Osservazioni istoanatomiche e sperimentali sulla innervazione dell'esofago di alcuni mammiferi

Enteric co-innervation of striated muscle in the esophagus: still enigmatic?

The existence of a distinct ganglionated myenteric plexus between the two layers of the striated tunica muscularis of the mammalian esophagus has represented an enigma for quite a while. Although an enteric co-innervation of vagally innervated motor endplates in the esophagus has been suggested repeatedly, it was not possible until recently to demonstrate this dual innervation. Twenty-two years ago, we were able to demonstrate that motor endplates in the rat esophagus receive dual innervation from both vagal nerve fibers originating in the brain stem and from varicose enteric nerve fibers originating in the myenteric plexus. Meanwhile, a considerable amount of data has been gathered on enteric co-innervation and its occurrence in the esophagus of a variety of species including humans, its neurochemistry, spatial relationships on motor endplates, ontogeny and possible functional roles. These data underline the significance of this newly discovered innervation component, although its function in vivo is still largely unknown. The aim of this review, which is an update of our previous paper (Wörl and Neuhuber in Histochem Cell Biol 123(2):117-130. doi: 10.1007/s00418-005-0764-7 , 2005a), is to summarize the current knowledge about enteric co-innervation of esophageal striated muscle and to provide some hints as to its functional significance.

Glutamatergic functions of primary afferent neurons with special emphasis on vagal afferents

Glutamate has been identified as the main transmitter of primary afferent neurons. This was established based on biochemical, electrophysiological, and immunohistochemical data from studies on glutamatergic receptors and their agonists/antagonists. The availability of specific antibodies directed against glutamate and, more recently, vesicular glutamate transporters corroborated this and led to significant new discoveries. In particular, peripheral endings of various classes of afferents contain vesicular glutamate transporters, suggesting vesicular storage in and exocytotic release of glutamate from peripheral afferent endings. This suggests that autocrine mechanisms regulate sensory transduction processes. However, glutamate release from peripheral sensory terminals could also enable afferent neurons to influence various cells associated with them. This may be particularly relevant for vagal intraganglionic laminar endings, which could represent glutamatergic sensor-effector components of intramural reflex arcs in the gastrointestinal tract. Thus, morphological analysis of the relationships of putative glutamatergic primary afferents with associated tissues may direct forthcoming studies on their functions.

Innervation of the mammalian esophagus

Understanding the innervation of the esophagus is a prerequisite for successful treatment of a variety of disorders, e.g., dysphagia, achalasia, gastroesophageal reflux disease (GERD) and non-cardiac chest pain. Although, at first glance, functions of the esophagus are relatively simple, their neuronal control is considerably complex. Vagal motor neurons of the nucleus ambiguus and preganglionic neurons of the dorsal motor nucleus innervate striated and smooth muscle, respectively. Myenteric neurons represent the interface between the dorsal motor nucleus and smooth muscle but they are also involved in striated muscle innervation. Intraganglionic laminar endings (IGLEs) represent mechanosensory vagal afferent terminals. They also establish intricate connections with enteric neurons. Afferent information is implemented by the swallowing central pattern generator in the brainstem, which generates and coordinates deglutitive activity in both striated and smooth esophageal muscle and orchestrates esophageal sphincters as well as gastric adaptive relaxation. Disturbed excitation/inhibition balance in the lower esophageal sphincter results in motility disorders, e.g., achalasia and GERD. Loss of mechanosensory afferents disrupts adaptation of deglutitive motor programs to bolus variables, eventually leading to megaesophagus. Both spinal and vagal afferents appear to contribute to painful sensations, e.g., non-cardiac chest pain. Extrinsic and intrinsic neurons may be involved in intramural reflexes using acetylcholine, nitric oxide, substance P, CGRP and glutamate as main transmitters. In addition, other molecules, e.g., ATP, GABA and probably also inflammatory cytokines, may modulate these neuronal functions.

Vagal efferent and afferent innervation of the rat esophagus as demonstrated by anterograde DiI and DiA tracing: focus on myenteric ganglia

Anterograde tracing with the carbocyanine tracer DiI and the aminostyrol derivative DiA was used to selectively label fibers from the nucleus ambiguus, dorsal motor nucleus and nodose ganglion, respectively, terminating in the rat esophagus, and to compare them with the innervation of the gastric fundus in the same animals. Ambiguus neurons terminated on motor endplates distributed mainly to the ipsilateral half of the esophagus. There was no evidence of preganglionic innervation of myenteric ganglia from ambiguus neurons. Neurons of the dorsal motor nucleus supplied sparse fibers to only about 10% of enteric ganglia in the esophagus while they innervated up to 100% of myenteric ganglia in the stomach. Neurons of the nodose ganglion terminated profusely on more than 90% of myenteric ganglia of the esophagus and on about 50% of ganglia in the stomach. Afferent vagal fibers were also frequently found in smooth muscle layers starting at the esophago-gastric junction. In contrast, they were extremely rare in the striated muscle part of the esophagus. These morphological data suggest a minor influence of neurons of the dorsal motor nucleus and a prominent influence of vagal afferent terminals onto myenteric neurons in the rat esophagus.