Additional appendix (5 p.) is pasted onto back end-paper. Bibliography: leaves 219-244. Investigates the complexity of the vagal reflexes arising from the upper gastrointestinal tract by recording single unit vagal afferents and efferents in the ferret. The potential involvement of various neurotransmitters in mediating and modulating gastrointestinal tract inputs is also explored.

Orientadores: Claudio Aparecido Casatti, Roelf Justino Cruz Rizzolo / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-13T07:48:09Z (GMT). No. of bitstreams: 1 Andrade_JoaoCleberTheodorode_D.pdf: 4798610 bytes, checksum: b8d22ab273e3f97ec7f0b085497c5842 (MD5) Previous issue date: 2009 / Resumo: O hormônio concentrador de melanina (MCH) e a orexina A (OXA) são neuromediadores expressos em neurônios distribuídos no diencéfalo, principalmente na área hipotalâmica lateral, que emitem projeções para inúmeras regiões do neuroeixo. Esses neuropeptídeos exercem potente ação orexigênica, estimulando a ingestão alimentar e o controle do balanço energético. Em vista disso, propusemos analisar esses sistemas neuropeptidérgicos no núcleo motor dorsal do nervo vago, um importante grupamento neuronal pré-motor parassimpático responsável pelas modulações da motilidade e secreção do tubo gastrointestinal, que indiretamente colaboram na ingestão alimentar. Para esses propósitos, foram empregados os métodos de transporte neuronal retrógrado e imunoistoquímica. Os principais dados advindos desse estudo neuroanatômico permite concluir que o núcleo motor dorsal do nervo vago apresenta uma distribuição heterogênea da inervação imunorreativa a OXA (OXA-ir) e ao MCH (MCH-ir), com preponderância da inervação OXA-ir. Os neurônios desse núcleo parassimpático que enviam fibras nervosas para a parte abdominal do esôfago, estômago e segmento proximal do duodeno, recebem inúmeros contatos morfológicos dos terminais nervosos OXA-ir ou ao MCH-ir, sugestivos de contatos sinápticos. Finalmente, as aferências diencefálicas OXA-ir ou ao MCH-ir para o DMV, foram elucidadas, revelando que as partes dorsais e laterais da área hipotalâmica lateral são os principais locais de origem dessa inervação neuropeptidérgica. / Abstarct: Melanin-concentrating hormone (MCH) and orexin-A (OXA) are neuromediators expressed in neurons distributed in the diencephalum, mainly in the lateral hypothalamic area, projecting nerve fibers to several parts of the central nervous system. These neuropeptides exert potent orexigenic activity, increasing feeding and controlling the energetic balance. Consequently, these neuropeptidergic systems were evaluated in the dorsal motor nucleus of the vagus nerve, a fundamental premotor parasympathetic nucleus that modulates the motility and secretion of the gastrointestinal tract, indirectly collaborating in the feeding behaviour. For these purposes retrograde neuronal tracing and immunohistochemistry methods were used. The main results from this neuroanatomical study showed that the dorsal motor nucleus of the vagus nerve exhibits a heterogeneous rostro-caudal MCH- or OXA-innervation patterns, being the latter more significant. Parasympathetic neurons that send nerve fibers to subdiafragmatic esophagus, stomach and proximal duodenum receive MCH- or OXA-immunoreactive nerve endings like synapses. Finally, the MCH or OXA-immunoreactive diencephalic afferents to dorsal motor nucleus of the vagus nerve were elucidated. These afferents are mainly from dorsal and lateral parts of the lateral hypothalamic area. / Doutorado / Anatomia / Doutor em Biologia Celular e Estrutural

Os nervos são abundantemente vascularizados em toda sua extensão, por intermédio de uma sucessão de vasos que, por suas consecutivas divisões e anastomoses no interior do nervo, formam uma rede vascular intraneural ininterrupta. Já está bem definido que o número de vasos nutrientes para um nervo em particular varia amplamente, não apenas de indivíduo para indivíduo, como também entre os dois lados do corpo. Nervos maiores não necessariamente recebem mais vasos que nervos menores. Os nervos podem percorrer distâncias consideráveis sem receber um vaso nutriente e o calibre desses vasos varia em amplos intervalos. Desse modo, o número e o tamanho dos vasos, juntamente com a sua distribuição no interior dos nervos estão sujeitos a uma grande variabilidade, não apenas em vários segmentos do mesmo nervo como também no mesmo nervo em diferentes sujeitos. Nosso objetivo, com o presente estudo foi o de realizar uma descrição do padrão longitudinal de vascularização do endoneuro e de avaliar a existência de uma possível correlação entre a área fascicular e a área endoneural ocupada pelos vasos capilares, no nervo vago de ratas da linhagem Wistar-Kyoto, em três diferentes fases da vida: 30, 180 e 360 dias de idade. Para tanto, três animais de cada grupo foram mortos e tiveram seus nervos vagos direitos preparados com técnicas histológicas de rotina para inclusão em resina epóxi. Secções transversais semifinas (0,4 µm) seriadas, obtidas a cada 100 µm de extensão longitudinal do nervo, até o esgotamento completo dos blocos, foram analisadas em nível de microscopia de luz. A morfometria dos fascículos e dos vasos capilares endoneurais, foi realizada com o auxílio de um sistema analisador de imagens computacional. A área fascicular média e a área média ocupada pelos capilares foram calculadas para cada segmento estudado (proximal, médio e distal) e comparadas entre segmentos (estudo longitudinal) e entre os grupos. A correlação entre a área fascicular total e a área endoneural ocupada pelos capilares foi estudada através de uma análise de regressão linear e do cálculo dos coeficientes de correlação. A porcentagem da área fascicular total ocupada pelos capilares endoneurais também foi calculada para cada segmento estudado e comparada entre segmentos e entre os grupos. Nossos resultados mostram que a área fascicular média de todos os segmentos estudados foi significativamente maior nos animais com 180 e 360 dias, comparados aos com 30 dias, em todos os segmentos estudados, acompanhando o ganho ponderal dos animais. Interessantemente, nos animais jovens (30 dias), houve uma tendência ao aumento dos valores dessa área no sentido longitudinal dos nervos, o que não foi observado nos animais mais velhos (180 e 360 dias). A área média dos capilares endoneurais aumentou no sentido longitudinal em todos os grupos estudados. Na comparação entre os grupos, houve uma estabilização da área fascicular média nos animais mais velhos enquanto que houve uma diminuição da área média dos capilares endoneurais com o avançar da idade. A porcentagem da área fascicular total ocupada pelos capilares aumentou, no sentido longitudinal, nos animais jovens (30 dias) e tendeu à estabilidade nos animais mais velhos (180 e 360 dias), havendo nítida diminuição progressiva dessa porcentagem com o avançar da idade. O estudo dos diâmetros dos capilares endoneurais mostrou que esses diâmetros variam amplamente, sem nenhum padrão específico entre segmentos de um mesmo grupo os entre os diferentes grupos. Nossos resultados também mostraram a existência de uma correlação positiva fraca (coeficientes de correlação com valores muito baixos) entre a área fascicular total e a área endoneural ocupada pelos capilares. Esses dados sugerem que a entrada dos capilares no nervo não é acompanhada de um aumento proporcional na área do fascículo. Os dados de diminuição da porcentagem da área fascicular total ocupada pelos capilares com o avançar da idade podem sugerir que os nervos de animais mais velhos possam ser mais susceptíveis aos processos isquêmicos. / Peripheral nerves are abundantly vascularised throughout their length by a succession of vessels which, by their repeated division and anastomosis within the nerve, for an unbroken intraneural vascular network. It is well defined that the number of nutrient vessels to any particular nerve varies greatly not only from subject to subject but also on the two sides of the body. Larger nerves do not necessarily receive more vessels than do smaller nerves. Nerves may run considerable distances without receiving a nutrient vessel and the caliber of the nutrient vessels fluctuates over wide limits. Thus, the number and size of these vessels, together with their distribution within the nerve, are subject to a wide range of variation, not only between various segments of a nerve but also in the same nerve in different specimens. In this way, our objectives were to study the longitudinal pattern of the endoneural vascularisation and, to determine the existence of a correlation between the fascicular total area and the endoneural area occupied by the capillary vessels on the vagus nerve of Wistar-Kyoto female rats, in three different ages. Three animas aged 30, 180 or 360 days were killed and their right vagus nerves were prepared for epoxy resin embedding and light microscopy study, by conventional techniques. Serial semihtin sections (0.4 µm), obtained every 100 µm of the vagus nerve longitudinal extension were measured with the aid of a computer software. The average fascicular area and the average area occupied by the endoneural capillary were obtained for each segment (proximal, medium and distal) and compared between segments (longitudinal study) and between ages. The correlation between the fascicular area and the area occupied by the endoneural capillary was accessed by linear regression analysis and correlation coefficient calculations. The percentage of the total fascicular area occupied by the capillaries was also calculated for each segment and compared between segments and between ages. Our results show that the average fascicular area, in all segments studied, was significantly larger in the older animals (180 and 360 days), compared to the younger (30 days). This was compatible with the weight gain of the animals. Interestingly, in the younger animals, there was a tendency of an increase in the average fascicular area from proximal to distal, and this was not observed in the older animals (180 and 360 days). The average area of the endoneural capillaries increased from proximal to distal in all groups studied. The analysis between groups showed a stabilization of the fascicular area in the older animals while the average capillary area got smaller with ageing. The percentage of the fascicular area occupied by the endoneural capillary vessels increased from proximal to distal in the younger animals (30 days) and got stable in the older (180 and 360 days). There was an obvious decrease in this percentage with ageing. The capillary vessels diameter study showed that this parameter varied considerably, without a established pattern between segments or groups. Our results also show the existence of a weak but positive correlation between the fascicular area and the area occupied by the endoneural capillary. This data suggests that the entrance of blood vessels to the endoneural space is not followed by an increase on the fascicular area. The result of a smaller percentage of the fascicular area occupied by the capillary vessels with ageing suggests that older animals may be more susceptible to nerve ischemia.

Infectious diseases are the worldwide leading cause of morbidity and mortality. Sepsis is the major cause of death in infectious diseases. It is one of the most serious and also one of the most difficult treatable conditions of contemporary medicine. Sepsis is the main cause of death in intensive care units. Causal therapy of sepsis does not yet exist. With a far better understanding of patho/physiological mechanism of sepsis, it is possible to model new preclinical experiments to verify the efficiency and security of new therapeutic procedures. Large animal experiments in progressive sepsis, with the use of domestic porcine, play a vital role. Long-standing experience with this model and similarity to human facilitate the realization of more complex experiments with potential for the relevant translation of results into the subsequent clinical studies on human subjects. The objective of this doctoral dissertation was to assess on the clinically relevant model: 1) the efficiency and security of extracorporeal membrane oxygenation in the event of vasoplegic septic shock; and 2) the benefit of two innovative therapeutic approaches to treatment of sepsis: a) the intravenous administration of mesenchymal stem cells; and b) the activation of the neuro-inflammatory reflex through the vagus nerve stimulation.

Using vagus nerve stimulation (VNS), we sought to determine the contribution of vagal afferents to efferent control of cardiac function. In anesthetized dogs, the right and left cervical vagosympathetic trunks were stimulated in the intact state, following ipsilateral or contralateral vagus nerve transection (VNTx), and then following bilateral VNTx. Stimulations were performed at currents from 0.25 to 4.0 mA, frequencies from 2 to 30 Hz, and a 500-μs pulse width. Right or left VNS evoked significantly greater current-and frequency-dependent suppression of chronotropic, inotropic, and lusitropic function subsequent to sequential VNTx. Bradycardia threshold was defined as the current first required for a 5% decrease in heart rate. The threshold for the right vs. left vagus-induced bradycardia in the intact state (2.91 ± 0.18 and 3.47 ± 0.20 mA, respectively) decreased significantly with right VNTx (1.69 ± 0.17 mA for right and 3.04 ± 0.27 mA for left) and decreased further following bilateral VNTx (1.29 ± 0.16 mA for right and 1.74 ± 0.19 mA for left). Similar effects were observed following left VNTx. The thresholds for afferent-mediated effects on cardiac parameters were 0.62 ± 0.04 and 0.65 ± 0.06 mA with right and left VNS, respectively, and were reflected primarily as augmentation. Afferent-mediated tachycardias were maintained following β-blockade but were eliminated by VNTx. The increased effectiveness and decrease in bradycardia threshold with sequential VNTx suggest that 1) vagal afferents inhibit centrally mediated parasympathetic efferent outflow and 2) the ipsilateral and contralateral vagi exert a substantial buffering capacity. The intact threshold reflects the interaction between multiple levels of the cardiac neural hierarchy.

Background Autonomic regulation therapy involving either vagus nerve stimulation (VNS) or spinal cord stimulation (SCS) represents emerging bioelectronic therapies for heart disease. The objective of this study was to determine if VNS and/or SCS modulate primary cardiac afferent sensory transduction of the ischemic myocardium. Methods Using extracellular recordings in 19 anesthetized canines, of 88 neurons evaluated, 36 ventricular-related nodose ganglia sensory neurons were identified by their functional activity responses to epicardial touch, chemical activation of their sensory neurites (epicardial veratridine) and great vessel (descending aorta or inferior vena cava) occlusion. Neural responses to 1 min left anterior descending (LAD) coronary artery occlusion (CAO) were then evaluated. These interventions were then studied following either: i) SCS [T1-T3 spinal level; 50 Hz, 90% motor threshold] or ii) cervical VNS [15–20 Hz; 1.2 × threshold]. Results LAD occlusion activated 66% of identified nodose ventricular sensory neurons (0.33 ± 0.08–0.79 ± 0.20 Hz; baseline to CAO; p < 0.002). Basal activity of cardiac-related nodose neurons was differentially reduced by VNS (0.31 ± 0.11 to 0.05 ± 0.02 Hz; p < 0.05) as compared to SCS (0.36 ± 0.12 to 0.28 ± 0.14, p = 0.59), with their activity response to transient LAD CAO being suppressed by either SCS (0.85 ± 0.39–0.11 ± 0.04 Hz; p < 0.03) or VNS (0.75 ± 0.27–0.12 ± 0.05 Hz; p < 0.04). VNS did not alter evoked neural responses of cardiac-related nodose neurons to great vessel occlusion. Conclusions Both VNS and SCS obtund ventricular ischemia induced enhancement of nodose afferent neuronal inputs to the medulla.

Key points: The evoked cardiac response to bipolar cervical vagus nerve stimulation (VNS) reflects a dynamic interaction between afferent mediated decreases in central parasympathetic drive and suppressive effects evoked by direct stimulation of parasympathetic efferent axons to the heart. The neural fulcrum is defined as the operating point, based on frequency–amplitude–pulse width, where a null heart rate response is reproducibly evoked during the on-phase of VNS. Cardiac control, based on the principal of the neural fulcrum, can be elicited from either vagus. Beta-receptor blockade does not alter the tachycardia phase to low intensity VNS, but can increase the bradycardia to higher intensity VNS. While muscarinic cholinergic blockade prevented the VNS-induced bradycardia, clinically relevant doses of ACE inhibitors, beta-blockade and the funny channel blocker ivabradine did not alter the VNS chronotropic response. While there are qualitative differences in VNS heart control between awake and anaesthetized states, the physiological expression of the neural fulcrum is maintained. Abstract: Vagus nerve stimulation (VNS) is an emerging therapy for treatment of chronic heart failure and remains a standard of therapy in patients with treatment-resistant epilepsy. The objective of this work was to characterize heart rate (HR) responses (HRRs) during the active phase of chronic VNS over a wide range of stimulation parameters in order to define optimal protocols for bidirectional bioelectronic control of the heart. In normal canines, bipolar electrodes were chronically implanted on the cervical vagosympathetic trunk bilaterally with anode cephalad to cathode (n = 8, ‘cardiac’ configuration) or with electrode positions reversed (n = 8, ‘epilepsy’ configuration). In awake state, HRRs were determined for each combination of pulse frequency (2–20 Hz), intensity (0–3.5 mA) and pulse widths (130–750 μs) over 14 months. At low intensities and higher frequency VNS, HR increased during the VNS active phase owing to afferent modulation of parasympathetic central drive. When functional effects of afferent and efferent fibre activation were balanced, a null HRR was evoked (defined as ‘neural fulcrum’) during which HRR ≈ 0. As intensity increased further, HR was reduced during the active phase of VNS. While qualitatively similar, VNS delivered in the epilepsy configuration resulted in more pronounced HR acceleration and reduced HR deceleration during VNS. At termination, under anaesthesia, transection of the vagi rostral to the stimulation site eliminated the augmenting response to VNS and enhanced the parasympathetic efferent-mediated suppressing effect on electrical and mechanical function of the heart. In conclusion, VNS activates central then peripheral aspects of the cardiac nervous system. VNS control over cardiac function is maintained during chronic therapy.

Vagus nerve stimulation (VNS) currently treats patients with drug-resistant epilepsy, depression, and heart failure. The mild intensities used in chronic VNS suggest that primary visceral afferents and central nervous system activation are involved. Here, we measured the activity of neurons in the nucleus of the solitary tract (NTS) in anesthetized rats using clinically styled VNS. Our chief findings indicate that VNS at threshold bradycardic intensity activated NTS neuron discharge in one-third of NTS neurons. This VNS directly activated only myelinated vagal afferents projecting to second-order NTS neurons. Most VNS-induced activity in NTS, however, was unsynchronized to vagal stimuli. Thus, VNS activated unsynchronized activity in NTS neurons that were second order to vagal afferent C-fibers as well as higher-order NTS neurons only polysynaptically activated by the vagus. Overall, cardiovascular-sensitive and -insen-sitive NTS neurons were similarly activated by VNS: 3/4 neurons with monosynaptic vagal A-fiber afferents, 6/42 neurons with monosynaptic vagal C-fiber afferents, and 16/21 polysynaptic NTS neurons. Provocatively, vagal A-fibers indirectly activated C-fiber neurons during VNS. Elevated spontaneous spiking was quantitatively much higher than synchronized activity and extended well into the periods of nonstimulation. Surprisingly, many polysynaptic NTS neurons responded to half the bradycardic intensity used in clinical studies, indicating that a subset of myelinated vagal afferents is sufficient to evoke VNS indirect activation. Our study uncovered a myelinated vagal afferent drive that indirectly activates NTS neurons and thus central pathways beyond NTS and support reconsideration of brain contributions of vagal afferents underpinning of therapeutic impacts. NEW & NOTEWORTHY Acute vagus nerve stimulation elevated activity in neurons located in the medial nucleus of the solitary tract. Such stimuli directly activated only myelinated vagal afferents but indirectly activated a subpopulation of second- and higher-order neurons, suggesting that afferent mechanisms and central neuron activation may be responsible for vagus nerve stimulation efficacy.

Transcutaneous auricular vagal nerve stimulation (taVNS) is a non-invasive method of activating axons in the auricular branch of the vagus nerve through the concha of the outer ear. taVNS is under investigation as an alternative treatment option for a wide range of disorders. Vagal afferent fibers terminate in the nucleus of the solitary tract (NTS) where information is processed and relayed to higher brain regions influencing sympathetic and parasympathetic systems. Due to extensive neuronal connections, it is likely that taVNS could serve as a treatment option for many disorders, specifically cardiac, migraine, and gastric motility disorders. Human fMRI studies have indicated that taVNS elicits neuronal responses within NTS and spinal trigeminal nucleus (Sp5c). Studies have indicated that caudal NTS (cNTS) has substantial connections with the cardiac system, rostral NTS (rNTS) is relevant for gastric motility, and Sp5c is likely involved in migraine disorders due to meningeal connections. Aberrant neuronal signaling is likely responsible for the development of these disorders, and taVNS has the potential to modulate neuronal activity to reestablish homeostatic signaling. In this study, electrophysiological methods were used to interrogate neuronal activity of 50-70 neurons within cNTS, rNTS, and Sp5c following taVNS. A high-impedance tungsten electrode was placed stereotaxically in 15 male Sprague-Dawley rats anesthetized with chloralose. Changes in neuronal firing rates were investigated during and immediately following taVNS by comparing changes in neuronal activity to baseline levels using the software Spike 2 v9.14. Neurons were classified as negative responders if activity decreased more than 20%, positive responders if activity increased more than 20%, or non-responders if activity changes were less than 20%. Six different taVNS parameters were investigated using three frequencies (20, 100, 250Hz) at two intensity levels (0.5, 1.0mA). Data from this study suggest that taVNS can modulate neuronal activity in a frequency and intensity-dependent manner. The greatest positive activation for all 3 brain regions occurred at 20Hz, 1.0mA stimulation where an average of 46% ± 9% neurons showed increased firing compared to 29% ± 2% positive responders for other paradigms. The greatest negative activation for all 3 regions occurred at 100Hz, regardless of intensity, where an average of 33% ± 1% neurons showed reduced firing compared to 15% ± 2% negative responders for remaining paradigms. Based on what is known about cardiac, migraine, and gastric motility disorders, it is likely that taVNS can be used to modulate activity in NTS and Sp5c to provide beneficial treatment options to patients. Specifically, using paradigms yielding decreased activity in Sp5c could improve migraine symptoms, and paradigms increasing activity in cNTS and rNTS could improve cardiac and gastric motility disorders, respectively.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20755号 / 医博第4285号 / 新制||医||1024(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊佐 正, 教授 宮本 享, 教授 井上 治久 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM