K
+, Na
+ and Ca
2+ play important roles in neuronal signaling due to conduction of electrical activity of neurons (
McCormick and Huguenard, 1994). Therefore, control of excitability of neurons is maintained by the ionic environment. Intracellular concentrations of Na
+ and Ca
2+ are several folds lower and that of potassium are higher as compared to their extracellular concentrations. The net transmembrane potential across the membrane is maintained at −60 mV. If the ionic concentration is perturbed (e.g., levels of intracellular Ca
2+ and Na
+ or extracellular K
+ are altered), this can lead to depolarization and abnormal neuronal activity due to depolarization of neuronal-terminals, neurotransmitters release, depolarization of neurons and discharge of action potential (Somojen, 2002).
Na
+/K
+-ATPase and Ca
2+/Mg
2+-ATPase are two ATP-hydrolyzing enzymes which maintain the electrochemical gradient in the cells in an energy-dependent manner. Na
+/K
+-ATPase extrudes three Na
+ molecules in exchange for internalization of two K
+ molecules. The Na
+/K
+-ATPase is composed of multiple isoforms (α1, α2 and α3), and these isoforms differ in their distribution in tissues and during development.
Lingrel et al. (2007) reported that haploinsuffciency of its α2 and α3 isoforms results in behavioral defects. In another study, mutations in a C-terminal region of other voltage-gated Na
+ channels have been reported to reduce the amount of channel inactivation (
Glaaser et al., 2006;
Kim et al., 2004). Another report suggests functional deficit of Ca
2+-activated K
+ channel (BKCa), a synaptic regulator of neuronal excitability with autism (
Laumonnier et al., 2006). Disruption of the BKCa gene (KCNMA1) led to haploinsufficiency and reduced BKCa activity in autism. These reports on decrease in BKCa channel activity, and reduced inactivation of voltage-gated Ca
2+ channels in individuals with autism, raise the possibility that excessive ion channel activity may lead to ASD.
Since K
+, Na
+ and Ca
2+ play important roles in developing electrochemical gradients and in neuronal signaling, the altered activities of Na
+/K
+-ATPase and Ca
2+/Mg
2+-ATPase may have a significant impact on brain function in autistic subjects. Our results show that the activities of both Na
+/K
+-ATPase and Ca
2+/Mg
2+-ATPase were significantly increased in the cerebellum in autism as compared with age-matched controls, while the activity of Na
+/K
+-ATPase was also significantly increased in the frontal cortex in autism. In other regions of cerebrum i.e., occipital, parietal and temporal cortex, the activities of Na
+/K
+-ATPase and Ca
2+/Mg
2+-ATPase were similar between autistic and control subjects. Increased activity of Na
+/K
+-ATPase has been reported in several other pathological conditions such as in experimentally induced epilepsy (
Fernandes et al., 1996;
Reime et al., 2007), and in Crush syndrome (
Desai and Desai, 2007). In chronic fatigue syndrome, the activities of both Na
+/K
+-ATPase and Ca
2+/Mg
2+-ATPase are increased in sarcoplasmic reticulum membranes (
Fulle et al., 2003). In addition,
Takser et al. (2003) reported a correlation of ATPase activities with early psychomotor development in humans. Rapid eye movement sleep deprivation has also been reported to increase Na
+/K
+-ATPase activity (
Mallick et al., 2000). In addition, certain environmental factors such as lead have been reported to increase the activity of Na
+/K
+-ATPase (
Regunathan and Sundaresan, 1985).
After a stimulus, calcium flows rapidly into neurons through various types of membrane channels including voltage-dependent and receptor-coupled channels. Intracellular Ca
2+ concentrations are quickly restored to resting levels primarily through Ca
2+/Mg
2+-ATPase, Na
+/Ca
+ exchange, and endoplasmic sequestration. Calcium is essential for neurotransmitter release, and Ca
2+ influx is essential for neuronal excitability. Improper intracellular regulation of calcium has been linked with several neurological disorders. The receptor-coupled increase in intracellular levels of calcium is important for neuronal survival, differentiation, migration, and synaptogenesis (
Aamodt and Constantine-Paton, 1999;
Cline, 2001;
Komuro and Rakic, 1998;
Moody and Bosma, 2005;
Represa and Ben Ari, 2005;
Spitzer et al., 2004). Defects in these developmental processes can lead to neuroanatomical abnormalities, such as increased cell-packing density, decreased neuron size and arborizations, and alterations in connectivity. Such abnormalities have been associated with ASD patients (
Courchesne et al., 2005;
DiCicco-Bloom et al., 2006). Plasma membrane calcium-ATPase plays an important role in the translocation of calcium from the cytosol to the extracellular milieu. Our results suggest that Ca
2+/Mg
2+-ATPase activity is significantly increased in the cerebellum of autistic subjects, but not in other regions of the brain. Although Ca
2+/Mg
2+-ATPase activity in the frontal cortex of autism subjects was not significantly changed but a trend towards increased Ca
2+/Mg
2+-ATPase activity was observed as compared to controls. The median Ca
2+/Mg
2+-ATPase activity in the frontal cortex for autism was 113 µg phosphorus released/mg protein/hr while for control group, it was 99 µg phosphorus released/mg protein/hr. A differential effect of ATPase activity in different regions of brain is not unique. In epilepsy, the intrasynaptosomal Ca
2+/Mg
2+-ATPase activity was reported to be decreased in the hippocampus, but not in the temporal cortex (
Nagy et al., 1990).
Voltage-gated calcium channels mediate calcium influx in response to membrane depolarization and regulate intracellular processes such as contraction, secretion, neurotransmission, and gene expression. Their activity is essential for coupling electrical signals on the cell surface to physiological events in cells. Functional mutations in genes encoding voltage-gated Ca
2+ channels have been suggested as a possible cause of ASD (Hemara-Wahanui et al., 2005b;
Splawski et al., 2006;
Splawski et al., 2004). Point mutations in the gene encoding the L-type voltage-gated Ca
2+channel CaV1.2 (CACNA1C) cause Timothy syndrome, a multisystem disorder that includes cardiac abnormalities and autism (
Splawski et al., 2005;
Splawski et al., 2004). CaV1.2 plays an important role in the activation of transcription factors, such as cAMP response-element-binding protein (CREB) and myocyte enhancer factor 2 (MEF2), involving neuronal survival and dendritic arborization (
West et al., 2001). The mutations associated with Timothy syndrome prevent voltage-dependent inactivation of CaV1.2, which causes the channels to remain open longer and allow the influx of more Ca
2+ than wild-type channels (
Splawski et al., 2005;
Splawski et al., 2004) leading to increased intracellular Ca
2+. Additional evidence of calcium’s involvement in autism comes from a mutation identified in the CACNA1F gene, which encodes the L-type voltage-gated Ca
2+ channel, CaV1.4. This mutation was reported to cause autistic symptoms in a New Zealand family where the affected subjects have stationary night blindness (Hemara-Wahanui et al., 2005a;
Hope et al., 2005). ASD-associated mutations have been identified not only in genes encoding Ca
2+ channels themselves but also in genes encoding ion channels whose activity is directly modulated by Ca
2+ such as Ca
2+-dependent Na
+ channels. Several point mutations in SCN1A and SCN2A genes, which encode the voltage-activated Na
+ channels NaV1.1 and NaV1.2 respectively has been reported (
Kamiya et al., 2004;
Weiss et al., 2003).
Wingless-type mouse mammary tumor virus (MMTV) integration site member (Wnt) proteins are known to form a family of highly conserved and secreted signaling molecules, which regulate cell-to-cell interactions during embryogenesis. The role of WNT2 has been implicated in ASD. Two families with mutations in WNT2 have been identified, and a polymorphism in an upstream region of WNT2 has been associated with families characterized with severe language abnormalities (
Wassink et al., 2001). Increase in Ca
2+ concentration has been reported to enhance the synthesis and release of Wnt through the activity of the Ca
2+-regulated transcription factor CREB (
Wayman et al., 2006). Because of the pivotal role of calcium in cellular signaling, calcium may play an important role in the etiology of ASD.
The increased activity of Ca
2+/Mg
2+-ATPase in the cerebellum of autistic subjects may be attributable to several factors. Ca
2+/Mg
2+-ATPase activity may increase due to compensatory mechanisms in response to increased intracellular calcium levels in autism.
Heguilen et al. (2009) reported increases in Ca
2+/Mg
2+-ATPase activity in patients with hypercalciuric nephrolithiasis. In addition, Ca
2+/Mg
2+-ATPase activity can also be activated by lysophosphatidylcholine, a phospholipase A
2 (PLA
2)–mediated lipolytic product in the membrane. It has also been reported that the levels of polyunsaturated fatty acids, another lipolytic product of PLA
2, are decreased in the erythrocyte membranes of autistic subjects as compared with normal control subjects (
Bell et al., 2000). Increased activity of PLA
2, an enzyme that removes unsaturated fatty acids from phospholipids, has also been reported in erythrocytes from autistic subjects (
Bell et al., 2004). Additionally, increased levels of phospholipase A
2 have been observed in the erythrocytes of patients with schizophrenia (
Ward, 2000) and dyslexia (
MacDonell et al., 2000). Since chromosomal linkage studies in autism point to a locus which includes the PLA
2 gene (
Lamb et al., 2000), this enzyme may also have an important role in the etiology of autism. In conclusion, Na
+/K
+-ATPase and Ca
2+/Mg
2+-ATPase activities in autism may be increased in response to increased intracellular calcium concentration, and may contribute to altered neocotical circuitry in the cerebellum and frontal cortex of individual with autism.