High-Dose Benzodiazepines Positively Modulate GABA<sub>A</sub> Receptors via a Flumazenil-Insensitive Mechanism

oleh: Na Wang, Jingjing Lian, Yanqing Cao, Alai Muheyati, Shanshan Yuan, Yujie Ma, Shuzhuo Zhang, Gang Yu, Ruibin Su

Format: Article
Diterbitkan: MDPI AG 2021-12-01

Deskripsi

Benzodiazepines (BZDs) produce versatile pharmacological actions through positive modulation of GABA<sub>A</sub> receptors (GABA<sub>A</sub>Rs). A previous study has demonstrated that high concentrations of diazepam potentiate GABA currents on the α<sub>1</sub>β<sub>2</sub>γ<sub>2</sub> and α<sub>1</sub>β<sub>2</sub> GABA<sub>A</sub>Rs in a flumazenil-insensitive manner. In this study, the high-concentration effects of BZDs and their sensitivity to flumazenil were determined on synaptic (α<sub>1</sub>β<sub>2</sub>γ<sub>2</sub>, α<sub>2</sub>β<sub>2</sub>γ<sub>2</sub>, α<sub>5</sub>β<sub>2</sub>γ<sub>2</sub>) and extra-synaptic (α<sub>4</sub>β<sub>2</sub>δ) GABA<sub>A</sub>Rs using the voltage-clamp electrophysiology technique. The in vivo evaluation of flumazenil-insensitive BZD effects was conducted in mice via the loss of righting reflex (LORR) test. Diazepam induced biphasic potentiation on the α<sub>1</sub>β<sub>2</sub>γ<sub>2</sub>, α<sub>2</sub>β<sub>2</sub>γ<sub>2</sub> and α<sub>5</sub>β<sub>2</sub>γ<sub>2</sub> GABA<sub>A</sub>Rs, but did not affect the α<sub>4</sub>β<sub>2</sub>δ receptor. In contrast to the nanomolar component of potentiation, the second potentiation elicited by micromolar diazepam was insensitive to flumazenil. Midazolam, clonazepam, and lorazepam at 200 µM exhibited similar flumazenil-insensitive effects on the α<sub>1</sub>β<sub>2</sub>γ<sub>2</sub>, α<sub>2</sub>β<sub>2</sub>γ<sub>2</sub> and α<sub>5</sub>β<sub>2</sub>γ<sub>2</sub> receptors, whereas the potentiation induced by 200 µM zolpidem or triazolam was abolished by flumazenil. Both the GABA<sub>A</sub>R antagonist pentylenetetrazol and Fa173, a proposed transmembrane site antagonist, abolished the potentiation induced by 200 µM diazepam. Consistent with the in vitro results, flumazenil antagonized the zolpidem-induced LORR, but not that induced by diazepam or midazolam. Pentylenetetrazol and Fa173 antagonized the diazepam-induced LORR. These findings support the existence of non-classical BZD binding sites on certain GABA<sub>A</sub>R subtypes and indicate that the flumazenil-insensitive effects depend on the chemical structures of BZD ligands.