Ketamine alleviates NMDA receptor hypofunction through synaptic trapping.

Activity-dependent modulations of N-methyl-D-aspartate glutamate receptor (NMDAR) trapping at synapses regulate excitatory neurotransmission and shape cognitive functions. Although NMDAR synaptic destabilization has been associated with severe neurological and psychiatric conditions, tuning NMDAR synaptic trapping to assess its clinical relevance for the treatment of brain conditions remains a challenge. Here, we report that ketamine (KET) and other clinically relevant NMDAR open channel blockers (OCBs) promote interactions between NMDAR and PDZ-domain-containing scaffolding proteins and enhance NMDAR trapping at synapses. We further show that KET-elicited trapping enhancement compensates for depletion in synaptic receptors triggered by autoantibodies from patients with anti-NMDAR encephalitis. Preventing synaptic depletion mitigates impairments in NMDAR-mediated CaMKII signaling and alleviates anxiety- and sensorimotor-gating-related behavioral deficits provoked by autoantibodies. Altogether, these findings reveal an unexpected dimension of OCB action and stress the potential of targeting receptor anchoring in NMDAR-related synaptopathies.

Alteration of NMDA receptor trafficking as a cellular hallmark of psychosis.

A dysfunction of the glutamatergic transmission, especially of the NMDA receptor (NMDAR), constitutes one of the main biological substrate of psychotic disorders, such as schizophrenia. The NMDAR signaling hypofunction, through genetic and/or environmental insults, would cause a neurodevelopmental myriad of molecular, cellular, and network alterations that persist throughout life. Yet, the mechanisms underpinning NMDAR dysfunctions remain elusive. Here, we compared the membrane trafficking of NMDAR in three gold-standard models of schizophrenia, i.e., patient's cerebrospinal fluids, genetic manipulations of susceptibility genes, and prenatal developmental alterations. Using a combination of single nanoparticle tracking, electrophysiological, biochemical, and behavioral approaches in rodents, we identified that the NMDAR trafficking in hippocampal neurons was consistently altered in all these different models. Artificial manipulations of the NMDAR surface dynamics with competing ligands or antibody-induced receptor cross-link in the developing rat brain were sufficient to regulate the adult acoustic startle reflex and compensate for an early pathological challenge. Collectively, we show that the NMDAR trafficking is markedly altered in all clinically relevant models of psychosis, opening new avenues of therapeutical strategies.

NMDA receptor membrane dynamics tunes the firing pattern of midbrain dopaminergic neurons.

KEY POINTS: NMDA receptors (NMDARs) expressed by dopamine neurons of the ventral tegmental area (VTA) play a central role in glutamate synapse plasticity, neuronal firing and adaptative behaviours. The NMDAR surface dynamics shapes synaptic adaptation in hippocampal networks, as well as associative memory. We investigated the basic properties and role of the NMDAR surface dynamics on cultured mesencephalic and VTA dopamine neurons in rodents. Using a combination of single molecule imaging and electrophysiological recordings, we demonstrate that NMDARs are highly diffusive at the surface of mesencephalic dopamine neurons. Unexpectedly, the NMDAR membrane dynamics per se regulates the firing pattern of VTA dopaminergic neurons, probably through a functional interplay between NMDARs receptors and small-conductance calcium-dependent potassium (SK) channels. ABSTRACT: Midbrain dopaminergic (DA) neurons play a central role in major physiological brain functions, and their dysfunctions have been associated with neuropsychiatric diseases. The activity of midbrain DA neurons is controlled by ion channels and neurotransmitter receptors, such as the glutamate NMDA receptor (NMDAR) and small-conductance calcium-dependent potassium (SK) channels. However, the cellular mechanisms through which these channels tune the firing pattern of midbrain DA neurons remain unclear. Here, we investigated whether the surface dynamics and distribution of NMDARs tunes the firing pattern of midbrain DA neurons. Using a combination of single molecule imaging and electrophysiological recordings, we report that NMDARs are highly diffusive at the surface of cultured midbrain DA neurons from rodents and humans. Reducing acutely the NMDAR membrane dynamics, which leaves the ionotropic function of the receptor intact, robustly altered the firing pattern of midbrain DA neurons without altering synaptic glutamatergic transmission. The reduction of NMDAR surface dynamics reduced apamin (SK channel blocker)-induced firing change and the distribution of SK3 channels in DA neurons. Together, these data show that the surface dynamics of NMDAR, and not solely its ionotropic function, tune the firing pattern of midbrain DA neurons partly through a functional interplay with SK channel function.

Human Autoantibodies Against N-Methyl-D-Aspartate Receptor Modestly Alter Dopamine D1 Receptor Surface Dynamics.

Circulating autoantibodies directed against extracellular domains of the glutamatergic N-methyl-D-aspartate receptors (NMDAR-Ab) elicit psychotic symptoms in humans and behavioral deficits in animal models. Recent advances suggest that NMDAR-Ab exert their pathogenic action by altering the trafficking of NMDAR, which results in a synaptic NMDAR hypofunction consistent with the consensual glutamatergic hypothesis of psychotic disorders. Yet, dysfunction in the dopaminergic signaling is also proposed to be at the core of psychotic disorders. Since NMDAR and dopamine D1 receptors (D1R) form membrane signaling complexes, we investigated whether NMDAR-Ab purified from patients with NMDAR-encephalitis or schizophrenia impaired D1R surface dynamics. As previous data demonstrated that NMDAR-Ab, at least from NMDAR-encephalitis patients, mainly bind to hippocampal NMDAR, we used single nanoparticle imaging to track D1R specifically at the surface of hippocampal neurons that were exposed to either purified G type immunoglobulins (IgGs) from NMDAR-Ab seropositive patients suffering from NMDAR-encephalitis or schizophrenia, or control IgGs from healthy NMDAR-Ab seropositive or seronegative subjects. We report that overnight incubation with NMDAR-Ab from patients, but not from healthy carriers, decreased the surface dynamics of D1R compared with NMDAR-Ab seronegative IgGs. This decrease was abolished, and even reversed, in D1R mutant that cannot physically interact with NMDAR. Overall, our data indicate that NMDAR-Ab from patients with psychotic symptoms alter the trafficking of D1R, likely through the surface crosstalk between NMDAR and D1R.

Dynamic disorganization of synaptic NMDA receptors triggered by autoantibodies from psychotic patients.

The identification of circulating autoantibodies against neuronal receptors in neuropsychiatric disorders has fostered new conceptual and clinical frameworks. However, detection reliability, putative presence in different diseases and in health have raised questions about potential pathogenic mechanism mediated by autoantibodies. Using a combination of single molecule-based imaging approaches, we here ascertain the presence of circulating autoantibodies against glutamate NMDA receptor (NMDAR-Ab) in about 20% of psychotic patients diagnosed with schizophrenia and very few healthy subjects. NMDAR-Ab from patients and healthy subjects do not compete for binding on native receptor. Strikingly, NMDAR-Ab from patients, but not from healthy subjects, specifically alter the surface dynamics and nanoscale organization of synaptic NMDAR and its anchoring partner the EphrinB2 receptor in heterologous cells, cultured neurons and in mouse brain. Functionally, only patients' NMDAR-Ab prevent long-term potentiation at glutamatergic synapses, while leaving NMDAR-mediated calcium influx intact. We unveil that NMDAR-Ab from psychotic patients alter NMDAR synaptic transmission, supporting a pathogenically relevant role.

Cell- and Single Molecule-Based Methods to Detect Anti-N-Methyl-D-Aspartate Receptor Autoantibodies in Patients With First-Episode Psychosis From the OPTiMiSE Project.

Circulating autoantibodies against glutamatergic N-methyl-D-aspartate receptor (NMDAR) have been reported in a proportion of patients with psychotic disorders, raising hopes for more appropriate treatment for these antibody-positive patients. However, the prevalence of circulating autoantibodies against glutamatergic NMDAR in psychotic disorders remains controversial, with detection prevalence rates and immunoglobulin classes varying considerably between studies, perhaps because of different detection methods. Here, we compared the results of serum assays for a large cohort of patients with first-episode psychosis using classical cell-based assays in three labs and a single molecule-based imaging method. Most assays and single molecule imaging in live hippocampal neurons revealed the presence of circulating autoantibodies against glutamatergic NMDAR in approximately 5% of patients with first-episode psychosis. However, some heterogeneity between cell-based assays was clearly observed, highlighting the urgent need for new sensitive methods to detect the presence of low-titer autoantibodies against glutamatergic NMDAR in seropositive patients who cannot be clinically identified from seronegative ones.

Clinical and autoimmune features of a patient with autism spectrum disorder seropositive for anti-NMDA-receptor autoantibody.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by dysfunctions in social interactions resulting from a complex interplay between immunogenetic and environmental risk factors. Autoimmunity has been proposed as a major etiological component of ASD. Whether specific autoantibodies directed against brain targets are involved in ASD remains an open question. Here, we identified within a cohort an ASD patient with multiple circulating autoantibodies, including the well-characterized one against glutamate NMDA receptor (NMDAR-Ab). The patient exhibited alexithymia and previously suffered from two major depressive episodes without psychotic symptoms. Using a single molecule-based imaging approach, we demonstrate that neither NMDAR-Ab type G immunoglobulin purified from the ASD patient serum, nor that from a seropositive healthy subject, disorganize membrane NMDAR complexes at synapses. These findings suggest that the autistic patient NMDAR-Abs do not play a direct role in the etiology of ASD and that other autoantibodies directed against neuronal targets should be investigated.

El trastorno del espectro autista (TEA) es un trastorno del neurodesarrollo caracterizado por dísfunciones en las interacciones sociales que se traducen en un complejo interjuego entre factores de riesgo ambientales e inmunogenéticos. Se ha propuesto a la autoinmunidad como un componente etiológico importante en el TEA. Sigue pendiente saber si hay autoanticuerpos específicos dirigidos contra blancos cerebrales involucrados en el TEA. En este artículo se identificó, dentro de una cohorte, un paciente con TEA con múltiples autoanticuerpos circulantes, incluyendo uno bien caracterizado contra el receptor de glutamato NMDA (NMDAR-Ab). El paciente presentaba alexitimia y previamente había tenido dos episodios depresivos mayores sin síntomas psicóticos. Mediante técnica de imágenes de molécula única se demostró que ni la γ inmunoglobulina purificada del NMDAR-Ab del suero del paciente con TEA, ni la de un sujeto sano seropositivo desorganizaban los complejos de membrana del NMDAR en las sinapsis. Estos hallazgos sugieren que los auto-anticuerpos del NMDAR de pacientes autistas no juegan un papel directo en la etiología del TEA y que se deben investigar otros autoanticuerpos dirigidos contra blancos neuronales.

Les troubles du spectre autistique (TSA) sont des maladies neurodéveloppementales caracterisées par des dysfonctions des interactions sociales provoquées par un jeu complexe entre des facteurs de risque immunogénétiques et environnementaux. L'auto-immunité a été proposée comme composant étiologique majeur des TSA. Il reste à savoir si des auto-anticorps spécifiques dirigés contre des cibles cérébrales sont impliqués dans les TSA. Dans cet article, nous identifions au sein d'une cohorte, un patient TSA ayant de nombreux auto-anticorps circulants dont celui très connu contre le récepteur NMDA du glutamate (NMDAR-Ab). Ce patient présente une alexithymie et a eu antérieurement deux épisodes dépressifs caractérisés sans symptômes psychotiques. Grâce à l'utilisation d'une technique d'imagerie de molécule unique, nous démontrons que ni l'immunoglobuline γ purifiée NMDAR-Ab sérique du patient TSA ni celle d'un patient sain ayant le même anticorps ne désorganisent les complexes membranaires NMDAR au niveau synaptique. Ces résultats semblent indiquer que les auto-anticorps NMDAR-Ab de patients autistes ne jouent pas de rôle direct dans I'étiologie des TSA et que d'autres autoanticorps dirigés contre des cibles neuronales devraient faire l'objet de recherches.

Neural control of on-line guidance of hand reaching movements.

Orienting one's gaze towards a peripheral target is usually composed of a hypometric primary saccade followed by a secondary 'corrective saccade' triggered automatically (without conscious perception) by the retinal error at the end of the primary saccade and characterised by a short latency. Due to visual suppression during the saccade, the artificial introduction of a random small target jump during that short period remains undetected and triggers after the end of the primary saccade a normal 'corrective saccade'. As a result this procedure simulates an error in the planning of the primary saccade. On the other hand optimum hand pointing (trade-off between movement time and accuracy) is considered classically to involve a natural parallel initiation of saccade and hand response based on a poor peripheral retinal location, and a further amendment of the hand motor response based on the retinal error provided by the simultaneous vision of target and hand during the movement home phase. To test the hypothesis that the retinal feedback at the end of the primary saccade is used to update the visual target position and amend the ongoing hand motor response, we developed a paradigm involving both an optimum hand pointing and an undetected random target perturbation during the orienting saccade. In order to show that the amendments were controlled by a loop comparing the perceived target location with the dynamic hand position signal, vision of the limb was removed at movement onset. Results showed that the movement was smoothly monitored on-line without additional time processing demands. This functional property of flexibility of the ongoing hand motor response, was generalized from movement extent to movement direction. The undetectability of the perturbation at a conscious level was not a prerequisite for motor flexibility, which was further shown to depend on a critical phase of the limb movement beyond which the latter was no longer amendable, even when the limb was visible. The hand pointing flexibility was further generalised from pointing to the more complex hand reaching and grasping process. It was shown that the flexibility of both the transport and the grasp components were closely coupled. A careful analysis of the data suggested the controlled variable to be the general posture of the upper limb, reaching Bernstein's intuitions about redundancy reduction in skeletomotor systems with degrees of freedom in excess. A kinematics study of the motor flexibility of reaching and grasping in a patient with a bilateral optic ataxia favoured the idea of a posterior parietal cortex involvement in the error processing underlying motor flexibility, reaching the same conclusions as other recent studies using either Positron Emission Tomography or Transcranial Magnetic Stimulation.

A lesion of the posterior parietal cortex disrupts on-line adjustments during aiming movements.

It is long known that the posterior parietal cortex (PPC) is critically involved in goal-directed movements. Nevertheless, there are still some controversies about its specific functions. Although most published studies have emphasised the role of PPC in sensorimotor planning processes, it has been recently suggested that PPC can also participate to on-line movement control. We studied kinematics of hand movements in a patient with a bilateral PPC lesion who exhibited no deficit in planning of her grasping movements in central vision. She was instructed to reach and grasp a cylinder presented at different locations and her motor performance was compared to that of four healthy control subjects. To address on-line control specifically, the cylinder was quickly and unexpectedly jumped, on a few trials, at movement onset, to a new location some 10 degrees (of apparent visual angle) from the original location. The patient could easily grasp stationary objects seen in foveal vision, exhibiting the same kinematic pattern as controls. Therefore, she could plan movements accurately. In response to the object jump, unlike the controls, the patient was unable to amend her ongoing movement. In this situation, she completed two distinct movements, a first one toward the initial object location and a second one toward the final object location. These results support the hypothesis that beyond a role in movement planning, PPC plays a major role in the on-line control of reach-to-grasp movements.