Changes in synaptic populations in the spinal dorsal horn following a dorsal rhizotomy in the monkey.

Studies in monkeys have shown substantial neuronal reorganization and behavioral recovery during the months following a cervical dorsal root lesion (DRL; Darian-Smith [2004] J. Comp. Neurol. 470:134-150; Darian-Smith and Ciferri [2005] J. Comp. Neurol. 491:27-45, [2006] J. Comp. Neurol. 498:552-565). The goal of the present study was to identify ultrastructural synaptic changes post-DRL within the dorsal horn (DH). Two monkeys received a unilateral DRL, as described previously (Darian-Smith and Brown [2000] Nat. Neurosci. 3:476-481), which removed cutaneous and proprioceptive input from the thumb, index finger, and middle finger. Six weeks before terminating the experiment at 4 post-DRL months, hand representation was mapped electrophysiologically within the somatosensory cortex, and anterograde tracers were injected into reactivated cortex to label corticospinal terminals. Sections were collected through the spinal lesion zone. Corticospinal terminals and inhibitory profiles were visualized by using preembedding immunohistochemistry and postembedding gamma-aminobutyric acid (GABA) immunostaining, respectively. Synaptic elements were systematically counted through the superficial DH and included synaptic profiles with round vesicles (R), pleomorphic flattened vesicles (F; presumed inhibitory synapses), similar synapses immunolabeled for GABA (F-GABA), primary afferent synapses (C-type), synapses with dense-cored vesicles (D, mostly primary afferents), and presynaptic dendrites of interneurons (PSD). Synapse types were compared bilaterally via ANOVAs. As expected, we found a significant drop in C-type profiles on the lesioned side ( approximately 16% of contralateral), and R profiles did not differ bilaterally. More surprising was a significant increase in the number of F profiles ( approximately 170% of contralateral) and F-GABA profiles ( approximately 315% of contralateral) on the side of the lesion. Our results demonstrate a striking increase in the inhibitory circuitry within the deafferented DH.

Pain and the primate thalamus.

Noxious stimuli that are perceived as painful, are conveyed to the thalamus by the spinothalamic tract (STT) and the spinotrigeminothalamic tracts (vSTT), arising from the dorsal horn of the spinal cord and medulla, respectively. Most investigators have concluded that the thalamic terminus of these pathways include several nuclei of the somatosensory and intralaminar thalamus. Non-noxious stimuli are carried by the dorsal column/medial lemniscal or the trigeminothalamic pathways which terminate in much more restricted regions of the thalamus than do the STT and vSTT systems. Lesions of components of the somatosensory pathways result in profound changes in the circuitry of the recipient thalamic nuclei. Not only are there the expected losses of the injured axons and their synaptic terminations, but there is also a marked reduction of the intrinsic GABAergic circuitry, even though the GABAergic neurons contributing to the circuitry have not been injured directly by lesions of the afferent pathways. Such changes in the inhibitory circuitry observed in experimental animals may explain the abnormal bursting behavior of thalamic neurons found in patients with central deafferentation pain syndromes. One potential approach to treating chronic pain would be to selectively remove the neurons of the superficial dorsal horn (lamina I) that specifically respond to noxious stimuli (NS neurons). A toxin has been developed (SSP saporin) that binds to the substance P receptor of NS neurons, is internalized by the neuron and kills the cell. SSP saporin has been shown to be effective in rats, and we have recently demonstrated that it effectively causes lesions in NS neurons of the lumbar spinal cord in the monkey and reduces the animals' response to noxious cutaneous stimuli. The SSP-saporin administration to the lumbar spinal cord destroys a relatively small number of the total neurons that project into the somatosensory thalamus and does not lead to demonstrable changes in the inhibitory circuitry of the thalamus, in contrast to lesions of major pathways that lead to reductions in the thalamic inhibitory circuitry.

Fetal pain: a systematic multidisciplinary review of the evidence.

CONTEXT: Proposed federal legislation would require physicians to inform women seeking abortions at 20 or more weeks after fertilization that the fetus feels pain and to offer anesthesia administered directly to the fetus. This article examines whether a fetus feels pain and if so, whether safe and effective techniques exist for providing direct fetal anesthesia or analgesia in the context of therapeutic procedures or abortion. EVIDENCE ACQUISITION: Systematic search of PubMed for English-language articles focusing on human studies related to fetal pain, anesthesia, and analgesia. Included articles studied fetuses of less than 30 weeks' gestational age or specifically addressed fetal pain perception or nociception. Articles were reviewed for additional references. The search was performed without date limitations and was current as of June 6, 2005. EVIDENCE SYNTHESIS: Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by nonpainful stimuli and occur without conscious cortical processing. Fetal awareness of noxious stimuli requires functional thalamocortical connections. Thalamocortical fibers begin appearing between 23 to 30 weeks' gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks. For fetal surgery, women may receive general anesthesia and/or analgesics intended for placental transfer, and parenteral opioids may be administered to the fetus under direct or sonographic visualization. In these circumstances, administration of anesthesia and analgesia serves purposes unrelated to reduction of fetal pain, including inhibition of fetal movement, prevention of fetal hormonal stress responses, and induction of uterine atony. CONCLUSIONS: Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester. Little or no evidence addresses the effectiveness of direct fetal anesthetic or analgesic techniques. Similarly, limited or no data exist on the safety of such techniques for pregnant women in the context of abortion. Anesthetic techniques currently used during fetal surgery are not directly applicable to abortion procedures.

The neurodegeneration sequence in prion diseases: evidence from functional, morphological and ultrastructural studies of the GABAergic system.

Loss of the GABAergic system of neurons has been reported to be the first detectable neuropathological change in prion diseases, which features the accumulation of an aberrant isoform of the prion protein (PrP(Sc)). To determine the timing of GABAergic system dysfunction and degeneration and its relationship to PrP(Sc) accumulation during the course of prion disease in Syrian hamsters, we applied 3 approaches: i) quantifying GABA-immunopositive neurons and their processes by light and electron microscopy to test for selective loss; ii) measuring evoked [3H]-GABA release from synaptosomes to test for functional abnormalities; and iii) determining the kinetics of PrP(Sc) accumulation in subcellular fractions to correlate it with GABAergic dysfunction. At the terminal stages of disease, we found a significant increase in the number of GABA-positive and -negative presynaptic boutons with abnormally aggregated synaptic vesicles. At the same stage, we also found an equal degree of GABA-immunopositive and -immunonegative presynaptic bouton loss. In contrast, GABA-positive neocortical cell bodies increased, based on stereologic estimates in the terminal stage of scrapie. In the context of these abnormalities, evoked release of [3H]-GABA from cortical and thalamic synaptosomes was significantly decreased, which correlated well with the accumulation of PrP(Sc) in synaptosomes and cell membrane fractions.

Axonal sprouting of a brainstem-spinal pathway after estrogen administration in the adult female rhesus monkey.

The nucleus retroambiguus (NRA) is located in the caudal medulla oblongata and contains premotor neurons that project to motoneuronal cell groups in the brainstem and spinal cord. NRA projections to the lumbosacral cord are species specific and might be involved in mating behavior. In the female cat, this behavior is estrogen dependent, and estrogen induces axonal sprouting in the NRA-lumbosacral pathway. Because female receptive behavior in primates is not fully dependent on estrogen, the question arises as to whether the capacity of estrogen-induced sprouting is preserved in primates. The effect of estrogen was studied on the NRA-lumbosacral projection with the use of wheat germ agglutinin conjugated to horseradish peroxidase as a tracer in six adult ovariectomized rhesus monkeys with or without estrogen priming (three controls and three treated with 20 microg/day of estradiol benzoate subcutaneously for 14 days). Light microscopy showed that the density of arborizing labeled NRA axons in the lumbosacral cord was greater in estrogen-treated than in control animals. Ultrastructurally, labeled NRA terminal profiles were quantified in motoneuron pools that supply muscles of the abdominal wall, axial, and pelvic floor. After estrogen treatment, the average number of labeled terminal profiles per area of the abdominal wall, axial, and pelvic floor motoneuron pool increased 1.5-, 3.3-, and 2.8-fold, respectively. In the estrogen-treated cases, 8.9% of labeled terminal profiles showed characteristics of growth cones. In controls, such profiles were rarely observed. The results showed that estrogen induces axonal sprouting in a brainstem-spinal pathway in the adult female rhesus monkey. These findings supported the concept that the NRA-lumbosacral pathway may be involved in sexual behavior. Moreover, they demonstrated that a long descending brainstem-spinal tract in adult nonhuman primates retains the capacity for axonal sprouting.

Estrogen receptor-alpha immunoreactive neurons in the ventrolateral periaqueductal gray receive monosynaptic input from the lumbosacral cord in the rhesus monkey.

Estrogen affects female sexual behavior, analgesia, and micturition in mammals. One of the possible sites at which estrogen might exert its effect on these functions is the periaqueductal gray (PAG). The PAG is involved in each of these functions, it receives sensory input relevant to these functions from the lumbosacral cord, and contains estrogen receptor-alpha immunoreactive (ER-alpha IR) neurons. The present light (LM) and electron microscopic (EM) study seeks to determine whether there are monosynaptic projections from the lumbosacral cord to ER-alpha IR neurons in the PAG of the female rhesus monkey. Tracer was injected into the lumbosacral cord to visualize the lumbosacral-PAG projection, and the distribution of ER-alpha IR neurons in the PAG was studied immunohistochemically. The medial part of the ventrolateral caudal PAG received the densest projection from the lumbosacral cord. Another prominent projection was found in the lateral PAG at the intercollicular level. Although ER-alpha IR neurons were widely distributed throughout the PAG, approximately 40% of ER-alpha IR PAG neurons were located as a distinct cluster in the medial portion of the ventrolateral, caudal PAG. Double labeling experiments showed that the location of this cluster precisely overlapped with the densest lumbosacral-PAG projection. EM revealed that axons from the lumbosacral cord made asymmetrical synaptic contacts with unlabeled dendrites and ER-alpha IR neuronal somata in the ventrolateral PAG. It is concluded that there exists a specific, monosynaptic pathway from lumbosacral neurons to ER-alpha expressing PAG neurons in the rhesus monkey. This pathway might be involved in the mechanisms of analgesia, blood pressure, mating behavior, and micturition.

The primate dorsal spinothalamic tract: evidence for a specific termination in the posterior nuclei (Po/SG) of the thalamus.

The spinothalamic tract in primates and other mammals arises primarily from cells in lamina I of the dorsal horn, from lamina V cells and to a lesser extent from other laminae. Most of the neurons of lamina I respond only to noxious mechanical or thermal stimuli. Spinothalamic tract (STT) cells of lamina V tend to respond to both innocuous and noxious stimuli. Recent studies have suggested that the classical STT in the anterolateral quadrant (ALQ) contains primarily the axons of lamina V cells and that the axons of lamina I cells travel more dorsally in the dorsolateral quadrant (DLQ) to constitute the dorsal spinothalamic tract (DSTT). Using the anterograde transport of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) injected into the spinal cord in conjunction with a contralateral anterolateral cordotomy, we have found there is a substantial projection of the DSTT to the posterior nuclei of the caudal-ventral thalamus, designated Po/SG. This projection is almost entirely abolished when the lesion includes the area of spinal cord white matter at the level of the denticulate ligament. Larger lesions that destroy the ALQ and much of the lateral column white matter, but that spare the dorsolateral column white matter in the region of the corticospinal tract, abolish all transport of WGA-HRP to the thalamus. We conclude that the spinothalamic pathway in the non-human primate encompasses a continuous fiber bundle that extends dorsally to include the region of lateral column white matter opposite the denticulate ligament and that the more dorsal aspect of this pathway projects primarily to Po/SG of thalamus.