Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, D-30559 Hannover, Germany.
J Neurosci. 2010 Jun 23;30(25):8602-12. doi: 10.1523/JNEUROSCI.0633-10.2010.
Accumulating evidence suggests that changes in neuronal chloride homeostasis may be involved in the mechanisms by which brain insults induce the development of epilepsy. A variety of brain insults, including status epilepticus (SE), lead to changes in the expression of the cation-chloride cotransporters KCC2 and NKCC1, resulting in intracellular chloride accumulation and reappearance of immature, depolarizing synaptic responses to GABA(A) receptor activation, which may critically contribute to the neuronal hyperexcitability underlying epileptogenesis. In the present study, it was evaluated whether prolonged administration of the selective NKCC1 inhibitor, bumetanide, after a pilocarpine-induced SE modifies the development of epilepsy in adult female rats. The antiepileptic drug phenobarbital, either alone or in combination, was used for comparison. Based on pharmacokinetic studies with bumetanide, which showed extremely rapid elimination and low brain penetration of this drug in rats, bumetanide was administered systemically with different dosing protocols, including continuous intravenous infusion. As shown by immunohistochemistry, neuronal NKCC1 expression was markedly upregulated shortly after SE. Prophylactic treatment with phenobarbital after SE reduced the number of rats developing spontaneous seizures and decreased seizure frequency, indicating a disease-modifying effect. Bumetanide did not exert any significant effects on development of spontaneous seizures nor did it enhance the effects of phenobarbital. However, combined treatment with both drugs counteracted several of the behavioral consequences of SE, which was not observed with single drug treatment. These data do not indicate that bumetanide can prevent epilepsy after SE, but the disease-modifying effect of this drug warrants further studies with more lipophilic prodrugs of bumetanide.
越来越多的证据表明,神经元氯离子稳态的变化可能与脑损伤诱导癫痫发生的机制有关。多种脑损伤,包括癫痫持续状态(SE),导致阳离子-氯离子共转运体 KCC2 和 NKCC1 的表达发生变化,导致细胞内氯离子积累和 GABA(A)受体激活后不成熟的去极化突触反应重新出现,这可能对癫痫发生的神经元过度兴奋起关键作用。在本研究中,评估了在匹罗卡品诱导的 SE 后长时间给予选择性 NKCC1 抑制剂布美他尼是否会改变成年雌性大鼠癫痫的发生。使用抗癫痫药物苯巴比妥进行了比较,无论是单独使用还是联合使用。基于布美他尼的药代动力学研究,该研究表明这种药物在大鼠体内极其快速消除且脑穿透性低,因此采用不同的给药方案,包括连续静脉输注,对布美他尼进行了系统给药。如免疫组织化学所示,SE 后不久神经元 NKCC1 表达明显上调。SE 后预防性给予苯巴比妥可减少自发发作大鼠的数量并降低发作频率,表明具有疾病修饰作用。布美他尼对自发发作的发展没有任何显著影响,也没有增强苯巴比妥的作用。然而,两种药物的联合治疗可抵消 SE 的多种行为后果,而单独使用一种药物则没有观察到这种作用。这些数据表明布美他尼不能预防 SE 后的癫痫,但该药的疾病修饰作用值得进一步研究,包括更亲脂性的布美他尼前药。