PUPILLARY REACTIVITY AS A MEASURE OF AUTONOMIC BALANCE IN CYSTIC FIBROSIS

Expression of cystic fibrosis transmembrane conductance regulator in paracervical ganglia

The cystic fibrosis transmembrane conductance regulator (CFTR) is an important protein that acts as a chloride channel and regulates many physiological functions, including salt transport and fluid flow. Mutations in the gene encoding the CFTR protein cause cystic fibrosis. CFTR is expressed in the epithelial cells of the lungs, pancreas, intestines, and other organs. In the peripheral and central nervous system, CFTR expression has been detected in the neurons of rat brains, ganglion cells of rat hearts, human hypothalamus, human spinal cord, and human spinal and sympathetic ganglia. However, CFTR has not been identified in other parts of the nervous system. In this study, we used immunohistochemistry, in situ hybridization, and laser-assisted microdissection (LMD) followed by reverse transcriptase (RT) PCR to identify CFTR proteins and messenger RNA in human and rat paracervical ganglion cells. CFTR and its gene expression were both detected in paracervical ganglion cells, a finding that might link this important protein to the neuronal regulation of female urogenital function. These findings could provide new insights into the symptoms related to the reproductive system frequently observed in female cystic fibrosis patients.

Cystic fibrosis transmembrane conductance regulator expression in human spinal and sympathetic ganglia

Cystic fibrosis transmembrane conductance regulator (CFTR) is a chloride channel protein, and mutations of its gene cause cystic fibrosis. CFTR is known to be expressed in epithelial cells of the respiratory, digestive and reproductive tracts. It is also present in rat neurons and heart ganglion cells. In humans, it is expressed in the hypothalamus, but has not been identified in other parts of the human nervous system. In this study, immunohistochemistry, double-staining immunofluorescence, in situ hybridization, nested reverse transcription-PCR and relative quantification of real-time PCR analysis were performed on spinal and sympathetic ganglia from seven human autopsies with no known nervous system disease. CFTR protein was expressed in most ganglion cells with no obvious difference in the amounts of mRNA transcript in ganglia of different sites. We conclude that CFTR protein and its mRNA were extensively expressed at relatively constant levels in human spinal and sympathetic ganglion cells, and may be important in physiological and pathological conditions. Moreover, CFTR in ganglia may be associated with pathophysiological changes seen in cystic fibrosis.

Autonomic nervous system abnormalities in cystic fibrosis

The basic defect in cystic fibrosis, the most common lethal genetic diseases of white Americans, is unknown, but the character of the generalized exocrinopathy suggests some disorder of the regulation and control of the process of glandular secretion. Definite abnormalities in all branches of the autonomic nervous system have been demonstrated in patients with cystic fibrosis, including increased sensitivity to alpha-adrenergically stimulated pupillary dilation; increased responsiveness to cholinergic stimulation of pupillary constriction, parotid saliva secretion, and eccrine sweat secretion; and decreased responsiveness to beta-adrenergic stimulation of the cardiovascular system as well as circulating lymphocytes and granulocytes. Since these abnormalities also occur in asymptomatic heterozygotes for cystic fibrosis (parents of patients), they are likely to be inherited characteristics and not secondarily acquired. This constellation of inherited autonomic abnormalities--alpha-adrenergic and cholinergic hyperresponsiveness and beta-adrenergic resistance--may contribute to the pathophysiology of cystic fibrosis and may also be an important clue to the nature of the basic defect.

The syndrome of functional dysautonomia

A perspective on disease is proposed which treats the brain and psyche as part of the soma. The brain, operating as a computer, coordinates energy metabolism in all organs, modulating the organisms's response to stress which results in a complex mixture of sympathetic, parasympathetic and endocrine drive governing behavior and host resistance. It is postulated that automatic activity in health maintains a balanced state of autonomic neurotransmission with behavioral responses varying according to the physiologic state of either sympathetic or parasympathetic dominance. The sympathetic system, irrespective of neurotransmitters involved, is defined as an action system which uses energy and the parasympathetic system is the opposing or balancing force. Genetic influences may create a greater state of sensitivity with one or other of these systems, thus governing behavior characteristics. The degree of dominance may be responsible for the unbalanced response to stress which will in turn have a major influence on the causation of organic disease. The state of reactivity within this system is influenced by the efficiency of the oxidative process which is in turn closely related to the quantity and quality of nutrition.