Recent clinical and basic science studies are beginning to provide insights into the mechanisms of neurological deficits and epileptogenesis in TSC (
Holmes et al., 2007;
Wong, 2008). Consistent with modern trends recognizing the importance of astrocytes in brain function and neurological disease, pathological studies of brains from TSC patients document a number of histological abnormalities in astrocytes (
Crino, 2004;
Sosunov et al., 2008;
Talos et al., 2008), suggesting that astrocyte dysfunction may be central to the pathophysiology of neurological deficits and epilepsy in TSC. We have explored the role of astrocytes in a mouse model of TSC involving
Tsc1 gene inactivation primarily in astrocytes (GFAP+ cells) (
Uhlmann et al., 2002). In the present study, we demonstrate that
Tsc1GFAPCKO mice are deficient in the astrocyte-specific gap junction protein, connexin 43, and have an associated impairment in gap junction coupling between astrocytes. Furthermore, we have provided evidence that this deficiency in gap junction coupling may contribute to altered potassium buffering and increased extracellular potassium levels in
Tsc1GFAPCKO mice. The abnormal connexin 43 expression and impaired potassium buffering in
Tsc1GFAPCKO mice were reversed by rapamycin, indicating that the mTOR pathway mediates these effects. Thus, given the known effects of extracellular potassium on neuronal excitability, we propose that abnormal astrocyte-controlled buffering of potassium may promote epileptogenesis and other neurological deficits in TSC.
The role of astrocytic gap junction coupling in the spatial buffering of potassium and other neuroactive compounds has long been suspected, but has only recently been directly tested. Although pharmacological inhibitors of gap junctions have lacked specificity to differentiate the contribution of different cell types, cell-specific differences in the molecular components of gap junctions, the connexin (Cx) proteins, have allowed the contribution of astrocytes to homeostatic mechanisms to be isolated. Astrocytic gap junctions consist primarily of Cx43, as well as Cx30 and Cx26 (
Nagy and Rash, 2000). Genetically-engineered mice deficient in Cx43 and Cx30 completely eliminates astrocyte coupling within hippocampus (
Theis et al., 2003;
Wallraff et al., 2006). Furthermore, as evidence of the physiological importance of astrocyte coupling, these mice exhibit reduced potassium buffering capabilities and increased suspectibility to epileptiform activity (
Wallraff et al., 2006).
The significance and relationship of astrocytic gap junction coupling to epilepsy per se is more complex and controversial. While astrocytic gap junctions may inhibit neuronal excitability and seizures by buffering extracellular potassium, it has also been proposed that the coupling of astrocyte networks might promote seizures, such as by non-synaptic synchronization of neuronal activity via glial calcium waves or other intracellular signals propagated between astrocytes (
Steinhauser and Seifert, 2002;
Samoilova et al. 2008). Variable changes (primarily increases, but also decreases) in astrocytic connexin proteins have been documented in human epilepsy brain specimens and animal models, and it is difficult to determine whether these changes represent causative or compensatory mechanisms for epileptogenesis (
Naus et al., 1991;
Elisevich et al., 1997;
Sohl et al., 2000;
Aronica et al., 2001;
Fonseca et al., 2002). Finally, the distinction between astrocytic and neuronal gap junctions is also important, as they may have different physiological roles related to epilepsy. While spatial buffering by astrocytes may reduce neuronal excitability, it is likely that neuronal gap junctions contribute directly to the spread of seizures among neuronal networks and thus that gap junction inhibitors may be effective anti-convulsant drugs (
Jahromi et al., 2002;
Gajda et al., 2003;
Gigout et al., 2006;
Medina-Ceja et al., 2008).
In the present study, the functional and pathophysiological significance of impaired astrocyte gap junction coupling in relation to epilepsy and other neurological deficits in
Tsc1GFAPCKO mice was not directly addressed. However, several lines of evidence from this and previous studies suggest that the deficient astrocyte coupling is detrimental and promotes epileptogenesis in this mouse model of TSC. First of all, the initial genetic defect in
Tsc1GFAPCKO mice primarily affects astrocytes, and progressive astrogliosis slightly precedes the onset of epilepsy in these mice (
Uhlmann et al., 2002;
Erbayat-Altay et al., 2007), suggesting that astrocyte dysfunction is responsible for epileptogenesis in this model. Furthermore, previous studies have found that hippocampal slices from
Tsc1GFAPCKO mice are more sensitive to elevated potassium-induced epileptiform activity (
Jansen et al., 2005), which would be consistent with the impaired potassium buffering in hippocampal slices of these mice in the present study. Finally, the decreased expression of Cx43 and impaired potassium buffering could be reversed by rapamycin, a treatment that has also been shown to prevent epilepsy in
Tsc1GFAPCKO mice (
Zeng et al. 2008), suggesting that the impaired astrocyte gap junction coupling may participate in epileptogenesis due to mTOR hyperactivation and mechanistically linking these astrocyte defects to
Tsc1 gene inactivation in these mice.
As mTOR can affect a variety of other downstream effectors through gene regulation, the abnormalities in Cx43 expression could represent just one component of a spectrum of brain abnormalities that promote epileptogenesis and other neurological deficits in
Tsc1GFAPCKO mice. This might include more global effects on brain metabolism, homeostasis, or blood brain maintenance (
Marchi et al., 2007) or other specific molecular defects in astrocytes or neurons. For example, although the decreased connexin expression and gap junction coupling of astrocytes could account for the excessive potassium concentrations following stimulation in the
Tsc1GFAPCKO mice, other mechanisms may also contribute to differences in potassium buffering. Both inward-rectifying potassium channels and sodium-potassium pumps of astrocytes and neurons have been implicated in absorbing extracellular potassium (
Haglund and Schwartzkroin, 1990;
Xiong and Stringer, 2000;
D’Ambrosio et al., 2002), and defects in these molecules may promote seizure generation (
Janigro et al., 1997;
Bordey and Sontheimer, 1998;
Gabriel et al., 1998;
Xiong and Stringer, 1999;
Hinterkeuser et al., 2000). In fact, decreased expression of specific inward-rectifying potassium channels have been previously documented and proposed to contribute to epileptogenesis in
Tsc1GFAPCKO mice (
Jansen et al., 2005). However, the effects of carbenoxolone in the present study in causing a further increase in [K
+]
0 in control mice, but not in
Tsc1GFAPCKO mice, suggest that gap junction mechanisms account, at least in part, for the observed differences in potassium buffering between control and
Tsc1GFAPCKO mice.
Assuming that defects in astrocyte gap junction coupling and potassium buffering do contribute to epileptogenesis in
Tsc1GFAPCKO mice, these findings have potentially significant clinical and therapeutic implications for epilepsy in human TSC. Although to our knowledge, abnormalities in astrocytic connexin expression or gap junction function have not yet been reported in human TSC, there have been several recent examples where initial findings in animal models of TSC have been subsequently confirmed in human TSC (
Wong, 2007). As the role of astrocytes in epilepsy in general has been receiving more attention recently (
Binder and Steinhauser, 2006;
Jabs et al., 2008;
Wetherington et al., 2008), future anti-epileptic therapies may be targeted specifically for astrocytes. As exemplified by the potentially opposite effects of neuronal versus astrocytic gap junctions on brain excitability, designing therapies that modulate cell-specific gap junctions will be important. While there is already much excitement and promise for developing novel anti-epileptogenic treatments for epilepsy in TSC (
Zeng et al., 2008), further understanding of astrocytic mechanisms of epileptogenesis should lead to safer, more effective treatments.