WNK-SPAK/OSR1 signaling pathway facilitates ictal activity via reduced neuronal chloride extrusion rate

Seizures upregulate Na+-K+-2Cl- (NKCC1)-mediated Cl- influx and downregulate K+-Cl- (KCC2)-mediated Cl- efflux via the WNK-SPAK/OSR1 kinases, leading to cytoplasmic chloride ([Cl-]i) accumulation, reduced GABAergic inhibition and anticonvulsant failure. Early studies found that inhibiting WNK-kinase reduced baseline [Cl-]i (ECl) and seizures via increased KCC2 activity. However, increased KCC2 activity alone should not affect ECl whose determinants are more complex. We determined the net effects of WNK-SPAK/OSR1 pathway inhibitor WNK463 on ECl and [Cl-]i transients during spontaneous ictal-like discharges (ILDs). We found that WNK463 reduced interictal [Cl-]i but did not change baseline [Cl-]i measured in the presence of TTX. WNK463 enhanced neuronal Cl- extrusion during and after ILDs, before abolishing ILDs. Pharmacological inhibition and targeted siRNA silencing demonstrated that the anti-ictal effects of WNK463 involved both NKCC1 and KCC2. Our data support a mechanism whereby mutual NKCC1 inhibition and KCC2 activation via the WNK-SPAK/OSR1 pathway exert powerful anti-ictal effects by facilitating [Cl-]i extrusion during ILDs.