Medici Valentina, Rossini Laura, Deleo Francesco, Tringali Giovanni, Tassi Laura, Cardinale Francesco, Bramerio Manuela, de Curtis Marco, Garbelli Rita, Spreafico Roberto
Clinical Epileptology and Experimental Neurophysiology Unit, Istituto Neurologico "C. Besta", Milan, Italy.
Department of Neurosurgery, IRCCS, Foundation Neurological Institute "C. Besta", Milan, Italy.
Epilepsia. 2016 Jul;57(7):1109-19. doi: 10.1111/epi.13405. Epub 2016 May 13.
Several studies have reported that inhibitory networks are altered in dysplastic tissue obtained from epilepsy surgery specimens. A consistent decrease in the number of inhibitory interneuronal subpopulation that expresses parvalbumin (PV) was reported in postsurgical tissue from patients with focal cortical dysplasia (FCD). We tested if the decrease in PV protein expression observed in epileptic tissue corresponds to a parallel impairment in the γ-aminobutyric acid (GABA)ergic compartment.
We analyzed postsurgical tissue from 30 surgically treated patients who underwent surgery for intractable epilepsy including 26 patients with FCD (types I, II, and III) and 4 patients without any microscopic visible lesion (cryptogenic) as controls. Serial sections were processed using in situ hybridization with GAD-65 and GAD-67 probes and immunocytochemistry with antibody against PV. The density of inhibitory PV-immunoreactive interneurons in relation to GABAergic cells was estimated in controls and in all different pathologic groups by using a two- and three-dimensional (2D and 3D) cell-counting technique. Field fraction and line profile analyses were added to estimate immunostaining proportion and distribution of PV signal generated in gray matter.
A reduction of PV-positive cells and PV-immunoreactivity was observed exclusively in FCD type I/III specimens compared with cryptogenic tissue from control patients with a poor postsurgical outcome. In FCD type II, a profound rearrangement in the cortical distribution of PV immunoreactivity was observed, without a quantitative reduction of the number of neurons and terminals. In situ hybridization did not reveal significant variations of GAD expression in any FCD subtype.
Our study suggests a preservation of inhibitory networks in FCD postsurgical tissue, demonstrated by a substantial normal count of GABAergic neurons. A selective PV expression impairment is demonstrated in FCD type I and III and an abnormal, but not reduced, distribution of PV cells and terminals is confirmed in type II FCD. Possible functional consequences are discussed.
多项研究报告称,从癫痫手术标本获取的发育异常组织中抑制性神经网络发生了改变。据报道,局灶性皮质发育异常(FCD)患者术后组织中表达小白蛋白(PV)的抑制性中间神经元亚群数量持续减少。我们测试了在癫痫组织中观察到的PV蛋白表达降低是否与γ-氨基丁酸(GABA)能区室的平行损伤相对应。
我们分析了30例因顽固性癫痫接受手术治疗的患者的术后组织,其中包括26例FCD(I型、II型和III型)患者以及4例无任何显微镜下可见病变(隐源性)的患者作为对照。连续切片采用与GAD-65和GAD-67探针的原位杂交以及抗PV抗体的免疫细胞化学方法进行处理。通过二维和三维(2D和3D)细胞计数技术,在对照和所有不同病理组中估计与GABA能细胞相关的抑制性PV免疫反应性中间神经元的密度。增加了视野分数和线轮廓分析以估计灰质中产生的PV信号的免疫染色比例和分布。
与术后预后较差的对照患者的隐源性组织相比,仅在I/III型FCD标本中观察到PV阳性细胞和PV免疫反应性降低。在II型FCD中,观察到PV免疫反应性在皮质分布上有深刻的重新排列,而神经元和终末数量没有定量减少。原位杂交未显示任何FCD亚型中GAD表达有显著变化。
我们的研究表明,FCD术后组织中的抑制性神经网络得以保留,这通过GABA能神经元数量基本正常得以证明。在I型和III型FCD中证明了选择性PV表达受损,在II型FCD中证实了PV细胞和终末分布异常但未减少。讨论了可能的功能后果。