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A Potent Antagonist of Smoothened in Hedgehog Signaling for Epilepsy. Int J Mol Sci 2022; 23:ijms232314505. [PMID: 36498832 PMCID: PMC9739937 DOI: 10.3390/ijms232314505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
Epilepsy is one of the common encephalopathies caused by sudden abnormal discharges of neurons in the brain. About 30% of patients with epilepsy are insensitive and refractory to existing antiseizure medications. The sonic hedgehog signaling pathway is essential to the development and homeostasis of brain. Aberrant sonic hedgehog signaling is increased in refractory epileptic lesions and may involve the etiology of epilepsy. Thus, new inhibitors of Smoothened, a key signal transducer of this signaling pathway are urgently need for refractory epilepsy. We have established a high-throughput screening platform and discovered several active small molecules targeting Smoothened including TT22. Here we show that the novel Smoothened inhibitor TT22 could block the translocation of βarrestin2-GFP to Smoothened, reduce the accumulation of Smoothened on primary cilia, displace Bodipy-cyclopamine binding to Smoothened, and inhibit the expression of downstream Gli transcription factor. Moreover, TT22 inhibits the abnormal seizure-like activity in neurons. Furthermore, we demonstrated that FDA-approved Smoothened inhibitor GDC-0449 and LDE-225 are able to inhibit abnormal seizure-like activity in neurons. Thus, our study suggests that targeting the sonic hedgehog signaling with new small-molecule Smoothened inhibitors might provide a potential new therapeutic avenue for refractory epilepsy.
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Wang Z, Xie R, Yang X, Yin H, Li X, Liu T, Ma Y, Gao J, Zang Z, Ruan R, Li Y, Huang K, Chen Q, Shen K, Lv S, Zhang C, Yang H, Warner M, Gustafsson JA, Liu S, Fan X. Female mice lacking ERβ display excitatory/inhibitory synaptic imbalance to drive the pathogenesis of temporal lobe epilepsy. Theranostics 2021; 11:6074-6089. [PMID: 33897900 PMCID: PMC8058727 DOI: 10.7150/thno.56331] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
Epilepsy is a highly prevalent and drug-refractory neurological disorder characterized by spontaneous recurrent seizures. Estrogen is identified to be proconvulsant and lowers the seizure threshold of female epilepsy. Estrogen receptor β (ERβ) has been proposed to mediate neuroprotection in epilepsy, although the underlying mechanism remains unknown. Rationale: In this study, we investigated the role of ERβ in the epileptogenesis of female temporal lobe epilepsy (TLE). Methods: Immunohistochemistry, immunofluorescence, western blots, Golgi staining, 1H MRS and whole-cell patch-clamp were used to evaluate ERβ expression, pathological changes, and synaptic excitation /inhibition (E/I) balance in female TLE patients and ovariectomized (OVX) chronic epileptic mice. Electroencephalogram (EEG) recordings were recorded to evaluate the epileptic susceptibility in OVX WT and ERβ-/- mice. And high-throughput RNA-sequence was performed to identify differential expression genes (DEGs) which can elucidate the potential mechanism of ERβ regulating the seizure susceptibility. Results: ERβ expression was decreased in the brains of female TLE patients and OVX chronic epileptic mice. ERβ deletion enhanced seizure susceptibility and exacerbated the imbalance of synaptic E/I in hippocampal CA1 area of OVX epileptic mice. In line with these observations, RNA-sequence data further identified glutamine ligase (GLUL) as the target of ERβ involved in regulating synaptic E/I in CA1. Furthermore, ERβ agonist WAY-200070 markedly suppressed epileptic phenotypes and normalized GLUL expression in CA1 region of kainic acid (KA) induced OVX chronic epileptic model. Conclusions: Our data provide novel insight into the pathogenesis of female TLE, and indicate ERβ provides a new therapeutic strategy for female TLE patients.
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Affiliation(s)
- Zhongke Wang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Ruxin Xie
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Xiaolin Yang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Huachun Yin
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Xin Li
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Tianyao Liu
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Yuanyuan Ma
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Junwei Gao
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Zhenle Zang
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Ruotong Ruan
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
| | - Yang Li
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Kaixuan Huang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Qingbo Chen
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Kaifeng Shen
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Shengqing Lv
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Chunqing Zhang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Hui Yang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Maragret Warner
- Center for Nuclear Receptors and Cell Signaling, University of Houston, Houston, TX 77054
| | - Jan-Ake Gustafsson
- Center for Nuclear Receptors and Cell Signaling, University of Houston, Houston, TX 77054
- Center for Innovative Medicine, Department of Biosciences and Nutrition, Karolinska Institute, 141 86 Novum, Sweden
| | - Shiyong Liu
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), 400037 Chongqing, China
| | - Xiaotang Fan
- Department of Developmental Neuropsychology, School of Psychology, Army Medical University (Third Military Medical University), 400038 Chongqing, China
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Alonso-Caraballo Y, Ferrario CR. Effects of the estrous cycle and ovarian hormones on cue-triggered motivation and intrinsic excitability of medium spiny neurons in the Nucleus Accumbens core of female rats. Horm Behav 2019; 116:104583. [PMID: 31454509 PMCID: PMC7256930 DOI: 10.1016/j.yhbeh.2019.104583] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/08/2022]
Abstract
Naturally occurring alterations in estradiol influence food intake in females. However, how motivational responses to food cues are affected by the estrous cycle or ovarian hormones is unknown. In addition, while individual susceptibility to obesity is accompanied by enhanced incentive motivational responses to food cues and increased NAc intrinsic excitability in males, studies in females are absent. Therefore, we examined basal differences in intrinsic NAc excitability of obesity-prone vs. obesity-resistant females and determined how conditioned approach (a measure of cue-triggered motivation), food intake, and motivation for food vary with the cycle in naturally cycling female obesity-prone, obesity-resistant, and outbred Sprague-Dawley rats. Finally, we used ovariectomy followed by hormone treatment to determine the role of ovarian hormones in cue-triggered motivation in selectively-bred and outbred female rats. We found that intrinsic excitability of NAc MSNs and conditioned approach are enhanced in female obesity-prone vs. obesity-resistant rats. These effects were driven by greater MSN excitability and conditioned approach behavior during metestrus/diestrus vs. proestrus/estrus in obesity-prone but not obesity-resistant rats, despite similar regulation of food intake and food motivation by the cycle in these groups. Furthermore, estradiol and progesterone treatment reduced conditioned approach behavior in obesity-prone and outbred Sprague-Dawley females. To our knowledge, these data are the first to demonstrate cycle- and hormone-dependent effects on the motivational response to a food cue, and the only studies to date to determine how individual susceptibility to obesity influences NAc excitability, cue-triggered food-seeking, and differences in the regulation of these neurobehavioral responses by the estrous cycle.
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Affiliation(s)
| | - Carrie R Ferrario
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States of America; Department of Pharmacology, University of Michigan, Ann Arbor, MI, United States of America.
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Huang Y, Zhang Y, Kong S, Zang K, Jiang S, Wan L, Chen L, Wang G, Jiang M, Wang X, Hu J, Wang Y. GIRK1-mediated inwardly rectifying potassium current suppresses the epileptiform burst activities and the potential antiepileptic effect of ML297. Biomed Pharmacother 2018; 101:362-370. [PMID: 29499411 DOI: 10.1016/j.biopha.2018.02.114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/24/2022] Open
Abstract
G protein-gated inwardly rectifying potassium (GIRK) channels are important inhibitory regulators of neuronal excitability in central nervous system, and the impairment of GIRK channel function has been reported to be associated with the susceptibility of epilepsy. However, the dynamics of GIRK channels in the pathogenesis of epilepsy are still unclear. In this study, our results showed that cyclothiazide, a potent convulsant, dose dependently increased the epileptiform bursting activities and suppressed the baclofen induced GIRK currents. In addition, TPQ, a selective GIRK antagonist, significantly decreased the total inwardly rectifying potassium (Kir) current, and increased the neuronal epileptiform activities. In contrast, ML297, a potent and selective GIRK channel agonist, reversed the cyclothiazide induced decrease of GIRK currents and the increase of neuronal excitability in cultured hippocampal neurons. Further investigation revealed that GIRK1, but not GIRK2, played a key role in suppressing epileptic activities. Finally, in pilocarpine mice seizure model, we demonstrated that ML297 significantly suppressed the seizure behavior. In summary, our current results indicate that GIRK channels, especially GIRK1-containing channels, are involved in epileptic activities and ML297 has a potential antiepileptic effect.
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Affiliation(s)
- Yian Huang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China; State Key Laboratory of New Drug and Pharmaceutical Process, Shanghai Institute of Pharmaceutical Industry, China State Institute of Pharmaceutical Industry, Shanghai 200437, China
| | - Yuwen Zhang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Shuzhen Kong
- College of Environment and Resource, Chongqing Technology and Business University, Chongqing 400067, China
| | - Kai Zang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Shize Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200032, China
| | - Li Wan
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Lulan Chen
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Guoxiang Wang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Min Jiang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Xin Wang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China
| | - Jie Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200032, China.
| | - Yun Wang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, China.
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Huang Y, Liu X, Wang G, Wang Y. SK channels participate in the formation of after burst hyperpolarization and partly inhibit the burst strength of epileptic ictal discharges. Mol Med Rep 2017; 17:1762-1774. [PMID: 29257204 PMCID: PMC5780121 DOI: 10.3892/mmr.2017.8068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/16/2017] [Indexed: 01/03/2023] Open
Abstract
Epilepsy is a common disease of the central nervous system. Tetanic spasms and convulsions are the key symptoms exhibited during epileptic seizures. However, the majority of patients have a significant post-seizure silence following a serious seizure; the underlying molecular neural mechanisms in this burst interval are unclear. The aim of the present study was to reveal the effect and role of calcium-activated potassium channels during this seizure interval silence period. Cyclothiazide (CTZ) was used to establish the seizure model in rat hippocampal cultured neurons, then the after-burst hyperpolarization (ABH) activities were recorded using the patch clamp technique. By comparing the amplitude and duration of hyperpolarizations, the present study analyzed the association between epileptiform bursts and ABHs when treated with different concentrations of CTZ. In addition, apamin and iberiotoxin were used for pharmacological tests. An intracranial electroencephalogram (EEG) recording was also performed when the CTZ experiments were repeated on animals. The experimental results revealed that treatment with high levels of CTZ induced larger ABHs and was associated with stronger burst activities, which suggested a positive correlation between ABH and epileptiform burst. Apamin, an antagonist of small conductance calcium-activated potassium (SK) channels, decreased the amplitude of ABH; however, reduced ABH was associated with enhanced burst activity, in burst probability and burst strength. These results revealed an important role of SK channels in the formation of ABH and in the inhibition of burst activity. Iberiotoxin, an antagonist of big conductance calcium-activated potassium (BK) channels, had no significant effect on ABH and burst activity. In addition, a positive correlation was identified between burst duration and ABH parameters. An intracellular calcium chelator impaired the amplitude of ABH; however, it did not affect the burst parameters. The rat cortical EEG recordings also exhibited a similar positive correlation between the duration of epileptic burst and after burst depression. Collectively, the results indicate that ABH may serve in the physiological feedback system to reduce the strength of epileptic hyperexcitation, a process in which SK channels are important.
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Affiliation(s)
- Yian Huang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, P.R. China
| | - Xu Liu
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, P.R. China
| | - Guoxiang Wang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, P.R. China
| | - Yun Wang
- Institutes of Brain Science and State Key Laboratory for Medical Neurobiology, Department of Neurology at Zhongshan Hospital, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200032, P.R. China
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Lara-Valderrábano L, Galván EJ, Rocha L. Propylparaben suppresses epileptiform activity in hippocampal CA1 pyramidal cells in vitro. Epilepsy Res 2017; 136:126-129. [PMID: 28843182 DOI: 10.1016/j.eplepsyres.2017.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/18/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022]
Abstract
Epilepsy is a highly prevalent neurological disorder. Additionally, a percentage of patients do not respond to conventional antiepileptic drugs. Therefore, drugs for epilepsy control are still being developed. In the present study, the effect of propylparaben (PPB) in the epileptiform activity induced by 4-aminopyridine in hippocampal CA1 pyramidal neurons was evaluated using individual recordings in current-clamp mode. Results indicated that PPB suppressed the epileptiform activity in registered neurons. This effect disappeared when PPB was removed from the solution of incubation. In contrast, phenytoin only reduced the firing frequency without abolishing epileptiform activity. Our results indicate that PPB exerts an antiepileptic effect on CA1 pyramidal neurons in vitro. Therefore, PPB may represent an effective antiepileptic compound.
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Affiliation(s)
| | - Emilio J Galván
- Pharmacobiology Department, Center of Research and Advanced Studies, México City, Mexico
| | - Luisa Rocha
- Pharmacobiology Department, Center of Research and Advanced Studies, México City, Mexico.
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Inhibition of 17-beta-estradiol on neuronal excitability via enhancing GIRK1-mediated inwardly rectifying potassium currents and GIRK1 expression. J Neurol Sci 2017; 375:335-341. [DOI: 10.1016/j.jns.2017.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/24/2017] [Accepted: 02/14/2017] [Indexed: 12/21/2022]
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Chen L, Wan L, Wu Z, Ren W, Huang Y, Qian B, Wang Y. KCC2 downregulation facilitates epileptic seizures. Sci Rep 2017; 7:156. [PMID: 28279020 PMCID: PMC5427808 DOI: 10.1038/s41598-017-00196-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/13/2017] [Indexed: 11/18/2022] Open
Abstract
GABAA receptor-mediated inhibition depends on the maintenance of low level intracellular [Cl-] concentration, which in adult depends on neuron specific K+-Cl- cotransporter-2 (KCC2). Previous studies have shown that KCC2 was downregulated in both epileptic patients and various epileptic animal models. However, the temporal relationship between KCC2 downregulation and seizure induction is unclear yet. In this study, we explored the temporal relationship and the influence of KCC2 downregulation on seizure induction. Significant downregulation of plasma membrane KCC2 was directly associated with severe (Racine Score III and above) behavioral seizures in vivo, and occurred before epileptiform bursting activities in vitro induced by convulsant. Overexpression of KCC2 using KCC2 plasmid effectively enhanced resistance to convulsant-induced epileptiform bursting activities in vitro. Furthermore, suppression of membrane KCC2 expression, using shRNAKCC2 plasmid in vitro and shRNAKCC2 containing lentivirus in vivo, induced spontaneous epileptiform bursting activities in vitro and Racine III seizure behaviors accompanied by epileptic EEG in vivo. Our findings novelly demonstrated that altered expression of KCC2 is not the consequence of seizure occurrence but likely is the contributing factor.
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Affiliation(s)
- Lulan Chen
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Li Wan
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Zheng Wu
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Wanting Ren
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Yian Huang
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Binbin Qian
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China
| | - Yun Wang
- Institutes of Brain Science, State Key Laboratory for Medical Neurobiology, Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China.
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Eag1 K + Channel: Endogenous Regulation and Functions in Nervous System. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:7371010. [PMID: 28367272 PMCID: PMC5358448 DOI: 10.1155/2017/7371010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/27/2016] [Accepted: 01/31/2017] [Indexed: 02/04/2023]
Abstract
Ether-à-go-go1 (Eag1, Kv10.1, KCNH1) K+ channel is a member of the voltage-gated K+ channel family mainly distributed in the central nervous system and cancer cells. Like other types of voltage-gated K+ channels, the EAG1 channels are regulated by a variety of endogenous signals including reactive oxygen species, rendering the EAG1 to be in the redox-regulated ion channel family. The role of EAG1 channels in tumor development and its therapeutic significance have been well established. Meanwhile, the importance of hEAG1 channels in the nervous system is now increasingly appreciated. The present review will focus on the recent progress on the channel regulation by endogenous signals and the potential functions of EAG1 channels in normal neuronal signaling as well as neurological diseases.
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