment, and the vertigo parameters, measured by the Dizziness Handicap Inventory and the Vertigo Symptom Scale, showed an improvement, as did the anxiety and depression scores 2 months after BTX-A treatment. The low-frequency fluctuation analysis of the rs-fMRI data found significant changes in the functional connectivity of the right superior temporal gyrus. Adoption of this cluster as the seed region increased the functional connectivity with the left post-central gyrus, right supramarginal gyrus, and right middle temporal gyrus after BTX-A treatment.

Conclusion

This prospective study suggests that BTX-A treatment is effective at ameliorating migraine and vertigo symptoms in VM patients who were resistant to conventional therapies. Along with symptomatic improvements, changes in the functional connectivity within the multisensory vestibular and pain networks suggest a dysmodulation of multimodal sensory integration and abnormal cortical processing of the vestibular and pain signals in VM patients.

Activation of GABAB receptors results in excitatory modulation of calyx terminals in rat semicircular canal cristae

Previous studies have found GABA in vestibular end organs. However, existence of GABA receptors or possible GABAergic effects on vestibular nerve afferents has not been investigated. The current study was conducted to determine whether activation of GABAB receptors affects calyx afferent terminals in the central region of the cristae of semicircular canals. We used patch-clamp recording in postnatal day 13-18 (P13-P18) Sprague-Dawley rats of either sex. Application of GABAB receptor agonist baclofen inhibited voltage-sensitive potassium currents. This effect was blocked by selective GABAB receptor antagonist CGP 35348. Application of antagonists of small (SK)- and large-conductance potassium (BK) channels almost completely blocked the effects of baclofen. The remaining baclofen effect was blocked by cadmium chloride, suggesting that it could be due to inhibition of voltage-gated calcium channels. Furthermore, baclofen had no effect in the absence of calcium in the extracellular fluid. Inhibition of potassium currents by GABAB activation resulted in an excitatory effect on calyx terminal action potential firing. While in the control condition calyces could only fire a single action potential during step depolarizations, in the presence of baclofen they fired continuously during steps and a few even showed repetitive discharge. We also found a decrease in threshold for action potential generation and a decrease in first-spike latency during step depolarization. These results provide the first evidence for the presence of GABAB receptors on calyx terminals, showing that their activation results in an excitatory effect and that GABA inputs could be used to modulate calyx response properties.NEW & NOTEWORTHY Using in vitro whole cell patch-clamp recordings from calyx terminals in the vestibular end organs, we show that activation of GABAB receptors result in an excitatory effect, with decreased spike-frequency adaptation and shortened first-spike latencies. Our results suggest that these effects are mediated through inhibition of calcium-sensitive potassium channels.

Efferent synaptic transmission at the vestibular type II hair cell synapse

In the vestibular peripheral organs, type I and type II hair cells (HCs) transmit incoming signals via glutamatergic quantal transmission onto afferent nerve fibers. Additionally, type I HCs transmit via "non-quantal" transmission to calyx afferent fibers, by accumulation of glutamate and potassium in the synaptic cleft. Vestibular efferent inputs originating in the brainstem contact type II HCs and vestibular afferents. Here, synaptic inputs to type II HCs were characterized by using electrical and optogenetic stimulation of efferent fibers combined with in vitro whole cell patch-clamp recording from type II HCs in the rodent vestibular crista. Properties of efferent synaptic currents in type II HCs were similar to those found in cochlear HCs and mediated by activation of α9-containing nicotinic acetylcholine receptors (nAChRs) and small-conductance calcium-activated potassium (SK) channels. While efferents showed a low probability of release at low frequencies of stimulation, repetitive stimulation resulted in facilitation and increased probability of release. Notably, the membrane potential of type II HCs during optogenetic stimulation of efferents showed a strong hyperpolarization in response to single pulses and was further enhanced by repetitive stimulation. Such efferent-mediated inhibition of type II HCs can provide a mechanism to adjust the contribution of signals from type I and type II HCs to vestibular nerve fibers, with a shift of the response to be more like that of calyx-only afferents with faster non-quantal responses.NEW & NOTEWORTHY Type II vestibular hair cells (HCs) receive inputs from efferent neurons in the brain stem. We used in vitro optogenetic and electrical stimulation of vestibular efferent fibers to study their synaptic inputs to type II HCs. Stimulation of efferents inhibited type II HCs, similar to efferent effects on cochlear HCs. We propose that efferent inputs adjust the contribution of signals from type I and II HCs to vestibular nerve fibers.

A review of efferent cholinergic synaptic transmission in the vestibular periphery and its functional implications

It has been over 60 years since peripheral efferent vestibular terminals were first identified in mammals, and yet the function of the efferent vestibular system remains obscure. One reason for the lack of progress may be due to our deficient understanding of the peripheral efferent synapse. Although vestibular efferent terminals were identified as cholinergic less than a decade after their anatomical characterization, the cellular mechanisms that underlie the properties of these synapses have had to be inferred. In this review we examine how recent mammalian studies have begun to reveal both nicotinic and muscarinic effects at these terminals and therefore provide a context for fast and slow responses observed in classic electrophysiological studies of the mammalian efferent vestibular system, nearly 40 years ago. Although incomplete, these new results together with those of recent behavioral studies are helping to unravel the mysterious and perplexing action of the efferent vestibular system. Armed with this information, we may finally appreciate the behavioral framework in which the efferent vestibular system operates.

The role of the brainstem in migraine: Potential brainstem effects of CGRP and CGRP receptor activation in animal models

Background

Migraine is a severe debilitating disorder of the brain that is ranked as the sixth most disabling disorder globally, with respect to disability adjusted life years, and there remains a significant unmet demand for an improved understanding of its underlying mechanisms. In conjunction with perturbed sensory processing, migraine sufferers often present with diverse neurological manifestations (premonitory symptoms) that highlight potential brainstem involvement. Thus, as the field moves away from the view of migraine as a consequence of purely vasodilation to a greater understanding of migraine as a complex brain disorder, it is critical to consider the underlying physiology and pharmacology of key neural networks likely involved.

Discussion

The current review will therefore focus on the available evidence for the brainstem as a key regulator of migraine biology and associated symptoms. We will further discuss the potential role of CGRP in the brainstem and its modulation for migraine therapy, given the emergence of targeted CGRP small molecule and monoclonal antibody therapies.

Conclusion

The brainstem forms a functional unit with several hypothalamic nuclei that are capable of modulating diverse functions including migraine-relevant trigeminal pain processing, appetite and arousal regulatory networks. As such, the brainstem has emerged as a key regulator of migraine and is appropriately considered as a potential therapeutic target. While currently available CGRP targeted therapies have limited blood brain barrier penetrability, the expression of CGRP and its receptors in several key brainstem nuclei and the demonstration of brainstem effects of CGRP modulation highlight the significant potential for the development of CNS penetrant molecules.

Efferent innervation of turtle semicircular canal cristae: comparisons with bird and mouse

In the vestibular periphery of nearly every vertebrate, cholinergic vestibular efferent neurons give rise to numerous presynaptic varicosities that target hair cells and afferent processes in the sensory neuroepithelium. Although pharmacological studies have described the postsynaptic actions of vestibular efferent stimulation in several species, characterization of efferent innervation patterns and the relative distribution of efferent varicosities among hair cells and afferents are also integral to understanding how efferent synapses operate. Vestibular efferent markers, however, have not been well characterized in the turtle, one of the animal models used by our laboratory. Here we sought to identify reliable efferent neuronal markers in the vestibular periphery of turtle, to use these markers to understand how efferent synapses are organized, and to compare efferent neuronal labeling patterns in turtle with two other amniotes using some of the same markers. Efferent fibers and varicosities were visualized in the semicircular canal of red-eared turtles (Trachemys scripta elegans), zebra finches (Taeniopygia guttata), and mice (Mus musculus) utilizing fluorescent immunohistochemistry with antibodies against choline acetyltransferase (ChAT). Vestibular hair cells and afferents were counterstained using antibodies to myosin VIIa and calretinin. In all species, ChAT labeled a population of small diameter fibers giving rise to numerous spherical varicosities abutting type II hair cells and afferent processes. That these ChAT-positive varicosities represent presynaptic release sites were demonstrated by colabeling with antibodies against the synaptic vesicle proteins synapsin I, SV2, or syntaxin and the neuropeptide calcitonin gene-related peptide. Comparisons of efferent innervation patterns among the three species are discussed.

Large basolateral processes on type II hair cells are novel processing units in mammalian vestibular organs

Sensory receptors in the vestibular system (hair cells) encode head movements and drive central motor reflexes that control gaze, body movements, and body orientation. In mammals, type I and II vestibular hair cells are defined by their shape, contacts with vestibular afferent nerves, and membrane conductance. Here we describe unique morphological features of type II vestibular hair cells in mature rodents (mice and gerbils) and bats. These features are cytoplasmic processes that extend laterally from the hair cell base and project under type I hair cells. Closer analysis of adult mouse utricles demonstrated that the basolateral processes of type II hair cells vary in shape, size, and branching, with the longest processes extending three to four hair cell widths. The hair cell basolateral processes synapse upon vestibular afferent nerves and receive inputs from vestibular efferent nerves. Furthermore, some basolateral processes make physical contacts with the processes of other type II hair cells, forming some sort of network among type II hair cells. Basolateral processes are rare in perinatal mice and do not attain their mature form until 3-6 weeks of age. These observations demonstrate that basolateral processes are significant signaling regions of type II vestibular hair cells and suggest that type II hair cells may directly communicate with each other, which has not been described in vertebrates.

The expression of calcitonin gene-related Peptide and acetylcholine in the vestibular-related nucleus population of wild-type mice and retinal degeneration fast mice after rotary stimulation

Due to the lack of an appropriate animal model, few studies have addressed the integration of visual and vestibular information in the visual system. Using a mouse model with a visual defect (retinal degeneration fast, rdf), we have verified that the prepositus hypoglossal nucleus (PrH) and the Kooy cap of the inferior olive medial nucleus (IOK) are key regions in which visual and vestibular information integrate. Although the integration regions were identified, the precise mechanisms of integration require further investigation. The rdf mice and wild-type Kunming mice were randomly assigned to experimental and control subgroups, respectively. Mice in the experimental groups were exposed to rotary motion for 30 min three times at 24-h intervals, whereas mice in the control groups were not exposed to rotary motion. Differences in the number of calcitonin gene-related peptide positive (CGRP-positive) and choline acetyltransferase positive (ChAT-positive) neurons in the vestibular-related nucleus populations of two types of mice were determined. After rotatory stimulus, the number of CGRP-positive and ChAT-positive neurons in the PrH and the IOK was significantly less in rdf mice compared with that in wild-type mice. There were differences in the number of CGRP-positive and ChAT-positive neurons in the other vestibular-related regions, but the differences were not significant, except the difference in the number of ChAT-positive neurons in the medial vestibular nucleus. The expression patterns of CGRP and ChAT were similar to that of Fos in the vestibular-related regions in the two types of mice after rotatory stimulus. The number of CGRP-positive and ChAT-positive neurons and the number of active nerve cells were consistent in those regions in the two types of mice after rotary stimulus. Therefore, we speculated that CGRP and Ach generated and released by neurons in the PrH and the IOK may play roles in the sensory integration of visual and vestibular information in mice.

Two distinct channels mediated by m2mAChR and α9nAChR co-exist in type II vestibular hair cells of guinea pig

Acetylcholine (ACh) is the principal vestibular efferent neurotransmitter among mammalians. Pharmacologic studies prove that ACh activates a small conductance Ca2+-activated K+ channels (KCa) current (SK2), mediated by α9-containing nicotinic ACh receptor (α9nAChR) in mammalian type II vestibular hair cells (VHCs II). However, our studies demonstrate that the m2 muscarinic ACh receptor (m2mAChR) mediates a big conductance KCa current (BK) in VHCs II. To better elucidate the correlation between these two distinct channels in VHCs II of guinea pig, this study was designed to verify whether these two channels and their corresponding AChR subtypes co-exist in the same VHCs II by whole-cell patch clamp recordings. We found that m2mAChR sensitive BK currents were activated in VHCs II isolated by collagenase IA, while α9nAChR sensitive SK2 currents were activated in VHCs II isolated by trypsin. Interestingly, after exposing the patched cells isolated by trypsin to collagenase IA for 3 min, the α9nAChR sensitive SK2 current was abolished, while m2mAChR-sensitive BK current was activated. Therefore, our findings provide evidence that the two distinct channels and their corresponding AChR subtypes may co-exist in the same VHCs II, and the alternative presence of these two ACh receptors-sensitive currents depended on isolating preparation with different enzymes.

Expression of calcitonin gene-related peptide in efferent vestibular system and vestibular nucleus in rats with motion sickness

Motion sickness presents a challenge due to its high incidence and unknown pathogenesis although it is a known fact that a functioning vestibular system is essential for the perception of motion sickness. Recent studies show that the efferent vestibular neurons contain calcitonin gene-related peptide (CGRP). It is a possibility that the CGRP immunoreactivity (CGRPi) fibers of the efferent vestibular system modulate primary afferent input into the central nervous system; thus, making it likely that CGRP plays a key role in motion sickness. To elucidate the relationship between motion sickness and CGRP, the effects of CGRP on the vestibular efferent nucleus and the vestibular nucleus were investigated in rats with motion sickness.

Muscarinic acetylcholine receptor subtype expression in type vestibular hair cells of guinea pigs

Recent studies have demonstrated that five subtypes (M1-M5) of muscarinic acetylcholine receptor (mAChR) are expressed in the vestibular periphery. However, the exact cellular location of the mAChRs is not clear. In this study, we investigated whether there is the expression of M1-M5 muscarinic receptor mRNA in isolated type II vestibular hair cells of guinea pig by using single-cell RT-PCR. In vestibular end-organ, cDNA of the expected size was obtained by RT-PCR. Moreover, mRNA was identified by RT-PCR from individually isolated type II vestibular hair cells (single-cell RT-PCR). Sequence analysis confirmed that the products were M1-M5 mAChR. These results demonstrated that M1-M5 mAChR was expressed in the type II vestibular hair cells of the guinea pig, which lends further support for the role of M1-M5 mAChR as a mediator of efferent cholinergic signalling pathway in vestibular hair cells.

Characteristic findings of auditory brainstem response and otoacoustic emission in the Bronx waltzer mouse

Auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) were evaluated serially from 1 to 22 months in Bronx waltzer homozygotes (bv/bv), heterozygotes (+/bv) and control (+/+) mice, which were differentiated by means of PCR of marker DNA (D5Mit209). The wave IV threshold of the click-evoked ABR was higher than the DPOAE threshold with the DP growth method in each bv/bv, although the two thresholds were almost the same in the +/+ group. The DP value at 2f(1) - f(2) in the bv/bv showed an apparent decrease at 2 to 3 months of age with 80 dB SPL stimulation using f(2) frequency 7996 Hz and frequency ratio f(2)/f(1) = 1.22, compared to control or heterozygote mice. It was characteristic that the 2f(2) - f(1) DP signal-to-noise ratio (SNR) value was more preserved from 80 to 60 dB SPL than the 2f(1) - f(2) DP value at f(2) frequency 7996 Hz in most bv/bv, however, control mice showed almost the same levels of 2f(1) - f(2) and 2f(2) - f(1) SNR value at both f(2) frequencies of 6006 and 7996 Hz. The preservation of a substantial 2f(2) - f(1) DP suggested that it would be generated basal to the primary-tone place on the basilar membrane and there might be a reflection of the unique function of the remaining outer hair cells in the Bronx waltzer mice. These findings suggest that combination of ABR with DPOAE could offer useful information about differentiating the mechanism of hair cell dysfunction of the hereditary hearing impairment in the clinical fields.

The properties of ACh-induced BK currents in guinea pig type II vestibular hair cells

Molecular biological studies have demonstrated that both muscarinic receptor subtypes and nicotinic receptor subunits were located in mammalian vestibular sensorineural epithelium. However, the functional roles are still unclear, with the exception of the well-known alpha9-containing nicotinic ACh receptor (alpha9nAChR). In this study, the properties of acetylcholine (ACh)-induced currents were investigated by whole-cell patch clamp technique in isolated type II vestibular hair cells (VHCs II) of guinea pig. VHCs II displayed a sustained, non-inactivating current when extracellular application of ACh. ACh-induced currents restored gradually and it took about 60 s to get a complete recovery. ACh-induced current was not affected by extracellular Na(+), but strongly affected by extracellular K(+) and Ca(2+). Depletion of the intracellular Ca(2+) stores by intracellular application of inositol 1,4,5-trisphosphate (IP3) or blocking of the release of intracellular Ca(2+) stores by intracellular application of heparin failed to inhibit this current. ACh-induced currents were inhibited by nifedipine, Cd(2+), tetraethylammonium (TEA), charybdotoxin (CTX), iberiotoxin (IBTX), atropine and d-tubocurarine (DTC), respectively, but not by apamin. In conclusion, ACh stimulates a large conductance, Ca(2+)-activated K(+) current (BK) in guinea pig VHCs II by activation of the influx of Ca(2+) ions, which is mediated by an ACh receptor that could not be defined to be the odd-number muscarinic receptor.

Neuronal responses in the inferior colliculus of mutant mice (Bronx waltzer) with hereditary inner hair cell loss

Bronx waltzer mice lose a great proportion of their cochlear inner hair cells during early development. Hair cell counts revealed that these mice lacked on average 86% of their inner hair cells. Outer hair cells were present in a normal number, but appeared disarranged. The effect of this inner hair cell loss on the properties of central auditory neurons was investigated by recording neuronal responses in the inferior colliculus. Neuronal thresholds were on average elevated by 40 dB compared to CBA controls. The frequency tuning curves of the mutants were broad, and in part (18.5%) multi-peaked. The tonotopy found in the inferior colliculus of the Bronx waltzer mice appeared diffuse. Both the driven and spontaneous discharge rates were not statistically significantly different from the controls. However, the average first spike latency was significantly longer in the Bronx waltzer mice.