The source of histamine in the CNS is the tuberomammillary nucleus (TMN) of the hypothalamus, which provides widespread innervation to the forebrain, brainstem, and spinal cord. Histamine, acting via H1, H2, and H3 receptors, controls neuronal excitability, synaptic transmission, and synaptic plasticity, both directly and via interactions with other neurotransmitter systems. Histaminergic TMN neurons are active during wakefulness and exert multiple functions. Studies on knockout mice indicate that histamine has a major role in maintenance of arousal and contributes to modulation of circadian rhythms, homeostasis, motor behavior, and cognition. The histaminergic system is involved in narcolepsy and may also contribute to the manifestations of Alzheimer disease (AD), Parkinson disease (PD), Tourette syndrome, and other neurologic disorders. Drugs that affect histamine receptors have therapeutic potential for sleep disorders, pain, epilepsy, and cognitive disorders. These subjects have been recently reviewed.1,–,5 ### Tuberomammillary nucleus and its targets. The TMN of the hypothalamus is the sole source of histaminergic innervation of the CNS1,–,3,6,7 (figure 1). Varicose axons of TMN neurons provide widespread input to all areas of the CNS via 2 ascending pathways that innervate the hypothalamus, basal forebrain, basal ganglia, amygdala, hippocampus, and cerebral cortex; there is one descending pathway that innervates the brainstem, including the cholinergic and monoaminergic nuclei, cerebellum, and spinal cord.2 The most densely innervated target of histaminergic fibers is the hypothalamus. In humans, there is a well-organized network of histaminergic varicose fibers in the cerebral cortex, particularly in lamina I, where the fibers extend parallel to the pial surface.2 Figure 1 The brain histaminergic system The tuberomammillary nucleus (TMN) of the hypothalamus is the sole source of histaminergic innervation of the CNS. Varicose axons of TMN neurons provide widespread input to all areas of the CNS via 2 ascending pathways that innervate the hypothalamus, basal …
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