ACTAUNIVERSITATIS

UPSALIENSISUPPSALA

2016

Digital Comprehensive Summaries of Uppsala Dissertationsfrom the Faculty of Medicine 1209

GABA signaling regulation byGLP-1 receptor agonists andGABA-A receptors modulator

OMAR M. BABATEEN

ISSN 1651-6206ISBN 978-91-554-9548-0urn:nbn:se:uu:diva-282431

Dissertation presented at Uppsala University to be publicly examined in C2:301, BMC,Husargatan 3, 751 24, Uppsala, Tuesday, 31 May 2016 at 09:15 for the degree of Doctor ofPhilosophy (Faculty of Medicine). The examination will be conducted in English. Facultyexaminer: Professor Lena Eliasson (Department of Clinical Sciences, Lund university,Diabetic Center, Malmö).

AbstractBabateen, O. M. 2016. GABA signaling regulation by GLP-1 receptor agonists and GABA-A receptors modulator. Digital Comprehensive Summaries of Uppsala Dissertationsfrom the Faculty of Medicine 1209. 51 pp. Uppsala: Acta Universitatis Upsaliensis.ISBN 978-91-554-9548-0.

GABA (γ-aminobutyric acid) is the main neuroinhibitory transmitter in mammalian brains. Itbinds to GABA-A and GABA-B receptors. The GABA-A receptors are ligand-gated chloridechannels. A variety of GABA-A receptor agonists and antagonists have been developed tostudy the GABA-mediated inhibition and to explore new medications. In this thesis I haveexamined the role of GABA in brain tumors and the effects of the metabolic hormone GLP-1on GABAergic signaling in neurons.

I studied if GABA-A receptors subunits were expressed and formed functional ion channelsin the glioblastoma cell line U3047MG. I identified the mRNA of 11, α2, α3, α5, β1, β2, β3, δ,γ3, π, θ and ρ2, out of the 19 known GABA-A subunits. Immunostaining demonstrated abundantexpression of the α3 and β3 subunits. Interestingly, whole-cell GABA-activated currents wererecorded in only 12% of the cells. The GABA-activated currents half-maximal concentration(EC50) was 36 µM. The currents were modulated by diazepam (1 µM) and the general anestheticspropofol (50 µM) and etomidate (EC50 = 50 nM).

GLP-1 and exendin-4 transiently enhanced the GABA-A receptor-mediated currents in CA3neurons of the rat hippocampus. The tonic and the spontaneous inhibitory postsynaptic currentsincreased as compared to control in a concentration dependent manner. The increase was relatedto enhanced release of GABA from the presynaptic terminals and increased insertion or affinityof GABA-A receptors in the CA3 postsynaptic neuron. In contrast to GLP-1 and exendin-4,liraglutide enhanced the currents only in a subset of the neurons and the effect was mainlymediated by presynaptic mechanisms.

In conclusion, GABA signaling in neurons is modified by the metabolic hormone GLP-1 andits mimetics highlighting the important cross-talk that takes place between the brain and otherorgans. Medicines modifying GABA signaling in the brain may be important for a number ofdiseases.

Omar M. Babateen, Department of Neuroscience, Physiology, Box 593, Uppsala University,SE-75123 Uppsala, Sweden.

© Omar M. Babateen 2016

ISSN 1651-6206ISBN 978-91-554-9548-0urn:nbn:se:uu:diva-282431 (http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-282431)

علوم الغرب منبعھا وحاضرھا في ماضينا تغـــــربنا لننقـــلھا لتسكن في اراضينا

محمد عمر بابطين.د

وراء كل انجاز عظيم اشخاص عظماء

ابي امي زوجتي و بناتي ما كان لھذا الجھد ان يتكلل بالنجاح بعد توفيق رب العباد لوال وقفتكم و دعمكم

انتم صناعه الحقيقيون

Cover page is drawn by my daughters Jawan babateen and Leen babateen

List of Papers

This thesis is based on the following papers, which are referred to in the text by their Roman numerals:

I Babateen, O., Jin, Z., Bhandage, A., Korol, SV., Westermark, B., Forsberg Nilsson K, Uhrbom L, Smits A, Birnir B. (2015) Etomidate, propofol and diazepam potentiate GABA-evoked GABAA currents in a cell line derived from human glioblastoma. Eur J Pharmacol, 748:101-107.

II Korol SV, Jin Z, Babateen O, Birnir B. (2015) GLP-1 and exendin-4 transiently enhance GABAA receptor-mediated synaptic and tonic currents in rat hippocampal CA3 pyramidal neurons. Diabetes, 64(1):79-89.

III Babateen, O, Korol, SV, Jin, Z, Bhandage, A, Birnir B. Liraglutide differentially modulates GABAergic signaling in rat CA3 pyramidal neurons. (Manuscript).

Reprints were made with permission from the respective publishers.

Contents

Introduction ................................................................................................... 11 1. Transmission of signals in the brain ..................................................... 11 2. The neurotransmitter γ-aminobutyric acid (GABA) ............................ 12 3. GABA receptors ................................................................................... 13 

3.1. GABA-A receptors ....................................................................... 14 3.2. GABA-B receptors ....................................................................... 14 

4. The GABA-A receptor structure .......................................................... 14 5. Distribution of GABA-A receptors in CNS ......................................... 15 6. Modes of GABA-A receptors activated currents ................................. 16 7. The extrasynaptic GABA-A receptor composition .............................. 17 8. Pharmacology of GABA-A receptors .................................................. 18 

8.1. The GABA binding site ................................................................ 18 8.2. Benzodiazepines ........................................................................... 19 8.3. Propofol and etomidate ................................................................. 20 

9. GABA-A receptor trafficking and phosphorylation ............................. 20 9.1. GABA-A receptor trafficking and insertion ................................. 20 9.2. GABA-A receptor phosphorylation .............................................. 21 

10. Glial cells and gliomas ....................................................................... 21 11. The hippocampus ............................................................................... 23 12. Glucagon like peptide-1 and its analogue exendin-4 ......................... 24 13. GABA and GABA-A receptors in glia and glioblastoma .................. 28 

Aims of the thesis.......................................................................................... 30 

Experimental strategy ................................................................................... 31 1. Human glioma cell line ........................................................................ 31 2. Quantitative PCR .................................................................................. 31 3. Immunocytochemistry .......................................................................... 32 4. Hippocampal slice preparation ............................................................. 32 5. Patch clamp electrophysiology ............................................................. 32 

Results and discussion .................................................................................. 35 Study I ...................................................................................................... 35 Study 2 ..................................................................................................... 36 Study 3 ..................................................................................................... 37 

Conclusions ................................................................................................... 38 

Acknowledgements ....................................................................................... 39 

References ..................................................................................................... 41 

Abbreviations

SSADH Succinic semialdehyde dehydrogenase

BBB Blood-brain barrier

BZ Benzodiazepines

CA1 Cornu Ammonis, region 1

CNS Central nervous system

CSF Cerebrospinal fluid

CT Cycle Threshold

GABA Gamma-aminobutyric acid

GABA-A Gamma-aminobutyric acid receptor type A

GABA-B Gamma-aminobutyric acid receptor type B

GABARAP Gamma-aminobutyric acid receptor-associated

protein

GABA-T 4-aminobutyrate aminotransferase

GAD Glutamate decarboxylase

GAD 65/67 Glutamate decarboxylase 65/67

GAT 1-4 GABA transporter 1-4

IPSC Inhibitory Postsynaptic Currents

PCR Polymerase Chain Reaction

GBM Glioblastoma

PKA Protein Kinase A

PKC Protein Kinase C

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Introduction

1. Transmission of signals in the brain The brain of humans is known to be a very complex organ that works by receiving information, integrates and modulates it and forms the appropriate commands needed. Brain performs all these tasks by neurons that are the major players and the most important component of the nervous system. The neuron is a nerve cell that is an electrically excitable cell with three major cell compartments: the cell body (soma), the axon, and the dendrites (Fig.1). Neurons receive and transmit information using electrical and chemical sig-nals. Synaptic transmission is the process used for communication and send-ing signals from one neuron to another. Signals are received by the dendrites and soma then they are transferred to axon hillock where there will be a summation of signals in the cells. When the depolarization is large enough it will evoke an action potential. Then the action potential travels from axon hillock to the axon terminal where synaptic transmission allows the signal to transfer to other neurons (Fig.1). What will happen is that the action-

Figure 1. Signal transmission through neurons

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-potential reaches the presynaptic terminal, the depolarization of the presyn-aptic membrane will activate the voltage-gated calcium channels causing intracellular rise in calcium and resulting in the release of the neurotransmit-ter into the synaptic cleft (Barnett & Larkman 2007).

Neurons are not the only cells in the brain, there are also other cells called glial cells. The number of glial cells is many folds higher than the number of neurons, however recent studies claim that the ratio may be close to 1:1 but vary somewhat from one region to another (Azevedo et al. 2009, Rasband 2016). Some of glial cells are specifically present in the central nervous sys-tem while others can be found in the peripheral nervous system (Rasband 2016). Glial cells in the brain are divided into different subclasses which allow them to mediate diverse functions starting from their important role in maintaining the extracellular environment, modulating synaptic transmis-sion, participating in blood-brain barrier formation, to the formation of the myelin sheath. Microglia are known to work as the resident immune cells in the brain (Jessen & Mirsky 1980, Torres et al. 2012).

2. The neurotransmitter γ-aminobutyric acid (GABA) The mammalian adult central nervous system (CNS) uses the major inhibito-ry neurotransmitter GABA as a counterpart to the excitatory glutamate sig-naling system. The formation of GABA (Fig.2) begins by the transamination of α - ketogutarate to glutamate with the help of the enzyme 4-aminobutyrate aminotransferase (GABA-T). Then glutamate is decarboxylated to form GABA by the enzyme glutamate decarboxylase (GAD). In mammals GAD has two isoforms GAD67 and GAD65. At the nerve terminals GAD65 has an association with synaptic vesicles which could mean that it is responsible for synthesizing GABA for the purpose of neurotransmission while GAD67 are known to be expressed throughout the neuronal cells (Pinal & Tobin 1998). GABA is further catabolized by GABA-T to form succinate semialdehyde. Succininc acid is the final result of the conversion of succinic semialdehyde by the enzyme succinic semialdehyde dehydrogenase (SSADH). The whole pathway is called the GABA shunt (Erlander & Tobin 1991).

Glial cells also have the capability to release GABA in a calcium-independent but sodium-dependent mechanism via the reverse transport of the GABA transporter or via the opening of an anion channel bestrophin 1 (best1) (Attwell et al. 1993, Clark et al. 1992) (Lee et al. 2010).

GABA will not stay for long time in the synaptic cleft and it will be re-moved immediately, in a matter of milliseconds, by the action of GABA transporters (GAT1-4) which are Na+ dependent co-transporters. GABA transporters are located on the presynaptic terminals and also in the glial

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cells. By removing GABA from the synaptic cleft the synaptic transmission will be terminated (Glykys & Mody 2007).

Figure 2. The diagram of the GABA shunt. GAD, glutamate decarboxylase; GABA-T, 4-aminobutyrate aminotransferase, SSADH, Succinic semialdehyde dehydrogen-ase.

The GABA that has been taken up into the presynaptic terminal will then be repacked and used again. The story is different when it comes to glial cells. In glial cells GABA is metabolized by GABA-T into succinic semialdehyde which will finally transfer it to neuron in the form of glutamine (Gether et al. 2006).

3. GABA receptors GABA receptors have two main subtypes: GABA-A and GABA-B receptors based on their amino acid sequence and structure. The GABA-A receptors are ionotropic receptors while the GABA-B receptors are metabotropic G-protein coupled receptors.

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3.1. GABA-A receptors GABA-A receptors are ion channels opened when GABA or its selective agonist muscimol binds to the receptor. In contrast, when the competitive antagonists bicuculline or SR-95531 (gabazine) binds to the GABA-A recep-tors, the GABA-evoked current is decreased. GABA-A receptors are blocked with picrotoxin, a non-competitive blocker, that blocks the GABA-A recep-tor pore. Benzodiazepines and barbiturates are positive allosteric modulators of GABA-A receptors and can enhance the currents of these channels (Macdonald & Olsen 1994, Olsen & Sieghart 2008, Olsen & Sieghart 2009). To date, 19 GABA-A receptor subunits have been identified: α 1-6, β 1-3, γ1-3, δ, ε, θ, and ρ 1-3. (Olsen & Sieghart 2009).

3.2. GABA-B receptors GABA-B receptors are G-protein coupled receptors and are activated by GABA or baclofen, a known GABA-B selective agonist. Their neuronal responses are dependent on their coupling to different intracellular cascades. GABA-B receptors that are present at the presynaptic membrane work to inhibit voltage-activated Ca2+ channels and decrease GABA, glutamate and other neurotransmitters release, while GABA-B receptors located at the post synaptic membrane stimulate inwardly rectifier potassium channels and hy-perpolarize the neuron (Bowery et al. 2002, Chalifoux & Carter 2011, Gassmann & Bettler 2012). Strong stimulus is needed to activate GABA-B receptors in the brain slice (Jurado-Parras et al. 2016)

Functionally GABA-B receptors are composed of two subunits: GABA-B1 that has two isoforms GABA-B1a and GABA-B1b and the other subunit is GABA-B2. GABA-B1 with its both isoforms heterodimerizes with the second subunit GABA-B2 forming either GABA-B (1a,2) or GABA-B (1b,2) (Filip et al. 2014).

4. The GABA-A receptor structure Five out of the 19 known subunits co-assemble to form the GABA-A recep-tor. The receptor is usually composed of 2α, 2β plus one other subunit (Olsen & Sieghart 2009) (Fig.3).

Each subunit is composed of a large extracellular hydrophilic N-terminus, four transmembrane (TM) regions and short extracellular C-terminus. Be-tween TM3 and TM4 there is a large intracellular loop. This loop has the sites for phosphorylation and sequences that are responsible for the interac-tions with various intracellular proteins. The channel pore lining is shaped by the TM2.

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Figure 3. GABA-A receptor with the binding site for GABA and different drugs identified.

GABA-A receptors function and pharmacology can be affected by interac-tion between the intracellular domains with intracellular and transmembrane proteins (Birnir & Korpi 2007). Regarding the binding site of GABA, studies have shown that it is at the α/β subunits interface in the N-terminal domains (Korpi et al. 2002, Birnir & Korpi 2007, Althoff et al. 2014). The charge selectivity of GABA-A receptor is coming from the net positive charge at the intracellular mouth of the GABA-A receptors. An important residue is the arginine located at the 0` TM2 position and the arginine residue at the 19` TM2 position in the α, β1 and γ2 GABA-A subunits. (Keramidas et al. 2004, Kash et al. 2004).

5. Distribution of GABA-A receptors in CNS Many studies have been conducted to examine the GABA-A receptors subu-nits distribution in the central nervous system. These studies have shown that some GABA-A receptors subunits are expressed throughout the brain while others are tied to specific regions (Laurie et al. 1992, Pirker et al. 2000). Among all the GABA-A receptors subunits the α1 subunit is the most widely expressed and is present in all brain regions (Pirker et al. 2000) and it is co- expressed with β2 and γ2 (Wisden et al. 1992). The α5 subunit has higher expression in the hippocampal area and it is co-localized with β1 while cere-

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bellar granule cells highly express the α6 subunit (Laurie et al. 1992, Wisden et al. 1992). The γ3 subunit is also distributed throughout the brain but ex-pressed at low levels (Pirker et al. 2000). There are high expression levels of δ subunits in striatum, cortex, cerebellar granular cells, thalamus and dentate gyrus molecular layer (Pirker et al. 2000). The monoaminergic neurons express the θ and the ε subunits. These subunits are also expressed in the brainstem and in the hypothalamus but as low levels in rats (Sinkkonen et al. 2000). The subunits are expressed in different grades of gliomas (Smits et al. 2012). The most abundant GABA-A receptors subunits composition in the brain is α1β2γ2 (Olsen & Sieghart 2008, Olsen & Sieghart 2009).

6. Modes of GABA-A receptors activated currents GABA-mediated phasic and tonic inhibition are two types of GABA signal-ing in the brain. The location of GABA-A receptors at the synapse or outside the synapse determines the phasic and the tonic inhibition, respectively. The phasic inhibition is mainly mediated by the low affinity GABA-A receptors located at the synapse, whereas the tonic inhibition is mediated by the high affinity GABA-A receptors located extrasynaptically (Semyanov et al. 2004, Birnir & Korpi 2007, Halonen et al. 2009, Glykys & Mody 2007) (Fig.4).

Activation of GABA-A receptors leads to flow of chloride ions through the open channel. On the post synaptic site GABA-A receptors are activated by the release of high concentration (mM) of GABA from the presyntaptic terminal, which will finally lead to the influx or outflux of anions. Inhibitory postsynaptic potentials (IPSPs) are the results of postsynaptic membrane hyperpolarization (Semyanov et al. 2004). It is extremely important to re-move GABA rapidly from the synaptic cleft (Gether et al. 2006) as high concentration of GABA will lead to fast desensitization of the GABA-A receptors (Semyanov et al. 2004). The removal of GABA is achieved by co-transporters, GAT1-4, that are located on glial cells and presynaptic mem-brane and transport GABA from the synaptic cleft (Gether et al. 2006). By means of transient activation of the GABA-A receptors, the phasic inhibition occurs within milliseconds (Birnir & Korpi 2007, Glykys & Mody 2007, Brickley & Mody 2012) and can rapidly change the excitability of neural networks.

The extrasynaptic channels have high affinity for GABA and can be acti-vated by low, ambient GABA concentrations (sub-µM). These receptors generate the tonic inhibition (Glykys & Mody 2007, Lindquist & Birnir 2006, Jin et al. 2011). The activation of the extrasynaptic channels generates persistent tonic conduction, in contrast to the fast transient synaptic currents. (Birnir & Korpi 2007, Glykys & Mody 2007, Brickley & Mody 2012). The basal excitability of neuronal networks is modulated by the tonic current (Pavlov et al. 2009). The extrasynaptic GABA-A receptors are important for

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studying a wide range of neurological diseases as they are the site for bind-ing of many clinically relevant drugs (Semyanov et al. 2004, Birnir & Korpi 2007, Jin et al. 2011).

The maintenance of the extracellular GABA concentration can potential-ly take place by several mechanisms: 1) astrocyte GABA release (Héja 2014, Liu et al. 2000), 2) GABA diffusion or spill-over from the synapse (Semyanov et al. 2003, de Groote & Linthorst 2007), 3) GABA transami-nase activity reduction (Han et al. 2014, Overstreet & Westbrook 2001), 4) vesicular release (Brickley & Mody 2012), 5) non-vesicular release (Lee et al. 2010) and finally by action of other biological molecules like stress hor-mones which also can influence the GABA release (Meyerhoff et al. 2014, de Groote & Linthorst 2007).

Figure 4. Inherent GABA-activated phasic and tonic currents in hippocampal CA3 pyramidal neuron in rat brain slices.

7. The extrasynaptic GABA-A receptor composition Any GABA-A receptor subunit can be present in the extrasynaptic mem-brane (Olsen & Sieghart 2009). Whether the receptor is activated or not depends on the GABA affinity of the GABA-A receptor subtypes and on the concentration of GABA. To date, α1, α4, α5, α6, γ2, δ or ε are the most common subunits of the extrasynaptic GABA-A receptor, in different CNS neurons, that can evoke tonic currents (Olsen & Sieghart 2009, Lindquist & Birnir 2006, Jin et al. 2011). It has been shown that in cerebellar granule cells tonic inhibition is generated by GABA-A receptors containing the α4, α6 and δ subunits while in hippocampal neurons, tonic inhibition is com-

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monly mediated by the receptors containing α1, α4, α5 with γ2 or δ subunits (Lindquist et al. 2003, Lindquist et al. 2004) (Semyanov et al. 2004, Lindquist et al. 2005, Stell et al. 2003, Nusser et al. 1998, Essrich et al. 1998, Jin et al. 2011)

The GABA-A receptors that contain the δ subunit have longer opening time than receptors containing other GABA-A subunits and a slow rate of desensitization (Saxena & Macdonald 1994). These channels have high sen-sitivity to endogenous neurosteroids (Lambert et al. 2009). In the CA1 part of the hippocampus, the tonic current is mainly generated by the GABA-A receptors containing the α5βγ2 subunits (Jin et al. 2011, Caraiscos et al. 2004). Our group has shown that in CA1 part of hippocampus insulin can induce high-affinity extrasynaptic GABA-A receptors (Jin et al. 2011). In single-channel studies, the GABA-A receptors containing α1βγ2 or α4βγ2 subunits are responsible for mediating tonic currents in the dentate gyrus area of the rat hippocampus (Lindquist & Birnir 2006). In addition, in the dentate gyrus area , other studies have shown that the tonic current can be mediated by α4βδ subunits containing GABA-A receptors (Stell et al. 2003). Many drugs used in the clinic target the extrasynaptic GABA-A receptors such as the anesthetic drugs, benzodiazepine sleeping pills and neurosteroids.

8. Pharmacology of GABA-A receptors Drugs targeting GABA-A receptors have been used in clinics as treatments for many CNS diseases such as seizures and anxiety. Those drugs work to enhance the activity of GABA-activated neuronal inhibition. Benzodiaze-pines, barbiturate, etomidate and many anesthetic drugs are currently used by clinicians and also as experimental tools to study the composition of GABA-A receptors subunits and the receptors functions in neurophysiology.

8.1. The GABA binding site It has been shown that there are two binding sites for GABA located at the α/β subunits interface (Olsen & Sieghart 2009, Kash et al. 2004). GABA-A receptors are also activated by muscimol that is a selective agonist of GABA and 4, 5, 6, 7-tetrahydroisoxazolo-pyridin-3-o1 (THIP). Both muscimol and THIP bind at the GABA binding site on the receptor (Olsen & Sieghart 2009, Drasbek & Jensen 2006). Bicuculline and SR-95531 (gabazine) are competitively antagonize GABA at GABA-A receptors (Olsen & Sieghart 2009, Li et al. 2014). Picrotoxin is a non-competitive antagonist at GABA-A receptors and blocks the open GABA-A channel (Sedelnikova et al. 2006, Yoon et al. 1993). In this thesis we used GABA, GABA-A agonists and antagonists to study GABA-A channels activity.

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8.2. Benzodiazepines Benzodiazepines act by binding to GABA-A receptor at α/γ subunit inter-face (Middendorp et al. 2014). It requires the existence of either γ2 or γ3 in the receptor complex (Middendorp et al. 2014, May et al. 2013). Benzodiaz-epines enhance the GABA effect on GABA-A receptors by increasing the channel opening frequency, increase conductance and mean open time of the channel (Eghbali et al. 1997, Fritschy & Mohler 1995). The effect of benzo-diazepines on GABA-A receptors requires the presence of GABA (Rudolph & Knoflach 2011). The chloride conductance does not increase if the con-centration of GABA is saturating (Eghbali et al. 1997). To study the phar-macological characteristic of GABA-A receptors, genetic approaches have been used. To date, point mutation studies have given valuable information about GABA-A receptors function and pharmacology. It has been shown that the α1 subunit containing receptors mediate sedation and hypnotic ac-tions, α2 containing receptors mediate anxiolytic action while α5 subunit containing receptors modulate memory and learning (Wingrove et al. 1997, Rudolph et al. 2001, Rudolph & Knoflach 2011, Dias et al. 2005, Rudolph & Möhler 2006, May et al. 2013). Although, flumazenil works as a competi-tive antagonist of benzodiazepines it generally has no effect on the receptor function (Nutt et al. 1990, Jin et al. 2011). Clinicians use flumazenil as a treatment for diazepam overdose since it reverses the action of benzodiaze-pines (Veiraiah et al. 2012).

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8.3. Propofol and etomidate Propofol belongs to another class of drugs that are used for anesthesia. It is the most widely used intravenous general anesthetic (Yip et al. 2013, Wang et al. 2004). It works positively to modulate the GABA-A receptors and enhance the effect of GABA on these receptors (Yip et al. 2013, Krasowski et al. 1998). Many studies have been done to identify the exact binding site of propofol but it is still debated (Yip et al. 2013). However, there is an agreement that the β subunit is required for forming part of the binding site for propofol (Yip et al. 2013).

Etomidate is another type of drugs that is used to induce anesthesia and sedation (Guo et al. 2014). Etomidate can also work as a modulator of GABA-A receptors and it enhances the effects of GABA-A receptors (Feng et al. 2014). GABA-A receptors made by α1β2/3γ2 or α4β3δ subunits can be modulated with etomidate (Chiara et al. 2012, Li et al. 2006, Feng et al. 2014, Brown et al. 2002, Meera et al. 2009, Ranna et al. 2006, Belelli et al. 1997, Hill-Venning et al. 1997). Studies show the memory blockade effect of etomidate through GABA-A receptor subunit α5 (Martin et al. 2009, Jiang et al. 2014). It has been shown in heterologous expression studies, that the θ subunit when expressed with the α and β subunits can also form a func-tional GABA-A receptor that is modulated by the general anesthetics (Ranna et al. 2006). In addition, at high non-clinical concentrations both propofol and etomidate can open the GABA-A receptors in the absence of GABA.

9. GABA-A receptor trafficking and phosphorylation

9.1. GABA-A receptor trafficking and insertion GABA-A receptor transportation from the intracellular compartment to the surface of the cells is regulated by intracellular proteins like the GABA-A receptor associated proteins (GABARAP), radixin, kinases and phosphatases (Kittler & Moss 2003). The function of GABARAP is receptor trafficking and receptors anchoring to cytoskeleton (Kittler & Moss 2003), whereas radixin and gephyrin are important for clustering the GABA-A receptors in the plasma membrane (Kittler & Moss 2003).

Receptors stability occurs within the plasma membrane with the assis-tance of other proteins after the receptors reach the synapse. Gephyrin also plays a role in interaction with GABA-A receptors subunits which will stabi-lize intracellular and plasma membrane GABA-A receptors (Kneussel & Betz 2000, Kneussel et al. 1999, Essrich et al. 1998, Kittler & Moss 2003, Lorenzo et al. 2014, Tyagarajan & Fritschy 2014). It has been shown by immunochemical analysis that gephyrin co-localizes with GABA-A recep-tors containing α1, α2, α3, γ2 subunits, and it interacts with α1-α3 subunits

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while γ2 subunit does not interact directly with gephyrin but it has an indi-rect effect (Tyagarajan & Fritschy 2014). The insertion of the receptor oc-curs at the extrasynaptic area (Bogdanov et al. 2006, Lüscher & Keller 2004) then GABA-A receptors somehow mobilize to enter the synaptic zone to increase the number of the receptor at the post synaptic terminal (Bogdanov et al. 2006, Bannai et al. 2009). This movement of the receptors from the extrasynaptic area to the synaptic area takes approximately two minutes (Thomas et al. 2005).

9.2. GABA-A receptor phosphorylation Many studies have been done to study the effect of phosphorylation on GABA-A receptors function (Kittler & Moss 2003, Lüscher & Keller 2004, McDonald et al. 1998, Moss et al. 1995, Comenencia-Ortiz et al. 2014). Phosphorylation of GABA-A receptor subunits takes place by the activity of 3`-5`-cyclic adenosine monophosphate (cAMP) dependent kinase (Heuschneider & Schwartz 1989). Other protein kinases that may also partic-ipate include: type II Ca2+/calmodulin-dependent protein kinase (Machu et al. 1993) and protein tyrosine kinase (Moss et al. 1995) or the Ca2+/phospholipid-dependent protein kinase (Sigel & Baur 1988). GABA-A receptor subunits phosphorylation is important for trafficking and stability of the receptor (Comenencia-Ortiz et al. 2014). A study has shown that phos-phorylation mediates the GABA/benzodiazepine uncoupling at the interac-tion site (Gutiérrez et al. 2014). Another study has shown that phosphoryla-tion of a tyrosine residue in the γ2-subunit of GABA-A receptor has an ef-fect on regulating the tonic and phasic inhibition in the thalamus (Nani et al. 2013). Furthermore, the GABAergic currents can be changed by phosphory-lation that will cause receptors desensitization and change the open probabil-ity of the single-channel (Kittler & Moss 2003). GABA-A receptor subunits β1 and β3 but not β2 subunit are phosphorylated by PKA whereas PKC phosphorylates all GABA-A receptor β subunits (McDonald et al. 1998, Oberlander et al. 2012). In addition, it has been shown that the phosphoryla-tion of GABA-A subunit composition containing α4β3δ by PKA increases the current through the receptors via increasing the opening frequency of the single-channel (Tang et al. 2010).

10. Glial cells and gliomas Glial cells are non-neuronal cells present in the CNS that maintain homeo-stasis and work as mechanical and metabolic supportive cells. The microglia are the resident immune cells in the CNS (Jessen & Mirsky 1980, Laming et al. 2000). Glial cells are classified in regard to their location, morphology, origin and also how they function in the central nervous system (Rasband

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2016). Astrocytes have the capacity to remove excess potassium and also neurotransmitters from the synaptic cleft (Ben Achour & Pascual 2012). Modulation of synaptic transmission is another function of astrocytes and it occurs by transmitter release (GABA, ATP and glutamate) (Ben Achour & Pascual 2012). Glial cells cannot generate an action potential as they do not have the necessary plasma membrane properties to do so even though they have some of the voltage-sensitive ion channels expressed in neurons (Carmignoto 2000, Sheehan 1977, Vernadakis 1996, Cuoghi & Mola 2009). Processing of information requires the communication between glial cells and neurons (Laming et al. 2000). However, they do not use neuronal type electrical flow but use signaling systems that includes gap junctions between cells (Fields & Stevens-Graham 2002, Vernadakis 1996). Activation of glial cells plays roles in formation of synapses, myelination, neurodevelopment, neuroprotection, microcirculation in the brain, and regulation of neuronal activity (Barres 2008). Four types of glial cells have been recognized and studied in the central nervous system: astrocytes, oligodendrocytes, micro-glia and ependymocytes (Krawczyk & Jaworska-Adamu 2010) (Fig.5).

Figure 5. Types of glial cells

Gliomas are brain tumors that arise from glial cells. It includes astrocytomas, oligodendrogliomas, ependymomas and some other types (Mamelak & Jacoby 2007). Regarding CNS tumors, approximately 30% of all CNS tu-mors are made up of glioma but up to 80% of all malignant type of brain tumors are made up by glioblastomas. However, the etiology is unknown (Goodenberger & Jenkins 2012). The 2007 World Health Organization has

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classified gliomas into 4 grades. Low grade glioma was considered as grade I and II and more malignant ones as grades III and IV (Louis et al. 2007, Rousseau et al. 2008). The glioblastoma is most common and aggressive primary brain tumors that affect adults. It is highly invasive and that is why it is not curable, even with surgical resection or other regimes of treatments (Wirsching et al. 2016, Cuddapah et al. 2014). A minority of glioblastomas are developed from previously grade I or II and they are classified clinically as secondary glioblastoma (Wirsching et al. 2016). Patients with glioblastoma have low survival rate of only 1-2 years after the patient is positively diagnosed (Stupp et al. 2005, Cuddapah et al. 2014). Surgical removal combined with radiotherapy has given the best treatment results so-far (Roa et al. 2004, Watts & Sanai 2016). However, some studies claim that another probable way to treat glioma is by combining chemotherapy together with radiotherapy (Tallet et al. 2012). Studies have shown that self-renewing glioma stem cells may take part in the malignant growth (Zhang et al. 2013).

11. The hippocampus The hippocampus is an important part of the limbic system of the vertebrate brain. It has a major role in memory formation and learning (Jarrard 1993) and even in metabolic control (Deuker et al. 2014, Lathe 2001). The hippo-campal formation is part of a system that supports variety of functions in the CNS including: emotion, behavior, olfaction and long term memory. There is one hippocampus in each cerebral hemisphere in humans and other mam-mals. The hippocampus is located underneath the cortical surface, in the medial temporal lobe of the brain. Cornu ammonis (CA) has three major subdivisions: CA1, CA2, CA3 and together with the dentate gyrus and subiculum form the principal parts of the hippocampus (Fig.6).

The information travels within the hippocampus in a trisynaptic neuronal network pathway: The perforant pathway carries the information from entorhinal cortex to the granular cell layer in dentate gyrus; from granule cells, axons (mossy fibers) are sent to pyramidal cells in the CA3. Axons from CA3 pyramidal cells branch and synapse with CA1 pyramidal cells. One of these branches is the Schaffer collateral. From CA1 pyramidal cells there is a projection back to entorhinal cortex directly or via subiculum (Bird & Burgess 2008) (Fig.6). It is important to mention that the trisynaptic pathway is the most prominent pathway even though it is not the only one. The hippocampus can receive information from different regions of the CNS including cortex, amygdala, hypothalamus and contralateral hippocampus. It is very important to study the hippocampus because of its important role in learning and memory and also for its relation in anxiety, epilepsy and meta-bolic disorders.

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Interneurons are small locally projecting neurons in the brain and spinal cord with short axons where they form connections between neurons within a structure and often function together. Interneurons are known to be the GABAergic cells in the cortex and hippocampus (Ascoli et al. 2008, DeFelipe et al. 2013).

Figure 6. Schematic of the main trisynaptic pathway in the hippocampus. EC: entorhinal cortex; PP: perforant pathway; DG: dentate gyrus; MF: mossy fibers; SC: Schaffer collateral; SUB: subiculum; CA: Cornu ammonis.

12. Glucagon like peptide-1 and its analogue exendin-4 Glucagon like peptide-1 is a 30 amino acid gut hormone secreted, as a body response to food intake, by intestinal L-cells (Hölscher 2012). GLP-1 recep-tors mRNA is expressed in different parts of the brain including neocortex, hippocampus, thalamus, brainstem, hypothalamus, globus pallidus and cau-date putamen (Lathe 2001, Holst 2007, Alvarez et al. 2005). GLP-1 can be produced by neurons with their cell bodies located in the brainstem and it is also able to cross the blood-brain barrier (Davidson et al. 2007, Jin et al. 1988). GLP-1 has many functions including stimulating insulin and inhibit-ing glucagon secretion in a glucose-dependent manner and thus regulating glucose homeostasis after meals (Holst 2007). GLP-1 and its agonists exendin-4 and liraglutide can potentially be used to treat cognitive declines related to diabetes mellitus (Patrone et al. 2014, Duarte et al. 2013).

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In plasma, the activity of GLP-1 only lasts for 1-2 minutes and is then de-graded by the activity of the enzyme dipeptidyl peptidase-4 (DDP-4) (Holst 2007, Vilsbøll et al. 2003). DDP-4 inactivates GLP-1 by cleaving two amino acids from the NH2-terminal (Holst 2007). The result is an inactive form of GLP-1 that may work as a competitive antagonist at the receptor of GLP-1 (Deacon et al. 1995, Holst 2007, Knudsen & Pridal 1996). Interestingly, the intact active form of GLP-1 after its secretion is less than 25%. A consecu-tive degradation of 40-50% will occur in the liver, finally what will reach to systemic circulation is only about 10-15 % of the total secreted GLP-1 (Deacon et al. 1996). Internalization of GLP-1 receptors occurs in pancreatic islets following their activation with GLP-1 but the receptors may reappear in the plasma membrane after passing through recycling endosomes or may be degraded (Widmann et al. 1995, Roed et al. 2014). Studies have shown that GLP-1 has the ability to regulate food intake, modulates memory for-mation and has neuroprotective and anti-inflammatory actions (Fig.7). GLP-1 can also modulate synaptic plasticity (Tang-Christensen et al. 1998, During et al. 2003, Campbell & Drucker 2013, Iwai et al. 2009).

Exendin-4 (Ex-4) is a long acting agonist at the GLP-1 receptor. Exendin-4 is resistant to DDP-4 (Khorsandi et al. 2016). It has 53% amino acid se-quence similarity with GLP-1 (Eng 1992, Unger & Parkin 2011) (Fig.8). It is a peptide of 39 amino acids, and contains a carboxyl-terminal serine amide with amino-terminal histidine. Extracts of Ex-4 was first isolated from the saliva of gila monster Heloderma suspectum (Eng 1992, Eng et al. 1992). Ex-4 has a longer half-life (2.4 hrs) (Unger & Parkin 2011) as compared to GLP-1 (Hölscher 2012). Studies have shown that exenatide, a synthetic ana-logue of exendin-4 improves glycaemic control in type 2 diabetes mellitus in combination with diet and exercise. It is used as subcutaneous injection twice per day 60 minutes before meal with a dose of 163 pg/mL (Unger & Parkin 2011). A study that has been performed on diabetic mice and rats reported that Ex-4 possesses a long term beneficial effects on levels of blood glucose (Greig et al. 1999). By beneficial effects on neogenesis of the pre-cursor cells, Ex-4 is reported to increase β-cell replication and thus beta cell mass (Tourrel et al. 2001, Movassat et al. 2002, Xu et al. 1999).

Liraglutide is a long acting analogue of human GLP-1 and it shares 97% homology with the GLP-1 (Fig.8). Liraglutide is synthesized by recombi-nant DNA technology from yeast cells (http: //www.medicines.org.uk/emc/medicine/21986/SPC/). Liraglutide differs from GLP-1 by replacement of an amino acid lysine with arginine at the

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Figure 7. GLP-1 is released into the blood in response to food intake and it activates GLP-1 receptors in pancreatic islets and brain.

position 34 and with an attachment of a fatty acid chain (Malm-Erjefält et al. 2010). These structural changes allow the binding of the molecule to plasma albumin and prolong liraglutide half-life by protecting it from being degrad-ed by DDP-4 (Madsen et al. 2007, Knudsen et al. 2000). It is used in the clinic as a once daily subcutaneous injection with a half-life of 10-15 hours (Agersø et al. 2002, Elbrønd et al. 2002, Russell-Jones 2009). The starting dose of liraglutide is 0.6 mg/day with the highest dose of 1.8 gm/day if needed (http: //www.medicines.org.uk/emc/medicine/21986/SPC/. (Ac-cessed). Like GLP-1, liraglutide can cross blood brain barrier (Kastin et al. 2002, Hunter & Hölscher 2012). It exerts its effects by binding to the GLP-1 receptor. GLP-1 activation may improve memory and learning in addition to neuroprotective effects (McClean et al. 2011, Li et al. 2009). In a study con-ducted by Candeias et al., (Candeias et al. 2015) liraglutide showed anti-inflammatory, anti-apoptotic and neuroprotective effects when used as treatment of type 2 diabetes. Talbot et al.(Talbot 2014) conducted a study in mice and found that liraglutide may decrease Alzheimer disease pathology by reducing hippocampal insulin resistance, and by restoration of cognitive functions in the brain.

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The brain has receptors for many metabolic hormones including insulin and the incretins (Lathe 2001, Jin et al. 2011). GLP-1 receptor knock-out mice, show impairment in memory formation and synaptic plasticity (Abbas et al. 2009). GLP-1 has been shown to decrease currents that are generated by glutamate in cultured hippocampus neurons (Gilman et al. 2003). Inter-estingly, it has been shown that GABA formation can be stimulated by GLP-1 in pancreatic β-cells (Wang et al. 2007).

Figure 8. Structures of GLP-1 receptor agonists

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13. GABA and GABA-A receptors in glia and glioblastoma At GABAergic synapses a cycle of GABA-glutamine takes place. Neurons will take up glutamine which will be converted to glutamate by the enzyme glutaminase. Glutamate will be metabolized to GABA by the enzyme gluta-mate decarboxylase (GAD). When GABA is released into synaptic cleft it is taken up by astrocyte via the GABA transporters. By the use of Krebs cycle GABA will catabolize to form glutamine as the end product which will be released by astrocytes and taken by neurons and used again (Bak et al. 2006) (Fig.9).

It has been suggested that GABA-A receptors are expressed in the major classes of glial cells (astrocytes, microglia, and cells of the oligodendroglial lineage) (Kettenmann et al. 1984, Kettenmann & Schachner 1985, Vélez-Fort et al. 2012). The conductance that these receptors have is similar to what is recorded from neurons but the receptors have different pharmacolo-gy at the benzodiazepine site (Bormann & Kettenmann 1988, Rosewater & Sontheimer 1994). Immunohistochemical studies have shown the presence of α1 and β1 on hippocampal astrocyte (Fraser et al. 1995) and α2 and γ1 on Bergmann glia (Riquelme et al. 2002). GABA-A receptor activation induced membrane depolarization in cultured astrocytes (Fraser et al. 1995, MacVicar et al. 1989, Malchow et al. 1989, Meier et al. 2008). The depolar-ization of astrocytes is due to the high intracellular Cl– concentration result-ing in Cl– reversal potential being more positive than the resting membrane potential (Vélez-Fort et al. 2012). This depolarizing effect of astrocyte con-tinues throughout development (Meier et al. 2008, Bekar et al. 1999, Bernstein et al. 1996). Astrocytes do not have the capability to produce ac-tion potential or propagate the depolarization (Vélez-Fort et al. 2012).

Gliomas also express GABA-A receptors subunits from low grade to the high grade glioblastoma. Whether the receptors are functional is generally not known (Smits et al. 2012). GABA-A subunits are down regulated in high grade gliomas as compared to the low grades (Smits et al. 2012, Jussofie et al. 1994). Previous studies have not detected functional GABA-A receptors (Labrakakis et al. 1998).

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Figure 9. Schematic of the GABA-glutamine cycle

Many studies have shown that glioblastoma affect memory functions. A case report showed that there might be a relation between Alzheimer disease and glioblastoma (Poole & Kepes 1991). Another case report suggests a relation between late stage glioma and amnesia (Shimauchi et al. 1989). In addition, gliomas can cause memory disturbance by hippocampal atrophy due to the mass effect of the tumor (Aradachi et al. 1992). If GABA has some negative effect on cell proliferation and/or migration, drugs acting at the GABA-A receptors could help to decrease the tumors proliferation or migration and potentially help recovery after surgical removal of the tumor.

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Aims of the thesis

I. To investigate the expression profile of GABA-A receptor subunits

in the glioblastoma cell line U3047MG and explore if they form

functional GABA-A receptors and then explore the pharmacology of

these receptors.

II. To study the effects of GLP-1 and its agonists exendin-4 on GABA-

A signaling in hippocampal CA3 pyramidal neurons in rat brain

slices.

III. To study the effects of liraglutide (a long acting GLP-1 analogue)

and to compare its effect to those of GLP-1 and exendin-4 on the

hippocampal neurons.

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Experimental strategy

1. Human glioma cell line The human glioma cell line named as U3047MG was established from biop-sies of glioblastoma grade IV (Pollard et al. 2009). Serum free media was used to grow the cell line with a 1:1 mixture of DMEM/F12 glutamax (Life technologies) and neurobasal medium (Life Technologies) supplemented with 1% B27 (Life Technologies), 0.5% N2 (Life Technologies) 1% penicil-lin/streptomycin (Sigma-Aldrich), and 10 ng/ml FGF2 and EGF2 (Peprotech). When the cells reach 70% confluence, they were split 1:3 with the use of the enzyme accutase (Life Technologies). The cells were then centrifuged at 1000 g for 5 min and seeded onto poly-ornithine/laminine-coated dishes (Sigma-Aldrich; R & D systems; BD Bioscience). The cells were seeded onto glass cover slips in a 24-well plate for patch-clamping and immunostaining experiments.

2. Quantitative PCR Real time PCR has been one of the most effective and widely used procedure for detection and quantification of mRNA.

In this thesis quantitative PCR was used to detect the expression of GABA-A subunits in a glioblastoma cell line. Isolation of total RNA was followed by synthesis of cDNA (complementary DNA). Before starting the qPCR, total RNA was measured qualitatively and quantitatively by a Nanodrop ND-1000 spectrophotometer (Nanodrop Technologies, Inc., USA). A mixture of random hexamers and oligoDT were used to obtain a faithful cDNA. This cDNA was used as a template for amplification of the genes of interest by using the specific primers for the target genes. The can-didate reference gene was expressed at a high level. Threshold cycle (CT) is the endpoint quantification of PCR and it is inversely related to the amount of desired amplicon. CT is defined as the PCR cycle at which fluorescent signal crosses the threshold.

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3. Immunocytochemistry Immunohistochemistry is the method used to localize the protein antigen in samples using specific antibody that bound to the antigen of interest. Anti-gen - antibody reaction allows at the visualization of the location and pres-ence of the antigen under the microscope.

In my study I used immunocytochemistry to localize the GABA-A recep-tors in a glioblastoma cell line. Cells were first grown on cover slips then fixed in 4% paraformaldehyde for 20 minutes, blocked in 5% bovine serum albumin for 15 minutes at room temperature. Cells were incubated with pri-mary antibodies, rabbit anti-GABA-A receptor α3, (1:400, Almone labs) and mouse anti-GABA-A receptor β3, (1:500, NeuroMab) at 4 °C overnight. After washing with PBS cells were incubated with fluorophore-conjugated secondary antibody for 1 hour at room temperature, and the nucleus was stained with DAPI for 5 minutes. Confocal microscopy was used to examine the signal.

4. Hippocampal slice preparation Brain slices were dissected from postnatal 16-22 days old Wistar rats for electrophysiological experiments. All animal procedures were conducted in accordance with the local ethical guidelines and approved animal care proto-cols by the Uppsala djurförsöksetiska nämnd, Uppsala, Sweden (Uppsala Animal Ethical board). Animals were sacrificed by decapitation, the brain removed quickly and immersed into ice-cold artificial cerebrospinal fluid (ACSF) containing (in mmol/L): 124 NaCl, 3 KCl, 2.5 CaCl2, 1.3 MgSO4, 26 NaHCO3, 2.5 Na2HPO4 and 10 glucose. The pH was 7.3-7.4 when bub-bled with carbogen (95% O2 and 5% CO2). Hippocampal slices were pre-pared using sagittal or coronal slices 400 µm thick with the use of vibratome (Leica VT1200S) in the ice-cold ACSF. Bubbling with 95% O2 and 5% CO2 was continuous during the preparation. The hippocampal slices were placed in Petri plates filled with ACSF on a black background for easy visualiza-tion. Sharp surgical blade is used to isolate the hippocampus from the sur-rounding tissue. Slices were then incubated in the same ACSF solution at 37 oC for 1h with continuous bubbling with carbogen. Slices were then kept at room temperature until used.

5. Patch clamp electrophysiology Neher and Sakmann were the first people who developed the patch-clamp technique in 1976 and they received a Nobel prize in physiology or medicine for their discovery. The patch-clamp technique is used to isolate a patch of a

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membrane electrically and to record the current flow across this patch. The technique can also be used in measuring membrane potential and membrane capacitance. A pipette filled with the proper solution is pressed over the membrane to form a gigaseal followed by gentle suction to form a whole cell configuration which means that the interior of the cell is dialyzed with the pipette solution and then the cell is voltage-clamped. By this mode we can monitor all the current that passes through the channels (Fig.10).

Modes of patch clamp include:

Cell-attached configuration: this is a basic configuration for the patch-clamp technique. A sharp tip glass micropipette to make a gigaseal on to the cell membrane when positive pressure is released with application of gentle suc-tion. This method is the method used for single-channel measurements. The interior of the cell is intact and there is no exchange of cell interior with the pipette solution (Fig.10). Whole-cell configuration: Application of gentle suction after forming a gigaseal will lead to whole-cell configuration, which means the rupture of the cell membrane and exchange of the pipette solution with the internal milieu of the cell. By this configuration one can measure the total channel activity in the cell membrane (Fig.10). Inside-out patch: After forming a gigaseal the glass pipette is withdrawn from the cell with part of the membrane. By this mode we can manipulate the channel activity from the internal side of the membrane (Fig.10). Outside-out patch: After forming a whole-cell patch configuration the pi-pette is slowly withdrawn. This allows the cell membrane to reform so that the outside of the membrane become outside of the patch membrane at the tip of the pipette. This configuration is commonly used to measure single-channel activity (Fig.10).

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Figure 10. Schematic of patch clamp configurations

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Results and discussion

Study I Gliomas are known to be the most common primary brain tumors with un-known origin. Unfortunately, glioblastomas are the majority of all gliomas and are considered to be the most aggressive and deadly. To date there is no curable treatment of glioblastomas and the survival prognosis is very poor.

GABA-A receptors are pentameric chloride channels that are opened with the main inhibitory neurotransmitter GABA. Researchers have cloned 19 different GABA-A receptors subunits: α1-6, β1-3, γ1-3, δ, ε, θ, and ρ1-3. To study the functional and pharmacological properties of GABA-A recep-tors it is important to determine the subunit composition of the receptor sub-types.

We need an in vitro system that resembled tumor cells to study if GABA-A receptors expressed in tumors are affected with the therapeutic drugs available today. In our study we examined GABA signaling in a human de-rived glioblastoma cell line U3047MG.

In the glioblastoma cell line U3047MG we identified α2, α3, α5, β1, β2, β3, δ, γ3, , θ and ρ2 mRNAs of GABA-A receptors subunit. Subunits β3 and θ have the highest expression of mRNA, for α3, α5 and there was moderate expression and the remaining subunits gave lower levels of expres-sion. Immunocytochemistry showed an abundant level of protein expression for the subunits α3 and β3. Interestingly, I examined 875 cells but only in 102 (12%) of the cells where I recorded in whole-cell mode had GABA-activated currents. I could not apply the full range of GABA concentrations to a single cell as the current-response to 100 µM GABA often showed sig-nificant rundown. The GABA-activated current half-maximal concentration (EC50) was 36 µM. The benzodiazepine diazepam (1µM), propofol (50 µM) and the general anesthetics etomidate (100 nM) all enhanced the 10 µM GABA activated currents by a fraction of 2.2 (n = 11), 1.8 (n = 4) and 1.5 (n = 12), respectively. Since GABA-A receptors containing θ subunit have been reported to be highly sensitive to etomidate (Ranna et al. 2006) and the θ subunit is highly expressed in the U3047MG cell line, we examined over range of etomidate concentrations how the response of 10 µM GABA was enhanced. We found that the glioma GABA-A receptors were unusually sensitive to etomidate (EC50= 55 nM). We propose that the U3047MG glioblastoma cell line has similar profile of GABA-A receptors as human

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glioblastomas (Smits et al. 2012) and it can be used as a model system to study how tumor development is affected by GABA signaling.

Study 2 Diabetes is a known risk factor affecting memory functions. The brain con-tains receptors for many metabolic hormones including the incretins. The center for memory and learning in the brain is the hippocampus. GLP-1 is a gut hormone secreted from the intestinal L-cells after food intake and the receptor for GLP-1 hormone is expressed in hippocampus. We studied if GLP-1 and exendin-4, an agonist of GLP-1 receptors has an effect on GABA-A receptors located in CA3 hippocampal neurons. Acute application of 10 pM GLP-1 enhanced the spontaneous inhibitory postsynaptic current (sIPSC) amplitude by factor of 1.8 and average frequency by factor of 1.8 compared with control. Higher concentrations of GLP-1 (100 pM-10 nM) did not increase the sIPSC amplitude. While 100 pM and 1 nM GLP-1 con-centrations increased the average sIPSC frequency by a factor 1.6 and 1.8, respectively, compared to control. The tonic current increased with concen-trations between 10 pM to 1 nM of GLP-1 while it was similar to control in case of 10 nM of GLP-1. We found that the effect of GLP-1 on the GABA activated synaptic current could be prevented with exendin (9-39), the com-petitive antagonist of GLP-1. Exendin-4 also enhanced both synaptic and tonic currents in a concentration dependent manner (10, 50 and 100 nM). Exendin-4 did not increase the sIPSC amplitude but it did enhance the sIPSC frequency by a factor of 1.4 for 10 nM, 1.5 for 50 nM and 1.4 for 100 nM. The exendin-4 concentration of 0.5 nM did not change the frequency or am-plitude. All exendin-4 concentrations used (0.5, 10, 50 and 100 nM) en-hanced the tonic currents.

GABA signaling is enhanced by GLP-1 and exendin-4 with processes such as increase of GABA release from presynaptic terminals, increase of GABA-A receptors in postsynaptic terminals, increase of GABA spillover from the synaptic cleft or insertion of new or modified GABA-A receptors with higher affinity into the membrane of the postsynaptic neuron. Tetrodotoxin (TTX) was used to differentiate between presynaptic and postsynaptic effect on synaptic currents of GLP-1 and exendin-4. In the presence of TTX neither GLP-1 nor exendin-4 enhanced the frequency or amplitude of the synaptic current. This suggests that the enhancing effect of GLP-1 and exendin-4 is related to the increase of GABA release from pre-synaptic terminals. The tonic current was only reduced by 50% in the pres-ence of TTX which indicates that only a part of the tonic current amplitude is related to the spillover of GABA from the synapse. The remaining tonic current recorded in the presence of TTX was still sensitive to GLP-1 and exendin-4. These results are consistence with the idea that the modulation of

37

GABA-A signaling in CA3 pyramidal neuron by GLP-1 and exendin-4 oc-curring both by pre and postsynaptic mechanisms.

The results demonstrate regulation of hippocampal function by GLP-1R agonists and may have implications in health and disease e.g. type 2 diabetes and Alzheimer's disease.

Study 3 Diabetes mellitus is a progressive disease that results in high blood glucose levels due to insulin resistance. Studies have shown that diabetes is a risk factor for dementia and Alzheimer disease. The brain contains receptors for GLP-1 and other metabolic hormons. The hippocampus is the center of memory and learning and CA3 pyramidal neurons form an essential part of the hippocampal neuronal network. It is now apparent that metabolic hormons can enhance GABA signaling in the hippocampal neurons. Activa-tion of GLP-1 receptors may regulate synaptic plasticity and memory for-mation. Also, the activation of GLP-1 receptors have been shown to be anti-inflammatory, neuroprotective and to regulate food intake.

Liraglutide, a type 2 diabetic drug (T2D), is a long acting analogue of GLP-1 with 97% amino acid similarity to human GLP-1. In this study. I examined if liraglutide modulated GABA signaling in CA3 hippocampal neurons. GABA is the main inhibitory neurotransmitter and can regulate the activity of neuronal networks. I used different concentration of liraglutide from 1 nM to 1 µM to study its effect on the CA3 hippocampal neurons. Only 100 nM liraglutide significantly changed the spontaneous postsynapyic currents (sIPSCs) but surprisingly only 50% of the neurons were modulated by the drug. In neurons responsive to liraglutide both frequency of sIPSCs and the most probable amplitudes increased. The GABA release driven by action potential firing was inhibited with tetrodotoxin (TTX) but the results were similar in TTX and TTX + 100 nM liraglutide. The results demonstrate that effect of liraglutide is mostly on the presynaptic neurons resulting in increased IPSCs frequency and amplitude but with minimal effects on the tonic current. The results suggest the three agonists at the GLP-1 receptor differentially activate the GLP-1 receptor, potentially resulting in differential activation of intracellular G-proteins. These findings show that GLP-1 recep-tor agonists regulate hippocampal functions in healthy control and can po-tentially be used to treat/prevent neurodegenerative diseases.

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Conclusions

I. GABA-A receptor subunits are expressed in high grade gliomas but they form functional receptors only in a subset of cells. The recep-tors are highly sensitive to modulation by etomidate.

II. GLP-1 and exendin-4 modulate GABA signaling in hippocamapal

neurons. Both substances enhance GABA release from presynaptic terminals resulting in enhanced IPSC. GLP-1 and exendin-4 do also enhance the tonic current by activating the GLP-1 receptor in the post synaptic neuron, resulting in expression of high affinity extrasynaptic GABA-A receptors.

III. Liraglutide primarily enhances the presynaptic release of GABA.

The results are consistent with differential potency of GLP-1, exindin-4 and liraglutide in activating GLP-1 activated intracellular cascades.

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Acknowledgements

Sometimes words cannot express the real feeling people have, it was a long journey with a lot of up's and downs, but finally we will reach what we want to be.

Omar Babateen is the name appears on the cover of this thesis but great many people contributed to make this thesis possible. What I achieved could not be accomplished without god welling then my family support specially my mother haniya, and my father mohammad. Thanks for your patience with me and for supporting me in spite of all the times I spent away from you. My wife omniya and my little queens Jawan and Leen: I know that the journey was long but with all your support and patience we could make it. I cannot forget all the years we spent away from our families and friends but you were everything for me. You are one of the best gifts I’ve ever got-ten. I am so glad God gave me you. I would like to thank you for your understanding and love and also your help to get me through the bad times. I would like also to thank my brothers, my sisters, my mother in law and my father in law and of course each and every one who encouraged me, I need more than a book to mention all the names but all what I can say is that I owe my gratitude to all of you.

No doubt that professor Bryndis Birnir is an excellent supervisor, she was really supportive, encouraging and there all the times I needed help. It has been pleasure working under her supervision and grape some of her out-standing knowledge. All valuable information I have in research and lab skills was just part of knowledge she was willing giving it to all of her stu-dents. I would like to say thank you for believing in me, supporting me and helping me during my years as part of your group. Þakka þér

Zhe Jin my co-supervisor, thank you for all your comments and discus-sions, and utmost your patience. Your guidance in so many aspects of my research, your supportive words will always be in my mind. I wish you all the best 謝謝.

40

Sergiy Korol I can say that you also have been my co-supervisor, you helped me a lot and taught me many things, thank you for your cooperation and for patiently answering all my questions. I wish you will have a bright future. Спасибі.

Amol Bhandage we started together and we will finish together. You are more than just a colleague, your precious comments and ideas helped me and made the difficult task sooooo easy. I would like to thank you for all the nice time we spent discussing science and many other stuff. You will be a great scientist so keep your nice personality and keep you motivation always up. ध यवाद thank you.

I also would like to thank Karin Nygren for all nice times we spent together and all help I got when I needed you are like the soul of the corridor.

All the current people in the physiology department. Olof Nylander, Svante Winberg, Markus Sjöblom, Louise Flood, Arianna Cocco, Laura Vossen, P-O. And all the people that left the department Hanna Taylor, Suresh Mendu, Yang Jin, Karin Nordström, Wan Salman Wan Saudi, Josefin Dahlbom, Frank Lee, Krzysztof Nowak, Yifan Zhou, Xiaolin Huang for chairing everyday life and raising up nice speech and discussions during lunches and fikas. I would like t acknowledge all the Administration for their kind help through my studying years.

Homesick was a big issue for me but having a great friends around me helped me stay sane through these difficult years. without their support and care it would be so difficult to overcome setbacks. special thanks to Mo-hammad Omar Altai I want to acknowledge your support and friendship and tell you how much they have meant to me, I have been blessed by your support and friendship over the years. Meshari Alwzae, Megbel Alnugaibani, Abdulrahim Bukhari, Zaid Alshrari, Rami Alzahrani, Saad Alqahtani, Mel långstrump, Asim Alzoman, Nadir Alkamli, Abdulgafoor Halawani, Hattan Alsobhi, Abdulrahman Alayid.

Last but not least I am so grateful to the ministry of higher education in Saudi Arabia which funded my studies.

I owe my gratitude to all those people i have mentioned and also others who were not mentioned here but their help and support is appreciable and unfor-gettable. You all made this long experience one that i will cherish forever.

God bless you ALL

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References

Abbas, T., Faivre, E. and Hölscher, C. (2009) Impairment of synaptic plasticity and memory formation in GLP-1 receptor KO mice: Interaction between type 2 dia-betes and Alzheimer's disease. Behav Brain Res, 205, 265-271.

Agersø, H., Jensen, L. B., Elbrønd, B., Rolan, P. and Zdravkovic, M. (2002) The pharmacokinetics, pharmacodynamics, safety and tolerability of NN2211, a new long-acting GLP-1 derivative, in healthy men. Diabetologia, 45, 195-202.

Althoff, T., Hibbs, R. E., Banerjee, S. and Gouaux, E. (2014) X-ray structures of GluCl in apo states reveal a gating mechanism of Cys-loop receptors. Nature, 512, 333-337.

Alvarez, E., Martínez, M. D., Roncero, I. et al. (2005) The expression of GLP-1 receptor mRNA and protein allows the effect of GLP-1 on glucose metabolism in the human hypothalamus and brainstem. J Neurochem, 92, 798-806.

Aradachi, H., Yamashima, T., Tuchida, A., Noguchi, Y. and Kubota, T. (1992) [A case of malignant glioma associated with verbal recent memory disturbance due to left hippocampal atrophy; case report]. No Shinkei Geka, 20, 883-886.

Ascoli, G. A., Alonso-Nanclares, L., Anderson, S. A. et al. (2008) Petilla terminolo-gy: nomenclature of features of GABAergic interneurons of the cerebral cortex. Nat Rev Neurosci, 9, 557-568.

Attwell, D., Barbour, B. and Szatkowski, M. (1993) Nonvesicular release of neuro-transmitter. Neuron, 11, 401-407.

Azevedo, F. A., Carvalho, L. R., Grinberg, L. T., Farfel, J. M., Ferretti, R. E., Leite, R. E., Jacob Filho, W., Lent, R. and Herculano-Houzel, S. (2009) Equal num-bers of neuronal and nonneuronal cells make the human brain an isometrically scaled-up primate brain. J Comp Neurol, 513, 532-541.

Bak, L. K., Schousboe, A. and Waagepetersen, H. S. (2006) The glutamate/GABA-glutamine cycle: aspects of transport, neurotransmitter homeostasis and ammo-nia transfer. J Neurochem, 98, 641-653.

Bannai, H., Lévi, S., Schweizer, C., Inoue, T., Launey, T., Racine, V., Sibarita, J. B., Mikoshiba, K. and Triller, A. (2009) Activity-dependent tuning of inhibitory neurotransmission based on GABAAR diffusion dynamics. Neuron, 62, 670-682.

Barnett, M. W. and Larkman, P. M. (2007) The action potential. Pract Neurol, 7, 192-197.

Barres, B. A. (2008) The mystery and magic of glia: a perspective on their roles in health and disease. Neuron, 60, 430-440.

Bekar, L. K., Jabs, R. and Walz, W. (1999) GABAA receptor agonists modulate K+ currents in adult hippocampal glial cells in situ. Glia, 26, 129-138.

Belelli, D., Lambert, J. J., Peters, J. A., Wafford, K. and Whiting, P. J. (1997) The interaction of the general anesthetic etomidate with the gamma-aminobutyric ac-id type A receptor is influenced by a single amino acid. Proc Natl Acad Sci U S A, 94, 11031-11036.

42

Ben Achour, S. and Pascual, O. (2012) Astrocyte-neuron communication: functional consequences. Neurochem Res, 37, 2464-2473.

Bernstein, M., Lyons, S. A., Möller, T. and Kettenmann, H. (1996) Receptor-mediated calcium signalling in glial cells from mouse corpus callosum slices. J Neurosci Res, 46, 152-163.

Bird, C. M. and Burgess, N. (2008) The hippocampus and memory: insights from spatial processing. Nat Rev Neurosci, 9, 182-194.

Birnir, B. and Korpi, E. R. (2007) The impact of sub-cellular location and intracellu-lar neuronal proteins on properties of GABA(A) receptors. Curr Pharm Des, 13, 3169-3177.

Bogdanov, Y., Michels, G., Armstrong-Gold, C., Haydon, P. G., Lindstrom, J., Pangalos, M. and Moss, S. J. (2006) Synaptic GABAA receptors are directly re-cruited from their extrasynaptic counterparts. EMBO J, 25, 4381-4389.

Bormann, J. and Kettenmann, H. (1988) Patch-clamp study of gamma-aminobutyric acid receptor Cl- channels in cultured astrocytes. Proc Natl Acad Sci U S A, 85, 9336-9340.

Bowery, N. G., Bettler, B., Froestl, W., Gallagher, J. P., Marshall, F., Raiteri, M., Bonner, T. I. and Enna, S. J. (2002) International Union of Pharmacology. XXXIII. Mammalian gamma-aminobutyric acid(B) receptors: structure and function. Pharmacol Rev, 54, 247-264.

Brickley, S. G. and Mody, I. (2012) Extrasynaptic GABA(A) receptors: their func-tion in the CNS and implications for disease. Neuron, 73, 23-34.

Brown, N., Kerby, J., Bonnert, T. P., Whiting, P. J. and Wafford, K. A. (2002) Pharmacological characterization of a novel cell line expressing human al-pha(4)beta(3)delta GABA(A) receptors. Br J Pharmacol, 136, 965-974.

Campbell, J. E. and Drucker, D. J. (2013) Pharmacology, physiology, and mecha-nisms of incretin hormone action. Cell Metab, 17, 819-837.

Candeias, E. M., Sebastião, I. C., Cardoso, S. M. et al. (2015) Gut-brain connection: The neuroprotective effects of the anti-diabetic drug liraglutide. World J Diabe-tes, 6, 807-827.

Caraiscos, V. B., Elliott, E. M., You-Ten, K. E. et al. (2004) Tonic inhibition in mouse hippocampal CA1 pyramidal neurons is mediated by alpha5 subunit-containing gamma-aminobutyric acid type A receptors. Proc Natl Acad Sci U S A, 101, 3662-3667.

Carmignoto, G. (2000) Reciprocal communication systems between astrocytes and neurones. Prog Neurobiol, 62, 561-581.

Chalifoux, J. R. and Carter, A. G. (2011) GABAB receptor modulation of synaptic function. Curr Opin Neurobiol, 21, 339-344.

Chiara, D. C., Dostalova, Z., Jayakar, S. S., Zhou, X., Miller, K. W. and Cohen, J. B. (2012) Mapping general anesthetic binding site(s) in human α1β3 γ-aminobutyric acid type A receptors with [³H]TDBzl-etomidate, a photoreactive etomidate analogue. Biochemistry, 51, 836-847.

Clark, J. A., Deutch, A. Y., Gallipoli, P. Z. and Amara, S. G. (1992) Functional expression and CNS distribution of a beta-alanine-sensitive neuronal GABA transporter. Neuron, 9, 337-348.

Comenencia-Ortiz, E., Moss, S. J. and Davies, P. A. (2014) Phosphorylation of GABAA receptors influences receptor trafficking and neurosteroid actions. Psy-chopharmacology (Berl).

Cuddapah, V. A., Robel, S., Watkins, S. and Sontheimer, H. (2014) A neurocentric perspective on glioma invasion. Nat Rev Neurosci, 15, 455-465.

Cuoghi, B. and Mola, L. (2009) Macroglial cells of the teleost central nervous sys-tem: a survey of the main types. Cell Tissue Res, 338, 319-332.

43

Davidson, T. L., Kanoski, S. E., Schier, L. A., Clegg, D. J. and Benoit, S. C. (2007) A potential role for the hippocampus in energy intake and body weight regula-tion. Curr Opin Pharmacol, 7, 613-616.

de Groote, L. and Linthorst, A. C. (2007) Exposure to novelty and forced swimming evoke stressor-dependent changes in extracellular GABA in the rat hippocam-pus. Neuroscience, 148, 794-805.

Deacon, C. F., Johnsen, A. H. and Holst, J. J. (1995) Degradation of glucagon-like peptide-1 by human plasma in vitro yields an N-terminally truncated peptide that is a major endogenous metabolite in vivo. J Clin Endocrinol Metab, 80, 952-957.

Deacon, C. F., Pridal, L., Klarskov, L., Olesen, M. and Holst, J. J. (1996) Glucagon-like peptide 1 undergoes differential tissue-specific metabolism in the anesthe-tized pig. Am J Physiol, 271, E458-464.

DeFelipe, J., López-Cruz, P. L., Benavides-Piccione, R. et al. (2013) New insights into the classification and nomenclature of cortical GABAergic interneurons. Nat Rev Neurosci, 14, 202-216.

Deuker, L., Doeller, C. F., Fell, J. and Axmacher, N. (2014) Human neuroimaging studies on the hippocampal CA3 region - integrating evidence for pattern sepa-ration and completion. Front Cell Neurosci, 8, 64.

Dias, R., Sheppard, W. F., Fradley, R. L. et al. (2005) Evidence for a significant role of alpha 3-containing GABAA receptors in mediating the anxiolytic effects of benzodiazepines. J Neurosci, 25, 10682-10688.

Drasbek, K. R. and Jensen, K. (2006) THIP, a hypnotic and antinociceptive drug, enhances an extrasynaptic GABAA receptor-mediated conductance in mouse neocortex. Cereb Cortex, 16, 1134-1141.

Duarte, A. I., Candeias, E., Correia, S. C. et al. (2013) Crosstalk between diabetes and brain: glucagon-like peptide-1 mimetics as a promising therapy against neurodegeneration. Biochim Biophys Acta, 1832, 527-541.

During, M. J., Cao, L., Zuzga, D. S. et al. (2003) Glucagon-like peptide-1 receptor is involved in learning and neuroprotection. Nat Med, 9, 1173-1179.

Eghbali, M., Curmi, J. P., Birnir, B. and Gage, P. W. (1997) Hippocampal GABA(A) channel conductance increased by diazepam. Nature, 388, 71-75.

Elbrønd, B., Jakobsen, G., Larsen, S., Agersø, H., Jensen, L. B., Rolan, P., Sturis, J., Hatorp, V. and Zdravkovic, M. (2002) Pharmacokinetics, pharmacodynamics, safety, and tolerability of a single-dose of NN2211, a long-acting glucagon-like peptide 1 derivative, in healthy male subjects. Diabetes Care, 25, 1398-1404.

Eng, J. (1992) Exendin peptides. Mt Sinai J Med, 59, 147-149. Eng, J., Kleinman, W. A., Singh, L., Singh, G. and Raufman, J. P. (1992) Isolation

and characterization of exendin-4, an exendin-3 analogue, from Heloderma suspectum venom. Further evidence for an exendin receptor on dispersed acini from guinea pig pancreas. J Biol Chem, 267, 7402-7405.

Erlander, M. G. and Tobin, A. J. (1991) The structural and functional heterogeneity of glutamic acid decarboxylase: a review. Neurochem Res, 16, 215-226.

Essrich, C., Lorez, M., Benson, J. A., Fritschy, J. M. and Lüscher, B. (1998) Postsynaptic clustering of major GABAA receptor subtypes requires the gamma 2 subunit and gephyrin. Nat Neurosci, 1, 563-571.

Feng, H. J., Jounaidi, Y., Haburcak, M., Yang, X. and Forman, S. A. (2014) Etomidate produces similar allosteric modulation in α1β3δ and α1β3γ2L GABAA receptors. Br J Pharmacol, 171, 789-798.

Fields, R. D. and Stevens-Graham, B. (2002) New insights into neuron-glia commu-nication. Science, 298, 556-562.

44

Filip, M., Frankowska, M., Sadakierska-Chudy, A., Suder, A., Szumiec, L., Mierzejewski, P., Bienkowski, P., Przegaliński, E. and Cryan, J. F. (2014) GABAB receptors as a therapeutic strategy in substance use disorders: Focus on positive allosteric modulators. Neuropharmacology.

Fraser, D. D., Duffy, S., Angelides, K. J., Perez-Velazquez, J. L., Kettenmann, H. and MacVicar, B. A. (1995) GABAA/benzodiazepine receptors in acutely iso-lated hippocampal astrocytes. J Neurosci, 15, 2720-2732.

Fritschy, J. M. and Mohler, H. (1995) GABAA-receptor heterogeneity in the adult rat brain: differential regional and cellular distribution of seven major subunits. J Comp Neurol, 359, 154-194.

Gassmann, M. and Bettler, B. (2012) Regulation of neuronal GABA(B) receptor functions by subunit composition. Nat Rev Neurosci, 13, 380-394.

Gether, U., Andersen, P. H., Larsson, O. M. and Schousboe, A. (2006) Neurotrans-mitter transporters: molecular function of important drug targets. Trends Pharmacol Sci, 27, 375-383.

Gilman, C. P., Perry, T., Furukawa, K., Grieg, N. H., Egan, J. M. and Mattson, M. P. (2003) Glucagon-like peptide 1 modulates calcium responses to glutamate and membrane depolarization in hippocampal neurons. J Neurochem, 87, 1137-1144.

Glykys, J. and Mody, I. (2007) Activation of GABAA receptors: views from outside the synaptic cleft. Neuron, 56, 763-770.

Goodenberger, M. L. and Jenkins, R. B. (2012) Genetics of adult glioma. Cancer Genet, 205, 613-621.

Greig, N. H., Holloway, H. W., De Ore, K. A., Jani, D., Wang, Y., Zhou, J., Garant, M. J. and Egan, J. M. (1999) Once daily injection of exendin-4 to diabetic mice achieves long-term beneficial effects on blood glucose concentrations. Diabetologia, 42, 45-50.

Guo, Z., Pang, L., Jia, X., Wang, X., Su, X., Li, P., Mi, W. and Hao, J. (2014) In-traoperative target-controlled infusion anesthesia application using remifentanil hydrochloride with etomidate in patients with severe burn as monitored using Narcotrend. Burns.

Gutiérrez, M. L., Ferreri, M. C., Farb, D. H. and Gravielle, M. C. (2014) GABA-induced uncoupling of GABA/benzodiazepine site interactions is associated with increased phosphorylation of the GABAA receptor. J Neurosci Res, 92, 1054-1061.

Halonen, L. M., Sinkkonen, S. T., Chandra, D., Homanics, G. E. and Korpi, E. R. (2009) Brain regional distribution of GABA(A) receptors exhibiting atypical GABA agonism: roles of receptor subunits. Neurochem Int, 55, 389-396.

Han, Y., Cao, D., Li, X., Zhang, R., Yu, F., Ren, Y. and An, L. (2014) Attenuation of γ-aminobutyric acid (GABA) transaminase activity contributes to GABA in-crease in the cerebral cortex of mice exposed to β-cypermethrin. Hum Exp Toxicol, 33, 317-324.

Heuschneider, G. and Schwartz, R. D. (1989) cAMP and forskolin decrease gamma-aminobutyric acid-gated chloride flux in rat brain synaptoneurosomes. Proc Natl Acad Sci U S A, 86, 2938-2942.

Hill-Venning, C., Belelli, D., Peters, J. A. and Lambert, J. J. (1997) Subunit-dependent interaction of the general anaesthetic etomidate with the gamma-aminobutyric acid type A receptor. Br J Pharmacol, 120, 749-756.

Holst, J. J. (2007) The physiology of glucagon-like peptide 1. Physiol Rev, 87, 1409-1439.

45

Hunter, K. and Hölscher, C. (2012) Drugs developed to treat diabetes, liraglutide and lixisenatide, cross the blood brain barrier and enhance neurogenesis. BMC Neurosci, 13, 33.

Héja, L. (2014) Astrocytic target mechanisms in epilepsy. Curr Med Chem, 21, 755-763.

Hölscher, C. (2012) Potential role of glucagon-like peptide-1 (GLP-1) in neuroprotection. CNS Drugs, 26, 871-882.

Iwai, T., Suzuki, M., Kobayashi, K., Mori, K., Mogi, Y. and Oka, J. (2009) The influences of juvenile diabetes on memory and hippocampal plasticity in rats: improving effects of glucagon-like peptide-1. Neurosci Res, 64, 67-74.

Jarrard, L. E. (1993) On the role of the hippocampus in learning and memory in the rat. Behav Neural Biol, 60, 9-26.

Jessen, K. R. and Mirsky, R. (1980) Glial cells in the enteric nervous system contain glial fibrillary acidic protein. Nature, 286, 736-737.

Jiang, Y. H., Ni, X. Q., Xiong, W. W., Wang, H., Tan, Y., Huang, Z. H. and Yao, X. Y. (2014) Different effects of etomidate and propofol on memory in immature rats. Int J Neurosci.

Jin, S. L., Han, V. K., Simmons, J. G., Towle, A. C., Lauder, J. M. and Lund, P. K. (1988) Distribution of glucagonlike peptide I (GLP-I), glucagon, and glicentin in the rat brain: an immunocytochemical study. J Comp Neurol, 271, 519-532.

Jin, Z., Jin, Y., Kumar-Mendu, S., Degerman, E., Groop, L. and Birnir, B. (2011) Insulin reduces neuronal excitability by turning on GABA(A) channels that generate tonic current. PLoS One, 6, e16188.

Jurado-Parras, M. T., Delgado-García, J. M., Sánchez-Campusano, R., Gassmann, M., Bettler, B. and Gruart, A. (2016) Presynaptic GABAB Receptors Regulate Hippocampal Synapses during Associative Learning in Behaving Mice. PLoS One, 11, e0148800.

Jussofie, A., Reinhardt, V. and Kalff, R. (1994) GABA binding sites: their density, their affinity to muscimol and their behaviour against neuroactive steroids in human gliomas of different degrees of malignancy. J Neural Transm Gen Sect, 96, 233-241.

Kash, T. L., Trudell, J. R. and Harrison, N. L. (2004) Structural elements involved in activation of the gamma-aminobutyric acid type A (GABAA) receptor. Biochem Soc Trans, 32, 540-546.

Kastin, A. J., Akerstrom, V. and Pan, W. (2002) Interactions of glucagon-like pep-tide-1 (GLP-1) with the blood-brain barrier. J Mol Neurosci, 18, 7-14.

Keramidas, A., Moorhouse, A. J., Schofield, P. R. and Barry, P. H. (2004) Ligand-gated ion channels: mechanisms underlying ion selectivity. Prog Biophys Mol Biol, 86, 161-204.

Kettenmann, H., Backus, K. H. and Schachner, M. (1984) Aspartate, glutamate and gamma-aminobutyric acid depolarize cultured astrocytes. Neurosci Lett, 52, 25-29.

Kettenmann, H. and Schachner, M. (1985) Pharmacological properties of gamma-aminobutyric acid-, glutamate-, and aspartate-induced depolarizations in cul-tured astrocytes. J Neurosci, 5, 3295-3301.

Khorsandi, L., Saremy, S., Khodadadi, A. and Dehbashi, F. (2016) Effects of Exendine-4 on The Differentiation of Insulin Producing Cells from Rat Adi-pose-Derived Mesenchymal Stem Cells. Cell J, 17, 720-729.

Kittler, J. T. and Moss, S. J. (2003) Modulation of GABAA receptor activity by phosphorylation and receptor trafficking: implications for the efficacy of synap-tic inhibition. Curr Opin Neurobiol, 13, 341-347.

46

Kneussel, M. and Betz, H. (2000) Receptors, gephyrin and gephyrin-associated proteins: novel insights into the assembly of inhibitory postsynaptic membrane specializations. J Physiol, 525 Pt 1, 1-9.

Kneussel, M., Brandstätter, J. H., Laube, B., Stahl, S., Müller, U. and Betz, H. (1999) Loss of postsynaptic GABA(A) receptor clustering in gephyrin-deficient mice. J Neurosci, 19, 9289-9297.

Knudsen, L. B., Nielsen, P. F., Huusfeldt, P. O., Johansen, N. L., Madsen, K., Pedersen, F. Z., Thøgersen, H., Wilken, M. and Agersø, H. (2000) Potent deriv-atives of glucagon-like peptide-1 with pharmacokinetic properties suitable for once daily administration. J Med Chem, 43, 1664-1669.

Knudsen, L. B. and Pridal, L. (1996) Glucagon-like peptide-1-(9-36) amide is a major metabolite of glucagon-like peptide-1-(7-36) amide after in vivo admin-istration to dogs, and it acts as an antagonist on the pancreatic receptor. Eur J Pharmacol, 318, 429-435.

Korpi, E. R., Gründer, G. and Lüddens, H. (2002) Drug interactions at GABA(A) receptors. Prog Neurobiol, 67, 113-159.

Krasowski, M. D., Koltchine, V. V., Rick, C. E., Ye, Q., Finn, S. E. and Harrison, N. L. (1998) Propofol and other intravenous anesthetics have sites of action on the gamma-aminobutyric acid type A receptor distinct from that for isoflurane. Mol Pharmacol, 53, 530-538.

Krawczyk, A. and Jaworska-Adamu, J. (2010) Synantocytes: the fifth type of glia? In comparison with astrocytes. Folia Histochem Cytobiol, 48, 173-177.

Labrakakis, C., Patt, S., Hartmann, J. and Kettenmann, H. (1998) Functional GABA(A) receptors on human glioma cells. Eur J Neurosci, 10, 231-238.

Lambert, J. J., Cooper, M. A., Simmons, R. D., Weir, C. J. and Belelli, D. (2009) Neurosteroids: endogenous allosteric modulators of GABA(A) receptors. Psychoneuroendocrinology, 34 Suppl 1, S48-58.

Laming, P. R., Kimelberg, H., Robinson, S., Salm, A., Hawrylak, N., Müller, C., Roots, B. and Ng, K. (2000) Neuronal-glial interactions and behaviour. Neurosci Biobehav Rev, 24, 295-340.

Lathe, R. (2001) Hormones and the hippocampus. J Endocrinol, 169, 205-231. Laurie, D. J., Seeburg, P. H. and Wisden, W. (1992) The distribution of 13 GABAA

receptor subunit mRNAs in the rat brain. II. Olfactory bulb and cerebellum. J Neurosci, 12, 1063-1076.

Lee, S., Yoon, B. E., Berglund, K., Oh, S. J., Park, H., Shin, H. S., Augustine, G. J. and Lee, C. J. (2010) Channel-mediated tonic GABA release from glia. Science, 330, 790-796.

Li, B., Wang, L., Sun, Z. et al. (2014) The anticonvulsant effects of SR 57227 on pentylenetetrazole-induced seizure in mice. PLoS One, 9, e93158.

Li, G. D., Chiara, D. C., Sawyer, G. W., Husain, S. S., Olsen, R. W. and Cohen, J. B. (2006) Identification of a GABAA receptor anesthetic binding site at subunit interfaces by photolabeling with an etomidate analog. J Neurosci, 26, 11599-11605.

Li, Y., Perry, T., Kindy, M. S. et al. (2009) GLP-1 receptor stimulation preserves primary cortical and dopaminergic neurons in cellular and rodent models of stroke and Parkinsonism. Proc Natl Acad Sci U S A, 106, 1285-1290.

Lindquist, C. E. and Birnir, B. (2006) Graded response to GABA by native extrasynaptic GABA receptors. J Neurochem, 97, 1349-1356.

Lindquist, C. E., Dalziel, J. E., Cromer, B. A. and Birnir, B. (2004) Penicillin blocks human alpha 1 beta 1 and alpha 1 beta 1 gamma 2S GABAA channels that open spontaneously. Eur J Pharmacol, 496, 23-32.

47

Lindquist, C. E., Ebert, B. and Birnir, B. (2003) Extrasynaptic GABA(A) channels activated by THIP are modulated by diazepam in CA1 pyramidal neurons in the rat brain hippocampal slice. Mol Cell Neurosci, 24, 250-257.

Lindquist, C. E., Laver, D. R. and Birnir, B. (2005) The mechanism of SR95531 inhibition at GABA receptors examined in human alpha1beta1 and al-pha1beta1gamma2S receptors. J Neurochem, 94, 491-501.

Liu, Q. Y., Schaffner, A. E., Chang, Y. H., Maric, D. and Barker, J. L. (2000) Per-sistent activation of GABA(A) receptor/Cl(-) channels by astrocyte-derived GABA in cultured embryonic rat hippocampal neurons. J Neurophysiol, 84, 1392-1403.

Lorenzo, L. E., Godin, A. G., Wang, F., St-Louis, M., Carbonetto, S., Wiseman, P. W., Ribeiro-da-Silva, A. and De Koninck, Y. (2014) Gephyrin clusters are ab-sent from small diameter primary afferent terminals despite the presence of GABA(A) receptors. J Neurosci, 34, 8300-8317.

Louis, D. N., Ohgaki, H., Wiestler, O. D., Cavenee, W. K., Burger, P. C., Jouvet, A., Scheithauer, B. W. and Kleihues, P. (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol, 114, 97-109.

Lüscher, B. and Keller, C. A. (2004) Regulation of GABAA receptor trafficking, channel activity, and functional plasticity of inhibitory synapses. Pharmacol Ther, 102, 195-221.

Macdonald, R. L. and Olsen, R. W. (1994) GABAA receptor channels. Annu Rev Neurosci, 17, 569-602.

Machu, T. K., Firestone, J. A. and Browning, M. D. (1993) Ca2+/calmodulin-dependent protein kinase II and protein kinase C phosphorylate a synthetic pep-tide corresponding to a sequence that is specific for the gamma 2L subunit of the GABAA receptor. J Neurochem, 61, 375-377.

MacVicar, B. A., Tse, F. W., Crichton, S. A. and Kettenmann, H. (1989) GABA-activated Cl- channels in astrocytes of hippocampal slices. J Neurosci, 9, 3577-3583.

Madsen, K., Knudsen, L. B., Agersoe, H., Nielsen, P. F., Thøgersen, H., Wilken, M. and Johansen, N. L. (2007) Structure-activity and protraction relationship of long-acting glucagon-like peptide-1 derivatives: importance of fatty acid length, polarity, and bulkiness. J Med Chem, 50, 6126-6132.

Malchow, R. P., Qian, H. H. and Ripps, H. (1989) gamma-Aminobutyric acid (GABA)-induced currents of skate Muller (glial) cells are mediated by neu-ronal-like GABAA receptors. Proc Natl Acad Sci U S A, 86, 4326-4330.

Malm-Erjefält, M., Bjørnsdottir, I., Vanggaard, J., Helleberg, H., Larsen, U., Oosterhuis, B., van Lier, J. J., Zdravkovic, M. and Olsen, A. K. (2010) Metabo-lism and excretion of the once-daily human glucagon-like peptide-1 analog liraglutide in healthy male subjects and its in vitro degradation by dipeptidyl peptidase IV and neutral endopeptidase. Drug Metab Dispos, 38, 1944-1953.

Mamelak, A. N. and Jacoby, D. B. (2007) Targeted delivery of antitumoral therapy to glioma and other malignancies with synthetic chlorotoxin (TM-601). Expert Opin Drug Deliv, 4, 175-186.

Martin, L. J., Oh, G. H. and Orser, B. A. (2009) Etomidate targets alpha5 gamma-aminobutyric acid subtype A receptors to regulate synaptic plasticity and memory blockade. Anesthesiology, 111, 1025-1035.

May, A. C., Fleischer, W., Kletke, O., Haas, H. L. and Sergeeva, O. A. (2013) Ben-zodiazepine-site pharmacology on GABAA receptors in histaminergic neurons. Br J Pharmacol, 170, 222-232.

48

McClean, P. L., Parthsarathy, V., Faivre, E. and Hölscher, C. (2011) The diabetes drug liraglutide prevents degenerative processes in a mouse model of Alzhei-mer's disease. J Neurosci, 31, 6587-6594.

McDonald, B. J., Amato, A., Connolly, C. N., Benke, D., Moss, S. J. and Smart, T. G. (1998) Adjacent phosphorylation sites on GABAA receptor beta subunits de-termine regulation by cAMP-dependent protein kinase. Nat Neurosci, 1, 23-28.

Meera, P., Olsen, R. W., Otis, T. S. and Wallner, M. (2009) Etomidate, propofol and the neurosteroid THDOC increase the GABA efficacy of recombinant al-pha4beta3delta and alpha4beta3 GABA A receptors expressed in HEK cells. Neuropharmacology, 56, 155-160.

Meier, S. D., Kafitz, K. W. and Rose, C. R. (2008) Developmental profile and mechanisms of GABA-induced calcium signaling in hippocampal astrocytes. Glia, 56, 1127-1137.

Meyerhoff, D. J., Mon, A., Metzler, T. and Neylan, T. C. (2014) Cortical gamma-aminobutyric acid and glutamate in posttraumatic stress disorder and their rela-tionships to self-reported sleep quality. Sleep, 37, 893-900.

Middendorp, S. J., Hurni, E., Schönberger, M., Stein, M., Pangerl, M., Trauner, D. and Sigel, E. (2014) Relative Positioning of Classical Benzodiazepines to the γ2-Subunit of GABAA Receptors. ACS Chem Biol.

Moss, S. J., Gorrie, G. H., Amato, A. and Smart, T. G. (1995) Modulation of GABAA receptors by tyrosine phosphorylation. Nature, 377, 344-348.

Movassat, J., Beattie, G. M., Lopez, A. D. and Hayek, A. (2002) Exendin 4 up-regulates expression of PDX 1 and hastens differentiation and maturation of human fetal pancreatic cells. J Clin Endocrinol Metab, 87, 4775-4781.

Nani, F., Bright, D. P., Revilla-Sanchez, R., Tretter, V., Moss, S. J. and Smart, T. G. (2013) Tyrosine phosphorylation of GABAA receptor γ2-subunit regulates tonic and phasic inhibition in the thalamus. J Neurosci, 33, 12718-12727.

Nusser, Z., Sieghart, W. and Somogyi, P. (1998) Segregation of different GABAA receptors to synaptic and extrasynaptic membranes of cerebellar granule cells. J Neurosci, 18, 1693-1703.

Nutt, D. J., Glue, P., Lawson, C. and Wilson, S. (1990) Flumazenil provocation of panic attacks. Evidence for altered benzodiazepine receptor sensitivity in panic disorder. Arch Gen Psychiatry, 47, 917-925.

Oberlander, J. G., Porter, D. M., Onakomaiya, M. M., Penatti, C. A., Vithlani, M., Moss, S. J., Clark, A. S. and Henderson, L. P. (2012) Estrous cycle variations in GABA(A) receptor phosphorylation enable rapid modulation by anabolic an-drogenic steroids in the medial preoptic area. Neuroscience, 226, 397-410.

Olsen, R. W. and Sieghart, W. (2008) International Union of Pharmacology. LXX. Subtypes of gamma-aminobutyric acid(A) receptors: classification on the basis of subunit composition, pharmacology, and function. Update. Pharmacol Rev, 60, 243-260.

Olsen, R. W. and Sieghart, W. (2009) GABA A receptors: subtypes provide diversi-ty of function and pharmacology. Neuropharmacology, 56, 141-148.

Overstreet, L. S. and Westbrook, G. L. (2001) Paradoxical reduction of synaptic inhibition by vigabatrin. J Neurophysiol, 86, 596-603.

Patrone, C., Eriksson, O. and Lindholm, D. (2014) Diabetes drugs and neurological disorders: new views and therapeutic possibilities. Lancet Diabetes Endocrinol, 2, 256-262.

Pavlov, I., Savtchenko, L. P., Kullmann, D. M., Semyanov, A. and Walker, M. C. (2009) Outwardly rectifying tonically active GABAA receptors in pyramidal cells modulate neuronal offset, not gain. J Neurosci, 29, 15341-15350.

49

Pinal, C. S. and Tobin, A. J. (1998) Uniqueness and redundancy in GABA produc-tion. Perspect Dev Neurobiol, 5, 109-118.

Pirker, S., Schwarzer, C., Wieselthaler, A., Sieghart, W. and Sperk, G. (2000) GABA(A) receptors: immunocytochemical distribution of 13 subunits in the adult rat brain. Neuroscience, 101, 815-850.

Pollard, S. M., Yoshikawa, K., Clarke, I. D. et al. (2009) Glioma stem cell lines expanded in adherent culture have tumor-specific phenotypes and are suitable for chemical and genetic screens. Cell Stem Cell, 4, 568-580.

Poole, E. C. and Kepes, J. J. (1991) Glioblastoma multiforme of the hippocampus in advanced Alzheimer's disease. Neuropathol Appl Neurobiol, 17, 509-513.

Ranna, M., Sinkkonen, S. T., Möykkynen, T., Uusi-Oukari, M. and Korpi, E. R. (2006) Impact of epsilon and theta subunits on pharmacological properties of alpha3beta1 GABAA receptors expressed in Xenopus oocytes. BMC Pharmacol, 6, 1.

Rasband, M. N. (2016) Glial Contributions to Neural Function and Disease. Mol Cell Proteomics, 15, 355-361.

Riquelme, R., Miralles, C. P. and De Blas, A. L. (2002) Bergmann glia GABA(A) receptors concentrate on the glial processes that wrap inhibitory synapses. J Neurosci, 22, 10720-10730.

Roa, W., Brasher, P. M., Bauman, G. et al. (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective random-ized clinical trial. J Clin Oncol, 22, 1583-1588.

Roed, S. N., Wismann, P., Underwood, C. R. et al. (2014) Real-time trafficking and signaling of the glucagon-like peptide-1 receptor. Mol Cell Endocrinol, 382, 938-949.

Rosewater, K. and Sontheimer, H. (1994) Fibrous and protoplasmic astrocytes ex-press GABAA receptors that differ in benzodiazepine pharmacology. Brain Res, 636, 73-80.

Rousseau, A., Mokhtari, K. and Duyckaerts, C. (2008) The 2007 WHO classifica-tion of tumors of the central nervous system - what has changed? Curr Opin Neurol, 21, 720-727.

Rudolph, U., Crestani, F. and Möhler, H. (2001) GABA(A) receptor subtypes: dis-secting their pharmacological functions. Trends Pharmacol Sci, 22, 188-194.

Rudolph, U. and Knoflach, F. (2011) Beyond classical benzodiazepines: novel ther-apeutic potential of GABAA receptor subtypes. Nat Rev Drug Discov, 10, 685-697.

Rudolph, U. and Möhler, H. (2006) GABA-based therapeutic approaches: GABAA receptor subtype functions. Curr Opin Pharmacol, 6, 18-23.

Russell-Jones, D. (2009) Molecular, pharmacological and clinical aspects of liraglutide, a once-daily human GLP-1 analogue. Mol Cell Endocrinol, 297, 137-140.

Saxena, N. C. and Macdonald, R. L. (1994) Assembly of GABAA receptor subunits: role of the delta subunit. J Neurosci, 14, 7077-7086.

Sedelnikova, A., Erkkila, B. E., Harris, H., Zakharkin, S. O. and Weiss, D. S. (2006) Stoichiometry of a pore mutation that abolishes picrotoxin-mediated antagonism of the GABAA receptor. J Physiol, 577, 569-577.

Semyanov, A., Walker, M. C. and Kullmann, D. M. (2003) GABA uptake regulates cortical excitability via cell type-specific tonic inhibition. Nat Neurosci, 6, 484-490.

Semyanov, A., Walker, M. C., Kullmann, D. M. and Silver, R. A. (2004) Tonically active GABA A receptors: modulating gain and maintaining the tone. Trends Neurosci, 27, 262-269.

50

Sheehan, G. A. (1977) Exercise--hazard or health aid. Am Heart J, 94, 537. Shimauchi, M., Wakisaka, S. and Kinoshita, K. (1989) Amnesia due to bilateral

hippocampal glioblastoma. MRI finding. Neuroradiology, 31, 430-432. Sigel, E. and Baur, R. (1988) Activation of protein kinase C differentially modulates

neuronal Na+, Ca2+, and gamma-aminobutyrate type A channels. Proc Natl Acad Sci U S A, 85, 6192-6196.

Sinkkonen, S. T., Hanna, M. C., Kirkness, E. F. and Korpi, E. R. (2000) GABA(A) receptor epsilon and theta subunits display unusual structural variation between species and are enriched in the rat locus ceruleus. J Neurosci, 20, 3588-3595.

Smits, A., Jin, Z., Elsir, T. et al. (2012) GABA-A channel subunit expression in human glioma correlates with tumor histology and clinical outcome. PLoS One, 7, e37041.

Stell, B. M., Brickley, S. G., Tang, C. Y., Farrant, M. and Mody, I. (2003) Neuroactive steroids reduce neuronal excitability by selectively enhancing tonic inhibition mediated by delta subunit-containing GABAA receptors. Proc Natl Acad Sci U S A, 100, 14439-14444.

Stupp, R., Mason, W. P., van den Bent, M. J. et al. (2005) Radiotherapy plus con-comitant and adjuvant temozolomide for glioblastoma. N Engl J Med, 352, 987-996.

Talbot, K. (2014) Brain insulin resistance in Alzheimer's disease and its potential treatment with GLP-1 analogs. Neurodegener Dis Manag, 4, 31-40.

Tallet, A. V., Azria, D., Barlesi, F., Spano, J. P., Carpentier, A. F., Gonçalves, A. and Metellus, P. (2012) Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment. Radiat Oncol, 7, 77.

Tang, X., Hernandez, C. C. and Macdonald, R. L. (2010) Modulation of spontane-ous and GABA-evoked tonic alpha4beta3delta and alpha4beta3gamma2L GABAA receptor currents by protein kinase A. J Neurophysiol, 103, 1007-1019.

Tang-Christensen, M., Vrang, N. and Larsen, P. J. (1998) Glucagon-like peptide 1(7-36) amide's central inhibition of feeding and peripheral inhibition of drink-ing are abolished by neonatal monosodium glutamate treatment. Diabetes, 47, 530-537.

Thomas, P., Mortensen, M., Hosie, A. M. and Smart, T. G. (2005) Dynamic mobili-ty of functional GABAA receptors at inhibitory synapses. Nat Neurosci, 8, 889-897.

Torres, A., Wang, F., Xu, Q., Fujita, T., Dobrowolski, R., Willecke, K., Takano, T. and Nedergaard, M. (2012) Extracellular Ca²⁺ acts as a mediator of communica-tion from neurons to glia. Sci Signal, 5, ra8.

Tourrel, C., Bailbé, D., Meile, M. J., Kergoat, M. and Portha, B. (2001) Glucagon-like peptide-1 and exendin-4 stimulate beta-cell neogenesis in streptozotocin-treated newborn rats resulting in persistently improved glucose homeostasis at adult age. Diabetes, 50, 1562-1570.

Tyagarajan, S. K. and Fritschy, J. M. (2014) Gephyrin: a master regulator of neu-ronal function? Nat Rev Neurosci, 15, 141-156.

Unger, J. R. and Parkin, C. G. (2011) Glucagon-like peptide-1 (GLP-1) receptor agonists: Differentiating the new medications. Diabetes Ther, 2, 29-39.

Veiraiah, A., Dyas, J., Cooper, G., Routledge, P. A. and Thompson, J. P. (2012) Flumazenil use in benzodiazepine overdose in the UK: a retrospective survey of NPIS data. Emerg Med J, 29, 565-569.

Vernadakis, A. (1996) Glia-neuron intercommunications and synaptic plasticity. Prog Neurobiol, 49, 185-214.

51

Vilsbøll, T., Agersø, H., Krarup, T. and Holst, J. J. (2003) Similar elimination rates of glucagon-like peptide-1 in obese type 2 diabetic patients and healthy subjects. J Clin Endocrinol Metab, 88, 220-224.

Vélez-Fort, M., Audinat, E. and Angulo, M. C. (2012) Central role of GABA in neuron-glia interactions. Neuroscientist, 18, 237-250.

Wang, C., Mao, R., Van de Casteele, M., Pipeleers, D. and Ling, Z. (2007) Gluca-gon-like peptide-1 stimulates GABA formation by pancreatic beta-cells at the level of glutamate decarboxylase. Am J Physiol Endocrinol Metab, 292, E1201-1206.

Wang, X., Huang, Z. G., Gold, A., Bouairi, E., Evans, C., Andresen, M. C. and Mendelowitz, D. (2004) Propofol modulates gamma-aminobutyric acid-mediated inhibitory neurotransmission to cardiac vagal neurons in the nucleus ambiguus. Anesthesiology, 100, 1198-1205.

Watts, C. and Sanai, N. (2016) Surgical approaches for the gliomas. Handb Clin Neurol, 134, 51-69.

Widmann, C., Dolci, W. and Thorens, B. (1995) Agonist-induced internalization and recycling of the glucagon-like peptide-1 receptor in transfected fibroblasts and in insulinomas. Biochem J, 310 ( Pt 1), 203-214.

Wingrove, P. B., Thompson, S. A., Wafford, K. A. and Whiting, P. J. (1997) Key amino acids in the gamma subunit of the gamma-aminobutyric acidA receptor that determine ligand binding and modulation at the benzodiazepine site. Mol Pharmacol, 52, 874-881.

Wirsching, H. G., Galanis, E. and Weller, M. (2016) Glioblastoma. Handb Clin Neurol, 134, 381-397.

Wisden, W., Laurie, D. J., Monyer, H. and Seeburg, P. H. (1992) The distribution of 13 GABAA receptor subunit mRNAs in the rat brain. I. Telencephalon, dien-cephalon, mesencephalon. J Neurosci, 12, 1040-1062.

Xu, G., Stoffers, D. A., Habener, J. F. and Bonner-Weir, S. (1999) Exendin-4 stimu-lates both beta-cell replication and neogenesis, resulting in increased beta-cell mass and improved glucose tolerance in diabetic rats. Diabetes, 48, 2270-2276.

Yip, G. M., Chen, Z. W., Edge, C. J. et al. (2013) A propofol binding site on mam-malian GABAA receptors identified by photolabeling. Nat Chem Biol, 9, 715-720.

Yoon, K. W., Covey, D. F. and Rothman, S. M. (1993) Multiple mechanisms of picrotoxin block of GABA-induced currents in rat hippocampal neurons. J Physiol, 464, 423-439.

Zhang, X., Zhang, W., Mao, X. G., Zhen, H. N., Cao, W. D. and Hu, S. J. (2013) Targeting role of glioma stem cells for glioblastoma multiforme. Curr Med Chem, 20, 1974-1984.

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