Kir6.2-containing KATP channels are necessary for glucose dependent increases in amyloid-beta and Alzheimer's-related pathology

Increased neuronal excitability contributes to amyloid-{beta} (A{beta}) production and aggregation in the Alzheimers disease (AD) brain. Previous work from our lab demonstrated that hyperglycemia, or elevated blood glucose levels, increased brain excitability and A{beta} release potentially through inward rectifying, ATP-sensitive potassium (KATP) channels. KATP channels are present on several different cell types and help to maintain excitatory thresholds throughout the brain. KATP channels are sensitive to changes in the metabolic environment, which are coupled to changes in cellular excitability. Therefore, we hypothesized that neuronal KATP channels are necessary for the hyperglycemic-dependent increases in extracellular A{beta} and eliminating KATP channel activity will uncouple the relationship between metabolism, excitability, and A{beta} pathology. First, we demonstrate that Kir6.2/KCNJ11, the pore forming subunits, and SUR1/ABCC8, the sulfonylurea receptors, are predominantly expressed on excitatory and inhibitory neurons in the human brain and that cortical expression of KCNJ11 and ABCC8 change with AD pathology in humans and rodent models. Next, we crossed APP/PS1 mice with Kir6.2 -/- mice, which lack neuronal KATP channel activity, to define the relationship between KATP channels, A{beta}, and hyperglycemia. Using in vivo microdialysis and hyperglycemic clamps, we explored how acute elevations in peripheral blood glucose levels impacted hippocampal interstitial fluid (ISF) glucose, lactate, and A{beta} levels in APP/PS1 mice with or without KATP channels. Kir6.2+/+, APP/PS1 mice and Kir6.2-/-, APP/PS1 mice were exposed to a high sucrose diet for 6 months to determine the effects of chronic hyperglycemia on A{beta} deposition. We found that elevations in blood glucose levels correlate with increased ISF A{beta}, amyloidogenic processing of amyloid precursor protein (APP), and amyloid plaque pathology in APP/PS mice with intact KATP channels. However, neither acute hyperglycemia nor chronic sucrose overconsumption raised ISF A{beta} or increased A{beta} plaque burden in APP/PS1 mice lacking Kir6.2-KATP channel activity. Mechanistic studies demonstrate ISF glucose not only correlates with ISF A{beta} but also ISF lactate. Without KATP channel activity, ISF lactate does not increase during hyperglycemia, which correlates with decreased monocarboxylate transporter 4 (MCT4) expression, a lactate transporter responsible for astrocytic lactate release. This suggests that KATP channel activity regulates ISF lactate during hyperglycemia, which is important for A{beta} release and aggregation. These studies identify a new role for Kir6.2-KATP channels in Alzheimers disease pathology and suggest that pharmacological antagonism of Kir6.2-KATP channels holds therapeutic promise in reducing A{beta} pathology, especially in diabetic and prediabetic patients.