Central control of the circulation by the rostral ventrolateral reticular nucleus: anatomical substrates

Lateral medullary vascular compression manifesting as paroxysmal hypertension

Neurovascular compression of the rostral ventrolateral medulla (RVLM) has been described as a possible cause of refractory essential hypertension. We present the case of a patient affected by episodes of severe paroxysmal hypertension, some episodes associated with vago-glossopharyngeal neuralgia. Classical secondary forms of hypertension were excluded. Imaging revealed a neurovascular conflict between the posterior inferior cerebellar artery (PICA) and the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves (CN IX-X REZ). A MVD of a conflict between the PICA and the RVLM and adjacent CN IX-X REZ was performed, resulting in reduction of the frequency and severity of the episodes. Brain MRI should be performed in cases of paroxysmal hypertension. MVD can be considered in selected patients.

Longitudinal interrogation of sympathetic neural circuits and hemodynamics in preclinical models

Neurological disorders, including spinal cord injury, result in hemodynamic instability due to the disruption of supraspinal projections to the sympathetic circuits located in the spinal cord. We recently developed a preclinical model that allows the identification of the topology and dynamics through which sympathetic circuits modulate hemodynamics, supporting the development of a neuroprosthetic baroreflex that precisely controls blood pressure in rats, monkeys and humans with spinal cord injuries. Here, we describe the continuous monitoring of arterial blood pressure and sympathetic nerve activity over several months in preclinical models of chronic neurological disorders using commercially available telemetry technologies, as well as optogenetic and neuronal tract-tracing procedures specifically adapted to the sympathetic circuitry. Using a blueprint to construct a negative-pressure chamber, the approach enables the reproduction, in rats, of well-controlled and reproducible episodes of hypotension-mimicking orthostatic challenges already used in humans. Blood pressure variations can thus be directly induced and linked to the molecular, functional and anatomical properties of specific neurons in the brainstem, spinal cord and ganglia. Each procedure can be completed in under 2 h, while the construction of the negative-pressure chamber requires up to 1 week. With training, individuals with a basic understanding of cardiovascular physiology, engineering or neuroscience can collect longitudinal recordings of hemodynamics and sympathetic nerve activity over several months.

Involvement of brainstem noradrenergic system in cutaneous heat loss during exercise

The involvement of brainstem noradrenergic system in thermoregulation during exercise was evaluated by assessing the neuronal activation of A1, A2, locus coeruleus (LC) during exercise. Male Wistar rats weighing 280-330 g were used in the present study. Ninety minutes after exercise bout until fatigue, animals were anaesthesiated and brain removed and processed immunohistochemically for Fos protein and tyrosine hydroxylase in A1, A2 and LC and for Fos in POA subregions. Core and tail temperature were recorded during all running period by telemetry system. Heat storage rate (HSR, cal.min^-1), maximum tail vasoconstriction (°C) and vasodilatation threshold (°C) were calculated and correlated with Fos expression in all nuclei studied. Fos expression in LC correlated inversely with maximum tail skin vasoconstriction (r = -0.787, p < 0.03) and HSR (r = -0.834, p < 0.02) and positively to time to fatigue (r = 0.862, p < 0.01). A1 nucleus showed an inverse correlation with tail skin vasodilatation threshold (r = -0.861, p < 0.01). Fos expression in LC correlated inversely with Fos expression in the median (MnPO, r = -0.909, p < 0.01) and medial preoptic nucleus (MPOM, r = -0.942, p < 0.05). Our results bring further evidences that noradrenergic neurons from LC and A1 nuclei are involved in cutaneous heat loss mechanisms during exercise. LC nucleus probably modulates the sympathetic tonus of tail artery and integrates the central network LC / POA that could represent an important circuitry of temperature regulation during exercise. Also, noradrenergic neurons from A1 nucleus could be involved in cutaneous heat loss during exercise by modulating of vasodilatation threshold.

Baroreflex functionality in the eye of diffusion tensor imaging

By applying diffusion tensor imaging (DTI) as a physiological tool to evaluate changes in functional connectivity between key brainstem nuclei in the baroreflex neural circuits of mice and rats, recent work has revealed several hitherto unidentified phenomena regarding baroreflex functionality. (1) The presence of robust functional connectivity between nucleus tractus solitarii (NTS) and nucleus ambiguus (NA) or rostral ventrolateral medulla (RVLM) offers a holistic view on the moment-to-moment modus operandi of the cardiac vagal baroreflex or baroreflex-mediated sympathetic vasomotor tone. (2) Under pathophysiological conditions (e.g. neurogenic hypertension), the disruption of functional connectivity between key nuclei in the baroreflex circuits is reversible. However, fatality ensues on progression from pathophysiological to pathological conditions (e.g. hepatic encephalopathy) when the functional connectivity between NTS and NA or RVLM is irreversibly severed. (3) The absence of functional connectivity between the NTS and caudal ventrolateral medulla (CVLM) necessitates partial rewiring of the classical neural circuit that includes CVLM as an inhibitory intermediate between the NTS and RVLM. (4) Sustained functional connectivity between the NTS and NA is responsible for the vital period between brain death and the inevitable cardiac death. (5) Reduced functional connectivity between the NTS and RVLM or NA points to inherent anomalous baroreflex functionality in floxed and Cre-Lox mice. (6) Disrupted NTS-NA functional connectivity in Flk-1 (VEGFR2) deficient mice offers an explanation for the hypertensive side-effect of anti-vascular endothelial growth factor therapy (anti-VEGF) therapy. These newly identified baroreflex functionalities revealed by DTI bear clinical and therapeutic implications.

Cardiovascular dysfunction following spinal cord injury

Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury (SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia (AD). AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.

Autonomic consequences of spinal cord injury

Spinal cord injury (SCI) results not only in motor and sensory deficits but also in autonomic dysfunctions. The disruption of connections between higher brain centers and the spinal cord, or the impaired autonomic nervous system itself, manifests a broad range of autonomic abnormalities. This includes compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. These disabilities evoke potentially life-threatening symptoms that severely interfere with the daily living of those with SCI. In particular, high thoracic or cervical SCI often causes disordered hemodynamics due to deregulated sympathetic outflow. Episodic hypertension associated with autonomic dysreflexia develops as a result of massive sympathetic discharge often triggered by unpleasant visceral or sensory stimuli below the injury level. In the pelvic floor, bladder and urethral dysfunctions are classified according to upper motor neuron versus lower motor neuron injuries; this is dependent on the level of lesion. Most impairments of the lower urinary tract manifest in two interrelated complications: bladder storage and emptying. Inadequate or excessive detrusor and sphincter functions as well as detrusor-sphincter dyssynergia are examples of micturition abnormalities stemming from SCI. Gastrointestinal motility disorders in spinal cord injured-individuals are comprised of gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract. As a critical consequence of SCI, neurogenic bowel dysfunction exhibits constipation and/or incontinence. Thus, it is essential to recognize neural mechanisms and pathophysiology underlying various complications of autonomic dysfunctions after SCI. This overview provides both vital information for better understanding these disorders and guides to pursue novel therapeutic approaches to alleviate secondary complications.

Autonomic cardiovascular control in Paralympic athletes with spinal cord injury

INTRODUCTION

Disruption of autonomic control after spinal cord injury (SCI) results in life-threatening cardiovascular dysfunctions and impaired endurance performance; hence, an improved ability to recognize those at risk of autonomic disturbances is of critical clinical and sporting importance.

PURPOSE

The objective of this study is to assess the effect of neurological level, along with motor, sensory, and autonomic completeness of injury, on cardiovascular control in Paralympic athletes with SCI.

METHODS

Fifty-two highly trained male Paralympic athletes (age, 34.8 ± 7.1 yr) from 14 countries with chronic SCI (C2-L2) completed three experimental trials. During trial 1, motor and sensory functions were assessed according to the American Spinal Injury Association Impairment Scale. During trial 2, autonomic function was assessed via sympathetic skin responses (SSR). During trial 3, cardiovascular control was assessed via the beat-by-beat blood pressure response to orthostatic challenge.

RESULTS

Athletes with cervical SCI exhibited the lowest seated blood pressure and the most severe orthostatic hypotension (P < 0.025). There were no differences in cardiovascular function between athletes with different American Spinal Injury Association Impairment Scale grades (P > 0.96). Conversely, those with the lowest SSR scores exhibited the lowest seated blood pressure and the most severe orthostatic hypotension (P < 0.002). Linear regression demonstrated that the combined model of neurological level and autonomic completeness of SCI explained the most variance in all blood pressure indices.

CONCLUSION

We demonstrate for the first time that neurological level and SSR score provide the optimal combination of assessments to identify those at risk of abnormal cardiovascular control. We advocate the use of autonomic testing in the clinical and sporting classification of SCI athletes.

Electrophysiological properties of rostral ventrolateral medulla presympathetic neurons modulated by the respiratory network in rats

The respiratory pattern generator modulates the sympathetic outflow, the strength of which is enhanced by challenges produced by hypoxia. This coupling is due to the respiratory-modulated presympathetic neurons in the rostral ventrolateral medulla (RVLM), but the underlining electrophysiological mechanisms remain unclear. For a better understanding of the neural substrates responsible for generation of this respiratory-sympathetic coupling, we combined immunofluorescence, single cell qRT-pCR, and electrophysiological recordings of the RVLM presympathetic neurons in in situ preparations from normal rats and rats submitted to a metabolic challenge produced by chronic intermittent hypoxia (CIH). Our results show that the spinally projected cathecholaminergic C1 and non-C1 respiratory-modulated RVLM presympathetic neurons constitute a heterogeneous neuronal population regarding the intrinsic electrophysiological properties, respiratory synaptic inputs, and expression of ionic currents, albeit all neurons presented persistent sodium current-dependent intrinsic pacemaker properties after synaptic blockade. A specific subpopulation of non-C1 respiratory-modulated RVLM presympathetic neurons presented enhanced excitatory synaptic inputs from the respiratory network after CIH. This phenomenon may contribute to the increased sympathetic activity observed in CIH rats. We conclude that the different respiratory-modulated RVLM presympathetic neurons contribute to the central generation of respiratory-sympathetic coupling as part of a complex neuronal network, which in response to the challenges produced by CIH contribute to respiratory-related increase in the sympathetic activity.

Cannabinoid receptor 1 signaling in cardiovascular regulating nuclei in the brainstem: A review

Cannabinoids elicit complex hemodynamic responses in experimental animals that involve both peripheral and central sites. Centrally administered cannabinoids have been shown to predominantly cause pressor response. However, very little is known about the mechanism of the cannabinoid receptor 1 (CB₁R)-centrally evoked pressor response. In this review, we provided an overview of the contemporary knowledge regarding the cannabinoids centrally elicited cardiovascular responses and the possible underlying signaling mechanisms. The current review focuses on the rostral ventrolateral medulla (RVLM) as the primary brainstem nucleus implicated in CB₁R-evoked pressor response.

Cholinergic neurons in the mouse rostral ventrolateral medulla target sensory afferent areas

The rostral ventrolateral medulla (RVLM) primarily regulates respiration and the autonomic nervous system. Its medial portion (mRVLM) contains many choline acetyltransferase (ChAT)-immunoreactive (ir) neurons of unknown function. We sought to clarify the role of these cholinergic cells by tracing their axonal projections. We first established that these neurons are neither parasympathetic preganglionic neurons nor motor neurons because they did not accumulate intraperitoneally administered Fluorogold. We traced their axonal projections by injecting a Cre-dependent vector (floxed-AAV2) expressing either GFP or mCherrry into the mRVLM of ChAT-Cre mice. Transduced neurons expressing GFP or mCherry were confined to the injection site and were exclusively ChAT-ir. Their axonal projections included the dorsal column nuclei, medullary trigeminal complex, cochlear nuclei, superior olivary complex and spinal cord lamina III. For control experiments, the floxed-AAV2 (mCherry) was injected into the RVLM of dopamine beta-hydroxylase-Cre mice. In these mice, mCherry was exclusively expressed by RVLM catecholaminergic neurons. Consistent with data from rats, these catecholaminergic neurons targeted brain regions involved in autonomic and endocrine regulation. These regions were almost totally different from those innervated by the intermingled mRVLM-ChAT neurons. This study emphasizes the advantages of using Cre-driver mouse strains in combination with floxed-AAV2 to trace the axonal projections of chemically defined neuronal groups. Using this technique, we revealed previously unknown projections of mRVLM-ChAT neurons and showed that despite their close proximity to the cardiorespiratory region of the RVLM, these cholinergic neurons regulate sensory afferent information selectively and presumably have little to do with respiration or circulatory control.

Role of the lateral paragigantocellular nucleus in the network of paradoxical (REM) sleep: an electrophysiological and anatomical study in the rat

The lateral paragigantocellular nucleus (LPGi) is located in the ventrolateral medulla and is known as a sympathoexcitatory area involved in the control of blood pressure. In recent experiments, we showed that the LPGi contains a large number of neurons activated during PS hypersomnia following a selective deprivation. Among these neurons, more than two-thirds are GABAergic and more than one fourth send efferent fibers to the wake-active locus coeruleus nucleus. To get more insight into the role of the LPGi in PS regulation, we combined an electrophysiological and anatomical approach in the rat, using extracellular recordings in the head-restrained model and injections of tracers followed by the immunohistochemical detection of Fos in control, PS-deprived and PS-recovery animals. With the head-restrained preparation, we showed that the LPGi contains neurons specifically active during PS (PS-On neurons), neurons inactive during PS (PS-Off neurons) and neurons indifferent to the sleep-waking cycle. After injection of CTb in the facial nucleus, the neurons of which are hyperpolarized during PS, the largest population of Fos/CTb neurons visualized in the medulla in the PS-recovery condition was observed in the LPGi. After injection of CTb in the LPGi itself and PS-recovery, the nucleus containing the highest number of Fos/CTb neurons, moreover bilaterally, was the sublaterodorsal nucleus (SLD). The SLD is known as the pontine executive PS area and triggers PS through glutamatergic neurons. We propose that, during PS, the LPGi is strongly excited by the SLD and hyperpolarizes the motoneurons of the facial nucleus in addition to local and locus coeruleus PS-Off neurons, and by this means contributes to PS genesis.

Morphological substrate of autonomic failure and neurohormonal dysfunction in multiple system atrophy: impact on determining phenotype spectrum

Autonomic failure is a prominent clinical feature of patients with multiple system atrophy (MSA). Neurohormonal dysfunction is also a frequent accompaniment in patients with MSA. The determination of the pathological involvement of the autonomic neurons, which are responsible for circadian rhythms and responses to stress, provides new insight into autonomic failure and neurohormonal dysfunction in MSA. The disruptions of circadian rhythms and responses to stress may underlie the impairment of homeostatic integration responsible for cardiovascular and respiratory failures. These notions lead to the hypothesis that a pathological involvement of autonomic neurons is a significant factor of the poor prognosis of MSA. Beyond this perspective, endeavors to find the morphological phenotype that represents a predominant loss of autonomic neurons may elucidate the full spectrum of pathological involvements in MSA.

Posterior fossa brain tumors and arterial hypertension

Hypertension caused by arterial compression of the rostral ventrolateral medulla is well described. Much less information is available on the association between neurogenic hypertension and posterior fossa brain tumors. To date, multiple reports have supported the impression that a small subpopulation of patients with posterior fossa tumors can present with arterial hypertension, and many of those patients achieved significant improvement of their hypertension after tumor resection and medullary decompression. To review the relationship between posterior fossa brain tumors and hypertension, we detail the history, basic science, and clinical reports along with an illustrative case regarding this topic.

Which pathways must be spared in the injured human spinal cord to retain cardiovascular control?

Cardiovascular abnormalities following spinal cord injury are attributed to autonomic instability caused by a combination of changes occurring within the spinal cord, including loss of descending autonomic control and plastic changes within spinal and peripheral circuits. Previous animal studies have shown that localized disruption of the descending vasomotor pathways results in cardiovascular changes similar to those observed following cord injury. However, the location of these pathways in humans is uncertain. This chapter presents clinical and histopathological findings from individuals with spinal cord injury that associates a common area of white matter destruction with severe cardiovascular symptoms. These data provide evidence that descending vasomotor pathways in the human spinal cord project through the dorsal aspects of the lateral funiculus.

Activation of A1 and A2 noradrenergic neurons in response to running in the rat

Since running accompanied with blood lactate accumulation stimulates the release of adrenocorticotropic hormone (ACTH), running above the lactate threshold (LT) acts as stress (running stress). To examine whether A1/A2 noradrenergic neurons that project to the hypothalamus activate under running stress, c-Fos immunohistochemistry was used to compare the effects of running with or without stress response on A1/A2 noradrenergic neurons. Blood lactate and plasma ACTH concentrations significantly increased in the running stress group, but not in the running without stress response and control groups, confirming different physiological impacts between different intensity of running with or without stress. Running stress markedly increased c-Fos accumulation in the A1/A2 noradrenergic neurons. Running without stress response also induced a significant increase in c-Fos expression in the A1/A2 noradrenergic neurons, and the percentage of the increase was smaller than that of running stress. The extent of c-Fos expression in the A1/A2 noradrenergic neurons correlates with exercise intensity, signifying that this neuronal activation is running speed-dependent. We thus suggest that A1/A2 noradrenergic neurons are activated in response to not only running stress, but also to other physiological running, enhanced by non-stressful running. These findings will be helpful in studies of specific neurocircuits and in identifying their functions in response to running at different intensities.

Anterior hypothalamic neurons respond to blood pressure changes via γ-aminobutyric acid and angiotensins in rats

It has been suggested that neurons in the hypothalamus respond to baroreflex activation and deactivation. In this study, we examined whether angiotensin II-sensitive neurons in the anterior hypothalamic area (AHA) respond to baroreflex activation and deactivation, and which neurotransmitters are involved in mediating the baroreflex responses. Male Wistar rats were anesthetized and artificially ventilated. Extracellular potentials were recorded from single neurons in the AHA. Increases in blood pressure induced by intravenous phenylephrine completely inhibited the firing of AHA angiotensin II-sensitive neurons. The phenylephrine-induced inhibition of neuronal firing was blocked and enhanced by the pressure application of bicuculline and nipecotic acid, respectively, onto the same neurons. In contrast, decreases in blood pressure induced by intravenous nitroprusside increased the firing of angiotensin II-sensitive neurons. The nitroprusside-induced increase of neuronal firing was blocked by the pressure application of losartan onto the same neurons. These findings suggest that angiotensin II-sensitive neurons in the AHA respond to blood pressure changes via gamma-aminobutyric acid and angiotensins in rats.

Serotonergic neurons of the caudal raphe nuclei activated in response to hemorrhage in the rat

The response to a sudden, severe loss of blood volume is complex and results in a drastic fall in arterial blood pressure and sympathoinhibition. The present study examines the distribution of serotonergic neurons in the caudal raphe involved in the mediation of the response to severe hemorrhage. Hemorrhage was performed in rats anesthetised with urethane by withdrawal of blood at a rate of 1 ml/min for approximately 4 min until blood pressure fell to 50 mm Hg. Sections through the brainstem were processed immunohistochemically to identify Fos, the protein product of the proto-oncogene c-fos expressed in the nucleus of neurons activated during the hemorrhage stimulus, and double-labeled to identify serotonin (5-hydroxytryptamine; 5-HT) content of cells. In response to hemorrhage, double-labeled Fos/5-HT neurons were located in the B3 region which includes the raphe magnus (RM) and its lateral extension. Hemorrhage-induced Fos-positive neurons that were not serotonergic were located in raphe pallidus (RP), parapyramidal cell group (PP), and the B3 region. Serotonergic neurons not activated by hemorrhage were located in the nucleus raphe pallidus, the parapyramidal cell group, the raphe obscurus (RO), and the B3 region. The specific rostrocaudal distribution of activated neurons may indicate different functions of groups of neurons in the response to hemorrhage.

Rostral ventrolateral medulla: an integrative site for muscle vasodilation during defense-alerting reactions

1. Evidence gathered over the last 30 years has firmly established that the rostral ventrolateral medulla (RVLM) is a major vasomotor center in the brainstem, harboring sympathetic premotor neurons responsible for generating and maintaining basal vasomotor tone and resting levels of arterial blood pressure. Although the RVLM has been almost exclusively classified as a vasopressor area, in this report we review some evidence suggesting a prominent role of the RVLM in muscle vasodilation during defense-alerting responses. 2. Defense-alerting reactions are a broad class of behavior including flexion of a limb, fight/flight responses, apologies, etc. They comprise species-distinctive motor and neurovegetative adjustments. Cardiovascular responses include hypertension, tachycardia, visceral vasoconstriction, and muscle vasodilation. Since defense-alerting reactions generally involve intense motor activation, muscle vasodilation is regarded as a key feature of these responses 3. In anesthetized or unanesthetized-decerebrate animals, natural or electrical stimulation of cutaneous and muscle afferents produced hypertension, tachycardia, and vasodilation restricted to the stimulated limb. 4. Unilateral inactivation of the RVLM contralateral to the stimulated limb abolished cardiovascular adjustments to stimulation of cutaneous and muscle afferents. Within the RVLM glutamatergic synapses mediate pressor responses, whereas GABAergic synapses mediates muscle vasodilation. 5. In urethane-anesthetized rats, electrical stimulation of the hypothalamus elicited hypertension, tachycardia, visceral vasoconstriction, and hindlimb vasodilation. The hindlimb vasodilation induced by hypothalamic stimulation is a complex response, involving reduction of sympathetic vasoconstrictor tone, release of catecholamines by the adrenal medulla, and a still unknown system that may use nitric oxide as a mediator. 6. Blockade of glutamatergic transmission within the RVLM selectively blocks muscle vasodilation induced by hypothalamic stimulation. 7. The results obtained suggest that, besides its role in the generation and maintenance of the sympathetic vasoconstrictor drive, the RVLM is also critical for vasodilatory responses during defense reactions. The RVLM may contain several, distinctive mechanisms for muscle vasodilation. Anatomical and functional characterization of these pathways may represent a breakthrough in our understanding of cardiovascular control in normal and/or pathological conditions.

Descending Vasomotor Pathways in Humans: Correlation between Axonal Preservation and Cardiovascular Dysfunction after Spinal Cord Injury

Cardiovascular dysfunction is common after cervical spinal cord injury (SCI) in humans. At least three spinal cord elements involved in cardiovascular control have been identified: descending vasomotor pathways (DVPs), sympathetic preganglionic neurons, and spinal afferents. However, little is known about the localization of the DVPs within the human spinal cord, which limits our understanding of the mechanisms of cardiovascular dysfunction after SCI. This study was undertaken to examine the association of cardiovascular abnormalities after SCI in humans with the severity of degeneration and axonal loss within the DVPs. A detailed chart review and histopathological examination of postmortem spinal cord tissue was conducted in individuals with cervical SCI (n = 7) and control individuals with an intact central nervous system (n = 5). Individuals with SCI were divided into group 1 (severe cardiovascular abnormalities) and group 2 (no/minor cardiovascular disturbances). The area of degeneration and the number of preserved axons within different areas of the spinal cord were quantitated using EMPIX imaging software. Two areas of possible localization of DVPs were investigated: area I, within the dorsal aspects of the lateral funiculus; and area II, within the white matter adjacent to the dorsolateral aspect of the lateral horn. Comparison of the extent of axonal degeneration in both SCI groups demonstrated that individuals in group 1 had more extensive axonal degeneration than those in group 2. The number of intact axons within areas I and II in individuals from group 1 was significantly lower than those from group 2 or control cases (p = 0.029; p = 0.028). The most dramatic axonal loss was observed within area I in individuals with cardiovascular dysfunction. We conclude that loss and degeneration of DVPs, which are localized within the dorsolateral aspects of the human spinal cord, contributes to abnormal cardiovascular control after SCI. This information adds to our knowledge of pathobiology of cardiovascular dysfunction after human SCI and may ultimately suggest novel therapeutic strategies as regenerative and reparative approaches become translated to the clinic.

Fos and FRA protein expression in rat nucleus paragigantocellularis lateralis during different space flight conditions

The nucleus paragigantocellularis lateralis (LPGi) exerts a prominent excitatory influence over locus coeruleus (LC) neurons, which respond to gravity signals. We investigated whether adult albino rats exposed to different gravitational fields during the NASA Neurolab Mission (STS-90) showed changes in Fos and Fos-related antigen (FRA) protein expression in the LPGi and related cardiovascular, vasomotor, and respiratory areas. Fos and FRA proteins are induced rapidly by external stimuli and return to basal levels within hours (Fos) or days (FRA) after stimulation. Exposure to a light pulse (LP) 1 h prior to sacrifice led to increased Fos expression in subjects maintained for 2 weeks in constant gravity (either at approximately 0 or 1 G). Within 24 h of a gravitational change (launch or landing), the Fos response to LP was abolished. A significant Fos response was also induced by gravitational stimuli during landing, but not during launch. FRA responses to LP showed a mirror image pattern, with significant responses 24 h after launch and landing, but no responses after 2 weeks at approximately 0 or 1 G. There were no direct FRA responses to gravity changes. The juxtafacial and retrofacial parts of the LPGi, which integrate somatosensory/acoustic and autonomic signals, respectively, also showed gravity-related increases in LP-induced FRA expression 24 h after launch and landing. The neighboring nucleus ambiguus (Amb) showed completely different patterns of Fos and FRA expression, demonstrating the anatomical specificity of these results. Immediate early gene expression in the LPGi and related cardiovascular vasomotor and ventral respiratory areas may be directly regulated by excitatory afferents from vestibular gravity receptors. These structures could play an important role in shaping cardiovascular and respiratory function during adaptation to altered gravitational environments encountered during space flight and after return to earth.

Prostaglandin EP3 receptor protein in serotonin and catecholamine cell groups: a double immunofluorescence study in the rat brain

Prostaglandin E(2) exerts diverse physiological actions in the central nervous system with unknown mechanisms. We have reported the immunohistochemical localization of the EP3 receptor, one of the prostaglandin E receptor subtypes, in various brain regions including many monoaminergic nuclei. In the present study, a double immunofluorescence technique with an antibody to EP3 receptor and antibodies to markers for monoamine neurons was employed to examine the expression of the receptor in serotonin and catecholamine neurons, and to reveal the distribution of the receptor-expressing monoamine neurons in the rat brain. Almost all serotonergic cells in the medulla oblongata (B1-B4) exhibited EP3 receptor-like immunoreactivity, whereas mesencephalic and pontine serotonergic cell groups (B5-B9) contained relatively small populations of EP3 receptor-immunoreactive cells. In the catecholaminergic cell groups, many of the noradrenergic A7 cells in the subcoeruleus nucleus showed immunoreactivity for the receptor. The locus coeruleus exhibited EP3 receptor-like immunoreactivity densely in the neuropil and occasionally in neuronal cell bodies, all of which were immunopositive for dopamine beta-hydroxylase, as observed by confocal laser microscopy. Many of the other noradrenergic and adrenergic cell groups contained small populations of EP3 receptor-like immunoreactive cells. In contrast, no EP3 receptor-like immunoreactivity was detected in the noradrenergic A2 and A4, the adrenergic C2, and all the dopaminergic cell groups. The expression of EP3 receptor by most of the serotonergic, noradrenergic and adrenergic cell groups suggests that prostaglandin E(2) modulates many physiological processes mediated by widely distributed monoaminergic projections through activation of the EP3 receptor on the monoaminergic neurons; for instance, it may modulate nociceptive and autonomic processes by affecting the descending serotonergic pathway from the raphe magnus nucleus to the spinal cord.

Neurons of a limited subthalamic area mediate elevations in cortical cerebral blood flow evoked by hypoxia and excitation of neurons of the rostral ventrolateral medulla

Sympathoexcitatory reticulospinal neurons of the rostral ventrolateral medulla (RVLM) are oxygen detectors excited by hypoxia to globally elevate regional cerebral blood flow (rCBF). The projection, which accounts for >50% of hypoxic cerebral vasodilation, relays through the medullary vasodilator area (MCVA). However, there are no direct cortical projections from the RVLM/MCVA, suggesting a relay that diffusely innervates cortex and possibly originates in thalamic nuclei. Systematic mapping by electrical microstimulation of the thalamus and subthalamus revealed that elevations in rCBF were elicited only from a limited area, which encompassed medial pole of zona incerta, Forel's field, and prerubral zone. Stimulation (10 sec train) at an active site increased rCBF by 25 +/- 6%. Excitation of local neurons with kainic acid mimicked effects of electrical stimulation by increasing rCBF. Stimulation of the subthalamic cerebrovasodilator area (SVA) with single pulses (0.5 msec; 80 microA) triggered cortical EEG burst-CBF wave complexes with latency 24 +/- 5 msec, which were similar in shape to complexes evoked from the MCVA. Selective bilateral lesioning of the SVA neurons (ibotenic acid, 2 microg, 200 nl) blocked the vasodilation elicited from the MCVA and attenuated hypoxic cerebrovasodilation by 52 +/- 12% (p < 0.05), whereas hypercarbic vasodilation remained preserved. Lesioning of the vasodilator site in the basal forebrain failed to modify SVA-evoked rCBF increase. We conclude that (1) excitation of intrinsic neurons of functionally restricted region of subthalamus elevates rCBF, (2) these neurons relay signals from the MCVA, which elevate rCBF in response to hypoxia, and (3) the SVA is a functionally important site conveying vasodilator signal from the medulla to the telencephalon.

Microvascular decompression in the treatment of hypertension: review and update

BACKGROUND

Neurogenic hypertension in association with vascular compression of the left rostral ventrolateral medulla has been documented. A recent group of these clinical reports has raised great interest in decompression of this area of the brainstem as a definitive therapy for essential hypertension.

METHODS

To further clarify the mechanism by which decompression of the left rostral ventrolateral medulla relieves neurogenic hypertension, we describe in detail the basic science, animal models, human studies, and most recent clinical trials regarding surgical decompression of this area.

CONCLUSION

Multi-disciplinary evidence supports the hypothesis that a sub-population of hypertensive patients achieve significant relief of their hypertension after microvascular decompression. A multi-institutional, prospective, randomized study is necessary to determine the efficacy of microvascular decompression for neurogenic hypertension.

A brainstem area mediating cerebrovascular and EEG responses to hypoxic excitation of rostral ventrolateral medulla in rat

We sought to identify the medullary relay area mediating the elevations of regional cerebral blood flow (rCBF) and synchronization of the electroencephalogram (EEG) in the rat cerebral cortex elicited by hypoxic excitation of reticulospinal sympathoexcitatory neurons of the rostral ventrolateral medulla (RVLM ). In anaesthetized spinalized rats electrical stimulation of RVLM elevated rCBF (laser-Doppler flowmetry) by 31 +/- 6 %, reduced cerebrovascular resistance (CVR) by 26 +/- 8 %, and synchronized the EEG, increasing the power of the 5-6 Hz band by 98 +/- 25 %. Stimulation of a contiguous caudal region, the medullary cerebral vasodilator area (MCVA), had comparable effects which, like responses of RVLM, were replicated by microinjection of L-glutamate (5 nmol, 20 nl). Microinjection of NaCN (300 pmol in 20 nl) elevated rCBF (17 +/- 5 %) and synchronized the EEG from RVLM, but not MCVA, while nicotine (1.2 nmol in 40 nl) increased rCBF by 13 +/- 5 % and synchronized the EEG from MCVA. In intact rats nicotine lowered arterial pressure only from MCVA (101 +/- 3 to 52 +/- 9 mmHg). Bilateral electrolytic lesions of MCVA significantly reduced, by over 59 %, elevations in rCBF and, by 78 %, changes in EEG evoked from RVLM. Bilateral electrolytic lesions of RVLM did not affect responses from MCVA. Anterograde tracing with BDA demonstrated that RVLM and MCVA are interconnected. The MCVA is a nicotine-sensitive region of the medulla that relays signals elicited by excitation of oxygen-sensitive reticulospinal neurons in RVLM to reflexively elevate rCBF and slow the EEG as part of the oxygen-conserving (diving) reflex initiated in these neurons by hypoxia or ischaemia.

Differential cardiorespiratory control elicited by activation of ventral medullary sites in mice

We studied the respiratory and blood pressure responses to chemical stimulation of two regions of the ventral brainstem in mice: the rostral and caudal ventrolateral medulla (RVLM and CVLM, respectively). Stimulation of the RVLM by microinjections of the excitatory amino acid L-glutamate induced increases in diaphragm activity and breathing frequency, elevation of blood pressure (BP), and a slight increase in heart rate (HR). However, activation of the CVLM induced a decrease in breathing frequency, mainly due to prolongation of expiratory time (TE), and hypotension associated with a slight slowing of HR. Because adrenergic mechanisms are known to participate in the control of respiratory timing, we examined the role of alpha(2)-adrenergic receptors in the RVLM region in mediating these inhibitory effects. The findings demonstrated that blockade of the alpha(2)-adrenergic receptors within the RVLM by prior microinjection of SKF-86466 (an alpha(2)-adrenergic receptor blocker) significantly reduced changes in TE induced by CVLM stimulation but had little effect on BP responses. These results indicate that, in mice, activation of the RVLM increases respiratory drive associated with an elevation of BP, but stimulation of CVLM induces prolongation of TE via an alpha(2)-adrenergic signal transduction pathway.

The medullary cerebrovascular vasodilator area mediates cerebrovascular vasodilation and electroencephalogram synchronization elicited from cerebellar fastigial nucleus in Sprague-Dawley rats

We investigated whether the medullary cerebrovasodilator area (MCVA), a region of ventral medulla mediating elevations of regional cerebral blood flow (rCBF) and electroencephalogram (EEG) synchronization elicited in cerebral cortex from stimulation of reticulospinal neurons of rostral ventrolateral medulla (RVLM), also mediates comparable responses from the cerebellar fastigial nucleus (FN). In spinalized rats, electrical stimulation of MCVA, RVLM or FN elevated rCBF and synchronized the EEG. The FN-evoked responses were significantly attenuated or blocked by bilateral lesions of MCVA. The MCVA is a novel region of medullary reticular formation mediating actions of medullary and cerebellar centers on rCBF and EEG to link visceral centers of brainstem and cerebral cortex.

Nucleus ambiguus and bulbospinal ventral respiratory group neurons in the neonatal rat

The in vitro brainstem-spinal cord preparation of the neonatal rat is an important model system for studies of the respiratory control system, yet there have not been studies to anatomically characterize respiratory neuron populations in the neonate. Fluorescent retrograde tracers were used to identify bulbospinal neurons of the ventral respiratory group and motoneurons of nucleus ambiguus in neonatal rats. Fluoro-Gold injections into the C4 ventral horn labeled bulbospinal neurons within a densely packed column within the ventrolateral intermediate reticular nucleus from the level of the pyramidal decussation to the facial nucleus. This cell column corresponded closely to the location of the ventral respiratory group of the adult rat. In particular, neurons were labeled in regions corresponding to the rostral ventral respiratory group and the Bötzinger complex. Unlike adult rats, the preBötzinger complex also contained many bulbospinal neurons. Fluoro-Gold-labeled neurons were also located in the medial reticular nuclei, raphe pallidus, and obscurus and spinal vestibular nucleus. As in adult rats, bulbospinal ventral respiratory group neurons overlapped with cervical vagal motoneurons in the external formation, and partially with those in the loose formation, but not with those in the semicompact or compact formation of nucleus ambiguus. These results indicate that the distribution of bulbospinal ventral respiratory group neurons corresponds with that observed in physiological studies of neonatal rats.

Expression of brain-derived neurotrophic factor in catecholaminergic neurons of the rat lower brainstem after colchicine treatment or hemorrhage

Widespread brain-derived neurotrophic factor messenger RNA expression has been detected in the region of catecholamine groups of the rat lower brainstem, while few brain-derived neurotrophic factor-immunoreactive cells were found in this area. In the present study, a double-color immunofluorescence technique for brain-derived neurotrophic factor and tyrosine hydroxylase after colchicine treatment was employed to evaluate the possible presence of brain-derived neurotrophic factor immunoreactivity in the catecholaminergic cells of the rat lower brainstem. We detected many new brain-derived neurotrophic factor-immunoreactive cells in the A1, A2, A4, A6-A10 and C1-C3 cell groups and in the other lower brainstem nuclei where, without colchicine treatment, brain-derived neurotrophic factor messenger RNA was expressed, but not brain-derived neurotrophic factor immunoreactivity. In addition, the catecholaminergic neurons were found to express brain-derived neurotrophic factor immunoreactivity with the co-existence being greatest, in percentage terms, in medullary catecholaminergic cell groups. Hypotensive hemorrhage, which activates medullary catecholaminergic neurons, induced the expression of brain-derived neurotrophic factor immunoreactivity in catecholaminergic neurons (A1/C1 and C2). The results demonstrate that brain-derived neurotrophic factor is regulated by neuronal activity in medullary catecholaminergic cell groups involved in central cardiovascular regulation.

Effect of graded spinal cord compression on cardiovascular neurons in the rostro-ventro-lateral medulla

In patients with spinal cord injury, cardiovascular disturbances such as hypotension, bradycardia and autonomic dysreflexia can be directly linked to abnormalities of central autonomic control. To date, the changes in bulbospinal innervation of sympathetic preganglionic neurons after compressive spinal cord injury have not been investigated. Thus, we examined the effect of varying severity of compressive spinal cord injury on neurons of the rostro-ventro-lateral medulla, a nucleus of key importance in cardiovascular control. Adult rats with 20 g, 35 g and 50 g clip compression injuries (n= 18) of the cord at T1 and uninjured controls (n=13) were studied. Neurons in the rostro-ventro-lateral medulla with preserved spinal connections eight weeks after spinal cord injury were identified by retrograde labelling with 4% FluoroGold introduced into the cord at T6. Bulbospinal neurons in the rostro-ventro-lateral medulla were also examined immunocytochemically for the adrenaline-synthesizing enzyme phenylethanolamine-N-methyltransferase. In control rats an average of 451+/-12 rostro-ventrolateral medulla neurons were phenylethanolamine-N-methyltransferase positive. Of these, 213+/-6 projected to the T6 spinal cord. The number of rostro-ventro-lateral medulla neurons retrogradely labelled by FluoroGold decreased as a linear function of severity of spinal cord injury (r= -0.95; P<0.0001). After 50g spinal cord injury at T1, only 7+/-1 rostro-ventro-lateral medulla neurons were labelled by FluoroGold, of which 6+/-1 were phenylethanolamine-N-methyltransferase positive. Moreover, the number of phenylethanolamine-N-methyltransferase positive rostro-ventro-lateral medulla neurons decreased to 361+/-16 after 50 g spinal cord injury. We conclude that compressive spinal cord injury results in disconnection of rostro-ventro-lateral medulla neurons, which project to the thoracic spinal cord, and that these changes vary with the severity of injury. The majority of these axotomized rostro-ventro-lateral medulla neurons maintain their immunopositivity for the adrenaline-synthesizing enzyme phenylethanolamine-N-methyltransferase.

The area postrema of newborn swine is activated by hypercapnia: relevance to sudden infant death syndrome?

This study was performed to investigate a role of the neonatal area postrema (AP) in the chemoreceptor response to hypercapnia which is defective in sudden infant death syndrome (SIDS). AP responses to CO2 inhalation were monitored in 1 to 5 week old piglets by mapping neurons that were induced to express the c-fos gene product, Fos--a marker of functional activation. Interpretive confounds were minimized by controlling for hypoxia, the effects of surgical procedures and ambient environmental stressors on neuronal activity (c-fos expression). The AP demonstrated a powerful and reproducible response in neonatal swine breathing 10% CO2 for 1 h. Intensely immunolabeled nuclei were detected throughout the longitudinal extent of the circumventricular organ, and were especially heavily concentrated at rostral levels proximal to obex. Quantitative analysis verified statistically significant increases in numbers of cells that were induced to express Fos-like immunoreactivity (FLI) in the AP of CO2- stimulated piglets as compared to control groups. No detectable age-related differences were observed in AP response patterns. Conclusions. The AP responds to hypercapnic stress in the newborn piglet. A mature circumventricular organ response in the neonate may be crucial in defending against common environmental stressors, such as nicotine exposure--an emetic agent acting via the AP and a major risk factor in SIDS. Hence, a defect of the AP or its network may underlie a loss of state-dependent controls over cardiopulmonary reflex function in SIDS.

Intrinsic vasomotor innervation of blood vessels in human ventrolateral medulla

Medullae were obtained at autopsy from seven patients with no neurologic disease, and sections were processed for tyrosine hydroxylase (TH), nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), or both. Both TH- and NADPH-d reactive neurons had close anatomical relationship with penetrating blood vessels in the ventrolateral medulla (VLM). Three patterns were identified: 1) processes arising from a neighboring neuron reaching the blood vessel; 2) direct appositions of cell bodies to blood vessels; and 3) fibers coursing parallel to the blood vessels. This intrinsic innervation may provide a mechanism of coupling among local metabolism, sympathetic activity, and blood flow in the VLM.

Ventrolateral medullary control of cardiovascular activity during muscle contraction

An overview of the role of ventrolateral medulla (VLM) in regulation of cardiovascular activity is presented. A summary of VLM anatomy and its functional relation to other areas in the central nervous system is described. Over the past few years, various studies have investigated the VLM and its involvement in cardiovascular regulation during static muscle contraction, a type of static exercise as seen, for example, during knee extension or hand-grip exercise. Understanding the neural mechanisms that are responsible for regulation of cardiovascular activity during static muscle contraction is of particular interest since it helps understand circulatory adjustments in response to an increase in physical activity. This review surveys the role of several receptors and neurotransmitters in the VLM that are associated with changes in mean arterial pressure and heart rate during static muscle contraction in anesthetized animals. Possible mechanisms in the VLM that modulate cardiovascular changes during static muscle contraction are summarized and discussed. Localized administration of an excitatory amino-acid antagonist into the rostral portion of the VLM (RVLM) attenuates increases in blood pressure and heart rate during static muscle contraction, whereas its administration into the caudal part of the VLM (CVLM) augments these responses. Opioid or 5-HT1A receptor stimulation in the RVLM, but not in the CVLM, attenuates cardiovascular responses to muscle contraction. Furthermore, intravenous, intracerebroventricular or intracisternal injection of an alpha 2-adrenoceptor agonist or a cholinesterase inhibitor attenuates increases in blood pressure and heart rate during static muscle contraction. Finally, the possible involvement of endogenous neurotransmitters in the RVLM and the CVLM associated with cardiovascular responses during static muscle contraction is discussed. An overview of the role of the VLM in the overall cardiovascular control network in the brain is presented and critically reviewed.

Spontaneous activity and barosensitivity of the barosensitive neurons in the rostral ventrolateral medulla of hypertensive rats induced by transection of aortic depressor nerves

In order to determine the role of the rostral ventrolateral medulla (RVLM) in the development of neurogenic hypertension, the aortic depressor nerves of rats were transected (tADN) to produce neurogenic hypertension. The rate and pattern of firing of the barosensitive RVLM neurons of the treated rats were studied. In neurogenic hypertensive rats, the RVLM barosensitive neurons exhibited a faster firing rate and a shorter interspike interval (ISI) than the corresponding values of the control and sham groups, indicating an enhanced spontaneous activity of these neurons in the hypertensive rats. The coefficient of variation (cv) and skewness (sk) of the ISI histogram, parameters reflecting the regularity of neuronal firing, were smaller in neurogenic hypertensive than in the control and sham-operated rats. Following tADN, the responsiveness of these neurons to blood pressure changes was attenuated, suggesting a reduced intrinsic barosensitivity of neurons and/or a reduced baroreceptor input. The increase in spontaneous activity and firing regularity of RVLM barosensitive neurons imply an enhancement in the efficacy of outflow from these neurons. The increased efficacy of the outflow from the RVLM barosensitive neurons and the resetting of the baroreflex may contribute to the genesis of neurogenic hypertension.

Angiotensin II in central nervous system physiology

In summary, the prevailing concept is that brain Ang II increases blood pressure by activating AT1 receptors, and that these have a neuromodulating effect to increase the activity of autonomic nervous system. Pathways for Ang II stimulating thirst and blood pressure, increased vasopressin release and sympathetic activation have been outlined. Brain RAS synthesis, while incompletely understood, is active in the absence of a peripheral RAS. Angiotensin elicits specific receptor mediated signals in neurons, particularly in the hypothalamus and brainstem. These actions are due to neuronal membrane ionic currents and the regulation of transcription factors. The areas to be explored further are characterization and functional roles of the other AT receptor subtypes, such as AT4, AT(1-7) and nuclear AT-R. Their interactions with other peptides and transmitters, and their signaling pathways need to be investigated. The story that began 100 years ago with renin is certainly not ended and will continue to unfold as further investigations with new techniques progress.

Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension

OBJECTIVE

To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective modality for treating elevated blood pressure in patients with severe medically refractory "essential" hypertension (HTN).

METHODS

Twelve patients with medically intractable HTN with or without autonomic dysreflexia underwent microvascular decompression of the left rostral ventrolateral medulla oblongata. Causes such as pheochromocytoma, carcinoid syndrome, and renal disease were ruled out before surgery. Indications for surgery included systolic blood pressures greater than 180 mm Hg refractory to three or more medications, severe blood pressure lability, or medically resistant HTN at systolic pressures greater than 160 mm Hg associated with autonomic dysreflexia and/or magnetic resonance images demonstrating left medullary compression. The median age and follow-up duration were 51 years and 4.1 years, respectively.

RESULTS

Ten of 12 patients experienced reductions in systolic blood pressure greater than 20 mm Hg. Of these 10 patients, pressure reductions were temporary (6 mo) in two. Seven of eight patients experienced improvement in blood pressure lability and/or autonomic dysreflexia, with five patients showing sustained improvements.

CONCLUSION

Microvascular decompression of the left rostral ventrolateral medulla oblongata may be an effective treatment modality for patients suffering from severe HTN and/or autonomic dysreflexia refractory to medical management.

Vagus nerve stimulation

Left vagus nerve stimulation (VNS) is a promising new treatment for epilepsy. In 1997, VNS was approved in the United States as an adjunctive treatment for medically refractory partial-onset seizures in adults and adolescents. For some patients with partial-onset seizures, the adverse effects of antiepileptic drugs (AEDs) are intolerable; for others, no single AED or combination of anticonvulsant agents is effective. Cerebral resective surgery is an option to pharmacotherapy in some cases, but many patients with partial-onset seizures are not optimal candidates for intracranial surgery. VNS entails implantation of a programmable signal generator--the Neuro-cybernetic Prosthesis (NCP)--in the chest cavity. The stimulating electrodes of the NCP carry electrical signals from the generator to the left vagus nerve. Although the mechanism of action of VNS is not known, controlled studies have shown that it is safe and well-tolerated by patients with long-standing partial-onset epilepsy. Side effects, which are generally of mild to moderate severity, almost always disappear after the stimulation settings are adjusted. Encouraging results have also been reported in pediatric patients.

Depletion of catecholaminergic neurons of the rostral ventrolateral medulla in multiple systems atrophy with autonomic failure

The ventrolateral portion of the intermediate reticular formation of the medulla (ventrolateral medulla, VLM), including the C1/A1 groups of catecholaminergic neurons, is thought to be involved in control of sympathetic cardiovascular outflow, cardiorespiratory interactions, and reflex control of vasopressin release. As all these functions are affected in patients with multiple systems atrophy (MSA) with autonomic failure, we sought to test the hypothesis that catecholaminergic (tyrosine hydroxylase [TH]-positive) neurons of the VLM are depleted in these patients. Medullas were obtained at autopsy from 4 patients with MSA with prominent autonomic failure and 5 patients with no neurological disease. Patients with MSA had laboratory evidence of severe adrenergic sudomotor and cardiovagal failure. Tissue was immersion fixed in 2% paraformaldehyde at 4 degrees C for 24 hours and cut into 1-cm blocks in the coronal plane from throughout the medulla. Serial 50-microm sections were collected and one section every 300 microm was stained for TH. There was a pronounced depletion of TH neurons in the rostral VLM in all cases of MSA. There was also significant reduction of TH neurons in the caudal VLM in 3 MSA patients compared with 3 control subjects. In 2 MSA cases and in 2 control subjects, the thoracic spinal cord was available for study. There was also depletion of TH fibers and sympathetic preganglionic neurons (SPNs) in the 2 MSA cases examined. Thus, depletion of catecholaminergic neurons in the VLM may provide a substrate for some of the autonomic and endocrine manifestations of MSA.

Brainstem neurons projecting to the rostral ventral respiratory group (VRG) in the medulla oblongata of the rat revealed by co-application of NMDA and biocytin

Groups of neurons in the medulla and pons are essential for the rhythm generation, pattern formation and modulation of respiration. The rostral Ventral Respiratory Group (rVRG) is thought to be a crucial area for rhythm generation. Here we co-applied biocytin and NMDA in the rVRG to label retrogradely brainstem neurons reciprocally connected to a population of inspiratory neurons in the rat rVRG. The procedure excited rVRG neurons in multi-unit recordings and led to a Golgi-like labelling of distant cells presumably excited by efferents from the rVRG. Injection of biocytin without NMDA did not label neurons in distant structures. Several brainstem ipsi- and contralateral structures were found to project to the rVRG, but three major respiratory-related structures, the nucleus of the solitary tract (NTS), the parabrachialis medialis and Kölliker-Fuse nuclei (PB/KF) and the caudal VRG, which are known to project bilaterally to the rVRG, were exclusively labelled ipsilaterally, suggesting an ipsilateral excitation of these structures by the rVRG. The pathways of efferent axons from labelled neurons in the rVRG were traced rostrally towards the pons and caudally to the spinal cord. Terminal axonal arborizations were seen in the same regions where retrogradely filled neurons were found as well as in a few other motor nuclei (the dorsal vagal motor nucleus and XII nucleus). Moreover, in the NTS and the PB/KF, efferent terminal varicosities were seen closely apposed to the soma and proximal dendrites of labelled neurons, suggesting monosynaptic connections between the rVRG and these nuclei.

Organization and transmitter specificity of medullary neurons activated by sustained hypertension: implications for understanding baroreceptor reflex circuitry

In situ expression of c-fos observed in response to phenylephrine (PE)-induced hypertension provided a basis for characterizing the organization and neurotransmitter specificity of neurons at nodal points of medullary baroreflex circuitry. Sustained hypertension induced by a moderate dose of PE provoked patterns of c-fos mRNA and protein expression that conformed in the nucleus of the solitary tract (NTS) to the termination patterns of primary baroreceptor afferents and in the caudal ventrolateral medulla (CVLM) to a physiologically defined depressor region. A majority of barosensitive CVLM neurons concurrently displayed markers for the GABAergic phenotype; few were glycinergic. Phenylephrine-sensitive GABAergic neurons that were retrogradely labeled after tracer deposits in pressor sites of the rostral ventrolateral medulla (RVLM) occupied a zone extending approximately 1.4 mm rostrally from the level of the calamus scriptorius, intermingled partly with catecholaminergic neurons of the A1 and C1 cell groups. By contrast, barosensitive neurons of the NTS were found to be phenotypically complex, with very few projecting directly to the RVLM. Extensive colocalization of PE-induced Fos-IR and markers for the nitric oxide phenotype were seen in a circumscribed, rostral, portion of the baroreceptor afferent zone of the NTS, whereas only a small proportion of PE-sensitive neurons in the NTS were found to be GABAergic. PE treatment parameters have been identified that provide a basis for defining and characterizing populations of neurons at the first station in the central processing of primary baroreceptor input and at a key inhibitory relay in the CVLM.

The recruitment pattern of single vasoconstrictor neurons in human

The aim of this study is to determine the recruitment pattern among individual vasoconstrictor neurons under the baroreceptor-mediated influence in man. Spikes of single vasoconstrictor units were detected from microneurograms with a template-matching method. A total of 39 single vasoconstrictor units were detected. Single vasoconstrictor units were different from each other in their susceptibility to be activated in response to changes in the R-R interval or blood pressure. The units with higher firing probability had a shorter threshold R-R interval and a higher threshold diastolic blood pressure than units with lower firing probability. In sympathetic responses consisting of only one spike (single-spike responses), units with a lower threshold frequently appeared and units with a higher threshold joined mull-spike responses. The units with a short threshold R-R interval tended to have a long inhibitory latency from R wave, suggesting low conduction velocity. The correlation between firing probability and firing threshold and that between appearance in single-spike response and multi-spike response suggest a hierarchical manner of recruitment of vasoconstrictor units. For beat-to-beat responses, however, some deviation from the hierarchical recruitment was also observed.

Increased gene expression of neuronal nitric oxide synthase in brain of adult spontaneously hypertensive rats

Neuronal nitric oxide is hypothesized to participate in regulation of autonomic function by decreasing sympathetic output to the periphery. This hypothesis predicts that gene expression of neuronal nitric oxide synthase is increased during states of heightened sympathetic activity. To test the hypothesis, we measured gene expression in the spontaneously hypertensive rat (SHR), a genetic model of hypertension in which sympathetic activity is correlated with increasing pressure. SHRs and two strains of control rats (Wistar-Kyoto [WKY] and Sprague-Dawley [SD]) at 4 weeks (pre-hypertensive) and 14 weeks (established hypertension) of age were used to measure gene expression in hypothalamus, dorsal pons, dorsal medulla, rostral ventrolateral medulla, and caudal ventrolateral medulla. Semi-quantitative reverse transcription-polymerase chain reactions and in situ hybridization were used to measure changes in neuronal nitric oxide synthase mRNA. No significant differences were found in any of the areas studied among the three strains of rats in the 4-week rats. At 14 weeks significant increases in gene expression were found in the hypothalamus (73% compared to WKYs, 104% compared to SDs), dorsal medulla (31% and 45%), and caudal ventrolateral medulla (24% and 27%) of SHRs. In situ hybridization revealed that neurons expressing the synthase gene in the hypothalamus were found primarily in the paraventricular (both parvo- and magnocellular divisions) and supraoptic nuclei. These data show that gene expression of neuronal nitric oxide synthase is increased in central autonomic centers in animals with increased sympathetic activity and they support the hypothesis that nitric oxide plays an important role in maintenance of homeostatic balance through modulation of sympathetic activity.

The pedunculopontine tegmental nucleus issues collaterals to the fastigial nucleus and rostral ventrolateral reticular nucleus in the rat

The pedunculopontine-laterodorsal tegmental nuclear complex was identified as a major source of brainstem afferents terminating in the fastigial cerebellar nucleus and/or ventrolateral reticular nucleus (n.Rvl). Collaterals from the pedunculopontine nucleus (Ch5 area) to rostral [vasopressor] regions of the fastigial nucleus and ventral reticular formation were revealed with a combined retrograde tracing technique. The data implicate acetylcholine as a transmitter and raise the hypothesis that the identified afferents may contribute to the autonomic and behavioral responses to midline cerebellar stimulation.

Distribution and relationships of neuropeptide Y and NADPH-diaphorase in human ventrolateral medulla oblongata

The ventrolateral medulla, including the A1 and C1 catecholamine cell groups, corresponds to the recently defined ventrolateral intermediate reticular zone (IRt) in humans. We sought to determine whether the distribution of neuropeptide Y (NPY) corresponds to that of subpopulations of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) reactive neurons in human ventrolateral IRt. Medullae obtained from 2 men (ages 69 and 59, no history of neurologic disease, postmortem delay 22 and 5 h, respectively) were processed for NPY, tyrosine hydroxylase (TH) and NADPH-d either alone or combining NADPH-d and NPY or NADPH-d and TH, respectively. Distribution of cells was plotted using computer-aided reconstruction. NPY-reactive neurons were found throughout the rostrocaudal extent of the ventrolateral IRt, particularly at mid-olivary levels. The distribution of NPY immunoreactivity overlapped TH but not NADPH-d reactivity. This indicates that NPY and NADPH-d reactivity may help identify different subpopulations of neurons in human ventrolateral IRt, which may be differentially susceptible to disease.

Stress-induced activation of nitric oxide-producing neurons in the rat brain

Nitric oxide (NO) is a gaseous neurotransmitter that may mediate a decrease in sympathetic output to the periphery. This implication predicts that NO-producing neurons in the brain are activated in animals experiencing increased levels of sympathetic activity. To test this prediction, we subjected three groups of experimental rats to differing levels of environmental stimulation for 1 hour: minimal stimulation, moderate stimulation, and restraint stress. NO-producing neurons were histochemically visualized in sections of the brain, and activation of these neurons was assessed according to the neuronal expression of the immediate early gene c-fos. Constitutive activation of NO-producing neurons was found in the hypothalamus (paraventricular and supraoptic nuclei), dorsal raphe nuclei, and spinal nucleus of the trigeminal nerve of minimally stimulated rats. When animals were subjected to a novel environment (moderate stimulation), additional NO-producing neurons were activated in the medial septum, medial amygdala, hypothalamic nuclei (lateral, periventricular, and posterior), colliculi, nucleus raphe obscurus, medial vestibular nucleus, nucleus of the tractus solitarius, and several components of the ventrolateral medulla. Restraint stress caused the activation of NO-producing neurons in all of these areas, often in increasing numbers, and the activation of additional NO-producing neurons in the diagonal band of Broca, lateral and medial preoptic areas, basomedial and basolateral amygdalar nuclei, hypothalamic nuclei (dorsomedial, retrochiasmatic supraoptic, and circularis), nucleus raphe pontus, lateral parabrachial nucleus, and pontine nuclei. Expressed as a proportion of NO-producing neurons per section, the largest percentages (>20%) of double-stained neurons were found in the basolateral amygdala (46%), hypothalamic paraventricular nucleus (35%), corpora quadrigemina (estimated at 40%), dorsal raphe (45%), nuclei raphe pontus (33%) and obscurus (63%), lateral parabrachial nucleus (22%), medial vestibular nucleus (25%), lateral division of the nucleus paragigantocellularis (26%), and lateral reticular nucleus (35%). Evidence from other studies increasingly supports the concept that NO plays a generalized role in autonomic regulation by decreasing sympathetic output. Our results show that more NO-producing neurons were activated during stress than during minimal or moderate levels of stimulation. Together, the evidence suggests that NO is a neurochemical messenger that is utilized by individual autonomic neurons as the organism responds to increased levels of sympathetic activity.