The Versatile GABAa Chloride Channel Receptor Complex

In today’s industrialized society we are constantly exposed to work related stresses. Consequently, anxiety and insomnia (sleeplessness) have become quite common. No wonder, we are using anxiolytics and sedatives more often; to get relief from the anxiety and insomnia respectively.

Benzodiazepines such as diazepam (Valium), chlordiazepoxide (Librium) can effectively treat anxiety and insomnia. They do so by binding with a receptor (called Benzodiazepine-GABAa-chloride ion channel complex [henceforth to be referred to simply as GABAa receptor]) in nerve cell membranes. It is known that most drugs (medicines) exert their actions by combining with receptors: macromolecular complexes present in the cell membrane or within the cytosol or the nucleus.

The GABAa receptor is a very versatile receptor complex (a hypothetical model is shown at the bottom). Its main action is to inhibit transmission along neurons in which they are present. Normally, proper functioning of the brain is ensured by a balance between the action of excitatory and inhibitory neurotransmitters [henceforth to be referred to simply as NTs]. Simply put, excitatory NTs (for example, glutamate) give a green or go signal; while inhibitory NTs (such as GABA) tell the nerve not to fire (red or stop signal). In this connection, it must be said that GABA (gamma amino butyric acid) is the most important inhibitory NT. When GABA binds with the GABA receptor ionophore complex, the receptor changes shape (conformation); and then a centrally located chloride channel, that is a part of the receptor itself, opens. Since the concentration of the chloride ions (Cl-) is much more on the outside of the cell than on the inside, Cl- now rushes in due to the increase in chloride conductance. The cell voltage goes further down and the interior of the cell becomes more negative (hyperpolarized) with respect to the outside. The cell becomes less excitable and is thus inhibited.

Apart from maintaining the much needed critical balance already mentioned, they also ensure that the brain works in a relatively noise free environment. Billions of neuronal units are always firing in the background creating a constant ‘noise’. A constant release of GABA by the brain drowns out this noise thus improving the ‘signal to noise’ ratio, making the brain’s task of finding the proverbial ‘needle in a haystack’ a lot easier.

The GABAa receptor not only binds with GABA, but it is a binding site for various other ligands. But before we discuss them, let us briefly analyze its structure first. The receptor has a pentameric structure which means that it consists of five subunits, and each subunit has four membrane-spanning (transmembrane) domains (see picture). And there are many of the polypeptide subunits to choose from a vast array consisting of alpha, beta, gamma, delta, pi, rho and so on. (In addition, there are six different forms of alpha, 4 beta and 3 gamma subunits). Thus, it’s no wonder that a great variety of GABAa receptors will be found, given the possible permutations!

This receptor heterogeneity explains actions of various pharmaceuticals on the receptor. One major form of GABAa receptor (found throughout the brain) consists of two alpha1, two beta2 and one gamma2 subunits. In this isoform, GABA ‘somewhere’ between alpha1 and beta2 subunits, and benzodiazepines bind with the BZ1 (also called omega1) pockets located between alpha1 and gamma2 subunits. Benzodiazepines act only when the receptor isoform has one of the following alpha subunits: 1, 2, 3 or 5 and the subunit should have a conserved histidine residue in the N-terminal domain. In ‘knock-in’ mice where histidine has been replaced by arginine in the alpha1 subunit (alpha1H101R; H for histidine and R for arginine in the 101st residue of alpha1 subunit) there was no sedation or amnesia (as evidenced by their unchanged ‘energy’ and memory to electric shocks). It may be mentioned at this moment that the so called ‘date rape’ pills exploit the amnestic properties of benzodiazepines. The drug plays tricks with the victims’ memories. However, the anxiolytic and muscle relaxant properties were retained in these mice.

These mice also do not respond to the hypnotic effects of zolpidem and zaleplon, non-benzodiazepines that act at GABAa receptors containing alpha1 subunits. But in mice with selective histidine arginine mutation in the alpha2 subunit of GABAa receptors, resistance to the antianxiety action of benzodiazepines has been seen. Based on these observations, it is thought that alpha1 subunit mediates sedative and amnestic effects, while alpha2 takes care of the anxiolytic and muscle relaxant ones. It also seems that we are poised to make better benzodiazepines in future (like one that works in anxiety but doesn’t wreak the patients’ memory).

Lastly, the versatility. The GABAa receptor also binds barbiturates (urea derivatives used as anesthetics, anticonvulsants, Marilyn Monroe supposedly died of its overdose) in addition to the benzos. Alcohol, alphaxolone (a steroid anesthetic), etomidate (a short acting anesthetic), propofol (diprivan, Michael Jackson supposedly used it), volatile anesthetics like halothane, anticonvulsants like gabapentin and vigabatrin, anthelminthics like ivermectin, and neurosteroids (metabolites of androgen and progesterone) exert part or all of their actions by acting through this receptor, thereby hyperpolarizing the neuron. Conversely, convulsants picrotoxin blocks the chloride channel directly, while bicuculline blocks the receptor’s GABAa binding site causing depolarization and convulsion. There's a lot more than this mere exegesis, and I hope to discuss about it furher later.

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Reference: Bertram G. Katzung, Basic and Clinical Pharmacology, ninth edition
Pharmacology: Rang, Dale, Ritter, Moore
Wisden, W., & Stephens, D. (1999). Pharmacology: Towards better benzodiazepines Nature, 401 (6755), 751-752 DOI: 10.1038/44482