Moderate Acute Intermittent Hypoxia Research Articles

Phrenic Long-term Facilitation Following Severe Acute Intermittent Hypoxia Is Preserved in Geriatric Male Rats

Acute intermittent hypoxia (AIH) elicits a form of respiratory motor plasticity known as phrenic long-term facilitation (pLTF). Both moderate and severe AIH elicit phenotypically similar pLTF but do so via completely distinct cellular mechanisms. With moderate AIH (mAIH), pLTF arises from a serotonin-dominant, adenosine-constrained mechanism. In aged rats, mAIH-induced pLTF is impaired due to increased basal spinal adenosine levels, which constrain serotonin-dependent pLTF. With severe AIH (sAIH), pLTF arises from an adenosine-dominant, serotonin-constrained mechanism. Since spinal adenosine levels are elevated in aged male rats, we hypothesized that age would actually enhance sAIH-induced- pLTF. Young (~3.5 month) and aged (~20 month) male Sprague Dawley rats were urethane anesthetized, artificially ventilated, vagotomized, paralyzed, and exposed to sAIH (3, 5-minute episodes; arterial Po2 = 25-30 mmHg). Integrated phrenic nerve burst activity was measured before (baseline), during hypoxic episodes and 60 minutes after sAIH. Neither baseline phrenic burst amplitude, the short-term hypoxic phrenic response nor pLTF magnitude (assessed as % change in phrenic burst amplitude from baseline to 60 minutes post-sAIH) were different in aged versus young rats (120 ± 22% vs. 98 ± 17%, respectively). Thus, aged male rats preserve the capacity for adenosine driven phrenic motor plasticity. Although we cannot conclude that sAIH-induced pLTF is actually increased, age effects on adenosine versus serotonin-driven plasticity are clearly different. NIH HL148030. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Acute Intermittent Hypoxia with Hypercapnia has Complex effects on Phrenic Long-Term Facilitation that Depend on Delivery in the Rest versus Active Phase in Rats

Exploration of mechanisms giving rise to respiratory motor plasticity, such as phrenic long-term facilitation (pLTF) following acute intermittent hypoxia (AIH), has inspired new therapeutic approaches to treat individuals affected by conditions such as spinal cord injury or other clinical disorders. One key step in the translation between rodent models and humans is the apparent need for hypercapnia (either baseline or within hypoxic episodes) during AIH. Whereas AIH consisting of 15, 1-minute hypoxic episodes (1-minute intervals) elicits robust pLTF in rats, similar protocols have minimal impact in humans—unless PaCO2 levels are increased. Although prior studies report that elevated baseline CO2 actually impairs AIH-induced pLTF in rats, the impact of hypercapnia within hypoxic episodes is not known. Thus, we compared AIH with and without concurrent hypercapnia (AIH versus AIHH) on pLTF in anesthetized rats. Since our laboratory recently reported profound time-of-day effects on pLTF magnitude and/or mechanisms, we also compared AIH versus AIHH-induced pLTF during the daily rest and active phase. We hypothesized that AIHH would enhance pLTF versus AIH in both phases, suggesting it may be a more effective intervention to elicit respiratory motor plasticity and respiratory rehabilitation. pLTF was assessed in anesthetized, paralyzed, vagotomized and ventilated male Sprague-Dawley rats ( n=6 per group) exposed to moderate AIH (arterial PO2 = 40-55mmHg) consisting of: 1) 15, 1-minute hypoxic episodes with concurrent hypercapnia (arterial PCO2 ~50mmHg) or 15, 1-minute episodes of isocapnic hypoxia (baseline arterial PCO2 ~2 mmHg above the recruitment threshold; ~40-42 mmHg). We also compared AIHH versus AIH during the active phase using prior published data (AIHH, n = 4; AIH, n = 7; data from Nair et al., Function, 2023 and Marciante et al., Function, 2023, respectively). Contrary to our hypothesis, pLTF was attenuated 90 minutes post-AIHH (37±8%) versus AIH (83±4%; p<0.001) in the rest phase. In striking contrast, during the active phase, pLTF was greater with AIHH (60±11%) versus AIH (30±4%; P=0.012). These unexpected outcomes demonstrate that time of day (or the rest/active phase) must be considered before adding hypercapnia to an AIH protocol. Although the mechanisms of this difference remain unclear, our results make clear that there is still a great deal to learn about mechanisms of AIH-induced respiratory motor plasticity, including the complex interplay between hypoxia, hypercapnia and their impact on pLTF. Supported by: NIH R01 HL147554 & R01 HL148030 (PI: G. Mitchell). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Brain Derived Neurotrophic Factor (BDNF) Immunolabeling in C4-C5 Spinal Cord of Adult Female Rats Following Acute Intermittent Hypoxia (AIH) Exposure Composed of 5,3-min Hypoxic Episodes (AIH5x3min) at 4-weeks After mid-thoracic SCI

Acute intermittent hypoxia (AIH) induces spinal neural plasticity in both respiratory and non-respiratory somatic motor systems. AIH-induced neural plasticity has been best studied in the respiratory neural control system, where exposure to moderate AIH (9-15% inspired O2), typically composed of 3,5-min hypoxic episodes (AIH3x5min), has been shown to consistently elicit a robust increase in phrenic motor activity due to a serotonin-dependent mechanism that promotes de novo synthesis of BDNF and activation of high affnity BDNF-TrkB receptors to initiate ERK MAP kinase signaling in phrenic motoneurons. Whether other protocols that use a total duration of 15 min of hypoxic exposure, but with an increased number of shorter duration hypoxic episodes ( e.g, AIH5x3min) similarly elicit serotonin-dependent BDNF pathway-mediated neural plasticity mechanisms in this region remains to be determined. To begin to assess this possibility, we evaluated BDNF expression in C4-C5 spinal cord segments containing the phrenic motor nucleus following single exposure to AIH5x3min (12% O2) in urethane-anesthetized spontaneously breathing adult female rats at 4-weeks after mid-thoracic SCI. Experiments using AIH3x5min (12% O2) exposure and intermittent normoxia (Nx, 21% O2) exposure served as controls. At ~60-90 min after the AIH or Nx exposure protocol, the rats were transcardially perfused with saline followed by 4% PFA, and various regions of the CNS, including the C3-C5 spinal cord were removed, post-fixed, and cryoprotected. 20 μm thick transverse sections were then cut to obtain sets of slides for single- or double-label fluorescence IHC staining to localize BDNF protein expression in the C4-C5 spinal cord, including the region containing the phrenic motor nucleus. Preliminary analyses show that both AIH5x3min and AIH3x5min exposures elicit increased BDNF expression when compared to Nx exposure, with both diffuse cytosolic and punctate immunofluorescence labeling in and around neurons within the phrenic motor nucleus region, including labeling of presumptive phrenic motoneurons. No labeling was seen in adjacent tissue sections that were incubated without the primary antibody. Immunofluorescence labeling was also seen in the more medial regions of lamina VIII in the ventral horn, the medial regions of laminae VI and VII, and throughout lamina X; these regions have been reported to contain the V0-V3 classes of spinal interneurons (SpINs) albeit we did not verify BDNF labeling of specific classes of presumptive SpINs. These preliminary observations suggest that AIH5x3min exposure likely recruits a serotonin-dependent BDNF pathway-mediated mechanism for neural plasticity in a manner similar to that seen for AIH3x5min exposure. APS Summer Undergraduate Research Fellowship; DOD CDMRP W81XWH-17-1-0260; NYS DOH SCIRB C37711GG. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Increased spinal adenosine impairs phrenic long-term facilitation in aging rats.

Moderate acute intermittent hypoxia (mAIH) elicits a form of spinal, respiratory motor plasticity known as phrenic long-term facilitation (pLTF). In middle-aged male and geriatric female rats, mAIH-induced pLTF is attenuated through unknown mechanisms. In young adults, mAIH activates competing intracellular signaling cascades, initiated by serotonin 2 and adenosine 2A (A2A) receptors, respectively. Spinal A2A receptor inhibition enhances mAIH-induced pLTF, meaning, serotonin dominates, and adenosine constrains mAIH-induced plasticity in the daily rest phase. Thus, we hypothesized elevated basal adenosine levels in the ventral cervical spinal cord of aged rats shifts this balance, undermining mAIH-induced pLTF. A selective A2A receptor antagonist (MSX-3) or vehicle was delivered intrathecally at C4 in anesthetized young (3-6 mo) and aged (20-22 mo) Sprague-Dawley rats before mAIH (3,5-min episodes; arterial Po2 = 45-55 mmHg). In young males, spinal A2A receptor inhibition enhanced pLTF (119 ± 5%) vs. vehicle (55 ± 9%), consistent with prior reports. In old males, pLTF was reduced to 25 ± 11%, but A2A receptor inhibition increased pLTF to levels greater than in young males (186 ± 19%). Basal adenosine levels in ventral C3-C5 homogenates are elevated two- to threefold in old vs. young males. These findings advance our understanding of age as a biological variable in phrenic motor plasticity and will help guide translation of mAIH as a therapeutic modality to restore respiratory and nonrespiratory movements in older populations afflicted with clinical disorders that compromise movement.NEW & NOTEWORTHY Advanced age undermines respiratory motor plasticity, specifically phrenic long-term facilitation (pLTF) following moderate acute intermittent hypoxia (mAIH). We report that spinal adenosine increases in aged male rats, undermining mAIH-induced pLTF via adenosine 2A (A2A) receptor activation, an effect reversed by selective spinal adenosine 2A receptor inhibition. These findings advance our understanding of mechanisms that impair neuroplasticity, and the ability to compensate for the onset of lung or neural injury with age, and may guide efforts to harness mAIH as a treatment for clinical disorders that compromise breathing and other movements.

Spinal adenosine 2A receptor inhibition restores phrenic long-term facilitation during mild systemic inflammation

Inflammation undermines several forms of neuroplasticity, including phrenic long-term facilitation (pLTF), a form of respiratory motor plasticity elicited by moderate acute intermittent hypoxia (mAIH; 3, 5-min episodes, 5 min intervals; arterial PO2 ~ 40–50 mmHg). Mild inflammation elicited by a low dose of the TLR-4 receptor agonist lipopolysaccharide (LPS; 100 mg/kg, i.p.) abolishes mAIH-induced pLTF by a mechanism that requires spinal p38 MAP kinase and protein phosphatase activity. Neuroinflammation activates microglia and other cells in the CNS, elevating extracellular levels of adenosine—a purine nucleoside known to suppress mAIH-induced pLTF. We hypothesized basal adenosine levels in ventral spinal C 3 -C 5 segments are increased in adult male Sprague-Dawley rats 24 hours post-LPS administration, thereby undermining mAIH-induced pLTF via adenosine 2A receptor (A 2A ) activation. Thus, we predicted that cervical intrathecal administration of the A 2A receptor inhibitor MSX-3 (10 μM, 12 μL) would rescue mAIH-induced pLTF in rats pre-treated with LPS. As predicted, LPS significantly increased basal ventral C 3 -C 5 adenosine levels (p=0.010 vs controls; n=7 per group). In control rats (saline injection, i.p.), MSX-3 enhanced pLTF versus vehicle controls (LPS: 110 ± 16% baseline; controls: 53 ± 6%; p=0.002; each n=6). As expected, mAIH-induced pLTF was abolished in LPS-treated rats (4 ± 6% baseline; n=6). MSX-3 restored mAIH-induced pLTF to levels equivalent to MSX-3 treated control rats (120 ± 14%; p<0.001; n=6; versus LPS controls with MSX-3: p=0.539). Thus, mild LPS-induced inflammation abolishes mAIH-induced pLTF by a mechanism associated with increased spinal adenosine levels and A 2A receptor activation. As we move mAIH forward as a therapeutic modality to improve breathing and non-respiratory movements in people with spinal cord injury or ALS, pretreatment with A 2A receptor inhibitors may offset the undermining effects of systemic inflammation associated with these severe neuromuscular disorders. NIH HL147554, HL148030, T32HL134621 (ABM) and the UF McKnight Brain Institute This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Aging Impairs Phrenic Long‐Term Facilitation in Rats by an Adenosine‐Dependent Mechanism

Phrenic long‐term facilitation (pLTF) is a form of respiratory plasticity elicited by acute intermittent hypoxia (AIH). AIH activates competing intracellular signaling cascades, initiated by phrenic motor neuron serotonin 2 and adenosine 2A (A2A) receptors, respectively. With moderate AIH (mAIH), the serotonin‐dependent Q pathway to phrenic motor facilitation dominates, with an adenosine constraint. Consequently, spinal A2Areceptor inhibition enhances mAIH‐induced pLTF. In middle‐aged male, and geriatric acyclic female rats, pLTF is attenuated through unknown mechanisms. We hypothesize that basal spinal adenosine levels are elevated in aged rats, thereby undermining mAIH‐induced pLTF. Thus, we predict that spinal A2A receptor inhibition in aged male rats will restore pLTF to levels equal to young male rats with A2A receptor inhibition. A selective A2A receptor antagonist (MSX‐3; 10 uM, 12 uL) or vehicle (0.9% sterile saline) were delivered intrathecally (C4) in anesthetized, vagotomized, paralyzed and ventilated young (3‐6 months) and aged (20‐22 months) male Sprague‐Dawley rats prior to mAIH (3, 5 min hypoxic episodes; arterial Po2= 45‐55 mmHg). In young males, mAIH elicits ~ 60% pLTF at 60 min post‐AIH. Spinal A2A receptor inhibition significantly enhanced mAIH‐induced pLTF in young males (119 + 5%; n = 6) vs vehicle controls (55 + 9%; n = 6; p < 0.001) and time controls (12 + 4%; n = 6; p < 0.001). In aged males, A2A receptor inhibition enhanced mAIH‐induced pLTF to a greater extent (186 + 19%; n = 7) vs vehicle controls (25 + 11%; n = 7; p < 0.001) and time controls (3 + 5%; n = 4; p < 0.001). Measured basal adenosine levels in ventral C3‐C5 homogenates were significantly elevated in aged vs young males (p = 0.008). Preliminary data suggest aged female rats (16‐18 months) also have enhanced mAIH‐induced pLTF with A2A receptor inhibition (173+ 24%; n = 3) vs vehicle controls (53 + 7%; n = 3) and time controls (5 + 17%; n = 2) in persistent estrus. These findings advance our understanding of mechanisms whereby age undermines mAIH‐induced phrenic motor plasticity. Understanding age and sex effects on AIH‐induced respiratory motor plasticity is crucial as we harness therapeutic AIH to treat severe neuromuscular disorders that compromise breathing.

Serum Estradiol Level Correlates With Molecules Regulating Phrenic Motoneuron Plasticity

Acute Intermittent Hypoxia (AIH) elicits phrenic long‐term facilitation (pLTF), an important model of respiratory motor plasticity. Although moderate AIH‐induced pLTF exhibits profound age‐dependent sexual dimorphism, little is known concerning the age or sex‐dependent changes in molecules regulating the Q or S pathways to phrenic motor facilitation. AIH elicits pLTF via distinct signaling pathways in phrenic motor neurons initiated by 5HT2A/2B(Q pathway) or 5HT7 & Adenosine 2A receptors (S pathway); these pathways interact via powerful crosstalk inhibition. Moderate AIH (mAIH)‐induced pLTF declines ~50% from 3 to 12 months of age in male rats (Zabka et al., 2001). Gonadectomy abolishes pLTF in young adult males, and it is restored by supplemental testosterone; pLTF is restored due to testosterone conversion into estrogen in the CNS (Zabka et al., 2006). Thus, CNS estrogen must impact keys molecules regulating the Q and/or S pathways to phrenic motor facilitation. Here, we tested the hypothesis that serum estradiol is correlated with keys molecules known to regulate the Q and S pathways in rats. We assessed the mRNA of molecules known to regulate pLTF in ventral cervical spinal homogenates containing the phrenic motor nucleus from young (3 month) and middle‐aged (12 month) male and female Sprague‐Dawley rats; mRNA levels were correlated with serum estradiol levels assessed via ELISA. Spinal cord tissues were preserved in “RNA Later” solution <10 min from harvest, and stored at ‐80°C until mRNA extraction. RT PCR was used to quantify mRNA levels for: serotonin 2A (Htr2a) & 2B (Htr2b) and adenosine 2A receptors (Adora2a); exchange protein activated by cAMP (EPAC); PKA catalytic subunit (Prkaa1); PKA regulatory subunit (Prkar1a); fractalkine (CX3CL1); phosphodiesterase type 4 (pde4b); NOX genes (gp91 and p47); and PKCδ. We found that serum estradiol was positively correlated with mRNA expression of EPAC (r2=0.28, p=0.002), pde4b mRNA (r2=0.15, p=0.029) and adora2a (r2=0.15, p=0.030), but not the other molecules studied. We conclude that serum estradiol may shift the Q‐S pathway balance, although we have not yet demonstrated a causal relationship. An important limitation of this study is that serum estradiol concentration may differ from that in the ventral cervical spinal cord. In future studies, it is important to test the significance in these neurochemical shifts in mechanisms giving rise to the age‐dependent sexual dimorphism in AIH‐induced pLTF.

Acute Intermittent Hypoxia Preconditioning Elicits Age and Sex‐Dependent Changes in Molecules Known to Regulate Phrenic Motor Plasticity

Acute intermittent hypoxia (AIH) elicits a form of respiratory motor plasticity known as phrenic long‐term facilitation (pLTF); preconditioning with daily AIH (dAIH) enhances pLTF, demonstrating metaplasticity. Two additional factors impacting pLTF expression are age and sex: whereas moderate AIH‐induced pLTF decreases with age in males, it increases in middle aged females. Unfortunately, little is known concerning mechanisms of dAIH preconditioning or age‐dependent sexual dimorphism in pLTF. Moderate AIH elicits 2 distinct signaling cascades in phrenic motor neurons initiated by 5HT2A/2B receptors (Q pathway) versus adenosine 2A or 5HT7 receptors (S pathway), respectively. The Q and S pathways interact via mutual cross‐talk inhibition, a powerful regulator of pLTF expression. To begin exploring the hypotheses that dAIH preconditioning and age/sex effects on pLTF can be accounted for by shifts in molecules regulating the Q and S pathways, we assessed mRNA of key molecules known to regulate pLTF in ventral cervical spinal homogenates from segments containing the phrenic motor nucleus from young (3 month) and middle‐aged (12 month) male and female Sprague‐Dawley rats. Rats (n=8/group) were exposed to sham or dAIH for 14 days (15, 1 min hypoxic episodes/day), and sacrificed 24 hours after the last AIH exposure. Tissues were harvested, preserved in RNA stabilizing solution (<10 min), and stored (‐80°C) until mRNA extraction. mRNA levels of molecules that regulate pLTF were assessed via RT PCR, including: serotonin 2A (Htr2a) & 2B (Htr2b); adenosine 2A (Adora2a); exchange protein activated by cAMP (Epac); PKA catalytic subunit (Prkaa1); PKA regulatory subunit (Prkar1a); fractalkine (Cx3cl1); phosphodiesterase type 4 (Pde4b); Gp91 and p47(NOX genes); and the Pkcδisoform. We also quantified protein expression in phrenic motor neurons (via immunofluorescence) for BDNF and adenosine‐1A & ‐2A receptors in rats fixed with 4% paraformaldehyde (n=4/group; analysis via MATLAB codes to quantify optical density in labeled motor neurons). We found significantly more Pde4b, Adora2a, and Pkcδ mRNA in young and older females versus age matched males; Epacwas also elevated, but only in young females (p<0.001). p47 was increased in older rats of both sexes (p<0.01). p47, Cx3cl1, Adora2a and Pkcδ mRNA were reduced by dAIH in older females (p<0.05), but not other groups. There were age‐dependent increases in adenosine 1A (p <0.0001) and 2A (p <0.0001) receptors, and BDNF (p<0.001) protein post‐AIH in both sexes. Thus, there are age, sex and dAIH preconditioning effects on molecules known to regulate the Q and S pathways to phrenic motor facilitation. These novel findings advance our understanding of pLTF, and inform translational research concerning the therapeutic potential of dAIH to treat breathing deficits in individuals of different ages or sex.

Daily acute intermittent hypoxia enhances phrenic motor output and stimulus-evoked phrenic responses in rats.

Plasticity is a hallmark of the respiratory neural control system. Phrenic long-term facilitation (pLTF) is one form of respiratory plasticity characterized by persistent increases in phrenic nerve activity following acute intermittent hypoxia (AIH). Although there is evidence that key steps in the cellular pathway giving rise to pLTF are localized within phrenic motor neurons (PMNs), the impact of AIH on the strength of breathing-related synaptic inputs to PMNs remains unclear. Furthermore, the functional impact of AIH is enhanced by repeated/daily exposure to AIH (dAIH). Here, we explored the effects of AIH versus 2 wk of dAIH preconditioning on spontaneous and evoked phrenic responses in anesthetized, paralyzed, and mechanically ventilated rats. Evoked phrenic potentials were elicited by respiratory cycle-triggered lateral funiculus stimulation at the C2 spinal level delivered before and 60 min post-AIH (or the equivalent in time controls). Charge-balanced biphasic pulses (100 μs/phase) of progressively increasing intensity (100-700 μA) were delivered during the inspiratory and expiratory phases of the respiratory cycle. Although robust pLTF (∼60% from baseline) was observed after a single exposure to moderate AIH (3 × 5 min; 5-min intervals), there was no effect on evoked phrenic responses, contrary to our initial hypothesis. However, in rats preconditioned with dAIH, baseline phrenic nerve activity and evoked responses were increased, suggesting that repeated exposure to AIH enhances functional synaptic strength when assessed using this technique. The impact of daily AIH preconditioning on synaptic inputs to PMNs raises interesting questions that require further exploration.NEW & NOTEWORTHY Two weeks of daily acute intermittent hypoxia (dAIH) preconditioning enhanced stimulus-evoked phrenic responses to lateral funiculus stimulation (targeting respiratory bulbospinal projection to phrenic motor neurons). Furthermore, dAIH preconditioning enhanced baseline phrenic motor output responses to maximal chemoreflex activation in intact rats.

The Influence of Circulating Sex Hormones on Severe Intermittent Hypoxia‐Induced Phrenic Long‐Term Facilitation in Female and Male Rats

Multiple, stimulus-specific cellular mechanisms give rise to phrenic long-term facilitation (pLTF), a well-studied form of respiratory neuroplasticity. We recently demonstrated that circulating sex hormones are critical for induction of pLTF following moderate acute intermittent hypoxia (mAIH; 35-45mmHG PaO2) in adult female rats; mAIH-induced pLTF is not expressed during estrous cycle stages with low circulating 17β-estradiol (the most neuroactive form of estrogen) or following removal of the ovaries, the primary source of circulating sex hormones. Castrated male rats also do not express mAIH-induced pLTF supporting a link between circulating sex hormones and pLTF expression in males as well. More severe AIH protocols (sAIH; 25-35mmHg PaO2) induce pLTF through a unique set of cellular pathways. However, all studies of sAIH-induced pLTF to date have been completed in young-adult, gonadally-intact male rats. Our primary Aims for these studies were two-fold: 1) determine if sAIH-induced pLTF was expressed in female rats across stages of the estrous cycle; and 2) determine if removal of the gonads (ovaries or testicles) influenced expression of sAIH-induced pLTF. We hypothesized that sAIH-induced pLTF would be expressed in females regardless of estrous cycle stage, and that sAIH-induced pLTF would be expressed in both females and males following removal of the gonads. Young adult (12-13 weeks) female and male Sprague-Dawely rats were used for each study. In study 1, pLTF was quantified in female rats on the morning of estrus (low circulating 17β-estradiol) or proestrus (high circulating 17β-estradiol) based on examination of vaginal cell characteristics in vaginal smears using light microscopy. In study 2, ovariectomy or castration was completed at least 7 days prior to pLTF assessments. Contrary to our hypothesis, preliminary results suggest that sAIH-induced pLTF may be significantly influenced by circulating sex hormones. Though female rats exhibited sAIH-induced plasticity across estrous cycle stages, the magnitude of pLTF was associated with circulating estradiol levels. Additionally, removal of the gonads abolished the expression of sAIH-induced pLTF in both female and male rats, suggesting a direct influence of sex hormones on sAIH mechanisms to pLTF. These data provide further evidence that sex hormones may play a critical role in expression of AIH-induced respiratory neuroplasticity.

Cervical spinal injury compromises caudal spinal tissue oxygenation and undermines acute intermittent hypoxia-induced phrenic long-term facilitation

An important model of respiratory motor plasticity is phrenic long-term facilitation (pLTF), a persistent increase in phrenic burst amplitude following acute intermittent hypoxia (AIH). Moderate AIH elicits pLTF by a serotonin-dependent mechanism known as the Q pathway to phrenic motor facilitation. In contrast, severe AIH (greater hypoxemia) increases spinal adenosine accumulation and activates phrenic motor neuron adenosine 2A receptors, thereby initiating a distinct mechanism of plasticity known as the S pathway. Since the Q and S pathways interact via mutual cross-talk inhibition, the balance between spinal serotonin release and adenosine accumulation is an important pLTF regulator. Spinal injury decreases spinal tissue oxygen pressure (PtO2) caudal to injury. Since AIH is being explored as a neurotherapeutic to restore breathing ability after cervical spinal injury, we tested the hypothesis that decreased PtO2 in the phrenic motor nucleus after C2 spinal hemisection (C2Hx) undermines moderate AIH-induced pLTF, likely due to shifts in the adenosine/serotonin balance. We recorded C3/4 ventral cervical PtO2 with an optode, and bilateral phrenic nerve activity in anesthetized, paralyzed and ventilated rats, with and without C2Hx. In intact rats, PtO2 was lower during severe versus moderate AIH as expected. In chronic C2Hx rats (> 8 weeks post-injury), PtO2 was lower during baseline and moderate hypoxic episodes, approaching severe AIH levels in intact rats. After C2Hx, pLTF was blunted ipsilateral, but observed contralateral to injury. We conclude that C2Hx compromises PtO2 near the phrenic motor nucleus and undermines pLTF, presumably due to a shift in the serotonin versus adenosine balance during hypoxic episodes. These findings have important implications for optimizing AIH protocols in our efforts to restore breathing ability with therapeutic AIH in people with chronic cervical spinal injury.

Baseline Arterial CO2 Pressure Regulates Acute Intermittent Hypoxia-Induced Phrenic Long-Term Facilitation in Rats.

Moderate acute intermittent hypoxia (mAIH) elicits a progressive increase in phrenic motor output lasting hours post-mAIH, a form of respiratory motor plasticity known as phrenic long-term facilitation (pLTF). mAIH-induced pLTF is initiated by activation of spinally-projecting raphe serotonergic neurons during hypoxia and subsequent serotonin release near phrenic motor neurons. Since raphe serotonergic neurons are also sensitive to pH and CO2, the prevailing arterial CO2 pressure (PaCO2) may modulate their activity (and serotonin release) during hypoxic episodes. Thus, we hypothesized that changes in background PaCO2 directly influence the magnitude of mAIH-induced pLTF. mAIH-induced pLTF was evaluated in anesthetized, vagotomized, paralyzed and ventilated rats, with end-tidal CO2 (i.e., a PaCO2 surrogate) maintained at: (1) ≤39 mmHg (hypocapnia); (2) ∼41 mmHg (normocapnia); or (3) ≥48 mmHg (hypercapnia) throughout experimental protocols. Although baseline phrenic nerve activity tended to be lower in hypocapnia, short-term hypoxic phrenic response, i.e., burst amplitude (Δ = 5.1 ± 1.1 μV) and frequency responses (Δ = 21 ± 4 bpm), was greater than in normocapnic (Δ = 3.6 ± 0.6 μV and 8 ± 4, respectively) or hypercapnic rats (Δ = 2.0 ± 0.6 μV and −2 ± 2, respectively), followed by a progressive increase in phrenic burst amplitude (i.e., pLTF) for at least 60 min post mAIH. pLTF in the hypocapnic group (Δ = 4.9 ± 0.6 μV) was significantly greater than in normocapnic (Δ = 2.8 ± 0.7 μV) or hypercapnic rats (Δ = 1.7 ± 0.4 μV). In contrast, although hypercapnic rats also exhibited significant pLTF, it was attenuated versus hypocapnic rats. When pLTF was expressed as percent change from maximal chemoreflex stimulation, all pairwise comparisons were found to be statistically significant (p < 0.05). We conclude that elevated PaCO2 undermines mAIH-induced pLTF in anesthetized rats. These findings contrast with well-documented effects of PaCO2 on ventilatory LTF in awake humans.

Mechanisms of severe acute intermittent hypoxia-induced phrenic long-term facilitation.

Moderate acute intermittent hypoxia (mAIH; 35-55 mmHg PaO2) elicits phrenic long-term facilitation (pLTF) by a mechanism that requires activation of Gq protein-coupled serotonin type 2 receptors, MEK/ERK MAP kinase, and NADPH oxidase activity and is constrained by cAMP-PKA signaling. In contrast, severe AIH (sAIH; 25-35 mmHg PaO2) elicits Gs protein-coupled adenosine type 2 A receptor-dependent pLTF. Another Gs protein-coupled receptor, serotonin 7 receptors, elicits phrenic motor facilitation (pMF) by a mechanism that requires exchange protein activated by cyclic AMP (EPAC) and phosphatidylinositol 3-kinase/Akt (PI3K/Akt) activation and is constrained by NADPH oxidase activity. Here, we tested the hypothesis that the same downstream signaling mechanisms giving rise to serotonin 7 (vs. serotonin 2) receptor-induced pMF underlie sAIH-induced pLTF. In anesthetized rats, sAIH-induced pLTF was compared after pretreatment with intrathecal (C4) injections of inhibitors for: 1) EPAC (ESI-05); 2) MEK/ERK (UO126); 3) PKA (KT-5720); 4) PI3K/Akt (PI828); and 5) NADPH oxidase (apocynin). In partial agreement with our hypothesis, sAIH-induced pLTF was abolished by ESI-05 and PI828 and marginally enhanced by apocynin but, surprisingly, was abolished by UO126 and attenuated by KT-5720. Mechanisms of sAIH-induced pLTF reflect elements of both Gq and Gs pathways to pMF, likely as a consequence of the complex, cross-talk interactions between them.NEW & NOTEWORTHY Distinct mechanisms give rise to pLTF induced by moderate and severe AIH. We demonstrate that, unlike moderate AIH, severe AIH-induced pLTF requires EPAC and PI3K/Akt and is marginally constrained by NADPH oxidase activity. Surprisingly, sAIH-induced pLTF requires MEK/ERK activity similar to moderate AIH-induced pLTF and is reduced by PKA inhibition. We suggest sAIH-induced pLTF arises from complex interactions between dominant mechanisms characteristic of moderate versus severe AIH-induced pLTF.

Systemic inflammation suppresses spinal respiratory motor plasticity via mechanisms that require serine/threonine protein phosphatase activity

BackgroundInflammation undermines multiple forms of neuroplasticity. Although inflammation and its influence on plasticity in multiple neural systems has been extensively studied, its effects on plasticity of neural networks controlling vital life functions, such as breathing, are less understood. In this study, we investigated the signaling mechanisms whereby lipopolysaccharide (LPS)-induced systemic inflammation impairs plasticity within the phrenic motor system—a major spinal respiratory motor pool that drives contractions of the diaphragm muscle. Here, we tested the hypotheses that lipopolysaccharide-induced systemic inflammation (1) blocks phrenic motor plasticity by a mechanism that requires cervical spinal okadaic acid-sensitive serine/threonine protein phosphatase (PP) 1/2A activity and (2) prevents phosphorylation/activation of extracellular signal-regulated kinase 1/2 mitogen activated protein kinase (ERK1/2 MAPK)—a key enzyme necessary for the expression of phrenic motor plasticity.MethodsTo study phrenic motor plasticity, we utilized a well-characterized model for spinal respiratory plasticity called phrenic long-term facilitation (pLTF). pLTF is characterized by a long-lasting, progressive enhancement of inspiratory phrenic nerve motor drive following exposures to moderate acute intermittent hypoxia (mAIH). In anesthetized, vagotomized and mechanically ventilated adult Sprague Dawley rats, we examined the effect of inhibiting cervical spinal serine/threonine PP 1/2A activity on pLTF expression in sham-vehicle and LPS-treated rats. Using immunofluorescence optical density analysis, we compared mAIH-induced phosphorylation/activation of ERK 1/2 MAPK with and without LPS-induced inflammation in identified phrenic motor neurons.ResultsWe confirmed that mAIH-induced pLTF is abolished 24 h following low-dose systemic LPS (100 μg/kg, i.p.). Cervical spinal delivery of the PP 1/2A inhibitor, okadaic acid, restored pLTF in LPS-treated rats. LPS also prevented mAIH-induced enhancement in phrenic motor neuron ERK1/2 MAPK phosphorylation. Thus, a likely target for the relevant okadaic acid-sensitive protein phosphatases is ERK1/2 MAPK or its upstream activators.ConclusionsThis study increases our understanding of fundamental mechanisms whereby inflammation disrupts neuroplasticity in a critical population of motor neurons necessary for breathing, and highlights key roles for serine/threonine protein phosphatases and ERK1/2 MAPK kinase in the plasticity of mammalian spinal respiratory motor circuits.

Hypoxia-induced hypotension elicits adenosine-dependent phrenic long-term facilitation after carotid denervation

Moderate acute intermittent hypoxia (AIH) elicits a persistent, serotonin-dependent increase in phrenic amplitude, known as phrenic long-term facilitation (pLTF). Although pLTF was originally demonstrated by carotid sinus nerve stimulation, AIH still elicits residual pLTF in carotid denervated (CBX) rats via a distinct, but unknown mechanism. We hypothesized that exaggerated hypoxia-induced hypotension after carotid denervation leads to greater spinal tissue hypoxia and extracellular adenosine accumulation, thereby triggering adenosine 2A receptor (A2A)-dependent pLTF. Phrenic activity, arterial pressure and spinal tissue oxygen pressure were measured in anesthetized CBX rats. Exaggerated hypoxia-induced hypotension after CBX was prevented via intravenous phenylephrine; without the hypotension, spinal tissue hypoxia during AIH was normalized, and residual pLTF was no longer observed. Spinal A2A (MSX-3), but not serotonin 2 receptor (5-HT2) inhibition (ketanserin), abolished residual pLTF in CBX rats. Thus, pLTF regulation may be altered in conditions impairing sympathetic activity and arterial pressure regulation, such as spinal cord injury.

Differential spinal tissue oxygen profile during moderate and severe acute intermittent hypoxia

Plasticity is a hallmark of the neural system controlling breathing. A frequently studied model of respiratory motor plasticity is phrenic long‐term facilitation (pLTF), a persistent increase in phrenic burst amplitude induced by acute intermittent hypoxia (AIH). Two independent mechanisms underlie pLTF, depending on details of the AIH protocol. For example, moderate AIH (3, 5 min hypoxic episodes of moderate arterial PO2 with 5 min intervals) elicits a form of pLTF that requires intact carotid bodies, raphe neuron spinal serotonin release, and phrenic motor neuron serotonin type 2 receptor activation; this mechanism is known as the Q pathway to phrenic motor facilitation. The same protocol with more severe hypoxic episodes elicits a distinct cellular mechanism known as the S pathway; severe AIH leads to spinal adenosine accumulation and phrenic motor neuron adenosine 2A receptor activation, initiating the S pathway to pLTF. Since these pathways interact via mutual cross‐talk inhibition, intermediate AIH protocols fail to elicit pLTF since the Q and S pathways cancel one another. Thus, the balance of raphe serotonergic neuron activation (fast) versus spinal tissue hypoxia (slower) is a key determinant in regulating pLTF expression. Since the specific levels of spinal tissue hypoxia tipping this balance are not known, we compared spinal tissue oxygen profiles between moderate (PaO2 40 – 50 mmHg) vs severe AIH (PaO2 25 – 30 mmHg). Ventral cervical spinal tissue oxygen pressure (PtO2) and phrenic nerve activity were recorded in anesthetized, paralyzed and ventilated rats (IFO2 = 60%). As reported before, severe AIH elicited greater short‐term hypoxic phrenic responses and pLTF vs moderate AIH. Severe AIH elicited greater decreases in PtO2, reaching a nadir below ~5 mmHg. Following each episode, a transient overshoot in PtO2 was observed, reaching 90 mmHg above baseline conditions. Following the third hypoxic episode, PtO2 remained above baseline for at least 15 minutes post AIH (~ 10 mmHg). With moderate AIH, tissue hypoxia was less severe (PtO2 nadir ~ 16 mmHg), and post‐hypoxia overshoots far less prominent. In summary, spinal tissue oxygen dynamics are complex during AIH protocols; differences in PtO2 profiles likely underlie mechanistic differences in pLTF observed with moderate vs severe AIH. Understanding these dynamics (including the post‐AIH PtO2 “memory”) may help understand how to optimize AIH protocols to maximize plasticity and, potentially, functional benefits when harnessing AIH to restore breathing deficits with neural injury and/or disease.Support or Funding InformationNIH HL147554 and HL148030

Spinal AMP kinase activity differentially regulates phrenic motor plasticity.

Acute intermittent hypoxia (AIH) elicits phrenic motor plasticity via multiple distinct cellular mechanisms. With moderate AIH, phrenic motor facilitation (pMF) requires Gq protein-coupled serotonin type 2 receptor activation, ERK MAP kinase activity, and new synthesis of brain-derived neurotrophic factor. In contrast, severe AIH elicits pMF by an adenosine-dependent mechanism that requires exchange protein activated by cAMP, Akt, and mammalian target of rapamycin (mTOR) activity, followed by new tyrosine receptor kinase B protein synthesis; this same pathway is also initiated by Gs protein-coupled serotonin 7 receptors (5-HT7). Because the metabolic sensor AMP-activated protein kinase (AMPK) inhibits mTOR-dependent protein synthesis, and mTOR signaling is necessary for 5-HT7 but not 5-HT2 receptor-induced pMF, we hypothesized that spinal AMPK activity differentially regulates pMF elicited by these distinct receptor subtypes. Serotonin type 2A receptor [5-HT2A; (±)-2,5-dimethoxy-4-iodoamphetamine hydrochloride] or 5-HT7 (AS-19) receptor agonists were administered intrathecally at C4 (3 injections, 5-min intervals) while recording integrated phrenic nerve activity in anesthetized, vagotomized, paralyzed, and ventilated rats. Consistent with our hypothesis, spinal AMPK activation with 2-deoxyglucose or metformin blocked 5-HT7, but not 5-HT2A receptor-induced pMF; in both cases, pMF inhibition was reversed by spinal administration of the AMPK inhibitor compound C. Thus, AMPK differentially regulates cellular mechanisms of serotonin-induced phrenic motor plasticity.NEW & NOTEWORTHY Spinal AMP-activated protein kinase (AMPK) overactivity, induced by local 2-deoxyglucose or metformin administration, constrains serotonin 7 (5-HT7) receptor-induced (but not serotonin type 2A receptor-induced) respiratory motor facilitation, indicating that metabolic challenges might regulate specific forms of respiratory motor plasticity. Pharmacological blockade of spinal AMPK activity restores 5-HT7 receptor-induced respiratory motor facilitation in the presence of either 2-deoxyglucose or metformin, showing that AMPK is an important regulator of 5-HT7 receptor-induced respiratory motor plasticity.

Cervical spinal 5-HT2A and 5-HT2B receptors are both necessary for moderate acute intermittent hypoxia-induced phrenic long-term facilitation.

Serotonin (5-HT) is a key regulator of spinal respiratory motor plasticity. For example, spinal 5-HT receptor activation is necessary for the induction of phrenic long-term facilitation (pLTF), a form of respiratory motor plasticity triggered by moderate acute intermittent hypoxia (mAIH). mAIH-induced pLTF is blocked by cervical spinal application of the broad-spectrum 5-HT-receptor antagonist, methysergide. However, methysergide does not allow distinctions between the relative contributions of different 5-HT receptor subtypes. Intravenous administration of the Gq protein-coupled 5-HT2A/2C receptor antagonist ketanserin blocks mAIH-induced pLTF when administered before, but not after, mAIH; thus, 5-HT2 receptor activation is necessary for the induction but not maintenance of mAIH-induced pLTF. However, systemic ketanserin administration does not identify the site of the relevant 5-HT2A/2C receptors. Furthermore, this approach does not differentiate between the roles of 5-HT2A versus 5-HT2C receptors, nor does it preclude involvement of other Gq protein-coupled metabotropic 5-HT receptors capable of eliciting long-lasting phrenic motor facilitation, such as 5-HT2B receptors. Here we tested the hypothesis that mAIH-induced pLTF requires cervical spinal 5-HT2 receptor activation and determined which 5-HT2 receptor subtypes are involved. Anesthetized, paralyzed, and ventilated adult male Sprague Dawley rats were pretreated intrathecally with cervical (~C3-C5) spinal injections of subtype selective 5-HT2A/2C, 5-HT2B, or 5-HT2C receptor antagonists before mAIH. Whereas cervical spinal 5-HT2C receptor inhibition had no impact on mAIH-induced pLTF, pLTF was no longer observed after pretreatment with either 5-HT2A/2C or 5-HT2B receptor antagonists. Furthermore, spinal pretreatment with an MEK/ERK MAPK inhibitor blocked phrenic motor facilitation elicited by intrathecal injections of 5-HT2A but not 5-HT2B receptor agonists. Thus, mAIH-induced pLTF requires concurrent cervical spinal activation of both 5-HT2A and 5-HT2B receptors. However, these distinct receptor subtypes contribute to phrenic motor facilitation via distinct downstream signaling cascades that differ in their requirement for ERK MAPK signaling. The demonstration that both 5-HT2A and 5-HT2B receptors make unique contributions to mAIH-induced pLTF advances our understanding of mechanisms that underlie 5-HT-induced phrenic motor plasticity.NEW & NOTEWORTHY Moderate acute intermittent hypoxia (mAIH) triggers a persistent enhancement in phrenic motor output, an effect termed phrenic long-term facilitation (pLTF). mAIH-induced pLTF is blocked by cervical spinal application of the broad-spectrum serotonin (5-HT) receptor antagonist methysergide, demonstrating the need for spinal 5-HT receptor activation. However, the exact type of 5-HT receptors required for initiation of pLTF remains unknown. To the best of out knowledge, the present study is the first to demonstrate that 1) spinal coactivation of two distinct Gq protein-coupled 5-HT2 receptor subtypes is necessary for mAIH-induced pLTF, and 2) these receptors contribute to pLTF via cascades that differ in their requirement for ERK MAPK signaling.

Adenosine 2A Receptor Antagonism in Acute Cervical Contusion/Compression Injury Preserves Serotonin‐Dependent Phrenic Motor Plasticity

Cervical spinal cord injury (cSCI) disrupts descending respiratory neural pathways, causing respiratory muscle paralysis and decreased breathing capacity. Immediately following acute trauma, a suite of pathogenic mechanisms contributes to secondary degeneration and respiratory failure including spinal ischemia, excitotoxicity and inflammation. These events are accompanied by increased extracellular adenosine that activates adenosine receptor signaling cascades. Adenosine 2A receptor (A2AR) antagonism is shown to preserve neurons in neurodegenerative diseases and ischemic injury, likely due to reduced excitotoxicity and inflammation. However, little is known concerning how A2AR activation immediately following cSCI impacts the respiratory control system and its neuromodulatory inputs. Thus, the fundamental hypothesis guiding this study is that A2ARs exert pathogenic effects on respiratory function and plasticity immediately following cSCI. Serotonergic plasticity plays a significant role in the respiratory control network. For example, the phrenic motor system exhibits phrenic long‐term facilitation (pLTF) following moderate acute intermittent hypoxia (AIH), a form of phrenic motor plasticity that requires raphe serotonergic neuron activation. Spinal trauma induces neurodegeneration in descending raphe serotonergic axons, undermining the capacity for pLTF following cSCI. Here, we tested the hypothesis that A2AR antagonism in acute cSCI preserves serotonin‐dependent, AIH‐induced pLTF in adult male Sprague‐Dawley rats with mid‐cervical spinal contusion with compression (cSCC). Addition of a brief compression with dwell time exacerbated the impact of C4/5 contusion as demonstrated by: 1) high death rates (~50% vs &lt;10% without compression); 2) severe paralysis in all limbs for up to 5 days; 3) delays in regaining of the righting reflex; 4) ventilatory deficits when challenged with 7% CO2 + 10.5% O2; and 5) profound neurodegeneration extending rostrally to the brainstem. One week post‐cSCC, pLTF is abolished, consistent with degeneration in raphe serotonergic neurons. However, even a single administration of istradefylline 1‐hour post‐cSCC preserved and even augmented pLTF 1‐week post‐cSCC. Respiratory and locomotor functional studies are in progress. These exciting preliminary data suggest that plasticity outcomes are improved by A2AR antagonism in acute cSCC.Support or Funding InformationNIH OT2OD023854 (SPARC), HL69064, and K12 HD055929 (EGR), and the McKnight Brain Institute.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

BDNF‐dependent phrenic motor facilitation: role of protein synthesis

Moderate acute intermittent hypoxia (mAIH) induces a form of respiratory motor plasticity known as phrenic long‐term facilitation (pLTF) — a persistent increase in inspiratory phrenic motor output that requires cervical spinal serotonin receptor activation and new synthesis of brain‐derived neurotrophic factor (BDNF). One fundamental difference between short‐term (minutes) and long‐term (days) synaptic plasticity is the reliance on transcription versus translation of genes required for protein synthesis. Although it is known that mAIH‐induced pLTF requires new synthesis of BDNF protein (Baker‐Herman et al. 2004), it is unknown if this form of plasticity also requires gene transcription. In turn, neurotrophins such as BDNF regulate synaptic transmission via rapid protein synthesis‐independent versus delayed protein synthesis‐dependent mechanisms. Although BDNF protein synthesis is necessary for mAIH‐induced pLTF, and cervical spinal application of exogenous BDNF is sufficient to elicit phrenic motor facilitation, it is unknown if phrenic motor facilitation requires new‐protein synthesis downstream from BDNF/TrkB signaling. Thus, we tested the hypotheses that: 1) mAIH‐induced pLTF requires transcriptional regulation of new protein synthesis, and 2) if translational regulation of new protein synthesis is necessary for BDNF‐induced phrenic motor facilitation. Experiments were performed on anesthetized, mechanically ventilated adult male Sprague Dawley rats. To inhibit spinal transcription, rats were pre‐treated with cervical spinal intrathecal injections of the transcription inhibitor triptolide, and then exposed to mAIH (3, 5‐min hypoxic episodes, PaO2 35–55 mmHg; 5 min intervals). To explore the requirement for new protein synthesis downstream from BDNF/TrkB signaling, a widely used translation inhibitor (emetine), was injected into the intrathecal space prior to BDNF injections. Intrathecal cervical spinal triptolide injections had no discernible effect on mAIH‐induced pLTF, demonstrating that pLTF does not require gene transcription. On the other hand, pre‐treatment with emetine blocked mAIH‐induced pLTF, confirming that pLTF requires new protein synthesis. Whereas cervical spinal BDNF injections induced phrenic motor facilitation similar to pLTF, its magnitude was unaffected by emetine pre‐treatment. Thus, BDNF/TrkB elicits phrenic motor facilitation via a mechanism that does not require additional protein synthesis. Collectively, our findings suggest that pLTF requires new synthesis of BDNF protein via translation‐dependent, transcription‐independent mechanisms, whereas additional new protein synthesis is not required downstream from BDNF/TrkB signaling. Thus, BDNF‐induced phrenic motor facilitation likely occurs exclusively via covalent modifications of existing proteins, presumably phosphorylation events mediated via BDNF/TrkB dependent activation of PKC‐q (Agosto‐Marlin &amp; Mitchell, 2017).Support or Funding InformationNIH HL69064, HL111598 and the UF McKnight Brain InstituteThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.