Widely used general anesthetics require administration by highly trained and vigilant experts, in part because they produce many undesirable effects and can be lethal at clinically used doses, particularly in elderly patients an those with systemic diseases. The safest (highest animal LD50/ED50 ratios) anesthetics, etomidate and alphaxalone, are both potent and selective modulators of GABAA receptors that also display stereoselectivity. These and similar drugs represent optimal starting points for developing improved and safer anesthetics. The overall aim of this renewal proposal is to define the interactions of etomidate, alphaxalone, propofol (a potent but less safe anesthetic) and a novel potent barbiturate (mTFD-MPAB) at their sites on pentameric (?1)2(?3)2?2L GABAA receptors, and to clarify conformational changes in these sites that couple anesthetic binding to functional effects. Our working hypothesis is that these drugs act at distinct sites within the fiv inter-subunit transmembrane clefts formed by M1, M2, and M3 domains, and that these clefts expand during receptor activation and desensitization. Our studies to date have identified novel contact points for etomidate, propofol, alphaxalone, and mTFD-MPAB within multiple inter-subunit clefts. We also have engineered cysteines into these sites to reveal GABA-enhanced sulfhydryl modification and GABA-dependent anesthetic protection. We have also developed quantitative allosteric models that explain multiple GABAAR mutant functional phenotypes, including subsite contributions to each drug's actions.
In Aim 1, we will identify which of the fiv inter-subunit sites interacts with each anesthetic, and which subsites transduce drug binding into enhanced receptor gating. We will use cysteine-substitutions in transmembrane domains M1, M2, and M3 of each subunit, along with chemical modification, protection, and electrophysiology, to define the binding clefts and residues closest to each anesthetic.
Aim 2 will test the hypothesis that GABA activation enlarges all five inter-subunit transmembrane clefts in concert. We will examine anesthetic subsite interactions using cysteine accessibility assays and estimate the effective """"""""cut-off"""""""" size of the anesthetic binding pockets using variable size mutations and cysteine adducts for three anesthetics that bind in the same inter-subunit clefts. We will also use novel sulfhydryl-modifying anesthetic derivatives and cysteine substituted residues to further define the binding orientation of stereoselective anesthetics.
Aim 3 will test whether anesthetics influence GABAA receptor rates of desensitization and whether the shape of the inter-subunit clefts differs between open and desensitized states, again based on cysteine accessibility. These studies will use submillisecond solution switching and patch-clamp electrophysiology. Data will be analyzed using functional allosteric models and further interpreted in the context of evolving GABAAR structural models.

Public Health Relevance

General anesthetics are among the most beneficial but also the most dangerous drugs in routine clinical use. To guide development of future anesthetics, we aim to understanding the mechanisms of anesthetics proven safest in animals, which are potent and stereoselective modulators of GABAA receptors: etomidate, alphaxalone, and a novel barbiturate. We will use electrophysiology, targeted cysteine substitutions, chemical modification, and protection assays to map the transmembrane inter-subunit GABAA receptor sites for these anesthetics, to determine the nature of their rearrangements during both channel activation and desensitization, and to establish the orientation of stereoselective anesthetic binding in these sites.

National Institute of Health (NIH)
National Institute of General Medical Sciences (NIGMS)
Research Project (R01)
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Special Emphasis Panel (ZRG1-SBIB-V (02))
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Cole, Alison E
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Massachusetts General Hospital
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Forman, Stuart A (2018) Combining Mutations and Electrophysiology to Map Anesthetic Sites on Ligand-Gated Ion Channels. Methods Enzymol 602:369-389
Feng, Hua-Jun; Forman, Stuart A (2018) Comparison of ??? and ??? GABAA receptors: Allosteric modulation and identification of subunit arrangement by site-selective general anesthetics. Pharmacol Res 133:289-300
Ziemba, Alexis M; Szabo, Andrea; Pierce, David W et al. (2018) Alphaxalone Binds in Inner Transmembrane ?+-?- Interfaces of ?1?3?2 ?-Aminobutyric Acid Type A Receptors. Anesthesiology 128:338-351
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Forman, Stuart A; Miller, Keith W (2016) Mapping General Anesthetic Sites in Heteromeric ?-Aminobutyric Acid Type A Receptors Reveals a Potential For Targeting Receptor Subtypes. Anesth Analg 123:1263-1273
Stern, Alex T; Forman, Stuart A (2016) A Cysteine Substitution Probes ?3H267 Interactions with Propofol and Other Potent Anesthetics in ?1?3?2L ?-Aminobutyric Acid Type A Receptors. Anesthesiology 124:89-100
Nourmahnad, Anahita; Stern, Alex T; Hotta, Mayo et al. (2016) Tryptophan and Cysteine Mutations in M1 Helices of ?1?3?2L ?-Aminobutyric Acid Type A Receptors Indicate Distinct Intersubunit Sites for Four Intravenous Anesthetics and One Orphan Site. Anesthesiology 125:1144-1158
Forman, Stuart A; Chiara, David C; Miller, Keith W (2015) Anesthetics target interfacial transmembrane sites in nicotinic acetylcholine receptors. Neuropharmacology 96:169-77
Liu, K; Jounaidi, Y; Forman, S A et al. (2015) Etomidate uniquely modulates the desensitization of recombinant ?1?3? GABA(A) receptors. Neuroscience 300:307-13

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