GABAA Receptor

Consciousness and Anesthesia
Takashi Mashimo (Graduate School of Medicine)
眞下 節(医学系研究科麻酔・集中治療医学教室)
・General Anesthesia
・Anesthesia and EEG
・Mechanism of Anesthesia
-GABAA Receptor-
Global COE
Cognitive Neuroscience Robotics
General Anesthesia
Operation
without
Anesthesia
First Anesthesia with Ether
by Dr. Morton in 1846
A Patient under General Anesthesia
Purpose of General Anesthesia
• Amnesia and Unconsciousness
• Immobility with Surgical Stimuli
• Suppression of Stress Responses to
Surgical Stimuli
Three Requisites for General Anesthesia
• Sedative, Hypnotic (Anesthetic)
• Analgesic (Opioid)
• Muscle Relaxant
Inhalational Anesthetics
Anesthesia Machine
Intravenous Anesthetics
Continuous Infusion of Propofol and Remifentanyl
Components of the Anesthetized State
• General anesthesia consists of several
components.
• Some of the discrete brain regions and
neural circuits are involved in specific
components of the anesthetized state.
• General anesthetics interact with
subpopulations of nervous system cells to
create each of the separate properties of
anesthesia
Main Components
of General Anesthesia
•
•
•
•
•
•
Sedation(鎮静、思考力低下)
Amnesia(記憶消失)
Unconsciousness, Hypnosis (無意識)
Analgesia(無痛)
Immobility(不動化)
Adrenergic Suppression(交感神経抑制)
Sites in the CNS that are thought to be involved
in the anesthetic components; sedative, hypnotic
and immobilizing actions of propofol
Correlation between propofol level and anesthetic depth
Rudolph & Antkowiak: Nature Reviews Neuroscience 5: 709, 2004
Dose-response Curves of Main Components
of General Anesthesia
ED50s of Dose-response Curves of Anesthetic Components:
Amnesia<Unconsciousness<Immobility<Adrenergic
Suppression
How do Anesthetics Produce the Broad
Effects throughout the Brain?
• Individual aspects of the anesthetized
state are attributable to different sets of
nerve cells, which are themselves
distinguished by specific surface proteins
(receptors) that interact with anesthetics.
• New compounds designed to target just
those proteins, and hence the desirable
effects of anesthetics –as well as
sedatives, sleep aids and memory drugs.
Anesthesia and EEG
Arousal (Consciousness)
and
Anesthesia (Unconsciousness)
Unconsciousness (Hypnosis)
• Mechanism of arousal (consciousness) is
complex.
• Centers of arousal are thought to be frontal
cortex, thalamus and midbrain reticular
formation.
• It is difficult to pinpoint a single anatomical
source of unconsciousness during anesthesia.
• Unconsciousness is simply the result of
cognitive unbinding: a severing of
communication between the many brain regions
that cooperate in higher cognition processing.
GABAA Receptor and EEG
10Hz spindle
wave
GABAA Receptor
Activation
of GABAA
receptor
with general
anesthetics
Increase in
amplitude of
10Hz spindle
wave
Electroencepharogram (EEG)
Dendrite of Cone Cell
- --
- --
Cerebral Cortex
- -
+++
+ +
Cone Cell
+
①
Thalamus
EEG is thought to originate in the cone cells of cerebral cortex.
Stages of Sleep and EEG
• Stage 2: 10Hz spindle waves
• Stage 3: 2Hz slow waves (20~50%)
• Stage 4: 2Hz slow waves (over 50%)
Changes in EEG during Anesthesia
Awake/light anesthesia: low amplitude rapid wave
Low amplitude
1 sec
10Hz
Moderate anesthesia: high amplitude slow wave
High amplitude
1 sec
5Hz
BIS (EEG) Electrode during Anesthesia
BIS value
100
Sevoflurane Anesthesia and EEG
Awake
80
+50
Light anesthesia
低振幅速波
0
-50
+50
60
Moderate anesthesia
高振幅徐波
(α wave)
0
高振幅徐波
(δwave)
20
0
-50
Deep anesthesia
BIS = 60
4
(sec)
BIS = 40
4
(sec)
BIS=15
Burst & suppression
+50
0
4
(sec)
-50
+50
40
BIS = 80
Too deep anesthesia
Flat EEG
0
-50
BIS = 0
4
(sec)
Power Spectrum of EEG
2% sevoflurane anesthesia
+50
0
-50
4
(sec)
①
②
② 2Hz
Power spectrum of EEG
① 10Hz
EEG Power Spectra during
Sevoflurane Anesthesia
Sevoflurane 1.0%
BIS 61
Sevoflurane 1.5%
BIS 53
Sevoflurane 2.0%
BIS 46
2Hz
10Hz
EEG Power Spectra during Sevoflurane
Anesthesia in Infants and Adults
Infant
Adult
1.0%
1.5%
2.0%
2.5%
Concentration of sevoflurane (%)
3.0%
Sevoflurane Concentrations in Which an Amplitude
of the EEG’s 10Hz wave Reaches the Highest
P<0.05
2.3±0.3%
1.8±0.4%
Sevoflurane
(%)
Infant
Adult
Mechanism of General
Anesthesia
The effect of anesthesia is analogous to pulling
out plugs at the switchboard in the brain
• Unconsciousness is simply the result of
cognitive unbinding: a severing of
communication between the many brain
regions that cooperate in higher cognition
processing.
• If one imagines groups of neurons as forming
lines in a vast telephone network, the effect of
general anesthesia is analogous to pulling out
plugs at the switchboard.
Anesthetics
interacts with
multiple varieties
of specific proteins,
known as receptors,
on the surface of
neurons
Receptors and Anesthetics
• Anesthetics interacts with multiple varieties of
specific proteins, known as receptors, on the surface
of neuron cells.
• Families of receptors contain different versions
which tend to predominate in different areas of the
CNS. The presence of particular receptor subtypes
on only certain subpopulations of neurons will
determine which cells are influenced by an
anesthetic.
• Receptor variants are the targets of current
anesthetic drugs, understanding how the drugs
interact with the receptors to change the cell’s
function and how those cellular changes produce the
components of anesthesia.
GABA and GABAA Receptor
• GABA is an inhibitory neurotransmitter,
which has the ability to block neuronal
communication
• It helps to maintain overall balance in the
CNS by dampening neuron’ ability to
respond to excitatory messages from other
cells.
• GABAA receptor is thought to play a
central part in the actions of anesthetics
Orser BA, Sci Am, June:32-9,2007
GABAA receptor plays a central part
in the actions of anesthetics
• Anesthetics increases the function of
GABAA receptors by interacting at discrete
binding cavities or attaching to specific
amino acids in the receptors themselves.
• Anesthetics prolong the chloride ion
channel opening, which causes
hyperpolarization of the cell membrane.
• It extends the inhibitory effects of GABA
molecules bound to the receptor.
Anesthetics and GABA:Changing Charge
Orser BA, Sci Am, June:32-9,2007
Anesthetics bind the GABAA receptor and prolonging the channel
opening, which causes hyperpolarization of the cell membrane
GABAA Receptor
• GABAA receptor is a protein complex
composed of five subunit parts, which can be
mixed and matched in various combinations.
• At least 19 different GABAA receptor subunits
exists in mammals, and most of those have
variant subtypes.
• Most GABAA receptors are composed of 2
alpha subunits, 2 betas and 1 gamma.
GABAA Receptor’s Subunit
Composition
The GABAA receptor’s subunit
composition dramatically alters its
pharmacological properties: just one
subunit difference within a GABAA
receptor’s structure can determine
whether and how it will respond to a
particular anesthetic drug.
Anesthetics is Jamming Nervous
Transmission
• Anesthetics dampen neuronal
communication, in part, by enhancing the
effects of neurotransmitter GABA, a
signaling molecule that inhibits nerve cells
from firing.
• Current research is focused on how the
anesthetics interact with cellular GABAA
receptors to block neural activity.
神経受容体発現と電気生理学的測定
cDNA
プラスミドに組み込み
2電極電位固定
法
cDNA
pBluescript
大腸菌内で大
量に増殖
プラスミドを収穫
し,制限酵素で直
線化
24-48時間培養
Xenopus
oocyte
cDNA
プロモーター部
位より翻訳
アフリカツメガエ
ル卵へ注入
mRNA
Amino-acid Point Mutations in β2(N265S) Mice and
β3(N265M) Mice
Unconsciousness
Rudolph & Antkowiak: Nature Reviews Neuroscience 5: 709, 2004より引用
Behavioural Responses to Intravenous Anesthetics in
β3(N265M) Mice and β2(N265S) Mice
Rudolph & Antkowiak: Nature Reviews Neuroscience 5: 709, 2004より引用
Effects of Volatile Anesthetics on Ligand-gated Ion Channels
サブタイプ
Halothane
Isoflurane
Sevoflurane
Potentiation
Potentiation
Inhibition
α4
β2
Inhibition
Inhibition
Inhibition
α7
Inhibition
No effect
αβγδ
Little
inhibition
Little
inhibition
Little
inhibition
GABAA受容
体
Potentiation
Potentiation
Potentiation
NMDA受容
体
Inhibition
Inhibition
Inhibition
5-HT3受容体
nACh受容体
5-HT3A
神経
性
骨格
筋
Machu et al. J Pharmacol Exp Ther
1994
Jenkins et al. Br J Pharmacol 1996
Violet JM et al. Anesthesiology 1997
Flood P et al. Anesthesiology 1997
Jenkins A et al. Anesthesiology 1999
Hollmann MW et al. Anesth Analg
2001
Effects of Gaseous Anesthetics on Ligand-gated Ion Channels
サブタイプ
5-HT3受容体
5-HT3A
Xe
N2O
Inhibition
Inhibition
神経
nACh受容体 性
α 4β 2
Inhibition
Inhibition
α7
Inhibition
Inhibition
骨格
筋
αβγδ
GABAA受容
体
No effect
Potentiation
No effect
Potentiation
NMDA受容
体
Inhibition
Inhibition
Yamakura et al. Anesthesiology 2000
Suzuki et al. Anesth Analg 2003