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Up-regulation of the persistent sodium current (INaP) and down-regulation of the potassium/chloride extruder KCC2 lead to spasticity after spinal cord injury (SCI). We here identified calpain as the driver of the up- and down-regulation of INaP and KCC2, respectively, in neonatal rat lumbar motoneurons. Few days after SCI, neonatal rats developed behavioral signs of spasticity with the emergence of both hyperreflexia and abnormal involuntary muscle contractions on hindlimbs. At the same time, in vitro isolated lumbar spinal cords became hyperreflexive and displayed numerous spontaneous motor outputs. Calpain-I expression paralleled with a proteolysis of voltage-gated sodium (Nav) channels and KCC2. Acute inhibition of calpains reduced this proteolysis, restored the motoneuronal expression of Nav and KCC2, normalized INaP and KCC2 function, and curtailed spasticity. In sum, by up- and down-regulating INaP and KCC2, the calpain-mediated proteolysis of Nav and KCC2 drives the hyperexcitability of motoneurons which leads to spasticity after SCI.

International audience; After a spinal cord injury (SCI), patients develop spasticity, a motor disorder characterized by hyperreflexia and stiffness of muscles. Spasticity results from alterations in motoneurons with an upregulation of their persistent sodium current (INaP), simultaneously with a disinhibition caused by a reduction of expression of chloride (Cl-) co-transporters KCC2. Until recently the origin of alterations was unknown. After reviewing pathophysiology of spasticity, the manuscript relates our recent work showing a tight relationship between the calpain-dependent proteolysis of voltage-gated sodium channels, the upregulation of INaP and spasticity following SCI. We also discuss KCC2 as a substrate of calpains which may contribute to the disinhibition of motoneurons below the lesion. This led us to consider the proteolytic cleavage of both sodium channels and KCC2 as the upstream mechanism contributing to the development of spasticity after SCI.; Suite à un traumatisme de la moelle épinière, la plupart des patients développent une exagération du tonus musculaire appelée spasticité, qui aboutit souvent à une incapacité motrice. Dans cette revue, nous résumerons les principaux mécanismes physiopathologiques de la spasticité qui découlent d’une lésion médullaire puis décrirons l’apport de nos récents travaux identifiant une protéase, la calpaïne, comme le promoteur de ces mécanismes physiopathologiques. Cette découverte ouvre de nouvelles pistes thérapeutiques dans le traitement de la spasticité.Suite à un traumatisme de la moelle épinière, la plupart des patients développent une exagération du tonus musculaire appelée spasticité, qui aboutit souvent à une incapacité motrice. Dans cette revue, nous résumerons les principaux mécanismes physiopathologiques de la spasticité qui découlent d’une lésion médullaire puis décrirons l’apport de nos récents travaux identifiant une protéase, la calpaïne, comme le promoteur de ces mécanismes physiopathologiques. Cette découverte ouvre de nouvelles pistes thérapeutiques dans le traitement de la spasticité.

International audience; a r t i c l e s nature medicine advance online publication Spasticity, a common debilitating complication in people with spinal cord injury (SCI), is characterized by a velocity-dependent increase in the tonic stretch reflex and spasms 1. It is primarily attributed to a reduction in postsynaptic inhibition and an increase in the excit-ability of motoneurons below the lesion 2. Although disinhibition is related to a dysregulation of chloride homeostasis 3 , the mechanisms that cause motoneuron hyperexcitability are not yet fully understood. In the healthy spinal cord, the excitability of motoneurons is set by brainstem-derived serotonin (5-hydroxytryptamine (5-HT)). The activation of 5-HT type 2 receptors (5-HT 2) facilitates voltage-gated persistent calcium and sodium currents 4,5 (persistent inward currents, or PICs). These PICs considerably amplify the activity of brief synaptic excitatory inputs, which enables sustained muscle contractions 6. PICs are reduced early after SCI 7 as compared to those in healthy spinal cords, but slowly recover within weeks, leading to excessive motoneu-ron activity that is characterized by the plateau potentials associated with muscle spasms 8,9. The upregulation of Ca 2+ PICs in the chronic phase after the injury is due to the increased expression of 5-HT sub-type 2C receptors (5-HT 2C), which become constitutively active 10. However, a major question that remains is how the Na + PIC (I NaP)—a key conductance of the locomotor network 11–14 that drives plateau potentials in motoneurons 15 —is upregulated. In adult rats, spinal cord neurons express mRNA encoding five α-subunits of sodium channels (Nav1.1, Nav1.2, Nav1.3, Nav1.6 and Nav1.7) 16 , but the main α-subunits in spinal motoneurons are Nav1.1 and Nav1.6 (ref. 17). We demonstrate here that the upregulation of I NaP after SCI is accompanied by a proteolytic cleavage of the α-subunit of Nav channels. We further show that calpains, a family of intracellular calcium-dependent cysteine proteases 18 , are responsible for the cleavage of Nav1.6 channels. Our results open new therapeutic avenues, given that blocking either I NaP or the activity of calpain reduces spasticity. RESULTS Upregulation of Nav1.6 a-subunit expression after SCI We tested whether abnormal expression of Nav channels accounts for the upregulation of I NaP after SCI. To model SCI in rodents, we carried out a complete transection at the T8–T9 level in adult female rats to avoid regeneration of the supraspinal tracts. At 15 d, 30 d and 60 d after SCI or sham surgery, we performed immunohistochemistry in lumbar segments L4–L5 (caudal to the lesion) to analyze the expression of the two main Nav α-subunits that are present in motoneurons (Nav1.1 and Nav1.6 (ref. 17)). A pan-Nav antibody that recognizes all Nav1 isoforms strongly stained axon initial segments (AISs) of motoneurons in both sham-operated and SCI rats (Fig. 1a). Although the Nav1.1 α-subunit was hardly detectable (Supplementary Fig. 1a), Nav1.6-specific immunolabeling largely overlapped the pan-staining (Fig. 1a, middle and right). The intensity of Nav immunostaining revealed by both the pan-Nav and the Nav1.6 antibodies was higher in motoneurons after SCI than in sham-operated controls as early as 15 d after SCI (P < 0.001; Fig. 1a–c). Conversely, the Nav1.6-specific immunostaining in the AIS segments of Renshaw cells did not change after SCI (P > 0.05; Supplementary Fig. 1b,c). Calpain mediates proteolysis of Nav1.6 channels after SCI To confirm the changes in Nav expression after SCI, we performed western blots on the membrane fractions isolated from the lumbar Upregulation of the persistent sodium current (I NaP) in motoneurons contributes to the development of spasticity after spinal cord injury (SCI). We investigated the mechanisms that regulate I NaP and observed elevated expression of voltage-gated sodium (Nav) 1.6 channels in spinal lumbar motoneurons of adult rats with SCI. Furthermore, immunoblots revealed a proteolysis of Nav channels, and biochemical assays identified calpain as the main proteolytic factor. Calpain-dependent cleavage of Nav channels after neonatal SCI was associated with an upregulation of I NaP in motoneurons. Similarly, the calpain-dependent cleavage of Nav1.6 channels expressed in human embryonic kidney (HEK) 293 cells caused the upregulation of I NaP. The pharmacological inhibition of calpain activity by MDL28170 reduced the cleavage of Nav channels, I NaP in motoneurons and spasticity in rats with SCI. Similarly, the blockade of I NaP by riluzole alleviated spasticity. This study demonstrates that Nav channel expression in lumbar motoneurons is altered after SCI, and it shows a tight relationship between the calpain-dependent proteolysis of Nav1.6 channels, the upregulation of I NaP and spasticity.