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The Safety, Efficacy and Neuromotor Effects of the Neurosteroid Anaesthetic Alfaxalone in Rats Cora Lau Bvsc (Hons)

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The Safety, Efficacy and Neuromotor Effects of the Neurosteroid Anaesthetic Alfaxalone in Rats Cora Lau Bvsc (Hons) The Safety, Efficacy and Neuromotor Effects of the Neurosteroid Anaesthetic Alfaxalone in Rats Cora Lau BVSc (Hons) A thesis submitted for the degree of Doctor of Philosophy at The University of Queensland in 2013 School of Biomedical Sciences 1 Abstract Rodents are routinely anaesthetised for husbandry and biomedical research purposes. All anaesthetics carry a degree of risk, complications and side effects. An ideal anaesthetic for rodents is safe, predictable, alleviates pain and distress and can be performed without specialist training. A survey was created to identify anaesthetic agents frequently administered to rodents currently utilised by the research community. Findings indicated injectable anaesthetics were very commonly used and complications were often associated with use, highlighting the lack of a safe, predictable laboratory rodent anaesthetic protocol. Alfaxalone is a neuroactive steroid injectable anaesthetic agent with a high margin of safety, and is commonly used in veterinary anaesthesia as the Alfaxan® formulation. I sought to establish whether alfaxalone could be used as an injectable anaesthetic agent for laboratory rodents. A plasma pharmacokinetics study was performed using IV and IP Alfaxan® in adult female Wistar rats (7-10 -1 weeks). Mean T1/2elim for 2 and 5 mg.kg IV was short (~17 minutes), but could not be estimated for IP dosing due to sustained plasma levels for up to 60 minutes after injection. Clp for IV injection was -1 calculated at 24.5% and 23% of cardiac output respectively. The observed Cmax was 2.99 mg.L for IP administration, and 2.2 ± 0.9 and 5.2 ± 1.3 mg.L-1 for 2 and 5 mg.kg-1 IV administration -1 respectively. AUC0-60 was 96 min.mg.L for IP dosing. The relative bioavailability for IP dosing was 26% and 28%, compared to IV doses of 2 and 5mg.kg-1 respectively. Alfaxalone given IP caused longer sleep times than IV dosing, although anaesthesia was not induced in 30% of rats. Importantly, all rats exhibited muscle twitching after alfaxalone administration. I then sought to test whether combining IP injection of Alfaxalone with common premedication agents could improve anaesthetic induction rates and reduce muscle twitching, to provide a viable anaesthetic regimen for rats. Medetomidine (0.5 mg.kg-1), medetomidine-butorphanol (0.35 mg.kg-1-0.2 mg.kg-1), -1 -1 -1 -1 Acetylpromazine (ACP) -methadone (3 mg.kg -0.7 mg.kg ) and ACP-xylazine (3 mg.kg -3 mg.kg ) were administered IP 10 minutes prior to IP alfaxalone (20 mg.kg-1). ACP-xylazine, medetomidine and medetomidine-butorphanol all significantly reduced twitching. Medetomidine-butorphanol provided surgical anaesthesia without prolonged recovery and provided an adequate plane of anaesthesia for short painful surgical procedures. However, none of these premedication agents fully eliminated alfaxalone-induced muscle twitching. I therefore carried out electrophysiological studies of motor neurons (MN), to determine the mechanism causing neuromotor excitation in response to alfaxalone. Previous data has shown that alfaxalone can modulate strychnine-sensitive glycinergic receptors, which may, in part, contribute to the adverse neuromotor excitatory responses manifested as muscle twitching during alfaxalone anaesthesia. The 2 effects of alfaxalone on inhibitory synaptic transmission to hypoglossal motor neurones (HMNs) were investigated. Whole cell patch clamp recordings were performed on HMNs in transverse brainstem slices (300 µm thickness) prepared from 10-12 day old Wistar rats anaesthetised with sodium pentobarbitone (100 mg.kg-1 IP). Spontaneous and evoked glycinergic inhibitory post-synaptic currents (IPSCs) were recorded at a holding potential of –60mV, using a CsCl-based internal solution, in the presence of the non-NMDA and NMDA glutamate receptor blockers NBQX (10µM) and APV (50µM) and the GABAA receptor blocker bicuculline (5µM). An alfaxalone dose response study was performed with bath-applied alfaxalone at increasing concentrations of 10nM, 30nM, 100nM, 300nM, 1µM, 3µM and 10µM (n=7). Both spontaneous and paired evoked IPSCs (at 150 ms inter-stimulus interval) were recorded. A reduction in evoked IPSC peak amplitude, rise time and decay time without paired pulse ratio changes was consistent with alfaxalone altering postsynaptic glycine receptors, causing prolongation of both channel opening and closure. A decrease in spontaneous IPSC frequency at higher doses was suggestive of presynaptic modulation by alfaxalone, decreasing glycine release from the presynaptic terminal. At high doses, alfaxalone induced an inward current in HMNs, without significant change in input resistance. Cannabinoid receptors (CBR) can directly modulate both glycine release and GlyR function in HMNs. I postulated that alfaxalone exerted its effects on glycinergic transmission by increasing postsynaptic endocannabinoid synthesis and activation of cannabinoid 1 receptors (CB1Rs). The CB1R inverse agonist-antagonist AM251 (1µM; n= 6) or the CB1R competitive antagonist NESS0327 (100pM; n=5) both blocked spontaneous IPSC frequency depression, evoked IPSC amplitude reduction, decay time prolongation and baseline inward current produced by alfaxalone at micromolar concentrations. Application of the CB1R competitive agonist WIN55,212-2 (n=7) alone caused a dose-dependent evoked IPSC peak amplitude depression, starting at nanomolar concentrations. WIN55,212-2 (300nM; n=5) partially blocked IPSC amplitude reduction by co-application of alfaxalone, but did not alter increases in IPSC decay time or induction of an inward current. These findings indicate that alfaxalone induced endocannabinoid signalling to indirectly activate CB1Rs, which resulted in reduced postsynaptic glycine receptor activity at low alfaxalone doses, and reduced presynaptic release of glycine and induction of an inward current at higher alfaxalone doses. These responses to alfaxalone are likely to make HMNs more excitable, and may therefore underlie neuromotor excitation during alfaxalone anaesthesia. Combination of alfaxalone with CB1R antagonists or negative modulators of endocannabinoid signalling may therefore provide an optimal anaesthetic regime for laboratory rodents. 3 Declaration by author This thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis. I have clearly stated the contribution of others to my thesis as a whole, including statistical assistance, survey design, data analysis, significant technical procedures, professional editorial advice, and any other original research work used or reported in my thesis. The content of my thesis is the result of work I have carried out since the commencement of my research higher degree candidature and does not include a substantial part of work that has been submitted to qualify for the award of any other degree or diploma in any university or other tertiary institution. I have clearly stated which parts of my thesis, if any, have been submitted to qualify for another award. I acknowledge that an electronic copy of my thesis must be lodged with the University Library and, subject to the General Award Rules of The University of Queensland, immediately made available for research and study in accordance with the Copyright Act 1968. I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis. 4 Publications during candidature Chapter TWO was submitted and published in the Journal of Veterinary Pharmacology and Therapeutics as a short communication (Appendix Two, publications). Publications included in this thesis Publication citation – incorporated as Chapter 2. Contributor Statement of contribution Cora Lau Designed experiments (80%) Wrote the paper (75%) Dr Mark Bellingham Wrote and edited paper (15%) Dr Ian Shiels Designed experiments (10%) Edited paper (5%) Dr Kirby Pasloske Statistical analysis of data in table 2 Designed experiments (10%) Wrote and edited paper (5%) Millagahamanda Ranasinghe Plasma analysis for data in table 2 Wrote and edited paper (5%) Dr Helen Keates Edited paper (5%) 5 Contributions by others to the thesis Dr Ristan Greer aided in the design of the Rodent anaesthetic survey in Chapter 1. Dr John Morton supplied technical support for Chapter 2 in helping to design the cross over study. Statement of parts of the thesis submitted to qualify for the award of another degree None 6 Acknowledgements I would like to take this opportunity to formally acknowledge and thank the many people that have supported me throughout my PhD candidature. I could not have completed this PhD without the help of all of these people and I hope I have not missed anyone. I could not have asked for better supervisors- Dr Mark Bellingham, Dr Ian Shiels, Dr Helen Keates and Associate Professor Paul Mills, as they have been so encouraging and were always available at a moment’s notice. Their support and encouragement have made this candidature an experience that will remember with fond memories. I would also like to thank Professor Stephen Taylor and Associate Professor Peter Noakes for their strong support, and for the use of their laboratory space and equipment. I thank Jurox Pty Ltd for their generous contribution of drugs and technical expertise.
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