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Brain. 2019 Feb 1;142(2):391-411. doi: 10.1093/brain/awy320.

The role of astrocytes in seizure generation: insights from a novel in vitro seizure model based on mitochondrial dysfunction.

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Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, UK.
Wellcome Centre for Mitochondrial Research, Newcastle University, Institute of Neuroscience, The Medical School, Framlington Place, Newcastle upon Tyne, UK.
Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Neural Pathways DPU, GSK, 11 Biopolis Way, Singapore.
Discipline of Physiology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland.


Approximately one-quarter of patients with mitochondrial disease experience epilepsy. Their epilepsy is often severe and resistant towards conventional antiepileptic drugs. Despite the severity of this epilepsy, there are currently no animal models available to provide a mechanistic understanding of mitochondrial epilepsy. We conducted neuropathological studies on patients with mitochondrial epilepsy and found the involvement of the astrocytic compartment. As a proof of concept, we developed a novel brain slice model of mitochondrial epilepsy by the application of an astrocytic-specific aconitase inhibitor, fluorocitrate, concomitant with mitochondrial respiratory inhibitors, rotenone and potassium cyanide. The model was robust and exhibited both face and predictive validity. We then used the model to assess the role that astrocytes play in seizure generation and demonstrated the involvement of the GABA-glutamate-glutamine cycle. Notably, glutamine appears to be an important intermediary molecule between the neuronal and astrocytic compartment in the regulation of GABAergic inhibitory tone. Finally, we found that a deficiency in glutamine synthetase is an important pathogenic process for seizure generation in both the brain slice model and the human neuropathological study. Our study describes the first model for mitochondrial epilepsy and provides a mechanistic insight into how astrocytes drive seizure generation in mitochondrial epilepsy.

[Available on 2020-02-01]

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