The slow-channel myasthenic syndrome (SCS) is a hereditary disorder of the acetylcholine receptor (AChR) of the neuromuscular junction (NMJ) that leads to prolonged AChR channel opening, Ca 2+ overload, and degeneration of the NMJ. We used an SCS transgenic mouse model to investigate the role of the calcium-activated protease calpain in the pathogenesis of synaptic dysfunction in SCS. Cleavage of a fluorogenic calpain substrate was increased at the NMJ of dissociated muscle fibers. Inhibition of calpain using a calpastatin (CS) transgene improved strength and neuromuscular transmission. CS caused a 2-fold increase in the frequency of miniature endplate currents (MEPCs) and an increase in NMJ size, but MEPC amplitudes remained reduced. Persistent degeneration of the NMJ was associated with localized activation of the non-calpain protease caspase-3. This study suggests that calpain may act presynaptically to impair NMJ function in SCS but further reveals a role for other cysteine proteases whose inhibition may be of additional therapeutic benefit in SCS and other excitotoxic disorders.
IntroductionThe slow-channel congenital myasthenic syndrome (SCS) is a dominantly inherited neuromuscular disorder characterized by impaired neuromuscular transmission and degeneration of the neuromuscular junction (NMJ) (1-3). Patients with SCS manifest fatigability and progressive weakness of the skeletal muscles, with symptoms ranging from eye muscle and mild limb weakness to severe incapacitation and respiratory failure. Ultrastructural study of muscle in SCS reveals a focal degenerative and remodeling process selectively localized to the NMJ termed endplate myopathy. This progressive, purely synaptic disease process, in which the cleft is widened and nerve terminals are shrunken, is characterized by expansion and degeneration of postsynaptic folds as well as degeneration of subsynaptic nuclei, mitochondria, and myofibrils (1-4).The SCS is caused by missense mutations within the genes encoding nicotinic acetylcholine receptor (AChR) subunits. The mutations alter the AChR channel gating function, causing prolonged activation events, persistent synaptic currents, and localized calcium overload at the NMJ, amplified by calcium release from intracellular stores (1, 3, 5-10). These changes lead to weakness and impaired neuromuscular transmission through an effect on both pre- and postsynaptic determinants of synaptic transmission, including quantal release, synaptic cleft anatomy, and the