Head and neck paragangliomas: Recent advances in translational and clinical research and guidelines for patient care

Head and neck paragangliomas (HNPGLs), rare neuroendocrine tumors that mainly arise from parasympathetic ganglia along the cranial nerves, are challenging due to anatomic origin, tendency to aggressive neurovascular and skull base infiltration, unpredictable metastatic potential, radio-chemoresistance, and risk of multiplicity. Symptoms range from mild to life threatening depending on location/size, but rarely relate to catecholamine excess. Risk factors include female sex and pathogenic germline variants in genes affecting hypoxia signaling (foremost succinate dehydrogenase genes). Diagnostic work-up relies on imaging, measurements of plasma free metanephrines/methoxytyramine, genetic testing, and pathology/immunohistochemistry. Management is tailored to patient/tumor characteristics and encompasses wait-scan, upfront surgery, debulking surgery, and radiotherapy. Presurgical embolization is recommended, except for small tympanic and tympanomastoid tumors. Presurgical stenting is required for internal carotid artery involvement, and two-stage surgery for intradural extension. Current treatments for metastatic/inoperable HNPGL are non-curative, and long-term follow-up should be recommended for all patients to monitor local recurrence and new tumors.

Comparative exploration of the carotid body in domestic animals: morphology, physiology, histology, and pathology

The aim of the study was to present a review of the literature and research on the carotid body (CB) over the past years and update the latest findings. The purpose of this article is to present a general overview and comparative analysis of CB between species, from the microanatomy to the pathology of CB. This study gives information about the embryological development and physiological aspects of anatomical findings and their differences. The second part of the article gives a comparative analysis of the pathology of CB. Neoplasia of the CB in humans, namely, paraganglioma, in most cases, is part of a genetic MEN syndrome (multiple endocrine neoplasia). In dogs, paraganglioma is also involved with multiple neoplasia formations throughout the body, including endocrine and neuroendocrine glands. From this perspective, dogs are the most suitable specimens for studying carotid body tumors and their involvement in a MEN-like syndrome.

Stem Cell Niche in the Mammalian Carotid Body

Accumulating evidence suggests that the mammalian carotid body (CB) constitutes a neurogenic center that contains a functionally active germinal niche. A variety of transcription factors is required for the generation of a precursor cell pool in the developing CB. Most of them are later silenced in their progeny, thus allowing for the maturation of the differentiated neurons. In the adult CB, neurotransmitters and vascular cytokines released by glomus cells upon exposure to chronic hypoxia act as paracrine signals that induce proliferation and differentiation of pluripotent stem cells, neuronal and vascular progenitors. Key proliferation markers such as Ki-67 and BrdU are widely used to evaluate the proliferative status of the CB parenchymal cells in the initial phase of this neurogenesis. During hypoxia sustentacular cells which are dormant cells in normoxic conditions can proliferate and differentiate into new glomus cells. However, more recent data have revealed that the majority of the newly formed glomus cells is derived from the glomus cell lineage itself. The mature glomus cells express numerous trophic and growth factors, and their corresponding receptors, which act on CB cell populations in autocrine or paracrine ways. Some of them initially serve as target-derived survival factors and then as signaling molecules in developing vascular targets. Morphofunctional insights into the cellular interactions in the CB stem cell microenvironment can be helpful in further understanding the therapeutic potential of the CB cell niche.

Cellular basis of learning and memory in the carotid body

The carotid body is the primary peripheral chemoreceptor in the body, and critical for respiration and cardiovascular adjustments during hypoxia. Yet considerable evidence now implicates the carotid body as a multimodal sensor, mediating the chemoreflexes of a wide range of physiological responses, including pH, temperature, and acidosis as well as hormonal, glucose and immune regulation. How does the carotid body detect and initiate appropriate physiological responses for these diverse stimuli? The answer to this may lie in the structure of the carotid body itself. We suggest that at an organ-level the carotid body is comparable to a miniature brain with compartmentalized discrete regions of clustered glomus cells defined by their neurotransmitter expression and receptor profiles, and with connectivity to defined reflex arcs that play a key role in initiating distinct physiological responses, similar in many ways to a switchboard that connects specific inputs to selective outputs. Similarly, within the central nervous system, specific physiological outcomes are co-ordinated, through signaling via distinct neuronal connectivity. As with the brain, we propose that highly organized cellular connectivity is critical for mediating co-ordinated outputs from the carotid body to a given stimulus. Moreover, it appears that the rudimentary components for synaptic plasticity, and learning and memory are conserved in the carotid body including the presence of glutamate and GABAergic systems, where evidence pinpoints that pathophysiology of common diseases of the carotid body may be linked to deviations in these processes. Several decades of research have contributed to our understanding of the central nervous system in health and disease, and we discuss that understanding the key processes involved in neuronal dysfunction and synaptic activity may be translated to the carotid body, offering new insights and avenues for therapeutic innovation.

Comparative morphological and molecular studies on the oxygen-chemoreceptive cells in the carotid body and fish gills

Oxygen-chemoreceptive cells play critical roles for the respiration control. This review summarizes the chemoreceptive cells in the carotid body and fish gills from a morphological and molecular perspective. The cells synthesize and secrete biogenic amines, neuropeptides, and neuroproteins and also express many signaling molecules and transcription factors. In mammals, birds, reptiles, and amphibians, the carotid body primordium is consistently formed in the wall of the third arch artery which gives rise to the common carotid artery and the basal portion of the internal carotid artery. Consequently, the carotid body is located in the carotid bifurcation region, except birds in which the organ is situated at the lateral side of the common carotid artery. The carotid body receives branches of the cranial nerves IX and/or X dependent on the location of the organ. The glomus cell progenitors in mammals and birds are derived from the neighboring ganglion, i.e., the superior cervical sympathetic ganglion and the nodose ganglion, respectively, and immigrate into the carotid body primordium, constituting a solid cell cluster. In other animal species, the glomus cells are dispersed singly or forming small cell groups in intervascular stroma of the carotid body. In fishes, the neuroepithelial cells, corresponding to the glomus cells, are distributed in the gill filaments and lamellae. All oxygen-chemoreceptive cells sensitively respond to acute or chronic hypoxia, exhibiting degranulation, hypertrophy, hyperplasia, and upregulated expression of many genes.

The follicle-sinus complex of the bottlenose dolphin (Tursiops truncatus). Functional anatomy and possible evolutional significance of its somato-sensory innervation

Vibrissae are tactile hairs found mainly on the rostrum of most mammals. The follicle, which is surrounded by a large venous sinus, is called "follicle-sinus complex" (FSC). This complex is highly innervated by somatosensitive fibers and reached by visceromotor fibers that innervate the surrounding vessels. The surrounding striated muscles receive somatomotor fibers from the facial nerve. The bottlenose dolphin (Tursiops truncatus), a frequently described member of the delphinid family, possesses this organ only in the postnatal period. However, information on the function of the vibrissal complex in this latter species is scarce. Recently, psychophysical experiments on the river-living Guiana dolphin (Sotalia guianensis) revealed that the FSC could work as an electroreceptor in murky waters. In the present study, we analyzed the morphology and innervation of the FSC of newborn (n = 8) and adult (n = 3) bottlenose dolphins. We used Masson's trichrome stain and antibodies against neurofilament 200 kDa (NF 200), protein gene product (PGP 9.5), substance P (SP), calcitonin gene-related peptide, and tyrosine hydroxylase (TH) to characterize the FSC of the two age classes. Masson's trichrome staining revealed a structure almost identical to that of terrestrial mammals except for the fact that the FSC was occupied only by a venous sinus and that the vibrissal shaft lied within the follicle. Immunostaining for PGP 9.5 and NF 200 showed somatosensory fibers finishing high along the follicle with Merkel nerve endings and free nerve endings. We also found SP-positive fibers mostly in the surrounding blood vessels and TH both in the vessels and in the mesenchymal sheath. The FSC of the bottlenose dolphin, therefore, possesses a rich somatomotor innervation and a set of peptidergic visceromotor fibers. This anatomical disposition suggests a mechanoreceptor function in the newborns, possibly finalized to search for the opening of the mother's nipples. In the adult, however, this structure could change into a proprioceptive function in which the vibrissal shaft could provide information on the degree of rotation of the head. In the absence of psychophysical experiments in this species, the hypothesis of electroreception cannot be rejected.

Vasoactive Intestinal Polypeptide in the Carotid Body-A History of Forty Years of Research. A Mini Review

Vasoactive intestinal polypeptide (VIP) consists of 28 amino acid residues and is widespread in many internal organs and systems. Its presence has also been found in the nervous structures supplying the carotid body not only in mammals but also in birds and amphibians. The number and distribution of VIP in the carotid body clearly depends on the animal species studied; however, among all the species, this neuropeptide is present in nerve fibers around blood vessels and between glomus cell clusters. It is also known that the number of nerves containing VIP located in the carotid body may change under various pathological and physiological factors. The knowledge concerning the functioning of VIP in the carotid body is relatively limited. It is known that VIP may impact the glomus type I cells, causing changes in their spontaneous discharge, but the main impact of VIP on the carotid body is probably connected with the vasodilatory effects of this peptide and its influence on blood flow and oxygen delivery. This review is a concise summary of forty years of research concerning the distribution of VIP in the carotid body.