Comparative aspects of the area postrema: fine-structural considerations help to determine its function

Capillary connections between sensory circumventricular organs and adjacent parenchyma enable local volume transmission

Among contributors to diffusible signaling are portal systems which join two capillary beds through connecting veins (Dorland 2020). Portal systems allow diffusible signals to be transported in high concentrations directly from one capillary bed to the other without dilution in the systemic circulation. Two portal systems have been identified in the brain. The first was discovered almost a century ago and connects the median eminence to the anterior pituitary gland (Popa & Fielding 1930). The second was discovered a few years ago, and links the suprachiasmatic nucleus to the organum vasculosum of the lamina terminalis, a sensory circumventricular organ (CVO) (Yao et al. 2021). Sensory CVOs bear neuronal receptors for sensing signals in the fluid milieu (McKinley et al. 2003). They line the surface of brain ventricles and bear fenestrated capillaries, thereby lacking blood brain barriers. It is not known whether the other sensory CVOs, namely the subfornical organ (SFO), and area postrema (AP) form portal neurovascular connections with nearby parenchymal tissue. This has been difficult to establish as the structures lie at the midline and protrude into the ventricular space. To preserve the integrity of the vasculature of CVOs and their adjacent neuropil, we combined iDISCO clearing and light-sheet microscopy to acquire volumetric images of blood vessels. The results indicate that there is a portal pathway linking the capillary vessels of the SFO and the posterior septal nuclei, namely the septofimbrial nucleus and the triangular nucleus of the septum. Unlike the latter arrangement, the AP and the nucleus of the solitary tract share their capillary beds. Taken together, the results reveal that all three sensory circumventricular organs bear specialized capillary connections to adjacent neuropil, providing a direct route for diffusible signals to travel from their source to their targets.

Homeostatic Feelings and the Emergence of Consciousness

In this article, we summarize our views on the problem of consciousness and outline the current version of a novel hypothesis for how conscious minds can be generated in mammalian organisms. We propose that a mind can be considered conscious when three processes are in place: the first is a continuous generation of interoceptive feelings, which results in experiencing of the organism's internal operations; the second is the equally continuous production of images, generated according to the organism's sensory perspective relative to its surround; the third combines feeling/experience and perspective resulting in a process of subjectivity relative to the image contents. We also propose a biological basis for these three components: the peripheral and central physiology of interoception and exteroception help explain the implementation of the first two components, whereas the third depends on central nervous system integration, at multiple levels, from spinal cord, brainstem, and diencephalic nuclei, to selected regions of the mesial cerebral cortices.

Feelings Are the Source of Consciousness

In this view, we address the problem of consciousness, and although we focus on its human presentation, we note that the phenomenon is present in numerous nonhuman species and use findings from a variety of animal studies to explain our hypothesis for how consciousness is made. Consciousness occurs when mind contents, such as perceptions and thoughts, are spontaneously identified as belonging to a specific organism/owner. Conscious minds are said to have a self that experiences mental events. We hypothesize that the automatic identification that associates minds and organisms is provided by a continuous flow of homeostatic feelings. Those feelings arise from the uninterrupted process of life regulation and correspond to both salient physiological fluctuations such as hunger, pain, well-being, or malaise, as well as to states closer to metabolic equilibrium and best described as feelings of life/existence, such as breathing or body temperature. We also hypothesize that homeostatic feelings were the inaugural phenomena of consciousness in biological evolution and venture that they were selected because the information they provided regarding the current state of life regulation conferred extraordinary advantages to the organisms so endowed. The "knowledge" carried by conscious homeostatic feelings provided "overt" guidance for life regulation, an advance over the covert regulation present in nonconscious organisms. Finally, we outline a mechanism for the generation of feelings based on a two-way interaction between interoceptive components of the nervous system and a particular set of nonneural components of the organism's interior, namely, viscera and circulating chemical molecules involved in their operations. Feelings emerge from this interaction as continuous and hybrid phenomena, related simultaneously to two series of events. The first is best described by the terms neural/representational/and mental and the second by the terms nonneural/visceral/and chemical. We note that this account offers a solution for the mind-body problem: homeostatic feelings constitute the "mental" version of bodily processes.

Where the central canal begins: endoscopic in vivo description

OBJECTIVE

Although evidence and descriptions of the central canal (CC) along the medulla oblongata and the spinal cord have been provided by several anatomical and radiological studies, a clear picture and assessment of the opening of the CC, or apertura canalis centralis (ACC), into the fourth ventricle is lacking, due to its submillimetric size and hidden position in the calamus scriptorius.

METHODS

The authors reviewed all of their cases in which patients underwent ventricular transaqueductal flexible endoscopic procedures and selected 44 cases in which an inspection of the region of the calamus scriptorius had been performed and was suitable for study inclusion. Patients were divided into different groups, based on the presence or absence of a chronic pathological process involving the fourth ventricle. In each case, the visual appearance of the opening of the CC of the ACC was classified as no evidence (A0), indirect evidence (A1), or clear evidence (A2). Morphometric measurements were inferred from surrounding structures and the size of surgical tools visible in the field.

RESULTS

The opening of the CC could be clearly observed in all cases (A1 4.5%, A2 95.5%). In normal cases, a lanceolate shape along the median sulcus was most frequently found, with an average size of 600 × 250 µm that became rounded and smaller in size in cases of hydrocephalus. The distance between the caudal margin of the ACC and the obex was about 1.8 mm in normal cases, 2.1 mm in cases of obstructive hydrocephalus, and 1 mm in cases of normal pressure hydrocephalus. The two wings of the area postrema, variable in size and shape, were sited just caudal to the opening.

CONCLUSIONS

A flexible scope inserted through the cerebral aqueduct can approach the hidden calamus scriptorius like a pen fits into an inkpot. With this privileged viewpoint, the authors provide for the first time, to their knowledge, a clear and novel vision of the opening of the CC in the fourth ventricle, along with the precise location of this tiny structure compared to other anatomical landmarks in the inferior triangle.

Interoception and the origin of feelings: A new synthesis

Feelings are conscious mental events that represent body states as they undergo homeostatic regulation. Feelings depend on the interoceptive nervous system (INS), a collection of peripheral and central pathways, nuclei and cortical regions which continuously sense chemical and anatomical changes in the organism. How such humoral and neural signals come to generate conscious mental states has been a major scientific question. The answer proposed here invokes (1) several distinctive and poorly known physiological features of the INS; and (2) a unique interaction between the body (the 'object' of interoception) and the central nervous system (which generates the 'subject' of interoception). The atypical traits of the INS and the direct interactions between neural and non-neural physiological compartments of the organism, neither of which is present in exteroceptive systems, plausibly explain the qualitative and subjective aspects of feelings, thus accounting for their conscious nature.

A concise historical perspective of the area postrema structure and function

First described by Retzius at the end of the 19th century, the structure in the posterior medulla oblongata, then named area postrema, underwent an intense investigation into its function in the decades that followed. Findings, mainly in animal studies, have partially elucidated its role as an emetic center in the central nervous system. In the second half of the 20th century, this function was associated with reports of syndromes characterized by uncontrollable nausea and vomiting related to structural damage in the area postrema, mainly in the context of demyelinating diseases. At the beginning of the 21st century, the so-called area postrema syndrome has been consolidated as a diagnostic factor in diseases related to the spectrum of neuromyelitis optica, more than 100 years after its first description.

Which Antiemetic?

The choice of antiemetic should not be arbitrary, but should be based on knowledge of the different pathways of the various stimuli that lead to nausea and vomiting and the neuroreceptors involved. The steps to be taken in choosing an appropriate antiemetic are described. They are (a) to establish the probable cause of the nausea and vomiting, (b) to consider the afferent pathways involved, (c) to define the neuroreceptors activated at each of these sites, (d) to select the group of antiemetics that antagonizes these neuroreceptors, and (e) to choose the most potent antiemetic with the fewest side effects in that group. Causes for failure to respond to a chosen antiemetic are considered and the action to be taken is described.

Cellular Localization of Acid-Sensing Ion Channel 1 in Rat Nucleus Tractus Solitarii

By determining its cellular localization in the nucleus tractus solitarii (NTS), we sought anatomical support for a putative physiological role for acid-sensing ion channel Type 1 (ASIC1) in chemosensitivity. Further, we sought to determine the effect of a lesion that produces gliosis in the area. In rats, we studied ASIC1 expression in control tissue with that in tissue with gliosis, which is associated with acidosis, after saporin lesions. We hypothesized that saporin would increase ASIC1 expression in areas of gliosis. Using fluorescent immunohistochemistry and confocal microscopy, we found that cells and processes containing ASIC1-immunoreactivity (IR) were present in the NTS, the dorsal motor nucleus of vagus, and the area postrema. In control tissue, ASIC1-IR predominantly colocalized with IR for the astrocyte marker, glial fibrillary acidic protein (GFAP), or the microglial marker, integrin αM (OX42). The subpostremal NTS was the only NTS region where neurons, identified by protein gene product 9.5 (PGP9.5), contained ASIC1-IR. ASIC1-IR increased significantly (157 ± 8.6% of control, p < 0.001) in the NTS seven days after microinjection of saporin. As we reported previously, GFAP-IR was decreased in the center of the saporin injection site, but GFAP-IR was increased in the surrounding areas where OX42-IR, indicative of activated microglia, was also increased. The over-expressed ASIC1-IR colocalized with GFAP-IR and OX42-IR in those reactive astrocytes and microglia. Our results support the hypothesis that ASIC1 would be increased in activated microglia and in reactive astrocytes after injection of saporin into the NTS.

Insights into the central pathways involved in the emetic and behavioural responses to exendin-4 in the ferret

BACKGROUND

GLP-1 receptor agonists are utilised for the treatment of Type-2 diabetes but can be associated with undesirable effects of nausea and vomiting.

OBJECTIVES

To investigate the role of GLP-1 receptors in mechanisms of emesis, behaviours indicative of nausea (BIN) and food intake in the ferret.

RESULTS

Exendin-4 (10 and 30nmol, i.c.v.) induced emesis, inhibited food intake, and increased the frequency of BIN. Increases in c-Fos in the brainstem, midbrain and forebrain occurred in animals exhibiting emesis; no activation of the brainstem occurred in animals not vomiting. Exendin-4 (10nmol, i.c.v.) when preceded by i.c.v. saline (15μl), was not emetic but induced BIN and inhibited food intake; exendin (9-39) (100nmol) reduced BIN only. c-Fos showed that consistent with the absence of emesis in saline/exendin-4 treated animals there was no increase in c-Fos in the brainstem, but it increased in midbrain and forebrain nuclei. Excepting the amygdala, exendin (9-39) was without efffect on the increases in c-Fos. Analysis of c-Fos data showed a positive linear relationship between midbrain and forebrain areas irrespective of the occurrence of emesis induced by exendin-4. In contrast, brainstem and midbrain c-Fos levels were positively correlated, but only in animals with emesis.

CONCLUSIONS

The brainstem is critical for exendin-4-induced emesis but suppression of food intake and BIN involves more rostral brain sites. Exendin-4-induced BIN and c-Fos activation of the amygdala are sensitive to exendin (9-39), whereas the suppression of food intake is not implicating separate control mechanisms for emesis and BIN.

Mapping the calcitonin receptor in human brain stem

The calcitonin receptor (CTR) is relevant to three hormonal systems: amylin, calcitonin, and calcitonin gene-related peptide (CGRP). Receptors for amylin and calcitonin are targets for treating obesity, diabetes, and bone disorders. CGRP receptors represent a target for pain and migraine. Amylin receptors (AMY) are a heterodimer formed by the coexpression of CTR with receptor activity-modifying proteins (RAMPs). CTR with RAMP1 responds potently to both amylin and CGRP. The brain stem is a major site of action for circulating amylin and is a rich site of CGRP binding. This study aimed to enhance our understanding of these hormone systems by mapping CTR expression in the human brain stem, specifically the medulla oblongata. Widespread CTR-like immunoreactivity was observed throughout the medulla. Dense CTR staining was noted in several discrete nuclei, including the nucleus of the solitary tract, the hypoglossal nucleus, the cuneate nucleus, spinal trigeminal nucleus, the gracile nucleus, and the inferior olivary nucleus. CTR staining was also observed in the area postrema, the lateral reticular nucleus, and the pyramidal tract. The extensive expression of CTR in the medulla suggests that CTR may be involved in a wider range of functions than currently appreciated.

Interdigestive migrating motor complex -its mechanism and clinical importance

Migrating motor complex (MMC) is well characterized by the appearance of gastrointestinal (GI) contractions in the interdigestive state. The physiological importance of gastric MMC is a mechanical and chemical cleansing of the empty stomach in preparation for the next meal. MMC cycle is mediated via the interaction between motilin and 5-hydroxytryptamine (5-HT) by the positive feedback mechanism in conscious dogs. Luminal administration of 5-HT initiates duodenal phase II and phase III with a concomitant increase of plasma motilin release. Duodenal 5-HT concentration is increased during gastric phase II and phase III. Intravenous infusion of motilin increases luminal 5-HT content and induces phase III. 5-HT₄ antagonists significantly inhibit both of gastric and intestinal phase III, while 5-HT₃ antagonists inhibit only gastric phase III. These suggest that gastric MMC is regulated via vagus, 5-HT_3/4 receptors and motilin, while intestinal MMC is regulated via intrinsic primary afferent neurons (IPAN) and 5-HT₄ receptors. We propose the possibility that maximally released motilin by a positive feedback depletes 5-HT granules in the duodenal EC cells, resulting in no more contractions. Stress is highly associated with the pathogenesis of functional dyspepsia (FD). Acoustic stress attenuates gastric phase III without affecting intestinal phase III in conscious dogs, via reduced vagal activity. Subset of FD patients shows reduced vagal activity and impaired gastric phase III. The impaired gastric MMC may aggravate dyspeptic symptoms following a food ingestion. Maintaining MMC cycle in the interdigestive state is an important factor to prevent the postprandial dyspeptic symptoms.

A physiological perspective for utility or futility of alcohol-based hand rub gel against nausea-vomiting: is it P-6 acupoint or transnasal aroma?

Nausea-vomiting is a common and unpleasant phenomenon with numerous underlying mechanisms and pathways that are not always well elucidated. In clinical practice, refractory nausea-vomiting is encountered in several settings. Antiemetic medications may reduce these symptoms but are not always effective in all patients. In the absence of a well-defined optimal strategy for management of nausea-vomiting, the search for better approaches to treat this distressing symptom continues. One of the alternative treatment approaches is a compounded formulation called ABHR gel that is comprised of multiple antiemetic medications and has been shown to be useful for symptomatic relief in some patients with refractory nausea-vomiting. It has been suggested that alternative mechanisms should be explored to explain the perceived efficacy of ABHR gel, because transdermal absorption leading to nil-to-minimal or subtherapeutic blood concentrations of active ingredients does not explain the role of ABHR gel in the treatment of nausea-vomiting. In the current paper, we discuss possible mechanisms that may explain ABHR transdermal gel's efficacy. Compounded ABHR transdermal gel formulation's efficacy in antagonizing nausea-vomiting that has been recently questioned may be explained by alternative mechanisms mediated through the P-6 acupoint stimulation and facial-nasal, cooling-related counterstimulation.

The nature of feelings: evolutionary and neurobiological origins

Feelings are mental experiences of body states. They signify physiological need (for example, hunger), tissue injury (for example, pain), optimal function (for example, well-being), threats to the organism (for example, fear or anger) or specific social interactions (for example, compassion, gratitude or love). Feelings constitute a crucial component of the mechanisms of life regulation, from simple to complex. Their neural substrates can be found at all levels of the nervous system, from individual neurons to subcortical nuclei and cortical regions.

Mechanism of interdigestive migrating motor complex

Migrating motor complex (MMC) is well characterized by the appearance of gastrointestinal contractions in the interdigestive state. This review article discussed the mechanism of gastrointestinal MMC. Luminal administration of 5-hydroxytryptamine (5-HT) initiates duodenal phase II followed by gastrointestinal phase III with a concomitant increase of plasma motilin release in conscious dogs. Duodenal 5-HT concentration is increased during gastric phase II and phase III. Intravenous infusion of motilin increases luminal 5-HT content and induces gastrointestinal phase III. 5-HT(4) antagonists significantly inhibits both of gastric and intestinal phase III, while 5-HT(3) antagonists inhibited only gastric phase III. These suggest that gastrointestinal MMC cycle is mediated via the interaction between motilin and 5-HT by the positive feedback mechanism. Gastric MMC is regulated via vagus, 5-HT(3/4) receptors and motilin, while intestinal MMC is regulated via intrinsic primary afferent neurons and 5-HT(4) receptors. Stress is highly associated with the pathogenesis of functional dyspepsia. Acoustic stress attenuates gastric phase III without affecting intestinal phase III in conscious dogs, via reduced vagal activity and increased sympathetic activity. It has been shown that subset of functional dyspepsia patients show reduced vagal activity and impaired gastric phase III. The physiological importance of gastric MMC is a mechanical and chemical cleansing of the empty stomach in preparation for the next meal. The impaired gastric MMC may aggravate dyspeptic symptoms following a food ingestion. Thus, maintaining gastric MMC in the interdigestive state is an important factor to prevent the postprandial dyspeptic symptoms.

Use of antipsychotic medication in chemotherapy-induced nausea and vomiting

Nausea and vomiting continue to present significant problems for cancer patients undergoing chemotherapy. Initial work suggested an important role for central dopamine transmission in the underlying pathophysiology. However, recent evidence has implicated central and peripheral serotonin release. Although the implementation of 5-HT(3) receptor antagonists has resulted in significant improvement in acute symptoms of nausea and vomiting, they have not demonstrated optimal efficacy in anticipatory and delayed emetic syndromes and are significantly more expensive than other antiemetic therapies. The use of typical antipsychotic medication to reduce nausea and vomiting in cancer patients is discussed, as is the potential efficacy of newer atypical antipsychotics, which have activity at receptors implicated in the control of chemotherapy-induced nausea and vomiting and demonstrate an improved side-effect profile.

[Management of chemotherapy-induced emesis: what is the standard after 20 years of clinical research]

BACKGROUND

The knowledge of the importance, the physiopathological mechanisms, and the management of the chemotherapy-induced emesis has increased exponentially during the last 20 years. High-dosage metoclopramide (MCP) therapy has been introduced in the eighties and serotonine type-3 receptor antagonists (5-HT(3) antagonists) have been used since the late eighties and early nineties. Due to both classes of substances the results of the antiemetic therapies have improved drastically. After 20 years of intensive clinical research it seems to be appropriate to come to an intermediate conclusion.

METHOD

With the aid of an overview and a new analysis of the literature published on this topic so far, the current state of research is shown (including the fields in which further improvement will be necessary), and suggestions are made, wherever it seemed possible, to attain the "gold standard" in antiemetic therapy.

RESULTS AND CONCLUSIONS

In connection with all highly or very highly emetogenic chemotherapies, an antiemetic prophylaxis should be initiated on the day of therapy, especially when using platinum or most of the cyclophosphamide-based regimes for cancer treatment. The recommended prophylaxis consists of a combination of 5-HT(3) antagonists with a corticosteroid. To combat the so-called delayed emesis on the days following therapy, all patients should undergo an oral corticoid therapy, possibly in combination with MCP (especially platinum-therapy patients), less frequently with 5-HT(3) antagonists. With these means of prophylaxis emesis can be prevented/avoided completely in most patients, and nausea can at least be reduced. It is sufficient to administer a single dose of 5-HT(3) antagonists prior to chemotherapy. For ondansetron and granisetron, the best documented substances within this class of drugs, 8 mg (ondansteron) and 3 mg (granisetron) are considered standard dosages. Among the corticoids, most data have been accumulated for dexamethasone. A standard dose of 10 to 20 mg can be administered prior to chemotherapy. Right after and especially on the days following chemotherapy higher dosages seem to be indicated.

PROSPECT

Further therapy improvements, especially concerning emesis and nausea on the days following chemotherapy, are necessary and are currently object of clinical research.

Development of the area postrema: an immunohistochemical study in the macaque

The organization and chemical development of the area postrema (AP) in the macaque monkey was studied by immunohistochemistry imaged with conventional and confocal microscopy from day 40 of gestation to adulthood. The thin ependyma of the adult was found to develop from a thick continuous structure beginning in the second trimester. It was later invaded by tyrosine hydroxylase immunoreactive (TH+) and dopamine beta-hydroxylase immunoreactive (DBH+) cells and fibers, suggesting a possible route for release of neurotransmitter directly into ventricular cerebrospinal fluid. Other TH+ and/or DBH+ fibers were found in close approximation to blood vessels. Prominent vascularity of the parenchyma of AP was present late in the first trimester (fetal day (Fd)57 in the macaque) and increased further until birth. By contrast, the underlying solitary nucleus was hypervascular at Fd57, but its vascularity rapidly declined by late in the second trimester. TH+ neurons first appeared late in the first trimester, and DBH+ neurons appeared in the second trimester; these findings are consistent with the view that catecholaminergic cells in AP are the earliest members of the A2 noradrenergic group. Catecholaminergic cells or fibers in AP contained little labeling for synaptic vesicular proteins, suggesting that the release of neurotransmitter there may not involve a synaptic mechanism. Synapses were first observed in mid-second trimester, and most were associated with GABA+ fibers.

Opportunities for the replacement of animals in the study of nausea and vomiting

Nausea and vomiting are among the most common symptoms encountered in medicine as either symptoms of disease or side effects of treatments. Developing novel anti-emetics and identifying emetic liability in novel chemical entities rely on models that can recreate the complexity of these multi-system reflexes. Animal models (especially the ferret and dog) are the current gold standard; however, the selection of appropriate models is still a matter of debate, especially when studying the subjective human sensation of nausea. Furthermore, these studies are associated with animal suffering. Here, following a recent workshop held to review the utility of animal models in nausea and vomiting research, we discuss the limitations of some of the current models in the context of basic research, anti-emetic development and emetic liability detection. We provide suggestions for how these limitations may be overcome using non-animal alternatives, including greater use of human volunteers, in silico and in vitro techniques and lower organisms.

Protein components of the blood-brain barrier (BBB) in the brainstem area postrema-nucleus tractus solitarius region

The blood-brain barrier (BBB) prevents entry of circulating substances into the brain. The circumventricular organs (CVOs) lack a BBB and have a direct communication with the circulation blood. One of the CVOs, the area postrema (AP), which has a close relationship with the nucleus of the tractus solitarius (NTS) and dorsal motor nucleus of the vagus nerve (DMX), plays a role in controlling the entry of blood-borne substances to neurons of the brainstem. To clarify the cellular localization of protein components of the BBB in the brainstem AP-NTS region, we used antisera to--(1) Tight junctions: claudin-5 and zona occludens-1 (ZO-1). (2) Endothelial cells: (a) all endothelial cells--rat endothelial cell antigen-1 (RECA-1) and (b) endothelial cells at BBB--endothelial barrier antigen (EBA), glucose transporter 1 (GLUT1) and transferrin receptor (TfR). (3) Basal lamina--laminin. (4) Vascular smooth muscle cells--smooth muscle actin (SMA). (5) Pericytes--chondroitin sulfate proteoglycan (NG2). (6) Glial cells: (a) astrocytes--glial fibrillary acidic protein (GFAP), (b) tanycytes--dopamine- and cAMP-regulated phosphoprotein of 32 kDA (DARPP-32), and (c) microglia--CD11b. Neuronal cell bodies in the NTS were visualized by antisera to neuropeptide Y (NPY) and alpha-melanocyte-stimulating hormone (alpha-MSH), two peptides regulating energy balance. This study provides a detailed analysis of the cellular localization of BBB proteins in the AP and NTS and shows the existence of vessels in the dorsomedial aspect of the NTS that lack immunoreactivity for the BBB markers EBA and TfR. Such vessels may represent a route of entry for circulating substances to neurons in the NTS that inter alia regulate energy balance.

Effects of motilin and mitemcinal (GM-611) on gastrointestinal contractile activity in rhesus monkeys in vivo and in vitro

Neither the presence of motilin receptors nor their action has been investigated in monkeys. The object of this study was to determine the effects of motilin and mitemcinal (GM-611), an erythromycin derivative, on the gastrointestinal tract in rhesus monkeys in vivo and in vitro. In in vivo investigations in conscious monkeys, both motilin and mitemcinal induced migrating motor complex-like contractions in the interdigestive state and also accelerated gastric emptying. In in vitro investigations, the presence of motilin receptors in the gastrointestinal tract was demonstrated by receptor binding assays. Motilin and mitemcinal contracted isolated duodenum strips in a concentration-dependent manner. In conclusion, rhesus monkeys may be useful for studying the physiological and pharmacological roles of the motilin agonistic mechanism because they show reactivity to motilin both in vivo and in vitro.

A size selective vascular barrier in the rat area postrema formed by perivascular macrophages and the extracellular matrix

The fenestrated microvasculature of the area postrema shows a less restrictive blood-brain barrier than is found in other areas of the CNS. We have studied the expression and relationship of vascular endothelial tight junctional proteins, astrocytes, macrophages, and the extracellular matrix with the extravasation of fluorescently tagged dextrans and sodium fluorescein in the rat area postrema. Glial fibrillary acidic protein (GFAP) -positive astrocytes were present within the area postrema which was surrounded by a dense zone of highly GFAP-reactive astrocytes. Expression of the tight junction proteins claudin-5, -12 and occludin was absent, although diffuse cytoplasmic claudin-1 immunoreactivity was present. The extracellular matrix of the endothelium showed two non-fused thickened layers of laminin immunoreactivity. CD163 and CD169 immunoreactive perivascular macrophages were located within lacunae between these two laminin layers. Fluorescently tagged dextrans (10-70 kDa) passed from the vasculature but were retained between the inner and outer laminin walls and rapidly sequestered by the perivascular CD163 and CD169 macrophages. Three-kilodalton dextran diffused into the parenchyma, but was retained within the boundary of the area postrema at the interface with the highly reactive GFAP-astrocytes, while sodium fluorescein (0.3 kDa) passed from the area postrema into surrounding CNS areas. Our observations suggest that despite the absence of a tight blood-brain barrier, a size selective barrier restricting the movement of blood solutes into the parenchyma is present in the area postrema. We suggest that the rapid uptake by CD163 and CD169 macrophages together with the non-fused laminin immunoreactive layers of the extracellular matrix plays a size selective role in restricting movement of serum proteins and other blood borne macromolecules over 10 kDa in to the area postrema.

Cisplatin-induced long-term dynorphin A-immunoreactivity in cell somata of rat area postrema neurons

We evaluated long-term dynorphin A-immunoreactivity in the rat area postrema (AP) after the administration of cisplatin. First, rats were given 1, 5 and 10mg/kg body weight cisplatin (i.p.) and their behavior was monitored for 72h. We observed a delayed increase in pica 24-72h after injection, compared to the 24h before injection. We attributed this to the cisplatin injection. Pica was defined as an increase in the intake of non-nutritional matter such as kaolin. Administration of 1, 5 and 10mg/kg cisplatin led to an increase in kaolin intake on day 1. Administration of 5 and 10mg/kg of cisplatin led to decreased intake of laboratory chow (MF) on days 1-3, but 10mg/kg cisplatin causes an excessive aggravation of their condition. Following this behavioral experiment, we immunohistochemically examined the induction of dynorphin A in the AP at 24, 48 and 72h post-administration of 1 and 5mg/kg cisplatin. Administration of 5mg/kg cisplatin caused dynorphin A to accumulate gradually in the neurosoma of the AP neurons, and the numbers of positive AP neurosomata at 48 and 72h post-administration were higher than following an equal dosage of 0.9% NaCl. These findings suggest that dynorphin A increases in the central nervous system for a long time following administration, and causes certain behavioral and clinical changes, including those related to appetite and nausea.

Comparative activity of antiemetic drugs

Nausea and vomiting continues to be an important problem for cancer patients receiving chemotherapy. Chemotherapy-induced nausea and vomiting (CINV) are classified as acute, occurring within the first 24h, or delayed, occurring after the first 24h. A number of antiemetic agents are available for the management of nausea and vomiting, including 5-HT3-receptor-antagonists, corticosteroids, NK-1-receptor-antagonists, dopamine-receptor antagonists, benzodiazepines, neuroleptics and cannabinoids. With modern antiemetic therapy, vomiting can be prevented in 70-80% of patients, whereas the control of nausea remains suboptimal. The development of acute emesis is known to depend on serotonin. The pathophysiology of delayed emesis is less well understood, and multiple mechanisms may contribute, including substance P. Here, the most recent developments in the antiemetic therapy, including new antiemetic drugs and the latest guidelines for antiemetic prophylaxis, are reviewed.

Membrane-transport systems in the fenestrated capillaries of the area postrema in rat and calf

The capillaries of the area postrema (AP) lack the morphological peculiarity of the blood-brain barrier (BBB), and the AP neurons are considered located outside the BBB. Using the immunofluorescent method, we have investigated the expression of membrane transport systems that are instrumental to the BBB function, such as caveolin-1, -2, P-glycoprotein, and glut-4, in the capillary endothelium of the rat and calf AP. The expression of these molecules was verified after fibronectin immunostaining of the microvessels. Both in the rat and calf, caveolin-1, -2, and P-glycoprotein were expressed in the AP capillaries. A quantitative analysis revealed that the proportion of the capillary profiles expressing these transport systems was very close to 100% of the fibronectin immunolabelled profiles. On the contrary, none of the AP capillaries showed glut-4 immunoreactivity. The present investigation demonstrates that the endothelial layer of the AP capillaries, in spite of the paracellular passage of polar molecules through the leaky tight junctions and fenestrations, could be an active interface which is able to control the entry of a wide range of blood-borne compounds into the brain by means of specific mechanisms, including an efflux pump.

Delta9-tetrahydrocannabinol selectively acts on CB1 receptors in specific regions of dorsal vagal complex to inhibit emesis in ferrets

The aim of this study was to investigate the efficacy, receptor specificity, and site of action of Delta9-tetrahydrocannabinol (THC) as an antiemetic in the ferret. THC (0.05-1 mg/kg ip) dose-dependently inhibited the emetic actions of cisplatin. The ED50 for retching was approximately 0.1 mg/kg and for vomiting was 0.05 mg/kg. A specific cannabinoid (CB)1 receptor antagonist SR-141716A (5 mg/kg ip) reversed the effect of THC, whereas the CB2 receptor antagonist SR-144528 (5 mg/kg ip) was ineffective. THC applied to the surface of the brain stem was sufficient to inhibit emesis induced by intragastric hypertonic saline. The site of action of THC in the brain stem was further assessed using Fos immunohistochemistry. Fos expression induced by cisplatin in the dorsal motor nucleus of the vagus (DMNX) and the medial subnucleus of the nucleus of the solitary tract (NTS), but not other subnuclei of the NTS, was significantly reduced by THC rostral to obex. At the level of the obex, THC reduced Fos expression in the area postrema and the dorsal subnucleus of the NTS. The highest density of CB1 receptor immunoreactivity was found in the DMNX and the medial subnucleus of the NTS. Lower densities were observed in the area postrema and dorsal subnucleus of the NTS. Caudal to obex, there was moderate density of staining in the commissural subnucleus of the NTS. These results show that THC selectively acts at CB1 receptors to reduce neuronal activation in response to emetic stimuli in specific regions of the dorsal vagal complex.

Intraperitoneal corticotropin-releasing factor and urocortin induce Fos expression in brain and spinal autonomic nuclei and long lasting stimulation of colonic motility in rats

CRF injected intraperitoneally (i.p.) stimulates colonic motor function and induces Fos expression in colonic myenteric neurons. We investigated central and spinal Fos expression and changes in colonic motility in response to i.p. injection of CRF and urocortin. Ovine CRF(9-33) that is devoid of intrinsic activity at the CRF receptors, was used as control peptide. Myoelectrical activity was monitored for 1 h before and after peptide injection (10 microg/kg, i.p.) in conscious non fasted rats with chronically implanted intraparietal electrodes in the cecum and proximal colon. Brain and lumbosacral spinal cord were processed for Fos immunohistochemistry at 1 h postinjection. CRF and urocortin elicited defecation and a new pattern of ceco-colonic clustered spike bursts that peaked within 15 min and lasted for the 1 h experimental period while CRF(9-33) did not modify baseline myoelectrical activity and defecation. CRF increased significantly Fos expression in the central nucleus of the amygdala (lateral part), parabrachial nucleus (external lateral subnucleus), area postrema, nucleus tractus solitarius, locus coeruleus, paraventricular nucleus of the hypothalamus, the intermediolateral column and area I-VII, X at the L6-S1 level of the spinal cord by 11-, 6.5-, 5.3-, 5.0-, 4.7-, 2.7- and 1.4-fold, respectively compared with i.p. CRF(9-33) injected rats that had little Fos expression. Urocortin induced a similar pattern of Fos response in the brain and the spinal cord. These results indicate that i.p. CRF and urocortin induce a peptide specific activation of brain nuclei receiving viscerosensory inputs and involved in autonomic circuitries whose effector limbs may impact on visceral function.

Roles of substance P and NK(1) receptor in the brainstem in the development of emesis

The emetic response is primarily a protective reflex occurring in a wide variety of vertebrates in response to the ingestion of toxic compounds. The role of the nuclei in the brainstem, including the area postrema, nucleus tractus solitarius, the dorsal motor nucleus of the vagus, and the central pattern generator for vomiting, as well as the involvement of the abdominal visceral innervation relevant to the emetic reflex, have all been discussed by many researchers. The introduction of serotonin 5-HT(3)-receptor antagonists into clinical practice allowed for a dramatic improvement in the management of vomiting. However, vomiting still remains a significant problem. The mechanism of the emetic response is even more complicated than was first thought. This review attempts to bring together some of the evidence suggesting the roles of substance P and its receptor, neurokinin NK(1) receptor, in the brainstem nuclei in the development of emesis. Accordingly, NK(1)-receptor antagonists might represent novel drugs for the management of major types of emesis.

Orexin-A depolarizes dissociated rat area postrema neurons through activation of a nonselective cationic conductance

The area postrema (AP) is involved in the regulation of body fluid balance, feeding behavior, and cardiovascular function. Orexin (ORX)-A is a 33 aa peptide that regulates energy metabolism and sympathetic and cardiovascular actions. ORX immunoreactive axons and their varicose terminals have been found in AP. In this study, whole-cell, current- or voltage-clamp recordings were obtained from 108 dissociated rat AP neurons. The mean resting membrane potential of these neurons (n = 48) was -59.24 +/- 0.87 mV, the mean input resistance was 3.57 +/- 0.22 G(Omega), and the action potential amplitude of these cells was always >90 mV. Current-clamp studies showed bath application of ORX-A depolarized the majority of AP neurons tested (68.8%; 33 of 48), whereas small proportions of cells were either hyperpolarized (16.7%; 8 of 48) or unaffected (14.6%; 7 of 48). These depolarizing effects were found to be concentration dependent from 10(-8) to 10(-11) m. We then examined the contributions of specific ionic conductances to the ORX-A-induced excitation of AP neurons through whole-cell, voltage-clamp studies. Our results demonstrate that in contrast to previous studies on other neuronal populations, ORX-A did not affect net whole-cell potassium currents in AP neurons. Slow depolarizing voltage ramps, however, revealed that ORX-A enhanced a nonselective cationic conductance in AP neurons, effects which would explain the depolarizing effects of the peptide. These data demonstrate that AP neurons are directly influenced by ORX-A and suggest that ORX-A may exert its effects on the central control of feeding behavior and cardiovascular function through direct actions in AP.

The role of the dura in conditioned taste avoidance induced by cooling the area postrema of male rats

Experiments were designed to assess the contribution of the dura mater to the formation of conditioned taste avoidance induced by cooling the area postrema. The results of the first experiment verified that the temperature of the dura showed a temperature gradient at various distances from the tip of the cold probe. In the second and third experiments, a circle of dura was cut away so that different amounts of the area postrema could be cooled without cooling the overlying dura. Cooling the dura plus the area postrema did not produce a stronger avoidance than just cooling the area postrema. In the fourth experiment, the cerebellar cortex was cooled with and without cooling the dura. Cooling the cerebellar cortex produced conditioned taste avoidance, and cooling the dura plus the cerebellar cortex did not produce a stronger avoidance. Taken together, these results suggest that cooling the dura mater does not contribute to the conditioned taste avoidance induced by cooling the area postrema. The results of the fifth experiment showed that cooling the area postrema produced a stronger conditioned taste avoidance than cooling the cerebellar cortex. It is suggested that the avoidance induced by cooling both of these structures is the result of physiological changes occurring when neurons in these structures are inactivated and when the subdural meninges are cooled. Furthermore, these changes are more severe when the area postrema is cooled.

Combination therapy for postoperative nausea and vomiting - a more effective prophylaxis?

The problem of postoperative nausea and vomiting (PONV) remains far from being resolved. Despite the introduction of new classes of antiemetics and a vast amount of published research, there is a general impression that there has been little progress in this area. The multifactorial etiology of PONV might be better addressed using a combination of drugs acting at different receptor sites. This approach of balanced antiemesis may be the answer towards achieving a significant improvement in the management of PONV. This article will cover the different strategies used to prevent PONV with particular emphasis on combination antiemetics. A review of the currently available methods to manage PONV as well as the physiological and pharmacological basis of combination therapy is presented.

Effects of pinealectomy and sham-surgery on the area postrema in rats: a quantitative histological study with special reference to capillaries and neuronal cell nuclei

This study aimed to clarify the effects of pinealectomy and sham-surgery on the area postrema (AP) by quantitative histological methods. Male, Wistar rats of normal (NO), sham-operated (SX), and pinealectomized (PX) groups were used in the late dark phase at 7 weeks of age. Consecutive frontal sections including the AP were stained with hematoxylin and eosin, and immunostained using PGP 9.5 for neurons, or GFAP or vimentin for glial cells. Consecutive sections of the AP were separated into five portions starting from the point of the central canal opening to the fourth ventricle in the caudal direction, and used for measurements. Mean cross-sectional areas of capillaries showed a lower value in the SX group than in the other two groups (vs NO, P<0.005; vs PX, P<0.03). In addition, the frequency distributions of the nuclear diameters of nerve cells showed different patterns among the three experimental groups (P<0.01), the frequency of large nuclei being higher in the SX group than in the other two groups. Possible mechanisms of the effects of sham-pinealectomy and pinealectomy and significance of the pineal-AP relation are discussed. The results of this study indicate that stuctural changes in the AP can be induced by intracranial surgery, suggesting certain pineal involvement in these changes.

Area postrema ablation attenuates activation of neurones in the paraventricular nucleus in response to systemic adrenomedullin

Adrenomedullin (ADM) is a potent vasodilator in the periphery which also acts centrally to increase blood pressure and inhibit drinking, feeding and salt appetite. This study was designed to study the effects of circulating ADM on neuronal activation in autonomic centres in the rat brain and to examine whether neuronal nitric oxide (NO) may participate in these processes. We identified activated neurones 1 h after intravenous (i.v.) injections of ADM (2 nmol/kg) using immunohistochemistry for Fos. The nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemical reaction was used to localize putative NO-producing neurones and double labelling for Fos and NADPH-d was used to identify activated NO producing neurones. To separate baroreceptor-induced neuronal activation in autonomic centres by ADM from other effects which it may have, i.v. infusions of sodium nitroprusside (NP) were used to mimic the hypotensive effects of ADM in control rats. Significantly greater numbers of activated neurones were found in the paraventricular nucleus of the hypothalamus (PVN) and especially in the dorsolateral medial parvocellular division, the nucleus of the solitary tract, and the area postrema (AP) of ADM-treated rats compared to control rats. In addition, the number of activated NO-producing neurones in the PVN was significantly higher in ADM-treated rats compared to rats treated with NP. To determine whether AP is one of the possible routes through which systemic ADM enters the brain to exert its central effects, the APs of rats were ablated by aspiration. One hour after i.v. injections of ADM, significantly fewer PVN neurones were activated in AP ablation rats compared to AP sham ablation rats. Similarly, the number of activated NO-producing neurones in the PVN was significantly lower in AP ablation rats compared to AP sham ablation rats. In conclusion, our results suggest that systemic ADM gains access to the brain through the AP to regulate neuronal activity in autonomic centres and that neuronal NO might be involved in central autonomic and/or neuroendocrine regulation by ADM.

Plasticity in the mesenteric afferent response to cisplatin following vagotomy in the rat

The aim of this study was to investigate the actions of the cytotoxic drug cisplatin on populations of mesenteric afferents supplying the rat jejunum. Extracellular whole mesenteric nerve discharge was monitored and the activity of individual single afferent units determined using waveform discriminator software. Baseline whole nerve discharge was 21.5 +/- 3.8 impulses s(-1). Nerve discharge began to increase approximately 10 min after cisplatin administration, reached a plateau around 30 min, and remained elevated at 60 min (35.3 +/- 5.7 impulses s(-1), p < 0.01). Granisetron reversed the increase in nerve activity indicating that the response to cisplatin was mediated by the release of endogenous 5-HT acting on 5-HT3 receptors. Single afferent units, selected by waveform analysis on the basis of their response to exogenous 5-HT, showed a similar time course of activation following cisplatin. In contrast, the discharge frequency of afferent units that were insensitive to 5-HT was unaffected by cisplatin or granisetron. The sensitivity of mesenteric afferent bundles to exogenous 5-HT was absent in chronically vagotomized animals. However, cisplatin elicited an increase in nerve discharge in vagotomized animals that was not different from control (34.6 +/- 8.9 impulses s(-1)) but this increase was unaffected by treatment with granisetron. Thus, after vagotomy there is a switch from 5-HT3 mediated activation of vagal afferents to a 5-HT3-independent activation of non-vagal (possibly splanchnic) afferents. Since this later mechanism of activation is absent in control animals, it appears that there is plasticity in the gastrointestinal afferent sensitivity to cisplatin.

Vasopressin and sensory circumventricular organs

The subfornical organ, the area postrema and the organum vasculosum of the lamina terminalis are considered to be sensory circumventricular organs as they contain neuronal somata which are located outside the blood-brain barrier and are thus capable of serving as 'sensors' for blood-borne humoral messengers. The endocrine hormone, vasopressin (VP), not only causes strong antidiuresis by acting on the kidney, but also exerts centrally mediated effects as a neuromodulator. Several lines of evidence suggest that VP can influence regulatory functions mediated by the sensory circumventricular organs, since vasopressinergic somata and terminals as well as VP receptors have been reposted to be present in these structures. These biochemical prerequisites offer the possibility that blood-borne VP might on the one hand act as a feedback signal from the periphery and, on the other hand, synaptically released or locally produced VP could modulate the known functions of sensory circumventricular organs, such as thirst, fever or cardiovascular regulation. This review focuses on the possible physiological relevance of VP acting on sensory circumventricular organs in view of recent evidence obtained from biochemical and electrophysiological studies at the cellular level.

The distribution of estrogen receptors in the brainstem of female sheep

Estrogen receptors (ER) have been mapped in the brainstem of the female sheep with immunocytochemistry. A small group of ER-positive cells was found in the lateral and ventrolateral medulla and a larger number in the nucleus of the solitary tract. ER-positive cells were abundant in the area postrema. In the rostral brainstem a small number of ER-positive cells were found in the lateral and dorsal regions of the periaqueductal gray area, and some immediately lateral to the fourth ventricle. Many ER-positive cells were also present in the region around the superior cerebellar peduncle, particularly in the lateral parabrachial nucleus. These results describe for the first time the distribution of ER in the brainstem of the sheep and indicate that the majority of estrogen-containing cells are located in structures involved in the regulation of cardiovascular parameters and fluid balance.

The effects of cooling the area postrema of male rats on conditioned taste aversions induced by LiC1 and apomorphine

Although permanent lesion studies have demonstrated that the area postrema (AP), a chemoreceptor trigger zone, is part of the neural mechanism for conditioned taste aversions (CTAs), its exact role remains questionable. It has been suggested that the attenuated acquisition of a CTA after permanent lesions of the AP is the result of an inability to recognize the conditioned taste as novel. The present series of experiments was designed to test the hypothesis that lesions of the AP interfered with LiCl processing and not recognition of taste novelty. This was accomplished by using the reversible lesioning procedure, cooling, only during administration of the illness-inducing agent. In Expt. 1, measurement of thermal lines around the tip of the cold probe in the AP indicated that our cooling procedures allowed the majority of the AP to be cooled to temperatures that suppress neuronal activity and transsynaptic transmission, but not axonal transmission. In Expts. 2 and 3, rats were injected with either LiCl or apomorphine after consumption of a 10% sucrose solution. Cooling of the AP was initiated 5 min before administration of one of the illness-inducing agents and was continued for 55 min after injection. The rats were tested later for acquisition while the neural function of the AP was preserved. Our experimental results demonstrated that cooling the AP could attenuate the CTA induced by LiCl, but had no effect on the CTA induced by apomorphine. Since the AP was functional when the rats encountered the novel sucrose solution both before and after conditioning, but not functional when LiCl was given, these results do not support the recognition of taste novelty hypothesis.

Motilin and clinical application

Motilin is a regulatory polypeptide of 22 amino acid residues and orginates in motilin cells scattered in the duodenal epithelium of most mammals and chickens. Motilin is released into the general circulation at about 100-min intervals during the interdigestive state and is the most important factor in controlling the interdigestive migrating contractions. Recent studies have revealed that motilin stimulates endogenous release of the endocrine pancreas. Clinical application of motilin as a prokinetic has become possible since erythromycin and its derivatives were proved to be nonpeptide motilin agonists.

The dorsal vagal complex of the ferret: anatomical and immunohistochemical studies

To further the understanding of gastrointestinal function in this species, and in particular to advance our own work concerning central emetic pathways, the cytoarchitecture and the distribution of eight neurochemicals were studied in the ferret dorsal vagal complex (DVC; area postrema, nucleus of the solitary tract [nTS] and dorsal motor nucleus of the vagus). The cytoarchitectural features of this region in the ferret were similar to those seen in other species; however, the ferret possesses a particularly large and distinct subnucleus gelatinosus of the nTS. Dense calcitonin gene-related peptide-immunoreactivity was found in the gelatinous, interstitial and commissural subnuclei of the nTS, with lesser amounts in other regions of the DVC. Enkephalin-immunoreactivity of varying densities was found throughout the DVC. Moderate to dense galanin-immunoreactivity was observed throughout the DVC, with the exception of the subnucleus gelatinosus of the nTS, from which it was virtually absent. Dense neuropeptide Y-immunoreactivity was observed in the subnucleus gelatinosus and interstitial subnucleus, with moderate staining in other regions of the DVC. Neurotensin immunoreactivity was very sparse or absent. Immunoreactivity for serotonin was sparsely distributed throughout the DVC. Moderate somatostatin-immunoreactivity was observed over a large portion of the DVC, but was virtually absent from the gelatinosus and interstitial subnuclei. Substance P immunoreactivity was observed throughout the DVC and was particularly dense in the dorsal/dorsolateral subnucleus and the dorsal aspects of the medial and commissural subnuclei. In terms of its cytoarchitecture the DVC of the ferret is more similar to the cat than the rat, especially with regard to the area postrema and the subnucleus gelatinosus of the nTS. The distribution of neuroactive substances was largely similar to other species; however, differences were present particularly in patterns of immunoreactivity for enkephalin, serotonin, neuropeptide Y and somatostatin.

Caloric intake stimulates growth hormone secretion in food-deprived rats with anterolateral deafferentation of the medial basal hypothalamus or administered antiserum to somatostatin

In rats, food deprivation inhibits episodic growth hormone (GH) secretion. On the basis of previous studies, we hypothesized that during a recovery from prolonged fasting, caloric intake stimulates the release of GH-releasing factor (GRF) and this process does not depend on the specific macronutrients in the meal, while protein in the meal acts to restore characteristic ultradian rhythmicity of GH secretion. To test this hypothesis, the effect of caloric intake on GH secretion was examined in fasted adult male Wistar rats devoid of somatostatin (SS) influence on GH secretion either by anterolateral deafferentation (ALC) of the medial basal hypothalamus (MBH) or administration of anti-SS goat serum (ASS). Rats were provided with an indwelling right atrial cannula and were deprived of food for 72 h. ALC was performed 2 weeks prior to the study. ASS was given i.v. 8 h and 7 h prior to refeeding, respectively. Serial blood specimens were collected every 10 min. In rats with ALC (ALC rats) or rats given ASS (ASS rats), the blood GH level revealed irregularly occurring small fluctuations, instead of the usual high bursts and low trough level. The baseline GH level and the mean GH level of fasted ALC rats or fasted ASS rats were significantly lower than those of fed ALC rats or fed ASS rats. Feeding the isocaloric mixed meal, the protein meal or the protein-deficient meal increased the GH pulse frequency, the pulse amplitude, the baseline GH level and the mean GH level in 72-h fasted ALC rats. These changes in GH secretory pattern persisted during the period of observation and were independent of the type of meal ingested. Following feeding the mixed meal, similar changes in the GH secretory pattern demonstrated in 72-h fasted ALC rats were also observed in 72-h fasted ASS rats, suggesting that the stimulation of GH secretion following caloric intake is not limited to ALC rats. Since the influence of SS on GH secretion has been largely eliminated in ALC or ASS rats, it is highly unlikely that the augmentation of GH secretion following feeding after prolonged food deprivation was the consequence of inhibition of SS secretion. Although GRF measurement was not performed, it is conceivable that the signal of caloric intake is conveyed to the MBH and acts to stimulate GRF release.

A possible anti-emetic role for sodium valproate in cytotoxic chemotherapy

We report two patients with acute leukaemia who received emetogenic cytotoxic drugs and were on therapeutic doses of sodium valproate for epilepsy. Neither patient reported significant nausea nor vomited at any time during the chemotherapy, at times requiring no anti-emetic treatment whatsoever. We suggest that this absence of nausea was due to an anti-emetic effect of sodium valproate.

Neural responses of rat area postrema to stimuli producing nausea

To identify a neuron within the area postrema (AP) that participates in producing nausea, neural responses of the rat AP to noxious, excessive distension of the stomach were recorded electrophysiologically under urethane-chloralose anesthesia. There were two types of the neural responses; one is characterized by increasing the frequency of discharges responding to the stomach distension (excitatory type), while the other shows the opposite response (decreasing the frequency) to the same stimulation (inhibitory type). After this identification, the effect of LiCl or apomorphine superfused on the floor of IVth ventricle was examined to ascertain a convergence of afferents responding to chemical (LiCl or apomorphine) as well as mechanical noxious stimulation (stomach distension) on the same AP neuron. It was revealed that the rat AP involves multimodality neurons responsive to various emetic stimuli, so indicating their participation in producing nausea.

Histochemical evidence for abnormal copper distribution in the central nervous system of LEC mutant rat

After sulfide-silver staining if tissue sections treated with trichloroacetic acid, silver particles indicating the copper distribution were observed in several regions of normal rat brain, including the nucleus arcuatus, nucleus tractus solitarii, nucleus habenulae medialis, locus ceruleus, and cerebellum. However, copper in these regions disappeared or was greatly decreased in LEC mutant rats. The are postrema showed no detectable level of copper in normal rat brain, but exhibited an extremely high level of copper in LEC rats, with or without the onset of jaundice. The results suggest an abnormal copper metabolism in the central nervous system of LEC rat.

The connectivity of the area postrema in the ferret

The area postrema (AP) is the chemosensitive trigger zone for the emetic reflex. We have investigated the connectivity of the AP and adjacent solitary complex (SC) to identify possible sites of the motor emetic center. The AP and SC were infused with HRP or WGA-HRP in 30 ferrets that were perfused transcardially after 24-72 h. A block from the pons to upper cervical spinal cord, and one with hypothalamus and basal forebrain, was cut at 50 microns, reacted, and mounted. Data support the conclusion, at variance with those from other preparations, that in ferrets the AP has reciprocal connections only with the SC, which serves as a relay in both ascending and descending pathways between AP and higher levels of the neuraxis. Connectivity of the SC with brain stem and forebrain structures including the rostral ventrolateral medulla, parabrachial nuclei, paraventricular nucleus, and amygdala was demonstrated. At least in ferrets, our results suggest that the motor emetic center must be located within the SC. While this may not apply to all species, it is also possible that some reports of AP projections elsewhere were results of label within the SC. Alternatively, the somewhat different pattern of emesis in the ferret as compared to the dog (greater role for vagal inputs in response to radiation and cytotoxic drugs, lesser role for humoral inputs) may reflect differences in AP connectivity.

Localization of tyrosine hydroxylase in neuronal targets and efferents of the area postrema in the nucleus tractus solitarii of the rat

Catecholamines in the nucleus tractus solitarii (NTS) have been implicated in autonomic responses to circulating hormones that act on neurons in the area postrema, the most caudal circumventricular organ in brain. We combined immunoperoxidase labeling of the anterograde tracer, Phaseolus vulgaris leucoagglutinin (PHAL) with immunogold-silver labeling of tyrosine hydroxylase to determine whether this enzymatic marker for catecholamines was present in efferents from the area postrema or their targets in the rat NTS. At survival periods of 10-12 days after PHAL injections into the area postrema, light microscopy revealed numerous varicose processes containing peroxidase reaction product for PHAL in the dorsomedial, medial, and commissural NTS. Some of these labeled processes were located near neuronal perikarya and processes containing immunogold-silver intensified reaction product for tyrosine hydroxylase. Electron microscopy of the commissural and dorsomedial NTS established that the majority of the labeling for PHAL was in axon terminals, whereas immunogold labeling for tyrosine hydroxylase was mainly in soma and dendrites. Only 3 out of 579 PHAL-labeled terminals also contained detectable tyrosine hydroxylase immunoreactivity. Fifty-eight percent (335/579) of the PHAL-labeled terminals formed synapses with recognized symmetric junctions, whereas the remainder lacked synaptic specializations within the examined series of serial sections. Of those PHAL terminals forming recognized symmetric junctions, 22% were on tyrosine hydroxylase-immunoreactive dendrites, 74% on unlabeled dendrites and 4% on unlabeled axon terminals. From a total of 1,250 observed contacts on tyrosine hydroxylase labeled dendrites, 88 (7%) contained PHAL, 9 (< 1%) contained TH, and 1,180 (93%) lacked detectable immunoreactivity and formed primarily symmetric synapses. We conclude that a few catecholamine, but mainly noncatecholamine efferents from the area postrema provide a monosynaptic, and most likely inhibitory input to target neurons both with and without tyrosine hydroxylase immunoreactivity in the dorsomedial and commissural NTS. Synapses between the efferent terminals from the area postrema and tyrosine hydroxylase labeled and unlabeled dendrites as well as unlabeled axons in these specific subnuclei of the NTS suggest multiple sites for modulation of gastric and cardiovascular reflexes in response to circulating peptides.

Interaction of the antiemetic metopimazine and anticancer agents with brain dopamine D2, 5-hydroxytryptamine3, histamine H1, muscarine cholinergic and alpha 1-adrenergic receptors

The interactions of the antiemetic metopimazine (MPZ) and of the chemotherapeutic agents, cisplatin, carboplatin, doxorubicin, etoposide and vincristine were investigated at five neurotransmitter receptor binding sites. MPZ had nanomolar affinity for alpha 1, dopamine D2 and histamine H1 receptors, weak affinity for muscarinic cholinergic receptors, but no affinity for 5-hydroxytryptamine3 (5-HT3) receptors. Except for vincristine, which showed nanomolar affinity of muscarinic cholinergic receptors, none of the chemotherapeutic agents showed affinity for any of the receptors investigated at concentrations ranging between 10(-5) and 10(-7) M. Accordingly, chemotherapy-induced nausea and vomiting seems to be mediated by mechanisms other than the direct interaction of cytostatics with the neurotransmitter receptors investigated. Our finding that MPZ is without affinity for 5-HT3 receptors and therefore seems to mediate its antiemetic effect predominantly by dopamine D2 receptor blockade makes it an interesting drug for use in combinations with the new class of antiemetics, the 5-HT3 receptor antagonists. Data obtained in a recent clinical trial support this observation.

An atlas of the rat subpostremal nucleus tractus solitarius

The nucleus tractus solitarius (NTS) in the dorsal medulla is the principal visceral sensory relay nucleus in the brain. In the rat, numerous lines of evidence indicate that the caudal NTS at the level of the area postrema serves as a major integrating site for coordinating cardiorespiratory reflexes and viscerobehavioral responses. This region of the caudal NTS not only exhibits high densities of binding sites for an impressive array of transmitters and modulators but microinjections of many of these same neuroactive substances into the rat subpostremal NTS elicit pronounced cardiorespiratory and visceral response patterns. This report provides an abbreviated atlas of the rat subpostremal NTS consisting of a series of transverse, sagittal, and horizontal plates. Photomicrographs, together with their corresponding schematic drawings, are provided for the serial sections generated from each reference plane.