Alteration in the histochemical presence of tyrosine hydroxylase and CGRP-immunoreactivities in the eye following chronic sympathetic or sensory denervation

Innervated human corneal equivalents as in vitro models for nerve‐target cell interactions

A sensory nerve supply is crucial for optimal tissue function. However, the mechanisms for successful innervation and the signaling pathways between nerves and their target tissue are not fully understood. Engineered tissue substitutes can provide controllable environments in which to study tissue innervation. We have therefore engineered human corneal substitutes that promote nerve in-growth in a pattern similar to in vivo re-innervation. We demonstrate that these nerves (a) are morphologically equivalent to natural corneal nerves; (b) make appropriate contact with target cells; (c) can generate action potentials; (d) respond to chemical and physical stimuli; and (e) play an important role in the overall functioning of the bioengineered tissue. This model can be used for studying the more general topics of nerve ingrowth or regeneration and the interaction between nerves and their target cells and, more specifically, the role of nerves in corneal function. This model could also be used as an in vitro alternative to animals for safety and efficacy testing of chemicals and drugs.

Neurotrophic corneal endothelial failure complicating acute Horner syndrome

PURPOSE

The authors report the clinical findings of a unique case of rapid corneal endothelial decompensation in association with acute Horner syndrome.

STUDY DESIGN

Case report and literature review.

METHODS

The authors followed a 38-year-old woman who developed Horner syndrome after right jugular vein catheterization during cardiac valvular surgery. Shortly after the operation, Horner syndrome accompanied by conjunctival hyperemia and stromal corneal edema developed in the right eye. Over the course of 4 months, the eye became painful, the corneal endothelial cell count dropped precipitously, and the stromal edema worsened, causing a difference of 100 microm in central corneal thickness compared to the unaffected eye. Deep stromal vascularization started at the limbus, resembling interstitial keratitis.

RESULTS

A 3-week course of topical steroid treatment resulted in a dramatic improvement in the stromal corneal edema and regression of the deep stromal vascularization. Ocular and right hemicranial pain subsided shortly thereafter.

CONCLUSION

The authors hypothesize that corneal endothelial failure in this unique case may have resulted from traumatic sympathectomy. According to experimental evidence in the reviewed ophthalmologic literature, sympathetic innervation may have a neurotrophic role in the cornea. Corneal pathology similar to the authors' case has been described in hemifacial atrophy (Parry-Robson syndrome), a disorder that is assumed to result from sympathetic denervation and that can be produced in animals by cervical sympathectomy. The authors therefore hypothesize that sympathetic denervation of the cornea may rarely cause endothelial decompensation and corneal edema. To the authors' knowledge, this is the first reported case of corneal endothelial failure in Horner syndrome.

Parasympathetic varicosity proliferation and synaptogenesis in rat eyelid smooth muscle after sympathectomy

Parasympathetic innervation to eyelid smooth muscle inhibits sympathetic neurotransmission pre-junctionally without appreciable direct post-junctional effects. However, 5 weeks after sympathectomy, parasympathetic stimulation elicits substantial cholinergically mediated contractions. This study examined ultrastructural changes accompanying the conversion to parasympathetic excitation. In intact muscles, 64+/-9 nerve varicosities were encountered per 104 micron2. Most were close to muscle cells and not fully enclosed by supporting cells. Axo-axonal synapses were observed occasionally. Two days following sympathectomy, varicosity numbers were reduced by 97% and, relative to controls, remaining varicosities were farther from muscle cells and more frequently fully enclosed by supporting cells, but contained greater numbers of small spherical and large dense vesicles. By 6 weeks post-sympathectomy, numbers of varicosities per unit muscle volume increased to 14% of controls. These varicosities differed from those at 2 days in being closer to smooth muscle cells, less frequently enclosed, and having fewer small vesicles. These findings indicate that intact eyelid smooth muscle varicosities are predominantly sympathetic, but a small number of parasympathetic varicosities are present, some of which may form pre-junctional synapses with sympathetic nerves. Between 2 days and 6 weeks post-sympathectomy, varicosities increased in number and established appositions with smooth muscle cells. This suggests that parasympathetic nerves are capable of re-innervating an atypical smooth muscle target after sympathectomy, and that parasympathetic synaptogenesis is likely to contribute to conversion from pre-junctional inhibition to post-junctional excitation after sympathectomy.

Dental innervation: functions and plasticity after peripheral injury

Oral tissues including the periodontal ligament, gingiva, and tooth pulp have a relatively dense sensory innervation and a rich vascular supply. Teeth and supporting tissues are susceptible to tissue injury and inflammation, partly due to lack of collateral blood and nerve supply and to their low compliance. This review focuses on dental nerve functions and adaptive changes in the trigeminal ganglion and tooth pulp after peripheral injuries. An overview of the peptidergic innervation of oral tissues is presented, followed by a discussion of plasticity in neuropeptide expression in trigeminal peripheral neurons after local insults to teeth and peripheral nerve injuries. The functional implications of these adaptive changes are considered, with special reference to nerve regeneration, inflammation, and hemodynamic regulation.

GAP-43 mRNA and calcitonin gene-related peptide mRNA expression in sensory neurons are increased following sympathectomy

Sympathectomy has been shown to result in an increased density of fibers immunoreactive for sensory peptides in peripheral targets innervated by both sensory and sympathetic neurons, providing evidence for functional interactions between sympathetic and sensory systems. These findings provided the background for examining the hypothesis that axonal outgrowth is induced from sensory neurons following sympathectomy. We examined the expression of GAP-43 mRNA, a specific marker for axonal outgrowth, in cervical (C3, C7, C8) and thoracic (T1, T2) dorsal root ganglia (DRG) of the rat following bilateral removal of the superior cervical ganglion, to assess whether the described increases in peptidergic afferent fibers reflected axonal outgrowth. In situ hybridization was used with 35S labeled riboprobes complementary to GAP-43 mRNA, and to calcitonin gene-related peptide (CGRP) mRNA, a marker for a major subset of thin-fiber sensory neurons. The density of GAP-43 mRNA nearly doubled by 18 h following sympathectomy and reached a threefold increase by 3 days. By 45 days following surgery, the GAP-43 mRNA level was still nearly twice that of normal animals, CGRP immunoreactivity was also examined: the density of fibers in the iris and cornea of sympathectomized animals was considerably greater from two weeks to 45 days following surgery, than in sham-operated controls. Concomitantly, there was a slight but significant increase in CGRP mRNA expression in T1 and C3 DRG 14 days postsympathectomy. Quantitative computerized image analysis demonstrated that GAP 43 mRNA expression in sympathectomized animals was 1.5 times greater in medium-sized DRG neurons and almost fourfold greater in small DRG neurons than in control rats. These results indicate that sympathetic denervation elicits axonal outgrowth in the population of sensory neurons that give rise to the small unmyelinated and thinly myelinated axons of peripheral nerves.

Sympathectomy induces c-Jun in adult trigeminal neurons: an immunohistochemical and tract-tracing study

The induction of the immediate early gene product c-Jun was investigated in trigeminal ganglia following surgical removal of the superior cervical ganglion (SCG). A 5-fold increase in c-Jun-immunoreactive neurons was detected by 48 h post-surgery in ipsilateral trigeminal ganglia of sympathectomized rats. This increase persisted for 6 days. When examined 4 months after sympathectomy, c-Jun expression had returned to basal levels. The possibility that trigeminal neurons project to the SCG, and therefore induce c-Jun by being axotomized by sympathectomy, was also examined using retrograde fluorescent tracing. A very limited number of trigeminal neurons were retrogradely labeled from the SCG. These data indicate that c-Jun induction occurs in sensory neurons following perturbations to sympathetic ganglia, and that trigeminal neurons may project to the SCG, but that c-Jun induction cannot be ascribed to axotomy following surgical sympathectomy. Thus, these findings support anatomical and functional interconnections between the sensory and autonomic nervous systems. The relationship of c-Jun induction with plasticity phenomena is discussed.

Sprouting of non-sympathetic myelinated and unmyelinated fibres in response to chronic sympathetic denervation in the pineal gland of the Chinese hamster, Cricetulus griseus

We have examined the effects of chronic sympathetic denervation on non-sympathetic myelinated and unmyelinated fibres in the superficial pineal gland of the Chinese hamster (Cricetulus griseus), using LM, EM and immunohistochemistry. The results suggest that non-sympathetic, myelinated and unmyelinated fibres enter the superficial pineal gland at its distal portion by way of the nervi conarii, and that these fibres are immunoreactive for calcitonin gene-related peptide or substance P. Non-sympathetic, myelinated and unmyelinated fibres in the superficial pineal gland increased in number following chronic superior cervical ganglionectomy. The number of unmyelinated fibres in the nervi conarii also increased in ganglionectomized animals. Thus, the numerical increase of calcitonin gene-related peptide or substance P fibres found in the superficial pineal gland after long-term sympathectomy may be due to sprouting of these fibres. It is speculated that the growth of non-sympathetic, myelinated and unmyelinated fibres and myelination of the former fibres occurring after sympathectomy are caused by nerve growth factor-related mechanisms.

Superior cervical ganglionectomy in monkeys: aqueous humor dynamics and their responses to drugs

The role of sympathetic innervation in regulating the responses of aqueous humor flow, outflow facility and pupillary diameter to timolol and epinephrine was investigated in cynomolgus monkeys following unilateral superior cervical ganglionectomy. Aqueous humor flow was measured fluorophotometrically under pentobarbital anesthesia before the first and after the ninth of twice-daily topical doses of epinephrine, and under ketamine anesthesia before the first and after the ninth of twice-daily topical doses of timolol, 4-19 months after denervation. Baseline aqueous humor flow rates determined 2-4 months following denervation were 40% greater under ketamine than under pentobarbital anesthesia, with no difference between denervated and control eyes. Epinephrine increased aqueous humor flow by up to 50% in a dose-dependent fashion in both eyes, with a non-significant tendency toward slightly greater potency and efficacy in the denervated eyes. Timolol decreased aqueous humor flow by up to 50% in a dose-dependent fashion with equal maximal efficacy in both eyes, but with slightly and statistically significantly greater potency and efficacy in the control eyes at submaximal doses. Early (1-3 months) but not late (23-27 months) after denervation, baseline pupil diameter under ketamine anesthesia was smaller in the denervated eyes than in the controls. The mydriatic response to 600 micrograms epinephrine was more sensitive in the denervated than the control eye both early (1-3 months) and later on (23-27 months) after denervation; timolol had no effect on pupil diameter in either eye. No striking differences in intraocular pressure or refraction were observed between the eyes under any of these conditions. Resting outflow facility or resistance and perfusion-induced facility increase or resistance reduction, measured by two-level constant pressure perfusion under pentobarbital anesthesia 1.5-4.5 years after unilateral sympathectomy, did not differ significantly between sympathectomized and control eyes. Facility increased (by up to 30-50% beyond washout) and resistance decreased (by up to 20-30% beyond washout) similarly in control and sympathectomized eyes 10-60 min and 3-4 hr after bolus intracameral epinephrine doses of 0.55 and 5.5 micrograms.

Immunohistochemical localization of tyrosine hydroxylase in corneal nerves

The sympathetic innervation of the mammalian cornea is thought to play an important role in the regulation of epithelial ion transport, mitogenesis, and wound healing following corneal injuries. Anatomically, the three-dimensional organization and relative density of corneal sympathetic innervation in many species remains inadequately described. In the present study, the sympathetic innervation of five different mammals (guinea pig, rat, mouse, hamster, and human) was studied in corneas sectioned parallel to the main axis of fiber orientation by labeling the fibers immunohistochemically with antiserum against tyrosine hydroxylase and an avidin-biotin-diaminobenzidine technique. The results showed that each species displayed a distinctive pattern and density of tyrosine hydroxylase immunoreactive (TH-IR) corneal innervation that was unique to that species. The overall level of TH-IR innervation was highest in the guinea pig, moderate in the human, hamster, and rat, and lowest in the mouse. In all species examined, TH-IR nerves were most numerous in the corneoscleral limbus where they either formed intimate associations with blood vessels or coursed through the connective tissue matrix apparently unrelated to vascular elements. Other TH-IR nerves entered the cornea proper in radially directed stromal nerve bundles to give rise to subepithelial plexuses of varying complexity. Occasional intraepithelial penetrations were observed in the guinea pig, human, and rat. Removal of the superior cervical ganglion resulted in the total loss of TH-IR staining from guinea pig and hamster corneas and in the substantial but incomplete loss of TH-IR staining from rat and mouse corneas, thus demonstrating their predominantly sympathetic origin. Combined sympathetic and sensory ocular denervation in the rat eliminated almost all corneal and limbal TH-IR immunostaining, thus suggesting a minor TH-IR sensory component in this species. In agreement with this conclusion, small numbers of TH-IR sensory neurons and an abundance of TH-IR fibers were observed in the trigeminal ganglia of the rat and guinea pig. Removal of the rat main ciliary ganglion resulted in the loss of additional TH-IR fibers from the chamber angle and iris, thereby confirming a partial parasympathetic contribution to the rat iridial TH-IR innervation. Following unilateral removal of the superior cervical ganglion in rats and guinea pigs, the contralateral cornea contained increased numbers of TH-IR nerves, suggesting an upregulation of tyrosine hydroxylase (TH) expression in some contralateral axons.(ABSTRACT TRUNCATED AT 400 WORDS)

Sensory nerves impair sympathetic reinnervation and recovery of smooth muscle function

Neuronal populations projecting to a common target may compete for neurotrophic substances. To determine if competition impairs target reinnervation, we examined the effect of capsaicin-induced sensory denervation on sympathetic nerve ingrowth to the sympathectomized rat superior tarsal smooth muscle. In tarsal muscles with intact sympathetic innervation, capsaicin injection on Day 2 reduced numbers of perimuscular CGRP-ir sensory nerves by 68% at 3-4 months; however, it did not alter dopamine-beta-hydroxylase-ir nerve density, response to nerve stimulation, or tarsal muscle adrenoceptor-mediated contraction. Tarsal muscles denervated by ipsilateral superior cervical ganglionectomy on Postnatal Day 4 were partially reinnervated by fibers from the contralateral ganglion, as noted in previous studies. Sensory denervation by capsaicin improved sympathetic reinnervation, as evidenced by a 174% increase in numbers of DBH-ir nerves and a 62% increase in neurally mediated smooth muscle contraction evoked by electrical stimulation of the contralateral pathway relative to reinnervated muscles of vehicle-injected rats; smooth muscle function was also influenced, as indicated by a decrease toward normal in adrenoceptor sensitivity. Tarsal muscles denervated at 30 days were not reinnervated in either vehicle-injected or capsaicin-treated rats, indicating that sensory denervation does not extend the developmental window during which contralateral reinnervation can occur. Both the vehicle-injected and capsaicin-treated preparations with sustained juvenile sympathectomy showed sensory hyperinnervation as adults; thus, a chronic reduction in competition from sympathetics is a sufficiently powerful stimulus to overcome the decreased nerve density induced by neonatal capsaicin treatment. We conclude that sensory nerves limit the extent of sympathetic reinnervation and functional recovery that can occur following neonatal sympathetic denervation.

Developmental regulation of parasympathetic nerve density by sympathetic innervation in the tarsal smooth muscle of the rat

The developmental influence of sympathetic innervation on parasympathetic nerve density was investigated in the tarsal smooth muscle of the rat. Specificity of acetylcholinesterase staining as a marker for parasympathetic innervation was first determined by acute selective denervations. Excision of the ipsilateral superior cervical ganglion caused a 39% reduction in the density of acetylcholinesterase-positive nerves seven days later, indicating that sympathetic nerves contribute to cholinesterase-positive tarsal muscle innervation. Excision of the pterygopalatine ganglion concurrent with superior cervical ganglionectomy caused a virtually complete disappearance of acetylcholinesterase-positive innervation within seven days, indicating that non-sympathetic cholinesterase-positive fibers derive from the pterygopalatine ganglion and are presumed to be parasympathetic. Analysis of the control population indicated that parasympathetic nerve density did not vary significantly between males and females, between the superior and inferior muscles, or in rats studied at four and 12 months of age. The influence of sympathetic innervation on parasympathetic nerve density during postnatal development was examined by conducting surgical sympathectomies on postnatal day 5 and quantifying acetylcholinesterase-positive nerve density at four months of age. Neonatal sympathectomy caused a 46% reduction in cholinesterase-positive nerve density beyond that which occurred in acutely sympathectomized adult controls. It is concluded that sympathetic innervation is required for developing parasympathetic nerves to attain their normal density within the rat tarsal muscle. This finding is consistent with the idea that sympathetic nerves can exert positive effects on parasympathetic nerve outgrowth during development.

Review: mediation of the ocular response to injury

The structure of the anterior segment of the eye provide aqueous humour for metabolic traffic, regulation of intraocular pressure and the maintenance of a functional permeability barrier to separate internal compartments from general systemic influences. Irritative and injurous insults to the eye elicit an acute defensive miotic and vascular response which upsets the aqueous dynamics and provokes the influx of blood plasma proteins into the aqueous chambers. These events are initiated by antidromic activation of sensory elements within the anterior segment, releasing substance P and calcitonin gene-related peptide (CGRP) which, in lower mammals at least, stimulate respectively the miotic and vascular reactions. Considerable species differences can be found in the responsiveness of the eye to injury and in the effects of exogenous CGRP and substance P.