Innervation of airway smooth muscle. Efferent mechanisms

Abstract

The classical view, with one excitatory (cholinergic) and one inhibitory (noradrenergic) component, of the innervation of airway smooth muscle is incomplete and at least two other, possibly peptidergic, types of innervation must be included when the innervation of airways is considered. A summary of these neuronal components is given in Fig. 1 and their possible origin is outlined. Besides the inhibitory noradrenergic innervation of the airways observed in some species, an inhibitory NANC (i-NANC) innervation has been demonstrated. The polypeptide, VIP, seems to be the most likely candidate for the neurotransmitter in the i-NANC innervation of the airways. The excitatory cholonergic innervation is present in the airways from the trachea down to the peripheral bronchi. In the guinea-pig bronchi an excitatory NANC (e-NANC) innervation has been demonstrated as well. The e-NANC nerves may correspond to chemosensitive primary afferent nerves with substance P or a related tachykinin as transmitter. When the innervation of airway smooth muscle of different mammalian species is compared it is evident that all nerve components except the cholinergic, show a considerable variability among species. The cholinergic innervation seems to be present in all mammalian species whereas the other components may be completely absent from some species. Distinct regional variations in the innervation of the airways may occur, which is exemplified by the distribution of the autonomic innervation in the guinea-pig tracheo-bronchial tree. Cholinergic neuro-transmission in for example the guinea-pig and human airways can be modulated by NA via prejunctional inhibitory alpha 2-adrenoceptors. Furthermore, the e-NANC neuro-transmission in the guinea-pig airways may be modulated by NA or by selective alpha 2-adrenoceptor agonists, acting via prejunctional inhibitory alpha 2-adrenoceptors. The clinical importance of the NANC innervation in relation to asthma is discussed. The i-NANC nerves may exert a modulating effect on bronchoconstriction, and a functional defect would presumably lead to an exaggerated response to constrictor stimuli. The e-NANC nerves in the airways may also be clinically relevant since the transmitter (tachykinins) from these nerves can produce bronchoconstriction and promote inflammation of the airway epithelium, either by direct mechanisms or indirectly by activation of mast cells, and thus contribute to the features of asthma. Therefore, one way to improve the treatment of asthma in the future may be to inhibit the excitatory nerve transmission; the use of alpha 2-adrenoceptor agonists could be a way to modulate these pathways.