CHARACTERISTICS OF A SPINAL SYMPATHETIC REFLEX

Somatosympathetic Vasoconstrictor Reflexes in Human Spinal Cord Injury: Responses to Innocuous and Noxious Sensory Stimulation below Lesion

It is known that the sudden increases in blood pressure associated with autonomic dysreflexia in people with spinal cord injury (SCI) are due to a spinally mediated reflex activation of sympathetic vasoconstrictor neurons supplying skeletal muscle and the gut. Apart from visceral inputs, such as those originating from a distended bladder, there is a prevailing opinion that autonomic dysreflexia can be triggered by noxious stimulation below the lesion. However, do noxious inputs really cause an increase in blood pressure in SCI? Using microelectrodes inserted into a peripheral nerve to record sympathetic nerve activity we had previously shown that selective stimulation of small-diameter afferents in muscle or skin, induced by bolus injection of hypertonic saline into the tibialis anterior muscle or the overlying skin, evokes a sustained increase in muscle sympathetic nerve activity and blood pressure and a transient increase in skin sympathetic nerve activity and decrease in skin blood flow in able-bodied subjects. We postulated that these sympathetic responses would be exaggerated in SCI, with a purely noxious stimulus causing long-lasting increases in blood pressure and long-lasting decreases in skin blood flow. Surprisingly, though, we found that intramuscular or subcutaneous injection of hypertonic saline into the leg caused negligible changes in these parameters. Conversely, weak electrical stimulation over the abdominal wall, which in able-bodied subjects is not painful and activates large-diameter cutaneous afferents, caused a marked increase in blood pressure in SCI but not in able-bodied subjects. This suggests that it is activation of large-diameter somatic afferents, not small-diameter afferents, that triggers increases in sympathetic outflow in SCI. Whether the responses to activation of large-diameter afferents reflect plastic changes in the spinal cord in SCI is unknown.

Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints

Electroacupuncture (EA) at P5-P6 acupoints overlying the median nerve reduces premotor sympathetic cardiovascular neuronal activity in the rostral ventral lateral medulla (rVLM) and visceral reflex pressor responses. In previous studies, we have noted different durations of influence of EA comparing P5-P6 and S36-S37 acupoints, suggesting that point specificity may exist. The purpose of this study was to evaluate the influence of stimulating P5-P6 (overlying the median nerve), LI4-L7 (overlying branches of the median nerve and the superficial radial nerve), LI6-LI7 (overlying the superficial radial nerve), LI10-LI11 (overlying the deep radial nerves), S36-S37 (overlying the deep peroneal nerves), or K1-B67 (overlying terminal branches of the tibial nerves) specific acupoints, overlying deep and superficial somatic nerves, on the excitatory cardiovascular reflex and rVLM responses evoked by stimulation of chemosensitive receptors in the cat's gallbladder with bradykinin (BK) or direct splanchnic nerve (SN) stimulation. We observed point-specific differences in magnitude and duration of EA inhibition between P5-P6 or LI10-LI11 and LI4-L7 or S36-S37 in responses to 30-min stimulation with low-frequency, low-current EA. EA at LI6-LI7 and K1-B67 acupoints as well as direct stimulation of the superficial radial nerve did not cause any cardiovascular or rVLM neuronal effects. Cardiovascular neurons in the rVLM, a subset of which were classified as premotor sympathetic cells, responded to brief (30 s) stimulation of the SN as well as acupoints P5-P6, LI10-LI11, LI4-L7, S36-S37, LI6-LI7, or K1-B67, or underlying somatic pathways in a fashion similar to the reflex responses. In fact, we observed a significant linear relationship (r(2) = 0.71) between the evoked rVLM response and reflex change in mean arterial blood pressure. In addition, EA stimulation at P5-P6 and LI4-L7 decreased rVLM neuronal activity by 41 and 12%, respectively, for >1 h, demonstrating that prolonged input into the medulla during stimulation of somatic nerves, depending on the degree of convergence, leads to more or less inhibition of activity of these cardiovascular neurons. Thus EA at acupoints overlying deep and superficial somatic nerves leads to point-specific effects on cardiovascular reflex responses. In a similar manner, sympathetic cardiovascular rVLM neurons that respond to both visceral (reflex) and somatic (EA) nerve stimulation manifest graded responses during stimulation of specific acupoints, suggesting that this medullary region plays a role in site-specific inhibition of cardiovascular reflex responses by acupuncture.

Reflex effects of subluxation: the autonomic nervous system

BACKGROUND

The collective experience of the chiropractic profession is that aberrant stimulation at a particular level of the spine may elicit a segmentally organized response, which may manifest itself in dysfunction within organs receiving autonomic innervation at that level. This experience is at odds with classic views of neuroscientists about the potential for somatic stimulation of spinal structures to affect visceral function.

OBJECTIVE

To review recent findings from basic physiologic research about the effects of somatic stimulation of spinal structures on autonomic nervous system activity and the function of dependent organs.

DATA SOURCE

Findings were drawn from a major recent review of the literature on the influences of somatic stimulation on autonomic function and from recent original physiologic studies concerning somatoautonomic and spinovisceral reflexes.

CONCLUSIONS

Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.

Inhibitory and indirect excitatory effects of dopamine on sympathetic preganglionic neurones in the neonatal rat spinal cord in vitro

Regions of the thoraco-lumbar spinal cord containing sympathetic preganglionic neurones are rich in dopamine terminals. To determine the influence of this innervation intracellular recordings were made from antidromically identified sympathetic preganglionic neurones in (400 micrometers) transverse neonatal rat spinal cord slices. Dopamine applied by superfusion caused a slow monophasic hyperpolarisation in 46% of sympathetic preganglionic neurones, a slow monophasic depolarisation in 28% of sympathetic preganglionic neurones and a biphasic effect consisting of a slow depolarisation followed by a slow hyperpolarisation or vice-versa in 23% of sympathetic preganglionic neurones. Three percent of sympathetic preganglionic neurones did not respond to the application of dopamine. Low Ca2+/high Mg2+ Krebs solution or TTX did not change the resting membrane potential but abolished the slow depolarisation elicited by dopamine, indicating this was synaptic and did not prevent the dopamine induced hyperpolarisation. The dopamine induced slow hyperpolarisation was mimicked by the selective D1 agonists SKF 38393 or SKF 81297-C and blocked by superfusion with the D1 antagonist SCH 23390. It was not prevented by superfusion of the slices with alpha1 or alpha2 or beta-adrenoceptor antagonists, whereas the inhibitory or excitatory actions of adrenaline were prevented by alpha1 or alpha2 antagonists, respectively. The dopamine induced slow depolarisation occurring in a sub-population of sympathetic preganglionic neurones was mimicked by quinpirole, a D2 agonist, and blocked by haloperidol, a D2 antagonist. Haloperidol did not block the dopamine induced hyperpolarisations. Dopamine also induced fast synaptic activity which was mimicked by a D2 agonist and blocked by haloperidol. D1 agonists did not elicit fast synaptic activity.

Glutamate receptors on postganglionic sympathetic axons

The present study demonstrates that approximately 36% of postganglionic sympathetic axons in gray rami express receptors for the N-methyl-D-aspartate receptor 1 subunit of the N-methyl-D-aspartate receptor and 10% express the glutamate receptor 1 subunit of the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor. If these receptors are active, glutamate released from primary afferent terminals could activate these receptors resulting in the release of noradrenaline and other substances from postganglionic sympathetic neurons. This interaction would constitute a non-synaptic, sensory-sympathetic, peripheral reflex that might be important in local vascular control and in pain states that have a sympathetic component.

Reflex sympathetic dystrophy: does sympathetic dysfunction originate from peripheral neuropathy?

BACKGROUND

Sympathetic dysfunction in reflex sympathetic dystrophy (RSD) has been purported to consist of an afferently-induced increase in efferent sympathetic nerve impulses (somato-sympathetic reflex) and/or denervation-induced supersensitivity to catecholamines. In addition, both the central and peripheral nervous systems have been claimed to be involved. It was the aim of this study to obtain more insights into these underlying mechanisms.

METHODS

In the affected extremeties of 42 patients with RSD we investigated as indirect measures of sympathetic (dys)function: (1) skin blood flow and the vasoconstrictive response to dependency of skin microvessels by means of laser Doppler flowmetry (distal to the site of trauma), (2) relative distention of the brachial artery and changes in relative distention consequent to a cold pressor test by means of ultrasonic vessel wall tracking (proximal to the site of trauma), and (3) arterial blood pressures by means of the Finapres technique. Both provocation tests induce a sympathetically mediated response. Patients were divided into three categories according to their perception of skin temperature in their injured limb (stage I, stationary warmth sensation; stage II, intermittent warmth and cold sensation; or stage III, stationary cold sensation).

RESULTS

Distal to the site of trauma, when compared with controls, skin blood flow was increased at stage I and decreased at stages II and III, whereas the vasoconstrictive response to dependency was impaired at all three stages. Proximally, when compared with controls, relative distention of the brachial artery and its response to the cold pressor test were decreased at all three stages. No differences were observed in pulse pressure between patient groups and controls.

CONCLUSIONS

These results suggest that sympathetic dysfunction in extremities of patients with RSD distal to the site of trauma consists of hypersensitivity to catecholamines at stages II and III as a result of autonomic denervation at stage I, whereas proximal to the site of trauma sympathetic nerve impulses may be increased at all three stages.

Somatocardiovascular reflexes in anesthetized rats with the central nervous system intact or acutely spinalized at the cervical level

The effects of noxious mechanical stimulation of various segmental areas on heart rate and mean arterial blood pressure (MAP), as well as cardiac and renal sympathetic nerve activities were examined in anesthetized rats with the central nervous system (CNS) intact or acutely spinalized at the cervical level. In CNS-intact rats, pinching for 20 s applied to any segmental skin area, but particularly that of the paw, produced an increase in heart rate, blood pressure and the sympathetic nerve activities. In acutely spinalized rats, pinching the chest, abdomen and back of the body produced large increases, while hindlimb and perineum stimulation induced only a small increase or no increase in heart rate, blood pressure and the sympathetic nerve activities. Stimulation of the right side produced particularly large responses in heart rate and stimulation of the ipsilateral side produced large responses in cardiac and renal sympathetic nerve activities in spinalized rats. These results suggest the existence of the two types of reflex responses, supraspinal and propriospinal, in the somatocardiovascular reflex. The supraspinal one has characteristics of diffuse reflex organization, while the propriospinal one has strong segmental and lateral organization.

The shoulder-hand syndrome after stroke: a prospective clinical trial

Shoulder-hand syndrome developed in 36 (27%) of 132 hemiplegic patients in a prospective study. Subluxation, paresis of the shoulder girdle, moderate spasticity, and deficits in confrontation visual field testing were the major risk factors. In a placebo-controlled, nonblinded trial, 31 of the 36 patients became almost symptom free within 10 days' treatment with low doses of oral corticosteroids. Shoulder joint capsules taken at autopsy of 7 patients showed signs of previous trauma of the affected shoulder. In the second part of this study on another 86 patients, early awareness of potential injuries to shoulder joint structures reduced the frequency of shoulder-hand syndrome from 27 to 8%. These clinical findings suggest that shoulder-hand syndrome in hemiplegia is initiated by peripheral lesions. A self-perpetuating vicious cycle may be established, followed by the clinical picture of a "reflex sympathetic dystrophy." In the majority of stroke patients, this clinical phenomenon seems to be preventable by avoiding shoulder trauma.

Spinal cord lamina V and lamina VII interneuronal projections to sympathetic preganglionic neurons

This light and electron microscopic study sought to localize spinal cord interneurons that contribute to the normal and abnormal physiological regulation of spinal sympathetic preganglionic function. Sympathetic preganglionic neurons in caudal C8 through T4 of rat spinal cord were retrogradely labeled with wheat germ agglutinin (WGA) and/or cholera beta subunit (CT beta) following injections into the superior cervical ganglion (SCG). With two exceptions, the observed locations of retrogradely WGA- and CT beta-labeled sympathetic preganglionic neurons were as expected from previous studies. The exceptions were restricted populations of cells in caudal C8 and rostral T1 spinal segments. These neurons were classified as ventrolateral (vlSPN) and ventromedial (vmSPN) sympathetic preganglionic neurons; their somata and dendrites encircled dorsolateral lamina IX motoneurons. Only WGA was transported transneuronally following the retrograde labeling of sympathetic preganglionic neurons. Transneuronally WGA-labeled spinal interneurons were located principally in the reticulated division of lamina V and dorsolateral lamina VII. A strict segmental organization was observed. All transneuronally labeled interneurons were ipsilateral to, and coextensive with, retrogradely WGA-labeled sympathetic preganglionic neurons. Electron microscopic observations suggested that retrograde transsynaptic passage of WGA occurred within the sympathetic preganglionic neuropil and showed further that similar classes of organelles were WGA immunoreactive in retrogradely labeled sympathetic preganglionic neurons and in transneuronally labeled lamina V and lamina VII neurons: 1) cisternae and vesicles at the trans face of the Golgi apparatus, 2) large endosomes/dense bodies, and 3) multivesicular bodies. The data are consistent with two hypotheses: 1) Somatic and visceral primary afferent inputs to thoracic spinal cord modify segmental sympathetic preganglionic function through activation of a disynaptic pathway involving lamina V and/or lamina VII interneurons, and 2) long-loop propriospinal pathways access sympathetic preganglionic neurons through symmetrical, segmental interneuronal circuitry.

Development and migration of avian sympathetic preganglionic neurons

Modern neuronanatomical techniques were used to investigate the development of the avian sympathetic preganglionic cell column in the spinal cord of the chick embryo. [3H]thymidine autoradiography indicated that the majority of these preganglionic, or "Terni column" neurons are generated between stages 18 and 24 (days 2-4). This coincides with the genesis of the somatic motoneurons in the thoracic levels of the cord, and therefore differences in the time of origin cannot explain the divergent fates of these two neuronal populations. Data obtained from short-survival autoradiographic experiments indicated that many early born cells remain close to the ventral region of the ventricular epithelium until day 5 of incubation. Ventral root injections used to label retrogradely neurons projecting an axon into the ventral root (Terni cells and somatic motoneurons) have labeled neurons next to the ventricular epithelium at the same early stages. Thus, it seems likely that some Terni cells, if not all, maintain medial positions and do not migrate laterally to join a common motor column before initiating a dorsal migration. Analysis of a closely staged series of embryos, whose Terni column neurons were retrogradely labeled with wheat germ agglutinin-horseradish peroxidase (WGA-HRP), revealed that between days 5 and 8 of incubation, Terni column neurons migrated dorsally to attain their adult position adjacent to the central canal. These changes in position were reflected in the changing morphology of the Terni column neurons, visualized by the Golgi-like HRP labeling. The positions of the migrating Terni cells differed from those of commissural cells, indicating that these fibers are not the substrate for the dorsal migration. The dorsal migration of Terni column cells was not disrupted by the surgical removal of the sympathetic ganglia, the synaptic targets of these neurons, nor by disruption of spinal afferents. Taken together, these results suggest that the migratory behavior of Terni cells in distinctive when compared to that of somatic motoneurons, and that local and/or intrinsic cues within the spinal cord guide the dorsal migration of Terni column cells.

Intraspinal substance P-containing projections to the sympathetic preganglionic neuropil in pigeon, Columba livia: high-performance liquid chromatography, radioimmunoassay and electron microscopic evidence

The present study uses quantitative and electron microscopic methods to investigate the hypothesis that intraspinal substance P-sympathetic preganglionic neuron circuitry exists in vertebrates. Radioimmunoassay and high-performance liquid chromatography were used to: (1) characterize the chemical nature of the substance P-like immunoreactivity in the sympathetic preganglionic neuropil; and (2) quantify the relative contributions of brain stem, primary sensory and intraspinal neurons to the substance P content within the sympathetic preganglionic neuropil. Electron microscopic observations on the localization of substance P-like immunoreactivity within the preganglionic neuropil caudal to complete thoracic spinal cord transections are also reported. High-performance liquid chromatographic analyses demonstrate that pigeon substance P-like immunoreactivity co-migrates with synthetic substance P, suggesting that the substance P-like material is authentic substance P content within the sympathetic preganglionic neuropil. Electron microscopic observations on the localization of substance P-like immunoreactivity within the preganglionic neuropil caudal to complete preganglionic cell column (inclusive of intermediate spinal laminae V and VII as well as preganglionic neurons located within nucleus intercalatus spinalis); (2) cutting the dorsal rootlets entering the last cervical (C14) and first two thoracic (T1, T2) spinal segments resulted in massive depletion of substance P content in dorsal horn of T1, but no detectable losses within the preganglionic cell column or ventral horn of T1; and (3) total mid-thoracic (T3-4) spinal cord transection significantly depleted the substance P content in the preganglionic cell column (T3-4) as well as in the dorsal (T1-4) and ventral horns (T2-4). Ultrastructural examination of the sympathetic preganglionic neuropil caudal to spinal transections (survival times of 3-14 days) revealed the presence of numerous, intact, normal appearing substance P-like immunoreactive terminals. Immunolabeled terminals formed asymmetric contacts on medium-sized and small caliber dendrites. Extensive degeneration was evident in this material as well. The ultrastructural features of degenerating processes were distinctive and quite dissimilar in appearance from those exhibiting substance P-like immunoreactive staining. No evidence for damage-induced sequestration of substance P-like material into glial elements was found. The above observations are consistent with earlier findings in rat and pigeon, and provide new quantitative and qualitative evidence to support the hypothesis that intraspinal substance P-containing interneurons contribute t

Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point: comparison with the Hoku hand point sympathetic effects

Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point were evaluated by thermography in 19 normal subjects under the same procedure used in a previous study using the Hoku hand point. A generalized long-lasting warming (sympathetic inhibition) effect was observed under manual and electrical acupuncture of the Tsusanli point. In addition, a segmentally related short-lasting cooling (sympathetic activation) effect occurred with Tsusanli electrical acupuncture only. The warming effect is consistent with the results of the Hoku study and appears to be a central sympathetic inhibition evoked by acupuncture. The cooling effect was segmentally related to the acupuncture site in both studies. This cooling effect most likely reflects a segmental activation of vasomotor spinal reflexes and not a general emotional arousal. These sympathetic mechanisms may be functionally correlated with central and peripheral mechanisms of acupuncture analgesia.

Reflex responses evoked in the adrenal sympathetic nerve to electrical stimulation of somatic afferent nerves in the rat

The present study was initiated to determine the role of somatic A (myelinated) and C (unmyelinated) afferent fibers in both responses of increases and decreases in adrenal sympathetic nerve activities during repetitive mechanical pinching and brushing stimulations of the skin in anesthetized rats with central nervous system (CNS) intact. Accordingly, changes in adrenal sympathetic nerve activity resulting from repetitive and single shock electrical stimulation of various spinal afferent nerves, especially the 13th thoracic (Th13) spinal nerve and the sural nerve, were examined in urethane/chloralose-anesthetized rats. Repetitive electrical stimulation of A afferent fibers in Th13 spinal or sural nerve decreased the adrenal nerve activity similarly as brushing stimulation of skin of the lower chest or hindlimb did, while repetitive stimulation of A plus C afferent fibers of those nerves increased the adrenal nerve activity as pinching stimulation of those skins did. Single shock stimulation of spinal afferent nerves evoked various reflex components in the adrenal nerve: an initial depression of spontaneous activity (the early depression); the following reflex discharge due to activation of A afferent fibers (the A-reflex); a subsequent reflex discharge due to activation of C afferent fibers (the C-reflex); and following post-excitatory depressions. These reflexes seem to be mediated mainly via supraspinal pathways since they were abolished by spinal transection at the C1-2 level. Although the supraspinal A- and C-reflexes could be elicited from stimulation of a wide variety of spinal segmental afferent levels, the early depression was more prominent when afferents at spinal segments closer to the level of adrenal nerve outflow were excited. It is suggested that the decreased responses of the adrenal nerve during repetitive electrical stimulation of A afferent nerve fibers are attributable to summation of both the early depression and post-excitatory depression evoked by single shock stimulation, while the increased responses during repetitive stimulation of A plus C afferent fibers are attributable to summation of the C-reflex after single shock stimulation. In spinalized rats, repetitive stimulation of Th13 always increased the adrenal nerve activities regardless of whether A fibers alone or A plus C fibers were stimulated, just as brushing and pinching of the lower chest skin always increased them. The increased responses in spinal animals seem to be related to the fact that single electrical stimuli of Th13 produced A- and C-reflexes of spinal origin without clear depressions.

Effects of morphine on somatocardiac sympathetic reflexes in spinalized cats

The effects of morphine on sympathetic reflexes, recorded in the inferior cardiac nerve, to myelinated A and unmyelinated C afferent stimulation were tested in 17 acutely spinalized cats. Stable sympathetic A and C reflexes of short latency (approximately 30 ms and 140 ms in the case of the ulnar nerve, respectively) could be recorded in the inferior cardiac sympathetic nerve to stimulation of somatic A and C afferents in the ulnar and upper thoracic intercostal nerves, ipsilaterally. Spinal sympathetic A reflexes, which were primarily evoked from stimulation of A delta afferent fibers, could be elicited from more segmental levels than could sympathetic C reflexes. Additionally, smaller reflexes, only from A afferent fiber activation, were identified from stimulations on the contralateral side of the body. Small doses of morphine (0.02 mg kg-1, i.v.) proved to be ineffective at altering sympathetic A and C reflexes, while somewhat larger doses (0.2 mg kg-1, i.v.) produced a clear 62% decrease in C reflexes and a 33% decrease in A reflexes, Dosages of 1 and 2 mg kg-1 severely depressed both A and C reflexes. All of the above effects of morphine administration were completely and immediately reversible by naloxone (i.v.). The results are discussed with regard to the effects of morphine on sympathetic A and C reflexes in CNS intact, anesthetized cats.

Cardiovascular reflexes arising from the gallbladder and pancreas in spinal and in decerebrate cats

Cardiovascular responses to chemical stimulation of thin-fiber afferents from the gallbladder and pancreas were determined before and after C1 transection of the spinal cord in cats. Additional cats were studied before and after decerebration. Stimulation of gallbladder and pancreatic afferents caused significant increases in arterial pressure and heart rate in all groups; however, smaller responses often occurred in spinal cats. These results demonstrate that spinal circuitry alone can generate cardiovascular responses to visceral stimulation and that supraspinal, though not necessarily suprapontine areas, are involved in producing the full response.

Sympathetic preganglionic neurons in the isolated spinal cord of the neonatal rat

A preparation of the isolated spinal cord of the neonatal rat was developed for the study of sympathetic preganglionic neurons (PGNs). PGNs were identified for extracellular single unit recording by their location and by antidromic activation by ventral root stimulation. PGNs could be synaptically activated by stimulation of the dorsal root and spinal pathways. Spontaneous firing was observed in 18% of the PGNs. The average firing rate was 1 Hz with a range of 0.3 to 2 H z. PGNs (and motoneurons) were visualized by incubating ventral roots in horseradish peroxidase (HRP) solutions. The location and morphology of PGNs were similar to those reported in studies using adult animals. Primary afferent fibers were visualized by incubating dorsal roots in HRP solutions. Dorsal root projections appeared mature in the neonatal rat. Primary afferents did not appear to project directly to PGNs. It is concluded that PGNs are viable in this preparation and that spinal sympathetic systems are relatively mature in the neonatal rat.

Segmental distribution and central projections of renal afferent fibers in the cat studied by transganglionic transport of horseradish peroxidase

The segmental and central distributions of renal nerve afferents in adults cats and kittens were studied by using retrograde and transganglionic transport of horseradish peroxidase (HRP). Transport of HRP from the central cut ends of the left renal nerves labelled afferent axons in the ipsilateral minor splanchnic nerves and sensory perikarya in the dorsal root ganglia from T12 to L4. The majority of labeled cells (85%) were located between L1 and L3. A few neurons in the contralateral dorsal root ganglia were also labeled. Labeled cells were not confined to any particular region within a dorsal root ganglion. Some examples of bifurcation of the peripheral and central processes within the ganglion were noted. A small number of preganglionic neurons, concentrated in the intermediolateral nucleus, were also identified in some experiments. In addition, many sympathetic postganglionic neurons were labeled in the renal nerve ganglia, the superior mesenteric ganglion, and the ipsilateral paravertebral ganglia from T12 to L3. Transganglionic transport of HRP labeled renal afferent projections to the spinal cord of kittens from T11 to L6, with the greatest concentrations between L1 and L3. These afferents extended rostrocaudally in Lissauer's tract and sent collaterals into lamina I. In the transverse plane, a major lateral projection and a minor medial projection were observed along the outer and inner margins of the dorsal horn, respectively. From the lateral projection many fibers extended medially in laminae V and VI forming dorsal and ventral bundles around Clarke's nucleus. The dorsal bundle was joined by collaterals from the medial afferent projection and crossed to the contralateral side. The ventral bundle extended into lamina VII along the lateroventral border of Clarke's nucleus. Some afferents in the lateral projection could be followed ventrally into the dorsolateral portion of lamina VII in the vicinity of the intermediolateral nucleus. In the contralateral spinal cord, labeled afferent fibers were mainly seen in laminae V and VI. These results provide the first anatomical evidence for sites of central termination of renal afferent axons. Renal inputs to regions (laminae I, V, and VI) containing spinoreticular and spinothalamic tract neurons may be important in the mediation of supraspinal cardiovascular reflexes as well as in the transmission of activity from nociceptors in the kidney. In addition, the identification of a bilateral renal afferent projection in close proximity to the thoracolumbar autonomic nuclei is consistent with the demonstration in physiological experiments of a spinal pathway for the renorenal sympathetic reflexes.

Stabilization of the discharge rate of sympathetic preganglionic neurons

A characteristic feature of the sympathetic preganglionic neuron (SPN) is the low rate of firing during both tonic and evoked activity. Firing rates between 1 and 2 Hz are typical of tonic activity, and the rates increase only slightly during sustained reflex activation. The low mean firing rate of the SPN may result from mechanisms which depress the excitability of the neuron and /or from a very low synaptic efficacy of its excitatory inputs. In recent years depressant mechanisms, other than baroreceptor inhibition, have been identified which may be involved in the control of SPN firing rate. Some of these mechanisms are spinal. This paper reviews data on 3 depressant mechanisms, namely post-impulse depression, recurrent inhibition and inhibition by myelinated spinal afferents, which are operating within the spinal cord.

Inhibition of sympathetic activity by stimulating in the raphe nuclei and the role of 5-hydroxytryptamine in this effect

The possibility that the putative transmitter 5-hydroxytryptamine (5-HT) is involved in the mediation of long latency to onset raphe-spinal inhibition of sympathetic preganglionic neurones was investigated in anaesthetized cats by stimulating sites located in nucleus raphe pallidus and obscurus and recording sympathetic discharge in T3 or T10 white rami evoked either reflexively or by intraspinal stimulation at cervical level. Several putative 5-HT antagonists were administered intravenously (i.v.) or topically to the spinal cord. In 7 cats lysergic acid diethylamide (LSD) in a dose range 25-50 microgram/kg i.v. or 0.6 microgram topically, reversibly reduced the raphe spinal inhibition by 40-100%. Topical application was more effective than i.v. administration. In 5 cats stimulating within the ventromedial reticular formation at sites unlikely to involved 5-HT neurones produced a short latency to onset inhibition which was unaffected by LSD. Methysergide, cinanserin and cyproheptadine depressed sympathetic discharge in the absence of brain stimulation in cats with CNS intact and in unanaesthetized decerebrate spinal cats. The results are discussed in the light of the known actions of the putative 5-HT antagonists.

The central control of the lumbar sympathetic pathway to the large intestine of the cat

1. The origin of the lumbar sympathetic inhibitory outflow to the large intestine was studied by recording simultaneously changes in colonic motility and efferent firing in the lumbar colonic nerves (l.c.n.) following lesions at various levels of the neuraxis. 2. Multiunit recordings from the l.c.n. usually consisted of irregular grouped discharges which were unrelated to spontaneous colonic contractions or to respiratory or cardiac cycles. The firing was depressed by the administration of ganglionic blocking agents or by decentralization of the inferior mesenteric ganglion, indicating that it was post-ganglionic and primarily central in origin. 3. In the majority of experiments colonic motility and l.c.n. firing were not altered by transection of the cervical (C2-C3) or thoracic (T10-T13) spinal cord. However, in these acute spinal animals destruction of the lumbar ventral roots or the lumbar spinal cord markedly enhanced colonic motility and depressed l.c.n. firing. These findings indicate supraspinal mechanisms are not essential for the generation of the lumbar inhibitory outflow to the colon. 4. Transection of the l.c.n. enhanced colonic motility in animals with an intact neuraxis, in acute spinal animals and in animals where the thoracolumbar sympathetic outflow was blocked. It is concluded that peripheral ganglionic as well as spinal pathways can sustain an inhibitory input to the colon. 5. L.c.n. firing was enchanced by stretching or pinching the proximal colon or small intestine or by electrical stimulation of intestinal afferent fibres (Adelta and C fibres) in the l.c.m. and mesenteric branches of the splanchnic nerves. The reflexes occurred via spinal pathways and were blocked by transection of the lumbar dorsal roots. Spontaneous firing in the l.c.n. was also generated by isolated segments of the lumbar spinal cord; however, this firing occurred independently of traditional reflex pathways since it was uanffected by transection of the lumbar dorsal roots. It is concluded that the spontaneous firing must be generated via ventral root afferent pathways or via endogenous oscillator circuits in the lumbar spinal cord.

Bulbospinal tryptaminergic neurones. A search for the role of bulbospinal tryptaminergic neurones in the control of sympathetic activity

1. The possible role of bulbospinal tryptaminergic neurones in the control of sympathetic activity has been investigated in anaesthetised cats. 2. Depletion of spinal cord stores of 5-hydroxytryptamine was achieved by systemic administration of p-chlorophenylalanine or by intraspinal microinjections of 5,6-dihydroxytryptamine. 3. Blood pressure was little changed by these treatments, neither was the pattern of ongoing activity in sympathetic nerves (arterial pulse rhythmicity and respiratory modulation), the influence of pulmonary afferent nerves on this activity (determined by an airway occlusion technique), the sympatho-inhibitory influence of the carotid sinus baroreceptors, nor the sympatho-inhibitory or -excitatory influences of somatic afferent nerves. 4. Since both p-chlorophenylalanine and 5,6-dihydroxytryptamine treatment caused extensive disruption of the bulbospinal tryptaminergic neurones, it was concluded that these play no significant role in the mediation of the responses tested in anaesthetised cats in the present study.

Supraspinal regulation of spinal reflex discharge into cardiac sympathetic nerves

(1) In chloralose anaesthetized cats, reflex responses were recorded in inferior cardiac nerves following stimulation of intercostal nerves and hind limb afferent nerves. (2) In 80% of cats, a long latency reflex response alone was recorded, whereas, in the others, a short and long latency response was present to intercostal nerve stimulation. (3) In cats displaying only a long latency somatocardiac reflex response, damage to the ventral quadrant of the ipsilateral cervical spinal cord, through which runs a bulbospinal inhibitory pathway, resulted in the appearance of shorter latency reflexes to intercostal nerve stimulation. Lesions elsewhere in the cervical cord did not do this. (4) The characteristics of the early responses indicated that they were somatosympathetic reflexes and not dorsal root reflexes. (5) The early reflexes remained and the late reflex disappeared on subsequent complete transection of the spinal cord. The early reflexes were therefore spinal reflexes, and suppressed in the animal with cord intact. (6) Lesions at C4, which included a contralateral hemisection and a section of dorsal columns extending into the dorsal part of the lateral funiculus, abolished the inhibition of a sympathetic reflex that followed stimulation of some somatic afferent nerve fibres. These sections did not release the spinal reflex. Therefore, this reflex inhibition was not responsible for the suppression of the spinal somatosympathetic reflex. (7) The descending inhibitory influence on the segmental reflex pathway was not antagonized by strychnine, bicuculline or picrotoxin. (8) The possibility is discussed that the spinal reflex pathway into cardiac sympathetic nerves is tonically inhibited by a bulbospinal pathway originating from the classical depressor region of the ventromedial reticular formation.

Depression of sympathetic preganglionic neurons by clonidine: evidence for stimulation of 5-HT receptors

In unanesthetized spinal cats, clonidine HCl (5-50 microgram/kg, i.v.) rapidly and markedly depressed excitatory transmission through two spinal pathways to sympathetic preganglionic neurons. Depression through either pathway was dose-dependent and persisted for more than 3 hr but could be rapidly antagonized at any stage by tolazoline HCl in a dose-ratio of about 1:100. The two spinal pathways were also depressed transiently by L-dopa and for prolonged periods by 5-HTP; both precursors were shown to act by releasing 5-HT from bulbospinal 5-HT terminals and their depressant effects were also antagonized by tolazoline. In the absence of 5-HT-induced depression, L-dopa only enhanced transmission through both pathways by inducing release of catecholamines from bulbospinal NE terminals. These results indicate that clonidine depresses sympathetic activity by stimulating inhibitory 5-HT receptors on sympathetic preganglionic neurons, a mechanism that adequately accounts for its central vasodepressor effect.

The spinal route of sympatho-inhibitory pathways descending from the medulla oblongata

1. The effect of making discrete lesions in the cervical spinal cord on the brainstem elicited inhibition of a spinal somato-sympathetic reflex response has been studied in anaesthetized cats. 2. Electrical stimulation within three areas of the medulla caused an inhibition of the spinal component of the reflex response elicited in thoracic white rami communicantes by stimulation of intercostal nerves. The three medullary areas studied were the ventrolateral medulla and the caudal rephe nucleus, from where bulbospinal monoamine neurones originate, and the ventromedial reticular formation. 3. The inhibitory effects of stimulation in the ventrolateral medulla and raphe nucleus were abolished by the destruction of parts of the ipsilateral dorsolateral funiculus of the cervical spinal cord, whereas the inhibition produced by ventromedial reticular formation stimulation was abolished by lesions which included part of the ventral quadrant of the cord. 4. The time course of the inhibitory effects of electrical stimulation of descending sympatho-inhibitory tracts in the cervical spinal cord was studied in unanaesthetized decerebrate cats spinalized at C1. Inhibition obtained from the dorsolateral funiculus characteristically had a longer time to onset than inhibition obtained from the ventrolateral and ventral funiculi.

Some properties of sympathetic neuron inhibition by depressor area and intraspinal stimulation

In Nembutal anesthesized cats single shock stimulation of the depressor area of the medulla oblongata evoked inhibition of spontaneous and glutamate-evoked activity of sympathetic preganglionic units. Single shocks to the lateral funiculus of the cervical or upper thoracic spinal cord in acute spinal cats evoked inhibition of the spontaneous and glutamate-evoked activity of single units and of the segmental reflex mass discharge evoked by spinal afferent stimulation. Cats studied 4 to 6 weeks after a complete transection of the spinal cord also showed, on stimulation of the lateral funiculus below the transection, an inhibition of the segmental reflex with time course similar to that seen in the acute spinal state, but of lower threshold and greater intensity. These results suggest that the inhibitory coupling between supraspinal levels and sympathetic preganglionic units is mediated, at least in part, by propriospinal neuronal system which survive after chronic spinal section. On the assumption that the observed changes in the properties of inhibition are due to plastic changes consequent to partial denervation the results also suggest that continuous descending tracts exist, and that both the continuous and the propriospinal descending tracts may be converging onto some common neural element.

Central neural regulation of heart and blood vessels in mammals

The study of the central regulation of the circulation in the past has been directed primarily at observing reflex responses to stimulation of peripheral receptors and at producing changes in cardiovascular parameters during electrical stimulation of central sites. These studies have demonstrated that the nervous system can regulate the circulation to different vascular beds with a high degree of specificity and that it has the ability to provide a range of coordinated responses which are appropriate to the metabolic needs of a particular behavioural pattern. In addition, it has become firmly established that the nervous system is capable of coupling cardiovascular changes with other autonomic and somatic activities to produce an integrated response. In the last decade it has become apparent that although the mode of operation of central cardiovascular regulation has been described in general terms, very little is known about the accurate anatomical localization of neuronal circuits and pathways and of impulse traffic corresponding to the changes in cardiovascular parameters that have been observed. This essay reviews recent information on discrete neuronal circuits and pathways and their mode of operation in electrophysiological terms. One of the most serious difficulties in this endeavour is the problem of demonstrating specificity of pathways and circuits because patterns of firing of afferent and efferent peripheral nerves can be usually identified, but the demonstration of specificity of central structures is a conceptual and technical challenge to the most skilled investigator. Several studies have been made in the last decade in an attempt to trace anatomically and functionally pathways involved in central cardiovascular regulation. Progress has been made especially with regard to the precise sites of termination of cardiovascular afferent fibres and the pattern of discharge of efferent cardiovascular neurons; some work has also been done to trace discrete pathways between the hypothalamus and the medulla and the medulla and the spinal cord. However, in view of the difficulties of establishing the specificity of cardiovascular pathways, progress will depend on the acquisition of a wiring diagram of simple cardiovascular reflex arcs before attempts are made to study the functional interactions of regions in the brain that have been traditionally associated with central regulation of the circulation. Future experiments should concentrate less on the demonstration of cardiovascular responses to stimulation or lesions in the central nervous system and more on the connections of discrete regions.(ABSTRACT TRUNCATED AT 400 WORDS)

The influence of bulbospinal monoaminergic pathways on sympathetic nerve activity

1. Spontaneous and reflex activity was recorded from renal and splanchnic nerves and thoracic white rami during discrete electrical stimulation within the medulla oblongata of anaesthetized cats.2. Inhibition or excitation of spontaneous sympathetic nerve activity was obtained from several medullary regions.3. The long-circuited reflex elicited in renal nerves and the spinally mediated reflex discharge produced in white rami by single shock stimulation of intercostal nerves were inhibited by stimulation within the sympatho-inhibitory areas of the medulla.4. Activation of spontaneous sympathetic nerve activity or inhibition of spontaneous and reflex sympathetic nerve activity was obtained during electrical stimulation within the lateral funiculi of the cervical spinal cord in unanaesthetized decerebrate cats, spinalized at C1.5. There was a correlation between the position of some sympatho-inhibitory regions of the medulla and spinal cord and the position of the cell bodies and axons of descending monoamine-containing neurones.6. Intravenous administration of the precursor of noradrenaline, L-DOPA, to unanaesthetized decerebrate cats, spinalized at C1, was followed by a depression of spontaneous activity in renal nerves and reflex responses elicited in renal nerves and white rami.7. Similarly the precursor of 5-hydroxytryptamine, 5-HTP, caused a depression of reflex activity elicited in renal nerves and white rami, but had no effect on spontaneous renal nerve activity.8. It is suggested that there exist both noradrenergic and tryptaminergic pathways which descend to the spinal cord from the medulla and which are inhibitory to sympathetic outflow.

Evidence for the involvement in the baroreceptor reflex of a descending inhibitory pathway

1. The onset and time course of baroreceptor inhibition of pre- and post-ganglionic sympathetic reflex activity has been examined in the anaesthetized cat.2. The shortest time to the onset of inhibition of an intercostal evoked reflex response in cardiac and renal nerve was less than 90 msec following a rise in pressure in a carotid sinus blind sac, and around 55 msec following stimulation of the ipsilateral sinus nerve. The cardiac nerve response was completely inhibited before the renal nerve response.3. Because of the long delays in the somato-sympathetic reflex pathway it is argued that these minimum times will be much less than the real central delay of baroreceptor inhibition. These were estimated by adding on the central times for the somato-sympathetic reflexes to give latencies of 94-143 msec for the inhibition.4. A spinal sympathetic reflex was inhibited by 30-75% following a rise in pressure in a carotid sinus blind sac or sinus nerve stimulation. The minimum time for this inhibition was around 100 msec.5. The baroreceptor inhibition of the spinal sympathetic reflex was abolished following section of a restricted region in the dorsolateral part of the lateral funiculus of the cervical spinal cord.6. Both pre- and post-ganglionic reflexes could be inhibited when stimulating within three regions of the medulla oblongata. The latency to inhibition elicited from the ventromedial reticular formation was short, some 5-30 msec, whereas that elicited from a ventrolateral region or the mid line raphe nucleus was long, some 90-160 msec.7. The possibility is discussed that the baroreceptor inhibition of both the pre- and post-ganglionic reflexes examined in this study is occurring at the spinal level via a pathway from either the raphe nuclei or ventrolateral medulla.

Reflex firing in the lumbar sympathetic outflow to activation of vesical afferent fibres

1. Activation of vesical afferent fibres in the Agammadelta range by electrical stimulation of the pelvic nerve or by bladder distension elicited reflex firing in hypogastric nerves and in preganglionic nerves to the inferior mesenteric ganglion.2. The multisynaptic reflex was present in cats with an intact spinal cord and in acute and chronic spinal animals (transections at T10-T12). The reflex pathway was partially crossed in the sacral cord, and in the periphery at the level of the inferior mesenteric ganglia. In contrast, an inhibitory response to raised intravesical pressure was mediated by a supraspinal inhibitory mechanism which was activated in parallel with the micturition reflex.3. Since enhancement as well as depression of sympathetic firing accompanied reflex micturition, it is concluded that at least two distinct populations of lumbar preganglionic neurones are responsive to vesical afferent activity: one population being excited, the other depressed, during micturition. The latter population may be involved in an inhibitory feed-back mechanism on to the bladder.