Re-Evaluation of the Ultrastructural Localization of Tonic GABA-A Receptors

Cell membrane receptors play key roles in physiological and pathological processes, yet the mechanisms governing their expression and distribution across the plasma membrane remain not completely understood. Broadly, membrane receptors can be categorized into phasic and tonic receptors. Tonic GABA-A receptors have attracted considerable interest due to their distinct molecular composition and their capacity to mediate highly sensitive, sustained inhibitory responses in the presence of ambient GABA. Traditionally, these receptors have been described as residing in peri- and extrasynaptic regions, where they are thought to sense GABA spillover and generate tonic inhibition. However, evidence accumulated over several decades has challenged this canonical view. Multiple studies have reported activity-dependent and pathology-associated relocalization of tonic GABA-A receptor subunits from their typical peri- and extrasynaptic domains into the synaptic cleft. This phenomenon has been documented in both in vivo and in vitro models, yet major questions remain regarding its occurrence, underlying mechanisms, functional significance, and adaptive value. This review synthesizes current evidence and highlights ongoing controversies surrounding the ultrastructural localization of tonic GABA-A receptors. Based on an exhaustive search of the PubMed database, this review summarizes key findings from studies investigating the subcellular distribution of these receptors and discusses emerging perspectives on their potential synaptic presence.