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GABAergic cortical network physiology in frontotemporal lobar degeneration.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Hughes, Laura E 
Rouse, Matthew A 
Phillips, Holly N 
Shaw, Alexander D 

Abstract

The clinical syndromes caused by frontotemporal lobar degeneration are heterogeneous, including the behavioural variant frontotemporal dementia (bvFTD) and progressive supranuclear palsy. Although pathologically distinct, they share many behavioural, cognitive and physiological features, which may in part arise from common deficits of major neurotransmitters such as γ-aminobutyric acid (GABA). Here, we quantify the GABAergic impairment and its restoration with dynamic causal modelling of a double-blind placebo-controlled crossover pharmaco-magnetoencephalography study. We analysed 17 patients with bvFTD, 15 patients with progressive supranuclear palsy, and 20 healthy age- and gender-matched controls. In addition to neuropsychological assessment and structural MRI, participants undertook two magnetoencephalography sessions using a roving auditory oddball paradigm: once on placebo and once on 10 mg of the oral GABA reuptake inhibitor tiagabine. A subgroup underwent ultrahigh-field magnetic resonance spectroscopy measurement of GABA concentration, which was reduced among patients. We identified deficits in frontotemporal processing using conductance-based biophysical models of local and global neuronal networks. The clinical relevance of this physiological deficit is indicated by the correlation between top-down connectivity from frontal to temporal cortex and clinical measures of cognitive and behavioural change. A critical validation of the biophysical modelling approach was evidence from parametric empirical Bayes analysis that GABA levels in patients, measured by spectroscopy, were related to posterior estimates of patients' GABAergic synaptic connectivity. Further evidence for the role of GABA in frontotemporal lobar degeneration came from confirmation that the effects of tiagabine on local circuits depended not only on participant group, but also on individual baseline GABA levels. Specifically, the phasic inhibition of deep cortico-cortical pyramidal neurons following tiagabine, but not placebo, was a function of GABA concentration. The study provides proof-of-concept for the potential of dynamic causal modelling to elucidate mechanisms of human neurodegenerative disease, and explains the variation in response to candidate therapies among patients. The laminar- and neurotransmitter-specific features of the modelling framework, can be used to study other treatment approaches and disorders. In the context of frontotemporal lobar degeneration, we suggest that neurophysiological restoration in selected patients, by targeting neurotransmitter deficits, could be used to bridge between clinical and preclinical models of disease, and inform the personalized selection of drugs and stratification of patients for future clinical trials.

Description

Keywords

GABA, conductance-based modelling, dynamic causal modelling, frontotemporal dementia, progressive supranuclear palsy, Aged, Cerebral Cortex, Cross-Over Studies, Double-Blind Method, Female, Frontotemporal Dementia, GABA Uptake Inhibitors, Humans, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Magnetoencephalography, Male, Models, Neurological, Nerve Net, Supranuclear Palsy, Progressive, Synaptic Transmission, Tiagabine, gamma-Aminobutyric Acid

Journal Title

Brain

Conference Name

Journal ISSN

0006-8950
1460-2156

Volume Title

144

Publisher

Oxford University Press (OUP)
Sponsorship
Wellcome Trust (103838/Z/14/Z)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
MRC (unknown)
Medical Research Council (MC_U105597119)
Medical Research Council (MC_UU_00005/12)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (MR/M008983/1)
Medical Research Council (MR/M009041/1)