Location of the area postrema pressor pathway in the dog brain stem

Brain angiotensin converting enzyme-2 in central cardiovascular regulation

The brain renin-angiotensin system (RAS) plays an important role in the regulation of autonomic and neuroendocrine functions, and maintains cardiovascular homeostasis. Ang-II is the major effector molecule of RAS and exerts most of its physiological functions, including blood pressure (BP) regulation, via activation of AT1 receptors. Dysregulation of brain RAS in the central nervous system results in increased Ang-II synthesis that leads to sympathetic outflow and hypertension. Brain angiotensin (Ang) converting enzyme-2 (ACE2) was discovered two decades ago as an RAS component, exhibiting a counter-regulatory role and opposing the adverse cardiovascular effects produced by Ang-II. Studies using synthetic compounds that can sustain the elevation of ACE2 activity or genetically overexpressed ACE2 in specific brain regions found various beneficial effects on cardiovascular function. More recently, ACE2 has been shown to play critical roles in neuro-inflammation, gut dysbiosis and the regulation of stress and anxiety-like behaviors. In the present review, we aim to highlight the anatomical locations and functional implication of brain ACE2 related to its BP regulation via modulation of the sympathetic nervous system and discuss the recent developments and future directions in the ACE2-mediated central cardiovascular regulation.

Area Postrema: Fetal Maturation, Tumors, Vomiting Center, Growth, Role in Neuromyelitis Optica

INTRODUCTION

The area postrema in the caudal fourth ventricular floor is highly vascular without blood-brain or blood-cerebrospinal fluid barrier. In addition to its function as vomiting center, several others are part of the circumventricular organs for vasomotor/angiotensin II regulation, role in neuromyelitis optica related to aquaporin-4, and somatic growth and appetite regulation. Functions are immature at birth. The purpose was to demonstrate neuronal, synaptic, glial, or ependymal maturation in the area postrema of normal fetuses. We describe three area postrema tumors.

METHODS

Sections of caudal fourth ventricle of 12 normal human fetal brains at autopsy aged six to 40 weeks and three infants aged three to 18 months were examined. Immunocytochemical neuronal and glial markers were applied to paraffin sections. Two infants with area postrema tumors and another with neurocutaneous melanocytosis and pernicious vomiting also studied.

RESULTS

Area postrema neurons exhibited cytologic maturity and synaptic circuitry by 14 weeks'. Astrocytes coexpressed vimentin, glial fibrillary acidic protein, and S-100β protein. The ependyma is thin over area postrema, with fetal ependymocytic basal processes. A glial layer separates area postrema from medullary tegmentum. Melanocytes infiltrated area postrema in the toddler with pernicious vomiting; two children had primary area postrema pilocytic astrocytomas.

CONCLUSIONS

Although area postrema is cytologically mature by 14 weeks, growth increases and functions mature during postnatal months. We recommend neuroimaging for patients with unexplained vomiting and that area postrema neuropathology includes synaptophysin and microtubule-associated protein-2 in patients with suspected dysfunction.

Efferent projection from the rostral ventrolateral medulla to the area postrema in rats

The rostral ventrolateral medulla (RVLM) is a region of the brain primarily involved in cardiovascular control. It receives information from several areas of the brainstem, among which the area postrema (AP) and the nucleus of the solitary tract (NTS). The medial subnuclei of the solitary tract (TS) project towards the RVLM, providing cardiopulmonary information, and the AP serves information about circulatory hormones. Although the efferent pathways are well known, it is not the case for the connections from the RVLM towards the AP and the NTS. The present study was designed to examine the efferent connections from the RVLM onto the dorsal structures of the medulla: quantitatively by means of anatomical techniques, and functionally by means of electrophysiological techniques. Morphologically, Biocytin or Biotinylated dextran amine microinjections into the RVLM were followed by labelling of many fibres running towards the bulbar dorsomedial structures, with some pathways lying in the AP itself, or located in its caudal vicinity. Conversely, when microinjections of Fast Blue (FB) were made into the AP, FB-labelled cells could be observed within the RVLM. Electrophysiologically, single shock stimulation carried on AP allowed identification of axonal fibres issuing from somata located into the cardiovascular neuronal pool in the RVLM. From these results, we can assume: (1) the existence of dense efferent projection from RVLM to aspects of the dorsal vagal complex, including the AP and, among this dense projection, (2) the existence of some fibres terminating in, or crossing through the AP, and identified as conveying baroreceptor-related information, in the rat.

Role of area postrema in transgene hypertension

Transgenic [Tg(+)] rats carrying the mouse Ren-2d gene [(mRen-2d)27] are a newly established monogenetic form of experimental hypertension. To determine whether the area postrema contributes to the development of hypertension in mRen-2 Tg(+) rats, this circumventricular organ in the fourth ventricle was removed from 5-week-old Tg(+) rats. From weeks 4 through 9, systolic blood pressure was measured weekly by tail-cuff plethysmography in area postrema-lesioned and sham-lesioned Tg(+) rats. Although systolic blood pressure rose markedly in sham-lesioned Tg(+) rats, the increase in systolic blood pressure was significantly attenuated in area postrema-lesioned Tg(+) rats. At 9 weeks of age, a femoral artery was cannulated for the measurement of arterial pressure in awake rats. Mean arterial pressure (MAP) in area postrema-lesioned Tg(+) rats was significantly (P < .01) lower than that in sham-lesioned rats: 171 +/- 7 and 132.+/- 5 mm Hg, respectively. Baroreceptor reflex was evaluated by intravenous infusion of sodium nitroprusside. There was no significant difference in baroreceptor reflex sensitivity between the two groups. Intravenous pentolinium (5 mg/kg), used to produce sympathetic ganglionic block, caused significant decreases in MAP in both groups. However, the reduction of MAP in the sham-lesioned group was significantly (P < .05) greater than that in the area postrema-lesioned group: -73 +/- 4 and -48 +/- 6 mm Hg, respectively. The ratio of left ventricular weight to body weight in sham-lesioned Tg(+) rats was significantly larger than that of area postrema-lesioned rats. These results suggest that ablation of the area postrema markedly attenuates the development of hypertension in mRen-2d Tg(+) rats, and this attenuation may be attributed to decrease in sympathetic outflow.

Early development of the human area postrema and subfornical organ

The first appearance and early development of two circumventricular organs, the area postrema (AP) and the subfornical organ (SFO), were investigated in human embryos and fetuses from the 4th to the 40th gestational weeks (GW). The AP appears very early in development, during the GW 10; its high vascularization can be seen from GW14, and differentiated neurons are observed from GW 16. The SFO is characterized by a late onset of development. It can first be distinguished at GW 17, but it does not attain cytological differentiation until the last weeks of gestation. It is suggested that the AP has important functions during fetal life, which are related to normal fetal weight and growth; in contrast the SFO, which is connected with drinking behavior and salt/water balance, seems to play a less essential role in early fetal life.

Alcohol effects on the morphometric development of the subfornical organ and area postrema of the albino mouse

We have studied the development of the nuclear sizes of ependymocytes and neurons of two circumventricular organs of the male alcoholic mouse: the Subfornical Organ (SFO) and the Area Postrema (AP), comparing the results with a control group. The global volume of both centers was also studied. The results show that the SFO, a structure related to the control of fluid balance, responds to alcoholism with an increase of the global volume. This increase could be related to the variations of salt-water balance and/or blood pressure in chronic alcoholism. However, the size of cell nuclei in the SFO is not affected. In contrast, the AP responds to chronic alcoholism like other nervous centres, with a decrease of the nuclear size of its cells. The global volume of AP does not change.

Distribution of catecholaminergic neuronal systems in the canine medulla oblongata and pons

The distribution of catecholamine-containing neurons, fibers, and varicosities in the brainstem of both adult and juvenile dogs was mapped in detail with glyoxylic acid histofluorescence. Four separate groups of catecholamine-fluorescent neurons were identified within the canine medulla and pons in locations comparable to the A1, A2, A5, and A6 regions reported in other species. However, aspects of the pattern and density of the catecholaminergic neuronal systems appeared to be unique to the dog. The A1 neurons of the caudal ventrolateral medulla were much more scattered than in rats or rabbits, but relatively similar to cats. In the A2 region of the dorsomedial medulla, catecholaminergic cells and fibers were uniquely distributed compared to other species: fluorescent neurons were scattered only within the dorsal motor nucleus of the vagus, and a distinctive pattern of fibers and varicosities outlined the nucleus of the solitary tract and dorsal motor nucleus of the vagus. The A5 neurons of the rostral ventrolateral medulla appeared at the rostral limit of the A1 region. Fluorescent A5 cells were more sparse than in rats or primates, and were patterned similarly to cats and rabbits. The canine A6 region contained the most extensive and dense grouping of catecholamine neurons and was similar in pattern to the rabbits but less extensive than that seen in cats or primates. An ascending catecholaminergic fiber pathway was traced through the central tegmental field of the canine medulla and pons, with features similar to the primate. The present study provides the first description of the catecholaminergic neuronal systems of the canine medulla.

Neuronal responses to angiotensin II in the in vitro slice from the canine medulla

The present studies utilized the in vitro slice preparation of the canine dorsomedial medulla, which we have recently developed, to obtain direct evidence for the effects of angiotensin II (Ang II) on the activity of single neurons in this region. Horizontally oriented slices (300 micron) containing the area postrema, nucleus tractus solitarii (NTS), and dorsal motor nucleus of the vagus were perifused with oxygenated artificial cerebrospinal fluid. The effects of microdrop application of Ang II and its antagonist [Sar1,Thr8]Ang II on spontaneous firing rate were determined in 27 extracellularly recorded neurons. Ang II substantially increased the firing rate of 13 neurons located in the medial NTS, but it did not alter the spontaneous activity of the remaining 14 neurons. In most cases Ang II elicited a slowly developing, prolonged excitatory response. The effects of both Ang II and [Sar1,Thr8]Ang II were tested in 13 neurons. [Sar1,Thr8]Ang II produced a short latency, brief excitation in three neurons, marked inhibition of spontaneous firing in two cells, and no effect on the other eight neurons. Administration of [Sar1,Thr8]Ang II blocked the excitatory effects of subsequent administration of Ang II in three neurons. To our knowledge, these observations provide the first evidence for direct actions of both Ang II and [Sar1,Thr8]Ang II on neurons in the canine NTS and for the specificity of the neuronal effects of Ang II as documented by blockade of the excitatory response to Ang II by [Sar1,Thr8]Ang II.

Quantitative distribution of angiotensin II binding sites in rat brain by autoradiography

Angiotensin II binding sites were localized and quantified in individual brain nuclei from single rats by incubation of tissue sections with 1 nM 125I-[Sar1]-angiotensin II, [3H]-Ultrofilm autoradiography, computerized microdensitometry and comparison with 125I-standards. High angiotensin II binding was present in the circumventricular organs (organon vasculosum laminae terminalis, organon subfornicalis and area postrema), in selected hypothalamic nuclei (nuclei suprachiasmatis, periventricularis and paraventricularis) and in the nucleus tractus olfactorii lateralis, the nucleus preopticus medianus, the dorsal motor nucleus of the vagus and the nucleus tractus solitarii. High affinity (KA from 0.3 to 1.5 X 10(9) M-1) angiotensin II binding sites were demonstrated in the organon subfornicalis, the nucleus tractus solitarii and the area postrema after incubation of consecutive sections from single rat brains with 125I-[Sar1]-angiotensin II in concentrations from 100 pM to 5 nM. These results demonstrate and characterize brain binding sites for angiotensin II of variable high affinity binding both inside and outside the blood-brain barrier.

Diuretic treatment alters clonidine suppression of plasma norepinephrine

The effect of short-term diuretic treatment on the action of clonidine was evaluated in eight subjects with mild, uncomplicated hypertension. A single oral dose of clonidine (0.3 mg) was given before and after 1 week of therapy with hydrochlorothiazide, 50 mg, and amiloride, 5 mg, taken daily. Changes in mean arterial pressure, heart rate, plasma norepinephrine and epinephrine levels, and plasma renin activity were assessed. Diuretic treatment caused a significant weight loss, increased plasma renin activity, and reduced serum potassium concentration but did not significantly alter the absolute reduction in mean arterial pressure caused by clonidine. Absolute clonidine-induced reduction in plasma renin activity after diuretic treatment was three times greater than before treatment, although percent changes were similar. Before diuretic therapy, clonidine significantly reduced the level of norepinephrine (absolute and percent change). After diuretic treatment, clonidine failed to suppress norepinephrine, and the difference from prediuretic changes was significant. The level of epinephrine was not altered significantly either by diuretic treatment or clonidine. These results indicate that diuretic therapy alters the clonidine-activated mechanism for reduction of arterial pressure through a shift from overall suppression of sympathetic tone to pathways that are more restricted to renal tone. This shift may be due to changes in fluid or electrolyte balance that alter the action of alpha 2-adrenergic receptor-mediated pathways. Use of the clonidine suppression test for the diagnosis of pheochromocytoma may give false-positive results in diuretic-treated patients.

Area postrema lesions augment the pressor activity of centrally administered vasopressin

The effects of arginine vasopressin given into either the vertebral arteries, a peripheral vein (IV), or the cisterna magna of 15 morphine-chloralose anesthetized dogs were measured before and after pharmacological blockade with the antagonist [d(CH2)5 Tyr(Me) AVP]. The contribution of the area postrema to the pressor activity of vasopressin was assessed in nine other dogs by comparing the responses to vasopressin before and after surgical ablation of this structure. Administration of vasopressin either via the vertebral arteries or intravenously produced comparable gradual rises in blood pressure, accompanied by bradycardia and decreases in the plasma levels of norepinephrine. Administration of intracisternal vasopressin elicited a smaller rise in arterial pressure, tachycardia, and increases in plasma norepinephrine levels. The pressor and bradycardic effects of IV vasopressin were abolished when the antagonist was given via the same route. In contrast, intravertebral infusion of the vasopressin antagonist caused tachycardia and modest hypotension in response to intravenous or intravertebral infusions of vasopressin. Pressor effects of vasopressin given into the cisterna magna were not altered by systemic delivery of the vasopressin blocker. Removal of the area postrema selectively augmented the pressor effects of intravertebral vasopressin, whereas the pressor activity of IV vasopressin remained unchanged. These findings provide new evidence for an action of circulating vasopressin in cardiovascular regulation, mediated in part by the area postrema.