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Excitotoxicity
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<h2 id="history">History</h2> <p>The harmful effects of glutamate on the <a href="/facts/Central_nervous_system/k8I6To97">central nervous system</a> were first observed in 1954 by T. Hayashi, a Japanese scientist who stated that direct application of glutamate caused <a href="/facts/Seizure/zuIrQyze">seizure</a> activity,<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> though this report went unnoticed for several years. D. R. Lucas and J. P. Newhouse, after noting that "single doses of [20–30 grams of <a href="/facts/Monosodium_glutamate/cADzIYgU">sodium glutamate</a> in humans] have ... been administered intravenously without permanent ill-effects", observed in 1957 that a <a href="/facts/Subcutaneous_injection/L4srK61u">subcutaneous</a> dose described as "a little less than lethal", destroyed the neurons in the inner layers of the <a href="/facts/Retina/v0ISNX2S">retina</a> in newborn <a href="/facts/Mouse/6m1X7m0g">mice</a>.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> In 1969, <a href="/facts/John_Olney/QVcFcgxN">John Olney</a> discovered that the phenomenon was not restricted to the retina, but occurred throughout the <a href="/facts/Brain/Xo5ABfXl">brain</a>, and coined the term excitotoxicity. He also assessed that <a href="/facts/Cell_death/UYCzvewT">cell death</a> was restricted to <a href="/facts/Postsynaptic/M1x5rhz7">postsynaptic</a> neurons, that glutamate <a href="/facts/Agonist/nz8U5NNp">agonists</a> were as <a href="/facts/Neurotoxicity/FrgTICfX">neurotoxic</a> as their efficiency to activate glutamate receptors, and that glutamate <a href="/facts/Receptor_antagonist/PuXHVNdV">antagonists</a> could stop the neurotoxicity.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p><p>In 2002, <a href="/facts/Hilmar_Bading/AKR2uPof">Hilmar Bading</a> and co-workers found that excitotoxicity is caused by the activation of <a href="/facts/NMDA_receptor/BqMhXEbU">NMDA receptors</a> located outside synaptic contacts.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> The molecular basis for toxic <a href="/facts/Extrasynaptic_NMDA_receptor/KqKDd42V">extrasynaptic NMDA receptor</a> signaling was uncovered in 2020 when Hilmar Bading and co-workers described a death signaling complex that consists of <a href="/facts/Extrasynaptic_NMDA_receptor/KqKDd42V">extrasynaptic NMDA receptor</a> and <a href="/facts/TRPM4/05f6euWt">TRPM4</a>.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> Disruption of this complex using NMDAR/TRPM4 interface inhibitors (also known as 'interface inhibitors‘) renders <a href="/facts/Extrasynaptic_NMDA_receptor/KqKDd42V">extrasynaptic NMDA receptor</a> non-toxic. </p> <h2 id="pathophysiology">Pathophysiology</h2> <p>Excitotoxicity can occur from substances produced within the body (<a href="/facts/Endogenous/DFkSLkRI">endogenous</a> excitotoxins). Glutamate is a prime example of an excitotoxin in the brain, and it is also the major excitatory neurotransmitter in the central nervous system of mammals.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> During normal conditions, glutamate <a href="/facts/Concentration/wqBmz5od">concentration</a> can be increased up to 1<a href="/facts/Molar_concentration/P2WL5b9q">mM</a> in the <a href="/facts/Synaptic_cleft/M1x5rhz7">synaptic cleft</a>, which is rapidly decreased in the lapse of milliseconds.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> When the glutamate concentration around the synaptic cleft cannot be decreased or reaches higher levels, the neuron kills itself by a process called <a href="/facts/Apoptosis/8dVzSm4y">apoptosis</a>.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> </p><p>This pathologic phenomenon can also occur after <a href="/facts/Acquired_brain_injury/e35vWnYY">brain injury</a> and <a href="/facts/Spinal_cord_injury/D0vo3ArR">spinal cord injury</a>. Within minutes after spinal cord injury, damaged neural cells within the lesion site spill glutamate into the extracellular space where glutamate can stimulate presynaptic glutamate receptors to enhance the release of additional glutamate.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> <a href="/facts/Traumatic_brain_injury/DTq110vw">Brain trauma</a> or <a href="/facts/Stroke/DwpjdzY0">stroke</a> can cause <a href="/facts/Ischemia/ySL9xbCl">ischemia</a>, in which <a href="/facts/Blood/03zEulkj">blood</a> flow is reduced to inadequate levels. Ischemia is followed by accumulation of glutamate and <a href="/facts/Aspartate/9DFSFPa1">aspartate</a> in the <a href="/facts/Extracellular_fluid/hzm4qatP">extracellular fluid</a>, causing cell death, which is aggravated by lack of <a href="/facts/Oxygen/acyn6o8r">oxygen</a> and <a href="/facts/Glucose/oUSkoLCD">glucose</a>. The <a href="/facts/Biochemical_cascade/bCsA7XXG">biochemical cascade</a> resulting from ischemia and involving excitotoxicity is called the <a href="/facts/Ischemic_cascade/Ql1Tpjx6">ischemic cascade</a>. Because of the events resulting from ischemia and glutamate receptor activation, a deep <a href="/facts/Induced_coma/hWpqTe5P">chemical coma</a> may be induced in patients with brain injury to reduce the metabolic rate of the brain (its need for oxygen and glucose) and save energy to be used to remove glutamate <a href="/facts/Active_transport/7EAcsfb2">actively</a>. (The main aim in induced comas is to reduce the <a href="/facts/Intracranial_pressure/GVyhAWpH">intracranial pressure</a>, not brain <a href="/facts/Metabolism/WxDrm8k5">metabolism</a>). </p><p>Increased extracellular glutamate levels leads to the activation of Ca2+ permeable NMDA receptors on myelin sheaths and <a href="/facts/Oligodendrocytes/vjyKr3w2">oligodendrocytes</a>, leaving oligodendrocytes susceptible to Ca2+ influxes and subsequent excitotoxicity.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> One of the damaging results of excess calcium in the cytosol is initiating apoptosis through cleaved <a href="/facts/Caspase/YPl75Q9B">caspase</a> processing.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> Another damaging result of excess calcium in the cytosol is the opening of the <a href="/facts/Mitochondrial_permeability_transition/6Mhf8lxR">mitochondrial permeability transition</a> pore, a pore in the membranes of <a href="/facts/Mitochondria/ErHqrdJ1">mitochondria</a> that opens when the organelles absorb too much calcium. Opening of the pore may cause mitochondria to swell and release <a href="/facts/Reactive_oxygen_species/GpwSRugH">reactive oxygen species</a> and other proteins that can lead to <a href="/facts/Apoptosis/8dVzSm4y">apoptosis</a>. The pore can also cause mitochondria to release more calcium. In addition, production of <a href="/facts/Adenosine_triphosphate/nB9bwgcU">adenosine triphosphate</a> (ATP) may be stopped, and <a href="/facts/ATP_synthase/5NBMxsVX">ATP synthase</a> may in fact begin <a href="/facts/Hydrolysis/JTvwIHPs">hydrolysing</a> ATP instead of producing it,<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> which is suggested to be involved in depression.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> </p><p>Inadequate <a href="/facts/Adenosine_triphosphate/nB9bwgcU">ATP</a> production resulting from brain trauma can eliminate <a href="/facts/Electrochemical_gradient/IEfjjoIL">electrochemical gradients</a> of certain ions. <a href="/facts/Glutamate_transporter/XDN1nTIS">Glutamate transporters</a> require the maintenance of these ion gradients to remove glutamate from the extracellular space. The loss of ion gradients results in not only the halting of glutamate uptake, but also in the reversal of the transporters. The Na+-glutamate transporters on neurons and astrocytes can reverse their glutamate transport and start secreting glutamate at a concentration capable of inducing excitotoxicity.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> This results in a buildup of glutamate and further damaging activation of glutamate receptors.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> </p><p>On the <a href="/facts/Molecular_biology/YgqU35ub">molecular</a> level, calcium influx is not the only factor responsible for apoptosis induced by excitoxicity. Recently,<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> it has been noted that extrasynaptic NMDA receptor activation, triggered by both glutamate exposure or hypoxic/ischemic conditions, activate a <a href="/facts/CREB/ug1kE9j0">CREB</a> (<a href="/facts/Cyclic_adenosine_monophosphate/flK2vwUe">cAMP</a> response element binding) <a href="/facts/Protein/Jxmagu3E">protein</a> shut-off, which in turn caused loss of <a href="/facts/Mitochondrial_membrane/ErHqrdJ1">mitochondrial membrane</a> potential and apoptosis. On the other hand, activation of synaptic NMDA receptors activated only the CREB <a href="/facts/Metabolic_pathway/8Py8HKJd">pathway</a>, which activates <a href="/facts/BDNF/1v80e05e">BDNF</a> (brain-derived neurotrophic factor), not activating apoptosis.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a><a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> </p> <h3>Exogenous excitotoxins</h3> <p>Exogenous excitotoxins refer to neurotoxins that also act at postsynaptic cells but are not normally found in the body. These toxins may enter the body of an organism from the environment through wounds, food intake, aerial dispersion etc.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> Common excitotoxins include glutamate analogs that mimic the action of glutamate at glutamate receptors, including AMPA and NMDA receptors.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> </p> <h3>BMAA</h3> <p>The L-alanine derivative β-methylamino-L-alanine (<a href="/facts/BMAA/nGtyYbPz">BMAA</a>) has long been identified as a <a href="/facts/Neurotoxin/I7nLuFE7">neurotoxin</a> which was first associated with the <a href="/facts/Amyotrophic_lateral_sclerosis/9fIXnNL4">amyotrophic lateral sclerosis</a>/<a href="/facts/Parkinsonism/orfkyX69">parkinsonism</a>–<a href="/facts/Dementia/T0MRDE9I">dementia</a> complex (<a href="/facts/Lytico-bodig_disease/QvKP0w0p">Lytico-bodig disease</a>) in the <a href="/facts/Chamorro_people/oK5e6awJ">Chamorro people</a> of Guam.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> The widespread occurrence of BMAA can be attributed to <a href="/facts/Cyanobacteria/S8bKxIU9">cyanobacteria</a> which produce BMAA as a result of complex reactions under nitrogen stress.<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> Following research, excitotoxicity appears to be the likely mode of action for BMAA which acts as a <a href="/facts/Glutamate/7oXbNcvu">glutamate</a> agonist, activating <a href="/facts/AMPA/jeQWeMVw">AMPA</a> and <a href="/facts/NMDA/7jnfxMBU">NMDA</a> receptors and causing damage to cells even at relatively low concentrations of 10 μM.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> The subsequent uncontrolled influx of Ca2+ then leads to the pathophysiology described above. Further evidence of the role of BMAA as an excitotoxin is rooted in the ability of NMDA antagonists like MK801 to block the action of BMAA.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> More recently, evidence has been found that BMAA is misincorporated in place of L-serine in human proteins.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> A considerable portion of the research relating to the toxicity of BMAA has been conducted on <a href="/facts/Rodents/mT4m8QJq">rodents</a>. A study published in 2016 with vervets (Chlorocebus sabaeus) in St. Kitts, which are homozygous for the apoE4 (APOE-ε4) allele (a condition which in humans is a risk factor for Alzheimer's disease), found that vervets orally administered BMAA developed hallmark histopathology features of Alzheimer's Disease including amyloid beta plaques and neurofibrillary tangle accumulation. Vervets in the trial fed smaller doses of BMAA were found to have correlative decreases in these pathology features. This study demonstrates that BMAA, an environmental toxin, can trigger neurodegenerative disease as a result of a gene/environment interaction.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> While BMAA has been detected in brain tissue of deceased ALS/PDC patients, further insight is required to trace neurodegenerative pathology in humans to BMAA. </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Glutamate_(neurotransmitter)/GRqBSJ1P">Glutamate_(neurotransmitter)</a></li> <li><a href="/facts/Glutamic_acid_(flavor)/337RzmDQ">Glutamic acid (flavor)</a></li> <li><a href="/facts/NMDA_receptor_antagonist/4VJvEpdK">NMDA receptor antagonist</a></li> <li><a href="/facts/Dihydropyridine/32ycuVra">Dihydropyridine</a></li></ul> <h2 id="further-reading">Further reading</h2> <ul><li><a href="/facts/Eric_R._Kandel/GD1pRcNN">Kandel ER</a>, Schwartz JH, Jessel TM (2000). <a href="/facts/Principles_of_Neural_Science/EdX5C8tW"><i>Principles of Neural Science</i></a> (4th ed.). McGraw Hill. p. <a href="https://archive.org/details/isbn_9780838577011/page/928">928</a>.</li> <li><a href="/facts/Russell_Blaylock/M99WL5Ck">Blaylock RL</a> (1996). <i>Excitotoxins: The Taste That Kills</i>. Health Press. <a href="/facts/ISBN_(identifier)/15AdSPa9">ISBN</a> 0-929173-25-2.</li> <li>Lau A, Tymianski M (July 2010). "Glutamate receptors, neurotoxicity and neurodegeneration". <i>Pflügers Archiv</i>. 460 (2): 525–542. <a href="/facts/Doi_(identifier)/muM9Etpq">doi</a>:<a href="https://doi.org/10.1007%2Fs00424-010-0809-1">10.1007/s00424-010-0809-1</a>. <a href="/facts/PMID_(identifier)/JlHAvMHt">PMID</a> <a href="https://pubmed.ncbi.nlm.nih.gov/20229265">20229265</a>. <a href="/facts/S2CID_(identifier)/ldJsHa2Y">S2CID</a> <a href="https://api.semanticscholar.org/CorpusID:12421120">12421120</a>. Invited Review</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Jaiswal MK, Zech WD, Goos M, Leutbecher C, Ferri A, Zippelius A, et al. (June 2009). 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