Rhythmic properties of neurons in the rostral ventrolateral medulla of the rat in vitro: effects of clonidine

A case report of clonidine induced syncope: a review of central actions of an old cardiovascular drug

Background

Clonidine is an imidazoline sympatholytic, acting on both α₂-adrenergic and imidazoline receptors in the brainstem to induce antihypertensive and negative chronotropic effects in the vasculature and heart respectively.

Case presentation

A 69-year-old gentleman with hypertension presented to the emergency department after multiple syncopal episodes over the past 12 months. Electrocardiogram demonstrated sinus bradycardia with a heart rate of 42 beats per minute. It was hypothesized that the antihypertensive agent clonidine was responsible for inducing symptomatic bradycardia. Clonidine was thus gradually tapered and then discontinued over five days restoring normal sinus rhythm rates while avoiding hypertensive rebound related to sympathetic surge. His heart rate and blood pressure remained within normal limits after the clonidine taper and subsequent adjustments to his other hypertensive medications and he was discharged.

Conclusions

While clonidine has fallen out of favor for its indication as an antihypertensive, it remains a viable option for the use of opioid withdrawal, chronic pain, and smoking cessation, necessitating the appropriate clinical and pharmacological competencies for a physician to prescribe. A discussion of the clinical effects of clonidine brainstem receptor activation follows.

Different types of barosensory synaptic inputs to rostral ventrolateral medulla neurons of the rat

Neurons situated in the rostral ventrolateral medulla (RVLM) with descending axons to the spinal cord and that are modulated by different baroreceptor inputs are considered the main central generators of vasomotor activity. In the urethane-anesthetized, curarized rat, we recorded intracellular potentials from 14 neurons located in the RVLM and investigated their barosensory properties by analysis of the relation between neuronal membrane potential (MP), including spike potentials, and high-pressure barosensory activity, which was indicated by arterial blood pressure (BLPR). Time-domain (cross-correlations or triggered averaging) and frequency-domain (autospectra and coherences) analysis showed that 7 of 14 neurons had cardiac-cycle-correlated rhythms. EXCITATORY CARDIAC-CYCLE-RELATED MODULATION: One type of barosensitive neuron, with strong cardiac-related activity, was antidromically activated from the spinal cord and received inhibitory inputs from aortic nerve stimulation. These neurons had strong pulse-modulated activity consisting of EPSPs and spike potentials locked to the cardiac cycle and occurring at the end of diastole. INHIBITORY CARDIAC-CYCLE-RELATED MODULATION: Another type of barosensitive neuron showed hyperpolarizations locked to the cardiac cycle that started during late diastole and ended during the systolic period, but which had little relation to spike firing. The hyperpolarizations might be due to either IPSPs or disfacilitation. RESPIRATORY AND CARDIAC MODULATION: Some neurons also showed modulation of synaptic potentials and/or spike firing locked to the oscillation produced by ventilator pressure. It is suggested that the different types of cardiac- and respiratory-related rhythm reflect different functional roles of neurons in baroreceptor regulation of vasomotor activity.

Blockade of N-methyl-d-aspartate receptors within the rostral ventrolateral medulla antagonizes clonidine-induced cardiovascular effects

There is wide agreement that the rostral ventrolateral medulla (RVLM) plays a crucial role in the regulation of blood pressure (BP), and that there may be a close correlation between the actions of centrally acting antihypertensive agents and N-methyl-D-aspartate (NMDA) receptor functional states. The present study was done to test the hypothesis that NMDA receptors within the RVLM were involved in the cardiovascular effects of centrally acting antihypertensive drug clonidine in anesthetized and paralyzed rats. Prior unilateral microinjection of NMDA receptor antagonist dizocilpine (MK801, 500 pmol) into the RVLM significantly attenuated (p<0.01, n=9) the reductions of BP (-24+/-6 to -8+/-4 mm Hg) and heart rate (-49+/-9 to -14+/-7 bpm) induced by unilaterally injected clonidine (5 nmol) into the RVLM. Prior bilateral microinjection of MK801 (500 pmol for each side) into the RVLM effectively (p<0.01, n=7) antagonized the hypotension (-25+/-5 to -8+/-2 mm Hg) and bradycardia (-43+/-7 to -11+/-4 bpm) of intravenously administered clonidine (10 microg kg(-1)). Importantly, iontophoretic application of MK801 (60 nA) significantly (p<0.01, n=9) prevented the inhibitory effect of intravenously (10 microg kg(-1)) injected clonidine on the discharge of presympathetic neurons in the RVLM (neuronal inhibition: -39+/-6 to -10+/-2%). In conclusion, the present study shows that the RVLM administrated MK801 effectively antagonizes clonidine-induced cardiovascular effects, and suggests that NMDA receptors within the RVLM contribute to clonidine actions.

Modulatory inputs on sympathetic neurons in the rostral ventrolateral medulla in the rat

1. The first part of this study looks at spontaneously active neurons located in the rostral ventrolateral medulla (RVLM) with projections to the thoracic spinal cord. Sixteen neurons were intracellularly recorded in vivo. Four out of 16 neurons were antidromically activated from the thoracic spinal cord (axonal conduction velocities varied from 1.8 m/s to 9.5 m/s). 2. The simultaneous averages of the neuronal membrane potential and arterial blood pressure triggered by the pulsatile arterial wave or the EKG-R wave demonstrated changes in membrane potential (hyperpolarization or depolarization) locked to the cardiac cycle in four neurons in this group. These neurons (three of them bulbospinal) were further tested for barosensitivity by characterizing the responses to electrical stimulation of the aortic depressor nerve. Four neurons responded with inhibitory hyperpolarizing responses characterized as inhibitory postsynaptic potentials (IPSP) to aortic nerve stimulation (onset latency: 32.3 +/- 5.0 ms; mean +/- SEM). 3. In two neurons in the RVLM, one of them characterized as barosensitive, electrical stimulation of the opposite RVLM (0.5 Hz, 1.0 ms pulse duration, 25-100 microA) elicited excitatory postsynaptic potentials (EPSPs) with latencies of 9.07 and 10.5 ms. At resting membrane potential, the onset latency of the evoked EPSPs did not change with increasing stimulus intensities. Some of the recorded neurons were intracellularly labelled with biocytin for visualization. They were found in the RVLM. 4. These experiments in vivo would support the idea of a functional commissural pathway between the RVLM of both sides. 5. Anatomical data have shown that some of those commissural bundle fibers originate in the C1 adrenergic neuronal group in the RVLM. In the second part of this study, we used an intracellular recording technique in vitro to investigate the effects of the indirect adrenergic agonist tyramine on neurons in the RVLM with electrophysiological properties similar to premotor sympathetic neurons in vivo. 6. Tyramine (0.5-1 mM) produced a pronounced inhibitory effect with hyperpolarization and increase in membrane input resistance on two neurons characterized as regularly firing (R), and on one neuron characterized as irregularly firing (1). This effect was preceded by a transient depolarization with increases in firing rate. 7. These results would indicate that neurons in the RVLM recorded in vitro and with properties similar to premotor sympathetic neurons can be modulated by catecholamines released from terminals probably making synaptic contacts.