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Huff AD, Karlen-Amarante M, Oliveira LM, Ramirez JM. Chronic intermittent hypoxia reveals role of the Postinspiratory Complex in the mediation of normal swallow production. eLife 2024; 12:RP92175. [PMID: 38655918 PMCID: PMC11042803 DOI: 10.7554/elife.92175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder that results in multiple bouts of intermittent hypoxia. OSA has many neurological and systemic comorbidities, including dysphagia, or disordered swallow, and discoordination with breathing. However, the mechanism in which chronic intermittent hypoxia (CIH) causes dysphagia is unknown. Recently, we showed the postinspiratory complex (PiCo) acts as an interface between the swallow pattern generator (SPG) and the inspiratory rhythm generator, the preBötzinger complex, to regulate proper swallow-breathing coordination (Huff et al., 2023). PiCo is characterized by interneurons co-expressing transporters for glutamate (Vglut2) and acetylcholine (ChAT). Here we show that optogenetic stimulation of ChATcre:Ai32, Vglut2cre:Ai32, and ChATcre:Vglut2FlpO:ChR2 mice exposed to CIH does not alter swallow-breathing coordination, but unexpectedly disrupts swallow behavior via triggering variable swallow motor patterns. This suggests that glutamatergic-cholinergic neurons in PiCo are not only critical for the regulation of swallow-breathing coordination, but also play an important role in the modulation of swallow motor patterning. Our study also suggests that swallow disruption, as seen in OSA, involves central nervous mechanisms interfering with swallow motor patterning and laryngeal activation. These findings are crucial for understanding the mechanisms underlying dysphagia, both in OSA and other breathing and neurological disorders.
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Affiliation(s)
- Alyssa D Huff
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Luiz M Oliveira
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological Surgery, University of Washington School of MedicineSeattleUnited States
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González-García M, Carrillo-Franco L, Morales-Luque C, Dawid-Milner MS, López-González MV. Central Autonomic Mechanisms Involved in the Control of Laryngeal Activity and Vocalization. BIOLOGY 2024; 13:118. [PMID: 38392336 PMCID: PMC10886357 DOI: 10.3390/biology13020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
In humans, speech is a complex process that requires the coordinated involvement of various components of the phonatory system, which are monitored by the central nervous system. The larynx in particular plays a crucial role, as it enables the vocal folds to meet and converts the exhaled air from our lungs into audible sounds. Voice production requires precise and sustained exhalation, which generates an air pressure/flow that creates the pressure in the glottis required for voice production. Voluntary vocal production begins in the laryngeal motor cortex (LMC), a structure found in all mammals, although the specific location in the cortex varies in humans. The LMC interfaces with various structures of the central autonomic network associated with cardiorespiratory regulation to allow the perfect coordination between breathing and vocalization. The main subcortical structure involved in this relationship is the mesencephalic periaqueductal grey matter (PAG). The PAG is the perfect link to the autonomic pontomedullary structures such as the parabrachial complex (PBc), the Kölliker-Fuse nucleus (KF), the nucleus tractus solitarius (NTS), and the nucleus retroambiguus (nRA), which modulate cardiovascular autonomic function activity in the vasomotor centers and respiratory activity at the level of the generators of the laryngeal-respiratory motor patterns that are essential for vocalization. These cores of autonomic structures are not only involved in the generation and modulation of cardiorespiratory responses to various stressors but also help to shape the cardiorespiratory motor patterns that are important for vocal production. Clinical studies show increased activity in the central circuits responsible for vocalization in certain speech disorders, such as spasmodic dysphonia because of laryngeal dystonia.
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Affiliation(s)
- Marta González-García
- Department of Human Physiology, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
- Unit of Neurophysiology of the Autonomic Nervous System (CIMES), University of Málaga, 29010 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA Plataforma BIONAND), 29010 Málaga, Spain
| | - Laura Carrillo-Franco
- Department of Human Physiology, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
- Unit of Neurophysiology of the Autonomic Nervous System (CIMES), University of Málaga, 29010 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA Plataforma BIONAND), 29010 Málaga, Spain
| | - Carmen Morales-Luque
- Department of Human Physiology, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
| | - Marc Stefan Dawid-Milner
- Department of Human Physiology, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
- Unit of Neurophysiology of the Autonomic Nervous System (CIMES), University of Málaga, 29010 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA Plataforma BIONAND), 29010 Málaga, Spain
| | - Manuel Víctor López-González
- Department of Human Physiology, Faculty of Medicine, University of Málaga, 29010 Málaga, Spain
- Unit of Neurophysiology of the Autonomic Nervous System (CIMES), University of Málaga, 29010 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA Plataforma BIONAND), 29010 Málaga, Spain
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Moncho D, Poca MA, Rahnama K, Sánchez Roldán MÁ, Santa-Cruz D, Sahuquillo J. The Role of Neurophysiology in Managing Patients with Chiari Malformations. J Clin Med 2023; 12:6472. [PMID: 37892608 PMCID: PMC10607909 DOI: 10.3390/jcm12206472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Chiari malformation type 1 (CM1) includes various congenital anomalies that share ectopia of the cerebellar tonsils lower than the foramen magnum, in some cases associated with syringomyelia or hydrocephalus. CM1 can cause dysfunction of the brainstem, spinal cord, and cranial nerves. This functional alteration of the nervous system can be detected by various modalities of neurophysiological tests, such as brainstem auditory evoked potentials, somatosensory evoked potentials, motor evoked potentials, electromyography and nerve conduction studies of the cranial nerves and spinal roots, as well as brainstem reflexes. The main goal of this study is to review the findings of multimodal neurophysiological examinations in published studies of patients with CM1 and their indication in the diagnosis, treatment, and follow-up of these patients, as well as their utility in intraoperative monitoring.
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Affiliation(s)
- Dulce Moncho
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Maria A. Poca
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Kimia Rahnama
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
| | - M. Ángeles Sánchez Roldán
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
| | - Daniela Santa-Cruz
- Department of Clinical Neurophysiology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (K.R.); (M.Á.S.R.); (D.S.-C.)
| | - Juan Sahuquillo
- Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
- Department of Neurosurgery, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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Baldy C, Chamberland S, Fournier S, Kinkead R. Sex-Specific Consequences of Neonatal Stress on Cardio-Respiratory Inhibition Following Laryngeal Stimulation in Rat Pups. eNeuro 2017; 4:ENEURO.0393-17.2017. [PMID: 29308430 PMCID: PMC5753062 DOI: 10.1523/eneuro.0393-17.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022] Open
Abstract
The presence of liquid near the larynx of immature mammals triggers prolonged apneas with significant O2 desaturations and bradycardias. When excessive, this reflex (the laryngeal chemoreflex; LCR) can be fatal. Our understanding of the origins of abnormal LCR are limited; however, perinatal stress and male sex are risk factors for cardio-respiratory failure in infants. Because exposure to stress during early life has deleterious and sex-specific consequences on brain development it is plausible that respiratory reflexes are vulnerable to neuroendocrine dysfunction. To address this issue, we tested the hypothesis that neonatal maternal separation (NMS) is sufficient to exacerbate LCR-induced cardio-respiratory inhibition in anesthetized rat pups. Stressed pups were separated from their mother 3 h/d from postnatal days 3 to 12. At P14-P15, pups were instrumented to monitor breathing, O2 saturation (Spo2), and heart rate. The LCR was activated by water injections near the larynx (10 µl). LCR-induced apneas were longer in stressed pups than controls; O2 desaturations and bradycardias were more profound, especially in males. NMS increased the frequency and amplitude of spontaneous EPSCs (sEPSCs) in the dorsal motor nucleus of the vagus (DMNV) of males but not females. The positive relationship between corticosterone and testosterone observed in stressed pups (males only) suggests that disruption of neuroendocrine function by stress is key to sex-based differences in abnormal LCR. Because testosterone application onto medullary slices augments EPSC amplitude only in males, we propose that testosterone-mediated enhancement of synaptic connectivity within the DMNV contributes to the male bias in cardio-respiratory inhibition following LCR activation in stressed pups.
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Affiliation(s)
- Cécile Baldy
- Department of Pediatrics, Centre de Recherche de l’Institut de Cardiologie et Pneumologie de Québec, Université Laval, Québec, G1V 4G5, Canada
| | - Simon Chamberland
- Department of Psychiatry and Neuroscience, Québec Mental Health Institute, Université Laval, Québec, G1J 2G3, Canada
| | - Stéphanie Fournier
- Department of Pediatrics, Centre de Recherche de l’Institut de Cardiologie et Pneumologie de Québec, Université Laval, Québec, G1V 4G5, Canada
| | - Richard Kinkead
- Department of Pediatrics, Centre de Recherche de l’Institut de Cardiologie et Pneumologie de Québec, Université Laval, Québec, G1V 4G5, Canada
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Pilowsky PM. Foreword. Respir Physiol Neurobiol 2016; 226:1-2. [PMID: 27305188 DOI: 10.1016/j.resp.2016.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Paul M Pilowsky
- University of Sydney, 7 Eliza St, Newtown, Sydney, NSW 2042, Australia.
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