NitroSynapsin for the treatment of neurological manifestations of tuberous sclerosis complex in a rodent model

Tuberous sclerosis (TSC) is an autosomal dominant disorder caused by heterozygous mutations in the TSC1 or TSC2 gene. TSC is often associated with neurological, cognitive, and behavioral deficits. TSC patients also express co-morbidity with anxiety and mood disorders. The mechanism of pathogenesis in TSC is not entirely clear, but TSC-related neurological symptoms are accompanied by excessive glutamatergic activity and altered synaptic spine structures. To address whether extrasynaptic (e)NMDA-type glutamate receptor (NMDAR) antagonists, as opposed to antagonists that block physiological phasic synaptic activity, can ameliorate the synaptic and behavioral features of this disease, we utilized the Tsc2+/− mouse model of TSC to measure biochemical, electrophysiological, histological, and behavioral parameters in the mice. We found that antagonists that preferentially block tonic activity as found at eNMDARs, particularly the newer drug NitroSynapsin, provide biological and statistically significant improvement in Tsc2+/− phenotypes. Accompanying this improvement was correction of activity in the p38 MAPK-TSC-Rheb-mTORC1-S6K1 pathway. Deficits in hippocampal long-term potentiation (LTP), histological loss of synapses, and behavioral fear conditioning in Tsc2+/− mice were all improved after treatment with NitroSynapsin. Taken together, these results suggest that amelioration of excessive excitation, by limiting aberrant eNMDAR activity, may represent a novel treatment approach for TSC. •Agents that preferentially block tonic extrasynaptic NMDA receptor activity ameliorate tuberous sclerosis phenotypes.•Aberrant activity in the p38 MAPK-TSC-Rheb-mTORC1-S6K1 pathway of Tsc2+/- mice is rescued by NitroSynapsin treatment.•NitroSynapsin corrects deficits in hippocampal LTP, loss of synapses, and fear conditioning in Tsc2+/- mice.•Limiting excessive extrasynaptic NMDA receptor activity may be a treatment for tuberous sclerosis.