Excitatory action of 5-HT on deglutitive substrates in the rat solitary complex

Effect of acupuncture on post-stroke dysphagia: a randomized controlled trial

Introduction

Post-stroke dysphagia (PSD) is associated with various complications that increase morbidity and mortality rates. Acupuncture has been used extensively in China to treat these complications; however, its therapeutic efficacy remains uncertain. We therefore aimed to study the clinical effects of acupuncture on PSD.

Methods

Patients (n = 101) were randomly divided into acupuncture (n = 50) and rehabilitation training control (n = 51) groups based on the treatment used. Both groups were treated once daily, 6 days a week, for a total of 4 weeks. Pulse oxygen saturation (SpO2) and standardized swallowing assessment (SSA) were performed before the intervention, 2 weeks into treatment, after the intervention (4 weeks post-intervention), and at a 6-month follow-up (28 weeks). The levels of hemoglobin (Hb) and albumin (ALB), and 5-hydroxytryptamine (5-HT) and dopamine (DA) were measured before the intervention, 2 weeks into treatment, and after the intervention (4 weeks), as nutrition and swallowing function indices, respectively.

Results

Following the intervention, significant differences were observed between the acupuncture and control groups. The acupuncture group exhibited considerably superior enhancements in SpO2 and SSA scores at 4 weeks (p < 0.001). Moreover, this group demonstrated significantly greater improvements in Hb, ALB, 5-HT, and DA values 4 weeks post-treatment (p < 0.001). However, sex-based differences were not observed (P > 0.005).

Conclusion

Acupuncture treatment can improve the swallowing function and nutritional status of patients with PSD, and increase the levels of 5-HT and DA. These findings strongly support the efficacy of acupuncture as a therapeutic intervention in patients with PSD.Clinical trial registration: identifier, ChiCTR2100052201. (https://www.chictr.org.cn/).

Serotonin therapies for opioid-induced disordered swallow and respiratory depression

Opioids are well-known to cause respiratory depression, but despite clinical evidence of dysphagia, the effects of opioids on swallow excitability and motor pattern are unknown. We tested the effects of the clinically relevant opioid buprenorphine on pharyngeal swallow and respiratory drive in male and female rats. We also evaluated the utility of 5-HT1A agonists (8-OH-DPAT and buspirone) to improve swallowing and breathing following buprenorphine administration. Experiments were performed on 44 freely breathing Sprague-Dawley rats anesthetized with sodium pentobarbital. Bipolar fine wire electrodes were inserted into the mylohyoid, thyroarytenoid, posterior cricoarytenoid, thyropharyngeus, and diaphragm muscles to measure electromyographic (EMG) activity of swallowing and breathing. We evaluated the hypotheses that swallowing varies by stimulus, opioids depress swallowing and breathing, and that 5-HT1A agonists improve these depressions. Our results largely confirmed the following hypotheses: 1) swallow-related EMG activity was larger during swallows elicited by esophageal distension plus oral water infusion than by either stimulus alone. 2) Buprenorphine depressed swallow in both sexes, but females were more susceptible to total swallow suppression. 3) Female animals were also more vulnerable to opioid-induced respiratory depression. 4) 8-OH-DPAT rescued breathing following buprenorphine-induced respiratory arrest, and pretreatment with the partial 5-HT1A agonist buspirone prevented buprenorphine-induced respiratory arrest in female animals. 5) 8-OH-DPAT enhanced mylohyoid and thyropharyngeus EMG amplitude during swallow but did not restore excitability of the swallow pattern generator following total suppression by buprenorphine. Our results highlight sex-specific and behavior-specific effects of buprenorphine and provide preclinical evidence of a 5HT1A agonist for the treatment of respiratory depression and dysphagia.NEW & NOTEWORTHY This is the first study, to our knowledge, to evaluate sex-specific effects of opioid administration on pharyngeal swallow. We expand on a small but growing number of studies that report a lower threshold for opioid-induced respiratory depression in females compared with males, and we are the first to produce this effect with the partial μ-opioid-receptor agonist buprenorphine. This is the first demonstration, to our knowledge, that activation of 5-HT1A receptors can improve swallow and breathing outcomes following systemic buprenorphine administration.

Deglutition and the Regulation of the Swallow Motor Pattern

Despite centuries of investigation, questions and controversies remain regarding the fundamental genesis and motor pattern of swallow. Two significant topics include inspiratory muscle activity during swallow (Schluckatmung, i.e., "swallow-breath") and anatomical boundaries of the swallow pattern generator. We discuss the long history of reports regarding the presence or absence of Schluckatmung and the possible advantages of and neural basis for such activity, leading to current theories and novel experimental directions.

Quipazine Elicits Swallowing in the Arterially Perfused Rat Preparation: A Role for Medullary Raphe Nuclei?

Pharmacological neuromodulation of swallowing may represent a promising therapeutic option to treat dysphagia. Previous studies suggested a serotonergic control of swallowing, but mechanisms remain poorly understood. Here, we investigated the effects of the serotonergic agonist quipazine on swallowing, using the arterially perfused working heart-brainstem (in situ) preparation in rats. Systemic injection of quipazine produced single swallows with motor patterns and swallow-breathing coordination similar to spontaneous swallows, and increased swallow rate with moderate changes in cardiorespiratory functions. Methysergide, a 5-HT2 receptor antagonist, blocked the excitatory effect of quipazine on swallowing, but had no effect on spontaneous swallow rate. Microinjections of quipazine in the nucleus of the solitary tract were without effect. In contrast, similar injections in caudal medullary raphe nuclei increased swallow rate without changes in cardiorespiratory parameters. Thus, quipazine may exert an excitatory effect on raphe neurons via stimulation of 5-HT2A receptors, leading to increased excitability of the swallowing network. In conclusion, we suggest that pharmacological stimulation of swallowing by quipazine in situ represents a valuable model for experimental studies. This work paves the way for future investigations on brainstem serotonergic modulation, and further identification of neural populations and mechanisms involved in swallowing and/or swallow-breathing interaction.

Swallow Motor Pattern Is Modulated by Fixed or Stochastic Alterations in Afferent Feedback

Afferent feedback can appreciably alter the pharyngeal phase of swallow. In order to measure the stability of the swallow motor pattern during several types of alterations in afferent feedback, we assessed swallow during a conventional water challenge in four anesthetized cats, and compared that to swallows induced by fixed (20 Hz) and stochastic (1-20Hz) electrical stimulation applied to the superior laryngeal nerve. The swallow motor patterns were evaluated by electromyographic activity (EMG) of eight muscles, based on their functional significance: laryngeal elevators (mylohyoid, geniohyoid, and thyrohyoid); laryngeal adductor (thyroarytenoid); inferior pharyngeal constrictor (thyropharyngeus); upper esophageal sphincter (cricopharyngeus); and inspiratory activity (parasternal and costal diaphragm). Both the fixed and stochastic electrical stimulation paradigms increased activity of the laryngeal elevators, produced short-term facilitation evidenced by increasing swallow durations over the stimulus period, and conversely inhibited swallow-related diaphragm activity. Both the fixed and stochastic stimulus conditions also increased specific EMG amplitudes, which never occurred with the water challenges. Stochastic stimulation increased swallow excitability, as measured by an increase in the number of swallows produced. Consistent with our previous results, changes in the swallow motor pattern for pairs of muscles were only sometimes correlated with each other. We conclude that alterations in afferent feedback produced particular variations of the swallow motor pattern. We hypothesize that specific SLN feedback might modulate the swallow central pattern generator during aberrant feeding conditions (food/liquid entering the airway), which may protect the airway and serve as potentially important clinical diagnostic indicators.

Mice Lacking Brain-Derived Serotonin Have Altered Swallowing Function

The intricate sensorimotor neural circuits that control swallowing are heavily reliant on serotonin (5-hydroxytryptamine [5-HT]); however, the impact of 5-HT deficiency on swallow function remains largely unexplored. We investigated this using mice deficient in tryptophan-hydroxylase-2 (TPH2), the enzyme catalyzing the rate-limiting step in 5-HT synthesis. Videofluoroscopy was utilized to characterize the swallowing function of TPH2 knockout (TPH2^-/-) mice as compared with littermate controls (TPH2^+/+). Results showed that 5-HT deficiency altered all 3 stages of swallowing. As compared with controls, TPH2^-/- mice had significantly slower lick and swallow rates and faster esophageal transit times. Future studies with this model are necessary to determine if 5-HT replacement may rescue abnormal swallowing function. If so, supplemental 5-HT therapy may have vast applications for a large population of patients with a variety of neurologic disorders resulting in life-diminishing dysphagia, particularly amyotrophic lateral sclerosis and Parkinson's disease, for which 5-HT deficiency is implicated in the disease pathogenesis.

Role of 5-HT1A in the nucleus of the solitary tract in the regulation of swallowing activities evoked by electroacupuncture in anesthetized rats

Somatic stimulation therapy, such as electroacupuncture (EA), has been widely applied in the clinic to treat dysphagia. However, its underlying mechanism has remained unknown. In the present study, the effect of EA at acupoints Fengfu (DU16) and Lianquan (RN23) on swallowing activities and the involvement of 5-HT_1A in the nucleus of the solitary tract (NTS) were examined in anesthetized rats. EA at DU16 and RN23 significantly evoked myoelectric activity of the mylohyoid muscle, which was attenuated by injection of 10 nmol 5-HT_1A antagonist (WAY-100635) into the NTS. Meanwhile, 5-HT_1A expression in the NTS increased following EA. The results suggested that EA at DU16 and RN23 promotes swallowing activity, and 5-HT_1A in the NTS may play an important role in the excitatory effects.

Central Respiration and Mechanical Ventilation in the Gating of Swallow With Breathing

Swallow-breathing coordination safeguards the lower airways from tracheal aspiration of bolus material as it moves through the pharynx into the esophagus. Impaired movements of the shared muscles or structures of the aerodigestive tract, or disruptions in the interaction of brainstem swallow and respiratory central pattern generators (CPGs) result in dysphagia. To maximize lower airway protection these CPGs integrate respiratory rhythm generation signals and vagal afferent feedback to synchronize swallow with breathing. Despite extensive study, the roles of central respiratory activity and vagal feedback from the lungs as key elements for effective swallow-breathing coordination remain unclear. The effect of altered timing of bronchopulmonary vagal afferent input on swallows triggered during electrical stimulation of the superior laryngeal nerves or by injection of water into the pharyngeal cavity was studied in decerebrate, paralyzed, and artificially ventilated cats. We observed two types of single swallows that produced distinct effects on central respiratory-rhythm across all conditions: post-inspiratory type swallows disrupted central-inspiratory activity without affecting expiration, whereas expiratory type swallows prolonged expiration without affecting central-inspiratory activity. Repetitive swallows observed during apnea reset the E2 phase of central respiration and produced facilitation of swallow motor output nerve burst durations. Moreover, swallow initiation was negatively modulated by vagal feedback and was reset by lung inflation. Collectively, these findings support a novel model of reciprocal inhibition between the swallow CPG and inspiratory or expiratory cells of the respiratory CPG where lung distension and phases of central respiratory activity represent a dual peripheral and central gating mechanism of swallow-breathing coordination.

Co-expression of GAD67 and choline acetyltransferase reveals a novel neuronal phenotype in the mouse medulla oblongata

GABAergic and cholinergic systems play an important part in autonomic pathways. To determine the distribution of the enzymes responsible for the production of GABA and acetylcholine in areas involved in autonomic control in the mouse brainstem, we used a transgenic mouse expressing green fluorescent protein (GFP) in glutamate decarboxylase 67 (GAD67) neurones, combined with choline acetyl transferase (ChAT) immunohistochemistry. ChAT-immunoreactive (IR) and GAD67-GFP containing neurones were observed throughout the brainstem. A small number of cells contained both ChAT-IR and GAD67-GFP. Such double labelled cells were observed in the NTS (predominantly in the intermediate and central subnuclei), the area postrema, reticular formation and lateral paragigantocellular nucleus. All ChAT-IR neurones in the area postrema contained GAD67-GFP. Double labelled neurones were not observed in the dorsal vagal motor nucleus, nucleus ambiguus or hypoglossal nucleus. Double labelled ChAT-IR/GAD67-GFP cells in the NTS did not contain neuronal nitric oxide synthase (nNOS) immunoreactivity, whereas those in the reticular formation and lateral paragigantocellular nucleus did. The function of these small populations of double labelled cells is currently unknown, however their location suggests a potential role in integrating signals involved in oromotor behaviours.

Raphé tauopathy alters serotonin metabolism and breathing activity in terminal Tau.P301L mice: possible implications for tauopathies and Alzheimer's disease

Tauopathies, including Alzheimer's disease are the most frequent neurodegenerative disorders in elderly people. Patients develop cognitive and behaviour defects induced by the tauopathy in the forebrain, but most also display early brainstem tauopathy, with oro-pharyngeal and serotoninergic (5-HT) defects. We studied these aspects in Tau.P301L mice, that express human mutant tau protein and develop tauopathy first in hindbrain, with cognitive, motor and upper airway defects from 7 to 8 months onwards, until premature death before age 12 months. Using plethysmography, immunohistochemistry and biochemistry, we examined the respiratory and 5-HT systems of aging Tau.P301L and control mice. At 8 months, Tau.P301L mice developed upper airway dysfunction but retained normal respiratory rhythm and normal respiratory regulations. In the following weeks, Tau.P301L mice entered terminal stages with reduced body weight, progressive limb clasping and lethargy. Compared to age 8 months, terminal Tau.P301L mice showed aggravated upper airway dysfunction, abnormal respiratory rhythm and abnormal respiratory regulations. In addition, they showed severe tauopathy in Kolliker-Fuse, raphé obscurus and raphé magnus nuclei but not in medullary respiratory-related areas. Although the raphé tauopathy concerned mainly non-5-HT neurons, the 5-HT metabolism of terminal Tau.P301L mice was altered. We propose that the progressive raphé tauopathy affects the 5-HT metabolism, which affects the 5-HT modulation of the respiratory network and therefore the breathing pattern. Then, 5-HT deficits contribute to the moribund phenotype of Tau.P301L mice, and possibly in patients suffering from tauopathies, including Alzheimer's disease.

The neurobiology of swallowing and dysphagia

The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic resonance imaging. The field has evolved from mapping the central neural pathway and peripheral nerves, to defining the importance of specific regions of the lower brain stem in terms of interneurons that provide sequential control for multiple muscles in the most complex reflex elicited by the nervous system, the pharyngeal phase of swallowing. The field is now emerging into defining how the higher cortical regions interact with this brain stem control and is providing a broader perspective of how the intact nervous system functions to control the three phases of swallowing (i.e., oral, pharyngeal, and esophageal). Much of the present interest focuses on how to retrain a damaged nervous system using a variety of stimulus techniques, which follow fundamentals in rehabilitation of the nervous system.

Relationship between respiratory control and feeding in the developing infant

Simultaneous breathing and nursing from a bottle or breast requires intricate coordination of the muscles that serve both respiration and feeding. During the buccopharyngeal phase of feeding reflex input to the brainstem from the oropharynx and larynx, as well as suprabulbar and chemoreceptor areas controls the sequential activity of the muscles of deglutition. Coordinated development of buccopharyngeal functions generally occurs by 35 weeks post-conceptional age in infants, but can be disrupted by respiratory disease or neuropathology. During the oesophageal phase of feeding, the bolus of food traverses the oesophagus and lower oesophageal sphincter, whose tone is also regulated by nuclei in the brainstem and modulated by respiratory drive. Control of the lower oesophageal sphincter gradually develops postnatally in premature infants. Although symptomatic gastro-oesophageal reflux can be problematic for the term or preterm infant, it does not appear that reflux is a common stimulus for apnoea of prematurity.

Brain stem control of swallowing: neuronal network and cellular mechanisms

Swallowing movements are produced by a central pattern generator located in the medulla oblongata. It has been established on the basis of microelectrode recordings that the swallowing network includes two main groups of neurons. One group is located within the dorsal medulla and contains the generator neurons involved in triggering, shaping, and timing the sequential or rhythmic swallowing pattern. Interestingly, these generator neurons are situated within a primary sensory relay, that is, the nucleus tractus solitarii. The second group is located in the ventrolateral medulla and contains switching neurons, which distribute the swallowing drive to the various pools of motoneurons involved in swallowing. This review focuses on the brain stem mechanisms underlying the generation of sequential and rhythmic swallowing movements. It analyzes the neuronal circuitry, the cellular properties of neurons, and the neurotransmitters possibly involved, as well as the peripheral and central inputs which shape the output of the network appropriately so that the swallowing movements correspond to the bolus to be swallowed. The mechanisms possibly involved in pattern generation and the possible flexibility of the swallowing central pattern generator are discussed.

Effect of quipazine, a selective 5-HT3 agonist, on dietary self-selection of different macronutrient diets in male and female rats

Macronutrient intakes, 2h and 12h, following administration of a selective 5-HT3 agonist, quipazine, N methyl, dimaleate (QUIPAZINE; 2.5, 5.0 and 7.5 mg/kg, i.p.) at dark onset were examined in three groups of adult male and female Wistar rats fed different sources of the three macronutrients: Group 1 (casein, corn starch, safflower oil), Group 2 (egg protein, corn starch/sucrose, lard) and Group S (casein hydrolysate, maltose dextrin, butter). QUIPAZINE decreased total food intake only in female rats from Group 1 (2 h) at a dose of 7.5 mg/kg and Group 2 (2h and 12h) with doses of 2.5 and 7.5 mg/kg. Intakes from corn starch and corn starch/sucrose diet (12h) were reduced in male and female rats, respectively, with doses of 2.5 and 7.5 mg/kg of QUIPAZINE. In conclusion, when provided with different sources of the three macronutrients, quipazine injection reduces specifically carbohydrate ingestion from corn starch-containing diets in male and female rats. Thus, the nature of the macronutrient source is of major importance to assess the effect of a drug on nutrient-specific selection.

Central control of lower esophageal sphincter relaxation

The lower esophageal sphincter is innervated by both parasympathetic (vagus) and sympathetic (primarily splanchnic) nerves; however, the vagal pathways are the ones that are essential for reflex relaxation of the lower esophageal sphincter (LES), such as that which occurs during transient LES relaxations. Vagal afferent sensory endings from the distal esophagus and LES terminate in the hindbrain nucleus tractus solitarius. The preganglionic motor innervation of the LES arises from the dorsal motor nucleus of the vagus. Together these nuclei comprise the dorsal vagal complex within which there is a neural network coordinating reflex control of the sphincter. Vagal efferent preganglionic neurons to the gastrointestinal tract are organized viscerotopically in the dorsal motor nucleus of the vagus. Stimulation of the dorsal motor nucleus of the vagus caudal to the opening of the fourth ventricle results in relaxations, whereas stimulation in the rostral portion of the nucleus evokes contractions of the LES. Few details are known about the neural circuitry that links sensory information from the stomach and esophagus within the nucleus tractus solitarius to these separate populations of neurons within the dorsal motor nucleus of the vagus. The motor vagal preganglionic output is primarily cholinergic, which ultimately stimulates excitatory or inhibitory motor neurons that control the smooth muscle tone. Excitatory neurons evoke muscarinic receptor-mediated muscle contraction. Inhibitory neurons evoke nitric oxide or vasoactive intestinal polypeptide-mediated relaxation of the lower esophageal sphincter. However, other neurotransmitters are found in vagal preganglionic neurons, including norepinephrine/dopamine and nitric oxide. A subpopulation of nitric oxide synthase-containing vagal preganglionic neurons innervate the upper gastrointestinal tract and mediate relaxation. The neurotransmitters and circuitry controlling lower esophageal sphincter pressure are important to characterize, because part of the dorsal vagal complex is outside of the blood-brain barrier and is a potential target for pharmacologic intervention in the treatment of such disorders as gastroesophageal reflux disease.

Evidence against a hemodynamic role for serotonin in the dorsal motor nucleus of the vagus

This study was performed to investigate the potential role of serotonin (5-HT) in the dorsal motor nucleus of the vagus (dmnX) in regulating peripheral hemodynamics. Microinjections (5 or 25 nmol in 50 nl) of the monoaminergic neurotransmitter were made into the dorsomedial medulla of the urethaneanesthetized rat during continuous recording of femoral arterial blood pressure. Heart rate was extracted electronically from the pressure waveform. Discrete injections of 5-HT placed directly in the dmnX were found to be entirely without effect on peripheral hemodynamics. In contrast, injections placed in the solitary tract nucleus, lying immediately above the dmnX, were found to have profound depressor and bradycardic effects, while the immediately subjacent hypoglossal nucleus appeared to contain both depressor and unresponsive sites. These findings cast doubt on the involvement of serotonin in the dmnX in the regulation of cardiovascular hemodynamics.

Electrophysiological effects of serotonin in the solitary tract nucleus of the rat

The nucleus tractus solitarius (nTS) is an important site for the integration of visceral information and its modification by afferent neural systems. One such afferent system arises from the raphe nuclei. This study investigated the electrophysiological effects of the primary transmitter of the raphe nuclei, serotonin (5-HT), on neurones in the nTS of the rat. Extracellular single unit recordings were made of the spontaneous activity of nTS neurones in isolated, superfused brainstem slices during bath-application of 5-HT (50, 100, 250, 500, 1000 nM). Twenty-seven of 46 neurones studied (approximately 59%) showed concentration-dependent decreases of firing rate, with a calculated EC50 of 261 nM. An additional 3 neurones displayed excitatory responses, while the remaining 16 were unaffected. The broad-spectrum 5-HT1 antagonist methysergide (200 nM) was highly effective in producing blockade of 5-HT-evoked depressions of neuronal activity (4 of 4), whereas the 5-HT1A receptor-selective antagonist spiroxatrine (5 nM) and the 5-HT2-selective antagonist mianserin (200 nM) were considerably less effective (1 of 5 and 2 of 5, respectively). Seven additional neurones were examined during exposure to the 5-HT1-selective agonist 5-carboxamidotryptamine (5-CT) or the 5-HT2-selective agonist DOI. 5-CT depressed the activity of three of the four neurones tested, the remaining neurone being unresponsive at concentrations up to 50 nM. DOI at concentrations up to 100 nM failed to affect the activity of two of the three neurones tested, and depressed the activity of the third at a concentration of 50 nM.(ABSTRACT TRUNCATED AT 250 WORDS)

The search for the central swallowing pathway: the quest for clarity

As the work of Dr. Martin Donner has brought a clarity to understanding swallowing, so has the work of various neuroscientists, including that of a Nobel Laureate, in providing us with a better comprehension of this complex motor pattern. Understanding the neural control of swallowing has been a process that has occurred during this century in which several investigators, primarily from Europe, Japan, Canada, and the United States, have brought their perspectives in applying particular techniques to decipher how the central and peripheral nervous system control swallowing. Swallowing represents a complex muscular response of the oral, pharyngeal, and esophageal regions which are integrated to provide an effective functional pattern that prepares and transports food while simultaneously protecting the airway. This adaptation of the upper gastrointestinal tract in mammals has been extensively studied peripherally by two methods: recording from the peripheral nerves and muscles, and stimulating peripheral nerves and their receptive fields that can induce the pharyngeal and esophageal phases of swallowing. The study of the peripheral nervous system has provided insight into the sensory receptive fields that evoke or facilitate swallowing, and has established the first serious evidence of the all-or-none sequential contraction pattern of the oropharyngeal and esophageal muscles. It has been these electromyographic studies of the muscles that has established much of the criteria for evaluating the central swallowing pathway. Five techniques have been applied to the central nervous system to study swallowing and include lesioning or destroying discrete regions to determine how swallowing is impaired or modified, electrically stimulating the central neural tissue to determine the type of effects on swallowing, recording from the central neural tissue with macro- and microelectrodes to ascertain when neurons respond in timing to the peripheral muscle activity during swallowing, applying pharmacological agents through micropipettes which could mimic or inhibit potential transmitters, and using immunochemical techniques to tag specific chemicals that could be transmitters used by the neurons in the central swallowing pathway. These various techniques have provided insight into how the central swallowing pathway is organized but the details of the central control are still in the process of being defined and will require as much effort this next century as has been previously developed over the past 90 years.

Effects of vagotomy on neurotransmitter receptors in the rat dorsal vagal complex

The dorsal vagal complex contains many different neurotransmitter receptors. The cyto-architectural localizations of some of these receptors remain largely unknown. In rats, vagotomy was performed to destroy vagal afferents terminating in the nucleus of the solitary tract and to produce chromatolysis of preganglionic motoneurons in the dorsal motor nucleus of the vagus. Quantitative receptor autoradiography was then employed to determine the effect of vagotomy upon the distribution of receptors for thyrotropin-releasing hormone, substance P, and serotonin within individual regions and subnuclei of the entire dorsal vagal complex. Vagotomy reduced the concentrations of thyrotropin-releasing hormone and substance P, but not serotonin1A, or serotonin1B, receptors in the dorsal motor nucleus of the vagus. Within the nucleus of the solitary tract, substance P receptors were reduced in only the medial and central subnuclei after vagotomy. In contrast, no effect was observed upon the concentrations of thyrotropin-releasing hormone, serotonin1A, or serotonin1B receptors in any subnuclei of the solitary tract following vagotomy. These results suggest that in the dorsal motor nucleus of the vagus, thyrotropin-releasing hormone and substance P receptors are localized upon vagal preganglionic motoneurons, while serotonin1A and serotonin1B receptors are present upon interneurons or other neuronal elements. These results also suggest that thyrotropin-releasing hormone, substance P, serotonin1A, and serotonin1B receptors in the nucleus of the solitary tract are localized upon internuncial neurons in the nucleus of the solitary tract.

Autoradiographic localization of 5HT1 binding sites in autonomic areas of the rat dorsomedial medulla oblongata

Serotonin (5HT) binding sites in autonomic portions of the dorsomedial medulla oblongata of the rat were localized using autoradiographic techniques with radioactive ligands that express high affinity for the 5HT1 (3H-5HT), 5HT1A (3H-8OH-DPAT), or 5HT1B (125I-CYP with isoproterenol) receptor subtypes. 5HT1A sites were densely distributed in the nucleus tractus solitarius (NTS), with the highest densities localized to the interstitial subnucleus and the central subnucleus. 5HT1B sites were also found in the NTS, with the highest densities localized to the substantia gelatinosa subnucleus. The dorsal motor nucleus of the vagus nerve and nucleus ambiguus exhibited low densities of 5HT1B sites. However, the nucleus intercalatus, a cerebellar relay nucleus that also contains dendrites of vagal parasympathetic preganglionic neurons and receives autonomic forebrain afferent input, showed very dense 5HT1B sites. The promontorium, paratrigeminal islands, and the dorsomedial portion of the trigeminal nucleus (DM5), which are areas of viscerosomatic integration, exhibited high densities of both 5HT1A and 5HT1B sites. The area postrema contained low levels of both 5HT1A and 5HT1B sites. Visceral deafferentation via cervical vagotomy or nodose ganglionectomy caused a significant decrease in 5HT1A sites in the interstitial subnucleus of the NTS ipsilateral to the lesion. No changes were seen in 5HT1B sites. These studies suggest that 5HT1A and 5HT1B sites are involved in the processing of visceral sensory information in the NTS and associated areas. Based upon viscerotopic organization of the NTS, 5HT1A sites appear preferentially distributed in portions of the NTS that are associated with the coordination of swallowing, respiration, and cardiovascular function, while 5HT1B sites appear preferentially distributed in areas of the NTS associated with gastrointestinal, hepatic, pancreatic, and cardiovascular function. However, since these association were not absolute and there was a great deal of overlap between the two sites, speculation regarding their specific functions in autonomic control must await pharmacological examination.

Autoradiographic localization of 5HT1 binding sites in the medulla oblongata of the rat

Serotonin (5HT) binding sites in the medulla oblongata of the rat were localized using autoradiographic techniques with radioactive ligands that express high affinity for the 5HT1 (3H-5HT), 5HT1A (3H-80H-DPAT), or 5HT1B (125I-CYP with isoproterenol) receptor subtypes. 5HT1A sites were concentrated primarily in certain sensory regions of the medulla and in regions that contain serotonergic neurons. 5HT1B sites were diffusely distributed throughout the reticular formation and motor regions as well as being localized to certain sensory regions. A surprising finding was an association of 5HT1B binding sites with the corticospinal tract. 3H-5HT binding generally reflected the combined pattern of 5HT1A and 5HT1B sites but was also extremely dense in the choroid plexus, which exhibited virtually no 5HT1A or 5HT1B ligand binding. Presumably this binding, which was blocked by ketanserin, corresponds to 5HT1C sites. Administration of the serotonergic neurotoxin 5,7-dihydroxytryptamine reduced 5HT1A binding sites in regions of the medulla that contain serotonergic neuronal cell bodies. 5HT1B binding was not significantly altered in any area of the medulla. These studies indicate an important role for 5HT1A ligands in the processing of visceral and somatic sensory information, in regulation of certain cerebellar afferent projections, and in the regulation of serotonergic neuronal activity. 5HT1B ligands would be expected to regulate visceral and somatic efferent activity, as well as sensory information and reticular efferent activity, and might presynaptically regulate cortical inputs to the brain stem and spinal cord.

Neuropharmacologic correlates of deglutition: lessons from fictive swallowing

Pharmacologic investigations into the transmission processes underlying fictive swallowing in the rat have disclosed the potential diversity of chemical signals used in central deglutitive pathways. Monoaminergic mechanisms appear to serve as links between subcortical structures and the medullary pattern generator of swallowing (PGS), and may play a critical role in maintaining internal facilitatory drive, required by the PGS for optimal responsivity to peripheral sensory input. Cholinergic bulbar interneurons form an integral component of the PGS subnetwork controlling esophageal peristalsis. Local GABA neurons exert a tonic inhibition of the buccopharyngeal stage, may regulate buccopharyngeal-esophageal coupling, and may contribute to peristaltic rhythmic generation at both the premotoneuronal and motoneuronal level. Receptor subtypes for excitatory amino acids (glutamate, aspartate) are differentially associated with deglutitive premotoneurons for both the buccopharyngeal and esophageal stage, as well as with ambiguus motoneurons. Preliminary evidence suggests the existence of excitatory peptidergic mechanisms involving thyrotropin-releasing hormone, vasopressin, oxytocin, and somatostatin, a probable candidate for excitatory transmitter in the solitarioambigual internuncial projection to motoneurons innervating esophageal striated musculature. Further validation of this experimental model may ultimately help to establish a framework for the clinical recognition, management, and exploitation of drug actions on central deglutitive neuroeffectors.

[The nucleus tractus solitarius: neuroanatomic, neurochemical and functional aspects]

The nucleus tractus solitarii (NTS) has long been considered as the first central relay for gustatory and visceral afferent informations only. However, data obtained during the past ten years, with neuroanatomical, biochemical and electrophysiological techniques, clearly demonstrate that the NTS is a structure with a high degree of complexity, which plays, at the medullary level, a key role in several integrative processes. The NTS, located in the dorsomedial medulla, is a structure of small size containing a limited number of neurons scattered in a more or less dense fibrillar plexus. The distribution and the organization of both the cells and the fibrillar network are not homogeneous within the nucleus and the NTS has been divided cytoarchitectonically into various subnuclei, which are partly correlated with the areas of projection of peripheral afferent endings. At the ultrastructural level, the NTS shows several complex synaptic arrangements in form of glomeruli. These arrangements provide morphological substrates for complex mechanisms of intercellular communication within the NTS. The NTS is not only the site of vagal and glossopharyngeal afferent projections, it receives also endings from facial and trigeminal nerves as well as from some renal afferents. Gustatory and somatic afferents from the oropharyngeal region project with a crude somatotopy within the rostral part of the NTS and visceral afferents from cardiovascular, digestive, respiratory and renal systems terminate viscero-topically within its caudal part. Moreover the NTS is extensively connected with several central structures. It projects directly to multiple brain regions by means of short connections to bulbo-ponto-mesencephalic structures (parabrachial nucleus, motor nuclei of several cranial nerves, ventro-lateral reticular formation, raphe nuclei...) and long connections to the spinal cord and diencephalic and telencephalic structures, in particular the hypothalamus and some limbic structures. The NTS is also the recipient of several central afferent inputs. It is worth to note that most of the structures that receive a direct projection from the NTS project back to the nucleus. Direct projections from the cerebral cortex to the NTS have also been identified. These extensive connections indicate that the NTS is a key structure for autonomic and neuroendocrine functions as well as for integration of somatic and autonomic responses in certain behaviors. The NTS contains a great diversity of neuroactive substances. Indeed, most of the substances identified within the central nervous system have also been detected in the NTS and may act, at this level, as classical transmitters and/or neuromodulators.(ABSTRACT TRUNCATED AT 400 WORDS)

Evidence that activation of N-methyl-D-aspartate (NMDA) and non-NMDA receptors within the nucleus tractus solitarii triggers swallowing

Swallowing is a patterned motor activity generated by neurons located within the nucleus tractus solitarii (NTS). Previous experiments have shown that administration of excitatory amino acids within the NTS induces swallowing. The present study was undertaken to identify the receptor subtypes involved in this effect. Pressure microinjections of L-glutamate (10-100 pmol), quisqualate (0.1-10 pmol) and N-methyl-D-aspartate (NMDA, 0.1-10 pmol) were performed into the NTS of decerebrate rats. Glutamate and quisqualate microinjections elicited short series of swallows while NMDA microinjections induced long-lasting, rhythmic swallowing. Pretreatment with the selective NMDA antagonist, DL-2-amino-5-phosphonovalerate (50 pmol), almost completely suppressed the response elicited by NMDA (10 pmol) but did not induce a significant modification of swallowing triggered by either glutamate (25 pmol) or quisqualate (10 pmol). Pretreatment with 6-cyano-7-nitroquinoxaline-2,3-dione (50 pmol), a selective blocker of non-NMDA receptors, suppressed the swallows elicited by glutamate and strongly inhibited the response elicited by quisqualate microinjections. The same pretreatment induced only a slight modification of the swallowing elicited by NMDA. These data demonstrate that deglutition can be triggered by activating either NMDA or non-NMDA receptors localized within the NTS, and therefore suggest that both receptor subtypes may be involved in swallowing elicited under physiological conditions.

Nicotinic cholinoceptor-mediated excitation in ambigual motoneurons of the rat

The purpose of this study was to determine if ambigual oesophageal motoneurons of the rat possess functional nicotinic cholinoceptors. In urethane anaesthetized rats, acetylcholine (20-50 pmol) delivered micropneumophoretically from multibarrelled pipettes to the compact formation of the nucleus ambiguus produced either synchronous or propulsive oesophageal contractions which were fully and reversibly blocked by dihydro-beta-erythroidine (8-10 pmol) but were resistant to D-tubocurarine and hexamethonium (10-20 pmol). 1,1-Dimethyl-4-phenyl-piperazinium but not muscarine (8 pmol) exerted an analogous agonist action. Ejection of glutamate at the same sites produced similar oesophageal responses which were, however, resistant to dihydro-beta-erythroidine. Acetylcholine applied 5-15 s prior to glutamate transiently facilitated the glutamate-evoked response. The facilitatory effect of acetylcholine was replicated by 1,1-dimethyl-4-phenyl-piperazinium but not muscarine and inhibited by dihydro-beta-erythroidine. Physostigmine, applied either intra-ambigually (10-20 pmol) or by intravenous injection (0.15-0.3 mumol/kg), enhanced both acetylcholine and glutamate-evoked responses. In brainstem transverse slices, application of acetylcholine and glutamate to quiescent ambigual neurons of the compact formation resulted in a rapid membrane depolarization associated with an increased membrane conductance and spiking. Under voltage clamp, both acetylcholine and glutamate elicited a net inward current. The depolarizing response of these neurons to acetylcholine was blocked by dihydro-beta-erythroidine (0.5-2 pmol), hexamethonium (0.2 mM) and D-tubocurarine (10 microM) and persisted in the presence of tetrodotoxin (10(-6) M) or Mn2+ (5 mM) in the bathing medium.(ABSTRACT TRUNCATED AT 250 WORDS)

Organization of serotonin 1A and 1B receptors in the nucleus of the solitary tract

We utilized 3H-8-hydroxy-N,N-dipropyl-2-aminotetralin (3H-DPAT) and 125I-iodocyanopindolol (125I-CYP) to label serotonin (5HT) 1A and 5HT1B receptors, respectively, in sections of the rat brain after characterizing the pharmacologic specificity of these agents. We then used quantitative autoradiography to measure the concentrations of 5HT1A and 5HT1B receptors in individual subnuclei of the nucleus of the solitary tract (NTS) and adjacent structures of the dorsal vagal complex. The highest 5HT1A receptor concentrations were observed within the central and intermediate subnuclei of the NTS, with low quantities of 3H-DPAT binding sites observed in the hypoglossal nucleus and dorsal motor nucleus of the vagus. In contrast, the density of 5HT1B receptors was relatively homogeneous through all NTS subnuclei, with the highest concentrations localized within the ventrolateral subnucleus. The hypoglossal and dorsal motor nuclei had slightly higher 5HT1B receptor densities than the NTS subnuclei, whereas the area postrema had a very low density. These data suggest that 5HT1A receptors are organized in a manner consistent with the cytoarchitectural and hodological parcellation of the NTS into individual subnuclei. The high concentrations of 5HT1A receptors in the central and intermediate subnuclei suggest a role for these receptors in medullary reflex pathways subserving deglutition. The relatively high density of 5HT1B receptors in the ventrolateral subnucleus suggests that these receptors modulate respiratory neurons, whereas the diffuse organization of 5HT1B receptors in the remaining subnuclei suggests that they are associated with central 5HT afferent pathways to the NTS. Further studies will be required to understand the physiologic role of 5HT1 receptors within the NTS.

Neurones in a discrete region of the nucleus tractus solitarius are required for the Breuer-Hering reflex in rat

1. The Breuer-Hering reflex consists of a shortening of inspiration and lengthening of expiration in response to afferent input from slowly adapting pulmonary stretch receptors (SAR). We hypothesized that neurones in a discrete region of the nucleus tractus solitarius (NTS) are required for producing the reflex. Accordingly, the present studies were undertaken to: (1) identify sites in the NTS in which chemical excitation of neurones inhibited phrenic nerve discharge in a manner consistent with SAR activation, (2) determine whether localized interruption of synaptic transmission prevented the Breuer-Hering reflex, and (3) determine whether these regions contained pump cells and SAR terminal afferents. Studies were carried out in urethane-anaesthetized rats. 2. Injection of picomoles of an excitatory amino acid, DL-homocysteic acid (DLH), in the NTS, at the rostrocaudal level of the area postrema and immediately medial to the tractus solitarius, silenced phrenic nerve activity similarly to that expected from SAR activation. These apnoeas lasted from 3 to 43 s and were produced with little or no change in arterial pressure or heart rate. 3. The Breuer-Hering reflex, physiologically activated by maintaining lung inflation, was transiently impaired by interruption of synaptic transmission following injections of cobalt chloride in the DLH-responsive region. 4. Pump cell (SAR interneurone) and SAR afferent activity were recorded at the site in which DLH produced apnoea. 5. Taken together, the results of chemical excitation, interruption of synaptic transmission and extracellular recording, suggest that cells within a discrete region of the NTS, probably pump cells, are necessary for the production of the Breuer-Hering reflex.

Substance P and serotonin mutually reverse their excitatory effects in the rat nucleus tractus solitarius

Actions and interactions of serotonin and substance P are described in the nucleus tractus solitarius using coronal brainstem slices and intracellular recordings. Substance P (10-100 nM) and serotonin (10-100 microM) applied alone were excitatory, causing depolarization and increasing the input resistance. Reversing effect was obtained using a protocol of long (greater than 5 min) conditioning applications of substance P and shorter (20-60 s) test applications of serotonin: serotonin, which was excitatory by itself during controls, became inhibitory for the steady action potential discharges induced by conditioning substance P applications. In the reverse situation, inhibition was also obtained using prolonged conditioning exposures to serotonin and test applications of substance P. Prolonged conditioning applications (greater than 5 min) were required in these experiments since addition or potentiation, but not inhibition, was found when combining 20-60 s substance P and serotonin applications. In addition to their excitatory effects, substance P and serotonin, applied alone, had another mechanism of action. They reduced the duration of tetraethylammonium-prolonged action potentials. This mechanism was also reversed using conditioning applications of substance P or serotonin. Thus, reversing effects appeared simultaneously on multiple ionic mechanisms. Furthermore, the reversing effect was unaffected in tetrodotoxin-treated preparations, which indicates a postsynaptic phenomenon. Consequently, the control of two different postsynaptic ionic mechanisms during substance P and serotonin interaction suggests that the underlying mechanisms take place at a common level, possibly in relation to second messenger processes. From a functional point of view, these results support the idea that in the nucleus tractus solitarius the effects of either neurotransmitter, serotonin or substance P, can be completely reversed by a previous release of the other one.

Excitatory amino acid receptor-mediated activation of solitarial deglutitive loci

The deglutitive actions of glutamate were investigated in urethane-anaesthetised rats in order to determine whether different excitatory amino acid receptors mediate activation of pattern generator elements contained within the nucleus tractus solitarii. When applied by micropneumophoresis (0.01-10 pmol) from multibarrelled glass micropipettes (tip diameter 2-5 microns), the excitatory amino acid-receptor agonists, N-methyl-D, L-aspartate (NMA), N-methyl-D-aspartate (NMDA), quisqualate and kainate displayed a rank order of potency at glutamate-responsive pharyngeal sites, in the subnuclei ventralis and intermedialis, where KA greater than NMA/NMDA greater than QA; however, the potency followed the order NMA/NMDA greater than KA greater than QA at oesophageal sites within the subnucleus centralis. The NMDA-receptor blockers, 2-amino-5-phosphonovaleric acid (APV) and 2-amino-7-phosphonoheptanoic acid (AP7), selectively and reversibly inhibited the glutamate-evoked oesophageal responses, but had no corresponding effect on rhythmic oesophageal responses elicited by muscarine. At loci in the nucleus tractus solitarius, where glutamate elicited a complete swallowing sequence, APV/AP7 spared the pharyngeal component but selectively blocked the oesophageal component. The nonselective glutamate-receptor antagonist, gamma-D-glutamylglycine suppressed both pharyngeal and oesophageal responses elicited by glutamate. It is concluded that different types of excitatory amino acid receptors are associated with the deglutitive premotor subnuclei of the nucleus tractus solitarii; kainate receptors predominate within the subnuclei ventralis and intermedialis and NMDA receptors within the subnucleus centralis. Both kainate- and NMDA-mediated mechanisms can operate under physiological conditions.

Modulation of solitarial deglutitive N-methyl-D-aspartate receptors by dihydropyridines

The ability of the dihydropyridine calcium channel activators, (-)-S-BAY K 8644 and (+)-S-202-791 and the calcium channel inhibitor, (+)-R-BAY K 8644, to modify the differential deglutitive actions of glutamate and muscarine at premotor loci in the nucleus tractus solitarii was investigated in urethane-anaesthetised rats. At subnuclei ventralis and intermedialis loci, pneumophoretic application (20-100 pl) from multibarrelled glass micropipettes (tip diameter 2-5 microns) of glutamate (10-20 pmol) evoked aminophosphonovaleric acid (APV)-insensitive pharyngeal swallows; at sites in the subnucleus centralis of the nucleus tractus solitarii glutamate evoked an APV-sensitive single-wave oesophageal response, whereas muscarine (5-10 pmol) evoked rhythmic oesophageal contractions. Both (-)-S-BAY K 8644 and (+)-S-202-791, applied in prepulses of 10-20 fmol and 100-200 fmol, respectively, either had no effect or selectively and reversibly enhanced or inhibited the glutamate-evoked responses. Identical results were obtained by intravenous administration of (-)-S-BAY K 8644 (10-50 micrograms/kg). Micropneumophoretic (20-50 fmol) or intravenous (10-50 micrograms/kg) administration of (+)-R-BAY K 8644 suppressed the N-methyl-D-aspartate (NMDA)-mediated oesophageal responses in a reversible and selective manner. The dihydropyridine vehicle produced a transient depression of all types of deglutitive responses. It is concluded that, within the deglutitive subnuclei of the nucleus tractus solitarii, "L"-type voltage-operated calcium channels are associated with NMDA-receptor-mediated deglutitive mechanisms. The inhibition or a lack of effect produced by the dihydropyridine calcium channel activators is explained in part by their actions at other sites e.g. release of inhibitory transmitters.

Neural mechanisms of swallowing: neurophysiological and neurochemical studies on brain stem neurons in the solitary tract region

Neurophysiological studies of the nuclei of the tractus solitarius (NTS) and adjacent regions have provided a partial understanding of the integrative brainstem network underlying swallowing and related functions such as respiration. The NTS is also richly endowed with an abundance of neuropeptides and other neuroactive substances, but only limited information is available on their influences on neurons involved specifically in swallowing. Since dysfunction of these neurophysiological and neurochemical regulatory mechanisms in the NTS region may be important in pathophysiological conditions such as dysphagia, increased awareness of and focus on these mechanisms are warranted. This paper outlines recent neurophysiological and neurochemical data that provide information on the afferent inputs and neurophysiological properties of neurons in NTS and adjacent caudal brainstem regions implicated in swallowing, respiration, and respiratory-related reflexes.

Viscerotopic representation of the upper alimentary tract in the rat: sensory ganglia and nuclei of the solitary and spinal trigeminal tracts

The aim of this study was to map the viscerotopic representation of the upper alimentary tract in the sensory ganglia of the IXth and Xth cranial nerves and in the subnuclei of the solitary and spinal trigeminal tracts. Therefore, in 172 rats 0.5-65 microliters of horseradish peroxidase (HRP), wheat germ agglutinin-HRP, or cholera toxin-HRP were injected into the trunks and major branches of the IXth and Xth cranial nerves as well as into the musculature and mucosa of different levels of the upper alimentary and respiratory tracts. The results demonstrate that the sensory ganglia of the IXth and Xth nerves form a fused ganglionic mass with continuous bridges of cells connecting the proximal and distal portions of the ganglionic complex. Ganglionic perikarya were labeled in crude, overlapping topographical patterns after injections of tracers into nerves and different parts of the upper alimentary tract. After injections into the soft palate, pharynx, esophagus, and stomach, anterograde labeling was differentially distributed in distinct subnuclei in the nucleus of the tractus solitarius (NTS). Palatal and pharyngeal injections resulted primarily in labeling of the interstitial and intermediate subnuclei of the NTS and in the paratrigeminal islands (PTI) and spinal trigeminal complex. Esophageal and stomach wall injections resulted in labeling primarily of the subnucleus centralis and subnucleus gelatinosus, respectively. The distribution of upper alimentary tract vagal-glossopharyngeal afferents in the medulla oblongata has two primary groups of components, i.e., a viscerotopic distribution in the NTS involved in ingestive and respiratory reflexes and a distribution coextensive with fluoride-resistant acid-phosphatase-positive regions of the PTI and spinal trigeminal nucleus presumably involved in visceral reflexes mediated by nociceptive or chemosensitive C fibers.

Responses of neurons in the lamb nucleus tractus solitarius to stimulation of the caudal oral cavity and epiglottis with different stimulus modalities

Receptors located in the posterior oral cavity and on the epiglottis play an important role in the initiation of upper airway reflexes such as swallowing, gagging, coughing and apnea. Peripheral nerves which innervate these receptor areas terminate in the nucleus tractus solitarius (NTS). We have recorded the responses of 61 neurons in the lamb NTS to stimulation of the caudal tongue, palate and epiglottis with mechanical, chemical and thermal stimuli and mapped receptive field location. Although there was some overlap in the areas of the NTS from which neurons with oral cavity and epiglottal receptive fields could be recorded, a significant difference was observed in the mean recording sites of the two groups of neurons. Neurons with oral cavity receptive fields were located more rostral, lateral and ventral in the NTS than neurons with receptive fields on the epiglottis. Little convergence of sensory input onto single cells in the NTS was observed between the oral cavity and the epiglottis. Only one NTS neuron had a receptive field in both of these receptor areas. In contrast, a large number of neurons with oral cavity receptive fields received input from two receptor areas. These neurons had a receptive field on the tongue which was located directly beneath the receptive field on the palate. Mechanical stimuli were the most effective for neurons with either oral cavity or epiglottal receptive fields and thermal stimuli were the least effective. Neurons which responded to mechanical stimuli responded better to a moving stimulus than to a punctate one, and large increases in the strength of a punctate stimulus were required to elicit significant increases in response frequency. Most NTS neurons responded to more than one of the stimulus modalities. However, a significant difference in the mean number of stimulus modalities which elicited responses was observed between neurons with oral cavity and epiglottal receptive fields. The number of multimodal neurons with epiglottal receptive fields was higher than those with oral cavity receptive fields. The multimodal nature of neurons which responded to epiglottal or oral cavity stimulation combined with their location in reflexogenic areas of the NTS suggests that these neurons could be important in the integration of afferent input from the oral cavity and upper airway. If these NTS neurons are involved in the control of oral and upper airway reflexes it would be important for them to respond to as many of the stimulus cues as possible and the majority of these neurons do just that.