Enhanced baroreflex-mediated inhibition of respiration after muscimol dialysis in the rostroventral medulla

Decreased GABAA receptor binding in the medullary serotonergic system in the sudden infant death syndrome

γ-Aminobutyric acid (GABA) neurons in the medulla oblongata help regulate homeostasis, in part through interactions with the medullary serotonergic (5-HT) system. Previously, we reported abnormalities in multiple 5-HT markers in the medullary 5-HT system of infants dying from sudden infant death syndrome (SIDS), suggesting that 5-HT dysfunction is involved in its pathogenesis. Here, we tested the hypothesis that markers of GABAA receptors are decreased in the medullary 5-HT system in SIDS cases compared with controls. Using tissue receptor autoradiography with the radioligand H-GABA, we found 25% to 52% reductions in GABAA receptor binding density in 7 of 10 key nuclei sampled of the medullary 5-HT system in the SIDS cases (postconceptional age [PCA] = 51.7 ± 8.3, n = 28) versus age-adjusted controls (PCA = 55.3 ± 13.5, n = 8) (p ≤ 0.04). By Western blotting, there was 46.2% reduction in GABAAα3 subunit levels in the gigantocellularis (component of the medullary 5-HT system) of SIDS cases (PCA = 53.9 ± 8.4, n = 24) versus controls (PCA = 55.3 ± 8.3, n = 8) (56.8% standard in SIDS cases vs 99.35% in controls; p = 0.026). These data suggest that medullary GABAA receptors are abnormal in SIDS infants and that SIDS is a complex disorder of a homeostatic network in the medulla that involves deficits of the GABAergic and 5-HT systems.

Neuroanatomic relationships between the GABAergic and serotonergic systems in the developing human medulla

gamma-Amino butyric (GABA) critically influences serotonergic (5-HT) neurons in the raphé and extra-raphé of the medulla oblongata. In this study we hypothesize that there are marked changes in the developmental profile of markers of the human medullary GABAergic system relative to the 5-HT system in early life. We used single- and double-label immunocytochemistry and tissue receptor autoradiography in 15 human medullae from fetal and infant cases ranging from 15 gestational weeks to 10 postnatal months, and compared our findings with an extensive 5-HT-related database in our laboratory. In the raphé obscurus, we identified two subsets of GABAergic neurons using glutamic acid decarboxylase (GAD65/67) immunostaining: one comprised of small, round neurons; the other, medium, spindle-shaped neurons. In three term medullae cases, positive immunofluorescent neurons for both tryptophan hydroxylase and GAD65/67 were counted within the raphé obscurus. This revealed that approximately 6% of the total neurons counted in this nucleus expressed both GAD65/67 and TPOH suggesting co-production of GABA by a subset of 5-HT neurons. The distribution of GABA(A) binding was ubiquitous across medullary nuclei, with highest binding in the raphé obscurus. GABA(A) receptor subtypes alpha1 and alpha3 were expressed by 5-HT neurons, indicating the site of interaction of GABA with 5-HT neurons. These receptor subtypes and KCC2, a major chloride transporter, were differentially expressed across early development, from midgestation (20 weeks) and thereafter. The developmental profile of GABAergic markers changed dramatically relative to the 5-HT markers. These data provide baseline information for medullary studies of human pediatric disorders, such as sudden infant death syndrome.

The effects of elevated body temperature on the complexity of the diaphragm EMG signals during maturation

In this paper, we examine the effect of elevated body temperature on the complexity of the diaphragm electromyography (EMGdia), the output of the respiratory neural network--using the approximate entropy method. The diaphragm EMG, EEG, EOG as well as other physiological signals (tracheal pressure, blood pressure and respiratory volume) in chronically instrumented rats were recorded at two postnatal ages: 25-35 days age (juvenile, n = 5) and 36-44 days age (early adult, n = 6) groups during control (36-37 degrees C), mild elevated body temperature (38 degrees C) and severe elevated body temperature (39-40 degrees C). Three to five trials of the recordings were performed at normal body temperature before raising the animal's core temperature by 1-4 degrees C with an electric heating pad. At the elevated temperature, another 3-5 trials were performed. Finally, the animal was cooled to the original temperature, and trials were again repeated. Complexity values of the diaphragm EMG signal were estimated and evaluated using the approximate entropy method (ApEn) over the ten consecutive breaths. Our results suggested that the mean approximate entropy values for the juvenile age group were 1.01 +/- 0.01 (standard error) during control, 0.91 +/- 0.02 during mild elevated body temperature and 0.81 +/- 0.02 during severe elevated body temperature. For the early adult age group, these values were 0.94 +/- 0.01 during control, 0.93 +/- 0.01 during mild elevated body temperature and 0.92 +/- 0.01 during severe elevated body temperature. Our results show that the complexity values and the durations of the diaphragm EMG (EMGdia) were significantly decreased when the elevated body temperature was shifted from control or mild to severe body temperature (p < 0.05) for the juvenile age group. However, for the early adult age group, an increase in body temperature slightly reduced the complexity measures and the duration of the EMGdia. But, these changes were not statistically significant. These results furthermore suggest that during maturation, the output of the central pattern generator becomes less complex probably because the elevated body temperature reduces the neural activity and alters the behavior of the central respiratory controller, making it more susceptible to sudden infant death syndrome (SIDS).

Mechanisms of pathogenesis in the Sudden Infant Death Syndrome

The likely processes of the Sudden Infant Death Syndrome (SIDS) were identified many years ago (apnea, failed arousal, failed autoresuscitation, etc.). The neurophysiological basis of these processes and the neurophysiological reasons some infants die of SIDS and others do not are, however, only emerging now. We reviewed recent studies that have shed light on the way in which epidemiological risk factors, genetics, neurotransmitter receptor defects and neonatal cardiorespiratory reflex responses interact to lead to sudden death during sleep in a small number of normal appearing infants. As a result of this review and analysis, we hypothesize that the neurophysiological basis of SIDS resides in a persistence of fetal reflex responses into the neonatal period, amplification of inhibitory cardiorespiratory reflex responses and reduced excitatory cardiorespiratory reflex responses. The hypothesis we developed explores the ways in which multiple subtle abnormalities interact to lead to sudden death and emphasizes the difficulty of ante-mortem identification of infants at risk for SIDS, although identification of infants at risk remains an essential goal of SIDS research.

Baroreceptor-mediated inhibition of respiration after peripheral and central administration of a 5-HT1Areceptor agonist in neonatal piglets

Inhibition of neurones in the ventral medulla accentuates the respiratory inhibition associated with acute blood pressure elevation in piglets. Activation of presynaptic 5-HT(1A) receptors inhibits serotonergic neurones in the ventral medulla and caudal raphé, and we tested the hypothesis that administration of 8-hydroxydipropylaminotetralin (8-OH-DPAT), a 5-HT(1A) agonist, within the rostroventral medulla and caudal raphé would enhance baroreceptor-mediated inhibition of respiratory activity in decerebrate, neonatal piglets. Baroreceptor stimulation was achieved by inflating a balloon in the distal aorta to elevate carotid blood pressure. After two to four control trials of baroreceptor stimulation, each piglet was given either a single intravenous (i.v.) dose of 10 microg kg(-1) 8-OH-DPAT or treated by adding 10 or 30 mm 8-OH-DPAT to the dialysate for approximately 10 min to inhibit serotonergic neurones, after which the baroreceptor stimulation trials were repeated. Baroreceptor stimulation reduced respiratory activity, particularly the respiratory frequency, which diminished from 35.7 +/- 3.3 to 33.8 +/- 3.1 breaths min(-1) (P < 0.02) and, following i.v. 8-OH-DPAT, baroreceptor-mediated inhibition of respiratory output was significantly accentuated (P < 0.05); the respiratory frequency declined from 34.5 +/- 3.6 to 26.5 +/- 2.9 breaths min(-1). Increasing aortic blood pressure reduced the respiratory frequency (P < 0.01), but focal dialysis of 10 or 30 mm 8-OH-DPAT had, on average, no effect on the ventilatory inhibition associated with an acute elevation of blood pressure. We conclude that activation of 5-HT(1A) receptors after systemic administration of 8-OH-DPAT enhanced baroreflex-mediated inhibition of ventilation, but this effect cannot be attributed to 5-HT(1A) receptor activation within the rostroventral medulla and caudal raphé.

Comparative anatomical assessment of the piglet as a model for the developing human medullary serotonergic system

Because the piglet is frequently used as a model for developmental disorders of the medullary serotonergic (5-HT) system in the human infant, this review compares the topography and developmental profile of selected 5-HT markers between humans in the first year of life and piglets in the first 60 days of life. The distribution of tryptophan hydroxylase-immunoreactive 5-HT neurons in the human infant medulla is very similar, but not identical, to that in the piglet. One notable difference is the presence of compact clusters of 5-HT neurons at the ventral surface of the piglet medulla. While it lacks these distinctive clusters, the human infant medulla contains potentially homologous 5-HT neurons scattered along the ventral surface embedded in the arcuate nucleus. Each species shows evidence of age-related changes in the 5-HT system, but the changes are different in nature; in the human infant, statistically significant age-related changes are observed in the proportional distribution of medullary 5-HT cells, while in the piglet, statistically significant age-related changes are observed in the levels of 5-HT receptor binding in certain medullary nuclei. Analyses of 5-HT receptor binding profiles in selected nuclei in the two species suggest that the equivalent postnatal ages for 5-HT development in piglets and human infants are, respectively, 4 days and 1 month, 12 days and 4 months, 30 days and 6 months, and 60 days and 12 months. Collectively, when certain species differences are considered, these data support the use of the piglet as a model for the human infant medullary 5-HT system.

Elevated body temperature enhances the laryngeal chemoreflex in decerebrate piglets

Hyperthermia and reflex apnea may both contribute to sudden infant death syndrome (SIDS). Therefore, we investigated the effect of increased body temperature on the inhibition of breathing produced by water injected into the larynx, which elicits the laryngeal chemoreflex (LCR). We studied decerebrated, vagotomized, neonatal piglets aged 3-15 days. Blood pressure, end-tidal CO(2), body temperature, and phrenic nerve activity were recorded. To elicit the LCR, we infused 0.1 ml of distilled water through a polyethylene tube passed through the nose and positioned just rostral to the larynx. Three to five LCR trials were performed with the piglet at normal body temperature. The animal's core body temperature was raised by approximately 2.5 degrees C, and three to five LCR trials were performed before the animal was cooled, and three to five LCR trials were repeated. The respiratory inhibition associated with the LCR was substantially prolonged when body temperature was elevated. Thus elevated body temperature may contribute to the pathogenesis of SIDS by increasing the inhibitory effects of the LCR.

The development of the medullary serotonergic system in the piglet

The anatomy of the 5-HT system in the medulla oblongata is well defined in several vertebrate species, but not in the piglet. A detailed map and developmental profile of this system is particularly important in the piglet because this species increasingly is used as a model for physiological studies of medullary homeostatic control and its disorders in human infancy, especially the sudden infant death syndrome. Tryptophan hydroxylase immunohistochemistry was used to identify 5-HT cells and map their distribution in the medullae of piglets between postnatal days 4 and 30, the putative comparable period to early human infancy. Tritiated (3H)-lysergic acid diethylamide (LSD) binding to 5-HT1A-D and 5-HT2 receptors and 3H-8-hydroxy-2-[di-N-propylamine]tetralin (8-OH-DPAT) binding to 5-HT1A receptors were used to quantify and map the distribution of these serotonin receptors between 4 and 60 postnatal days. The distribution of 5-HT cells was similar to that observed in other vertebrate species, with cell bodies in and lateral to the caudal raphé. Tritiated-LSD and 3H-8-OH-DPAT binding both showed significant age-related changes in select raphé and extra-raphé subnuclei. Taken together, these findings suggest that while the medullary 5-HT cells are topographically in place at birth in the piglet, changes in 5-HT neurotransmission take place during the first 30 days of life, as reflected by changes in patterns of receptor binding. Therefore, the first 30 days of life represent a critical period in the development of the 5-HT system and the homeostatic functions it mediates.

Prolongation of the laryngeal chemoreflex after inhibition of the rostral ventral medulla in piglets: a role in SIDS?

We tested the hypothesis that inhibition of neurons within the rostral ventral medulla (RVM) would prolong the laryngeal chemoreflex (LCR), a putative stimulus in the sudden infant death syndrome (SIDS). We studied the LCR in 19 piglets, age 3-16 days, by injecting 0.05 ml of saline or water into the larynx during wakefulness, non-rapid eye movement (NREM) sleep, and REM sleep, before and after 1 or 10 mM muscimol dialysis in the RVM. Muscimol prolonged the LCR (P < 0.05), and the prolongation was greater when the LCR was stimulated with water compared with saline (P < 0.02). The LCR was longer during NREM sleep than during wakefulness and longest during REM sleep (REM compared with wakefulness). Muscimol had no effect on the likelihood of arousal from sleep after LCR stimulation. We conclude that the RVM provides a tonic facilitatory drive to ventilation that limits the duration of the LCR, and loss of this drive may contribute to the SIDS when combined with stimuli that inhibit respiration.