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Circulating Serotonin,
Catecholamines, and Central
Nervous System Circuitry Related
to Some Cardiorespiratory,
Vascular, and Hematological
Disorders
Fuad Lechin, MD, PhD*
Bertha van der Dijs, MD*
Alex E. Lechin, MD†
*Universidad Central de Venezuela, Institute of Experimental Medicine, Sections of
Neurochemistry, Neurophysiology, Neuroimmunology and Neuropharmacology, Faculty of
Medicine, Caracas, Venezuela
†University of Houston, Department of Clinical Science, Houston, Texas
nuclei send excitatory and inhibitory deal with this syndrome focus on abnor-
axons, respectively, to the C1-Ad (adren- malities in the interaction between
aline neurons) located at the rostral ven- endothelial and smooth muscle cells that
trolateral medullary areas.55-59 These require mediators favoring vasoconstric-
C1-Ad nuclei are directly responsible tion. Pulmonary artery branches are
for adrenal gland secretion as shown by compliant structures with few muscle
retrovirus tracing.60 Conversely, a RP fibers, allowing the pulmonary vascular
serotonergic nucleus sends excitatory bed to function as a high-flow, low-pres-
axons to spinal sympathetic preganglion- sure circuit. Many circulating vasoactive
ic neurons located at the intermediolat- mediators have been postulated to play
eral columns of the thoracic plus lumbar a part in pulmonary hypertension,
sympathetic segments. These pregan- including 5-HT,72-76 which has been
glionic (ACh) sympathetic neurons send found raised during acute periods. With
ACh-preganglionic axons to the post- respect to this, plasma catecholamines
ganglionic (NA) cells, located at the and indolamines (5-HT) in 11 primary
sympathetic ganglia, whose axons consti- pulmonary hypertension cases plus two
tute the sympathetic nerves.61,62 Thus, cases associated with scleroderma and
peripheral sympathetic activity is made three associated with Raynaud disease
up of two separate systems, ruled by two have been investigated. In addition, 16
different CNS circuits. patients with secondary pulmonary
In short, the sympathetic pregan- hypertension (two with vasculitis, three
glionic neurons that send axons to adre- with chronic bronchitis, nine with chron-
nal glands are directly ruled by C1-Ad ic bronchial asthma, and two with obesi-
medullary nuclei, while the sympathetic ty) have been examined. All of these
preganglionic neurons sending axons to patients were investigated during
sympathetic ganglia belong to a separate relapse as well as relief periods.
circuit and receive direct axons from the Although the supine resting plus
NA(A5) plus NA(A6) pontine nucleus.63 orthostasis plus exercise test was per-
However, both central preganglionic formed during the latter period, only
sympathetic neurons receive serotoner- supine-resting assessment was per-
gic modulatory axons. According to the formed during relapse.77-81
above, two different branches of periph- The results showed that although all
eral sympathetic activities exist, and patients with pulmonary hypertension
these two branches converge to form the showed raised f-5-HT plasma values
pool of plasma catecholamines.64-69 One during relapses, opposite profiles were
part of that pool arises from NA-DA registered during relief periods. Patients
released from sympathetic nerves, while who presented with scleroderma and
the other pool (Ad + DA + NA) arises Raynaud disease had very high NA/Ad
from adrenal gland secretion.65-71 plasma ratio and very low plasma tryp-
tophane levels. Conversely, the other
PULMONARY VASOCONSTRICTION patients (those with vasculitis, chronic
Pulmonary vasoconstriction is the main bronchitis, obesity, and bronchial asth-
pathophysiologic disorder in both pri- ma) with pulmonary hypertension but
mary and secondary pulmonary hyper- not scleroderma or Raynaud disease
tension. It is characterized by raised showed low NA/Ad ratio (<2) and nor-
pulmonary vascular resistance, which mal tryptophane plasma levels. These
results in diminished right-heart func- opposing plasma neurotransmitter pro-
tion due to increased right ventricular files showed an absolute neurosympa-
afterload. Pathogenic mechanisms that thetic over adrenal sympathetic
predominance in the former whereas the the subjects are still awake. These find-
opposite profile is seen in the latter ings are consistent with the observation
group. These two plasma catecholamine that the NA pontine activity fades pro-
profiles are similar to those found in gressively throughout sleep periods.
patients with essential and nonessential Patients affected by essential hyperten-
hypertension, respectively.9,10,71 sion showed no NA plasma fall during
The fact that a small dose of oral sleep and, moreover, presented no REM
tianeptine (12.5 mg), a drug that sleep stage, which is consistent with the
enhances 5-HT uptake, suppressed acute hypernoradrenergic activity found in
symptoms in patients with pulmonary this type of hypertensive patient.9-11,71,86,87
hypertension within the first hour of its The investigation of circulating neu-
administration showed that the f-5-HT rotransmitters throughout wake-sleep
plasma peak was responsible for wors- periods in patients showing the “uncop-
ening the symptoms. It is logical to ing” stress profile revealed that they had
assume that the abrupt f-5-HT rise regis- a very low NA/Ad plasma ratio during
tered in secondary pulmonary hyperten- wake and sleep stages alike. The NA
sion is triggered by increased platelet plasma level fell abruptly during the
aggregability, secondary to increased supine-resting period. They did not pres-
plasma levels of Ad that were registered ent the normal SWS fading and abruptly
in these patients. However, this factor is reached the REM sleep stage.12-16,88,89
absent in patients with primary pul- This is explained by the exhaustion of
monary hypertension. The fact that NA pontine neurons registered in
these patients showed greatly raised “uncoping” stressed mammals.88 Plasma
plasma levels of DA during pulmonary catecholamine values are greater than
hypertension relapses should be noted, normal during REM sleep stage in
in accordance with the incontrovertible “uncoping” stressed mammals; however,
fact that not only ACh, but also DA, the NA/Ad ratio shows minimal values
interferes with platelet serotonin at this period because of the absolute
uptake.82,83 Obviously, the circulating DA absence of neural sympathetic activity. It
rise that registered in patients with pri- is consistent with the knowledge that
mary pulmonary hypertension during nocturnal cardiovascular, cerebrovascu-
attacks came from the DA pool existing lar, and respiratory attacks usually occur
at sympathetic terminals, which is not at REM periods in stressed subjects who
only co-secreted with NA but is released show maximal C1-Ad over the NA pon-
before NA during neural sympathetic tine neurons predominance at this sleep
discharge.42,43 For instance, it is known stage.
that NA(A6) plus NA(A5), DR-5-HT, The f-5-HT/p-5-HT plasma ratio reg-
and MR-5-HT pontine neuronal nuclei istered during REM sleep is an appropri-
show progressive reduction of their “fir- ate parameter of the parasympathetic
ing activity” throughout the four slow activity when tested in normal subjects.
wave sleep (SWS) stages and, further, This f-5-HT/p-5-HT ratio profile is paral-
they show zero firing activity during leled by the low blood pressure and min-
REM sleep.84,85 This slope is paralleled imal pulse rate registered in normal
by the NA but not the Ad plasma subjects. These findings are consistent
slope.11,86,87 NA plasma levels fall pro- with the fact that both NA and Ad reach
gressively and reach minimal levels at minimal levels at this period.11
the REM sleep stage whereas Ad plas- ACh interferes with platelet uptake,
ma levels fall abruptly during the first 10 which is consistent with the raised f-5-
minutes of supine resting position, when HT/p-5-HT ratio found during the REM
cells (NK-cell) cytotoxicity as well as the physiology. These results are supported
shifting of TH-2 to TH-1 immunologic not only by some recent therapeutic trial
profile, triggered by the neuropharmaco- failures but also by the ongoing iatro-
logic therapy prescribed to these carci- genic neuropharmachologic medication
noid patients, merits special mention. In prescribed by doctors seeking to treat
1987, neuropharmacologic therapy was depression, sleep disorders, and other
able to improve patients with different psychiatric disorders, whose ANS reper-
types of cancer.22 In addition, the clinical cussions are often ignored.
improvement was paralleled by an
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