Respiratory response to hypoxia and hypercapnia after elimination of central chemosensitivity

Connexin26 mediates CO2-dependent regulation of breathing via glial cells of the medulla oblongata

Breathing is highly sensitive to the PCO2 of arterial blood. Although CO2 is detected via the proxy of pH, CO2 acting directly via Cx26 may also contribute to the regulation of breathing. Here we exploit our knowledge of the structural motif of CO2-binding to Cx26 to devise a dominant negative subunit (Cx26DN) that removes the CO2-sensitivity from endogenously expressed wild type Cx26. Expression of Cx26DN in glial cells of a circumscribed region of the mouse medulla - the caudal parapyramidal area - reduced the adaptive change in tidal volume and minute ventilation by approximately 30% at 6% inspired CO2. As central chemosensors mediate about 70% of the total response to hypercapnia, CO2-sensing via Cx26 in the caudal parapyramidal area contributed about 45% of the centrally-mediated ventilatory response to CO2. Our data unequivocally link the direct sensing of CO2 to the chemosensory control of breathing and demonstrates that CO2-binding to Cx26 is a key transduction step in this fundamental process.

Young and middle-aged mouse breathing behavior during the light and dark cycles

Unrestrained barometric plethysmography is a common method used for characterizing breathing patterns in small animals. One source of variation between unrestrained barometric plethysmography studies is the segment of baseline. Baseline may be analyzed as a predetermined time‐point, or using tailored segments when each animal is visually calm. We compared a quiet, minimally active (no sniffing/grooming) breathing segment to a predetermined time‐point at 1 h for baseline measurements in young and middle‐aged mice during the dark and light cycles. Additionally, we evaluated the magnitude of change for gas challenges based on these two baseline segments. C57BL/6JEiJ x C3Sn.BliA‐Pde6b⁺/DnJ male mice underwent unrestrained barometric plethysmography with the following baselines used to determine breathing frequency, tidal volume (VT) and minute ventilation (VE): (1) 30‐sec of quiet breathing and (2) a 10‐min period from 50 to 60 min. Animals were also exposed to 10 min of hypoxic (10% O₂, balanced N₂), hypercapnic (5% CO₂, balanced air) and hypoxic hypercapnic (10% O₂, 5% CO₂, balanced N₂) gas. Both frequency and VE were higher during the predetermined 10‐min baseline versus the 30‐sec baseline, while VT was lower (P < 0.05). However, VE/V_O2 was similar between the baseline time segments (P > 0.05) in an analysis of one cohort. During baseline, dark cycle testing had increased VT values versus those in the light (P < 0.05). For gas challenges, both frequency and VE showed higher percent change from the 30‐sec baseline compared to the predetermined 10‐min baseline (P < 0.05), while VT showed a greater change from the 10‐min baseline (P < 0.05). Dark cycle hypoxic exposure resulted in larger percent change in breathing frequency versus the light cycle (P < 0.05). Overall, light and dark cycle pattern of breathing differences emerged along with differences between the 30‐sec behavior observational method versus a predetermined time segment for baseline.

The cellular building blocks of breathing

Respiratory brainstem neurons fulfill critical roles in controlling breathing: they generate the activity patterns for breathing and contribute to various sensory responses including changes in O2 and CO2. These complex sensorimotor tasks depend on the dynamic interplay between numerous cellular building blocks that consist of voltage-, calcium-, and ATP-dependent ionic conductances, various ionotropic and metabotropic synaptic mechanisms, as well as neuromodulators acting on G-protein coupled receptors and second messenger systems. As described in this review, the sensorimotor responses of the respiratory network emerge through the state-dependent integration of all these building blocks. There is no known respiratory function that involves only a small number of intrinsic, synaptic, or modulatory properties. Because of the complex integration of numerous intrinsic, synaptic, and modulatory mechanisms, the respiratory network is capable of continuously adapting to changes in the external and internal environment, which makes breathing one of the most integrated behaviors. Not surprisingly, inspiration is critical not only in the control of ventilation, but also in the context of "inspiring behaviors" such as arousal of the mind and even creativity. Far-reaching implications apply also to the underlying network mechanisms, as lessons learned from the respiratory network apply to network functions in general.

Peripheral chemoreceptors determine the respiratory sensitivity of central chemoreceptors to CO(2)

We assessed the contribution of carotid body chemoreceptors to the ventilatory response to specific CNS hypercapnia in eight unanaesthetized, awake dogs. We denervated one carotid body (CB) and used extracorporeal blood perfusion of the reversibly isolated remaining CB to maintain normal CB blood gases (normoxic, normocapnic perfusate), to inhibit (hyperoxic, hypocapnic perfusate) or to stimulate (hypoxic, normocapnic perfusate) the CB chemoreflex, while the systemic circulation, and therefore the CNS and central chemoreceptors, were exposed consecutively to four progressive levels of systemic arterial hypercapnia via increased fractional inspired CO(2) for 7 min at each level. Neither unilateral CB denervation nor CB perfusion, per se, affected breathing. Relative to CB control conditions (normoxic, normocapnic perfusion), we found that CB chemoreflex inhibition decreased the slope of the ventilatory response to CNS hypercapnia in all dogs to an average of 19% of control values (range 0-38%; n = 6), whereas CB chemoreflex stimulation increased the slope of the ventilatory response to CNS hypercapnia in all dogs to an average of 223% of control values (range 204-235%; n = 4). We conclude that the gain of the CNS CO(2)/H(+) chemoreceptors in dogs is critically dependent on CB afferent activity and that CNS-CB interaction results in hyperadditive ventilatory responses to central hypercapnia.

Contributions of central and peripheral chemoreceptors to the ventilatory response to CO2/H+

The major objective of this review is to evaluate existing information and reach conclusions regarding whether there is interaction between P(CO(2))/H(+) stimulation of carotid (peripheral) and intracranial (central) chemoreceptors. Interaction is defined as a ventilatory response to simultaneous changes in the degree of Pco2/H(+) stimulation of both chemoreceptors that is greater (hyperadditive) or less (hypoadditive) than the sum of the responses when stimulation of each set of chemoreceptors is individually altered. Simple summation of the simultaneous changes in stimuli results in no interaction (i.e., additive interaction). Knowledge of the nature of central/peripheral interaction is crucial for determining the physiological significance of newer models of ventilatory control based on recent neuroanatomic observations of the circuitry of key elements of the ventilatory control system. In this review, we will propose that these two sets of receptors are not functionally separate but rather that they are dependent on one another such that the sensitivity of the medullary chemoreceptors is critically determined by input from the peripheral chemoreceptors and possibly other breathing-related reflex afferents as well. The short format of this minireview demands that we be somewhat selective in developing our ideas. We will briefly discuss the limitations of experiments used to study CO(2)/H(+) sensitivity and interaction to date, traditional views of the relative contributions of peripheral and central chemoreceptors to CO(2)/H(+) sensitivity, the evidence for and against different types of interaction, and the effect of tonic carotid chemoreceptor afferent activity on central control mechanisms.

Cytoarchitecture of central chemoreceptors in the mammalian ventral medulla

We reviewed the previous reports on the fine anatomy of the mammalian ventral medulla with special attention to the cytoarchitecture of the superficial chemosensitive regions to summarize what is known, what is not yet known, and what should be studied in the future. We also reviewed studies on anatomical relationship between neurons and vessels, and morphological studies on dendrites of respiratory or chemosensitive neurons. When we compared the morphological reports on the ventral and dorsal putative chemosensitive regions, similarities were found as follows. Chemosensitive cells were often found not only near the ventral surface but near the dorsal surface of the brainstem. Dendritic projection towards the surface was a common characteristic in the ventral and dorsal chemosensitive neurons. Morphological abnormality in the brainstem of sudden infant death syndrome victims was also summarized. On the basis of the previous reports we discussed the perspective on the future study on central chemoreception. Among various unanswered questions in central chemosensitivity studies, physiological significance of surface cells and surface extending dendrites is the most important topic, and must be thoroughly investigated.

Reduced inspiratory drive following laryngeal chemoreflex apnea during hypoxia

Respiratory inhibition following laryngeal water administration was investigated by breath-by-breath analysis of inspiratory ventilation (VI) and central inspiratory drive (P0.1) in 15 unanesthetized lambs studied in 0.21 FIO2 (PaO2: 82-92 torr, PaCO2 41-43 torr) and in 0.1 FIO2 (Pao2 30-34 torr, PaCO2 32-33 torr). During the 30 sec period after stimulation, VI decreased significantly compared to prestimulation levels both in 0.21 FIO2 (-22, -21 and -18%) and in 0.1 FI(O2), (-16, -23 and -19%) at 5, 16 and 29 days, respectively. In contrast, P0.1 remained at prestimulation levels during normoxia in all age groups (1, 10 and 9%, NS), but decreased significantly during hypoxia (-11 and -13%, P < 0.05) at 16 and 29 days, respectively. Poststimulation apnea duration was significantly related to the decrease in VI (P < 0.001) but not to the change in P0.1. Laryngeal stimulation during hypoxemia/hypocapnia induces a prolonged decrease of central inspiratory drive in postneonatal lambs, a finding of potential significance for the mechanisms of sudden infant death syndrome.

Congenital central hypoventilation syndrome: an update

Awareness of the existence of CCHS has led to increasingly frequent reports of such patients from all over the world. However, the exact pathophysiologic mechanisms underlying the clinical manifestations of this congenital disease entity remain unknown. For the respiratory physiologist, CCHS can be viewed as an experiment of nature that provides an important and unique window into central cardiorespiratory regulation. For the pediatrician, CCHS children represent an unique clinical challenge in coordinating the diagnostic and therapeutic procedures required to enhance the patients' quality of life.

Effect of independent changes in mixed-venous PCO2 or PO2 on cardiac output in anesthetized sheep

To determine whether changes mixed-venous PCO2 or PO2 affect cardiac output independent of changes in arterial blood gases, we used extracorporeal gas exchange to increase mixed-venous PCO2 or decrease mixed-venous PO2 in adult sheep. Sheep were anesthetized, mechanically ventilated, and connected to a veno-venous extracorporeal circuit. The circuit included a gas exchanger which was used to increase mixed-venous PCO2 or decrease mixed-venous PO2; the native lungs were ventilated to maintain arterial PCO2 and PO2 at control levels. When mixed-venous PCO2 was increased by 32% above control levels for a period of 60 min, cardiac output increased significantly to 28% above control levels. Cervical vagotomy abolished this response. In contrast, decreasing mixed-venous PO2 by 29% did not increase cardiac output. These results demonstrate that increasing mixed-venous PCO2 can increase cardiac output independent of changes in arterial blood gases and that intact vagus nerves are necessary for this response to occur.

Ventral medullary surface responses to hypoxic and hyperoxic transient ventilatory challenges in the cat

Carotid body afferent contributions to activity of the intermediate area of the ventral medullary surface (IVMS) following transient hypoxia and hyperoxia were examined in 6 spontaneously breathing, pentobarbital-anesthetized cats. Two tidal breaths of 100% N2, 100% O2, or room air, were randomly administered before and after carotid sinus denervation (CSD). Images of scattered light from the IVMS showed that activity increased with hypoxia (10.1 +/- 2.4%), and decreased with hyperoxia (4.8 +/- 1.8%). CSD significantly increased the magnitude and delayed the onset of the hypoxic response, but reversed the initial component of the hyperoxic response. We conclude that carotid body afferents modulate the magnitude and timing of IVMS responses to transient respiratory challenges.

Localization of chemosensitive structures in the isolated brainstem of adult guinea-pig

1. Central respiratory chemosensitivity has been intensively examined but some questions remain unsolved; namely, what is the nature of the stimulus (fixed acid and/or CO2) and where is the site of brainstem chemosensitivity (near the ventral medullary surface or structures deeper within the brainstem)? To examine these questions, we used the in vitro isolated brainstem of adult guinea-pig perfused independently through the basilar artery and the bath. 2. Respiratory motor output was recorded with a suction electrode from cranial hypoglossal (XII) roots. Changes in pH and CO2 in the Krebs perfusate were made by changing either the bicarbonate concentration or the PCO2 saturating the Krebs solution. 3. Changes in basilar artery perfusate consisting of (i) an acidifying increase in PCO2 (hypercapnic acidic Krebs solution), (ii) an increase in PCO2 with no change in pH (hypercapnic Krebs solution), or (iii) a decrease in pH with no change in PCO2 (acidic Krebs solution) evoked increases in respiratory frequency and a concomitant decrease in inspiratory burst amplitude. 4. Bath superfusion with hypercapnic acidic Krebs solution increased the inspiratory burst amplitude with no effect on respiratory burst frequency. 5. Bath superfusion with hypercapnic non-acidic Krebs solution increased the inspiratory burst amplitude and decreased the respiratory frequency, while normocapnic acidic Krebs solution increased the respiratory frequency with no change in burst amplitude. 6. These results show that respiratory responses to changes in CO2 and pH depend upon the sites of action. While a CO2 increase or a pH decrease affected the respiratory frequency in the deep brainstem structures (perfused through the basilar artery), CO2 respiratory chemosensitivity at the ventral surface could be differentiated from the hydrogen ion chemosensitivity. This suggests that different mechanisms mediated respiratory responses when deep versus superficial brainstem structures were stimulated.

Hypoglossal and phrenic responses to central respiratory inhibition in piglets

Neonatal apnea is characterized by decreased neural output to the ventilatory muscles, and frequently associated with upper airway obstruction. We sought to characterize: (1) the role of central chemosensitive structures at the ventral medullary surface (VMS) in modulating hypoglossal and phrenic neural output, and (2) the recovery of hypoglossal and phrenic neural output during simulated central apnea. We studied 14 anesthetized, paralyzed, ventilated piglets aged 14-21 days and performed VMS cooling to inhibit central neural pathways mediating CO2 sensitivity. Phrenic and hypoglossal ENGs and end-tidal CO2 were continuously recorded. During CO2 rebreathing, hypoglossal activity was always more sensitive than phrenic activity to the inhibitory effects of VMS cooling. When phrenic apnea was induced by VMS cooling, and followed by discontinuation of ventilation for 60 sec in order to induce simultaneous hypercapnia and hypoxia, reappearance of hypoglossal ENG was delayed and recovery was significantly suppressed when compared to phrenic ENG. Therefore, attenuated central chemosensitivity during early postnatal life appears to preferentially inhibit neural output responsible for upper airway patency, and may predispose to upper airway obstruction during recovery from neonatal apnea.

In vivo and in vitro responses of neurons in the ventrolateral medulla to hypoxia

Neurons in the ventrolateral medulla (VLM) are known to be involved in several cardiorespiratory reflexes and to provide tonic drive to sympathetic preganglionic neurons. Recent studies have suggested that VLM neurons modulate the respiratory responses to hypoxia and to hypercapnia. The purpose of the present study was to determine with electrophysiological techniques if the discharge of these neurons is altered by hypoxia and/or by hypercapnia both in vivo and in vitro. Extracellular single-unit activity of VLM neurons (n = 39) was recorded during inhalation of a hypoxic gas (10% O2) and during inhalation of a hypercapnic gas (5% CO2) in anesthetized, spontaneously breathing rats (n = 16). Hypoxia elicited an increase in the discharge frequency in 64% of the VLM neurons studied; hypercapnia stimulated 42% of the neurons. Fifty-two percent of the neurons were stimulated by both hypoxia and hypercapnia. Signal averaging revealed that 76% of the hypoxia-stimulated neurons had a resting discharge related to the cardiac and/or respiratory cycle. Similar percentages of VLM neurons (35/54) were stimulated by hypoxia in a second group of animals (n = 14) that were studied after sinoaortic denervation. A rat brain slice preparation was then used to determine if hypoxia exerts a direct effect upon neurons in the VLM. Perfusing a hypoxic gas over the surface of medullary slices evoked an increase in the discharge frequency in the majority (39/49) of VLM neurons studied; responses were graded in relation to the magnitude of the hypoxic stimulus. Similar responses to hypoxia were observed in VLM neurons studied during perfusion with a synaptic blockade medium. Retrograde labeling of VLM neurons with rhodamine tagged microspheres injected into the thoracic intermediolateral cell column demonstrated that the hypoxia sensitive neurons were located in a region of the VLM that projects to the thoracic spinal cord. These results demonstrate that neurons in the ventrolateral medulla are excited by a direct effect of hypoxia; these neurons may play a critical role in the cardiorespiratory responses to hypoxia.

Modulation of respiratory reflexes by an excitatory amino acid mechanism in the ventrolateral medulla

Results from several studies suggest that the ventrolateral medulla (VLM) is involved in modulating the respiratory response to central and/or peripheral chemoreceptor stimulation. Furthermore, the excitatory amino acid (EAA) glutamate has been shown to have marked effects on respiration when administered to VLM sites. The purpose of this study was to determine if an excitatory amino acid mechanism in the VLM modulates the respiratory responses to hypoxia or hypercapnia in anesthetized rats. Exposure to hypoxic or hypercapnic gas under control conditions elicited increases in respiratory activity (diaphragmatic EMG activity and breathing frequency). Bilateral injection of kynurenic acid (KYN), an EAA antagonist, into rostral VLM sites evoked significant increases in breathing frequency; injections more caudal in the VLM typically caused apnea. Significantly larger increases in respiratory output were elicited by both hypoxia and hypercapnia after rostral VLM microinjections of KYN. The accentuated responses returned to control levels after a recovery of approximately 100 min. Microinjection of xanthurenic acid (XAN), an inactive analog of kynurenic acid, into the VLM prior to KYN had only slight effects on resting respiratory activity and no effects on the responses to hypoxia or hypercapnia. These results suggest two separate VLM sites which modulate respiration by EAA mechanisms. A more rostral site tonically inhibits respiratory activity and the respiratory responses to chemoreceptor stimulation and more caudal VLM sites may be required for the maintenance of respiratory activity.

Cooling the intermediate area of the ventral medullary surface affects tracheal responses to hypoxia

The intermediate area of the ventral medullary surface (VMS) influences changes in airway tone caused by hypercapnia and intrapulmonary irritant receptor activation. These studies evaluated the effects of cooling the intermediate area of the VMS on the reflex hypoxic responses of the trachealis smooth muscle and of the phrenic nerve. Anesthetized, paralyzed cats were hyperventilated with 100% oxygen to produce phrenic neural apnea. Tracheal tone was measured indirectly by evaluating pressure changes in an innervated tracheal segment and the phrenic electroneurogram was determined from the central end of a cut cervical root. Switching the inspired gas to 12% O2 increased tracheal pressure of 11 of 12 cats but caused phrenic activity to reappear in only 6 of the animals. Ventilation with 6% O2 significantly increased tracheal constriction prior to phrenic activity. After intravenous administration of atropine methyl nitrate tracheal responses to hypoxia were abolished but phrenic neural responses were unaltered. Neither the tracheal pressure nor the phasic phrenic electroneurogram responded to hypoxia after cutting the carotid sinus nerves. When the intermediate area of the VMS was cooled to 20 degrees C prior to ventilation with the hypoxic gases, both tracheal and phrenic responses were significantly diminished. While the cats were hyperventilated with 6% O2, cooling of the intermediate area significantly diminished tracheal pressure and phrenic nerve activity and both returned to the same levels after rewarming. Cooling of the intermediate area blunted tracheal and phrenic responses to carotid body stimulation by NaCN. However, the appearance of tracheal constriction prior to the onset of phasic phrenic activity may suggest that increased trachealis tone may occur independent of cyclical respiratory activity.

The role of the glycine sensitive area of the ventral medulla in cardiovascular responses to carotid chemoreceptor and peripheral nerve stimulation

The present study on cats anaesthetised with Althesin, which unlike more commonly used anaesthetics does not prevent reflex activation of the brain-stem defence areas, reaffirmed that carotid chemoreceptor stimulation and radial nerve stimulation can evoke the visceral components of the alerting stage of the defence response (visceral alerting response). This includes tachycardia, mesenteric vasoconstriction but vasodilatation in skeletal muscle which is not secondary to the hyperventilation. However, mild chemoreceptor stimulation which evoked but a weak hyperventilation elicited bradycardia and vasoconstriction is mesentery and in muscle i.e. a response comparable with that evoked by chemoreceptor stimulation under chloralose or barbiturate anaesthesia. This suggests that chemoreceptor stimulation can evoke two separate patterns of response, the visceral alerting response predominating when the defence areas are strongly activated. The efferent pathway from the defence areas is known to synapse in the 'glycine sensitive area' of the ventral medulla which contains neurones whose activity seems to provide the main sympatho-excitatory drive for normal arterial pressure. Bilateral application of glycine to that area produces a pronounced fall in arterial pressure, apnoea and greatly attenuates the response to defence area stimulation, the vasoconstrictor components being abolished. In the present study bilaterally applied glycine abolished the muscle vasodilatation of the visceral alerting response evoked by chemoreceptor and radial nerve stimulation but both stimuli evoked vasoconstriction in mesenteric and muscle vasculature at least until arterial pressure was very low. It is proposed that both chemoreceptor and peripheral nerve stimulation can activate the defence areas to produce a visceral alerting response which is relayed via neurones of the glycine sensitive area.(ABSTRACT TRUNCATED AT 250 WORDS)

Central chemosensitivity and the reaction theory

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Effects of medullary area I(s) cooling on respiratory response to chemoreceptor inputs

The effect on respiration, as measured by phrenic nerve activity, of bilateral graded cooling of the intermediate, or I(s), areas of the ventral medulla was determined in anesthetized, vagotomized, glomectomized and paralyzed cats. In addition the effect of cooling the I(s) areas on the responses to central and peripheral chemoreceptor afferent test stimuli were studied. When end-tidal PCO2 was kept constant, graded cooling of the I(s) areas led to graded reductions of phrenic activity and arterial pressure. Furthermore, the respiratory response to test stimuli (carotid sinus nerve or CO2) was decreased progressively during graded cooling of the I(s) areas from 40 degrees C to 20 degrees C. We conclude that area I(s) is part of a common pathway for afferent input from both the central and peripheral chemoreceptors and that it is involved in the initial integration of both inputs.