Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
Max Delbrück Center for Molecular Medicine, Berlin, Germany.
Shock. 2018 Sep;50(3):331-338. doi: 10.1097/SHK.0000000000001011.
Decompensation, a critical phase in the response to hemorrhage, is characterized by profound sympathoinhibition and the overriding of baroreflex mediated compensation. As sympathoexcitatory neurons of the rostral ventrolateral medulla (RVLM) maintain vasomotor tone and are essential for sympathetic baroreceptor reflex function, the RVLM is the likely mediator. However, how decompensation occurs is a mystery. Our previous work demonstrated that the inhibitory neuropeptide somatostatin (SST), evokes potent sympathoinhibition. Here we test the hypothesis that, in response to hypovolemia, SST in the RVLM evokes sympathoinhibition, driving decompensation and suppressing baroreflex compensation. We evaluated neuronal activation at sites that contain SST mRNA and project to the RVLM and, in SST2A expressing neurons in the RVLM. We determined the effects on cardiovascular and sympathetic responses to haemorrhage, of bilateral blockade of SST2 receptors in both the RVLM and A1 regions. Haemorrhage in conscious rats evoked c-Fos immunoreactivity in the amygdala, periaqueductal gray, and parabrachial nuclei, regions previously associated with hemorrhage, shown to contain SST and project to the RVLM. Although c-Fos labeling was found throughout the ventrolateral medulla, only a small subset of RVLM SST2A receptor expressing neurons were activated, consistent with the idea that these neurons are inhibited during hemorrhage. However, SST2 receptor antagonists bilaterally injected in the RVLM or the A1 region did not affect the decompensation response to hemorrhage. Thus somatostatin in the RVLM does not mediate decompensation. The physiological role associated with somatostatin-induced sympathoinhibition in the RVLM together with the central mechanisms responsible for decompensation remain elusive.
失代偿是对出血反应的一个关键阶段,其特征是深度交感抑制和对压力反射介导的代偿的抑制。由于延髓头端腹外侧区(RVLM)的交感兴奋神经元维持血管张力,并且对交感压力感受器反射功能至关重要,因此 RVLM 可能是介导者。然而,失代偿是如何发生的仍然是个谜。我们之前的工作表明,抑制性神经肽生长抑素(SST)可引起强烈的交感抑制。在这里,我们检验了以下假说:在低血容量时,RVLM 中的 SST 引发交感抑制,导致失代偿并抑制压力反射补偿。我们评估了含有 SST mRNA 并投射到 RVLM 的位点以及 RVLM 中 SST2A 表达神经元中的神经元激活。我们确定了双侧 RVLM 和 A1 区 SST2 受体阻断对心血管和交感对出血反应的影响。在清醒大鼠中,出血引起杏仁核、导水管周围灰质和臂旁核的 c-Fos 免疫反应,这些区域先前与出血有关,并且被证明含有 SST 并投射到 RVLM。尽管在腹外侧髓质中发现了 c-Fos 标记,但只有一小部分 RVLM SST2A 受体表达神经元被激活,这与这些神经元在出血期间被抑制的观点一致。然而,双侧 RVLM 或 A1 区注射 SST2 受体拮抗剂均不能影响出血引起的失代偿反应。因此,RVLM 中的生长抑素不能介导失代偿。与 RVLM 中生长抑素诱导的交感抑制相关的生理作用以及与失代偿相关的中枢机制仍然难以捉摸。