SUMMARY Alzheimer's disease (AD) results in cognitive decline and altered network activity, but the mechanisms are unknown. To identify such mechanisms, we studied human amyloid precursor protein (hAPP) transgenic mice, which simulate key aspects of AD. Electroencephalographic recordings in hAPP mice revealed spontaneous epileptiform discharges, indicating network hypersynchrony, primarily during reduced gamma oscillatory activity. Because this oscillatory rhythm is generated by inhibitory parvalbumin (PV) cells, network dysfunction in hAPP mice might arise from impaired PV cells. Supporting this hypothesis, hAPP mice and AD patients had decreased levels of the interneuron-specific and PV cell–predominant voltage-gated sodium channel subunit Nav1.1. Restoring Nav1.1 levels in hAPP mice by Nav1.1-BAC expression increased inhibitory synaptic activity and gamma oscillations and reduced hypersynchrony, memory deficits, and premature mortality. We conclude that reduced Nav1.1 levels and PV cell dysfunction critically contribute to abnormalities in oscillatory rhythms, network synchrony, and memory in hAPP mice and possibly in AD.

Stroke is a leading cause of disability; but no pharmacological therapy is currently available for promoting recovery. The brain region adjacent to stroke damage, the peri-infarct zone, is critical for rehabilitation, as it exhibits heightened neuroplasticity, allowing sensorimotor functions to re-map from damaged areas1–3. Thus, understanding the neuronal properties constraining this plasticity is important to developing new treatments. Here we show that after a stroke in mice, tonic neuronal inhibition is increased in the peri-infarct zone. This increased tonic inhibition is mediated by extrasynaptic GABAA receptors (GABAARs) and is caused by an impairment in GABA transporter (GAT-3/4) function. To counteract the heightened inhibition, we administered in vivo a benzodiazepine inverse agonist specific for the α5-subunit-containing extrasynaptic GABAARs at a delay after stroke. This treatment produced an early and sustained recovery of motor function. Genetically lowering the number of α5 or δ-subunit-containing GABAARs responsible for tonic inhibition also proved beneficial for post-stroke recovery, consistent with the therapeutic potential of diminishing extrasynaptic GABAAR function. Together, our results identify new pharmacological targets and provide the rationale for a novel strategy to promote recovery after stroke and possibly other brain injuries.

Neuroactive steroids are potent modulators of ␥-aminobutyric acid type A receptors (GABA ARs), and their behavioral effects are generally viewed in terms of altered inhibitory synaptic transmission. Here we report that, at concentrations known to occur in vivo, neuroactive steroids specifically enhance a tonic inhibitory conductance in central neurons that is mediated by extrasynaptic ␦ subunit-containing GABAARs. The neurosteroid-induced augmentation of this tonic conductance decreases neuronal excitability. Fluctuations in the circulating concentrations of endogenous neuroactive steroids have been implicated in the genesis of premenstrual syndrome, postpartum depression, and other anxiety disorders. Recognition that ␦ subunit-containing GABAARs responsible for a tonic conductance are a preferential target for neuroactive steroids may lead to novel pharmacological approaches for the treatment of these common conditions. hippocampus ͉ cerebellum ͉ neurosteroids ͉ inhibitory postsynaptic currents ͉ ␦ knockout mice G ABA A Rs (␥-aminobutyric acid type A receptors) are pentameric proteins that form Cl Ϫ -permeable ion channels activated by the neurotransmitter GABA. To date, 19 mammalian GABA A subunit isoforms have been identified, and these assemble to produce the dozen or so different receptor subtypes most frequently found in the brain (1). The most potent positive endogenous modulators of GABA A R function are the 3␣-hydroxy ring A-reduced pregnane steroids, that have sedativehypnotic, anticonvulsant, and anxiolytic effects (2-4). Severe mood disorders that can occur during the menstrual cycle and after pregnancy are suggested to involve alterations in the function of synaptic GABA A Rs (2, 3, 5) triggered by rapid decreases in the concentrations of these progesterone-derived neuroactive steroids (6).Recently, it has become apparent that distinct GABA A Rs participate in two types of inhibitory control. Transient activation of synaptic GABA A Rs is responsible for conventional phasic inhibition, whereas the continuous activation of extrasynaptic GABA A Rs can generate a form of tonic inhibition (7-14). GABA A Rs containing the ␦ subunit are restricted to extrasynaptic locations (15) and have an unusually high affinity for GABA (16,17), making them likely mediators of the tonic GABA A conductance recorded in both cerebellar (7,8) and dentate gyrus granule cells (DGGC) (10, 11). In mice lacking the ␦ subunit of the GABA A R, the effects of neuroactive steroids are greatly reduced (18). Moreover, recent reports (17,19,20) have raised the possibility that the steroid sensitivity of ␦ subunitcontaining GABA A Rs may be much higher than previously thought (21). In light of these findings, and the possible involvement of ␦ subunit-containing receptors in generating tonic conductances (8-11), we recorded from wild-type and ␦Ϫ͞Ϫ mice, and examined the effects of the naturally occurring neuroactive steroid 3␣,21-dihydroxy-5␣-pregnan-20-one (allotetrahydrodeoxycorticosterone, THDOC) on the tonic GABA A R-mediated conduct...

Disturbances of neuronal excitability changes during the ovarian cycle may elevate seizure frequency in women with catamenial epilepsy and enhance anxiety in premenstrual dysphoric disorder (PMDD). The mechanisms underlying these changes are unknown, but they could result from the effects of fluctuations in progesterone-derived neurosteroids on the brain. Neurosteroids and some anxiolytics share an important site of action: tonic inhibition mediated by delta subunit-containing GABA(A) receptors (deltaGABA(A)Rs). Here we demonstrate periodic alterations in specific GABA(A)R subunits during the estrous cycle in mice, causing cyclic changes of tonic inhibition in hippocampal neurons. In late diestrus (high-progesterone phase), enhanced expression of deltaGABA(A)Rs increases tonic inhibition, and a reduced neuronal excitability is reflected by diminished seizure susceptibility and anxiety. Eliminating cycling of deltaGABA(A)Rs by antisense RNA treatment or gene knockout prevents the lowering of excitability during diestrus. Our findings are consistent with possible deficiencies in regulatory mechanisms controlling normal cycling of deltaGABA(A)Rs in individuals with catamenial epilepsy or PMDD.

Over the past two decades, research has identified extrasynaptic GABAA receptor populations that enable neurons to sense the low ambient GABA concentrations present in the extracellular space in order to generate a form of tonic inhibition not previously considered in studies of neuronal excitability. The importance of this tonic inhibition in regulating states of consciousness is highlighted by the fact that extrasynaptic GABAA receptors (GABAARs) are believed to be key targets for anaesthetics, sleep-promoting drugs, neurosteroids, and alcohol. The neurosteroid sensitivity of these extrasynaptic GABAARs may explain their importance in stress-, ovarian cycle- and pregnancy-related mood disorders. Moreover, disruptions in network dynamics associated with schizophrenia, epilepsy and Parkinson’s disease may well involve alterations in the tonic GABAAR-mediated conductance. Extrasynaptic GABAARs may therefore present a potential therapeutic target for treatment of these diseases, but also to enhance cognition and aid post-stroke functional recovery.