Morphological study of noradrenaline innervation in the caudal raphe nuclei with special reference to fine structure

Regulation of fear extinction by long-term depression: The roles of endocannabinoids and brain derived neurotrophic factor

The extinction of a conditioned fear response is of great interest in the search for a means of ameliorating adverse neurobiological changes resulting from stress. The discovery that endocannibinoid (EC) levels are inversely related to the extent of such stress, and that the amygdala is a primary site mediating stress, suggests that ECs in this brain region might play a major role in extinction. Supporting this are the observations that the basolateral complex of the amygdala shows an increase in ECs only during extinction and that early clinical trials indicate that cannabinoid-like agents, when taken orally by patients suffering from post traumatic stress disorder (PTSD), reduce insomnia and nightmares. In order to optimize the potential of these agents to ameliorate symptoms of PTSD four important questions need to be answered: first, what is the identity of the cells that release ECs in the amygdala during extinction; second, what are their sites of action; third, what roles do the ECs play in the alleviation of long- depression (LTD), a process central to extinction; and finally, to what extent does brain derived neurotrophic factor (BDNF) facilitate the release of ECs? A review of the relevant literature is presented in an attempt to answer these questions. It is suggested that the principal cell involved in EC synthesis and release during extinction is the so-called excitatory extinction neuron in the basal nucleus of the amygdala. Furthermore that the main site of action of the ECs is the adjacent calcitonin gene-related peptide inhibitory interneurons, whose normal role of blocking the excitatory neurons is greatly diminished. The molecular pathways leading (during extinction trials) to the synthesis and release of ECs from synaptic spines of extinction neurons, that is potentiated by BDNF, are also delineated in this review. Finally, consideration is given to how the autocrine action of BDNF, linked to the release of ECs, can lead to the sustained release of these, so maintaining extinction over long times.

The pharmacology of putative early-onset antidepressant strategies

Depression is a serious and burdensome illness. Although selective serotonin reuptake inhibitors (SSRIs) have improved safety and tolerability of antidepressant treatment efficacy, the delay in the onset of action have not been improved. There is evidence to suggest that the delay in onset of therapeutic activity is a function of the drugs, rather than the disease. This suggests that research into the biological characteristics of depression and its treatments may yield faster-acting antidepressants. Emerging evidence from clinical studies with mirtazapine, venlafaxine and SSRI augmentation with pindolol suggests that these treatments may relieve antidepressant symptoms more rapidly than SSRIs. The putative mechanism of action of faster-acting antidepressant strategies presented here purports that conventional antidepressants acutely increase the availability of serotonin (5-hydroxytryptamine, 5-HT) or noradrenaline (NA), preferentially at their cell body level, which triggers negative feedback mechanisms. After continued stimulation, these feedback mechanisms become desensitised and the enhanced 5-HT availability is able to enhance 5-HT and/or NA neurotransmission. Putative fast-onset antidepressants, on the other hand, may uncouple such feedback control mechanisms and enhance 5-HT and/or NA neurotransmission more rapidly. Further studies are required to characterise in detail the interactions between NA and 5-HT systems and to definitively establish the early onset of candidate antidepressants such as mirtazapine, venlafaxine and pindolol augmentation.

The neuropharmacology of centrally-acting analgesic medications in fibromyalgia

As demonstrated above, the anatomy and neuropharmacology of the pain pathways within the CNS, even to the level of the midbrain, are extraordinarily complex. Indeed, discussions of the effects of these agents on the neuropharmacology of the thalamus, hypothalamus, and cortex were excluded from this review owing to their adding further to this complexity. Also, the dearth of data regarding FMS pain pathophysiology necessitated a relatively generic analysis of the pain pathways. As mentioned in the introduction, the current thought is that central sensitization plays an important role in FMS. However, we see in this chapter that the behavioral state of central sensitization may be a result of alterations in either the ascending systems or in one or more descending systems. Studies to assess the presence or relative importance of such changes in FMS are difficult to perform in humans, and to date there are no animal models of FMS. Accepting these limitations, it is apparent that many drugs considered to date for the treatment of FMS do target a number of appropriate sites within both the ascending and descending pain pathways. The data regarding clinical efficacy on some good candidate agents, however, is extremely preliminary. For example, it is evident from the present analysis that SNRIs, alpha 2 agonists, and NK1 antagonists may be particularly well suited to FMS, although current data supporting their use is either anecdotal or from open-label trials [114,149]. Other sites within the pain pathways have not yet been targeted. Examples of these include the use of CCKB antagonists to block on-cell activation or of nitric oxide synthetase antagonists to block the downstream mediators of NMDA activation. Efficacy of such agents may give considerable insight into the pathophysiology of FMS. Finally, as indicated previously, FMS consists of more than just chronic pain, and the question of how sleep abnormalities, depression, fatigues, and so forth tie into disordered pain processing is being researched actively. Future research focusing on how the various manifestations of FMS relate to one another undoubtedly will lead to a more rational targeting of drugs in this complex disorder.

Reflex sympathetic dystrophy treated with gabapentin

The use of the recently released anticonvulsant, gabapentin (Neurontin), in the treatment of severe and refractory reflex sympathetic dystrophy (RSD) pain in six patients ranging in age from 42 to 68 years is reported. Satisfactory pain relief obtained in all six patients suggests that this medication is an effective treatment for RSD pain. In addition to pain control, early evidence of disease reversal in these patients is suggested. Patient 6 is the first documented case of successful treatment and cure of the RSD pain syndrome using gabapentin alone. Specifically, reduced hyperpathia, allodynia, hyperalgesia, and early reversal of skin and soft tissue manifestations were noted. Gabapentin was chosen because it has properties similar to other anticonvulsant drugs and because previous studies have shown that it is well tolerated and appears to have a benign efficacy-to-toxicity ratio. It was considered an acceptable and compassionate therapeutic choice because previous medical and surgical approaches had been ineffective for these patients, who represent the first case series documenting the use of gabapentin for pain management. Presently, the mechanism of pain relief in these patients is unknown. In this article, the pathophysiology of RSD is discussed, and a mechanism by which gabapentin provides pain relief is proposed. In view of encouraging results in these and other RSD patients, further scientific investigation is needed to delineate the role of gabapentin in the treatment of reflex sympathetic dystrophy.

The origins of catecholaminergic innervation in the rostral ventromedial medulla oblongata of the rat

The localization of catecholaminergic neuronal cell bodies which project to the rostral ventromedial medulla oblongata (RVM) were investigated by the combined technique with dopamine beta-hydroxylase (DBH), phenylethanolamine N-methyltransferase (PNMT) or tyrosine hydroxylase (TH) immunocytochemistry and retrograde neuronal tracing method using fluorescent latex microspheres (FluoSpheres) injected into the center of the RVM, the nucleus raphe magnus (NRM). Noradrenaline (NA) neurons in A1, A5, A7 regions, locus coeruleus (LC) and nucleus subcoeruleus (SC) and adrenaline (Ad) neurons in C1 region were double-labeled due to DBH or PNMT and retrogradely transported FluoSpheres, and the ratio of their coexistence was higher in A1, A5, A7 and C1 than in LC and SC. No dopamine neurons in the midbrain and forebrain were double-labeled with TH and FluoSpheres. Thus, it was clarified that the RVM is innervated by the ventral groups of lateral tegmental NA and Ad neurons in the brainstem.

Innervation of serotonergic medullary raphe neurons from cells of the rostral ventrolateral medulla in rats

The rostral ventral medulla has been shown to consist of three distinct subregions: the midline or raphé region, the lateral paragigantocellular-gigantocellular region and the rostro-ventrolateral reticular nucleus. All three regions have been shown to contribute to central vaso-regulation and to project towards sympathetic preganglionic neurons of the thoracic spinal cord. Therefore it is of particular interest to describe the interconnections between the three regions and to see if local afferents reach cells which have been implicated in the regulation of descending inputs. Following injections of the anterograde tract tracer Phaseolus vulgaris leucoagglutinin into the lateral paragigantocellular nucleus or the rostroventrolateral reticular nucleus, labelled axons were traced into the medullary raphé nuclei and the contralateral rostral ventrolateral medulla. Efferents originating from both regions innervated the raphé pallidus, raphé obscurus and raphé magnus. However the distribution of terminals originating from the two regions was different in the contralateral ventrolateral medulla oblongata. The data indicate that the connection between the ipsi- and contralateral equivalents of both the lateral paragigantocellular-gigantocellular region and the rostroventrolateral reticular nucleus are stronger than the cross-connection between the ipsi- and contralateral parts of the two different regions. In the second part of the study, the existence of direct projections from the rostroventrolateral reticular nucleus and the lateral paragigantocellular-gigantocellular region onto serotonin-immunogold-labelled cells of the ventromedial medulla were investigated. The correlated light and electron microscopic analysis revealed direct synaptic contacts between axons originating from both the lateral paragigantocellular-gigantocellular region and the rostroventrolateral reticular nucleus, and serotonin-immunoreactive cells of the raphé obscurus and raphé pallidus. The results of the present light microscopic tract-tracing study revealed a different pattern of the intramedullary projection of the lateral paragigantocellular-gigantocellular region and the rostroventrolateral reticular nucleus. These data are in support of the proposed parcellation of the two cytoarchitectonically different areas of the rostral ventrolateral medulla into two functionally distinct subdivisions. Furthermore, the direct anatomical connection revealed in the present study between cells of the rostral ventrolateral and ventromedial medulla oblongata indicates the possibility that vasoregulatory effects of some cells of the rostral ventrolateral medulla oblongata might be executed via direct projections onto serotonin-immunoreactive cells of the medullary raphé nuclei.

Monoamine synaptic structure and localization in the central nervous system

The monoamines dopamine, noradrenaline, adrenaline, and serotonin as well as the diamine histamine have a widespread distribution in the central nervous system within synaptic terminals and nonsynaptic varicosities. In certain regions of the central nervous system the monoamines are contained in varicosities that have no synaptic specialization associated with them, suggesting a possible neuromodulatory role for some of the monoamines. The majority of monoamine labelled structures are synaptic terminals which are characterized by the presence of small, clear vesicles (40-60 nm) and large, granular vesicles (70-120 nm) within the terminal. A third population of vesicles--small, granular vesicles--which are visible only after histochemical staining, are probably the equivalent of the small, clear vesicles present after either autoradiographic or immunohistochemical labelling. Most monoamine containing terminals contact dendrites and dendritic spines and, less frequently, neuronal somata and other axons. Both asymmetrical and symmetrical membrane specializations are associated with monoaminergic terminals; however, asymmetrical contacts are the most frequent type found. These ultrastructural results indicate that monoamine containing terminals and varicosities in general share many common morphological features, but still have diverse functions.

Adrenergic input from medullary ventrolateral C1 cells to the nucleus raphe pallidus of the cat, as demonstrated by a double immunostaining technique

By means of a double immunostaining technique using unconjugated cholera-toxin B subunit (CTb) as a retrograde tracer combined with phenylethanolamine-N-methyltransferase (PNMT) immunohistochemistry, we demonstrated that the nucleus raphe pallidus of the cat receives a major projection from the ventrolateral part of the rostral medulla corresponding to the nucleus paragigantocellularis lateralis and the ventrolateral medullary reticular formation just caudal to it. We further showed that nearly 60% of the total CTb-labeled cells in this region are immunoreactive to PNMT. These double-labeled cells constitute one-third of the total PNMT-immunoreactive cells.

Brainstem and spinal pathways mediating descending inhibition from the medullary lateral reticular nucleus in the rat

The lateral reticular nucleus (LRN) in the caudal ventrolateral medulla has been implicated in descending monoaminergic modulation of spinal nociceptive transmission. Experiments were undertaken to examine the organization of pontine and spinal pathways mediating inhibition of the tail-flick (TF) reflex from the LRN in rats lightly anesthetized with pentobarbital. Microinjections of the local anesthetic lidocaine ipsilaterally or bilaterally into the dorsolateral pons blocked stimulation-produced inhibition of the TF reflex from the nucleus locus coeruleus/subcoeruleus (LC/SC), but had no effect on descending inhibition produced by microinjection of glutamate into the LRN. Thus, adrenergic modulation of the TF reflex from the LRN is not mediated by activation of spinopetal noradrenergic neurons in the LC/SC. The funicular course of descending inhibition produced by focal electrical stimulation in the LRN was studied in separate groups of rats by reversibly (local anesthetic blocks) or irreversibly (surgical transection) compromising conduction in the dorsolateral funiculi (DLFs) at the level of the cervical spinal cord. Bilateral lidocaine blocks in the DLFs significantly shortened control TF latencies and more than doubled the intensity of electrical stimulation in the LRN necessary to inhibit the TF reflex (153 +/- 29% increase from control); changes in these parameters produced by unilateral blocks of the DLFs were not statistically significant. Ipsilateral or bilateral transections of the DLFs significantly increased the intensity of electrical stimulation in the LRN to inhibit the TF reflex (110 +/- 24% and 265 +/- 46% from control, respectively). Neither lidocaine blocks nor transections of the DLFs completely blocked the descending inhibitory effects of electrical stimulation in the LRN. The DLFs appear to carry fibers mediating LRN stimulation-produced inhibition of the TF reflex as well as tonic descending inhibition of spinal reflexes. The results of the present study indicate that (1) adrenergic modulation of the nociceptive TF reflex from the LRN does not depend on a rostral loop through the pontine LC/SC, and (2) descending inhibitory influences from the LRN are contained in, but not confined to, the dorsal quadrants of the spinal cord.

Release of endogenous monoamines into spinal cord superfusates following the microinjection of phentolamine into the nucleus raphe magnus

Previous studies have suggested that raphe-spinal neurons located in the nucleus raphe magnus (NRM) are tonically inhibited by noradrenergic neurons. Furthermore, blockade of the inhibitory noradrenergic input to the NRM induces antinociception which appears to be mediated by the release of both serotonin and norepinephrine in the spinal cord. The present experiments were designed to directly measure the release of endogenous serotonin and norepinephrine into spinal cord superfusates before and after the microinjection of the alpha-adrenergic antagonist phentolamine into the NRM. High-performance liquid chromatography with electrochemical detection was used to quantitate the monoamines. The injection of phentolamine into the NRM induced a significant increase in the amount of both norepinephrine and serotonin released in the spinal cord. This enhanced release was not observed following either the injection of phentolamine into sites outside the NRM or the injection of saline vehicle into the NRM. These results support the proposal that the antinociception induced by the blockade of the inhibitory noradrenergic input to the NRM is mediated by the activation of spinally-projecting serotonergic and noradrenergic neurons.

Evidence for pain modulation by pre- and postsynaptic noradrenergic receptors in the medulla oblongata

Activation of neurons in nucleus raphe magnus (NRM) produces hypoalgesia which most likely results from inhibition of spinal cord pain transmission pathways. Previous reports from this laboratory suggest that noradrenergic (NA) neurons modulate the activity of NRM neurons. More specifically, NA projections to NRM neurons appear to be inhibitory since iontophoretically applied norepinephrine (NE) inhibits the activity of NRM neurons. Furthermore, blockade of NA receptors in the NRM by the microinjection of alpha-adrenergic antagonists produces potent analgesia. Thus, the NA input to the NRM appears to increase pain sensitivity by tonically inhibiting NRM neurons. Pharmacological and physiological studies have differentiated alpha-adrenergic receptors into alpha-1 and alpha-2 subtypes. The present study was designed to examine the nature of the alpha-adrenergic receptor subtypes in the NRM and their role in the modulation of pain sensitivity. The results of these experiments are consistent with the classical model of postsynaptic alpha-1 receptors and presynaptic alpha-2 receptors which modulate NE release. Both the alpha-1 antagonist, prazosin, and the alpha-2 agonist, clonidine, produced an increase in nociceptive threshold. Conversely, both the alpha-1 agonist, phenylephrine, and the alpha-2 antagonist, yohimbine, produced a decrease in nociceptive threshold. Thus, in the region of the NRM, both presynaptic alpha-2 and postsynaptic alpha-1 noradrenergic receptors may be involved in the modulation of nociception.

Monoamine distribution on the ventral surface of the rat medulla oblongata

The distribution of monoamine transmitters in the area near the ventral surface of the rat medulla oblongata was studied using the Falck-Hillarp histofluorescence method. Histological examination and scanning electron microscopy of these regions were also performed. It was found that there is a wide area dense with catecholamine terminals in the external layer of the ventral medulla oblongata. 5-Hydroxytryptamine-containing terminals and nerve cell bodies on and near the surface were also found. Due to their superficial localization these monoamines may influence the content of cerebrospinal fluid and in this way have effects on cardiovascular and other physiological functions.

Fine structure of histaminergic neurons in the caudal magnocellular nucleus of the rat as demonstrated by immunocytochemistry using histidine decarboxylase as a marker

The morphology of histamine-containing neurons in the caudal magnocellular nucleus was light and electron microscopically examined by means of peroxidase-antiperoxidase (PAP) immunocytochemistry with histidine decarboxylase (HDC) as a marker. HDC-like immunoreactive (HDCI) neurons had large (25-30 microns in diameter) perikarya from which two to four primary dendrites arose. The perikarya had a nearly round nucleus and well-developed Golgi apparatus in addition to a large number of mitochondria and rough endoplasmic reticulum. Immunoreactive endproducts were found diffusely throughout the perikarya, dendrites, and axons. HDCI neurons made synaptic contact with nonreactive axon terminals on the perikarya and dendrites. In addition, the HDCI neurons very frequently formed puncta adherentia with neuronal elements, either HDCI or nonreactive, or glial cells. Most of the HDCI axon terminals serially observed under electron microscopy did not exhibit typical synaptic contact in the caudal magnocellular nucleus. These findings suggest the nonsynaptic release of histamine in the caudal magnocellular nucleus.