The analysis of human gastric pacemaker activity

Synergistic augmentation of rhythmic myogenic contractions of human stomach by arginine vasopressin and adrenaline: Implications for the induction of nausea

BACKGROUND AND PURPOSE

Nausea is associated with the hormonal secretion of vasopressin and adrenaline, although their actions in inducing nausea is poorly understood. Here, we have investigated their actions on human stomach muscle.

EXPERIMENTAL APPROACH

Muscle strips were suspended in tissue baths and neuronal-/non-neuronally-mediated contractions were measured. Custom software analysed eight motility parameters defining spontaneous phasic non-neuronally mediated contractions. Receptor distributions were assessed by qPCR and immunofluorescence.

KEY RESULTS

V_1A receptors and α₁ -adrenoceptors were located on muscle as well as interstitial cells of Cajal (ICCs). Myogenic contractions of human proximal and distal stomach (respectively, 2.6 ± 0.1 and 2.7 ± 0.0 per minute; n = 44) were larger in the distal area (1.1 ± 0.1 and 5.0 ± 0.1 mN), developing relatively slowly (proximal) or rapidly (distal). Vasopressin caused tonic (proximal) or short-lived (distal) increases in muscle tone and increased myogenic contraction amplitude, frequency and rate (acting at V_1A receptors; thresholds 10^-11 -10^-10  M); by contrast, cholinergically mediated contractions were unaffected. Oxytocin acted similarly to vasopressin but less potently, at OT receptors). Adrenaline increased (10^-10 -10^-5  M; α₁ -adrenoceptors) and decreased (≥10^-6  M; β-adrenoceptors) muscle tone and enhanced/reduced myogenic contractions. Cholinergically mediated contractions were reduced (α₂ -adrenoceptors). Combined, vasopressin (10^-9  M) and adrenaline (10^-8  M) increased muscle tone and phasic myogenic activity in a synergistic manner.

CONCLUSIONS AND IMPLICATIONS

Vasopressin and adrenaline increased human gastric tone and myogenic contraction amplitude, rate of contraction and frequency. In combination, their actions were further increased in a synergistic manner. Such activity may promote nausea.

The gastric conduction system in health and disease: a translational review

Gastric peristalsis is critically dependent on an underlying electrical conduction system. Recent years have witnessed substantial progress in clarifying the operations of this system, including its pacemaking units, its cellular architecture, and slow-wave propagation patterns. Advanced techniques have been developed for assessing its functions at high spatiotemporal resolutions. This review synthesizes and evaluates this progress, with a focus on human and translational physiology. A current conception of the initiation and conduction of slow-wave activity in the human stomach is provided first, followed by a detailed discussion of its organization at the cellular and tissue level. Particular emphasis is then given to how gastric electrical disorders may contribute to disease states. Gastric dysfunction continues to grow in their prevalence and impact, and while gastric dysrhythmia is established as a clear and pervasive feature in several major gastric disorders, its role in explaining pathophysiology and informing therapy is still emerging. New insights from high-resolution gastric mapping are evaluated, together with historical data from electrogastrography, and the physiological relevance of emerging biomarkers from body surface mapping such as retrograde propagating slow waves. Knowledge gaps requiring further physiological research are highlighted.

Methods for High-Resolution Electrical Mapping in the Gastrointestinal Tract

Over the last two decades, high-resolution (HR) mapping has emerged as a powerful technique to study normal and abnormal bioelectrical events in the gastrointestinal (GI) tract. This technique, adapted from cardiology, involves the use of dense arrays of electrodes to track bioelectrical sequences in fine spatiotemporal detail. HR mapping has now been applied in many significant GI experimental studies informing and clarifying both normal physiology and arrhythmic behaviors in disease states. This review provides a comprehensive and critical analysis of current methodologies for HR electrical mapping in the GI tract, including extracellular measurement principles, electrode design and mapping devices, signal processing and visualization techniques, and translational research strategies. The scope of the review encompasses the broad application of GI HR methods from in vitro tissue studies to in vivo experimental studies, including in humans. Controversies and future directions for GI mapping methodologies are addressed, including emerging opportunities to better inform diagnostics and care in patients with functional gut disorders of diverse etiologies.

Problems with extracellular recording of electrical activity in gastrointestinal muscle

Motility patterns of the gastrointestinal tract are important for efficient processing of nutrients and waste. Peristalsis and segmentation are based on rhythmic electrical slow waves that generate the phasic contractions fundamental to gastrointestinal motility. Slow waves are generated and propagated actively by interstitial cells of Cajal (ICC), and these events conduct to smooth muscle cells to elicit excitation-contraction coupling. Extracellular electrical recording has been utilized to characterize slow-wave generation and propagation and abnormalities that might be responsible for gastrointestinal motility disorders. Electrode array recording and digital processing are being used to generate data for models of electrical propagation in normal and pathophysiological conditions. Here, we discuss techniques of extracellular recording as applied to gastrointestinal organs and how mechanical artefacts might contaminate these recordings and confound their interpretation. Without rigorous controls for movement, current interpretations of extracellular recordings might ascribe inaccurate behaviours and electrical anomalies to ICC networks and gastrointestinal muscles, bringing into question the findings and validity of models of gastrointestinal electrophysiology developed from these recordings.

Gastric arrhythmias in gastroparesis: low- and high-resolution mapping of gastric electrical activity

Gastric arrhythmias occur in gastroparesis but their significance is debated. An improved understanding is currently emerging, including newly-defined histopathologic abnormalities in gastroparesis. In particular, the observation that interstitial cells of Cajal are depleted and injured provides mechanisms for arrhythmogenesis in gastroparesis. Electrogastrography has been the dominant clinical method of arrhythmia analysis, but is limited by summative nature, low signal quality, and incomplete sensitivity and specificity. Recently, high-resolution (HR; multi-electrode) mapping has emerged, providing superior spatial data on arrhythmic patterns and mechanisms. However, HR mapping is invasive, and low-resolution approaches are being assessed as bridging techniques until endoscopic mapping is achieved.

Slow wave conduction patterns in the stomach: from Waller's foundations to current challenges

This review provides an overview of our understanding of motility and slow wave propagation in the stomach. It begins by reviewing seminal studies conducted by Walter Cannon and Augustus Waller on in vivo motility and slow wave patterns. Then our current understanding of slow wave patterns in common laboratory animals and humans is presented. The implications of slow wave arrhythmic patterns that have been recorded in animals and patients suffering from gastroparesis are discussed. Finally, current challenges in experimental methods and techniques, slow wave modulation and the use of mathematical models are discussed.

A theoretical analysis of the electrogastrogram (EGG)

In this study, a boundary element model was developed to investigate the relationship between the gastric electrical activity, also known as slow waves, and the electrogastrogram (EGG). A dipole was calculated to represent the equivalent net activity of gastric slow waves. The dipole was then placed in an anatomically-realistic torso model to simulate EGG. The torso model was constructed from a laser-scanned geometry of an adult male torso phantom with 190 electrode sites equally distributed around the torso so that simulated EGG could be directly compared between the physical model and the mathematical model. The results were analyzed using the Fast Fourier Transforms (FFT), spatial distribution of EGG potential and a resultant EGG based on a 3-lead configuration. The FFT results showed both the dipole and EGG contained identical dominant frequency component of 3 cycles per minute (cpm), with this result matching known physiological phenomenon. The -3 dB point of the EGG was 110 mm from the region directly above the dipole source. Finally, the results indicated that electrode coupling could theoretically be used in a similar fashion to ECG coupling to gain greater understanding of how EGG correlate to gastric slow waves.

Spatial analysis of slowly oscillating electric activity in the gut of mice using low impedance arrayed microelectrodes

Smooth and elaborate gut motility is based on cellular cooperation, including smooth muscle, enteric neurons and special interstitial cells acting as pacemaker cells. Therefore, spatial characterization of electric activity in tissues containing these electric excitable cells is required for a precise understanding of gut motility. Furthermore, tools to evaluate spatial electric activity in a small area would be useful for the investigation of model animals. We thus employed a microelectrode array (MEA) system to simultaneously measure a set of 8×8 field potentials in a square area of ∼1 mm². The size of each recording electrode was 50×50 µm², however the surface area was increased by fixing platinum black particles. The impedance of microelectrode was sufficiently low to apply a high-pass filter of 0.1 Hz. Mapping of spectral power, and auto-correlation and cross-correlation parameters characterized the spatial properties of spontaneous electric activity in the ileum of wild-type (WT) and W/W^v mice, the latter serving as a model of impaired network of pacemaking interstitial cells. Namely, electric activities measured varied in both size and cooperativity in W/W^v mice, despite the small area. In the ileum of WT mice, procedures suppressing the excitability of smooth muscle and neurons altered the propagation of spontaneous electric activity, but had little change in the period of oscillations. In conclusion, MEA with low impedance electrodes enables to measure slowly oscillating electric activity, and is useful to evaluate both histological and functional changes in the spatio-temporal property of gut electric activity.

The bioelectrical basis and validity of gastrointestinal extracellular slow wave recordings

  Gastrointestinal extracellular recordings have been a core technique in motility research for a century. However, the bioelectrical basis of extracellular data has recently been challenged by claims that these techniques preferentially assay movement artifacts, cannot reproduce the underlying slow wave kinetics, and misrepresent the true slow wave frequency. These claims motivated this joint experimental-theoretical study, which aimed to define the sources and validity of extracellular potentials. In vivo extracellular recordings and video capture were performed in the porcine jejunum, before and after intra-arterial nifedipine administration. Gastric extracellular recordings were recorded simultaneously using conventional serosal contact and suction electrodes, and biphasic and monophasic extracellular potentials were simulated in a biophysical model. Contractions were abolished by nifedipine, but extracellular slow waves persisted, with unchanged amplitude, downstroke rate, velocity, and downstroke width (P>0.10 for all), at reduced frequency (24% lower; P=0.03). Simultaneous suction and conventional serosal extracellular recordings were identical in phase (frequency and activation-recovery interval), but varied in morphology (monophasic vs. biphasic; downstroke rate and amplitude: P<0.0001). Simulations demonstrated the field contribution of current flow to extracellular potential and quantified the effects of localised depolarisation due to suction pressure on extracellular potential morphology. In sum, these results demonstrate that gastrointestinal extracellular slow wave recordings cannot be explained by motion artifacts, and are of a bioelectrical origin that is highly consistent with the underlying biophysics of slow wave propagation. Motion suppression is shown to be unnecessary as a routine control in in vivo extracellular studies, supporting the validity of the extant gastrointestinal extracellular literature.

Mapping and modeling gastrointestinal bioelectricity: from engineering bench to bedside

A key discovery in gastrointestinal motility has been the central role played by interstitial cells of Cajal (ICC) in generating electrical slow waves that coordinate contractions. Multielectrode mapping and multiscale modeling are two emerging interdisciplinary strategies now showing translational promise to investigate ICC function, electrophysiology, and contractions in the human gut.