Enhanced c-Fos expression in the rostral ventral respiratory complex and rostral parapyramidal region by inhibition of the Na+/H+ exchanger type 3

Orexin Neurons Contribute to Central Modulation of Respiratory Drive by Progestins on ex vivo Newborn Rodent Preparations

Dysfunction of central respiratory CO₂/H⁺ chemosensitivity is a pivotal factor that elicits deep hypoventilation in patients suffering from central hypoventilation syndromes. No pharmacological treatment is currently available. The progestin desogestrel has been suggested to allow recovery of respiratory response to CO₂/H⁺ in patients suffering from central hypoventilation, but except the fact that supramedullary regions may be involved, mechanisms are still unknown. Here, we tested in neonates whether orexin systems contribute to desogestrel’s central effects on respiratory function. Using isolated ex vivo central nervous system preparations from newborn rats, we show orexin and almorexant, an antagonist of orexin receptors, supressed strengthening of the increase in respiratory frequency induced by prolonged metabolic acidosis under exposure to etonogestrel, the active metabolite of desogestrel. In parallel, almorexant suppressed the increase and enhanced increase in c-fos expression in respiratory-related brainstem structures induced by etonogestrel. These results suggest orexin signalisation is a key component of acidosis reinforcement of respiratory drive by etonogestrel in neonates. Although stage of development used is different as that for progestin clinical observations, presents results provide clues about conditions under which desogestrel or etonogestrel may enhance ventilation in patients suffering from central hypoventilation syndromes.

Discovery and Optimization of 1-Phenoxy-2-aminoindanes as Potent, Selective, and Orally Bioavailable Inhibitors of the Na+/H+ Exchanger Type 3 (NHE3)

The design, synthesis, and structure-activity relationship of 1-phenoxy-2-aminoindanes as inhibitors of the Na⁺/H⁺ exchanger type 3 (NHE3) are described based on a hit from high-throughput screening (HTS). The chemical optimization resulted in the discovery of potent, selective, and orally bioavailable NHE3 inhibitors with 13d as best compound, showing high in vitro permeability and lacking CYP2D6 inhibition as main optimization parameters. Aligning 1-phenoxy-2-aminoindanes onto the X-ray structure of 13d then provided 3D-QSAR models for NHE3 inhibition capturing guidelines for optimization. These models showed good correlation coefficients and allowed for activity estimation. In silico ADMET models for Caco-2 permeability and CYP2D6 inhibition were also successfully applied for this series. Moreover, docking into the CYP2D6 X-ray structure provided a reliable alignment for 3D-QSAR models. Finally 13d, renamed as SAR197, was characterized in vitro and by in vivo pharmacokinetic (PK) and pharmacological studies to unveil its potential for reduction of obstructive sleep apneas.

Impact of sodium/proton exchanger 3 gene variants on sudden infant death syndrome

OBJECTIVE

To determine the contribution of variations in the sodium/proton exchanger 3 (NHE3) gene in sudden infant death syndrome (SIDS).

STUDY DESIGN

Variations in the exons and promoter of the NHE3 gene were analyzed with direct sequencing analysis and mini sequencing (SNaPshot analysis) in 251 cases of SIDS, plus 50 infant control subjects who had died of other causes, and 170 healthy adults.

RESULTS

The C2405T variant (exon 16) and 2 polymorphisms in the promoter (G1131A and C1197T) were encountered significantly more frequently in cases of SIDS than in control subjects. At least 1 of these 3 variants was detected in 49% of SIDS cases, but only in 30% of control subjects.

CONCLUSIONS

Our findings suggest the involvement of polymorphisms in the NHE3 gene and promoter in cases of SIDS, which may result in an overexpression of NHE3 in the medulla oblongata and which possibly leads to a disturbance in breathing control. Furthermore, our results underline the heterogeneous character of SIDS.

Systemic inhibition of the Na(+)/H (+) exchanger type 3 in intact rats activates brainstem respiratory regions

Selective inhibition of the Na(+)/H(+) exchanger type 3 (NHE3) increases the firing rate of brainstem ventrolateral CO(2)/H(+) sensitive neurons, resembling the responses evoked by hypercapnic stimuli. In anesthetized animals, NHE3 inhibition has also been shown to stimulate the central chemosensitive drive. We aimed to analyze the respiratory-related brainstem regions affected by NHE3 inhibition in anaesthetized spontaneously-breathing rats with intact peripheral afferents. For that, c-Fos immunopositive cells were counted along the brainstem in rats intravenously infused with the selective NHE3 inhibitor AVE1599. A rostral extension of the ventral respiratory column which includes the pre-Bötzinger complex was activated by the NHE3 inhibitor. In addition, the number of c-Fos positive cells resulted significantly increased in the most rostral extension of the retrotrapezoid nucleus/parapyramidal region. In the pons, the intravenous infusion of AVE1599 activated the lateral parabrachial and Kölliker-Fuse nuclei. Thus, selective NHE3 inhibition in anaesthetized rats activates the respiratory network and evokes a pattern of c-Fos expressing cells similar to that induced by hypercapnia.

The central respiratory chemoreceptor: where is it located?-Invited article

We review previous reports on the localization of the central chemoreceptor focusing on our studies that used various experimental techniques including lesioning (brainstem transection and removal of pia mater), analyses of neuronal responses to CO(2) by electrophysiological and optical recording, mapping of CO(2)-excitable neurons by c-fos immunohistochemistry and local acidic stimulation. Among these experimental techniques, voltage imaging with calculation of cross correlation coefficients between the respiratory output activity and each pixel, i.e., correlation coefficient imaging technique, enabled us to effectively analyze imaging data without empirical signal processing. The reviewed studies have indicated that the most superficial layer of the rostral ventral medulla, i.e., the surface portions of the nucleus retrotrapezoideus/parafacial respiratory group, nucleus parapyramidal superficialis and nucleus raphe pallidus, is important in central chemoreception. We suggest that one of the major respiratory rhythm generators, i.e., the preBötzinger complex, is not chemosensitive in itself or rather inhibited by CO(2). Based on our detailed analysis of c-fos immunohistochemistry, we propose a cell-vessel architecture model for the central respiratory chemoreceptor. Primary chemoreceptor cells are mainly located beneath large surface vessels within the marginal glial layer of the ventral medulla, and surround fine penetrating vessels that branch from a large surface vessel. Respiratory neurons in the rostral portion of the ventral respiratory group could be intrinsically chemosensitive, but their role in chemoreception might be secondary. Definitive identification of chemosensitive sites and chemoreceptor cells needs further studies.

Respiratory response to systemic inhibition of the Na+/H+ exchanger type 3 in intact rats

The Na+/H+ exchangers (NHEs) are a family of antiporters involved in the maintenance of neural steady-state intracellular pH. The NHE3 seems to be the predominant subtype in central chemosensitive cells. We aimed to analyze the effect of a selective NHE3 inhibition on the respiratory pattern in spontaneously breathing rats with intact vagi. Rats were intravenously infused for 10 min with the selective NHE3 inhibitor AVE1599 (Aventis Pharma Deustchland, 0.5 and 2 mg/kg) or with phosphate buffer. Whole-body plethysmography was used to monitor breathing pattern before, during, and up to 30 min after the drug infusion. Immunohistochemistry for the c-Fos protein was performed in the animal brains and c-Fos-positive cells were counted along the brainstem. Selective NHE3 inhibition induced a significant increase in the respiratory frequency and in the number of c-Fos immunopositive cells in the lateral parabrachial nucleus, the pre-Bötzinger complex and a rostral extension of the retrotrapezoid nucleus/parapyramidal region (p<0.05, ANOVA). We conclude that systemic administration of AVE1599 increases respiratory frequency and activates ponto-medullary areas implicated in the central control of breathing and chemoreception.

Role of Brainstem Sodium/Proton Exchanger 3 for Breathing Control during Chronic Acid–Base Imbalance

RATIONALE

The sodium/proton exchanger (NHE) 3 is expressed in brainstem areas with prevalence for central chemosensitivity. Selective NHE3 inhibitors can evoke CO(2) mimetic responses both in vitro and in vivo, demonstrating the functional significance of this pH-regulating protein. Moreover, levels of NHE3 expression are inversely correlated to interindividual differences of baseline ventilation in conscious rabbits.

OBJECTIVES

We explored the influence of chronic acid-base disturbances on mRNA levels of brainstem NHE3 in relation to breathing control.

METHODS

Alveolar ventilation (Va), blood gases, systemic base excess (BE), and metabolic Vco(2) were determined in rabbits shortly after exposure to either CO(2)-enriched air for 3 days (n = 5) or to ammonium chloride with drinking water for 2 days (n = 6). Untreated animals served as controls (n = 24). NHE3 mRNA within the obex region was quantified by real-time reverse transcription-polymerase chain reaction.

MEASUREMENTS AND MAIN RESULTS

After chronic hypercapnia, we found a compensatory rise of BE (mean +/- SEM) to 5.3 +/- 0.5 mmol x L(-1) with slightly elevated Pa(CO(2)). Brainstem NHE3 mRNA as well as Va were not significantly different from control levels. In the NH(4)Cl group, arterial pH was approximately 0.09 units lower than control, and BE decreased to -6.5 +/- 1.6 mmol x L(-1) with slightly decreased Pa(CO(2)), but considerably reduced Va (by approximately 25%; P < 0.05) and Vco(2). Concomitantly, brainstem NHE3 mRNA had increased from control level of 1.45 +/- 0.19 to 3.64 +/- 0.37 fg cDNA/mug RNA; P < 0.01.

CONCLUSIONS

Expression of brainstem NHE3 is up-regulated by chronic metabolic acidosis but not by prolonged hypercapnia. It is proposed that elevated brainstem NHE3 expression contributes to limit maladaptive hyperventilation during metabolic acidosis.