Examining the GABAA receptor α-subunits in the neonatal pig brain:Changes across development and the effect of seizures after hypoxic-ischaemic brain injury.
Stephanie Melita Miller BSc (Hons)
A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2017Faculty of Medicine i ABSTRACT Hypoxic ischaemic encephalopathy (HIE) is the most common cause of mortality and morbidity in the newborn. Reduced blood flow to the foetus, and consequently the foetal brain, due to maternal factors (e.g. hypertension) or foetal factors (e.g. umbilical cord compression); leads to significant brain injury and neurodevelopmental disability. HIE remains the leading cause of seizures in the term and preterm infant, accounting for over 60% of all seizures in the newborn period. Current antiepileptic drugs (AEDs) are largely ineffective in the newborn, however there has been little change to treatments for neonatal seizures over the last 50 years. AEDs achieve good seizure control in children and adults but these same AEDs have limited efficacy in the neonatal brain. Despite evidence that the AED phenobarbital is effective in only 30-50% of babies, it remains the standard first-line treatment for neonatal seizures in neonatal intensive care units around the world.In the perinatal hypoxic-ischaemic (HI) brain, over activation of excitatory neurotransmitter systems plays a key role in the generation of seizures and excitotoxic neuronal cell injury and cell death. In the mature brain GABA (γ-aminobutyric acid) hyperpolarises neurones and inhibits neuronal firing, thus providing a protective mechanism by reducing excitability.However, in the immature brain GABA depolarises the neurone due to differences in the chloride (Cl -) gradient across the membrane, and instead creates excitation when GABA binds to the GABAA receptor. Understanding the physiological consequences of activation of the GABA system in the HI newborn brain and in the presence of seizures, is critical to identifying the mechanisms behind the apparent failure of AEDs in the newborn as well as driving development of appropriate drugs for the treatment of neonatal seizures.The general aim of this thesis was to investigate changes to the GABAergic system following perinatal hypoxia and seizures, by examining alterations in expression of the GABAA receptor (GABAAR) α-subunit in the pig brain. The piglet brain growth trajectory most closely mirrors that of the human neonate, with respect to timing of myelination, neuronal and glial growth spurts, and the proportion of grey to white matter. Normal developmental expression of the α-subunits α1, α2, and α3 was characterised across gestation and multiple brain regions revealing the crossover in expression of α3 to α1 expression corresponding to the transition from foetal to postnatal life. There was a significant peak in α3 expression observed at 100d gestation (87% gestation), that coincides with a previously reported peak in prenatal pig brain growth.ii It has been suggested that the transition of...