Effects of ionic concentration dynamics on neuronal activity

Neuronen sind bei der Informationsübertragung des zentralen Nervensystems von entscheidender Bedeutung. Ihre Aktivität liegt der Signalverarbeitung und höheren kognitiven Prozessen zugrunde. Neuronen sind in den extrazellulären Raum eingebettet, der mehrere Teilchen, darunter auch Ionen, enthält. Ionenkonzentrationen sind nicht statisch. Intensive neuronale Aktivität kann intrazelluläre und extrazelluläre Ionenkonzentrationen verändern. In dieser Arbeit untersuche ich das Wechselspiel zwischen neuronaler Aktivität und der Dynamik der Ionenkonzentrationen. Dabei konzentriere ich mich hauptsächlich auf extrazelluläre Kalium- und intrazelluläre Natriumkonzentrationen. Mit Hilfe der Theorie dynamischer Systeme zeige ich, wie moderate Änderungen dieser Ionenkonzentrationen die neuronale Aktivität qualitativ verändern können, wodurch sich möglicherweise die Signalverarbeitung verändert. Dann modelliere ich ein leitfähigkeitsbasiertes neuronales Netzwerk mit Spikes. Das Modell sagt voraus, dass eine moderate Änderung der Konzentrationen, die einen Mikroschaltkreis von Neuronen umgeben, die Leistungsspektraldichte der Populationsaktivität verändern könnte. Insgesamt unterstreicht diese Arbeit die Bedeutung der Dynamik der Ionenkonzentrationen für das Verständnis neuronaler Aktivität auf langen Zeitskalen und liefert technische Erkenntnisse darüber, wie das Zusammenspiel zwischen ihnen modelliert und analysiert werden kann.Neurons are essential in the information transfer mechanisms of the central nervous system. Their activity underlies both basic signal processing, and higher cognitive processes. Neurons are embedded in the extracellular space, which contains multiple particles, including ions which are vital to their functioning. Ionic concentrations are not static, intense neuronal activity alters the intracellular and extracellular ionic concentrations which in turn affect neuronal functioning. In this thesis, I study the interplay between neuronal activity and ionic concentration dynamics. I focus specifically on the extracellular potassium and intracellular sodium concentrations. Using dynamical systems theory, I illustrate how moderate changes in these ionic concentrations can qualitatively change neuronal activity, potentially altering signal processing. I then model a conductance-based spiking neural network. The model predicts that a moderate change in the concentrations surrounding a microcircuit of neurons could modify the power spectral density of the population activity. Altogether, this work highlights the need to consider ionic concentration dynamics to understand neuronal activity on long time scales and provides technical insights on how to model and analyze the interplay between them

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life