Extracellular recording in rat area postrema in vitro and the effects of cholinergic drugs, serotonin and angiotensin II

COVID-19, nausea, and vomiting

Exclusion of nausea (N) and vomiting (V) from detailed consideration as symptoms of COVID-19 is surprising as N can be an early presenting symptom. We examined the incidence of NV during infection before defining potential mechanisms. We estimate that the overall incidence of nausea (median 10.5%), although variable, is comparable with diarrhea. Poor definition of N, confusion with appetite loss, and reporting of N and/or V as a single entity may contribute to reporting variability and likely underestimation. We propose that emetic mechanisms are activated by mediators released from the intestinal epithelium by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) modulate vagal afferents projecting to the brainstem and after entry into the blood, activate the area postrema (AP) also implicated in anorexia. The receptor for spike protein of SARS-CoV-2, angiotensin 2 converting enzyme (ACE2), and transmembrane protease serine (for viral entry) is expressed in upper gastrointestinal (GI) enterocytes, ACE2 is expressed on enteroendocrine cells (EECs), and SARS-CoV-2 infects enterocytes but not EECs (studies needed with native EECs). The resultant virus-induced release of epithelial mediators due to exocytosis, inflammation, and apoptosis provides the peripheral and central emetic drives. Additionally, data from SARS-CoV-2 show an increase in plasma angiotensin II (consequent on SARS-CoV-2/ACE2 interaction), a centrally (AP) acting emetic, providing a further potential mechanism in COVID-19. Viral invasion of the dorsal brainstem is also a possibility but more likely in delayed onset symptoms. Overall, greater attention must be given to nausea as an early symptom of COVID-19 and for the insights provided into the GI effects of SARS-CoV-2.

Neuroactive substances in the dorsal vagal complex of the medulla oblongata: nucleus of the tractus solitarius, area postrema, and dorsal motor nucleus of the vagus

The distributions of classical and putative neurotransmitters within somata and fibres of the dorsal vagal complex are reviewed. The occurrence within the dorsal medulla oblongata of receptors specific for some of these substances is examined, and possible functional correlations of the specific neurochemicals with respect to their distribution within the dorsal vagal complex are discussed. Many of the known transmitters and putative transmitters are represented in the dorsal vagal complex, particularly within various subnuclei of the nucleus of the solitary tract, the main vagal afferent nucleus. In a few cases, some of these have been examined in detail, particularly with respect to their possible mediation of cardiovascular or gastrointestinal functions. For example, the catecholamines, substance P and angiotensin II in the nucleus of the solitary tract have all been strongly implicated as playing a role in the central control of cardiovascular function. Other neurotransmitters or putative transmitters may be involved as well, but probably to a lesser extent. Similarly, the roles in the dorsal vagal complex of dopamine, the endorphins and cholecystokinin in control of the gut have been studied in some detail. Future investigations of the distributions of and electrophysiological parameters of neurotransmitters at the cellular level should provide much needed clues to advance our knowledge of the correlations between anatomical distributions of specific neurochemicals and physiological functions mediated by them.

The area postrema: a brain monitor and integrator of systemic autonomic state

The area postrema is a medullary structure lying at the base of the fourth ventricle. The area postrema's privileged location outside of the blood-brain barrier make this sensory circumventricular organ a vital player in the control of autonomic functions by the central nervous system. By virtue of its lack of tight junctions between endothelial cells in this densely vascularized structure and the presence of fenestrated capillaries, peptide and other physiological signals borne in the blood have direct access to neurons that project to brain areas with important roles in the autonomic control of many physiological systems, including the cardiovascular system and systems controlling feeding and metabolism. However, the area postrema is not simply a conduit through which signals flow into the brain, but it is now being recognized as the initial site of integration for these signals as they enter the circuitry of the central nervous system.

Nicotinic ACh receptors in area postrema neurons of immature rat brain

The electrophysiological properties of nicotinic ACh receptors (nAChR) were investigated in acutely dissociated area postrema (AP) neurons of the immature rat brain using the whole-cell patch-clamp recording method. ACh induced a transient inward current exhibiting a strong inward rectification. The ACh response was mimicked by nicotine and cytisine, and was inhibited by nAChR antagonists, but not by 10(-7) M atropine. Muscarinic AChR agonists did not induce any current. We confirmed the Ca2+ permeability of nAChR. These results indicate the presence of nAChR on AP neurons, and suggest that the activation of nAChR play important roles in cardiovascular functions in rats.

Nicotinic modulation of area postrema neuronal excitability in rat brain slices

We investigated the functions of nicotinic receptor activation on area postrema neurons by making whole-cell recordings in rat brainstem slices. Excitatory responses to nicotine application were found in approximately 78% (35/45) of all cells tested. Responsive cells included both the cells that display the hyperpolarization-activated cation current (I(h)) and cells that do not display I(h). An inhibitory effect of nicotine was never seen. Current-clamp recordings showed the nicotine-induced depolarization of a cell's membrane potential that could be sufficient to cause spontaneous firing. In voltage-clamp recordings, many cells showed nicotine-induced inward currents (18.3+/-3.2 pA, n=6) that persisted during pharmacological blockade of synaptic transmission (e.g., zero [Ca(2+)](out) and 5 mM [Mg(2+)](out), n=6/8). Other two cells, however, showed increases in the frequency of excitatory postsynaptic currents (EPSCs), which were blocked by CNQX (n=2/8). We analyzed miniature EPSCs (mEPSCs) recorded from cells that showed no inward currents but marked increases in the frequency of mEPSCs (0.8+/-0.2 to 4.8+/-1.7 Hz, n=4) during nicotine application. Nicotine augmented mEPSC amplitude (n=4); however, amplitude distribution was not significantly changed in two of four cells tested. We conclude that nicotinic receptors in the rat area postrema can excite cells via (1) a direct post- and/or extrasynaptic mechanism; and (2) an indirect enhancement of glutamate release.

Vasopressin and sensory circumventricular organs

The subfornical organ, the area postrema and the organum vasculosum of the lamina terminalis are considered to be sensory circumventricular organs as they contain neuronal somata which are located outside the blood-brain barrier and are thus capable of serving as 'sensors' for blood-borne humoral messengers. The endocrine hormone, vasopressin (VP), not only causes strong antidiuresis by acting on the kidney, but also exerts centrally mediated effects as a neuromodulator. Several lines of evidence suggest that VP can influence regulatory functions mediated by the sensory circumventricular organs, since vasopressinergic somata and terminals as well as VP receptors have been reposted to be present in these structures. These biochemical prerequisites offer the possibility that blood-borne VP might on the one hand act as a feedback signal from the periphery and, on the other hand, synaptically released or locally produced VP could modulate the known functions of sensory circumventricular organs, such as thirst, fever or cardiovascular regulation. This review focuses on the possible physiological relevance of VP acting on sensory circumventricular organs in view of recent evidence obtained from biochemical and electrophysiological studies at the cellular level.

Angiotensin II and glutamate influence area postrema neurons in rat brain slices

The area postrema (AP) has been repeatedly implicated in cardiovascular regulation. Microinjection and single unit recording studies in vivo have suggested specific actions for angiotensin II (ANG) and glutamate (GLU) in controlling the excitability of AP neurons. The present study was therefore designed to examine the responsiveness of AP neurons to bath administration of these substances. Of the 133 AP neurons tested with ANG (10(-8)-10(-6) M) 40% were excited, 13% inhibited and the remainder unresponsive. The excitatory effects of ANG on AP neurons were dose-dependent. Following blockade of synaptic transmission with a low calcium high magnesium solution excitatory responses were maintained in 12 of 15 cells tested. Pretreatment of slices with the AT1 receptor antagonist losartan blocked the excitatory effects of ANG in all cells (5/5) tested. The effects of GLU on AP neurons were also examined. Of the 71 AP cells tested, 40% were excited, 10% inhibited, 8% showed excitatory responses followed by periods of inhibition while the remaining cells were unaffected. Excitatory effects of GLU were maintained in all AP neurons (7/7) tested during perfusion with low calcium, high magnesium solutions. Similar responses to NMDA were observed in four of four cells tested, suggesting these GLU actions are mediated through NMDA receptors. These data demonstrate direct excitatory actions of ANG and GLU on AP neurons which are likely mediated through the AT1 and NMDA receptors, respectively.

Effects of arginine vasopressin and angiotensin II on area postrema neurons in rabbit brain slice preparation

Previous in vivo studies have indicated that both arginine vasopressin (AVP) and angiotensin II (ANG II) can modulate the baroreflex by acting on the area postrema (AP). In the present study, effects of AVP and ANG II on AP neuronal activity were investigated by recording extracellular activity in a rabbit brainstem slice preparation. AVP (1 nM-1 microM) inhibited 14.5% and excited 53.2% of the neurons while ANG II (1 nM-5 microM) inhibited 32.3% and excited 29% of the neurons. Application of AVP and ANG II to the same AP neurons at the same concentration indicated that more AP neurons responded to AVP than to ANG II. ANG II induced more inhibitory responses than AVP. The results suggest that AVP and ANG II may produce different effects on the baroreflex by acting on different pools of AP neurons and by exerting different effects on the same AP neuron.

Circulating vasopressin influences area postrema neurons

Extracellular single-unit recordings were obtained from 107 area postrema and 74 nucleus tractus solitarius neurons in sodium pentobarbital anaesthetized rats. Systemic administration of vasopressin (1-10 ng) decreased the firing frequency of 45.8% of area postrema neurons and 58.1% of nucleus tractus solitarius neurons tested while the firing frequency of 38.3% of area postrema neurons and 21.6% of nucleus tractus solitarius neurons was increased by this peptide. To determine whether these neurons were specifically influenced by vasopressin or the accompanying pressor response, the effects of alpha-adrenergic agonists on neuronal activity were also determined. Cells that responded similarly to vasopressin and the change in blood pressure elicited by alpha-adrenergic agonists were classified as "blood pressure-sensitive", whereas those neurons that responded differently to both agents were classified as "vasopressin-sensitive" neurons. The majority (85.2%) of area postrema cells that decreased firing frequency in response to vasopressin were determined to be "vasopressin-sensitive", while 68.8% of area postrema neurons responding to vasopressin with increases in firing frequency were classified as "blood pressure-sensitive". In contrast, 78.6% of nucleus tractus solitarius neurons that decreased firing frequency in response to vasopressin and 55.5% of those that increased firing frequency were classified as "blood pressure-sensitive" neurons. To determine whether the actions of vasopressin in the area postrema were mediated by V1 receptors the effect of vasopressin after V1 receptor blockade was examined in seven "vasopressin-sensitive" area postrema neurons. All seven neurons tested showed no response to vasopressin after such V1 receptor blockade. These data suggest that there exists a population of area postrema neurons specifically responsive to circulating vasopressin as a result of actions of this peptide at V1 receptors. They also implicate these neurons in the physiological mechanisms through which circulating vasopressin acts in the area postrema to influence baroreceptor reflex sensitivity.

Glucose-responsive neurons exist within the area postrema of the rat: in vitro study on the isolated slice preparation

Responses to glucose of spontaneously active neurons were investigated by extracellular recording in the rat area postrema slice preparations (in vitro). Among 67 spontaneously active neurons, 16 neurons displayed a marked increase or decrease in discharge rate in response to increases or decreases of the glucose concentration in perfusate. These results confirm the existence of glucose-responsive neurons within the area postrema suggested in prior in vivo experiments. Response to CCK or dopamine was also examined on the isolated area postrema slices. The neuron that showed a marked increase in discharge rate responding to glucose elicited a marked increase of discharge rate in response to 2.1 microM CCK, suggesting that glucose and CCK affect the same neurons. Some neurons showed a marked increase or decrease in the discharge rate in response to 20 microM dopamine, but these neurons showed neither response to CCK nor to glucose. It is likely that different neuronal networks in the area postrema contribute to control of ingestion and to initiation of nausea.

Electrophysiological responses of angiotensin peptides on the rat isolated nodose ganglion

Previous autoradiographic studies have identified angiotensin II (AII) binding sites over the nodose ganglion and along the vagal afferent neurons. In the present study, we examined whether these binding sites are functional receptors by measuring d.c. potential changes by extracellular recording techniques in the rat isolated nodose ganglion preparation in response to superfusion of angiotensin peptides. It was found that AII, as well as AI and AIII elicited concentration-dependent depolarisation of the nodose ganglion. However, the amino terminal angiotensin heptapeptide, A(1-7), failed to evoke any significant response. The AII receptor antagonist, saralasin had no intrinsic activity, but caused a concentration-dependent blockade of AII-induced depolarisation. This study provides evidence for direct neuronal effects of angiotensin peptides on rat vagal afferent neurons. Moreover, this preparation is a relatively convenient one in which to study functional neuronal AII receptor mechanisms on central or peripheral terminals of vagal sensory neurons.

Efferent projections from the periventricular and medial parvicellular subnuclei of the hypothalamic paraventricular nucleus to circumventricular organs of the rat: a Phaseolus vulgaris-leucoagglutinin (PHA-L) tracing study

The heterogeneous hypothalamic paraventricular nucleus (PVN) is intimately involved in the regulation of several homeostatic functions. These regulations might, at least partly, be mediated via neuronal projections from the PVN to circumventricular organs outside the blood-brain barrier. To study the efferent projections of the medial and periventricular parvicellular subnuclei of the PVN with particular emphasis on the projections to the circumventricular organs, anterograde tracing with Phaseolus vulgaris leucoagglutinin (PHA-L) was applied. Three major efferent pathways and one minor one coursed from the medial and periventricular parvicellular subnuclei to the circumventricular organs. The major fiber projections included a rostral, a lateral, and a dorsocaudal projection tract, whereas the minor projection coursed ventrally. Fibers of the rostral projection were followed to the preoptic area and along the fornix to the subfornical organ. Single fibers originating from this projection coursed further rostrally to the organum vasculosum laminae terminalis. The lateral projection equivalent to the hypothalamo-pituitary tract passed through the lateral hypothalamic area to the median eminence, and nerve terminals were observed throughout the rostrocaudal extent of this structure. A few fibers of this bundle continued into the infundibular stalk and some terminated in the posterior pituitary lobe. Few fibers of the lateral projection descended to caudal pontine levels, where they reached descending fibers of the dorsocaudal projection. The dorsocaudal projection was essentially restricted to midline structures. Along the midline, fibers were followed from the hypothalamus either dorsally through the thalamus to the dorsal part of the third ventricle or caudally alongside the ventricular wall to the mesencephalic periaqueductal grey. The density of fibers decreased along the caudal direction of the neuraxis. The dorsal part of this projection gave rise to terminals in the deep pineal gland and pineal stalk, whereas the caudal part of this projection sent terminating fibers into the area postrema. The minor ventrally directed projection could be followed through the periventricular region to the rostral part of the median eminence. The number of terminals in the circumventricular organs varied. Within the median eminence, a high density of afferents was observed in the entire rostrocaudal extent of the external zone, whereas a low density of fibers was seen in the internal zone. A medium density of afferents was observed in the organum vasculosum laminae terminalis, whereas a relative low density of nerve terminals was observed in the posterior pituitary, the deep pineal gland, the subfornical organ, and the area postrema.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of parabrachial stimulation on angiotensin and blood pressure sensitive area postrema neurons

Subpopulations of neurons in the area postrema (AP) and commissural nucleus tractus solitarius (NTS) have been identified according to their responses to systemic angiotensin-II (ANG-II) and increases in blood pressure (BP). In order to further define the functional connections of these subpopulations of cells, electrophysiological single unit recording studies have been done to determine the orthodromic effects of parabrachial nucleus (PBN) stimulation on these functionally defined cell groups. Orthodromic effects were seen in a similar proportion of ANG-II sensitive neurons in the AP (31.5%) and NTS (31%). PBN stimulation influenced a similar percentage of BP sensitive neurons in the AP (35%), although a larger proportion of this group of NTS cells was affected (55.5%). Twenty-five percent of ANG-II/BP sensitive neurons in the AP were orthodromically influenced, and 71.5% of this group of NTS neurons were affected by PBN stimulation. Small proportions of the neurons in the unaffected subpopulation of AP (10%) and NTS (27%) were also orthodromically affected by PBN stimulation. The remaining neurons in each group were not affected. This study suggests that there is no apparent preferential distribution of excitatory or inhibitory PBN efferents to any of the identified subpopulations of AP and NTS neurons.

Electrophysiological characterization of reciprocal connections between the parabrachial nucleus and the area postrema in the rat

Neuroanatomical studies have demonstrated reciprocal connections between the parabrachial nucleus (PBN) and both the area postrema (AP) and the nucleus tractus solitarius (NTS). To functionally characterize these projections, antidromic identification of AP and NTS neurons projecting to the PBN was attempted. Orthodromic influences on these cells, resulting from PBN stimulation, were also examined. Four percent of AP neurons tested (n = 74) were antidromically identified as projecting to the PBN [latency (L) = 26 +/- 4 msec, threshold current (T) = 79 +/- 11 microA]. Parabrachial stimulation orthodromically influenced 24% of AP cells. Equal numbers of these neurons (12%) were excited [L = 25 +/- 9 msec, duration (D) = 29 +/- 14 msec] and inhibited (L = 28 +/- 8 msec, D = 107 +/- 40 msec). Of 46 NTS neurons tested, 11% were antidromically identified as projecting to the PBN (L = 12 +/- 4 msec, T = 61 +/- 18 microA), while orthodromic influences were seen in 41% of these neurons. Initial responses of 30% of the cells were excitatory (L = 34 +/- 14 msec, D = 63 +/- 24 msec), PBN stimulation inhibited the remaining 11% of NTS neurons (L = 30 +/- 10 msec, D = 108 +/- 32 msec). These findings suggest that a functional heterogeneity exists in the PBN efferents to the AP and NTS. However, the small proportion of antidromically identified AP and NTS efferents to the PBN disagrees with neuroanatomical studies suggesting a denser projection.

The neurophysiology of vomiting

Nausea and vomiting can be induced by a wide variety of stimuli such as pregnancy, space travel, raised intracranial pressure, radiation and cytotoxic drugs. The mechanisms by which all these diverse stimuli culminate in a final common act is unknown. From studies in the 1950s a model of the emetic reflex emerged consisting of a chemoreceptor trigger zone in the area postrema and a vomiting centre in the brain stem. This concept has been reviewed and revised in the light of recent studies. Many discussions of emesis involve detailed descriptions of the gastrointestinal events associated with the act of vomiting only-nausea and retching receiving little attention. Here we have tried to give a broader view by considering the neurophysiology of such events and have included nausea and retching, phenomena that are usually inseparable from vomiting. The possible biological function of these events is also discussed. The involvement of visceral systems (such as the heart, airways and gut) is included, and particular attention is paid to vagal mechanisms underlying the changes in gut motor activity. Emesis has long been thought to be organized by a 'vomiting centre'; the possibility that this vomiting centre could be the parvocellular reticular formation is reviewed, as is the concept that the 'centre' is larger than an anatomically defined single group of cells. The mechanism of action of two clinically relevant emetic stimuli--radiation and cytotoxic drugs-is considered in detail. Recent studies of the antiemetic properties of novel 5-HT-3 receptor antagonists against radiation and cytotoxic drug-induced vomiting are discussed; these studies suggest that important advances will be made in the treatment of emesis induced by these and other related agents.

Actions of angiotensin on area postrema of the rat

Previous studies have reported that rats drink more saline after area postrema has been removed. The results presented here indicate that prolonged administration of angiotensin II into area postrema of unrestrained rats at 4 pmol/h also caused them to drink more saline. They drank more when angiotensin was released in the anterolateral part of the organ than when it was released anteromedially. Diurnal variation of drinking was not disordered. Dose-response curves showed that rats lacking area postrema drank more saline in response to systemic angiotensin than sham operated animals. The very large 'spontaneous' consumption of saline by rats lacking area postrema was not diminished by saralasin, an angiotensin antagonist. It is concluded that area postrema is a site where systemic angiotensin can act to promote sodium consumption: and that although removing area postrema increases the sensitivity of the drinking response to systemic angiotensin, this enhanced sensitivity is not the cause of the increased sodium consumption.

Angiotensin II-induced taste aversion learning in cats and rats and the role of the area postrema

The capacity of angiotensin II (AII, 1 mg/kg, IP) to produce a taste aversion was studied in cats and rats with and without lesions of the area postrema. Using a one-bottle test, injection of AII produced an aversion in cats but not in rats. Using a two-bottle test, injection of AII produced a slight, but significant, decrease in sucrose preference in intact rats, but had no effect on rats with area postrema lesions. Lesions of the area postrema prevented the acquisition of a taste aversion in cats. These results, which show a clear species difference in the capacity of AII to produce a taste aversion, are discussed as supporting the hypotheses that there is a relationship between the sensitivity of the area postrema to a compound and the capacity of that compound to produce a taste aversion; and that excitation of the area postrema constitutes a sufficient condition for taste aversion learning to occur.

Mechanisms of radiation-induced conditioned taste aversion learning

The literature on taste aversion learning is reviewed and discussed, with particular emphasis on those studies that have used exposure to ionizing radiation as an unconditioned stimulus to produce a conditioned taste aversion. The primary aim of the review is to attempt to define the mechanisms that lead to the initiation of the taste aversion response following exposure to ionizing radiation. Studies using drug treatments to produce a taste aversion have been included to the extent that they are relevant to understanding the mechanisms by which exposure to ionizing radiation can affect the behavior of the organism.

The effect of removing area postrema on the sodium and potassium balances and consumptions in the rat

Previous studies have indicated that rats lose weight and develop a taste preference for solutions of sodium chloride after area postrema has been removed; results in other species have suggested that area postrema may be concerned with regulating the excretion of sodium and potassium. The results reported here demonstrate that in rats the reduction of weight can be explained adequately by anorexia, that diminished excretion of sodium and potassium results from anorexia, and that the consequent slower rate of gain of weight causes diminution of sodium and potassium balances. The results also show that the rats do not drink more of a solution of sodium chloride because they eat less, and conversely that when they can drink a saline solution they do not eat more: and that they do not drink more saline because of salt loss. Furthermore, individual rats show no significant correlation between the severity of anorexia, and the increased consumption of saline. Taken together the results suggest that primary disorder of regulation of intake occurs in rats after area postrema has been removed, and that the reduced intake of food and the increased intake of sodium chloride occur independently.

The central neural connections of the area postrema of the rat

We applied the neuroanatomical tracers cholera toxin-horseradish peroxidase and wheat germ agglutinin-horseradish peroxidase to investigate the neural connections of the area postrema (AP) in the rat. We find that the AP projects to the nucleus of the solitary tract (NTS) and dorsal motor nucleus of the vagus bilaterally both rostral and caudal to obex; the nucleus ambiguus; the dorsal aspect of the spinal trigeminal tract and nucelus and the paratrigeminal nucleus; the region of the ventrolateral medullary catecholaminergic column; the cerebellar vermis; and a cluster of structures in the dorsolateral pons which prominently include a discrete set of subnuclei in the lateral parabrachial nucleus. The major central afferent input to the area postrema is provided by a group of neurons in the paraventricular and dorsomedial hypothalamic nuclei whose collective dendrites describe a horizontally oriented plexus which encircles the parvocellular nucleus of the hypothalamus bilaterally. In addition, the caudal NTS may project lightly to the AP. The lateral parabrachial nucleus provides a very light input as well. These connections, when considered in the context of the known vagal afferent input and reduced blood-brain barrier of AP, place this structure in a unique position to receive and modulate ascending interoceptive information and to influence autonomic outflow as well.

Distribution of FMRF-NH2-like immunoreactivity in rat and cat area postrema

The distribution of FMRF-NH2-like immunoreactivity, visualized with immunohistochemical techniques, was plotted in a range from very dense to none. The rat area postrema had differential immunostaining with the greatest amounts occurring at its ventral and ventrolateral borders by the nucleus of the solitary tract. Immunoreactive cell bodies were located mainly in this region. Throughout the central region of the rat area postrema scattered immunostaining was consistently observed. The cat area postrema had a different, greater, and more complex pattern of immunostaining than the rat. Very dense to dense accumulations of immunostaining occurred in the ventromedial region of the area postrema bordering the solitary tract and dorsal vagal nuclei, while the central region possessed scattered amounts of immunoreactivity. Following colchicine treatment, no visible FMRF-NH2-like immunoreactive cell bodies were observed in the cat area postrema.