Abstract
Neurodegenerative diseases, such as Parkinson's disease (PD), Alzheimer's disease (AD), and Dementia with Lewy bodies (DLB), display an accumulation of proteins including α-synuclein aggregates in cortical and subcortical regions of the brain. PD is a complex, progressive disease which involves damage of motor and cognitive brain regions, as well as autonomic and sensory areas. Since α-synuclein is a neuronal cytosolic protein, it is assumed that pathogenic changes induced by α-synuclein aggregates occur only at the cytoplasmic level. However, recent studies have identified the presence of extracellular α-synuclein, suggesting that the pathogenic action of this protein may also occur in the extracellular milieu through an unknown mechanism. One of the hypotheses is that extracellular α-synuclein aggregates or oligomers may directly disrupt the neuronal membrane by the formation of a pore reminiscent to the ones formed by β-amyloid aggregates. Here, we will review some evidence that support this mechanism, analyzing the interactions of α-synuclein with components of the plasma membrane, the formation of pore/perforated structures, and the implications on ionic dyshomeostasis. Furthermore, we will also discuss how this mechanism can be integrated into a general phenomenon that may explain the synaptotoxicity and neurotoxicity observed in different neurodegenerative diseases.
Neurodegenerative diseases and α-synuclein
Neurodegenerative diseases typically involve deposits of inclusion bodies that contain abnormal aggregated proteins (Bossy-Wetzel et al., ). Therefore, it has been suggested that protein aggregation is a pathogenic process, characterized by multi-steps in protein conformational changes (Ross and Poirier, 2004).
The homeostasis of proteins, or recently called Proteostasis, refers to different cellular pathways that regulate protein synthesis, folding, function, and degradation (Roth and Balch, 2011). There is plenty of evidence indicating that the overall proteostasis is impaired with aging, manifesting an increase in protein oxidation along with changes that exacerbate the aggregation, providing a partial explanation for several diseases known as conformational diseases (Balch et al., ). Neurodegenerative diseases are conformational diseases characterized by abnormal protein deposition, which can be cytoplasmic, nuclear, or extracellular (Bossy-Wetzel et al., ). Protein aggregates called Amyloid are characterized by a β-sheet secondary structure presenting higher affinity to bind dyes like Congo red and Thioflavin-T, higher resistance to proteolytic degradation, and a fibrillar appearance under electron microscopy (Ross and Poirier, 2004).
α-Synuclein is an unstructured soluble protein that can assemble into amyloid aggregates forming intracellular inclusion bodies called Lewy bodies (LBs) present in Parkinson's disease (PD), Dementia with Lewy bodies (DLB), and Multiple System Atrophy (MSA) (Spillantini et al., 1997, 1998; Tu et al., 1998). These disorders are known as synucleinopathies. However, this neuropathological feature is also commonly found in both sporadic and familial cases of Alzheimer's disease (AD). Therefore, α-synuclein dysfunction might be a common factor in several neurodegenerative diseases (Goedert, ).
LBs consist of eosinophilic and round cytoplasmic inclusions that are particularly enriched in the substantia nigra in PD (Braak et al., ), cortical brain areas in DLB (Kosaka, ), and amygdala in AD (Lippa et al., ). However, there is wide evidence that indicates that small α-synuclein species (i.e., oligomers) are responsible for the synaptotoxicity, neurotoxicity, and the final spread of this neurodegenerative disease throughout the brain (Winner et al., 2011). Therefore, the formation of α-synuclein inclusion bodies could be a protective mechanism against the smaller species. Nevertheless, it is possible that both soluble misfolded intermediates and amyloid-like fibril deposits may be toxic, but perhaps by different cellular mechanisms. For example, soluble oligomeric species in AD might affect synaptic transmission (Parodi et al., 2010), whereas LBs are intracellular space-occupying entities that may interfere with neuronal and glial intercellular communication (Goedert, ).
Here, we will review the progression pattern of PD and some properties of α-synuclein oligomers, especially their association to the membrane. Finally, we will propose that extracellular α-synuclein is implicated in synaptotoxicity and neurotoxicity by making the plasma membrane more permeable.
Parkinson's disease
PD is a human motor control disorder and the second most common neurodegenerative disorder after AD (Goedert, ). It affects 1–2% of the adult population over 65 years and is clinically characterized by muscle rigidity, bradykinesia (slowness of movement), and tremor at rest (Jankovic, ). Pathologically, PD is characterized by loss of dopaminergic neurons in the substantia nigra pars compacta (an important region of the basal ganglia that regulates movement) (Goedert, ) and by the intracellular accumulation of LBs in surviving neurons and Lewy neurites that advance in a topographically predictable sequence (Braak et al., ).
The etiology of PD is unknown, although older age and neurotoxins are established risk factors (Marttila and Rinne, ; Langston et al., ). Actually, there is much evidence suggesting that α-synuclein aggregates participate in the pathogenesis of the disease. First, intraneuronal LBs are a histological feature of PD (Spillantini et al., 1997, 1998). Second, genetic analyses have identified three mutations of α-synuclein associated to inherited forms of PD (Polymeropoulos et al., 1997; Kruger et al., ; Zarranz et al., 2004), where each of the mutant variants have been shown to alter the oligomerization or fibrilization of the protein (Conway et al., ). Finally, it was determined that duplication or triplication of the gene locus of α-synuclein results in an increased expression of this protein, linked to a familial form of PD (Singleton et al., 2003; Chartier-Harlin et al., ; Ibanez et al., ). Overall, these findings suggest that the accumulation of α-synuclein is a critical factor in PD.
Parkinson's progression
PD is mainly described as a motor disease, but as the disease progresses important regions associated to autonomic, limbic, and somatomotor functions become affected (Figure 1) (Braak et al., ). Moreover, dementia, a non-motor symptom, is detected in a large proportion of patients with PD over the course of the disease; however, the time of onset and rate of the cognitive decline is highly variable (Aarsland et al., ). Dementia with LBs accounts for β30% of all age-related dementias, and up to 40% of AD cases exhibit α-synuclein pathology (Parkkinen et al., 2003; Jellinger, ; Mikolaenko et al., 2005; Zaccai et al., 2005). It is interesting to note that 20–40% of PD patients have cognitive impairments at disease onset and that β80% of PD patients eventually develop dementia (PDD) (Aarsland et al., ). In some individuals, however, cognitive decline can develop in the presence of mild PD-related cortical pathology and, conversely, widespread cortical lesions do not necessarily lead to cognitive decline (Braak et al., ). The mechanisms leading to the initiation and spread of α-synuclein pathology in PD are not well understood and one possibility to answer this query is that α-synuclein aggregates can progress to different brain areas in a similar manner to the propagation of prion diseases (Aguzzi, ). Interestingly, spread of LBs from host tissues to long-term fetal cell grafts in the brain of PD patients has been shown (Kordower et al., ) and supported by other studies (Mendez et al., 2005; Li et al., ). Therefore, it appears possible to generate the formation of LB-like structures in healthy normal neurons.
Figure 1
Cell biology and biochemistry of α-synuclein
Localization
The synuclein protein family is expressed in three forms, α-, β-, and γ-synuclein, which have multiple locations (Lavedan,
Structure
α-Synuclein has four isoforms composed by 98, 112, 126, and 140 amino acids, with the latter being the most abundant (Bisaglia et al.,
Physiological role of α-synuclein
The physiological role of α-synuclein has not been determined with certainty yet, mainly because knockout mice for this protein do not present a substantial change in the phenotype, suggesting that its function is likely redundant (Chandra et al.,
Pathological role
Since α-synuclein is a cytosolic protein, it is assumed that the principal pathological alterations induced by this protein occur only at the intracellular level. Among the mechanisms that explain the role of intracellular α-synuclein on PD pathogenesis, the following are well known: (1) inhibition of the ubiquitin-proteasome system (Emmanouilidou et al.,
It is possible that α-synuclein has a dual role: a physiological role involved in the regulation of synaptic transmission; and a pathological role associated with neurodegenerative processes. Can these two roles be sequentially/temporally/directly connected? There is still no clear answer to these questions, but we think that there must be a synaptic switch that commands the onset of the disease. So it is important to understand what are the differences and similarities between the pathogenic and physiological mechanisms of α-synuclein. Part of the answer might lay in the structural flexibility that α-synuclein displays which facilitates the transition from a soluble (physiological) to an aggregate state (pathogenic).
α-synuclein aggregates
With respect to the process of α-synuclein aggregation, in vitro studies indicate the presence of a nucleation-dependent mechanism characterized by a slow onset (Cremades et al.,
α-synuclein secretion
How is α-synuclein secreted? Although the exact mechanism has not been characterized yet, it has been found that a small portion of α-synuclein is secreted into the extracellular medium via unconventional exocytosis, different to the classical exocytosis through ER/Golgi (Lee et al.,
Figure 2

A hypothetical model for secretion and synaptic targets of α-synuclein oligomers. The figure shows four different mechanisms for unconventional secretion of α-synuclein (Nickel and Rabouille, 2009). Mechanism 1 depicts a non-vesicular translocation of α-synuclein mediated by an unknown transmembrane protein located at the plasma membrane. Mechanisms 2–4 depict vesicular mechanisms for α-synuclein secretion that involve lysosomes (2), microvesicle shedding (3), or endosome/multivesicular bodies (4). Mechanisms 3 and 4 involve the release of α-synuclein into exosomes. Once in the extracellular space (Lee,
Role of Ca2+ in parkinson's disease
Ca2+ has critical roles in neuronal functions, including the regulation of neurite outgrowth and synaptogenesis, synaptic transmission and plasticity, and cell survival (Mattson, 2007). There is a lot of evidence indicating the involvement of Ca2+ in PD. Some studies indicate that α-synuclein controls the function of voltage gated calcium channels (Adamczyk and Strosznajder,
Formation of α-synuclein pores/perforations
One of the first steps in the formation of pores/perforations is the association of α-synuclein to the membrane, which is discussed in the following two sections:
α-synuclein association to membranes
It has been shown that α-synuclein associates with phospholipid bilayers in artificial membranes, especially with those membranes containing acidic phospholipids (Davidson et al.,
In natural membranes, α-synuclein has been shown to associate, as a peripheral membrane protein, with synaptic vesicles (Maroteaux et al.,
Models of α-synuclein pores/perforations
One of the biggest complications in understanding the structure of the α-synuclein pore is that there are no crystallographic data for this protein, likely due to the complexity to crystallize amyloid species. There is also a lack of high-resolution models for biological membranes that would aid in the understanding of the mechanism by which α-synuclein pores/perforations are formed. However, there are mainly two types of pore models, toroidal and barrel (Yang et al., 2001), that may explain α-synuclein perforation properties (Figure 3). A toroidal model involves a sequential binding of α-synuclein monomers to lipid membranes that result in the formation of pores or channels with α-helical conformation (Zakharov et al., 2007). In fact, it is believed that the basic KXKE repetitions in the N-terminal of α-synuclein act as a membrane voltage sensor (Zakharov et al., 2007). Furthermore, in silico studies have shown that the sequential binding of α-synuclein to the membrane occurs between the N-terminal of each of the monomers, leading to the formation of pentamers and hexamers to generate ring-type structures with different external size ranges (9–15 nm) and internal diameters (2–5 nm) (Tsigelny et al., 2007). Even aged samples of α-synuclein, with an expected β-sheet oligomeric conformation, were shown to bind vesicles in an α-helical state (Smith et al., 2008). This model contrasts with the barrel model that indicates that α-synuclein oligomers (β-sheet-rich) form ring structures with a central pore (Volles and Lansbury, 2003). These aggregates would bind in the membrane (Volles et al., 2001) causing its permeabilization in a concentration-dependent manner, which has been shown in liposomes (Volles et al., 2001) and artificial membrane bilayers (Kayed et al.,
Figure 3

Primary and secondary structure of α-synuclein. Top scheme shows the three main domains of α-synuclein. The N-terminal (red) is an amphipathic domain that contains the three point mutations (white bars) linked to the autosomal dominant form of PD (Bisaglia et al.,
Conclusions
In conclusion, we reviewed information that supports the role of extracellular α-synuclein in PD. Like other prone-aggregating proteins, α-synuclein can interact with lipids in the plasma membrane, increasing membrane permeability by the formation of not well characterized structures (pore or perforations) that may lead to calcium or transition metal dyshomeostasis, which may induce subsequent synaptotoxicity and neuronal death.
α-Synuclein protein is the main component of LBs present in PD, DLB, and related neurodegenerative diseases. Therefore, α-synuclein aggregates (intracellular and extracellular) could be enhancing the synaptotoxic/neurotoxic effects of other protein aggregates (oligomers) such as Aβ aggregates. In fact, recent studies have shown that Aβ and α-synuclein form hybrid pore-like oligomers that could change membrane permeability (Tsigelny et al., 2008b).
However, further studies are needed to understand the precise mechanisms by which extracellular α-synuclein forms channels, pores, or perforations and the role that these structures have in neurodegenerative diseases, especially in PD. A crucial question is what α-synuclein species are able to disrupt the plasma membrane? Future experiments should identify these structures and determine if they are potential targets for pharmacological therapies.
Currently, we believe that studies focused on unraveling the mechanism of the formation of α-synuclein pore/perforations will provide new insights for the generation of innovative approaches to interfere with these synaptotoxic/neurotoxic processes initiated at the neuronal membrane in order to develop new therapeutic strategies for treating people with PD and other neurodegenerative diseases.
Conflict of interest statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Statements
Acknowledgments
CONICYT Scholarship and FEBS Scholarship (C. Pacheco). Work supported by FONDECYT 1100502 (L. G. Aguayo and C. Opazo) and Anillo-PBCT ACT-04 (L. G. Aguayo and C. Opazo).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
- AD
Alzheimer's disease
- LBs
Lewy bodies
- PD
Parkinson's disease.
Abbreviations
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Summary
Keywords
Parkinson's disease, neurodegeneration, extracellular α-synuclein aggregates, plasma membrane, pore, perforation
Citation
Pacheco C, Aguayo LG and Opazo C (2012) An extracellular mechanism that can explain the neurotoxic effects of α-synuclein aggregates in the brain. Front. Physio. 3:297. doi: 10.3389/fphys.2012.00297
Received
15 March 2012
Accepted
08 July 2012
Published
26 July 2012
Volume
3 - 2012
Edited by
Raquel Marin, Universidad de La Laguna, Spain
Reviewed by
Patrizia Rosa, Italian National Research Council, Italy; Dimitra Mangoura, Biomedical Research Foundation of the Academy of Athens, Greece
Copyright
© 2012 Pacheco, Aguayo and Opazo.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.
*Correspondence: C. Opazo and L. G. Aguayo, Department of Physiology, University of Concepción, P.O. Box 160-C, Concepción, Chile. e-mail: carlosopazo@udec.cl; laguayo@udec.cl
This article was submitted to Frontiers in Membrane Physiology and Biophysics, a specialty of Frontiers in Physiology.
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