Current Pharmaceutical Design - Volume 19, Issue 24, 2013

The development of locomotor function in terrestrial higher vertebrates takes place during both the embryonic period and the first days (or weeks, depending on the species) of postnatal life. It relies on the maturation of different elements such as musculoskeletal system, sensory systems, network connectivity, and neuronal intrinsic properties. This maturation results from the interplay between genetic determinants and activity dependent processes. Numerous studies have shown that aminergic (serotonin, noradrenaline, dopamine) projections to the spinal cord could contribute to the maturation of locomotor networks. In this review we will describe the development of aminergic projections in the spinal cord of higher terrestrial vertebrates, and we will review literature describing the trophic role played by these pathways on different parameters of locomotor function.

Male sexual responses are reflexes mediated by the spinal cord and modulated by neural circuitries involving both the peripheral and central nervous system. While the brain interact with the reflexes to allow perception of sexual sensations and to exert excitatory or inhibitory influences, penile reflexes can occur despite complete transections of the spinal cord, as demonstrated by the reviewed animal studies on spinalization and human studies on spinal cord injury. Neurophysiological and neuropharmacological substrates of the male sexual responses will be discussed in this review, starting with the spinal mediation of erection and its underlying mechanism with nitric oxide (NO), followed by the description of the ejaculation process, its neural mediation and its coordination by the spinal generator of ejaculation (SGE), followed by the occurrence of climax as a multisegmental sympathetic reflex discharge. Brain modulation of these reflexes will be discussed through neurophysiological evidence involving structures such as the medial preoptic area of hypothalamus (MPOA), the paraventricular nucleus (PVN), the periaqueductal gray (PAG), and the nucleus para-gigantocellularis (nPGI), and through neuropharmacological evidence involving neurotransmitters such as serotonin (5-HT), dopamine and oxytocin. The pharmacological developments based on these mechanisms to treat male sexual dysfunctions will complete this review, including phosphodiesterase (PDE-5) inhibitors and intracavernous injections (ICI) for the treatment of erectile dysfunctions (ED), selective serotonin reuptake inhibitor (SSRI) for the treatment of premature ejaculation, and cholinesterase inhibitors as well as alpha adrenergic drugs for the treatment of anejaculation and retrograde ejaculation. Evidence from spinal cord injured studies will be highlighted upon each step.

In this review we will first give a historical account of how the discovery of persistent inward currents (PICs) and plateau potentials changed the understanding of the operation and function of the “final common path”, i.e. the motoneurons themselves. A major function of voltage-dependent PICs is to serve as an adjustable amplifier of classical synaptic inputs. The complex control of this, and other intrinsic properties, certainly adjusts the performance of the motoneurons to the needs of the behavioral settings. It has emerged that supraspinal facilitation, mainly by monoaminergic projections, is a prerequisite for the normal function of the PIC channels. When these pathways are interrupted following a spinal lesion the “gain” of the transmission across the motoneurons is reduced and this is likely to be an important explanation for the spinal shock. However, after a few weeks the “plateau properties” of the motoneurons return - now without descending monoaminergic control. This plasticity after spinal lesion is likely to contribute to the hyperreflexia (spasticity) seen after spinal lesions. We then review the current knowledge on PICs in other spinal (inter-)neurons. The monoaminergic systems seem to play a pivotal role in activating the spinal network generating the rhythm and basic motor pattern of locomotion and scratch - the spinal “central pattern generators” (CPGs). We give a short historical background of this research with a special emphasis on the importance of the descending monoaminergic systems.

Serotonin (5-HT) is one of the main transmitters in the nervous system. Serotonergic neurons in the raphe nuclei in the brainstem innervate most parts of the central nervous system including motoneurons in the spinal cord and brainstem. This review will focus on the modulatory role that 5-HT exerts on motoneurons and its physiological consequences. The somato-dendritic compartments of motoneurons are densely innervated by serotonergic synaptic boutons and several receptors are expressed in the membrane of motoneurons including 5-HT1A, 5-HT1B, 5-HT1D, 5-HT2A, 5-HT2B, 5-HT2C and 5-HT5A. The activation of serotonergic receptors induces a general increase of the excitability of motoneurons through the modulation of several classes of ion channels. 5-HT depolarizes motoneurons towards the threshold for action potentials by inhibiting leak conductances and promoting a hyperpolarization activated cationic current. At the same time, 5-HT increases the firing frequency by inhibiting the small Ca2+ activated K+ conductance (SK) responsible for the medium afterhyperpolarization (AHP) following action potentials. 5-HT also promotes persistent inward currents mediated by voltage sensitive Ca2+ and Na+ conductances, producing a sustained depolarization and an amplification of synaptic inputs. Under pathological conditions, such as after a spinal cord injury, the promotion of persistent inward currents by serotonin and/or the overexpression of autoactive serotonergic receptors may contribute to motoneuronal excitability, muscle spasms and spasticity and hence, impairment of stereotyped motor behaviors such as locomotion, ejaculation and micturition.

For many years, glial cells from the central nervous system have been considered as support cells involved in the homeostasis of the brain. However, a series of key-findings obtained during the past two decades has put light on unexpected roles for glia and it is getting more and more admitted that glia play an active role in several physiological functions. The discovery that a bidirectional communication takes place between astrocytes (the star shaped glial cell of the brain) and neurons, was a major breakthrough in the field of synaptic physiology. Astrocytes express receptors that get activated by neurotransmitters during synaptic transmission. In turn they release other transmitters - called gliotransmitters - that bind to neuronal receptors and modulate synaptic transmission. This feedback, which led to the concept of the tripartite synapse, has been reported with various transmitters including glutamate, ATP, GABA or serine. In the present review we will focus on astrocytes and review the evidence suggesting and demonstrating their role in motor control. Rhythmic motor behaviors such as locomotion, swimming or chewing are generated by networks of neurons termed central pattern generators (CPG). These networks are highly flexible and adjust the frequency of their output to the external environment. In the case of respiration, the CPG reacts when changes in the pH of the blood occur. The chemosensory control of breathing is ensured by astrocytes, which react to variation of the blood pH by releasing ATP on neurons that in turn adapt the frequency of respiration. In the spinal cord, diverse transmitters such as ATP, adenosine or endocannabinoids modulate the CPG responsible for locomotion. A growing body of evidence suggests that glial cells release some of these molecules. These data suggest that astrocytes play an essential role in motor control and we believe that a range of studies will confirm this view in the near future.

Spinal cord injury (SCI) often results in permanent paralysis because there is little spontaneous repair. Neuronal injury in the central nervous system (CNS) causes breakage of axonal connections, release of myelin, inflammation and cell death at the lesion site. Many factors contribute to the failure of spontaneous repair after SCI, including the presence of growth inhibitory proteins in myelin, the inflammatory environment of the injured CNS, and the resulting signaling cascades that result in over-activation of Rho, a signaling switch in neurons and axons. In this review, we provide a general overview of growth inhibition in the CNS, and show evidence that most growth inhibitory proteins signal through a common intracellular pathway. Rho is a convergent signal for growth inhibition, and also for signaling some of the secondary consequences of inflammation after SCI. We review the preclinical evidence that targeting Rho is an effective way to stimulate axon regeneration and functional recovery in preclinical animal models. In the last part of the review, we describe the creation of Cethrin, a new investigational drug, and summarize the results of the Phase I/IIa clinical study to examine the safety, tolerability and efficacy of Cethrin in patients with acute SCI. We conclude with some insight for future clinical studies.

Several motor behaviors such as locomotion, respiration, sexual function, and micturition are generated by rhythmic and stereotyped motor patterns of activity. In most cases, these functions are primarily controlled by signals and neuronal commands that originate from the brainstem and spinal cord. Defined as the storage and periodic elimination of urine, micturition requires a complex neural control system that coordinates the activities of a variety of effector organs including the smooth muscle of the urinary bladder and the smooth and striated muscle of the urethral sphincters. The lower urinary tract (LUT) reflex mechanisms, organized at the level of the lumbosacral spinal cord, are modulated predominantly by supraspinal controls. These LUT mechanisms include: (1) storage reflexes organized at the spinal level; (2) elimination reflexes organized at a supraspinal site in the pons; and (3) spinal storage reflexes modulated by inputs from the rostral pons. Precise coordination of the reciprocal functions of the urinary bladder and urethra and complex neural organization are required for normal function. Numerous neuropeptide/receptor systems are expressed in central and peripheral nervous system pathways that regulate the LUT and expression can also be found in both neural and non-neural (e.g., urothelium) components. Neuropeptides have tissue-specific distributions and functions in the LUT and exhibit neuroplastic changes in expression and function with LUT dysfunction with neural injury, inflammation, stress and disease. LUT dysfunction with abnormal voiding including urinary urgency, increased voiding frequency, nocturia, urinary incontinence, urinary retention, continence, detrusor dysynergia and/or pain may reflect a change in the balance of neuropeptides in central and peripheral bladder reflex pathways. LUT neuropeptide/receptor systems in LUT pathways may thus represent potential targets for therapeutic intervention.

Although research on neural tissue repair has made enormous progress in recent years, spinal cord injury remains a devastating condition for which there is still no cure. In fact, recent estimates of prevalence in the United States reveal that spinal cord injury has undergone a five-fold increase in the last decades. Though, it has become the second most common neurological problem in North America after Alzheimer’s disease. Despite modern trauma units and intensive care treatments, spinal cord injury remains associated with several comorbid conditions and unbearable health care costs. Regular administration of a plethora of symptomatic drug treatments aimed at controlling related-secondary complications and life-threatening problems in chronic spinal cord-injured patients has recently been reported. This article provides a thorough overview of the main drug classes and products currently used or in development for chronic spinal cord injury. Special attention is paid to a novel class of drug treatment designed to provide a holistic solution for several chronic complications and diseases related with spinal cord injury. There is clear evidence showing that new class can elicit ‘on-demand’ episodes of rhythmic and stereotyped walking activity in previously completely paraplegic animals and may consequently constitute a simple therapy against several physical inactivity-related comorbid problems. Understanding further pharmacological approaches to chronic spinal cord injury may improve both life expectancy and overall quality of life while reducing unsustainable cost increases associated with this debilitation condition.

Most animal models of contused, compressed or transected spinal cord injury (SCI) require a laminectomy to be performed. However, despite advantages and disadvantages associated with each of these models, the laminectomy itself is generally associated with significant problems including longer surgery and anaesthesia (related post-operative complications), neuropathic pain, spinal instabilities, deformities, lordosis, and biomechanical problems, etc. This review provides an overview of findings obtained mainly from our laboratory that are associated with the development and characterization of a novel murine model of spinal cord transection that does not require a laminectomy. A number of studies successfully conducted with this model provided strong evidence that it constitutes a simple, reliable and reproducible transection model of complete paraplegia which is particularly useful for studies on large cohorts of wild-type or mutant animals - e.g., drug screening studies in vivo or studies aimed at characterizing neuronal and non-neuronal adaptive changes post-trauma. It is highly suitable also for studies aimed at identifying and developing new pharmacological treatments against aging associated comorbid problems and specific SCI-related dysfunctions (e.g., stereotyped motor behaviours such as locomotion, sexual response, defecation and micturition) largely related with ‘command centers’ located in lumbosacral areas of the spinal cord.

In 1966, Shik, Severin and Orlovskii discovered that electrical stimulation of a region at the junction between the midbrain and hindbrain elicited controlled walking and running in the cat. The region was named Mesencephalic Locomotor Region (MLR). Since then, this locomotor center was shown to control locomotion in various vertebrate species, including the lamprey, salamander, stingray, rat, guinea-pig, rabbit or monkey. In human subjects asked to imagine they are walking, there is an increased activity in brainstem nuclei corresponding to the MLR (i.e. pedunculopontine, cuneiform and subcuneiform nuclei). Clinicians are now stimulating (deep brain stimulation) structures considered to be part of the MLR to alleviate locomotor symptoms of patients with Parkinson’s disease. However, the anatomical constituents of the MLR still remain a matter of debate, especially relative to the pedunculopontine, cuneiform and subcuneiform nuclei. Furthermore, recent studies in lampreys have revealed that the MLR is more complex than a simple relay in a serial descending pathway activating the spinal locomotor circuits. It has multiple functions. Our goal is to review the current knowledge relative to the anatomical constituents of the MLR, and its physiological role, from lamprey to man. We will discuss these results in the context of the recent clinical studies involving stimulation of the MLR in patients with Parkinson’s disease.

Much like locomotion or micturition, respiration is a rhythmic and stereotyped motor pattern controlled mainly by non-cortical structures including a complex circuit in the brainstem. Because tight regulation of lung ventilation is essential from the beginning of life, it has been presumed that the neural system regulating breathing is fixed, following a genetically predetermined developmental pattern. Here, we review evidence indicating that early life exposure to a non-systemic stress in the form of neonatal maternal separation (NMS) is sufficient to exert sex-specific consequences on the developmental trajectory of this vital homeostatic system that persist well into full maturity. At adulthood, male rats subjected to NMS are hypertensive and show an abnormally high hypoxic chemoreflex that correlates positively with respiratory instability during sleep. The effects are not observed in females. Investigation of the mechanisms this respiratory phenotype have highlighted the importance of 1) neuroendocrine influences on respiratory regulation and 2) stress-related imbalance between inhibitory (GABAergic) and excitatory (glutamatergic) modulation of the neural elements regulating breathing. These results provide new and valuable insight into the origins of respiratory disorders related to neural control dysfunction such as sleep disordered breathing.

γ-aminobutyric acid (GABA) plays many of its key roles in embryonic development and functioning of the central nervous system (CNS) by acting on ligand gated chloride-permeable channels known as GABAA receptors (GABAAR). Classically, GABAARmediated synaptic communication is tailored to allow rapid and precise transmission of information to synchronize the activity of large populations of cells to generate and maintain neuronal networks oscillations. An alternative type of inhibition mediated by GABAA receptors, initially described about 25 years ago, is characterized by a tonic activation of receptors that react to ambient extracellular GABA. The receptors that mediate this action are wide-spread throughout the nerve cells but are located distant from the sites of GABA release, and therefore they have been called extrasynaptic GABAA receptors. The molecular nature of the extrasynaptic GABAA receptors and the tonic inhibitory current they generate have been characterized in many brain structures, and due to its relevance in controlling neuron excitability they have become attractive pharmacological targets for a variety of neurological disorders such as schizophrenia, epilepsy and Parkinson disease. In the spinal cord, early studies have implicated these receptors in anesthesia, chronic pain, motor control, and locomotion. This review highlights past and present developments in the field of extrasynaptic GABAA receptors and emphasizes their subunit containing distribution and physiological role in the spinal cord.

Throughout life, neuronal network properties are modulated according to both external and internal stimuli. These adaptive capabilities of the central nervous system (CNS) have been generically termed “plasticity”. One prominent form of CNS plasticity is the capability of synapses to change their strength. Synaptic strength is not a constant value but depends at each moment on the synapse’s past activity. These changes in transmission efficacy are called activity-dependent synaptic plasticity (ADSP) and result in an increase (potentiation) or a decrease (depression) in synaptic strength. The ability of synapses to express one type of ADSP can change as a function of previous plasticity and previous activation of synapses. This plasticity of synaptic plasticity has been termed metaplasticity. ADSP and metaplasticity are now regarded as essential mechanisms for normal information processing in neuronal networks. Rhythmic activities such as locomotion are generated by rhythmically active central neuronal networks called central pattern generators (CPGs) that possess the intrinsic ability to generate rhythmic and organized activity in the absence of sensory inputs. The CPG activity arises from a complex dynamic interaction between synaptic transmission, intrinsic membrane properties and neuromodulatory inputs. A growing body of evidence suggests that the spinal cord matches the plastic and metaplastic properties found in other parts of the CNS, both under normal conditions and after spinal cord injury. Here, findings describing ADSP and its neuromodulation in vertebrate sensorimotor networks are reviewed, followed by a discussion of the potential role of ADSP and neuromodulation in the physiology and pathophysiology of motor circuit assembly.

Synaptic transmission through descending motor pathways to lumbar motoneurons and then to leg muscles is essential for walking in humans and rats. Spinal cord injury (SCI), even when incomplete, results in diminished transmission to motoneurons and very limited recovery of motor function. Neurotrophins have emerged as essential molecules known to promote cell survival and support anatomical reorganization in damaged spinal cord. This review will summarize the evidence implicating the role of neurotrophins in synaptic plasticity in both undamaged and damaged spinal cord, with special emphasis on the potential for neurotrophins to strengthen synaptic connections to motoneurons in support of the application of neurotrophins for recovery of locomotor function after SCI. An important consideration related to therapeutic use of neurotrophins is the successful delivery of these molecules. Prolonged delivery of neurotrophins to the spinal cord of adult mammals has recently become possible through advances in biotechnology. Fibroblasts engineered to secrete neurotrophins and gene transfer of neurotrophins via recombinant viral vectors are among the most promising therapeutic transgene delivery systems for safe and effective neurotrophin delivery. Administration of neurotrophins to the spinal cord using these delivery systems was found to enhance both anatomical and synaptic plasticity and improve functional recovery after SCI. The findings summarized here indicate that neurotrophins have translational research potential for SCI repair, most likely as an essential component of combination therapy.