Sensitization of meningeal afferents to locomotion-related meningeal deformations in a migraine model

Reviewer #1 (Public Review):

Summary:
Herein, Blaeser et al. explored the impact of migraine-related cortical spreading depression (CSD) on the calcium dynamics of meningeal afferents that are considered the putative source of migraine-related pain. Critically previous studies have identified widespread activation of these meningeal afferents following CSD; however, most studies of this kind have been performed in anesthetized rodents. By conducting a series of technically challenging calcium imaging experiments in conscious head fixed mice they find in contrast that a much smaller proportion of meningeal afferents are persistently activated following CSD. Instead, they identify that post-CSD responses are differentially altered across a wide array of afferents, including increased and decreased responses to mechanical meningeal deformations and activation of previously non-responsive afferents following CSD. Given that migraine is characterized by worsening head pain in response to movement, the findings offer a potential mechanism that may explain this clinical phenomenon.

Strengths:
Using head fixed conscious mice overcomes the limitations of anesthetized preps and the potential impact of anaesthesia on meningeal afferent function which facilitated novel results when compared to previous anesthetized studies. Further, the authors used a closed cranial window preparation to maximize normal physiological states during recording, although the introduction of a needle prick to induce CSD will have generated a small opening in the cranial preparation, rendering it not fully closed as suggested.

Weaknesses:
Although this is a well conducted technically challenging study that has added valuable knowledge on the response of meningeal afferents the study would have benefited from the inclusion of more female mice. Migraine is a female dominant condition and an attempt to compare potential sex-differences in afferent responses would undoubtedly have improved the outcome.

The authors imply that the current method shows clear differences when compared to older anaesthetized studies; however, many of these were conducted in rats and relied on recording from the trigeminal ganglion. Inclusion of a subgroup of anesthetized mice in the current preparation may have helped to answer these outstanding questions, being is this species dependent or as a result of the different technical approaches.

The authors discuss meningeal deformations as a result of locomotion; however, despite referring to their previous work (Blaeser et al., 2022), the exact method of how these deformations were measured could be clearer. It is challenging to imaging that simple locomotion would induce such deformations and the one reference in the introduction refers to straining, such as cough that may induce intracranial hypertension, which is likely a more powerful stimulus than locomotion.

Reviewer #2 (Public Review):

This is an interesting study examining the question of whether CSD sensitizes meningeal afferent sensory neurons leading to spontaneous activity or whether CSD sensitizes these neurons to mechanical stimulation related to locomotion. Using two-photon in vivo calcium imaging based on viral expression of GCaMP6 in the TG, awake mice on a running wheel were imaged following CSD induction by cortical pinprick. The CSD wave evoked a rise in intracellular calcium in many sensory neurons during the propagation of the wave but several patterns of afferent activity developed after the CSD. The minority of recorded neurons (10%) showed spontaneous activity while slightly larger numbers (20%) showed depression of activity, the latter pattern developed earlier than the former. The vast majority of neurons (70%) were unaffected by the CSD. CSD decreased the time spent running and the numbers of bouts per minute but each bout was unaffected by CSD. There also was no influence of CSD on the parameters referred to as meningeal deformation including scale, shear, and Z-shift. Using GLM, the authors then determine that there there is an increase in locomotion/deformation-related afferent activity in 51% of neurons, a decrease in 12% of neurons, and no change in 37%. GLM coefficients were increased for deformation related activity but not locomotion related activity after CSD. There also was an increase in afferents responsive to locomotion/deformation following CSD that were previously silent. This study shows that unlike prior reports, CSD does not lead to spontaneous activity in the majority of sensory neurons but that it increases sensitivity to mechanical deformation of the meninges. This has important implications for headache disorders like migraine where CSD is thought to contribute to the pathology in unclear ways with this new study suggesting that it may lead to increased mechanical sensitivity characteristic of migraine attacks.

Reviewer #3 (Public Review):

Summary:
Blaeser et al. set out to explore the link between CSD and headache pain. How does an electrochemical wave in the brain parenchyma, which lacks nociceptors, result in pain and allodynia in the V1-3 distribution? Prior work had established that CSD increased the firing rate of trigeminal neurons, measured electrophysiologically at the level of the peripheral ganglion. Here, Blaeser et al. focus on the fine afferent processes of the trigeminal neurons, resolving Ca2+ activity of individual fibers within the meninges. To accomplish these experiments, the authors injected AAV encoding the Ca2+ sensitive fluorophore GCamp6s into the trigeminal ganglion, and 8 weeks later imaged fluorescence signals from the afferent terminals within the meninges through a closed cranial window. They captured activity patterns at rest, with locomotion, and in response to CSD. They found that mechanical forces due to meningeal deformations during locomotion (shearing, scaling, and Z-shifts) drove non-spreading Ca2+ signals throughout the imaging field, whereas CSD caused propagating Ca2+ signals in the trigeminal afferent fibers, moving at the expected speed of CSD (3.8 mm/min). Following CSD, there were variable changes in basal GCamp6s signals: these signals decreased in the majority of fibers, signals increased (after a 25 min delay) in other fibers, and signals remained unchanged in the remainder of fibers. Bouts of locomotion were less frequent following CSD, but when they did occur, they elicited more robust GCamp6s signals than pre-CSD. These findings advance the field, suggesting that headache pain following CSD can be explained on the basis of peripheral cranial nerve activity, without invoking central sensitization at the brain stem/thalamic level. This insight could open new pathways for targeting the parenchymal-meningeal interface to develop novel abortive or preventive migraine treatments.

Strengths:
The manuscript is well-written. The studies are broadly relevant to neuroscientists and physiologists, as well as neurologists, pain clinicians, and patients with migraine with aura and acephalgic migraine. The studies are well-conceived and appear to be technically well-executed.

Weaknesses:

1. Lack of anatomic confirmation that the dura were intact in these studies: it is notoriously challenging to create a cranial window in mouse skull without disrupting or even removing the dura. It was unclear which meningeal layers were captured in the imaging plane. Did the visualized trigeminal afferents terminate in the dura, subarachnoid space, or pia (as suggested by Supplemental Fig 1, capturing a pial artery in the imaging plane)? Were z-stacks obtained, to maintain the imaging plane, or to follow visualized afferents when they migrated out of the imaging plane during meningeal deformations?
2. Findings here, from mice with chronic closed cranial windows, failed to fully replicate prior findings from rats with acute open cranial windows. While the species, differing levels of inflammation and intracranial pressure in these two preparations may contribute, as the authors suggested, the modality of measuring neuronal activity could also contribute to the discrepancy. In the present study, conclusions are based entirely on fluorescence signals from GCamp6s, whereas prior rat studies relied upon multiunit recordings/local field potentials from tungsten electrodes inserted in the trigeminal ganglion. As a family, GCamp6 fluorophores are strongly pH dependent, with decreased signal at acidic pH values (at matched Ca2+ concentration). CSD induces an impressive acidosis transient, at least in the brain parenchyma, so one wonders whether the suppression of activity reported in the wake of CSD (Figure 2) in fact reflects decreased sensitivity of the GCamp6 reporter, rather than decreased activity in the fibers. If intracellular pH in trigeminal afferent fibers acidifies in the wake of CSD, GCamp6s fluorescence may underestimate the actual neuronal activity.