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Respiratory Load Compensation Responses in Conscious Animals

Permanent Link: http://ufdc.ufl.edu/UFE0041963/00001

Material Information

Title: Respiratory Load Compensation Responses in Conscious Animals
Physical Description: 1 online resource (144 p.)
Language: english
Creator: Pate, Kathryn
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2010

Subjects

Subjects / Keywords: activity, anxiety, compensation, conscious, diaphragm, load, neural, occlusion, respiratory, stress, tracheal
Veterinary Medicine -- Dissertations, Academic -- UF
Genre: Veterinary Medical Sciences thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The respiratory load compensation reflex is well-characterized in anesthetized animals, but the load compensation response pattern to mechanical respiratory stimuli in conscious animals is variable and appears to be influenced by behavior. This is relevant to our understanding of respiratory obstructive diseases, which evoke load compensation responses in individuals on a regular basis. These studies were undertaken to determine the behavioral response pattern to repeated, transient, tracheal occlusions in conscious rats, understand how stress may contribute to the pattern, and elucidate neural structures underlying these responses. The first study was designed to test the hypothesis that intrinsic, transient, tracheal occlusions (ITTO) would elicit reflexive respiratory and neural load compensation, without changing blood gases, lung compliance, or tracheal integrity. It was known that resistive loads and airway occlusions applied to either inspiration or expiration separately evoked compensation responses including changes in breath volume-timing and increases in respiratory muscle activation. It was also known that previous models used to study load compensation responses to mechanical respiratory stimuli changed blood gases or lung compliance. ITTO was sustained for 2-3 breaths and elicited reflexive respiratory load compensation responses including a prolongation of inspiratory duration (Ti), expiratory duration (Te), an increase in diaphragm activity (EMGdia), and decrease in esophageal pressure (Pes), which is an indication of changes in pleural pressure. Additionally, neural activation in response to repeated ITTO, determined by c-Fos staining, was found in respiratory brainstem and suprapontine brain nuclei, suggesting that there is a neural compensation response to tracheal occlusions, including both sensory and motor components. The second study investigated the hypothesis that the respiratory load compensation response pattern in conscious animals is variable and changes as a result of conditioning. The variability, also observed in humans, has been attributed to between-individual differences in perception. Previous studies applying mechanical loads to breathing acutely in conscious humans and animals showed inconsistent changes in breath-timing but somewhat consistent respiratory motor responses to loads. The initial respiratory load compensation response pattern to ITTO in conscious rats consisted of a prolongation of Te and increase in EMGdia amplitude during occlusions. The change in Te did not habituate. The augmentation of EMGdia during occlusions was greater after ITTO conditioning, suggesting a sensitized behavioral response. These results suggest that the volume-timing reflex may be suppressed by behavioral mechanisms in conscious animals, which includes breath-holding and increases in respiratory muscle activation. The third study investigated the hypothesis that 10 days of ITTO causes stress and anxiety responses in conscious animals. We had evidence from human studies conducted by our laboratory that mechanical loads to breathing were stressful stimuli, and it is known that repeated stressful stimuli cause changes in an animal s basal and acute stress responses. We were also aware that individuals with respiratory obstructive diseases often have affective disorders such as anxiety and depression. After 10 days of ITTO rats had increased basal corticosterone levels, greater adrenal weights, and elevated anxiety levels, determined by the Elevated Plus Maze, compared to animals not receiving tracheal occlusions. Thus, healthy animals develop stress and anxiety responses to repeated, severe airway loading. The final study investigated the hypothesis that the behavioral, stress, and anxiety responses to 10 days of ITTO were mediated by plasticity within respiratory brainstem, stress-related, and suprapontine discriminative and affective neural regions. It was known that areas within the central nervous system were involved in the acute sensory and motor responses to respiratory loading, but how activity in these regions may be modified as a result of repeated loading was unknown. We conditioned animals to 10 days of ITTO or 10 days of handling, and removed brain tissue the following day. The tissue was stained for cytochrome oxidase (CO), which is used as an indicator of changes in neural activity. Significant increases in activity were found in the rostral nucleus of the solitary tract (nTS), caudal periaqueductal gray (PAG), dorsal raphe (DR), ventroposteromedial thalamus (VPM), and anterior insular cortex (AI), supporting our hypothesis and suggesting that respiratory load conditioning causes state changes in the brain that may lead to modulation of subsequent responses to respiratory loads. The results of these studies collectively indicate that ITTO elicits behavioral related neural load compensation responses in conscious animals, and that the pattern of these responses is altered through ITTO conditioning. Repeated ITTO leads to stress and anxiety, supporting the link between respiratory obstructive diseases, stress, and affective disorders.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Kathryn Pate.
Thesis: Thesis (Ph.D.)--University of Florida, 2010.
Local: Adviser: Davenport, Paul W.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2011-08-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0041963:00001

Permanent Link: http://ufdc.ufl.edu/UFE0041963/00001

Material Information

Title: Respiratory Load Compensation Responses in Conscious Animals
Physical Description: 1 online resource (144 p.)
Language: english
Creator: Pate, Kathryn
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2010

Subjects

Subjects / Keywords: activity, anxiety, compensation, conscious, diaphragm, load, neural, occlusion, respiratory, stress, tracheal
Veterinary Medicine -- Dissertations, Academic -- UF
Genre: Veterinary Medical Sciences thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The respiratory load compensation reflex is well-characterized in anesthetized animals, but the load compensation response pattern to mechanical respiratory stimuli in conscious animals is variable and appears to be influenced by behavior. This is relevant to our understanding of respiratory obstructive diseases, which evoke load compensation responses in individuals on a regular basis. These studies were undertaken to determine the behavioral response pattern to repeated, transient, tracheal occlusions in conscious rats, understand how stress may contribute to the pattern, and elucidate neural structures underlying these responses. The first study was designed to test the hypothesis that intrinsic, transient, tracheal occlusions (ITTO) would elicit reflexive respiratory and neural load compensation, without changing blood gases, lung compliance, or tracheal integrity. It was known that resistive loads and airway occlusions applied to either inspiration or expiration separately evoked compensation responses including changes in breath volume-timing and increases in respiratory muscle activation. It was also known that previous models used to study load compensation responses to mechanical respiratory stimuli changed blood gases or lung compliance. ITTO was sustained for 2-3 breaths and elicited reflexive respiratory load compensation responses including a prolongation of inspiratory duration (Ti), expiratory duration (Te), an increase in diaphragm activity (EMGdia), and decrease in esophageal pressure (Pes), which is an indication of changes in pleural pressure. Additionally, neural activation in response to repeated ITTO, determined by c-Fos staining, was found in respiratory brainstem and suprapontine brain nuclei, suggesting that there is a neural compensation response to tracheal occlusions, including both sensory and motor components. The second study investigated the hypothesis that the respiratory load compensation response pattern in conscious animals is variable and changes as a result of conditioning. The variability, also observed in humans, has been attributed to between-individual differences in perception. Previous studies applying mechanical loads to breathing acutely in conscious humans and animals showed inconsistent changes in breath-timing but somewhat consistent respiratory motor responses to loads. The initial respiratory load compensation response pattern to ITTO in conscious rats consisted of a prolongation of Te and increase in EMGdia amplitude during occlusions. The change in Te did not habituate. The augmentation of EMGdia during occlusions was greater after ITTO conditioning, suggesting a sensitized behavioral response. These results suggest that the volume-timing reflex may be suppressed by behavioral mechanisms in conscious animals, which includes breath-holding and increases in respiratory muscle activation. The third study investigated the hypothesis that 10 days of ITTO causes stress and anxiety responses in conscious animals. We had evidence from human studies conducted by our laboratory that mechanical loads to breathing were stressful stimuli, and it is known that repeated stressful stimuli cause changes in an animal s basal and acute stress responses. We were also aware that individuals with respiratory obstructive diseases often have affective disorders such as anxiety and depression. After 10 days of ITTO rats had increased basal corticosterone levels, greater adrenal weights, and elevated anxiety levels, determined by the Elevated Plus Maze, compared to animals not receiving tracheal occlusions. Thus, healthy animals develop stress and anxiety responses to repeated, severe airway loading. The final study investigated the hypothesis that the behavioral, stress, and anxiety responses to 10 days of ITTO were mediated by plasticity within respiratory brainstem, stress-related, and suprapontine discriminative and affective neural regions. It was known that areas within the central nervous system were involved in the acute sensory and motor responses to respiratory loading, but how activity in these regions may be modified as a result of repeated loading was unknown. We conditioned animals to 10 days of ITTO or 10 days of handling, and removed brain tissue the following day. The tissue was stained for cytochrome oxidase (CO), which is used as an indicator of changes in neural activity. Significant increases in activity were found in the rostral nucleus of the solitary tract (nTS), caudal periaqueductal gray (PAG), dorsal raphe (DR), ventroposteromedial thalamus (VPM), and anterior insular cortex (AI), supporting our hypothesis and suggesting that respiratory load conditioning causes state changes in the brain that may lead to modulation of subsequent responses to respiratory loads. The results of these studies collectively indicate that ITTO elicits behavioral related neural load compensation responses in conscious animals, and that the pattern of these responses is altered through ITTO conditioning. Repeated ITTO leads to stress and anxiety, supporting the link between respiratory obstructive diseases, stress, and affective disorders.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Kathryn Pate.
Thesis: Thesis (Ph.D.)--University of Florida, 2010.
Local: Adviser: Davenport, Paul W.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2011-08-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0041963:00001


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RESPIRATORY LOAD COMPENSATION RESPONSES IN CONSCIOUS ANIMALS


By

KATHRYN MACKENZIE PATE














A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

2010

































2010 Kathryn Mackenzie Pate

































To my loving parents









ACKNOWLEDGMENTS

I would first like to thank my mentor, Dr. Paul Davenport, for his guidance during

my Ph.D. career. He took a chance on me, giving me the opportunity to pursue a

doctorate in respiratory physiology without my having extensive research experience or

knowing with conviction my ultimate goals. He has been infinitely patient over the past

years, supporting my various interests and going to bat for me when others might not. I

would also like to thank those on my supervisory committee, including Dr. Donald

Bolser, Dr. Linda Hayward, Dr. Christine Sapienza, and Dr. David Fuller, whose wisdom

has shaped me in innumerable ways and without whom none of this would have been

possible.

This body of work was enhanced by the assistance of individuals who were

generous with their time: Mark Hotchkiss for his aid in the laboratory and with animal

surgeries, Dr. Roger Reep for the use of his laboratory space and troubleshooting with

imaging software, Margaret Stoll for her knowledge of histochemical techniques, and Dr.

Deborah Scheuer for her background in cardiovascular physiology and expertise in

stress. I have learned that collaborations and teamwork do not just make the science

behind research stronger, they make the experience richer.

Dr. Floyd Thompson, Dr. Kevin Anderson, and Dr. Davenport all deserve special

recognition for showing me the joys of teaching. My time spent as a teaching assistant

in their neuroscience, gross anatomy, and respiration courses were some of my most

memorable during my Ph.D. These individuals gave me the priceless gift of knowing

that academia is where I belong. I would also like to thank Dr. Anderson for his

friendship over the years and for bringing me into the world of cycling, which has

become an integral part of my life. He will be greatly missed.









The highest and lowest points during the past years of my doctoral career have all

been shared with my many laboratory members and friends, as only they could

understand the happiness and pain that accompany this process. Dr. Joslyn Ahlgren,

Dr. Carie Reynolds, Dr. Karen Porter, Dr. Pei-Ying Sarah Chan, Dr. Teresa Pitts, Mark

Hotchkiss and soon-to-be-doctor Vipa Bernhardt have all made this such a worthwhile

journey. Every success was celebrated with these amazing individuals, no matter how

insignificant. They have always been available to offer advice and keep me centered

during so many times when I felt off balance.

My family has also been an integral part of my success. Their love and support

have continually been the rock in my life, but especially during the completion of my

Ph.D. I thank my parents and brothers for listening whenever I wanted to share my

excitement or frustration, even when they may not have wanted to hear it again, and

again. I cannot express what it means to have had such unconditional support.

Additionally, I want to express gratitude to my brother, Matthew, who has had the

unfortunate luck of living with me during the last, stressful semester of my Ph.D., and

who has remained a peaceful force in my life during these difficult times.

Finally, I would like to acknowledge Dr. David Julian, who piqued my interest in

physiology as an undergraduate and opened my eyes to the possibility of pursuing a

Ph.D. Without his guidance I would not have discovered the path I am on today.









TABLE OF CONTENTS

page

A C KNOW LEDG M ENTS .......... ..................... ....... .. ......................................... 4

LIS T O F TA B LE S ............. .. ..... ......................................................... ...... ........ 9

LIST OF FIGURES.................................. ......... 10

A BST RA C T ............... ... ..... ......................................................... ...... 12

CHAPTER

1 RESPIRATORY LOAD COMPENSATION AND THE NEURAL CONTROL OF
BREATHING ................................................. ............... 16

Respiratory Load C om pensation ...................................................... ....... 16
A nesthetized R esponses ....................................... .... ............ ............... 17
Conscious Responses........................... ............ ............... 20
Respiratory Brainstem Network .............. .... ........ ............ .... .......... 22
Respiratory-Related Neural Activation Techniques .......... .......... ............ 24
Respiratory Discriminatory Sensory Processing and Detection ............................ 26
Respiratory Affective Sensory Processing ........................ ... ........ ...... 27
Experim ental Approach.............................. ............... 29

2 RESPIRATORY LOAD COMPENSATION AND NEURAL ACTIVATION IN
A N EST H ET IZE D RA TS ........................... .......... ......... ................................. 30

In tro d u c tio n .......... ......... .................................. ......................................... 3 0
M methods ............... .. ........ ............................................................. 32
Animals........................................... ............... 32
Surgical Procedures ............. .................. ......... 32
P ro to c o l ............... .... ..... ............................................................ 3 4
Immunohistochemical Analysis ...................... ..... .......................... 35
D a ta A n a ly s is ............. ......... .. .. .................................. ..... ............... 3 5
Breathing pattern ................ ............................... 35
c-Fos ....................... ..................................... 36
Statistics......................... ......... 36
Results .......... ......... .............................................. ............... 37
Breathing Pattern ..................................... .......................... ............... 37
Fos-like Im m unoreactivity................................... ................ ............... 37
D is c u s s io n ............. ......... .. .............. .. .................................................. 3 9
M edulla........................................... ............... 41
Pons ............... .................................... ....... ..... ..... ......... 43
M idbrain ........................... ............ ............... 44









3 RESPIRATORY LOAD COMPENSATION AND BEHAVIORAL CONDITIONING
IN CONSCIOUS RATS ............. .... ....................... ... ....... ........ 51

Introduction ......... .. ......... .. .................................... .... ... ..... 5 1
M methods ......... .. ......... .......................... .................... ........ 55
Animals........................................... .......... 55
S urgical P procedures ....................... .. ................ .. ............... ........... 55
Diaphragm electrodes .............. ......... .......................... 55
Tracheal cuff .......... ................................................... .............. 56
P rotoco l .............. ........... ...................... ...................... ......... ... 56
A n a lys is ......... ...... ... .. ...... ..................................................... ... 5 8
Results .................... ............................... 59
Timing.................................... ...... ............... 59
EMGdia Activity ......................................... ............... 59
D is c u s s io n ..................................... ......... .. .............................................. 6 0

4 STRESS AND ANXIETY RESPONSES TO REPEATED TRACHEAL
O C C LU S IO N S ..................................................... .................. ............... 7 1

Introduction ........................... ............... 71
Methods ............... ................................. ............... 73
Animals........................................... ............... 73
S urgical Procedures ................................ ......... .............................. 73
P ro to c o l ................................... ............. ............................................... 7 4
A na lyse s .................................................... .................... ............... 76
Results .................... ............................... 77
D is c u s s io n ..................................... ......... .. .............................................. 7 7

5 NEURAL PLASTICITY IN RESPONSE TO REPEATED TRACHEAL
O C C LU S IO N S ..................................................... .................. ............... 86

Introduction ........................... ............... 86
Methods ............... ................................. ............... 90
Animals........................................... ............... 90
S urgical P procedures ................................ ......... .............................. 91
P ro to c o l ................................... ............. ............................................... 9 2
Training ...... ................... ................................. 92
Cytochrom e oxidase (CO ).............................................. .................... 93
A n a ly s e s ................ .................................. ................................. 9 4
Im a g in g ................................. .......................................... ........ ....... 9 4
S tatistics............................................. 94
R e s u lts ................. ................................. 9 5
B ra in ste m .................................................. 9 5
Midbrain..... ................................................. 95
Higher Brain Centers, Discriminative & Affective....................... 95
D is c u s s io n .............. ... .............. ................. .... ..... ................................. 9 5









6 GENERAL DISCUSSION ........ .................. ...... ............... 110

Acute, Anesthetized Respiratory Load Compensation.................................. 110
Conditioned, Conscious Respiratory Load Compensation ......... .... ............... 112
Stress and Affective Responses to ITTO Conditioning in Conscious Animals...... 115
Neural Plasticity Responses to ITTO Conditioning in Conscious Animals............ 118
C o nclusio n ......... .................. ................................ ........................... 122

LIST OF REFERENCES .......... ............ ......... ................ ............... 125

BIOGRAPHICAL SKETCH .............. .. ........ ................. 144









LIST OF TABLES

Table page

2-1 c-Fos expression in brainstem and suprapontine nuclei ................ ............... 50

5-1 Brainstem CO staining after 10 days of ITTO or handling without occlusions.. 109

5-2 Midbrain CO staining after 10 days of ITTO or handling without occlusions..... 109

5-3 Higher brain centers, discriminative, and affective CO staining after 10 days
of ITTO or handling without occlusions........................ .... ........... .... 109









LIST OF FIGURES


Figure page

2-1 EMGdia and Pes traces during ITTO in an intact and tracheostomized animal..... 46

2-2 Inspiratory duration during ITTO in intact and tracheostomized animals............ 46

2-3 Expiratory duration during ITTO in intact and tracheostomized animals ............ 47

2-4 Total breath duration during ITTO in intact and tracheostomized animals.......... 47

2-5 Peak amplitude of the integrated EMGdia trace during ITTO in intact and
tracheostom ized anim als ....................... ............... ............... .............. 48

2-6 Peak negative Pes during ITTO in intact and tracheostomized animals.............. 48

2-7 c-Fos in the caudal nTS after repeated ITTO in a tracheostomized and intact
a n im a l ............. ......... .. .. ......... .. .. ......... ...................................... 4 9

3-1 Diaphragm activity during O on the first and last day of ITTO conditioning. ...... 67

3-2 Timing parameters during C and O breathing during ITTO conditioning. ........... 68

3-3 Relative timing parameters during C and O breathing during ITTO
conditioning .............. .... ............. ............................... .... ........... 69

3-4 Integrated EMGdia activity during C and O breathing during ITTO conditioning.. 70

4-1 Basal plasma Cort levels (pg/dL) after 10 days of ITTO or handling without
occlusions............... .... ............................................ .... .. ........ 84

4-2 Adrenal weights after 10 days of ITTO or handling without occlusions............ 84

4-3 Percent time spent in each section of the EPM before and after 10 days of
ITTO or handling without occlusions.................................................. 85

5-1 CO staining in the rostral nTS after 10 days of ITTO or handling without
o c c lu s io n s .................................................. ................ 1 0 7

5-2 CO staining in the caudal vPAG after 10 days of ITTO or handling without
occlusions ............... .... ...................................... .................. 107

5-3 CO staining in the VPM thalamus after 10 days of ITTO or handling without
occlusions ............... .... ...................................... .................. 108









5-4 CO staining in the Al and Cgl after 10 days of ITTO or handling without
occlusions ............... .... ...................................... .................. 108

6-1 Representation of central nervous system nuclei and pathways involved in
respiratory control ................................. ............................ .............. 124









Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

RESPIRATORY LOAD COMPENSATION RESPONSES IN CONSCIOUS ANIMALS

By

Kathryn Mackenzie Pate

August 2010

Chair: Paul W. Davenport
Major: Veterinary Medical Sciences

The respiratory load compensation reflex is well-characterized in anesthetized

animals, but the load compensation response pattern to mechanical respiratory stimuli

in conscious animals is variable and appears to be influenced by behavior. This is

relevant to our understanding of respiratory obstructive diseases, which evoke load

compensation responses in individuals on a regular basis. These studies were

undertaken to determine the behavioral response pattern to repeated, transient,

tracheal occlusions in conscious rats, understand how stress may contribute to the

pattern, and elucidate neural structures underlying these responses.

The first study was designed to test the hypothesis that intrinsic, transient, tracheal

occlusions (ITTO) would elicit reflexive respiratory and neural load compensation,

without changing blood gases, lung compliance, or tracheal integrity. It was known that

resistive loads and airway occlusions applied to either inspiration or expiration

separately evoked compensation responses including changes in breath volume-timing

and increases in respiratory muscle activation. It was also known that previous models

used to study load compensation responses to mechanical respiratory stimuli changed

blood gases or lung compliance. ITTO was sustained for 2-3 breaths and elicited









reflexive respiratory load compensation responses including a prolongation of

inspiratory duration (Ti), expiratory duration (Te), an increase in diaphragm activity

(EMGdia), and decrease in esophageal pressure (Pes), which is an indication of changes

in pleural pressure. Additionally, neural activation in response to repeated ITTO,

determined by c-Fos staining, was found in respiratory brainstem and suprapontine

brain nuclei, suggesting that there is a neural compensation response to tracheal

occlusions, including both sensory and motor components.

The second study investigated the hypothesis that the respiratory load

compensation response pattern in conscious animals is variable and changes as a

result of conditioning. The variability, also observed in humans, has been attributed to

between-individual differences in perception. Previous studies applying mechanical

loads to breathing acutely in conscious humans and animals showed inconsistent

changes in breath-timing but somewhat consistent respiratory motor responses to

loads. The initial respiratory load compensation response pattern to ITTO in conscious

rats consisted of a prolongation of Te and increase in EMGdia amplitude during

occlusions. The change in Te did not habituate. The augmentation of EMGdia during

occlusions was greater after ITTO conditioning, suggesting a sensitized behavioral

response. These results suggest that the volume-timing reflex may be suppressed by

behavioral mechanisms in conscious animals, which includes breath-holding and

increases in respiratory muscle activation.

The third study investigated the hypothesis that 10 days of ITTO causes stress

and anxiety responses in conscious animals. We had evidence from human studies

conducted by our laboratory that mechanical loads to breathing were stressful stimuli,









and it is known that repeated stressful stimuli cause changes in an animal's basal and

acute stress responses. We were also aware that individuals with respiratory obstructive

diseases often have affective disorders such as anxiety and depression. After 10 days

of ITTO rats had increased basal corticosterone levels, greater adrenal weights, and

elevated anxiety levels, determined by the Elevated Plus Maze, compared to animals

not receiving tracheal occlusions. Thus, healthy animals develop stress and anxiety

responses to repeated, severe airway loading.

The final study investigated the hypothesis that the behavioral, stress, and anxiety

responses to 10 days of ITTO were mediated by plasticity within respiratory brainstem,

stress-related, and suprapontine discriminative and affective neural regions. It was

known that areas within the central nervous system were involved in the acute sensory

and motor responses to respiratory loading, but how activity in these regions may be

modified as a result of repeated loading was unknown. We conditioned animals to 10

days of ITTO or 10 days of handling, and removed brain tissue the following day. The

tissue was stained for cytochrome oxidase (CO), which is used as an indicator of

changes in neural activity. Significant increases in activity were found in the rostral

nucleus of the solitary tract (nTS), caudal periaqueductal gray (PAG), dorsal raphe

(DR), ventroposteromedial thalamus (VPM), and anterior insular cortex (Al), supporting

our hypothesis and suggesting that respiratory load conditioning causes state changes

in the brain that may lead to modulation of subsequent responses to respiratory loads.

The results of these studies collectively indicate that ITTO elicits behavioral related

neural load compensation responses in conscious animals, and that the pattern of these

responses is altered through ITTO conditioning. Repeated ITTO leads to stress and









anxiety, supporting the link between respiratory obstructive diseases, stress, and

affective disorders.









CHAPTER 1
RESPIRATORY LOAD COMPENSATION AND THE NEURAL CONTROL OF
BREATHING

Respiratory Load Compensation

Respiration is a complex physiological process that is carried out continually for

the lifetime of an animal. The system is able to respond to voluntary input and a variety

of mechanical and metabolic stimuli in a way that allows the animal to continue

ventilation through changes in breathing pattern. Early respiratory studies focused on

defining normal respiratory patterns and control mechanisms and were primarily

conducted in anesthetized animals where reflexes and metabolic needs drive the

system. It wasn't until experiments were regularly carried out in conscious humans and

animals that researchers became aware that consciousness plays a major role in

modulating breathing. Voluntary control of breathing is capable of overriding the

expected responses to metabolic needs. It has even been determined that adaptive

responses to stimuli, if experienced repeatedly, can develop into regular breathing

pattern changes through conditioning and learning. Unfortunately, this also means that if

the respiratory system responds to a repeated stimulus in a maladaptive manner,

aberrant ventilatory patterns may arise. In conscious animals, the voluntary and

conscious behavioral changes to breathing are driven by respiratory afferents that

cause suprapontine activation, which is suppressed in anesthetized animals. Cortical

activation leads to respiratory sensations and emotional responses to those sensations,

and it is this combination that ultimately controls breathing in conscious humans and

animals.









Anesthetized Responses

The two components of the respiratory pattern that contribute to ventilation are

breath frequency and tidal volume. Clark and von Euler (Clark & von Euler, 1972)

showed that inspiratory time (Ti) is dependent upon inspiratory volume (Vi) in

anesthetized cats, but that this relationship can change depending upon the type of

anesthesia used. They reported a weak volume-timing (Vt-T) modulation of breathing

pattern in conscious humans. With the respiratory depressant pentobarbitone, the Vt-T

relationship is maintained for eupneic volumes and those well above eupneic values.

When using urethane, however, animals maintained a constant Ti for changing values

of Vi in the eupneic range, and Ti only became volume-dependent for large volumes,

mimicking the pattern observed in the conscious man. The subsequent expiratory

duration (Te) was thought to be dependent upon the preceding Ti. These volume-timing

relationships were abolished after vagotomy in anesthetized animals, indicating that

respiratory Vt-T requires intact vagal afferents.

Zechman and colleagues (Zechman et al., 1976) investigated the role of breath

phase in the Vt-T relationship during eupneic volumes. Extrinsic mechanical loads to

breathing allow for studying respiratory reflex control in response to mechanical stimuli.

Resistive (R) and elastic (E) loads are flow- and volume- dependent, respectively

(Zechman & Davenport, 1978). Zechman and colleagues (Zechman et al., 1976)

hypothesized that the dependence of Te upon Ti and the constant Ti seen during

eupneic volumes would be altered if a R load was applied separately to either the

inspiratory or expiratory breath phase. The response they observed is called the

respiratory load compensation reflex. Applying a R load to one phase of a single breath

causes decreased volume, increased duration, and a return to baseline of volume and









timing parameters for subsequent unloaded breaths in animals (Zechman et al., 1976)

and human infants (Kosch et al., 1986). These responses were vagal-dependent.

Koehler and Bishop (Koehler & Bishop, 1979) confirmed this volume-timing relationship

during the expiratory phase of breathing. For inspiration and expiration, there is a

volume threshold at which the breath phase is terminated that decreases with time.

During a complete occlusion, known as an infinite R load or functional vagotomy, a

change in lung volume is prevented, causing the system to rely upon its inherent

brainstem timing pattern to end one phase of the breath and begin another. The

increase in breath duration associated with occlusion approaches the values obtained

after vagotomy which are prolonged relative to intact animals and unaffected by volume

changes (Zechman et al., 1976).

It was hypothesized that slowly adapting pulmonary stretch receptors (PSR) are

the vagal afferents mediating the volume-dependent reflex control of breath phase

duration (Koehler & Bishop, 1979). Results from Davenport et al. (Davenport et al.,

1981a; Davenport et al., 1984) supported that PSR's were the vagal afferent involved in

mediating the Vt-T response to respiratory loading. Further investigation of PSR-

mediated responses led to the understanding that PSR input modulates Ti through

changes in action potential (spike) frequency and Te through changes in spike number

(Davenport et al., 1981a; Davenport & Wozniak, 1986), suggesting separate brainstem

regulatory mechanisms for Ti and Te. Additionally, Davenport and colleagues

(Davenport et al., 1981c) showed that PSR's respond to airway muscle tension, and it is

the change in tension associated with differing lung volumes that activates PSR's, not

the actual lung volume itself (Davenport et al., 1981b). Thus, the respiratory Vt-T









relationship can also be thought of as an airway transluminal pressure-timing

relationship, with the pressure referring to transmural pressure across the airways

during breathing. The transluminal pressure is further modulated by the smooth muscle

tone of the airways (Davenport et al., 1981b). In addition to volume-timing changes,

load compensation is also characterized by increased respiratory motor output

measured using electromyography (EMG), primarily in the diaphragm (EMGdia) during

inspiratory loading (Lopata et al., 1983) and also in the abdominal muscles during

expiratory loading (Koehler & Bishop, 1979).

PSR's are distributed throughout the smooth muscle of airways and respond to

airway pressure differently depending upon their location. Intra-thoracic PSR's in the

smooth muscle of bronchi and bronchioles transduce information to the central nervous

system (CNS) in phase with lung volume, whereas extra-thoracic receptors in the

smooth muscle of the trachealis muscle transduce information in phase with airflow

(Sant'Ambrogio & Mortola, 1977; Davenport et al., 1981b; Sant'Ambrogio, 1982). Upper

airway afferents have been shown to contribute to the load compensation response

during inspiratory (Webb et al., 1994) but not expiratory (Webb et al., 1996) resistive

loading in anesthetized animals. PSRs in the upper airways send their afferent fibers to

the brainstem via the cervical vagus, superior laryngeal (SLN), and recurrent laryngeal

nerves (RLN) (Sant'Ambrogio et al., 1977; Lee et al., 1992) depending upon their

location. These afferents differentially terminate on separate areas of the nucleus of the

solitary tract (nTS) (Kalia & Mesulam, 1980b, a; Kalia, 1981b). The nTS is part of the

dorsal respiratory group (DRG), a medullary area involved in inspiratory activity.

Preventing PSR input from reaching the brainstem by cutting the vagi abolishes the









modulation of Vt-T during loading and hyperinflation even in neonatal animals (Webb et

al., 1994, 1996). Afferents from PSR's in the trachea have been found to influence

cardiovascular activity (Traxel et al., 1976; Barthelemy et al., 1996) and respiratory

reflexes (Traxel et al., 1976; Remmers & Bartlett, 1977; Citterio et al., 1985). Thus, both

intra- and extra-thoracic vagal PSR's are necessary for the reflexive load compensation

pattern observed in anesthetized animals.

Conscious Responses

Studies in conscious humans and animals are less numerous. Results from

experiments in anesthetized animals provide information about reflexive and neural load

compensation, but do not add to our understanding of behavioral load compensation, or

voluntary modulation of the reflexive patterns. In a study in conscious neonatal lambs

exposed to a single expiratory R load, researchers observed decreased airflow and

prolonged Te which resulted in elevated end-expiratory volume (Watts et al., 1997).

Subsequent unloaded breaths showed decreased Vi, increased expiratory volume (Ve),

and the integrated EMG activity in the larynx and diaphragm remained active as a

compensatory mechanism to help restore lung volume to baseline (Watts et al., 1997).

In conscious goats presented with two consecutive inspiratory loads, the integrated

diaphragm and external abdominal oblique muscle responses were augmented and Ti

increased during the first breath (Hutt et al., 1991). These values remained the same for

the second loaded breath but returned to baseline during unloaded breaths, unlike the

responses seen during expiratory R loading in lambs (Watts et al., 1997). This

difference could be due to the fact that the magnitudes of the R loads were different

(370 cmH20/L/sec in lambs vs. 18 cmH20/L/sec in goats), animal ages were different

neonatess vs. adults), or perhaps that the inspiratory and expiratory phases of breathing









are under separate control mechanisms (Davenport et al., 1981a; Davenport &

Wozniak, 1986; Webb et al., 1994, 1996).

When multiple consecutive inspirations are loaded in conscious ponies, Ti is

prolonged while Te and Vt are decreased during the first breath (Forster et al., 1994).

During the second through fifth loaded breaths, small changes were seen in volume and

timing parameters which stabilized after the fifth breath for the subsequent 2-4 minutes

of loading. The time of EMGdia activation mirrored Ti, and mean EMGdia activity was

elevated during the first loaded breath to a value that remained augmented for

subsequent loaded breaths. During the first recovery breath following loading, Vt and

mean EMGdia activity increased above values during loading but timing parameters did

not change. All parameters progressively returned to control values over the course of

subsequent unloaded breaths. Surprisingly, the loaded and recovery breath

compensation effect persisted even after pulmonary and diaphragmatic deafferentation,

indicating that these afferents quantitatively but not qualitatively modulate the load

compensation response (Forster et al., 1994). These researchers hypothesized that

intercostal afferents and cortical input likely contributed greatly to the observed

response.

In the conscious man, some studies have shown that R loading decreases

volume, prolongs breath duration, and enhances motor output (Axen et al., 1983;

Daubenspeck & Bennett, 1983; Hudgel et al., 1987; Nishino & Kochi, 1994;

Daubenspeck & Rhodes, 1995). In addition, an augmented recovery response to

loading has been documented (Altose et al., 1979), as have greater respiratory

responses to loads of larger magnitudes (Altose et al., 1979; Nishino & Kochi, 1994;









Calabrese et al., 1998). However, there seems to be great variability in response

patterns to respiratory loading and occlusion in conscious humans (Axen et al., 1983;

Daubenspeck & Bennett, 1983; Davenport et al., 1986; Hudgel etal., 1987; Nishino &

Kochi, 1994; Daubenspeck & Rhodes, 1995). Others have documented increases in

volume and decreases in frequency in response to inspiratory R loading (Iber et al.,

1982). Interestingly, load compensation responses that differed between individuals

remained qualitatively similar within the same individual in response to various load

magnitudes (Daubenspeck & Rhodes, 1995). Differing responses may be due to

perceptual differences between individuals (Daubenspeck & Rhodes, 1995).

Respiratory afferents other than those in the airways and in the main inspiratory

muscles must play a role in load compensation in conscious humans and animals.

These other afferents most likely transduce respiratory sensations associated with

loading and airway occlusion. The way a conscious human or animal feels (affective

component) about its breathing may further lead to modulation of the reflexive pattern of

load compensation.

Respiratory Brainstem Network

An intact brainstem respiratory neural network includes multiple nuclei in the

dorsal, ventral, and ventrolateral medulla and dorsolateral pons. These nuclei are

essential for normal breathing rhythm and contribute to respiratory reflexes, including

reflexive load compensation mediated by vagal afferents (Ezure, 1990; Bianchi et al.,

1995; St-John, 1998). Respiratory vagal afferents primarily terminate within the caudal

nTS but can also directly influence pontine respiratory centers to evoke motor

responses (Kalia & Mesulam, 1980b, a). Pontine respiratory centers include the

parabrachial (PBN) and Kolliker-Fuse (KF) nuclei, both of which have reciprocal









connections with the nTS (Herbert et al., 1990). The lateral PBN (IPBN) receives

projections from the nTS and is involved in sympathetic drive (Hayward, 2007). The

extensiveness of the respiratory neural network highlights the important ability of the

respiratory system to respond and adapt to a variety of different stimuli.

Dorsal periaqueductal gray (dPAG) stimulation leads to c-Fos expression in IPBN

subnuclei (Hayward & Castellanos, 2003). The PAG plays a major role in the

descending pain pathway (Cunha et al., 2010), and is a mediator of defensive behaviors

such as freezing, escape, and fear-potentiated startle (Brandao et al., 1994; Cunha et

al., 2010). Electrical stimulation of the dPAG elicits a progression of behaviors

characteristic of an animal exposed to a threat, and these behaviors are accompanied

by increases in mean arterial pressure, heart rate, and respiration (Hilton & Redfern,

1986; Brandao et al., 1990). Hayward and colleagues (Hayward et al., 2003)

disinhibited the dPAG and elicited changes in ventilation, which they further determined

was mediated by the IPBN in part by glutamate receptor activation (Hayward et al.,

2004). The observed increase in respiratory frequency was a result of a decrease in

both inspiratory and expiratory durations. Zhang and colleagues (Zhang et al., 2007)

observed the same increase in respiratory frequency with dPAG stimulation, along with

an increase in EMGdia activity and cardiovascular responses. Stimulation of the caudal

PAG evoked greater respiratory responses than in the rostral PAG, but there was no

difference in cardiovascular responses depending upon region (Zhang et al., 2007).

This same group found that chemical activation of the dPAG potentiated the load

compensation reflex with an increase in breath phase duration and diaphragm activity

associated with inspiratory and expiratory occlusions (Zhang et al., 2009).









Vianna and colleagues (Vianna et al., 2001) showed a progression of behaviors

from alertness and freezing to escape with increased electrical stimulation of the PAG.

The dorsal and ventral regions of the PAG differentially regulate these responses, such

that electrical stimulation of the dorsolateral PAG causes unconditioned freezing in rats

and the ventral PAG (vPAG) mediates conditioned responses (Vianna et al., 2001). The

amygdala shares a critical link with the PAG in the fear circuitry of the brain and is also

involved in both types of aversive responses (Brandao et al., 1994; Davis et al., 1994;

LeDoux, 2000; Martinez et al., 2006). The central nucleus of the amygdala (CeA) is the

site of many convergent inputs and is an important part of fear pathways (LeDoux et al.,

1988; Phillips & LeDoux, 1992; Davis et al., 1993; Davis et al., 1994; Campeau & Davis,

1995; Martinez et al., 2006). The basolateral and lateral amygdala act as the regulators

of information received from aversive stimuli reaching the CeA, the motor output

subnucleus of the amygdala (Campeau & Davis, 1995; Saha, 2005). Our laboratory has

shown (Shahan et al., 2008) that electrical stimulation of the CeA leads to an increase

in respiratory rate in anesthetized rats, likely through output to the PAG. The locus

coeruleus (LC), an area involved in the body's noradrenergic response to stressful

stimuli (Bremner et al., 1996; Van Bockstaele et al., 2001), receives afferent projections

from the CeA, the nTS, and the PAG (Van Bockstaele et al., 2001). It is evident that

respiration is intricately linked with a number of different neural regions, many of which

are involved in defensive, stress, and fear responses.

Respiratory-Related Neural Activation Techniques

There are a number of different methods available for determining neural

activation responses to stimuli. The primary non-invasive techniques for determining

brain activity in response to respiratory stimuli include functional magnetic resonance









imaging (fMRI) (Gozal et al., 1995; von Leupoldt & Dahme, 2005a) and cortical evoked

potentials (CEP) (Davenport et al., 1985; Davenport et al., 1986; Davenport et al., 1993;

Davenport & Hutchison, 2002; Davenport et al., 2006). Inspiratory occlusions lead to

activation in the somatosensory cortex in normal humans (Davenport et al., 1986),

double lung transplant patients (Davenport et al., 2006) and conscious lambs

(Davenport & Hutchison, 2002). Intercostal (Davenport et al., 1993) and phrenic

(Davenport et al., 1985) nerve stimulation also leads to increased activity in the

sensorimotor cortex.

Although these studies have added to our understanding of how the brain

processes respiratory stimuli, they do not provide information about activity at the

individual neuronal level within discrete brain nuclei. Analysis of neural tissue is one

way to obtain more specific information about central nervous system activity patterns in

response to a stimulus, but it requires removal of brain tissue after experimentation and

can therefore only be done in animals. One method that achieves this end is c-Fos

immunohistochemistry. c-Fos is a protein expressed in neurons recently activated and

is used as a marker to determine areas of the brain that have an excitatory response to

specific stimuli (Dragunow & Faull, 1989); however, it cannot differentiate between

sensory or motor activation and indicates little about neural inhibition. c-Fos expression

has been noted in the PAG in response to laryngeal afferent stimulation (Ambalavanar

et al., 1999), and throughout the brain and spinal cord in response to phrenic nerve

stimulation (Malakhova & Davenport, 2001). Another histochemical method is staining

neural tissue for cytochrome oxidase, (CO) an enzyme involved in oxidative metabolism

in the electron transport chain. CO is used to indicate changes in brain steady state









activity levels in response to stimuli (Wong-Riley, 1979; Wong-Riley, 1989; Gonzalez-

Lima & Garrosa, 1991; Hevner et al., 1995), and is therefore best used in studies of

prolonged rather than acute duration. CO can reveal adaptation within brain nuclei, and

neural adaptation has been documented in response to inspiratory resistive loading in

humans (Gozal et al., 1995). Thus, c-Fos immunohistochemistry can be used to

determine neural areas mediating an animal's acute response to a respiratory stimulus,

and CO staining can elucidate neural modulation resulting from repeated respiratory

stimuli.

Respiratory Discriminatory Sensory Processing and Detection

During normal respiration a barrage of sensory information is transmitted by

respiratory afferents about each breath, but rarely do conscious individuals become

aware of these sensations. When presented with a R load to breathing, humans and

animals become aware of their respiration (Zechman & Davenport, 1978; Davenport et

al., 1991). The qualities of breathing are relayed by various respiratory afferents such as

the phrenic (Davenport etal., 1985; Zechman et al., 1985) and intercostal nerves

(Davenport et al., 1993), which ultimately reach the somatosensory cortex, the neural

substrate for discriminative sensations. When respiratory afferents activate this cortical

area in humans and animals, the resulting sensations may cause behavioral changes in

order to enhance or diminish those sensations depending upon their quality (affective

sensations). The activation of the cortex produces CEP's, which have been elicited in

humans and animals in response to respiratory stimuli (Davenport & Hutchison, 2002),

classifying them as respiratory-related evoked potentials (RREP). RREP's are similar in

all species, suggesting respiratory information is processed similarly in humans and

animals.









Afferent information related to respiration may not reach the cortex if it does not

exceed a certain threshold (Chou & Davenport, 2007), is temporally too close to a prior

signal (Chan & Davenport, 2008), or if attention is manipulated (Chan & Davenport,

2009). Additionally, the time required for detecting a load to breathing decreases as the

load magnitude increases (Zechman & Davenport, 1978; Zechman et al., 1985), and is

also dependent upon background respiratory resistance (Zechman et al., 1985).

Detection and magnitude estimation of respiratory loads in the conscious human do not

require vagal feedback (Guz et al., 1966; Zhao et al., 2002a, 2003), nor is cortical

activation during a respiratory load dependent upon the vagi (Zhao et al., 2002b),

supporting the hypothesis that other respiratory afferents contribute to respiratory

sensations and may contribute to the behavioral load compensation response in

conscious animals. Similarly, anesthetizing the glossopharyngeal nerve (Guz et al.,

1966) or the upper airway (Chaudhary & Burki, 1978, 1980; Fitzpatrick et al., 1995)

does not alter load detection thresholds, and upper airway and mouth afferents are not

required for cortical activation during inspiratory occlusions (Davenport et al., 2006).

These studies collectively suggest that although lung, upper airway and mouth afferents

may contribute to load compensation in animals, they are not vital for evoking RREP's,

detecting loads, or estimating the magnitude of loads. Sensory feedback from

respiratory muscles must play a role in these processes (Killian et al., 1980; Killian et

al., 1982; Davenport & Hutchison, 2002), and ultimately influence the load

compensation response in conscious animals.

Respiratory Affective Sensory Processing

Breathing through increased airway resistance causes sensations of discomfort

while breathing, a subjective experience called dyspnea (O'Donnell et al., 2007).









Dyspnea is a primary symptom in respiratory obstructive diseases like chronic

obstructive pulmonary disease (COPD) and asthma (O'Donnell et al., 2007; Bernstein,

2008). Resistive loads are commonly used to experimentally induce and study dyspnea.

Dyspnea includes both a discriminative and affective component (von Leupoldt &

Dahme, 2005b). The discriminative component is relayed to the somatosensory brain

network, which is processed in a similar fashion in both humans and animals

(Davenport et al., 1985; Davenport et al., 1991; Davenport et al., 1993; Davenport &

Hutchison, 2002). The affective component is relayed to parts of the limbic neural

network and shares similarities with the affective component of pain, mostly via

processing in the insular and anterior cingulate cortices (Aleksandrov et al., 2000; von

Leupoldt & Dahme, 2005a; Schon et al., 2008). Individuals diagnosed with COPD have

dyspnea and are often concomitantly diagnosed with affective disorders such as anxiety

and depression (Karajgi et al., 1990; Brenes, 2003; Wagena et al., 2005). Patients

diagnosed with respiratory obstructive diseases lead sedentary lifestyles (ZuWallack,

2007; Bourbeau, 2009) and sedentary behavior can be a symptom of depression

(Roshanaei-Moghaddam et al., 2009). Because dyspnea is such an aversive sensation,

individuals modify their behavior in order to adapt or avoid experiencing the sensation. It

is therefore plausible that repeated respiratory obstructions cause intense sensations of

discomfort, leading to an experience of negative affect. Over time, this negative affect

may result in disorders such as anxiety or depression. Until the link between respiration,

sensations, behavior and mental state is determined we will not fully understand the

multitude of respiratory disease phenotypes, disease progression, or proper treatment

methods.









Experimental Approach


It has been demonstrated that:

Respiratory load compensation responses are seen in anesthetized and conscious
humans and animals. Although the pattern in conscious humans and animals is
less consistently defined, increased respiratory muscle recruitment is always
apparent.

Load compensation relies upon afferent and efferent projections relayed throughout the
central nervous system that have many connections to pathways involved in stress
and defensive behaviors.

Resistive loading and airway occlusion cause dyspnea, which has discriminative and
affective components, and respiratory obstructive diseases are associated with
affective disorders such as anxiety and depression.

Based on these previous studies, this dissertation investigated the following

hypotheses:

Hypothesis 1: Intrinsic, transient tracheal occlusions (ITTO) will evoke respiratory and
neural load compensation responses in anesthetized rats without changing lung
compliance or tracheal integrity.

Hypothesis 2: ITTO in conscious rats will elicit variable respiratory pattern responses
that change after 10 days of ITTO conditioning.

Hypothesis 3: Ten days of ITTO in conscious rats will lead to stress and anxiety
responses.

Hypothesis 4: Respiratory brainstem nuclei, areas involved in stress responses, and
suprapontine regions involved in discriminative and affective respiratory
information processing will show altered activity in response to 10 days of ITTO
conditioning.

The overall goal of this dissertation is to determine the pattern of the respiratory

load compensation response to tracheal occlusions in conscious rats. Urethane-

anesthetized and conscious, vagal-intact, adult, male Sprague-Dawley rats were used.

The behavioral, stress, and neural components of load compensation were investigated.

These results provide a new understanding of the conscious modulation of respiratory

load compensation reflexes.









CHAPTER 2
RESPIRATORY LOAD COMPENSATION AND NEURAL ACTIVATION IN
ANESTHETIZED RATS

Introduction

Respiratory load compensation in anesthetized animals has been characterized as

reflexive and vagal-dependent (Zechman et al., 1976), specifically mediated by

pulmonary stretch receptors (Davenport et al., 1981a; Davenport et al., 1984; Davenport

& Wozniak, 1986). Load compensation has been observed in response to mechanical

challenges to breathing such as resistive or elastic loads applied to the respiratory

circuit (Zechman & Davenport, 1978). The stereotypical response to a resistive load

applied to one phase of the breath included a decrease in volume inspired (Vi) or

expired (Ve) for the duration of the load and an increase in the loaded breath phase

duration (Zechman et al., 1976). The volume-timing (Vt-T) parameters of the unloaded

phase of the breath were unchanged. The Vt-T values obtained from complete

respiratory occlusion approached those seen after vagotomy, including long loaded

phase duration (Zechman et al., 1976). Load compensation is also characterized by

increased respiratory motor output, measured from respiratory muscle

electromyography (EMG) primarily in the diaphragm (Lopata et al., 1983), although

abdominal muscle responses are also observed (Koehler & Bishop, 1979).

Load compensation has brainstem and suprapontine neural components. The

primary non-invasive techniques for imaging brain activity in response to respiratory

stimuli includes functional magnetic resonance imaging (fMRI) (Gozal et al., 1995; von

Leupoldt & Dahme, 2005a) and cortical evoked potentials (CEP) (Davenport et al.,

1985; Davenport et al., 1993; Davenport & Hutchison, 2002; Davenport et al., 2006), but

these methods can be too general and do not provide information about activity at the









individual neuronal level. Analysis of neural tissue is one way to obtain more specific

information about activity patterns in response to a stimulus, but it requires removal of

brain tissue after experimentation and can therefore only be done in animals. One

method that achieves this end is c-Fos immunohistochemistry. c-Fos is a protein

expressed in neurons recently activated and is used as a metabolic marker to determine

areas of the brain that respond to specific stimuli (Dragunow & Faull, 1989). c-Fos

expression has been noted in the periaqueductal gray (PAG) in response to laryngeal

afferent stimulation (Ambalavanar et al., 1999), and throughout the brain and spinal

cord in response to phrenic nerve stimulation (Malakhova & Davenport, 2001).

Determining mechanistically how increased resistances during breathing affect the

respiratory pattern, motor output, and neural response is vital to understanding aspects

of respiratory obstructive diseases, which are characterized by elevated airway

resistance. These diseases include chronic obstructive pulmonary disease (COPD),

asthma, and obstructive sleep apnea (OSA). Researchers have utilized two primary

methods for increasing airway resistance. Bronchoconstriction, such as methacholine

challenge, is used to elicit intrinsic, non-specific, sustained mechanical loading.

Bronchoconstriction can also reduce lung compliance, induce lung inflammation and

change blood gases (Wiester et al., 1990), preventing the specific mechanical effects of

loading from being evaluated. Alternatively, R loads can be applied extrinsically at the

mouth or via a tracheal stoma, enabling load duration and intensity to be controlled.

However, extrinsic loading does not model the increase in airway resistance associated

with intrinsic obstructions occurring in individuals with COPD, asthma, or OSA.









Our laboratory has developed a model of tracheal occlusions in anesthetized rats

that produces increases in airway resistance without changing lung compliance. These

intrinsic, transient tracheal obstructions (ITTO) elicit load compensation Vt-T and

diaphragm activity changes. The neural substrates involved in mediating the load

compensation response were investigated using immunohistochemistry. It was

hypothesized that ITTO in the rat would elicit a load compensation respiratory motor

pattern response and neuronal activation, and the neurons activated by the mechanical

load will express c-Fos within brainstem and suprapontine brain nuclei.

Methods

Animals

These experiments were performed on male Sprague-Dawley rats (360.5 77.4

g). The animals were housed two to a cage in the University of Florida animal care

facility where they were exposed to a 12 h light/12 h dark cycle. The experimental

protocol was reviewed and approved by the Institutional Animal Care and Use

Committee of the University of Florida.

Surgical Procedures

All animals were anesthetized with urethane (1.3g/kg, ip) and anesthesia was

supplemented as needed (20 mg/ml). Anesthetic depth was verified by the absence of a

withdrawal reflex to a rear paw pinch. Body temperature was measured with a rectal

probe and maintained at 380C using a heating pad. Animals were spontaneously

breathing room air.

The right femoral artery was cannulated using a saline-filled catheter (Micro-

Renathane, 0.033 outer diameter, Braintree Scientific, Inc.) connected to a calibrated

differential pressure transducer (Konigsberg). A saline-filled tube (PE90) was passed









through the mouth into the esophagus and connected to a second calibrated pressure

transducer to measure esophageal pressure (Pes). Both pressure signals were amplified

(Stoelting; Wood Dale, IL), digitized at 1kHz [Cambridge Electronics Designs (CED)

1401 computer interface; Cambridge, UK], computer processed (Spike2, Cambridge

Electronics Design) and stored for subsequent analysis. Pleural pressure changes were

inferred from relative changes in Pes.

Diaphragm EMG (EMGdia) was recorded with Teflon-coated wire electrodes,

threaded through 25 gauge needles. The distal end of the wires were bared and bent to

form a hook. With the animal in a supine position, the right ribcage was lifted and the

needle was inserted in a rostral and dorsal direction through an incision in the skin. The

needle was retracted and the hooked tip of the electrode remained in the costal portion

of the right side of the diaphragm. Two electrodes were inserted for bipolar EMGdia

recording. The external ends were bared and connected to a high-impedance probe.

The signal was amplified (P511, Grass Instruments) and band-pass filtered (0.3-300

Hz). Analog output was digitized and processed as described above.

The trachea was exposed by a ventral incision. The trachea was freed from

surrounding tissue and an inflatable cuff (Fine Science Tools) was sutured around the

trachea, two cartilage rings caudal to the larynx. The actuator tube of the cuff was

connected to an air-filled syringe. The extent to which the bladder of the cuff was

inflated was dependent upon the amount of pressure applied with the syringe. When

fully inflated, the trachea was compressed to completely occlude the airway. Removal of

the pressure resulted in full recovery of the trachea with no interference to breathing.

Tracheal integrity was anatomically confirmed at the end of the experiment.









There were 4 groups of animals. The experimental group (n= 1) was prepared

and received tracheal occlusions as described above. Control group 1 (n=4) were

prepared as described above with a tracheostomy 0.5 cm below the tracheal cuff. A five

cm endotracheal tube (PE240) was inserted into the tracheostomy with the tube length

approximately equal to the distance between the oral cavity and incision to maintain

dead space volume. These animals received tracheal compression but breathing was

not obstructed. Control group 2 (n=4) were prepared as described above but did not

receive a tracheostomy or tracheal obstructions. Control group 3 (n = 6) consisted of

animals that were anesthetized with urethane and left undisturbed for 90 min before

being sacrificed and perfused.

Protocol

All animals were surgically prepared and maintained under anesthesia for 90

minutes. The experimental group and control group 1 animals were presented a 10 min

experimental occlusion trial. The tracheal cuff was inflated at end-expiration to

completely obstruct the airway. The occlusion was applied for 2-3 breaths and then

removed for 5-10 unobstructed breaths (confirmed by Pes). This was repeated for the

duration of the 10 min experimental trial. Animals in control groups 2 and 3 were

maintained without obstructions during the 10 min period.

Following completion of the experimental trial, the animal was maintained under

anesthesia for 90 minutes. Following this 90 min period the animal was sacrificed with

an overdose of anesthetic, transcardially perfused with 0.5 ml heparin into the left

ventricle, followed by 200 ml perfusion saline and 200 ml 4% paraformaldehyde in 0.4 M

phosphate buffered saline (PBS). The brain was removed and placed in 4%

paraformaldehyde for 24 h. The brain was then transferred to a solution of 30% sucrose









in PBS. The fixed tissue was frozen, sectioned with a cryostat (Carl Zeiss, HM101) into

coronal slices 40 pm thick, and placed in PBS for storage.

Immunohistochemical Analysis

For each brain, every third section of tissue was used for processing. Slices were

incubated for 1 h in a 1:30 solution of goat serum in PBS + Triton X-100 (GS-PBS-T).

The tissue then sat overnight in a solution of rabbit anti-c-Fos primary antibody (1:2000,

sc-52r; Santa Cruz Biotechnology). The following day the tissue was washed for 1 h in a

solution of 1% GS-PBS-T, and then incubated for 2 h in a solution of goat anti-rabbit

biotin (1:500, Jackson ImmunoResearch). Following another 1 h wash in 1% GS-PBS-

T, all slices were treated with avidin-biotin peroxidase complex (ABC Vectastain Kit;

Vector; Burlingame, CA), and washed again (1% GS-PBS-T for 1 h). To complete the

staining process, a chromagen solution (0.05% diaminobenzidine hydrochloride, 2.5%

ammonium sulfate, 0.033% hydrogen peroxide in 0.05 M Tris-HCI (DAB); Sigma) was

applied for roughly 3 min until the tissue changed to a darker brown color, indicative of

Fos-like immunoreactivity (FLI). The reaction was halted with distilled water, and then all

tissue was washed 3 times in PBS. Following staining, slices of tissue were mounted on

glass slides and were allowed to air-dry for 3 days. All slides were dehydrated with a

series of washes in alcohol and CitraSolv, then coverslipped (Vectamount).

Data Analysis

Breathing pattern

Breathing pattern analysis was performed with Spike 2 software on six

experimental animals and four control group 1 animals. Raw EMGdia signal recordings

were rectified and integrated (50 ms time constant). The amplitude of the integrated

EMGdia signal was measured from baseline to peak amplitude (relative units).









Inspiratory time (Ti) was the duration of EMGdia burst; expiratory time (Te) was the

duration between EMGdia bursts; total breath time (Ttot) was the sum of Ti and Te. Pes

was measured from end expiration to peak (Figure 2-1). These parameters were

analyzed for the complete unobstructed control breath (C) prior to occlusion, the

occluded breaths (01-03), and the complete unobstructed recovery breath (R)

immediately following occlusion (Figure 2-1). Ti, Te, and Ttot were averaged for each

rat and for each group. Pes and EMGdia amplitude were normalized by dividing 01-03

and R by the control breath, C. The normalized Pes and EMGdia values were compared

for each rat and for each group.

c-Fos

Images of brain sections to be analyzed were viewed using light microscopy (Zeiss

Axioskope) and captured with imaging software (AIS). Masks delineating areas to be

counted were drawn on the images using Adobe Photoshop according to brain regions

(Paxinos & Watson, 1997), and the masked images were saved. Neurons expressing c-

Fos were identified by the round, dark staining of their nuclei (Figure 2-7). Size and

shape limits were set to exclude spots that were too lightly stained, or were outside the

diameter range of 7-10Om. The number of c-Fos-labeled neurons in the area of interest

was counted (MetaMorph). For each brain, 3 sections per nucleus were counted

bilaterally. If no bilateral differences were seen, counts for that nucleus were averaged.

These values were then combined according to group, and used for between-group

comparisons (Table 2-1).

Statistics

All breathing parameters for C, 01, 02, 03, and R were averaged within each

rat. These values were used to conduct a two-way ANOVA for each parameter with









breath number and group as factors. Differences were statistically significant if p<0.05.

A one-way ANOVA was performed comparing c-Fos expression in all 4 groups for each

nucleus. If statistical significance was achieved (p<0.05), post-hoc analysis was

obtained via multiple t-tests with Bonferroni's correction to determine specific group

differences. All data are reported as means SEM.

Results

Breathing Pattern

In obstructed animals with an intact trachea, Ttot was significantly greater during

01-03 compared to preceding C and subsequent R breaths (p<0.002) (Figures 2-1 & 2-

4). Prolongation of Ti (p<0.03) (Figure 2-2) and to a greater extent Te (p<0.008) (Figure

2-3) contributed to this Ttot difference. The Ttot of R breaths returned to pre-obstruction,

C breath values. The rectified and integrated EMGdia signal progressively increased in

amplitude over the course of the obstruction (p<0.001), and remained significantly

elevated above C values during R breaths (p=0.02) (Figure 2-5). Similarly, inspiratory

Pes became increasingly negative during the obstruction (p<0.001) and also remained

significantly more negative during R breaths compared to C (p=0.004) (Figure 2-6).

During all obstructions in tracheostomized animals no changes in breath timing or

EMGdia were observed (Figures 2-1 to 2-5). Pre-surgical baseline recordings for Pes,

EMGdia, and breath timing did not differ from end-experiment recordings. Implantation of

the tracheal cuff had no effect on Pes, EMGdia or breathing pattern when it was sutured

in place and deflated.

Fos-like Immunoreactivity

Fos-like immunoreactivity (FLI) was found in all nuclei analyzed for all groups

(Table 2-1). In the medulla, the nucleus ambiguus (nA) and caudal nucleus of the









solitary tract (cnTS) (Figure 2-7) had significantly greater c-Fos expression in the

experimental group compared to all other groups (p-values < 0.002). There was also a

significant difference between groups in the rostral nTS (rnTS) (p=0.04) but post-hoc

analysis revealed no differences.

In the locus coeruleus (LC) the experimental group had the greatest amount of FLI

compared to controls. In the various parabrachial subnuclei the external lateral (elPBN)

area showed the greatest number of Fos-expressing cells. In the elPBN, dorsal lateral

(dlPBN), and central lateral (clPBN) subnuclei the experimental group had greater FLI

compared to all control groups, and the difference was significant in the dlBPN (p=0.03,

comparing Exp and Ctrl 3). The lateral crescent (IcrPBN) subnucleus was the only

pontine region analyzed where the tracheostomized animals had the greatest c-Fos

expression.

In the midbrain periaqueductal gray (PAG), the greatest amounts of FLI were

observed in the caudal ventral region (cvPAG). The tracheostomized control group 1

had the most stained cells in all PAG regions, and the difference in group means was

significant in the caudal dorsal (cdPAG) and cvPAG for this group compared to control

group 3 (p<0.007). The experimental group had significantly more c-Fos expression in

the cvPAG compared to control group 3 also (p=0.001). No differences between any

groups were seen in the rostral dorsal PAG (rdPAG). In addition, the experimental

group and control group 1 had significant (p<0.05) rostral-caudal differences in the

dorsal PAG; the experimental group showed significant dorsal-ventral (p<0.05)

differences in the PAG.









Discussion

Our method of ITTO for 2-3 breaths in anesthetized rats elicited respiratory load

compensation, including a prolongation of Ti and Te, increased EMGdia activity, and

more negative inspiratory Pes. ITTO in anesthetized rats also induced neural activation

in respiratory brainstem nuclei, and nuclei involved in cardiovascular, stress, and fear

responses. End-expiratory Pes did not change with obstruction or recovery in any

animals, indicating that ITTO does not change lung compliance (Figure 2-1). The short

duration of occlusions ensured minimal changes in blood gases, supporting our

hypothesis that ITTO elicits a load compensation respiratory motor pattern response

and neuronal activation within respiratory related brain nuclei. In the tracheostomized

control group 1, tracheostomy decreased baseline Pes to a value that remained stable

during obstructions and recovery. Because Ti, Te, EMGdia, and Pes were not altered in

control group 1 during ITTO, the changes in these parameters observed in the

experimental group result from the load compensation response of the respiratory

neural control system to a breathing effort against a closed airway. Tracheal

compression alone was not sufficient to evoke altered breath timing and respiratory

motor responses.

The decreased breathing frequency during ITTO was primarily due to an

increase in the duration of Te. Because Te is normally longer than Ti for a given breath,

there could be more potential for breath-timing modulation during Te than Ti. Many

previous studies on the responses to respiratory loading used loads applied to

inspiration (Zechman et al., 1976; Chaudhary & Burki, 1978; Davenport et al., 1981a;

Lopata et al., 1983; Davenport et al., 1991; Forster et al., 1994; von Leupoldt & Dahme,

2005b) and expiration (Zechman et al., 1976; Davenport et al., 1981a; Davenport et al.,









1984; Davenport & Wozniak, 1986; Webb et al., 1996; Watts et al., 1997) separately,

and this study was unique in that airway occlusion was maintained for both phases

during several breaths. Zechman and colleagues (Zechman et al., 1976) showed that

expiratory loading resulted in an upward shift in functional residual capacity (FRC). It is

the accumulated volume above FRC that contributes to the termination of the breath,

not the Vi or Ve during only that cycle. If the tracheal occlusion were to occur at FRC, as

was the aim in this study, both Vi and Ve would be restricted, preventing a net increase

in lung volume. A tracheal occlusion at end-inspiration would prevent full expulsion of

inspired air and a return to FRC, so subsequent breaths would occur upon inflated

lungs.

Lung inflation activates respiratory afferents, the primary group of which project to

the brain via the vagus nerve (Clark & von Euler, 1972; Zechman et al., 1976). An

important type of vagal afferent that contributes to the volume-timing relationship is the

pulmonary stretch receptor (PSR). These receptors lie within the smooth muscle of

bronchi and respond to increases in transpulmonary pressure (Ptp) which is influenced

by lung volume (Davenport et al., 1981b). As lung volume increases with inspiration, the

discharge rate of PSR's increases until a frequency threshold is reached that terminates

inspiration (Davenport et al., 1981a). Te is also influenced by PSR activity, although the

threshold for terminating expiration is dependent upon PSR discharge number rather

than frequency (Davenport et al., 1981a; Davenport & Wozniak, 1986). During ITTO at

FRC in anesthetized rats, the resistance caused by occlusion decreases Vi and Ve,

which subsequently decreases the frequency and number of PSR discharge,

lengthening Ti and Te, respectively. If ITTO occurs at end-inspiration, Ve decreases as









Te lengthens, but the subsequent inspiration will begin before the lungs can return to

FRC. This will result in a shorter Ti and Vi than if the occlusion were applied at FRC

since accumulated lung volume causes Ptp and PSR discharge frequency to remain

elevated. Thus, the Vt-T threshold that terminates Ti and Te does not change, but

accumulated volume history may modulate their durations for a specific breath.

Pes and EMGdia follow a similar pattern of activity during occluded breaths, with Pes

becoming more negative as EMGdia amplitude increases from 01 to 03. These values

remain elevated above control breaths during the recovery breaths, although they are

less than during obstructions. Forster and colleagues (Forster et al., 1994) found that

sustained inspiratory resistive loading in conscious ponies caused an augmentation of

Vt and respiratory motor but not breath timing responses during recovery breaths.

The augmentation of parameters during recovery breaths after ITTO is likely a result of

the respiratory system acting to restore ventilation after prolonged perturbation. Loading

or occluding one breath at a time does not affect subsequent breaths (Zechman et al.,

1976). The exact mechanisms underlying these responses are unknown, but it is clear

that consecutive obstructions to breathing necessitate a recovery response that exists in

both the anesthetized and conscious state. Although the augmented recovery response

in the conscious ponies has a reflexive component, it cannot be ruled out that it might

also be a behavioral response to the sensations associated with the loading.

Medulla

The rnTS and cnTS were activated with acute ITTO, indicated by enhanced FLI in

those regions compared to control groups. The rnTS and cnTS had more stained cells

compared to most other nuclei, which was expected considering the greater amount of

convergent input to these areas. The load compensation response in anesthetized









animals is reflexive and dependent upon PSR activation (Zechman et al., 1976;

Davenport et al., 1981a; Davenport et al., 1984; Webb et al., 1994, 1996). The nTS, part

of the medullary dorsal respiratory group, is the primary target of these vagal afferents

(Kalia & Mesulam, 1980a, b; Kalia, 1981a). Although vagal afferents from the lung play

a large role in controlling the breath Vt-T response during load compensation upper

airway vagal afferents also contribute to that response during inspiratory (Webb et al.,

1994) but not expiratory (Webb et al., 1996) resistive loading. Upper airway tracheal

stretch receptors lie within the trachealis muscle (Davenport et al., 1981c) and send

their afferent fibers to the brainstem via the cervical vagus, superior laryngeal (SLN),

and recurrent laryngeal nerves (RLN) (Sant'Ambrogio et al., 1977; Lee et al., 1992). The

afferents from these receptors also terminate in the nTS (Kalia, 1981b) and were likely

activated by the squeeze of the cuff during ITTO. Thus, both pulmonary and tracheal

receptors were activated by ITTO, sending convergent input to the nTS where a

compensatory motor response could be initiated. The nA, a nucleus within the ventral

respiratory group (VRG), also showed significant increases in FLI in experimental

animals compared to controls. This nucleus is activated by the nTS (Loewy & Burton,

1978), phrenic, vagus, carotid sinus, and SLN stimulation, bronchoconstriction, and

inspiratory occlusions (Davenport & Vovk, 2009). The increase in FLI in medullary

respiratory nuclei results from tracheal afferents stimulated by the squeeze of the cuff,

pulmonary afferents activated by lung inflation, and efferents mediating changes in

respiratory pattern. Thus, respiratory load compensation has a neural component that

includes both sensory- and motor-activated medullary neurons.









Pons


ITTO also evoked significant neural activation in the dlPBN. The dlPBN responds

to various respiratory stimuli including inspiratory occlusions (Davenport & Vovk, 2009),

and is also an important part of the descending pathway from the PAG involved in

cardiovascular (Hayward et al., 2004; Hayward, 2007) and respiratory (Hayward et al.,

2004) control. Neurons in the nTS that are activated by vagal afferents send projections

to pontine respiratory groups, including to the IPBN (Loewy & Burton, 1978; Ezure et al.,

1998). Specifically, the respiratory (ventrolateral) nTS has reciprocal connections with

the dlPBN (Herbert et al., 1990). The FLI seen in the IPBN after ITTO could be a

response to afferent projections to that nucleus, but it could also be a result of

projections from the IPBN to other neural areas such as the limbic system (Saper &

Loewy, 1980). No differences were seen between groups in the LC, despite receiving

input from the medullary dorsal and ventral respiratory groups (Herbert et al., 1990).

The LC is the main source of norepinephrine in the brain and is greatly involved in

stress responses (Berridge & Waterhouse, 2003). The lack of group differences in the

LC appears to be a result of substantial neural activation across all group conditions,

possibly resulting from global urethane activation or an elevated and sustained stress

response from handling the animals before bringing them to the laboratory. Neural

activation seen in the PBN is likely primarily the result of integrating ascending

medullary and descending PAG projections into both respiratory and cardiovascular

responses to ITTO. The PBN is also involved in defensive, fear, and limbic pathways

and although animals in this study were anesthetized and non-behaving, those roles

should also be considered.









Midbrain

The caudal region of the midbrain PAG was activated by ITTO, with the ventral

region more than the dorsal. The PAG is known to be involved in defensive behaviors

(Bandler & Carrive, 1988; Brandao et al., 1994; Vianna et al., 2001), pain modulation

(Mayer et al., 1971; Behbehani, 1995), respiratory activation (Hayward et al., 2003;

Zhang et al., 2005), and modulation of the respiratory load compensation response

(Zhang et al., 2009). The results of Zhang et al., (Zhang et al., 2007) showed greater

respiratory activation in response to cdPAG compared to rdPAG stimulation. SLN

stimulation activates the PAG (Ambalavanar et al., 1999), and the PAG and nTS have

reciprocal projections (Loewy & Burton, 1978; Farkas et al., 1998). The dPAG and

vPAG have been implicated in panic and anxiety, respectively (Carrive, 1993; Bandler &

Shipley, 1994; Brandao et al., 1994; Vianna et al., 2001; Cunha et al., 2010), and the

vPAG appears to be involved in conditioned fear responses (Vianna et al., 2001). It is

possible that ITTO causes respiratory-specific activation in the cdPAG and cvPAG, but

that ITTO also stimulates stress or fear pathways that additionally contribute to PAG

activation. In addition, one cannot rule out the potential contribution of other sensory

afferents to respiratory Vt-T, motor, and neural responses to ITTO.

Any lack of significant differences in FLI expression between control group 1 and

the experimental group in certain nuclei might signify that tracheal compression is a

powerful stimulant of afferents that project to those specific areas. Although FLI is a

useful indicator of neural activity in response to acute stimuli, many control groups are

needed to ensure activation is not a result of handling, anesthesia, noise, scent, or

another factor. Urethane was used to anesthetize animals for this study, and it is known

that urethane causes neural activation throughout the brain, so differences between









treatments may have been difficult to determine above an already elevated pattern of

activation. Furthermore, cells stained positively for the c-Fos protein cannot be divided

into sensory or motor activation, and it cannot give any indication of inhibition. If proper

control groups are designed, however, c-Fos immunohistochemistry can lay the

foundation for understanding which neural substrates should be investigated further.

The results of this study suggest that airway resistance can be increased

intrinsically without changing lung compliance, evoking respiratory load compensation

indicated by breath timing, diaphragm activity, and esophageal pressure changes. This

model has potential applications in studying respiratory obstructive diseases

characterized by increased upper airway resistance. Individuals with asthma, OSA, and

COPD all experience some degree of airway mechanical changes, including increased

resistance, that are maintained over the course of many breaths. Using our model of

ITTO to investigate the neural mechanisms mediating the load compensation response

has important implications for elucidating the neural mechanisms modulated by these

diseases.










OPMss KMm


TI Te
4-+0---


Tracheostomized
p.S \/ -A -A\ I / ,/ ,
ij~.. a~~


0 1 2 3 4 5 6 7 8sec


Figure 2-1. EMGdia and Pes traces during tracheal occlusion in an intact (experimental)
and tracheostomized (control group 1) animal. Indications of how Ti and Te
were measured are displayed in the trace second from the top. There was no
change in end-expiratory Pes during the course of the experiment.


Figure 2-2. Inspiratory duration during tracheal occlusions in intact (Exp) and
tracheostomized (Ctrl) animals. 01-03 values were significantly different from
C for the Exp animal (*p=0.03).


EMG


1 1 --- I I I 1 9'1 1


Ti
0.5

0.4 -* *

0.3 -4Exp
1 3 ** ---- --- ^ --- ^--*^Exp

M 0.2 -- Ctrl

0.1

0 I
C 01 02 03 R




























Figure 2-3. Expiratory duration during tracheal occlusions in intact (Exp) and
tracheostomized (Ctrl) animals. 01-03 values were significantly different from
C for the Exp animal (*p=0.008).


Figure 2-4. Total breath duration during tracheal occlusions in intact (Exp) and
tracheostomized (Ctrl) animals. 01-03 values were significantly different from
C for the Exp animal (*p=0.002).


Te


0.9
*




- -4---Exp





0 0 0
C 01 02 03 R


Ttot
1.5





O ---*-- ---*-------.E* ._ ..
... 0.5- ---C trl 1

0.5


C 01 02 03 R






























Figure 2-5. Peak amplitude of the integrated EMGdia trace during tracheal occlusions in
intact (Exp) and tracheostomized (Ctrl) animals. Values were significantly
different from C for the Exp animal (*p=0.001, 01-03; *p=0.02, R).


Figure 2-6. Peak negative esophageal pressure during tracheal occlusions in intact
(Exp) and tracheostomized (Ctrl) animals. Values were significantly different
from C for the Exp animal (*p=0.001, 01-03; *p=0.004, R).


EMGda
1.2 *


1.1 -



P -4*-Ctril

0.9


0.8 -i
C 01 02 03 R


Pes
2.5

2 *

1.5
P-4-'Exp
S--1 E--Ctrl1

0.5

0
C 01 02 03 R
C 01 02 03 R





















Bregma -13.80 mm


&^f.Cil* -
::"":' : ;..' .' i" .. ~ I ":- .... ';.. .."'.: .~.. ..


Figure 2-7. c-Fos in the caudal nTS of anesthetized animals after repeated tracheal
occlusions in B) a tracheostomized and C) trachea-intact animal. The
tracheostomized animal did not experience occlusions to breathing because
the tracheostomy was distal to the cuff. The dashed line in part A shows the
area of the brain atlas (Paxinos & Watson, 1997) corresponding to the images
in B and C.









c-Fos Expression in brainstem and suprapontine nuclei.


Table 2-1.
Nucleus
cdPAG
cvPAG
rdPAG
nA
cnTS
rnTS
LC
clPBN
elPBN
IcrPBN
dlPBN


Naive
40.8 (6.4)
57.6(17.0)
59.5(18.9)
1.0(0.2)
61.9(16.0)
44 (0)
42.5(12.3)
13.2(3.0)
38.0 (4.9)
17.1 (2.7)
6.1 (1.3)


Sx Only
70.3 (22.2)
153(31.4)
58 (9.8)
0.5 (0.2)
37.6(10.5)
79.7 (26.5)
37.8(13.8)
26.8 (7.3)
30.1 (7.0)
17.9(2.7)
6.7 (0.8)


Trach'd
131 (33.7)*
236.7 (46.7)*
69.2 (19.4)
1.4(0.3)
66.6 (19.7)
53.3 (6.5)
42.7 (16.2)
15.1 (6.8)
20.7 (7.8)
18.1 (3.1)
9.1 (1.3)


The number of cells stained positively for c-Fos in each region of interest. SEM shown
in parentheses. *Values were significantly different from the Naive group;
**values are significantly different from all other groups. Naive (control group
3), Sx Only (control group 2), Trach'd (control group 1), Intact Obs
(experimental group).


Intact Obs
88.7 (17.6)
176.5 (39.2)*
52.8 (39.2)
4.9 (0.5)**
169.5 (21.5)**
203.3 (44.3)
44.9(10.2)
29.8(5.1)
38.1 (3.9)
16.4(2.4)
12.4(1.4)*


p-value
0.007
0.001
n/a
0.001
0.002
0.040
n/a
n/a
n/a
n/a
0.007









CHAPTER 3
RESPIRATORY LOAD COMPENSATION AND BEHAVIORAL CONDITIONING IN
CONSCIOUS RATS

Introduction

Respiratory load compensation has been observed in response to mechanical

challenges to breathing such as resistive or elastic loads applied to the respiratory

circuit (Zechman & Davenport, 1978). The response to a resistive (R) load applied to

one phase of the breath included a decrease in volume inspired (Vi) or expired (Ve) for

the duration of the load and an increase in the loaded breath phase duration (Zechman

et al., 1976). The volume-timing parameters of the unloaded phase of the breath were

unchanged. Respiratory load compensation in anesthetized animals has been

characterized as reflexive and vagal-dependent (Zechman et al., 1976), specifically

mediated by pulmonary stretch receptors (PSR) responding to transmural pressure

changes across the airways (Davenport et al., 1981a; Davenport et al., 1981b;

Davenport et al., 1984; Davenport & Wozniak, 1986). Modulation of Ti occurs through

changes in PSR spike frequency and Te through changes in spike number (Davenport

et al., 1981a; Davenport & Wozniak, 1986). There is also a muscle response during

load compensation which includes increased respiratory motor output, measured from

respiratory muscle electromyography (EMG), primarily in the diaphragm (Lopata et al.,

1983). The volume-timing values obtained from complete respiratory occlusion

approached those seen after vagotomy, including long loaded phase duration (Zechman

et al., 1976). Occlusion at end-expiration, or FRC, causes a prolongation of Ti and

increased EMGdia activity (Zechman et al., 1976; Kosch et al., 1986; Zhang &

Davenport, 2003; Zhang et al., 2009), and occlusion at end-inspiration causes a

prolongation of Te (Gautier et al., 1981; Zhang et al., 2009).









Studies in conscious humans and animals are less numerous. Results from

experiments in anesthetized animals provide information about reflexive and neural load

compensation, but do not add to our understanding of behavioral load compensation, or

voluntary modulation of the reflexive patterns. Single bouts of R loads or tracheal

occlusions have been applied during expiration in lambs via a facemask (Watts et al.,

1997) and inspiration in dogs through a tracheal stoma (Davenport et al., 1991).

Expiratory R loading causes a decrease in airflow and prolonged expiratory time (Te)

(Watts et al., 1997). Subsequent unloaded breaths showed decreased Vi, increased Ve,

and the integrated EMG activity in the larynx and diaphragm remained active as a

compensatory mechanism to help restore lung volume to baseline (Watts et al., 1997).

When inspiratory R loads are added to two consecutive breaths in conscious goats, the

integrated diaphragm and external abdominal oblique muscle responses were

augmented and inspiratory time (Ti) increased during both inspirations (Hutt et al.,

1991). These values returned to baseline during unloaded breaths, unlike the responses

seen during single bouts of expiratory R loading in lambs (Watts et al., 1997). This

difference could be due to the fact that the magnitudes of the R loads were different

(370 cmH20/ I/sec in lambs vs. 18 cmH20/ I/sec in goats), animal ages were different

(neonatal lambs vs. adult goats), or perhaps that the inspiratory and expiratory phases

of breathing are under separate control mechanisms (Davenport et al., 1981a;

Davenport & Wozniak, 1986; Webb et al., 1994, 1996).

When multiple consecutive inspirations are loaded, Ti is prolonged while Te and

tidal volume (Vt) are decreased during the first breath in conscious ponies (Forster et

al., 1994). During the second through fifth loaded breaths, small changes were seen in









volume and timing parameters which stabilized after the fifth breath for the subsequent

2-4 minutes of loading. The time of EMGdia activation mirrored Ti, and mean EMGdia

activity was elevated during the first loaded breath to a value that remained augmented

for subsequent loaded breaths. During the first recovery breath following loading, Vt and

mean EMGdia activity increased above values during loading but timing parameters did

not change. These responses differed from responses documented in conscious

animals in response to single- (Watts et al., 1997) or two-breath (Hutt et al., 1991)

loading. All parameters progressively returned to control values over the course of

subsequent unloaded breaths. Surprisingly, the loaded and recovery breath

compensation effect persisted even after pulmonary and diaphragmatic deafferentation,

indicating that these afferents quantitatively but not qualitatively modulate the load

compensation response (Forster et al., 1994). The authors of this study hypothesized

that intercostal afferents and cortical input likely contributed greatly to the observed

response.

In the conscious man, some studies have shown that R loading decreases

volume, prolongs breath duration, and enhances motor output (Axen et al., 1983;

Daubenspeck & Bennett, 1983; Hudgel et al., 1987; Nishino & Kochi, 1994;

Daubenspeck & Rhodes, 1995). In addition, an augmented recovery response to

loading has been documented (Altose et al., 1979) similar to some aspects of conscious

animal studies (Forster et al., 1994; Watts et al., 1997). Greater respiratory responses

to loads of larger magnitudes have also been recognized (Altose et al., 1979; Nishino &

Kochi, 1994; Calabrese et al., 1998). However, there seems to be great variability in

response patterns to both respiratory loading and occlusion in conscious humans (Axen









et al., 1983; Daubenspeck & Bennett, 1983; Davenport & Wozniak, 1986; Hudgel et al.,

1987; Nishino & Kochi, 1994; Daubenspeck & Rhodes, 1995). Others have documented

increases in volume and decreases in frequency in response to inspiratory R loading

(Iber et al., 1982). Interestingly, load compensation responses that differed between

individuals remained qualitatively similar within the same individual in response to

various load magnitudes (Daubenspeck & Rhodes, 1995). Differing responses may be

due to perceptual differences between individuals (Daubenspeck & Rhodes, 1995).

Respiratory afferents other than those in the airways and in the main inspiratory

muscles must play a role in load compensation in conscious humans and animals.

These other afferents most likely transduce respiratory sensations associated with

loading and airway occlusion. The way a conscious human or animal feels (affective

component) about its breathing may further lead to modulation of the reflexive pattern of

load compensation.

Our laboratory has developed a method to study the load compensation reflex in

conscious rats via intrinsic, transient and reversible tracheal occlusions (ITTO). ITTO is

performed by inflating a rubber cuff around the trachea with enough pressure to

reversibly close the lumen of the trachea. We designed a 10 day ITTO protocol in

conscious rats that would elicit and behaviorally condition the animal to respiratory load

compensation. It was hypothesized that ITTO in conscious rats would cause variable

respiratory load compensation pattern responses that are altered after 10 days of ITTO

conditioning.









Methods


Animals

These experiments were performed on four male Sprague-Dawley rats (387.5

71.3 g). The animals were housed two to a cage in the University of Florida animal care

facility where they were exposed to a 12 h light/12 h dark cycle. The experimental

protocol was reviewed and approved by the Institutional Animal Care and Use

Committee of the University of Florida.

Surgical Procedures

Animals were initially anesthetized using isoflurane gas (2-5% in 02) administered

in a whole-body gas chamber. Anesthetic depth was verified by the absence of a

withdrawal reflex from a rear paw pinch. Buprenorphine (0.01-0.05 mg/kg body weight)

and carprofen (5mg/kg body weight) were administered preoperatively via

subcutaneous injection. Incision sites were shaved and sterilized with povidine-iodine

topical antiseptic solution. Body temperature was maintained at 380C by a heating pad,

and anesthesia was maintained by isoflurane gas via a nose cone.

Diaphragm electrodes

The anesthetized animal was placed in a supine position and a 4 cm vertical

incision was made in the abdomen. The skin and muscular abdominal wall were pulled

laterally in order to expose the diaphragm. Diaphragm EMG (EMGdia) electrodes were

made using stainless steel, Teflon-coated wire (AS631, Cooner Wire, Chatsworth, CA,

USA), threaded through the tip of a 22 gauge needle. Two of these electrodes were

implanted into the exposed right diaphragm, parallel to one another and roughly 4 mm

apart. The wires were bared where they contacted the diaphragm and were secured









into place with knots. The insulated, distal ends of the electrode wires were routed

through the abdominal incision and directed subcutaneously to the dorsal surface of the

animal, between the scapulae, where they were externalized and secured in place with

sutures.

Tracheal cuff

The trachea was exposed by a ventral neck incision. The trachea was freed from

surrounding tissue and a saline-filled inflatable cuff (Fine Science Tools) was sutured

around the trachea, two cartilage rings caudal to the larynx. The actuator tube of the

cuff was plugged with a blunt needle and routed subcutaneously to the dorsal surface of

the animal, externalized via an incision between the scapulae, rostral to the EMGdia. The

tissue exposed in the ventral incision was pulled over the cuff and the skin was sutured

closed. The skin at the dorsal incision was sutured closed and the tube was secured in

place by tying the ends of the suture around a bead on the tube. Rats were then

administered warm normal saline (0.01-0.02 ml/g body weight) and isoflurane

anesthesia was gradually reduced. The animal was placed in a recovery cage on a

heating pad and was returned to the Animal Care Facilities once fully mobile.

Postoperative analgesia was provided for two to three days using buprenorphine (0.01-

0.05 mg/kg body weight) and carprofen (5mg/kg body weight) given every 24 hours.

Animals were allowed a full week of recovery before experiments began.

Protocol

The animals were retrieved from the Animal Care Facility on the morning of

Experiment Day 1 and were taken to the laboratory. They were placed in a recording

chamber for an acclimatization period of 15 minutes. During this time, the externalized

actuator tube of the tracheal cuff from the animal was connected to a saline-filled









syringe outside the chamber but no pressure was applied to the syringe. The external

ends of the EMGdia were bared and connected to a high-impedance probe. The signal

was amplified and band-pass filtered (0.3-3.0 kHz) (P511, Grass Instruments). Analog

output was sampled (PowerLab, ADInstruments), computer processed (LabChart 7 Pro,

ADInstruments), and stored for offline analysis. At the end of the 15 min protocol the

animal was returned to its home cage and the chamber was cleaned with alcohol wipes.

Once all animals had completed the acclimatization protocol they were returned to the

Animal Care Facility.

The animals were retrieved from the Animal Care Facility on the morning of

Experiment Day 2 and were brought to the testing laboratory. One animal was placed in

the recording chamber and the actuator tube was connected to a saline-filled syringe.

EMGdia were connected to the recording equipment. Diaphragm activity was recorded

and stored for later analysis. The animal was allowed to rest undisturbed in the chamber

for 2.5 minutes, followed by a series of cuff inflations. The syringe and cuff were

pressure calibrated so a known amount of fluid movement in the syringe would result in

the amount of pressure required to fully compress and occlude the trachea. Removing

the pressure allowed for full recovery of the trachea with no interference to breathing.

The cuff of the animal was inflated 3-6 seconds at a time with ~35 trials in a 15 minute

period. The trials were applied in a random time pattern. After the last trial, the animal

was allowed to rest undisturbed in the recording chamber for 2.5 minutes. At the end of

the 20 minutes, the animal was removed from the chamber and returned to its cage.

The recording chamber was cleaned with alcohol wipes between animals. The next

animal was placed in the recording chamber and the 20 minute protocol was repeated.









This was continued for all animals. All animals were returned to the Animal Care Facility

at the end of Experiment Day 2. This procedure was repeated daily for Experiment Days

3-11. Animals were sacrificed on Experiment Day 12.

Analysis

Breathing pattern analysis was performed offline (LabChart 7 Pro, ADInstruments).

Raw EMGdia signal recordings were rectified and integrated (50 ms time constant). The

integrated trace was integrated further to obtain total EMGdia activation (intEMGdia)

during the 3 seconds prior to (C) and the first 3-4 seconds of each occlusion (0). This

analysis was completed for the first and last day of ITTO conditioning. Additionally, the

number of EMGdia peaks (efforts) was counted during C and 0. The ratio of intEMGdia to

effort was obtained and averaged during C and O for each animal and for each day.

The relative contribution of Ti and Te to Ttot during C and O were determined. Ti was

defined as the duration of EMGdia activation, Te as the duration of EMGdia quiescence,

and Ttot as Ti + Te. Ti, Te, and Ttot were averaged during C and O for each animal and

for each day. A one-way repeated measures analysis of variance (RMANOVA) was

performed comparing breath (C vs. 0) and day (first vs. last), separately for the

following parameters: Ti, Te, Tot, Ti/Te, Ti/Ttot, Te/Ttot, intEMGdia/effort. Differences

were significant when p<0.05, and post-hoc comparisons were performed using Tukey's

HSD with overall significance of p<0.05. Additionally, a paired t-test was performed

comparing the ratio of O to C for intEMGdia/effort for the first and last day of ITTO with

significance at p-values < 0.05. All data are reported as means SEM.









Results


Timing

An example of the raw and integrated EMGdia signal (from the same animal)

during the initial segment of one tracheal occlusion at FRC on the first (A) and last (B)

day of the ITTO protocol is shown in Figure 3-1. Ti non-significantly increased during O

compared to C on both the first and last day of ITTO (Figure 3-2A). Te was significantly

prolonged during O compared to C on both the first and last day of ITTO (Figure 3-2B,

*p=0.03). Ttot was non-significantly longer during O compared to C on the first or last

days of ITTO (Figure 3-2C). Normalized breath timing values (O/C) for Ti, Te, Ttot are

shown in Figure 3-2D, and no difference in O/C ratios for any timing variable were seen

between the first and last day of ITTO (Figure 3-2A to 3-2D).

There was no significant change in relative contribution of Ti (Figure 3-3A, D) and

Te (Figure 3-3B, D) to Ttot during O or C on either the first or last day of ITTO, although

during O there was a trend for greater contribution to Ttot by Te. The Ti/Te ratio did not

change between C and 0, or between the first and last day of ITTO (Figure 3-3C, D).

EMGdia Activity

The intEMGdia activity is illustrated in Figure 3-4. intEMGdia/effort was not greater

during either 0 or C on the last compared to the first day of ITTO (Figure 3-4A, p=0.07

for difference between O on first compared to last day of ITTO). There was no

difference in values during O and C on the first day of ITTO, however, intEMGdia/effort

was significantly greater during O compared to C on the last day of ITTO (Figure 3-4A,

*p=0.03). The difference between relative values of intEMGdia/effort on the first and last

day of ITTO was significant (Figure 3-4B, *p=0.05).









Discussion

The results of this study show that repeated tracheal occlusions elicit a load

compensation response in conscious rats, and that the pattern of this response can be

altered as a result of repeated days of ITTO conditioning. The first day response to

ITTO consisted of a prolongation of Te with no significant changes in Ti, Ttot or

diaphragmatic activation. After 10 days of conditioning, conscious rats showed

lengthened Te and increased diaphragmatic activation during O compared to C breaths,

which were not accompanied by increases in Ti. There were no significant changes in

timing parameters from the first day of ITTO to the last day; however, there was a

significant increase in the O/C ratio of diaphragmatic activity per effort. This suggests

that after 10 days of ITTO, conscious animals preferentially change respiratory drive

rather than timing in response to the occlusions, and that the typical volume-timing

reflex seen in anesthetized animals is modulated by behavioral compensation in

conscious rats.

Previous studies investigating timing reflexes in response to airway occlusions

applied the occlusions to inspiration (Zechman et al., 1976; Kosch et al., 1986; Zhang &

Davenport, 2003; Zhang et al., 2009) or expiration (Zhang et al., 2009) separately. The

prolongation of Ti seen with occlusions at FRC is a response to functional vagotomy,

which does not allow changes to occur in PSR input and depends upon the internal

respiratory rhythm generator to establish timing parameters (Feldman et al., 2003). The

prolongation of Te seen with end-inspiratory occlusions results from an elevated

number of activated PSR's that delay inspiration from beginning (Gautier et al., 1981).

The ITTO protocol used in this study is unique in that airway occlusions were sustained

for both inspiration and expiration over the course of several consecutive breaths. We









tried to apply the tracheal occlusions at FRC in order to maintain a consistent method of

application and to avoid PSR-mediated first breath responses to each occlusion. We

expected that both Ti and Te would be prolonged during O compared to C since the

occlusions were sustained for both breath phases. We noticed a significant prolongation

of Te, but only a trend toward an increase in Ti during O. The increase in Te during O

on both the first and last day of the ITTO protocol could be explained by lung

hyperinflation. Applying the occlusion at end-inspiration or during expiration would lead

to sustained lung inflation, causing continuous PSR activation and producing prolonged

Te (Gautier et al., 1981; Zhang et al., 2009). Te would likely remain elevated for

subsequent breaths as long as the elevated lung volume was maintained. This could

explain why there was not a significant increase in Ti during O compared to C on either

the first or last day of ITTO. Although we attempted to prevent this response by applying

each occlusion at FRC, the rapid respiratory rate and movement of the animals

hindered precise timing with the occlusions. To control for the occlusion at lung volumes

above FRC, we evaluated parameters for occlusions that occurred near end-expiration,

most likely during the end-expiratory pause phase of the breath.

Another explanation for the prolongation of Te during O is behavioral breath

holding. Large resistive loads are known to cause multi-dimensional sensations

including air hunger and breathlessness (Simon et al., 1989; Simon et al., 1990; ATS,

1999), and these sensations are collectively referred to as the symptom dyspnea.

Dyspnea is a highly aversive sensation (von Leupoldt & Dahme, 2005b; von Leupoldt et

al., 2008) and is linked with the fear that arises in response to the threat of suffocation

(Lang et al., 2010) or asphyxiation (Campbell, 2007). Threat of asphyxiation is produced









when a stimulus leads to hypoxemia, hypercarbia, or increased inspiratory efforts

(Campbell, 2007). In the current study, only mechanical stimuli were used to elicit

responses. Furthermore, results from our laboratory (Van Diest et al., 2006) suggest

that respiratory loading is more distressing than hypercapnic stimulation of breathing.

Taken together, we conclude that the sensations associated with trying to breathe

through the tracheal occlusions were highly aversive to conscious rats. The

prolongation of Te observed during tracheal occlusions was likely the attempt of the

animals to hold their breath and avoid the sensations rather than breathe against the

closed airway. There was an increase in Te on both the first and last day of ITTO

training but those values were not different from each other. This suggests that even

with conditioning, animals continued to behaviorally adjust their load compensation

breathing pattern to avoid the aversive sensations associated with ITTO. Aversive

sensations associated with respiratory stimuli may not habituate, which is beneficial

when considering the survival of the animal.

Experimentally-induced voluntary breath holding responses in humans are

variable, mediated by conscious suppression of the central respiratory rhythm and

involuntary mechanisms which eventually restore respiration before loss of

consciousness (Parkes, 2006). The central respiratory rhythm does not stop, and only

its expression is suppressed (Agostoni, 1963). The eventual override of voluntary

suppression appears to be related to diaphragmatic afferents (Parkes, 2006). We have

observed (unpublished observations) that animals may initially respond to ITTO by

voluntary breath holding, but if the occlusion is maintained for 10-15 seconds the

animals will reach a breaking point where intense, ballistic respiratory efforts begin.









Future studies using 15 second occlusions and comparing the first 3 seconds with the

last 3 seconds would allow us to characterize the respiratory load compensation

response to sustained ITTO. In the present study, the short duration ITTO avoided

changes in blood gases and minimized chemical activation of respiration.

We observed no change in the breath timing pattern between the first and last day

of ITTO. The lack of alterations in breath timing is consistent with respiratory studies in

humans (Clark & von Euler, 1972; Axen et al., 1983). The only significant change we

noticed was the increased duration of Te during O breaths compared to C on both days.

The contribution of Ti and Te to Ttot were not different between O and C breaths or

between the first and last day of ITTO. The lack of significance was likely due to the

small, non-significant increase in Ti during O breaths that abolished any differences in

Te/Ttot. The Ti/Ttot ratio, or duty cycle, during C on the first and last day of ITTO in our

rats ranged from 0.44-0.48, consistent with other reports in Sprague-Dawley rats

(Walker et al., 1997). Ti/Ttot non-significantly decreased during O due to the prolonged

Te. Thus, Te increased in response to ITTO but there were no other pattern changes

due to O or resulting from conditioning, and the respiratory timing pattern in our animals

remained in the reported normal range.

The respiratory load compensation timing response is extremely variable in

conscious humans and animals (Axen et al., 1983). Increased respiratory muscle

activation appears to be a more consistently reported response in both the conscious

and anesthetized human and animal (Axen et al., 1983; Lopata et al., 1983; Hutt et al.,

1991; Frazier et al., 1993; Xu et al., 1993a; Xu et al., 1993b; Osborne & Road, 1995;

Zhang et al., 2009). The intEMGdia/effort in conscious rats was increased during O









compared to C in this study. This means that either the EMGdia was active for a longer

period of time or the amplitude of the signal was greater. A longer activation period

would correspond with an increase in Ti, which was not observed. Thus, the increase in

muscle activation per effort results from larger EMGdia amplitude, suggesting that more

motor units were recruited during Ti. The preferential response to ITTO is an increase in

respiratory motor drive rather than a change in timing. Taken together with our timing

data, the response of conscious rats to tracheal occlusions appears to be breath holding

and stronger inspiratory efforts. The increased intEMGdia/effort during O compared to C

was observed on both the first and last day of ITTO, and the ratio of O/C for this

measure was significantly increased on the last compared to the first day of ITTO. This

suggests a conditioning response characterized by increased diaphragmatic recruitment

during O after 10 days of ITTO.

Increasing inspiratory muscle activity would generate a greater driving force to

move air into the lungs if the airways were open; however, a complete tracheal

occlusion closes off the airways and prevents airflow. On the first day of ITTO the

animal has no experience with the occlusions and the increased EMGdia response

during O compared to C may reflect an attempt to re-establish airway patency and

restore ventilation. After 10 days of ITTO, however, we expected that the animals would

cease intense inspiratory efforts as a result of learning. The reverse was actually

observed: animals not only maintained a ratio of O/C greater than 1 for intEMGdia/effort,

the ratio was significantly greater on the last day of ITTO compared to the first day. In

another study done by our laboratory (unpublished results) we observed that this 10 day

ITTO protocol leads to diaphragm and intercostal muscle hypertrophy, indicated by









increased cross-sectional area in type IIx/b fibers. This suggests a potential increase in

muscular strength and force production, which would in turn require the recruitment of

fewer motor units to do the same work load. In the present study, the behavioral load

compensation reflex response was characterized by an increase in diaphragm muscle

recruitment during each inspiratory effort on the last day of ITTO, counter to what we

expected with muscle hypertrophy. Both the learning and muscle hypertrophy effects

should have resulted in less EMGdia activity per breath after 10 days of ITTO, hence the

observed increase implies that this type of respiratory stimulus drives the behavioral

load compensation response to make strong inspiratory efforts in an attempt to defend

minute ventilation.

The increased O/C ratio for intEMGdia/effort on the last day of ITTO compared to

the first day could be explained by a sensitized behavioral response to the occlusions.

We have shown that ITTO produces stress responses in conscious rats (unpublished

results), and others have reported fear potentiation in response to uncontrollable

stressors (Korte et al., 1999), of which ITTO is one. Also, our animals were trained in

the same context each day, and due to the aversive nature of the ITTO stimulus, it is

possible that affective conditioning occurred. Fear-potentiated behaviors are observed

as a result of contextual affective conditioning (Risbrough et al., 2009). The increased

O/C intEMGdia/effort response seen on the last day of ITTO compared to the first day

may also be due to a heightened affective state from contextual conditioning, which

could result in alterations in breath timing and EMGdia parameters during C as well.

However, resting behaviors in the context are known to habituate (Beck & Fibiger,

1995). Furthermore, if the animals did have potentiated breathing responses during C









we would have expected to see increased diaphragmatic activation and increased

breath frequency as a typical fear response (Van Diest et al., 2009). This would have

resulted in greater O/C ratios for timing parameters and an O/C ratio closer to 1 for the

EMGdia activity per breath which was not what was observed. It is possible that the

increase in inspiratory effort during O after 10 days of ITTO is a fear-potentiated

behavior.

In conclusion, the results of this study suggest that there is a behavioral

respiratory load compensation response to tracheal occlusions in conscious rats that is

different from the anesthetized reflexive response reported in animals exposed to

respiratory loads. We observed an increase in Te during O, attributable to breath

holding, and an increase in diaphragmatic activity per breath, attributable to a sensitized

affective behavioral response. Thus, the volume-timing reflex may be suppressed by

behavioral mechanisms in conscious animals where a voluntary increase in respiratory

drive is the preferential compensation response.










S0.05


Integratd EMG. (V-s) V


4L.J ..^ .. L.k l.LL LL


- i'r"F rr r P w' ir" 'rr T r


Raw EMGh (V)


o t


Time ()


B
0.05


Integrated EMGd (V's) __




Raw EMG, (V) 4
0 t


Time(s) 4


Figure 3-1. EMGdia during the initial segment (4 s) of one tracheal occlusion at FRC on
the first (A) and last (B) day of ITTO conditioning. Traces are from the same
animal. Arrows indicate when cuff inflation was performed. Inflation was
maintained over the rest of each segment shown in A and B.


_ __ _~__ ___











0.3


0-2
EOC
S0.1 M o


0
First Day Ti Last Day Ti



0.6


0.4


0.2 O 0


0
First Day Ttot Last Day Ttot


0.4

*
03


UO
0-2 E nc
00
0.1

0
First Day Te Last Day Te



2




Q 1 E- First Day

0.5 "| Last Day
CS 0.5

0
Ti Te Ttot


Figure 3-2. Timing parameters during control (C) and occluded (0) breathing. C from
the 3 s prior to occlusion, and the first 3-4 s of O are shown for Ti (A), Te (B),
and Ttot (C) on the first and last day of ITTO conditioning. Differences in Te
during C and O were significantly different on the first and last day (*p=0.03).
Normalized breath timing data (O/C) for Ti, Te, Ttot are also shown (D).











0.5
0.48
S0.46
0.44 C
0.42 0
0.4
0.38
FirstDay LastDay



1.2
1
0-8 T
0.6 EDC
0.4 O
0.2
0
FirstDay LastDay


0.6
S0.58
S0.56
0.54 o C
0.52 O
0.5
0.48
First Day Last Day



12
1
0.8
Q 0.6 FirstDay
S0.4 0 LastDay
o 0-2
0
TifTlot Teftot Tifffe


Figure 3-3. Relative timing parameters during control (C) and occluded (0) breathing.
The contribution of Ti to Ttot (A) and Te to Ttot (B) are shown for C from the 3
s prior to occlusion, and the first 3-4 s of O on the first and last day of ITTO.
The ratio of Ti/Te during C and O are also shown (C). These ratios are
expressed as normalized values (O/C; part D).










7 A 1.25
t 6 1.2
F4 5 1.15
.4-a

1 1
2 0 1.05

0 0.95
First Day Last Day First Day Last Day

Figure 3-4. Integrated EMGdia activity during control (C) and occluded (0) breathing.
intEMGdia/effort is shown during C from the 3 s prior to occlusion, and the first
3-4 s of O on the first and last day of ITTO (A), and the difference between O
and C on the last day of ITTO conditioning was significant (*p=0.03).
Normalized values (O/C) for intEMGdia/effort on the first and last day of ITTO
conditioning were significantly different (B, *p=0.05).


I -


r I









CHAPTER 4
STRESS AND ANXIETY RESPONSES TO REPEATED TRACHEAL OCCLUSIONS

Introduction

An animal's acute response to stress is characterized by activation of neural

pathways that lead to arousal in preparation for handling the threat posed by the

stressor. Arousal may include increases in heart rate, respiratory rate, blood pressure,

and heightened startle responses. The stress-related neural pathways converge upon

the paraventricular nucleus (PVN) of the hypothalamus (Herman et al., 2003; Herman et

al., 2008; Flak et al., 2009). The median parvocellular part (PaMP) is the neurosecretory

division of the hypothalamus responsible for producing corticotropin releasing hormone

(CRH) (Vale et al., 1981), released in response to stress (Herman et al., 2003; Herman

et al., 2008; Flak et al., 2009). CRH is released in the anterior pituitary and promotes

the secretion of adrenocorticotropic hormone (ACTH) (Vale et al., 1981; Antoni, 1986)

which circulates to the adrenal glands where glucocorticoids like corticosterone (Cort;

cortisol in humans) are released by the adrenal cortex. This pathway is known as the

hypothalamic-pituitary-adrenocortical (HPA) axis. Cort, via its many neurophysiologic

actions, plays a role in normal neuroendocrine function and assists an animal in

adapting to stressors (Sapolsky et al., 2000). Thus, measuring blood plasma Cort levels

is one way to determine the extent of HPA axis activation. Measuring PVN CRH or

blood CRH is not linearly correlated with chronic stress because repeated exposure to

the stress leads to a blunted CRH response (Harbuz et al., 1992). Additionally, the

acute HPA response to the presentation of a stimulus used in a chronic stress paradigm

shows habituation (Girotti et al., 2006; Grissom et al., 2007), while basal HPA activation

remains elevated (Fernandes et al., 2002; Armario, 2006; Filipovic et al., 2010).









The physiological response to stressful stimuli varies depending upon a number of

factors such as duration, predictability, and controllability of the stimulus (Levine, 2000;

Herman et al., 2003; Arnhold et al., 2007; Grissom et al., 2007). Stress-inducing stimuli

can be categorized as internal (visceral) physical, external physical, or psychological (Li

et al., 1996; Levine, 2000; Herman et al., 2003), and stimuli can fall under more than

one category. Respiratory afferents activated by resistive loads to breathing project to

subcortical neural areas, discriminative (Davenport et al., 1985; Davenport et al., 1991;

Davenport et al., 1993; Davenport & Hutchison, 2002), and affective sensory regions

(von Leupoldt & Dahme, 2005b; Schon et al., 2008) that may contribute to both internal

physical and psychological stress. Patients with respiratory obstructive diseases such

as chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in

the United States (Heron & Tejada-Vera, 2009), experience psychological stress and

often have affective disorders such as anxiety and panic (Brenes, 2003; Wagena et al.,

2005). Additionally, individuals diagnosed with affective disorders are more likely to

have higher salivary Cort levels upon waking (Vreeburg et al., 2010). It remains unclear,

however, what effect repeated, stressful respiratory stimuli may have on HPA activation

in healthy conscious animals, and whether the stimuli are sufficient to cause affective

responses.

Our laboratory has developed a model of unavoidable, intrinsic, transient tracheal

occlusions (ITTO) in conscious rats. A tracheal occlusion is, functionally, an infinite

resistive load to breathing, and our laboratory has shown that intense resistive loads are

stressful stimuli (Alexander-Miller & Davenport, 2010). Measuring resting plasma Cort

allows for the approximation of stress-related HPA activation. With repeated or chronic









stress, an animal's adrenal glands become enlarged due to sustained increased Cort

production (Harbuz et al., 1992; Fernandes et al., 2002; Marquez et al., 2004).

Comparing Cort levels and adrenal gland weight in animals after 10 days of ITTO

conditioning to values obtained from animals not receiving occlusions allowed us to

approximate the extent of stress caused by ITTO. In addition, the Elevated Plus Maze

(EPM) has been used as a behavioral test for anxiety in rodents (Pellow et al., 1985). All

animals completed an EPM test prior to ITTO and before their last day of ITTO to

determine changes in state anxiety caused by conditioning. It was hypothesized that

after 10 days of uncued ITTO, an unavoidable stress, rats would have elevated basal

plasma Cort, increased adrenal weights, and increased anxiety-like behavior measured

via the EPM.

Methods

Animals

These experiments were performed on 25 male Sprague-Dawley rats (374.0

55.0 g). The animals were housed two to a cage in the University of Florida Animal Care

Facility where they were exposed to a 12 h light/12 h dark cycle. The experimental

protocol was reviewed and approved by the Institutional Animal Care and Use

Committee of the University of Florida.

Surgical Procedures

Animals were initially anesthetized using isoflurane gas (2-5% in 02) administered

in a whole-body gas chamber. Anesthetic depth was verified by the absence of a

withdrawal reflex from a rear paw pinch. Buprenorphine (0.01-0.05 mg/kg body weight)

and carprofen (5mg/kg body weight) were administered preoperatively via

subcutaneous injection. Incision sites were shaved and sterilized with povidine-iodine









topical antiseptic solution. Body temperature was maintained at 380C by a heating pad,

and anesthesia was maintained by isoflurane gas via a nose cone.

The trachea was exposed by a ventral neck incision. The trachea was freed from

surrounding tissue and a saline-filled inflatable cuff (Fine Science Tools) was sutured

around the trachea, two cartilage rings caudal to the larynx. The actuator tube of the

cuff was plugged and routed subcutaneously to the dorsal surface of the animal,

externalized via an incision between the scapulae. The tissue exposed in the ventral

incision was pulled over the cuff and the skin was sutured closed. The skin at the dorsal

incision was sutured closed and the tube was secured in place by tying the ends of the

suture around a bead on the tube. Rats were then administered warm normal saline

(0.01-0.02 ml/g body weight) and isoflurane anesthesia was gradually reduced. The

animal was placed in a recovery cage on a heating pad and was returned to the Animal

Care Facilities once fully mobile. Postoperative analgesia was provided for two to three

days using buprenorphine (0.01-0.05 mg/kg body weight) and carprofen (5mg/kg body

weight) given every 24 hours. Animals were allowed a full week of recovery before

experiments began.

Protocol

The animals were retrieved from the Animal Care Facility on the morning of

Experiment Day 1 and were taken to the laboratory. Each animal was placed on the

EPM in a sound-proof room. The animal remained on the EPM for 5 minutes where it

was allowed to explore the two open arms and two closed arms freely and undisturbed.

The animal's movement was tracked with a video recording device and details of its

movement were analyzed with the EPM software. At the end of the 5 minutes the

animal was removed from the EPM and the EPM was cleaned with alcohol wipes. After









all animals completed the maze trial they were brought to the testing laboratory and

placed in one of two recording chambers placed side by side and separated by a visual

barrier. During this acclimatization period lasting 15 minutes, the externalized actuator

tube of the tracheal cuff from each animal was connected to a saline-filled syringe

outside the chamber but no pressure was applied to the syringe. At the end of the 15

min protocol animals were returned to their home cages and the chambers were

cleaned with alcohol wipes. Once all animals had completed the acclimatization protocol

they were returned to the Animal Care Facility.

The animals were retrieved from the Animal Care Facility on the morning of

Experiment Day 2 and were brought to the testing laboratory. They were divided into

two groups: experimental (n=13) and control (n=12). Tails were marked with colors to

identify group and unique animal number. One experimental and one control animal

were placed individually in the two recording chambers and the actuator tube was

connected to a saline-filled syringe. The experimental animal was allowed to rest

undisturbed in the chamber for 2.5 minutes, followed by a series of cuff inflations. The

syringe and cuff were pressure calibrated so a known amount of fluid movement in the

syringe would result in pressure required to fully compress and occlude the trachea.

Removing the pressure allowed for full recovery of the trachea with no interference to

breathing. The cuff of the experimental animal was inflated 3-6 seconds with at least 15

seconds separating the occlusions for ~35 trials in a 15 minute period. The ITTO trials

were applied in a random time pattern. After the final ITTO trial, the experimental animal

was allowed to rest undisturbed in the recording chamber for 2.5 minutes. The control

animal remained undisturbed for the duration of the 20 minute protocol. At the end of









the 20 minutes, both animals were removed from the chambers and returned to their

cages. The recording chambers were cleaned with alcohol wipes between animals. The

next control and experimental animals were placed in the recording chambers and the

20 minute protocol was repeated. This was continued for all animals. All animals were

returned to the Animal Care Facility at the end of Experiment Day 2. This procedure

was repeated daily for Experiment Days 3-11. Before the protocol on Experiment Day

11, all animals completed the EPM test for the second time.

The animals were brought to the laboratory on Experiment Day 12 and they were

allowed to remain undisturbed for 2 hours. Each animal was removed from its cage in a

random order and placed in a chamber with isoflurane gas (5% in 02). It was removed

from the chamber in an anesthetized state, within 1.5 min, and sacrificed. Adrenal

glands were removed and weighed. Trunk blood was collected. Clotted blood was

centrifuged at 40C for 15 minutes, and plasma was extracted and stored at -800C.

Plasma Cort (ng/ml) was measured using a radioimmunoassay (RIA) kit (rat Cort 1251,

MP Biomedicals).

Analyses

Adrenal gland weight was normalized by dividing adrenal weight by the animal's

body weight on the day the adrenals were removed, and these values were compared

between groups using a t-test (significance at p<0.05). Blood Cort levels were also

compared between groups using a t-test (p-value <0.05). Percent time spent in the

open, closed and center regions of the EPM during the test were obtained for each

animal on the first and ninth day of ITTO conditioning. Percent times were analyzed

(Pellow et al., 1985; Rodgers & Dalvi, 1997; Korte & De Boer, 2003) for each maze

region using a one-way repeated measures analysis of variance (RMANOVA),









comparing group (experimental vs. control) and day (pre- vs. post-ITTO conditioning).

Differences were significant when p<0.05, and post-hoc comparisons were performed

using Tukey's HSD with overall significance of p<0.05. All data are reported as means +

SEM.

Results

Figure 4-1 shows averages for basal plasma Cort levels in the control (2.9 1.2

pg/dl) and experimental (5.2 1.5 pg/dl) groups after 10 days of ITTO (p=0.02). The

difference in group averages for adrenal/body weight is shown in Figure 4-2 (control:

0.14 0.009; experimental: 0.17 0.006; p=0.03). The group averages for the percent

time spent on the open arms, closed arms, and center of the EPM during the 5 minute

protocol are shown for values obtained before (Pre-Tx) and after (Post-Tx) ITTO

conditioning in Figure 4-3. There were no group differences for parameters measured

Pre-Tx or Post-Tx, and there were no Pre-Post differences for parameters measured in

the control group; however, the percent time spent on the open arms of the maze Post-

Tx was significantly less than during Pre-Tx for the experimental group (p=0.05). There

were no Pre-Post differences in the experimental group for time spent on the closed

arms or on the center of the EPM.

Discussion

Ten days of uncued, uncontrollable ITTO elicited elevated Cort levels and

increased adrenal weight to body weight ratios in conscious rats. Increased anxiety,

measured by the decreased time in the open arms of the EPM, in the experimental

group was also observed after 10 days of ITTO. The results of this study suggest that

repeated exposure to tracheal occlusions in conscious animals can cause elevated

resting stress and anxiety levels in animals after only 10 days of conditioning. These









results support the link between intense respiratory stimuli, stress, and anxiety reported

with COPD.

We assessed resting blood Cort in the morning when the levels were lowest

(Windle et al., 1998), and obtained adrenal to body weight ratios to corroborate the Cort

measures. The combined results support the hypothesis that repeated bouts of ITTO

augment basal HPA activation. This is similar to stress responses elicited by a variety of

stimuli (Fernandes et al., 2002; Armario, 2006; Filipovic et al., 2010). Our study

indicated that ITTO is a respiratory stimulus sufficient to evoke the same kind of stress

responses seen with exposure to other stressful stimuli. It is clear that the stress

response pattern to ITTO including adrenal hypertrophy and increased basal Cort is

similar to that of other unavoidable intense stressors such as restraint and shock

(Raone et al., 2007), chronic variable stress (Herman et al., 1995), and intermittent

restraint (Fernandes et al., 2002), suggesting that repeated respiratory obstructions

qualify as stress-evoking stimuli. These responses are mediated by both physical and

psychological neural pathways, further suggesting that consciousness plays an

important role in the stress response to respiratory stimuli.

Ten days of ITTO in conscious rats led to increased anxiety. It is known that

uncontrollable stress causes blood Cort to increase (Levine, 2000), and sustained HPA

activation is linked with affective disorders such as anxiety and depression (Roy-Byrne

et al., 1986; Kling et al., 1991; Stenzel-Poore et al., 1994; Maier & Watkins, 2005).

Anxiety and depression share similar behavioral characterizations such as disrupted

sleep patterns, enhanced fear responses, fatigue, cognitive deficits, and weight loss due

to decreased appetite (Stenzel-Poore et al., 1994; Frazer & Morilak, 2005). In humans,









anxiety and depression often have overlapping symptoms according to DSM-IV (APA,

1994). Furthermore, depression is accompanied by hypercortisolism in some individuals

(Roy-Byrne et al., 1986; Vreeburg et al., 2010), and anxiogenic behavior is enhanced by

CRH overproduction (Stenzel-Poore et al., 1994) and correlated with elevated plasma

Cort levels in animals (Pellow et al., 1985). Although we did not test our animals for

depression after 10 days of ITTO, it is possible that they develop anxiety and

depression behaviors since both are linked with HPA dysregulation and share similar

behavioral characteristics.

The PVN projects to the dorsal raphe (DR) (Geerling et al., 2010), and the caudal

DR is excited by CRH (Lowry et al., 2000; Hammack et al., 2002). Serotonin (5-HT) is

released by the DR and is subject to CRH input (Valentino et al., 2009); 5-HT plays a

role in stress-induced CRH and ACTH secretion (Jorgensen, 2007). 5-HT and its

receptors have important implications in the psychological and behavioral responses to

uncontrollable stressors (Maier, 1984; Graeff, 1994; Graeff et al., 1996; Maier &

Watkins, 2005; Jorgensen, 2007; Valentino et al., 2009). According to Graeff and

colleagues (Graeff et al., 1996), stress activates the DR which releases 5-HT into the

periaqueductal gray (PAG) and amygdala, causing immediate escape behaviors that

ultimately become anxiety behaviors through conditioning or learning. When a stressor

is unavoidable, 5-HT released in the hippocampus helps the animal adapt to the stress.

If this pathway becomes dysfunctional, perhaps resulting from repeated activation with

chronic stress, depression behaviors emerge (Graeff et al., 1996). Serotonergic

pathways stimulated by stress likely play a role in the ITTO conditioning responses seen

in our animals, both with HPA axis and anxiety behaviors.









During the 10 days of ITTO conditioning, we observed the animals decreasing

their exploratory behavior and withdrawal fear responses to ITTO, and developing

immobility throughout the 20 minute ITTO trial. These responses are consistent with the

animals developing depression behaviors. However, we did not test for depression and

future studies need to include measures of depression. In another study done by our

laboratory we have found alterations in 5-HT receptor gene expression in thalamic

neural areas after one exposure to ITTO (Bernhardt et al., 2008) and after 10 days of

ITTO (Bernhardt et al., 2010). It appears that serotonergic signaling is modulated in

response to ITTO conditioning, likely from activation of stress responses (Maier, 1984;

Graeff, 1994; Graeff et al., 1996; Maier & Watkins, 2005; Jorgensen, 2007; Valentino et

al., 2009). Changes in serotonergic and stress pathways may suggest that ITTO can

modulate behavioral load compensation, control of respiration (Hodges et al., 2009) and

respiratory neural plasticity (Feldman et al., 2003; Doi & Ramirez, 2008). The PVN also

projects to the brainstem respiratory network, including the nucleus ambiguus (nA) and

the nucleus of the solitary tract (nTS) (Geerling et al., 2010), and the nTS has both

direct and indirect projections to the PVN (Hermes et al., 2006). This loop may be useful

in modulating respiratory motor output during situations of both respiratory and non-

respiratory related stress. The afferents activated by ITTO likely have direct projections

to the PVN that influence the internal physical stress response, while activated limbic

regions may mediate the psychological stress response that includes the HPA axis

(Jankord & Herman, 2008).

It is significant that conscious animals were used in these experiments because

consciousness introduces a behavioral component to the stress response and is









important in the cognitive processing of sensations associated with ITTO. Tracheal

occlusions are infinite resistive loads, and breathing through resistive loads causes

individuals to experience sensations of discomfort, known as dyspnea (von Leupoldt &

Dahme, 2005b; O'Donnell et al., 2007; Schon et al., 2008; von Leupoldt et al., 2008).

Dyspnea is a common symptom of respiratory obstructive diseases (von Leupoldt &

Dahme, 2005a; O'Donnell et al., 2007), and includes both a discriminative and affective

component (von Leupoldt & Dahme, 2005b). The discriminative component is relayed to

the somatosensory brain network, which is processed in a similar fashion in both

humans and animals (Davenport et al., 1985; Davenport et al., 1991; Davenport et al.,

1993; Davenport & Hutchison, 2002). The affective component is relayed to parts of the

limbic neural network and shares similarities with the affective component of pain via

processing in the insular and anterior cingulate cortices (Aleksandrov et al., 2000; von

Leupoldt & Dahme, 2005a; Schon et al., 2008). Thus, although dyspnea cannot be

assessed in animals as it is in humans, the neural correlates that mediate dyspnea are

similar. It is therefore plausible that respiratory obstructions in animals cause intense

sensations of discomfort, leading to an experience of negative affect. Over time, this

negative affect may result in disorders such as anxiety or depression, which are both

highly prevalent in patients with COPD who also experience dyspnea (Karajgi et al.,

1990; Brenes, 2003; Wagena et al., 2005). Dyspnea is a highly aversive sensation and

individuals modify their behavior in order to adapt or avoid experiencing the sensation.

Patients diagnosed with respiratory obstructive diseases often lead sedentary lifestyles

(ZuWallack, 2007; Bourbeau, 2009) and sedentary behavior can be a symptom of









depression (Roshanaei-Moghaddam et al., 2009). Determining if our animals

experience symptoms of depression as a result of ITTO is an important future study.

We hypothesized that repeated ITTO would change basal stress levels in animals.

We measured blood Cort the morning after the last exposure to ITTO. Habituation of the

acute HPA response to a homotypic stressor and sensitization to new stressors after a

chronic stress paradigm has been reported (Fernandes et al., 2002; Grissom et al.,

2007). It is possible that animals in the current study could express a blunted acute Cort

and PVN CRH response to ITTO after multiple days of conditioning, but these

responses would likely be increased if the animals experienced a novel stress such as

shock or restraint stress. These results suggest increased stress reactivity in individuals

who experience airway occlusions or intermittent, unpredictable increases in airway

resistance on a regular basis.

In general, one trial on the EPM is accepted as an indicator of anxiety levels

resulting from treatment differences. Behavior during a second exposure to the EPM is

thought by some to originate from other factors such as the animal's fear of heights, and

is resistant to anxiolytics during a short but not long test duration (File, 1993; File et al.,

1993). However, according to Treit and colleagues (Treit et al., 1993), open arm

avoidance during the EPM test was not related to a fear of heights. This group also

found that animals do not habituate to repeated exposures to the EPM, even after

forced exploration of the open arms. In the present study, a two-exposure protocol was

valid if used in conjunction with our appropriate controls. Hence, the decreased open

arm time after ITTO conditioning in the experimental animals supports our hypothesis

that repeated exposure (10 days) to unexpected, unavoidable, uncontrollable ITTO









produces state changes in conscious animals characterized by increased anxiety and

stress.

ITTO performed once a day for 10 days lead to elevated basal HPA activation,

anxiety, and potentially depression behavior. Intense, unavoidable respiratory stimuli

like tracheal occlusions likely produce intense physical discomfort and severe

psychological stress due to the life-threatening quality of ITTO, which is relevant for

individuals who experience respiratory stress on a regular basis, such as those with

COPD and asthma. Chronic experience with one type of stress can make an individual

more reactive to new types of stress, a dangerous fact when patients with asthma and

COPD have other physiological and psychological symptoms that could be worsened by

airway obstruction-dependent HPA activation. Determining the links between

respiration, sensations, stress, and psychological state is extremely important work that

needs to be continued.










Corticosterone levels
8 1

'6

54

2

0


Ctrl


Exp


Figure 4-1. Basal plasma corticosterone levels (pg/dL) after 10 days of ITTO training
(Exp) or handling without tracheal occlusions (Ctrl). The difference in group
averages was significant (*p=0.02).


Figure 4-2. Adrenal weight normalized to animal body weights after 10 days of ITTO
(Exp) or handling without tracheal occlusions (Ctrl). The difference in group
averages was significant (*p=0.03).


Adrenal weight
0.2



Ctrl 0.1
0.1





Ctrl Exp













Lil


.JLu


o Cd (n=9)
M*Exp (n=7)


60.0
40.0
S 20.0
E 0.0
0


Pr-Tx


Post-Tx


Figure 4-3. Percent time spent in each section of the EPM before (Pre-Tx) and after
(Post-Tx) 10 days of ITTO (Exp) or handling without tracheal occlusions (Ctrl).
Time spent on the open arms of the EPM Post-Tx was significantly different
from time spent on the open arms of the EPM Pre-Tx in Exp animals
(*p=0.05).


Open Closed Center Open Closed Center









CHAPTER 5
NEURAL PLASTICITY IN RESPONSE TO REPEATED TRACHEAL OCCLUSIONS

Introduction

The complexity of the respiratory system enables it to respond to a variety of

mechanical, metabolic, and voluntary stimuli, allowing for the continuation of ventilation

through changes in breathing pattern. Early respiratory studies focused on defining

normal respiratory patterns and control mechanisms and were primarily conducted in

anesthetized animals where reflexes and metabolic needs drive the system. For

example, mechanically challenging the respiratory system using resistive loads to

breathing causes respiratory load compensation, characterized by a decrease in loaded

phase volume and increase in the phase duration, and the unloaded phase of the

breath remains unchanged (Zechman et al., 1976). This response is a vagal-dependent

reflex (Clark & von Euler, 1972; Zechman et al., 1976). Others have described further

components of the load compensation reflex in anesthetized animals including

abdominal muscle activity (Koehler & Bishop, 1979), pulmonary stretch receptor (PSR)

discharge (Davenport et al., 1981a; Davenport et al., 1984; Davenport & Wozniak,

1986), influence of neural activation (Zhang et al., 2009), and the importance of upper

airway afferents during loading (Webb et al., 1994, 1996).

Consciousness and behavior play a major role in modulating breathing, however,

and voluntary control of breathing is capable of overriding the expected responses to

metabolic needs. Studies in conscious animals are less numerous, but they add a vital

component to the understanding of respiratory load compensation. Respiratory loads

elicit respiratory sensations that are detected in conscious animals presented with

inspiratory resistive loads (Davenport et al., 1991). Respiratory loads also elicit cortical









evoked potentials in conscious lambs (Davenport & Hutchison, 2002), suggesting the

load compensation response in conscious states may include suprapontine cognitive

behavioral components. The pattern of behavioral load compensation in conscious

animals is variable (Hutt et al., 1991; Forster et al., 1994; Watts et al., 1997) and differs

from the pattern seen in anesthetized animals. Also unlike anesthetized animals,

conscious animals do not require pulmonary or diaphragm afferents to respond to

resistive loading (Forster et al., 1994), and respiratory muscle activity is not suppressed

by serotonergic inhibition in conscious animals (Sood et al., 2006). The neural

mechanisms responsible for these differences are unclear.

Most of what is known about the neural control of breathing has been determined

from acute studies in anesthetized animals using immunohistochemical or

electrophysiological methods. In anesthetized rats, electrical stimulation of the phrenic

nerve causes neural activation, indicated by c-Fos immunohistochemistry, in the

nucleus of the solitary tract (nTS), rostral ventral respiratory group (rVRG), and

ventrolateral medullary reticular formation (Malakhova & Davenport, 2001). These

nuclei contribute to vagal efferents and are termination sites of vagal afferents, which

transduce information to and from the airways and lungs (Kalia & Mesulam, 1980b, a;

Kalia, 1981b, a). In a related study, c-Fos was found in the periaqueductal gray (PAG)

in response to superior laryngeal nerve (SLN) stimulation (Ambalavanar et al., 1999).

Afferents from tracheal receptors travel in the SLN and recurrent laryngeal nerve (RLN)

(Traxel et al., 1976; Sant'Ambrogio et al., 1977; Lee et al., 1992), respond to changes in

pressure (Traxel et al., 1976; Sant'Ambrogio & Mortola, 1977; Citterio et al., 1985) and

stretch (Davenport et al., 1981c), and have cortical projections via various relay nuclei









(O'Brien et al., 1971; Fukuyama et al., 1993). The PAG is a region involved in defensive

behaviors (Brandao et al., 1994; Vianna et al., 2001). Electrical stimulation and

chemical disinhibition of the dorsal PAG (dPAG) in anesthetized animals activates

respiration (Hayward et al., 2003; Zhang et al., 2005), and respiratory activation is

greater with caudal compared to rostral dPAG stimulation (Zhang et al., 2007).

Furthermore, chemical activation of the dPAG modulates the brainstem volume-timing

reflex in response to inspiratory and expiratory occlusions in anesthetized rats (Zhang et

al., 2009). The lateral parabrachial nucleus (IPBN) has been shown to mediate the

respiratory responses evoked by the dPAG (Hayward et al., 2004), and is a potential

site during voluntary breath holding where suprapontine efferents are integrated,

resulting in a cohesive response that exerts inhibitory control over brainstem respiratory

nuclei (McKay et al., 2008). Although brainstem and suprapontine nuclei important in

mediating acute respiratory responses in anesthetized animals would be expected to

play a role in mediating respiratory responses in conscious animals, their exact role is

unknown. It is additionally unknown whether neural activity in these nuclei may increase

or decrease in response to repeated respiratory stimuli.

Our laboratory has developed a method to study the load compensation reflex in

conscious rats via intrinsic, transient and reversible tracheal occlusions (ITTO). ITTO is

performed by inflating a rubber cuff around the trachea with enough pressure to

reversibly close the lumen of the trachea. Tracheal squeeze with ITTO is expected to

activate lung, airway, and muscle afferents that project to central neural structures and

elicit load compensation. In addition, because a conscious animal's response to

respiratory stimuli can be voluntarily modulated, higher brain centers were expected to









increase activity as a result of repeated ITTO. The somatosensory cortex, an area

responsible for processing discriminative components of stimuli, has increased activity

in response to phrenic (Davenport et al., 1985; Davenport & Vovk, 2009) and intercostal

(Davenport et al., 1993) nerve stimulation, and inspiratory occlusion in conscious lambs

(Davenport & Hutchison, 2002). The ventroposterior (VP) thalamic complex is also an

important area in discriminatory processing, regulating activation in the somatosensory

cortex (Rausell etal., 1992). Phrenic nerve-evoked cortical activation in the cat is

relayed through the VP (Yates et al., 1994; Zhang & Davenport, 2003), and the VP

responds to somatosensory stimuli depending upon body region (Bushnell et al., 1993).

It was expected that the VP would be involved in encoding the discriminatory

components of ITTO.

The anterior insular cortex (Al) is part of an animal's limbic system and is known to

be involved in affective sensory processing (Davenport & Vovk, 2009). The Al activates

respiration upon stimulation (Aleksandrov et al., 2000), and becomes active when

conscious humans breathe through large resistive loads (von Leupoldt & Dahme,

2005a; von Leupoldt et al., 2008). The symptom of dyspnea, or difficult and

uncomfortable breathing, is often associated with respiratory obstructive diseases and is

accompanied by activation in the Al (Banzett et al., 2000; Evans et al., 2002; von

Leupoldt & Dahme, 2005a; von Leupoldt et al., 2008) and amygdala (Evans et al., 2002;

von Leupoldt et al., 2008). The amygdala is also involved in affective sensory

processing and is vital in fear conditioning (LeDoux et al., 1988; Beck & Fibiger, 1995;

Campeau & Davis, 1995; Day et al., 2008), stress responses (Bremner et al., 1996;

Chowdhury et al., 2000), and is activated by phrenic nerve stimulation (Malakhova &









Davenport, 2001). The affective or emotional component evoked by ITTO should result

from activation in the Al and amygdala.

To determine the neural substrates that may mediate behavioral and reflex load

compensation, we stained neural tissue for cytochrome oxidase (CO), an enzyme

involved in oxidative metabolism in the electron transport chain. CO is used to indicate

changes in brain steady state activity levels in response to stimuli (Wong-Riley, 1979;

Wong-Riley, 1989; Gonzalez-Lima & Garrosa, 1991; Hevner et al., 1995), and is

therefore best used in studies of prolonged rather than acute duration. CO can reveal

adaptation within brain nuclei, and neural adaptation has been documented in response

to inspiratory resistive loading in humans (Gozal et al., 1995). CO staining would help

determine increases or decreases in neural activity in response to repeated ITTO,

significantly advancing our understanding of the neural areas mediating behavioral load

compensation. We designed a 10 day ITTO protocol in conscious rats that would elicit

and behaviorally condition the animal to respiratory load compensation. It was

hypothesized that 10 days of ITTO would induce state changes in respiratory brainstem

nuclei, areas involved in stress responses, and suprapontine nuclei involved in

discriminative and affective respiratory information processing.

Methods

Animals

These experiments were performed on 10 male Sprague-Dawley rats (363.2

38.3 g). The animals were housed two to a cage in the University of Florida animal care

facility where they were exposed to a 12 h light/12 h dark cycle. The experimental

protocol was reviewed and approved by the Institutional Animal Care and Use

Committee of the University of Florida.









Surgical Procedures

Animals were initially anesthetized using isoflurane gas (2-5% in 02)

administered in a whole-body gas chamber. Anesthetic depth was verified by the

absence of a withdrawal reflex from a rear paw pinch. Buprenorphine (0.01-0.05 mg/kg

body weight) and carprofen (5mg/kg body weight) were administered preoperatively via

subcutaneous injection. Incision sites were shaved and sterilized with povidine-iodine

topical antiseptic solution. Body temperature was maintained at 38C by a heating pad,

and anesthesia was maintained by isoflurane gas via a nose cone.

The animal was placed in a supine position and the trachea exposed by a ventral

neck incision. The trachea was freed from surrounding tissue and a saline-filled

inflatable cuff (Fine Science Tools) was sutured around the trachea, two cartilage rings

caudal to the larynx. The actuator tube of the cuff was plugged with a blunt needle and

routed subcutaneously dorsally and externalized through an incision between the

scapulae. The tissue exposed in the ventral incision was pulled over the cuff and the

skin was sutured closed. The skin at the dorsal incision was sutured closed and the

tube was secured in place by tying the ends of the suture around a bead on the tube.

Rats were then administered warm normal saline (0.01-0.02 ml/g body weight) and

isoflurane anesthesia was gradually reduced. The animal was placed in a recovery cage

on a heating pad and returned to the Animal Care Facilities once fully mobile.

Postoperative analgesia was provided for two to three days using buprenorphine (0.01-

0.05 mg/kg body weight) and carprofen (5mg/kg body weight) given every 24 hours.

Animals were allowed a full week of recovery before experiments began.









Protocol

The animals were retrieved from the Animal Care Facility on the morning of

Experiment Day 1 and were brought to the testing laboratory and placed in one of two

recording chambers side by side and separated by a visual barrier for an acclimatization

period of 15 minutes. During this time the externalized actuator tube of the tracheal cuff

from each animal was connected to a saline-filled syringe outside the chamber but no

pressure was applied to the syringe. Chambers were cleaned with alcohol wipes

between each animal. Animals were then returned to the Animal Care Facility.

Training

The animals were retrieved from the Animal Care Facility on the morning of

Experiment Day 2 and were brought to the laboratory. They were randomly divided into

two groups: Experimental (n=5) and Control (n=5). One experimental and one control

animal were placed individually in the two recording chambers and the actuator tube

was connected to a saline-filled syringe. The experimental animal was allowed to rest

undisturbed in the chamber for 2.5 minutes, followed by a series of cuff inflations. The

syringe and cuff were pressure calibrated to a known amount of fluid movement in the

syringe that would result in the pressure required to fully compress and occlude the

trachea. Removing the pressure allowed for full recovery of the trachea with no

interference to breathing. The 10 minute protocol consisted of twenty 10 second

inflations. The trials were applied in a random time pattern. After the last trial, the

experimental animal was allowed to rest undisturbed in the recording chamber for 2.5

minutes. The control animal remained undisturbed for the duration of the 15 minute

protocol. At the end of the 15 minutes, both animals were removed from the chambers

and returned to their cages. The recording chambers were cleaned with alcohol wipes









between animals. The next control and experimental animals were placed in the

recording chambers and the 15 minute protocol was repeated. This was continued for

all 5 pairs of animals. This protocol was repeated once daily for Experiment Days 2-11.

Experiment Day 12 began by retrieving the animals from the Animal Care Facility

and bringing them to the testing laboratory where they were allowed to remain

undisturbed for 2 hours. Each animal was removed from its cage in a random order and

placed in a chamber with isoflurane gas (5% in 02). It was removed from the chamber in

an anesthetized state and brains were removed, blocked into three pieces via coronal

cuts, and placed in 4% paraformaldehyde.

Cytochrome oxidase (CO)

The blocked brains remained in the paraformaldehyde solution for 3 days, and

then were transferred into a 30% sucrose solution for 2 days. Brains were cut with a

microtome and the tissue was placed one slice per well in 24-well plates. Each well was

filled with phosphate buffer saline, pH 7.4 (PBS), and the tissue remained in the PBS for

5 days. One full series (column) of tissue per animal brain was used for the staining

protocol, adapted from (Wong-Riley, 1979). Briefly, the CO solution was made [600 ml

PBS, 60 g sucrose, 300 mg cytochrome C (Sigma, C2506), 200 mg catalase (Sigma,

C9322) and 150 mg diaminobenzidine (Sigma, D5905)] and applied to the tissue. All

plates were put on a shaker and covered to prevent light exposure. They remained on

the shaker overnight, were removed 17 hours later and transferred into PBS. The

following day, tissue was mounted on glass microscope slides, dehydrated with ethanol,

cleaned with xylene, and coverslipped with Eukitt.









Analyses

Imaging

Slides of brain tissue were viewed using light microscopy (Zeiss Axioplan 2),

images were captured using a computer software system (ImagePro Plus), converted to

8-bit mono images, and stored. During each capture session the image of a blank slide

was also captured using the same settings. A standard optical density calibration

(arbitrary units) was created by setting black levels to zero and using the image of the

blank slide as the incident light reference. This corrects for differences in background

light levels between capture sessions where different settings may have been applied.

The standard calibration was applied to all relevant images before any measurements

were made. Three line readings were taken from within a nucleus, defined by

stereotaxic coordinates (Paxinos & Watson, 1997), for at least one slide per nucleus per

animal (Hevner et al., 1995). This results in at least three readings per nucleus per

animal that were averaged. The intensity of staining in each nucleus was determined for

each animal. Those values were normalized to the average intensity of staining in an

area of white matter (optic tract) for that animal to control for variability between staining

batches.

Statistics

The normalized values were combined according to group and were used to

conduct a t-test for each nucleus analyzed. Statistical significance was determined at p-

values < 0.05. The group means SEM are reported.









Results


Brainstem

In the brainstem, the primary respiratory neural areas included the VRG and

nTS. The level of CO staining measured in the rostral nTS in experimental animals was

significantly greater than in controls (Figure 5-1; p=0.01). There were no significant

differences in staining intensities between groups in the cnTS, VRG, AP, IPBN, or locus

coeruleus (LC).

Midbrain

Staining intensities in the PAG and the dorsal raphe (DR) (Table 5-2) were

greater in the experimental group compared to control, and differences between group

averages were statistically significant for all areas except the rostral dPAG (p=0.06).

The most significant difference between group averages in all nuclei was seen in the

caudal ventral PAG (vPAG) (Figure 5-2; p=0.004).

Higher Brain Centers, Discriminative & Affective

The amount of CO staining in the experimental group was significantly greater

compared to control in the ventroposteromedial thalamic nucleus (VPM), and the

agranular insular cortex (Al) (Figures 5-3, 5-4; p=0.02). There were no significant

differences in average CO staining between groups in the arcuate (Arc), PaMP,

centromedial thalamus (CM), ventroposterolateral thalamus (VPL), cingulated cortex

(Cgl), or central nucleus of the amygdala (CeA).

Discussion

The load compensation response in conscious animals arises as a result of

activated reflexive respiratory pathways and the modulation of these pathways by

conscious input. Ten days of repeated ITTO in conscious rats caused significant state









changes in the rostral nTS, PAG, DR, VPM and Al. This is the first evidence of neural

compensation in response to respiratory load conditioning in conscious animals. Other

techniques of conscious respiratory loading include tracheal banding (Greenberg et al.,

1995; Rao et al., 1997), restricting airflow to a head chamber (Farre et al., 2007), and

applying loads via a tracheostomy (Davenport et al., 1991; Osborne & Road, 1995;

Davenport & Hutchison, 2002) or facemask (Davenport & Hutchison, 2002). Tracheal

banding is a sustained increase in airway resistance that leads to compensation from

both mechanical and chemical activation. Restricting airflow via a head chamber,

tracheostomy, and facemask are extrinsic airway resistances and are often

implemented acutely. The model used by our laboratory is unique in that it allows for

intrinsic, transient, tracheal occlusions in conscious animals with a return to normal

airway resistance between cuff inflations.

Increases in neural metabolic activity after 10 days of ITTO were seen in the

experimental group compared to control in the rostral nTS but not the brainstem

respiratory nuclei such as the VRG or caudal nTS. The caudal nTS is the primary

nucleus targeted by cardiorespiratory afferents and is involved in respiratory control

(Kubin et al., 2006), whereas the rostral nTS is involved in gustatory sensory

processing. In other studies in our laboratory (unpublished results), we have shown that

ITTO elicits transient changes in blood pressure that temporally correspond with each

occlusion. This is likely due in part to sympathetic activation and in part to the

hemodynamic response to such large negative intrathoracic pressures. During each

occlusion, afferents activated in the lung, airway, trachea, and blood vessels ascend to

the caudal nTS. In addition, it is possible that afferents from chemoreceptors might also









ascend to the nTS if the 10 second tracheal occlusions are long enough to cause a

slight degree of hypoxia by the end of the occlusion. Farre and colleagues (Farre et al.,

2007) found a 10 s obstruction reduced the SpO2 to 83% in rats, and results from

Yasuma et al. (Yasuma et al., 1991) showed increased arousal in dogs at higher SaO2

levels when resistive loads were also applied. The mechanical stimulation may enhance

chemical stimulation, which would be relayed to the nTS by carotid body afferents

traveling in the glossopharyngeal nerve. With ITTO, the caudal nTS should receive

great amounts of intermittent, convergent mechanical and potential chemical input. This

input was not sufficient to induce permanent modulatory changes in activity level within

the caudal nTS after 10 days of ITTO, however. The observation of increased basal

activity in the rostral nTS due to ITTO conditioning could be related to the proximity of

the cuff to the pharynx and oral cavity, in which are taste receptors sending sensory

information to the rostral nTS. Rostral nTS activation could also be related to the fact

that cranial nerves relaying gustatory information to the rostral nTS are also involved in

mediating visceral sensations, some potentially related to cuff inflation, and that this

overlap resulted in the increase in CO activity seen in these results.

Plasticity is known as a "persistent change in the neural control system based on

prior experience" (Mitchell & Johnson, 2003). Neural modulation in the respiratory circuit

is known to occur in response to respiratory stimuli (Baker et al., 2001; Mitchell &

Johnson, 2003), and also occurs in other brain structures (Huang & Kandel, 1994;

Feldman et al., 1999). The nTS is an area well-known for its plastic abilities (Chen et al.,

2001; Kline, 2008), and it is possible that the rostral nTS alters basal neural activity as

an adaptation to the intermittent convergent input caused by repeated ITTO









conditioning. This could indicate that the nTS changes its state for conditioned load

compensation to subsequent airway obstruction challenges, allowing for adaptation of

physiological responses to the severe respiratory challenge posed by repeated ITTO.

McKay and colleagues (McKay et al., 2003) suggest that the brainstem respiratory

network, including the nTS, may be an important site for the voluntary control of

breathing in humans. Thus, the nTS may also be an important site for the voluntary

modulation of breathing in animals, with the rostral division undergoing plastic changes

as a result of ITTO conditioning and potentially generating a new response pattern for

the animal.

Veening and colleagues (Veening et al., 2009) found increased c-Fos expression

in the AP as a result of an anxiety-producing paradigm, and the AP projects to the nTS

(Bonham & Hasser, 1993). No group differences were seen in the present study in the

AP as a result of ITTO, indicating it did not undergo changes in baseline activity;

however, that does not rule out a potential role for the AP in the acute response to

ITTO. The AP projects to the IPBN (Herbert et al., 1990), and neurons in the nTS

activated by vagal afferents send projections to pontine respiratory groups, including to

the IPBN (Herbert et al., 1990; Ezure et al., 1998). The IPBN is involved in PAG-

activated cardiovascular (Hayward et al., 2004; Hayward, 2007) and respiratory

responses (Hayward et al., 2004), and the PAG has projections to other areas like the

medulla that also mediate these responses (Cameron et al., 1995; Farkas et al., 1998).

The lack of group differences in CO staining seen in the IPBN suggests that there was

no change in steady state activity after 10 days of ITTO, but this does not mean the

IPBN was not activated during ITTO or that this activation could not lead to steady state









changes in interconnected nuclei. The IPBN is not a brain region where a change in

basal activity is often seen, but the IPBN is known to play a role in plasticity in other

neural areas (Lopez de Armentia & Sah, 2007). Surprisingly, no change in baseline

activity was seen in the LC in response to 10 days of ITTO. The LC is involved in the

noradrenergic response to stressful stimuli (Bremner et al., 1996; Van Bockstaele et al.,

2001), and our laboratory has shown that ITTO is a stress-evoking stimulus

(unpublished results). The LC receives efferent projections from the CeA, nTS, and the

PAG (Van Bockstaele et al., 2001). There can be opposing actions on the LC from

these nuclei and others in response to different types of stressors (Van Bockstaele et

al., 2001); excitatory and inhibitory inputs to this area may prevent an alteration in

steady state activity. Alternatively, a change in baseline neural activity in the LC may not

be a necessary response to repeated ITTO. A study looking at the fMRI response to

inspiratory loading in humans showed that the level of activation in regions

corresponding with the LC decreased upon the second presentation of the load (Gozal

et al., 1995). Perhaps the LC initially responds to ITTO by increasing activity but does

not remain active if the stimulus is not present, having no effect on baseline activity

levels.

The midbrain PAG was the brain region with the largest differences in staining

between groups. The PAG is involved in defensive behaviors (Bandler & Carrive, 1988;

Brandao et al., 1994; Vianna et al., 2001), pain modulation (Mayer et al., 1971;

Behbehani, 1995), respiratory activation (Hayward et al., 2003; Zhang et al., 2005), and

modulation of the load compensation response (Zhang et al., 2009). Neural activation

was observed in the PAG in response to SLN stimulation (Ambalavanar et al., 1999),









which is one group of tracheal afferents likely stimulated by cuff inflation. After 10 days

of ITTO we noticed the greatest differences in the caudal compared to the rostral PAG.

Interestingly, the results of (Zhang et al., 2007) showed greater respiratory activation in

response to caudal vs. rostral dPAG stimulation. The caudal PAG has descending input

to the nTS and the ventrolateral PAG innervates the VRG and the paraventricular

hypothalamus (PVN) (Farkas et al., 1998). The dPAG showed significantly increased

steady state excitation in animals exposed to 10 days of ITTO, while increases in the

vPAG approached significance. The response of the PAG may have contributed to the

significant changes also seen in the rostral nTS. The dPAG and vPAG have been

implicated in panic and anxiety, respectively (Carrive, 1993; Bandler & Shipley, 1994;

Brandao et al., 1994; Vianna et al., 2001; Cunha et al., 2010), and the vPAG appears to

be involved in conditioned fear responses (Vianna et al., 2001). Repeated ITTO may

initially produce panicogenic responses that ultimately become anxiogenic as a result of

contextual fear during ITTO conditioning in our rats.

The raphe nucleus is a main source of serotonin (5-HT) in the brain. The DR is the

subdivision with the greatest serotonergic input to other nuclei, and the amygdala

receives most of its 5-HT from the DR (Azmitia & Segal, 1978; Li et al., 1990). After 10

days of ITTO the DR had elevated steady state activity, suggesting a potential role in

the adaptive response to repeated severe respiratory stimuli. 5-HT has been implicated

in respiratory (Lindsay & Feldman, 1993; Bianchi et al., 1995; Pena & Ramirez, 2002;

Hodges et al., 2009) and cardiovascular control (Merahi et al., 1992; Dergacheva et al.,

2009), and is also involved in respiratory plasticity (Baker et al., 2001; Fuller et al.,

2001; Bocchiaro & Feldman, 2004; Doi & Ramirez, 2008). The DR and serotonin also


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play a role in stress responses and mental disorders (Maier, 1984; Maier & Watkins,

2005; Jorgensen, 2007; Mizoguchi et al., 2008). Many individuals with respiratory

obstructive diseases have anxiety, and 5-HT is often pharmacologically manipulated to

treat anxiety in these patients (Brenes, 2003). Also, learned helplessness caused by

uncontrollable stressors can lead to sensitization of serotonergic neurons in the DR,

which respond to future stressors with exaggerated 5-HT release that subsequently

leads to behavioral changes (Maier & Watkins, 2005). ITTO is an unexpected,

uncontrollable, life-threatening stressor, and the increase in steady state DR activity

may be an indicator that the serotonergic system is sensitized as a result of our 10 day

protocol. This has implications for individuals who experience transient uncontrollable

respiratory stress, especially in the form of obstructive events occurring with asthma

and chronic obstructive pulmonary disease (COPD). These individuals may be

sensitized to exaggerated stress responses to other stimuli as well, creating an

unhealthy physiological and psychological state.

Serotonergic influence is dependent upon the nucleus and the receptor(s)

activated. It is generally considered that 5-HT1A and 5-HT1B receptor activation is

inhibitory (Barnes & Sharp, 1999), and both are present in the CeA (Saha et al., 2010).

The amygdala shares a critical link with the PAG in the fear circuitry of the brain and is

also involved in aversive responses (Brandao et al., 1994; Davis et al., 1994; LeDoux,

2000; Martinez et al., 2006). The CeA is the site of many convergent inputs, including

nociceptive afferents from the PBN and spinal cord (LeDoux, 2000). The basolateral

and lateral amygdala act as the regulators of information received from aversive stimuli

reaching the CeA, the motor output subnucleus of the amygdala (Campeau & Davis,


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1995). Our laboratory has shown (Shahan et al., 2008) that electrical stimulation of the

CeA leads to an increase in respiratory rate in anesthetized rats, potentially through

output to the PAG. We expected to see down regulation of CeA activity as a result of

ITTO conditioning, potentially via DR activity, assuming increased DR activation after

ITTO would result in greater 5-HT release in the CeA; however, there was no

observable change in CeA activity. The CeA has inhibitory projections to the PAG and

nTS via gamma aminobutyric acid (GABA) (Davis et al., 1994; Saha et al., 2010).

Down-regulation of CeA GABA-ergic innervation could disinhibit the PAG (Saha, 2005;

Oka et al., 2008). Thus, if baseline activity in the CeA decreased, activation of the PAG

and nTS could increase through disinhibition, potentiating the fear and anxiety

component of behavioral respiratory load compensation observed after repeated airway

obstruction experiences such as ITTO. This might allow the animal to modulate its

physiological responses to repeated respiratory mechanical stressors or fearful stimuli

via CeA plasticity. The lack of staining differences in the CeA suggests there are other

neural areas playing a larger role in the modulation of responses.

The PVN is another nucleus known to respond to stressful stimuli. The PaMP is

the neurosecretory division of the PVN responsible for producing corticotropin releasing

hormone (CRH) (Vale et al., 1981), and it projects to a number of brain regions

including the DR, PAG, PBN, nTS, and VRG (Dampney, 1994; Geerling et al., 2010).

Because ITTO is a stressful stimulus (unpublished results), the PaMP was expected to

have increased basal activity after 10 days of ITTO, however no significant differences

between groups were found. According to Arnhold and colleagues (Arnhold et al.,

2007), the PaMP response to acute stress may be different from repeated stress. They


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found decreased c-Fos expression in CRH-positive parvocellular neurons after repeated

episodes of restriction-induced drinking, a stress-evoking stimulus. They suggested that

the inhibition could be a result of conditioning. The lack of increased or decreased

activity in the PaMP after ITTO conditioning may be due to the duration of the protocol.

The 10 days of conditioning may be long enough that an increase in activity is no longer

observed, but short enough that a persistent downregulation of activity has not yet

occurred.

Subcortical neural networks are essential for maintaining normal cardiorespiratory

function, generating reflexes, and adapting to recurring or prolonged stimuli. Some

components of these networks can be voluntarily modulated in conscious animals via

cortical input. An awake animal has two defined systems involved in sensory

processing. The discriminative system encodes stimulus details such as intensity,

timing, and location of the stimulus, whereas the affective system integrates the

qualitative emotional aspects associated with the stimulus. The discriminative pathway

includes a relay through the thalamus to the somatosensory cortex, and the affective

pathway involves structures such as the amygdala, anterior cingulate (Cgl), and Al (von

Leupoldt & Dahme, 2005b, a; Schon et al., 2008; von Leupoldt et al., 2008; Davenport &

Vovk, 2009). Both these pathways are involved in respiratory sensations (von Leupoldt

& Dahme, 2005b, a; Schon et al., 2008; von Leupoldt et al., 2008; Davenport & Vovk,

2009). With ITTO we have found long-term increases in activity in the VPM thalamus

and Al. The VPM is an area that responds to facial stimuli. Prior experiments have

found activation in the VPL in response to phrenic nerve stimulation (Yates et al., 1994;

Zhang & Davenport, 2003). It is possible that tracheal afferents activated upon cuff


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inflation send projections beyond the brainstem to the VPM via polysnaptic pathways

(Ambalavanar et al., 1999). In addition, Cechetto and Saper (Cechetto & Saper, 1987)

found that the VPM projects visceral sensory information to the Al, some of which

includes cardiopulmonary afferent information. The present study shows changes in the

activity state of the discriminatory cortical pathway but the afferents activated by ITTO

mediating these changes remain unknown.

The affective Al had significantly increased CO staining in the experimental

animals compared to controls. The Al has an excitatory projection to the PAG

(Behbehani et al., 1993), responds to respiration, arterial chemoreceptors, and

cardiovascular baroreceptors (Cechetto & Saper, 1987), and is active during voluntary

breath-holding maneuvers (McKay et al., 2008). Aleksandrov and colleagues

(Aleksandrov et al., 2000) found a respiratory related area in the insular cortex that

produced either excitatory or inhibitory respiratory responses when stimulated,

depending upon whether the region was posterior or anterior, respectively. Of note, the

Al also plays a vital role in the neural processing of dyspnea, or the sensation of difficult

and uncomfortable breathing (von Leupoldt & Dahme, 2005a; von Leupoldt et al., 2008;

Davenport & Vovk, 2009). Because loaded breathing has been shown to produce

dyspnea (Schon et al., 2008), it is likely that the Al is activated by the sensations

associated with ITTO and may play a significant role in modulating the behavioral load

compensation responses to repeated ITTO. This modulatory function might arise from

plasticity within the region, suggested by the increase in basal activity after 10 days of

ITTO.


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In order to understand the neural mechanisms involved in load compensation

responses to respiratory stimuli in human subjects, non-invasive methods such as fMRI

and cortical evoked potentials (CEP) are most often used (Gozal et al., 1995; Davenport

et al., 2006; Chan & Davenport, 2008; von Leupoldt et al., 2008; Chan & Davenport,

2009). Both methods provide information regarding the brain's immediate response to a

stimulus. fMRI produces information about both inhibition and activation, and CEP

indicates temporal activity patterns primarily in the cortex. Both methods have been

used in animals. Although they produce large quantities of data, they offer little

information about specific neural networks and plasticity. Because of the ability to

conduct invasive experiments in animals, researchers can also use histochemistry to

determine specific neural changes in response to stimuli after the stimulus has been

delivered. A common method is staining neural tissue for c-Fos, which only depicts

areas of activation, not inhibition. Furthermore, c-Fos cannot differentiate between

afferent or efferent activation, and many control groups are needed. CO is another

histomchemical method, but unlike with c-Fos it can show both excitatory and inhibitory

state changes in brain activity but does not provide information on acute neural activity.

One potential difficulty with using CO lies in the fact that brain nuclei have inherent

differences in metabolic rates. Certain areas are always less active than others and will

have less intense CO staining. Determining group differences in metabolic activity for

these nuclei can be difficult when the changes are small. Similar to the observations of

Hevner and colleagues (Hevner et al., 1995), the greatest staining was observed in

special sensory and motor nuclei such as the dorsal and ventral respiratory groups,

while the lowest staining intensities were seen in limbic nuclei like the amygdala, which


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is known for less CO reactivity. The between-group differences in steady state activity in

limbic nuclei resulting from ITTO may actually be more robust than is indicated by CO

staining, especially if the change is a net decrease in activity level as was seen in the

amygdala in this study.

This study shows state changes in specific brain nuclei elicited by conscious load

compensation conditioning to respiratory mechanical stimuli. Significant findings include

increases in basal activity of the nTS, PAG, DR, VPM, and Al. This list includes

important respiratory nuclei, nuclei involved in an animal's stress response, and nuclei

mediating discriminative and affective sensory processing. These results suggest a

modulation of sensory brain regions, which is especially relevant to pulmonary diseases

characterized by transient, unexpected, inescapable, uncontrolled airway obstruction

such as asthma, COPD, and obstructive sleep apnea. Patients with these pulmonary

diseases have a high incidence of stress and affective disorders. Repeated obstructions

to breathing during sleep have resulted in impaired detection of R loads in conscious

humans (McNicholas et al., 1984), suggesting that neural structures involved in the

respiratory sensory processing in these patients may have been altered. The present

study reports state changes in brain pathways that are consistent with neural plasticity

related to affective disorders in pulmonary obstructive diseases. Characterizing the load

compensation response in conscious animals, how this response is altered after

repeated experience, and what neural structures mediate these responses is essential

to our understanding of respiratory diseases and rehabilitation.


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Figure 5-1. CO staining in the rostral nTS after A) 10 days of handling and no tracheal
occlusions, and B) 10 days of ITTO. Differences in staining averages between
groups were significant (p=0.01).
















Figure 5-2. CO staining in the caudal vPAG after A) 10 days of handling and no tracheal
occlusions, and B) 10 days of ITTO. Differences in staining averages between
groups were significant (p=0.004).


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Figure 5-3. CO staining in the VPM thalamus after A) 10 days of handling and no
tracheal occlusions, and B) 10 days of ITTO. Differences in staining averages
between groups were significant (p=0.02).

















Figure 5-4. CO staining in the Al and Cgl after A) 10 days of handling and no tracheal
occlusions, and B) 10 days of ITTO. Differences in staining averages between
groups were significant in the Al only (p=0.02).


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Table 5-1. Brainstem CO staining after 10 days of ITTO (Exp) or handling without
tracheal occlusions (Ctrl).
Nucleus Exp Ctrl p-value
caudal nTS 2.66 (.13) 2.46 (.10) 0.31
rostral nTS 2.87 (.19) 2.12 (.14) 0.01
cVRG 3.04 (.17) 2.86 (.10) 0.40
rVRG 3.08 (.16) 2.43 (.16) 0.02
AP 2.76 (.20) 2.85 (.30) 0.82
IPBN 2.07 (.10) 1.93 (.20) 0.57
LC 2.25 (.09) 1.85 (.17) 0.08
Reported values are staining intensities in each nucleus normalized to unstained white
matter from the same animal and staining batch.



Table 5-2. Midbrain CO staining after 10 days of ITTO (Exp) or handling without
tracheal occlusions (Ctrl).
Nucleus Obs Ctrl p-value
caudal dPAG 2.11 (.10) 1.74 (.08) 0.01
caudal vPAG 2.25 (.07) 1.90 (.04) 0.004
rostral dPAG 1.98 (.08) 1.70 (.10) 0.06
DR 2.11 (.06) 1.80(.11) 0.05
Reported values are staining intensities in each nucleus normalized to unstained white
matter from the same animal and staining batch.



Table 5-3. Higher brain centers, discriminative, and affective CO staining after 10 days
of ITTO (Exp) or handling without tracheal occlusions (Ctrl).
Nucleus Obs Ctrl p-value
Arc 2.22 (.14) 2.16 (.19) 0.79
PaMP 2.09 (.11) 2.12 (.27) 0.93
CM 1.74 (.08) 1.47 (.12) 0.09
VPL 2.45 (.13) 2.27 (.13) 0.37
VPM 2.48 (.08) 2.11 (.10) 0.02
Al 2.69 (.06) 2.43 (.06) 0.02
Cgl 2.60 (.13) 2.32 (.12) 0.19
CeA 1.34 (.03) 1.45 (.12) 0.39
Reported values are staining intensities in each nucleus normalized to unstained white
matter from the same animal and staining batch.


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CHAPTER 6
GENERAL DISCUSSION

Acute, Anesthetized Respiratory Load Compensation

Our method of intrinsic, transient, tracheal obstructions for 2-3 breaths in

anesthetized rats elicited respiratory load compensation, including a prolongation of Ti

and relatively longer Te, increased EMGdia activity, and more negative inspiratory Pes.

End-expiratory Pes did not change with obstruction or recovery in any animals, indicating

that ITTO does not change lung compliance. The changes in breath timing and

respiratory motor responses resulted from the load compensation response of the

respiratory neural control system to breathing efforts against a closed airway, and

tracheal squeeze alone was not sufficient to evoke responses. These responses were

mediated by respiratory afferents, including vagal PSR's responding to transpulmonary

pressure (Ptp), which is influenced by lung volume (Davenport et al., 1981b). The

elevated Pes and EMGdia during recovery breaths are consistent with other studies

(Forster et al., 1994; Watts et al., 1997), and it appears that whether respiratory motor

responses return to baseline during recovery depends upon the severity and properties

of the load (i.e. duration, magnitude, and whether it's applied to inspiration, expiration,

or both). Breath timing parameters are often reported to return to baseline during

recovery (Hutt et al., 1991; Forster et al., 1994). The augmentation of parameters during

recovery breaths after ITTO is likely a result of the respiratory system acting to restore

ventilation after prolonged perturbation.

Respiratory load compensation in the anesthetized animal is mediated by reflexive

neural mechanisms and is dependent upon lung, airway and muscle afferent activation,

including PSR's (Zechman et al., 1976; Davenport et al., 1981a; Davenport et al., 1984;


110









Webb et al., 1994, 1996). ITTO in anesthetized rats induced neural activation in

respiratory brainstem nuclei, and nuclei involved in cardiovascular, stress, and affective

responses, indicating that nuclei within these pathways may participate in the breath

timing and motor load compensation responses to ITTO. Our neural pathway model is

represented in Figure 6-1. The nTS is the primary target of lung (Kalia & Mesulam,

1980a, b; Kalia, 1981a) and upper airway afferents (Sant'Ambrogio et al., 1977; Kalia,

1981b; Lee et al., 1992). The nA is activated by the nTS (Loewy & Burton, 1978),

phrenic, vagus, carotid sinus, and superior laryngeal nerve stimulation,

bronchoconstriction, and inspiratory occlusions (Davenport & Vovk, 2009), and also

participates in load compensation responses. The increased FLI in medullary

respiratory nuclei results from tracheal afferents stimulated by the squeeze of the cuff,

pulmonary afferents activated by lung inflation, and efferents mediating changes in

respiratory pattern. ITTO also evoked significant neural activation in the dlPBN, which

has been shown to respond to occlusions (Davenport & Vovk, 2009) and neurons from

the nTS (Loewy & Burton, 1978; Ezure et al., 1998). The IPBN plays a role in the

descending pathway from the PAG involved in cardiovascular (Hayward et al., 2004;

Hayward, 2007) and respiratory (Hayward et al., 2004) control, and the PAG was also

activated by ITTO with the greatest response seen in the caudal region. The PAG is an

important nucleus involved in defensive behaviors (Bandler & Carrive, 1988; Brandao et

al., 1994; Vianna et al., 2001), pain modulation (Mayer et al., 1971; Behbehani, 1995),

panic and anxiety, (Carrive, 1993; Bandler & Shipley, 1994; Brandao et al., 1994;

Vianna et al., 2001; Cunha et al., 2010), conditioned fear (Vianna et al., 2001), and

respiratory responses (Hayward et al., 2003; Zhang et al., 2005, 2007, 2009). The FLI


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seen in the IPBN after ITTO could be a response to afferent projections to that nucleus,

but it could also be a result of projections from the IPBN to other neural areas such as

the limbic system (Saper & Loewy, 1980). The FLI seen in the PAG after ITTO could be

respiratory-specific and/or related to stress and fear pathways. The potential

contribution of other sensory afferents to respiratory volume-timing, motor, and neural

responses to ITTO cannot be ruled out. It is clear that reflexive respiratory load

compensation has a neural component that includes both sensory- and motor-activated

neurons involved in respiratory, cardiovascular, stress, and affective pathways (Figure

6-1).

Conditioned, Conscious Respiratory Load Compensation

The results of the first study in the anesthetized animal provide evidence that our

model of ITTO is effective for eliciting respiratory load compensation and elucidating the

neural component of that compensation. Behavioral load compensation is fundamental

to adaptation to respiratory loads in conscious animals (i.e. escape is a critical

compensation behavior in obstructive pulmonary diseases). It is known that changes in

respiratory behavior can be elicited through conditioning in conscious humans (Gallego

& Perruchet, 1991) and animals (Nsegbe et al., 1997; Nsegbe et al., 1998; Nsegbe et

al., 1999; Durand et al., 2003). Stimuli such as hypoxia and hypercapnia can be paired

with a discrete cue, like a tone or odor, or be implemented in an consistent context.

Conditioned responses were variable, depending upon the stimuli used, species, and

age of the animal. However, the results of those studies indicate that stimuli can change

respiratory behavior, which, over time, may become a persistent response as a result of

learning (conditioning).Thus, we developed a conscious rodent model of ITTO using the

same surgical procedures as in the first study in order to characterize the conscious


112









response to tracheal occlusions and understand how the behavioral control of breathing

modulates reflexive responses, especially after conditioning. The results of that study

showed that the first day response to ITTO consisted of a prolongation of Te with no

significant changes in Ti, Ttot or diaphragmatic activation. After 10 days of conditioning,

conscious rats lengthened Te and increased diaphragmatic activation during occluded

(0) compared to control (C) breaths, which were not accompanied by increases in Ti.

There were no significant changes in total breath timing parameters from the first day of

ITTO to the last day; however, there was a significant increase in the O/C ratio of

diaphragmatic activity per breath. This suggests that after 10 days of ITTO, conscious

animals preferentially change respiratory drive rather than timing in response to the

occlusions, and that the volume-timing reflex seen in anesthetized animals is modulated

in conscious rats.

The prolongation of Te during O was hypothesized to be a result of behavioral

breath holding rather than lung hyperinflation since we attempted to occlude animals at

FRC and only evaluate breaths where that was accomplished. The discomfort caused

by trying to breathe through a large resistive load (Simon et al., 1989; Simon et al.,

1990; ATS, 1999) is aversive (von Leupoldt & Dahme, 2005b; von Leupoldt et al., 2008)

and linked with the fear that arises in response to the threat of suffocation (Lang et al.,

2010) or asphyxiation (Campbell, 2007). The prolongation of Te observed during

tracheal occlusions was likely the attempt of the animals to hold their breath and avoid

the sensations rather than breathe through them. There was an increase in Te on both

the first and last day of ITTO training, however those values were not different from one

another suggesting that even with conditioning the animals will continue to breath-hold


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and avoid the aversive sensations associated with ITTO. Aversive sensations

associated with respiratory stimuli may not habituate, which is beneficial when

considering the survival of the animal. We observed no other changes in breath timing

between O and C or between the first and last day of ITTO indicating that the primary

respiratory load compensation response in conscious animals does not include

modulation of breath timing, which is consistent with respiratory studies in humans

(Clark &von Euler, 1972; Axen et al., 1983).

Increased respiratory muscle activation appears to be a more consistently

reported response in both the conscious and anesthetized human and animal (Axen et

al., 1983; Lopata et al., 1983; Hutt et al., 1991; Frazier et al., 1993; Xu et al., 1993a; Xu

et al., 1993b; Osborne & Road, 1995; Zhang et al., 2009). The diaphragmatic activation

per breath in conscious rats was increased during O compared to C in this study, and

the O/C ratio was greater on the last compared to the first day of ITTO. This was a

result of increased EMGdia amplitude (i.e. muscle fiber recruitment) during Ti, indicative

of stronger inspiratory efforts. These results suggest the enhanced diaphragm motor

response was a result of conditioning, attributed to behavioral sensitization. ITTO

produces stress responses in conscious rats (unpublished results), and others have

reported fear potentiation in response to uncontrollable stressors (Korte et al., 1999).

Additionally, fear-potentiated behaviors are observed as a result of contextual affective

conditioning (Risbrough et al., 2009) and the increased O/C diaphragm response seen

on the last day of ITTO compared to the first day may also due to a heightened affective

state from contextual conditioning. These potentiated behaviors were only apparent

during stimulus presentation and not during C breathing, consistent with habituation of


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resting behaviors during context exposure (Beck & Fibiger, 1995). These results

suggest that there is a respiratory load compensation response to tracheal occlusions in

conscious rats that is different from the anesthetized reflexive response and from other

patterns reported in conscious humans and animals exposed to respiratory loads. This

response includes breath holding and increased inspiratory effort potentially due to a

sensitized behavioral affective response. Thus, the volume-timing reflex may be

modulated in conscious animals by behaviorally mediated increased respiratory drive as

the preferential load compensatory mechanism.

Stress and Affective Responses to ITTO Conditioning in Conscious Animals

ITTO causes neural activation of nuclei involved in stress and affective pathways

in anesthetized animals and the pattern of the respiratory load compensation response

in conscious animals is influenced by behavioral control. To determine whether stress

and/or aversive mechanisms play a role in the behavioral modulation of respiratory load

compensation we conditioned conscious animals to 10 days of ITTO. Load

compensation responses were determined by physiological assays for stress and a

behavioral measure of anxiety. We found that 10 days of unexpected, unavoidable,

uncontrollable ITTO elevated basal Cort levels, increased adrenal weight, and

heightened anxiety in conscious rats. These results suggest that repeated exposure to

tracheal occlusions in conscious animals can cause elevated resting stress and anxiety

levels in animals after only 10 days of ITTO conditioning.

The augmentation of basal HPA activity is similar to responses evoked by other

repeated stressors (Fernandes et al., 2002; Armario, 2006; Filipovic et al., 2010). Our

study indicated that ITTO is a respiratory stimulus sufficient to evoke the same kind of

stress responses seen with exposure to other stressful stimuli such as restraint and


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shock (Raone et al., 2007), chronic variable stress (Herman et al., 1995), and

intermittent restraint (Fernandes et al., 2002). Sustained HPA activation is linked with

affective disorders such as anxiety and depression (Roy-Byrne et al., 1986; Kling et al.,

1991; Stenzel-Poore et al., 1994; Maier & Watkins, 2005), and 10 days of ITTO

increased anxiety in our rats. We did not test for depression in our animals, but because

anxiety and depression have many similarities (APA, 1994; Stenzel-Poore et al., 1994;

Frazer & Morilak, 2005), especially related to HPA activity (Pellow et al., 1985; Roy-

Byrne et al., 1986; Stenzel-Poore et al., 1994; Vreeburg et al., 2010), it is possible that

our animals developed depression behaviors. These responses are mediated by both

physical and psychological neural pathways, further suggesting that consciousness

plays an important role in the response to respiratory load stimuli.

It was hypothesized that the stress-anxiety response observed after 10 days of

ITTO is mediated in part by the PVN and CRH release, as well as the DR and 5-HT

release. These nuclei and neurotransmitters modulate the activity of one another (Lowry

et al., 2000; Hammack et al., 2002; Jorgensen, 2007; Valentino et al., 2009; Geerling et

al., 2010) and 5-HT and its receptors have important implications in the psychological

and behavioral responses to uncontrollable stressors (Maier, 1984; Graeff, 1994; Graeff

et al., 1996; Maier & Watkins, 2005; Jorgensen, 2007; Valentino et al., 2009), including

anxiety and depression behaviors arising from PAG and limbic activation (Graeff et al.,

1996). We have shown alterations in 5-HT receptor gene expression in thalamic neural

areas after one exposure to ITTO (Bernhardt et al., 2008) and after 10 days of ITTO

(Bernhardt et al., 2010). Alterations in the serotonergic and stress pathways suggests

that tracheal occlusions can cause changes in the neural modulators mediating


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behavioral load compensation, the control of respiration (Hodges et al., 2009) and

respiratory neural plasticity (Feldman et al., 2003; Doi & Ramirez, 2008). Furthermore,

the PVN has reciprocal projections with the brainstem respiratory network (Hermes et

al., 2006; Geerling et al., 2010) which may modulate respiratory motor output during

situations of both respiratory and non-respiratory related stress.

Because these experiments were performed in conscious animals, we were

expecting a substantial portion of the animal's responses would be a result of the

sensations associated with large resistive loads and tracheal occlusions since these

sensations, collectively referred to as dyspnea, are highly aversive (von Leupoldt &

Dahme, 2005b; O'Donnell et al., 2007; Schon et al., 2008; von Leupoldt et al., 2008).

Dypsnea includes both discriminative and affective components (von Leupoldt &

Dahme, 2005b) that are relayed to the somatosensory (Davenport et al., 1985;

Davenport et al., 1991; Davenport et al., 1993; Davenport & Hutchison, 2002) and limbic

neural networks (Aleksandrov et al., 2000; von Leupoldt & Dahme, 2005a; Schon et al.,

2008). Dyspnea cannot be assessed in animals but the neural correlates that mediate

dyspnea are similar, and it is plausible that respiratory obstructions in animals cause

similar intense and aversive sensations, leading to an experience of negative affect.

Negative affect, if experienced repeatedly may result in psychological disorders such as

anxiety or depression, which are both highly prevalent in patients with COPD who also

experience dyspnea (Karajgi et al., 1990; Brenes, 2003; Wagena et al., 2005). Indeed,

we observed anxiety responses in our animals after 10 days of ITTO. Furthermore,

individuals modify their behavior in order to adapt, avoid or escape from experiencing

the sensation of dyspnea. It was hypothesized that the prolongation of Te in response to


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the occlusions in the previous study was a behavioral breath holding technique used to

avoid the sensations associated with breathing through a respiratory load. Intense,

unavoidable respiratory stimuli like tracheal occlusions likely produce intense physical

discomfort and stress due to the life-threatening quality of ITTO, which is highly relevant

to individuals who experience these types of respiratory stressors on a regular basis,

such as those with COPD and asthma. This is also important because chronic

experience with one type of stress can make an individual more reactive to new types of

stress, which would be detrimental in patients with asthma and COPD who often have

other physiological and psychological symptoms that could be worsened by airway

obstruction-dependent HPA activation. Determining the neural mechanisms behind

these responses in future studies is extremely important.

Neural Plasticity Responses to ITTO Conditioning in Conscious Animals

This project investigated the neural structures and mechanisms mediating the

behavioral, stress, and anxiety responses observed in animals after 10 days of ITTO.

We hypothesized that respiratory brainstem nuclei, areas involved in stress responses,

and regions participating in discriminative and affective sensory processing would show

modulation in response to repeated ITTO. Significant state changes in the medullary

dorsal respiratory group, PAG, DR, discriminatory VPM and the affective Al were found,

indicated by alterations in CO staining. This was the first evidence of neural state

modulation in response to respiratory load conditioning in conscious animals. In this

study we used 10 s tracheal occlusions rather than the 3-6 s used in the other studies to

ensure a consistent pattern of neural activation. It is possible that chemoreceptor

afferents would have increased activation if the 10 s occlusions were long enough to

cause a slight hypercapnic or hypoxic response. However, Farre and colleagues (Farre


118









et al., 2007) found that a 5 second obstruction reduced the SpO2 to 85% in rats, and

that a 10 second obstruction only reduced the SpO2 to 83%. These values are both

greater than the 67-80% Sa02 that would result from the oxygen partial pressures of 35-

45 mmHg often used in intermittent hypoxia studies (Zabka et al., 2001; Lee & Fuller,

2010). Chemoreceptor afferents project to the nTS, which is also the primary target of

cardiorespiratory afferents in the lung, airway, trachea, and blood vessels. The pattern

of stimulation in the nTS from convergent input during ITTO was sufficient to induce

plasticity after 10 days, but the relationship between mechanical and chemical

stimulation mediating this plasticity are unknown. The plasticity in the nTS could indicate

that the nTS changes its state for conditioned load compensation to subsequent airway

obstruction challenges, allowing for adaptation of physiological responses to the severe

respiratory challenge posed by repeated ITTO. The results of McKay et al. (McKay et

al., 2003) suggest that the brainstem respiratory network, including nTS, may be an

important site for the voluntary control of breathing in humans. Thus, the nTS may also

be an important site for the behavioral modulation of breathing in animals, and may

undergo plastic changes as a result of ITTO conditioning, potentially generating a new

respiratory load compensation pattern for the animal.

Similar to the results of the acute ITTO protocol in anesthetized animals,

differences in neural activation between control and experimental groups were observed

in the midbrain dorsal and ventral PAG. This indicates that the PAG plays an important

role in the respiratory load compensation response in conscious animals and mediates

the behavioral, stress, and anxiety responses observed after ITTO conditioning. The

PAG participates in defensive behaviors (Bandler & Carrive, 1988; Brandao et al., 1994;


119









Vianna et al., 2001), pain modulation (Mayer et al., 1971; Behbehani, 1995), respiratory

activation (Hayward et al., 2003; Zhang et al., 2005), modulation of the load

compensation response (Zhang et al., 2009), stress pathways (Farkas et al., 1998), and

fear responses (Carrive, 1993; Bandler & Shipley, 1994; Brandao et al., 1994; Vianna et

al., 2001; Cunha et al., 2010). Interestingly, we also found a significant increase in DR

activity after ITTO conditioning. This result supports our hypothesis that the DR and 5-

HT are important in mediating the stress and anxiety behaviors we observed, and

indicates a possible role in the adaptive response to repeated severe respiratory load

stimuli. The plasticity within the DR may have implications for plasticity in other

pathways and responses in which 5-HT has a modulatory function (Maier, 1984; Merahi

et al., 1992; Lindsay & Feldman, 1993; Bianchi et al., 1995; Baker et al., 2001; Fuller et

al., 2001; Pena & Ramirez, 2002; Bocchiaro & Feldman, 2004; Maier & Watkins, 2005;

Jorgensen, 2007; Doi & Ramirez, 2008; Mizoguchi et al., 2008; Dergacheva et al., 2009;

Hodges et al., 2009).

After ITTO conditioning we observed non-significant decreases in neural activity

within the CeA and PaMP. The CeA is part of the limbic system in the brain and is

essential for fear conditioning and aversive responses (Brandao et al., 1994; Davis et

al., 1994; LeDoux, 2000; Martinez et al., 2006). Our laboratory has shown (Shahan et

al., 2008) that electrical stimulation of the CeA leads to an increase in respiratory rate in

anesthetized rats, possibly via output to the PAG. CeA activity decreased in response to

repeated ITTO that may, in part, be due to the increase in DR activity after ITTO. The

CeA has inhibitory projections to the PAG and nTS (Davis et al., 1994; Saha et al.,

2010), so a potential down-regulation of CeA GABAergic innervation is likely to disinhibit


120









the PAG (Saha, 2005; Oka et al., 2008). Thus, a decrease in CeA activity could lead to

activation of the PAG and nTS through disinhibition. This suggests that the animal

modulates its physiological responses to repeated respiratory mechanical stressors via

CeA plasticity. A change in basal activity within the CeA may influence the behavioral

sensitization of the inspiratory efforts during occlusions observed on the 10th day of

ITTO. The PaMP also responds to stressful stimuli by producing CRH (Vale et al.,

1981). Because we have shown that ITTO evokes stress responses, the PaMP was

initially expected to increase activity in response to 10 days of ITTO. However, the

PaMP showed a non-significant decrease in steady state activity. Although circulating

CORT is known to be elevated as a result of chronic stress, basal PVN activity is

blunted as a result of conditioning (Girotti et al., 2006; Arnhold et al., 2007). The CeA

and PaMP downregulation support our hypothesis that these nuclei mediate fear-

potentiated behavioral sensitization of inspiratory effort, breath holding, stress, and

anxiety responses to ITTO.

The discriminative pathway includes a relay through the thalamus to the

somatosensory cortex, and the affective pathway involves structures such as the

amygdala, Cg1, and Al (von Leupoldt & Dahme, 2005b, a; Schon et al., 2008; von

Leupoldt et al., 2008; Davenport & Vovk, 2009). These pathways are involved in

respiratory sensations (von Leupoldt & Dahme, 2005b, a; Schon et al., 2008; von

Leupoldt et al., 2008; Davenport & Vovk, 2009), and have shown plasticity in response

to 10 days of ITTO. Specifically, significant increases were found in steady state activity

in the VPM thalamus and Al. It is possible that tracheal afferents stimulated during

occlusion project to the VPM via polysnaptic pathways (Ambalavanar et al., 1999). In


121









addition, (Cechetto & Saper, 1987) found that the VPM projects visceral sensory

information to the insular cortex, some of which includes cardiopulmonary afferent

information. The Al has an excitatory projection to the PAG (Behbehani et al., 1993),

responds to respiration, arterial chemoreceptors, and cardiovascular baroreceptors

(Cechetto & Saper, 1987), and is active during voluntary breath-holding maneuvers

(McKay et al., 2008), a behavior our animals appeared to use in response to ITTO. The

Al is known to play a vital role in the neural processing of dyspnea (von Leupoldt &

Dahme, 2005a; von Leupoldt et al., 2008; Davenport & Vovk, 2009) and we have

previously established that loaded breathing produces dyspnea (Schon et al., 2008).

Thus, affective neural processing likely takes place in the Al during ITTO and results in

significant modulation of the behavioral load compensation responses to repeated

ITTO. This modulatory function might arise from plasticity within the region, suggested

by the increase in steady state activity after ITTO conditioning.

Conclusion

Collectively, the results of these studies show that tracheal occlusions elicit neural

and behavioral load compensation responses in conscious animals, supporting the link

between intense respiratory stimuli, stress, and affective disorders. This has important

implications for individuals with respiratory obstructive diseases such as COPD,

asthma, and obstructive sleep apnea, who experience repeated life-threatening,

intermittent, unpredictable increases in airway mechanical load. The increase in airway

load leads to sensory activation and load compensation behaviors. Sensory activation in

response to the airway obstructions can result in intense physical discomfort, or

dyspnea (von Leupoldt & Dahme, 2005a; O'Donnell et al., 2007) and compensation

behaviors often include leading a sedentary lifestyle (ZuWallack, 2007; Bourbeau,


122









2009). It is well established that emotions and respiration are tightly linked (Ley, 1999),

and individuals with respiratory obstructive diseases are frequently diagnosed with

affective disorders such as anxiety and depression. Furthermore, sedentary behavior

can be a symptom of depression (Roshanaei-Moghaddam et al., 2009). The severe

chronic stress experienced by these individuals could potentially make them more

reactive to new types of stress (Fernandes et al., 2002), which is particularly

problematic since patients with asthma and COPD often have physiological and

psychological symptoms that may be worsened by airway obstruction-dependent HPA

activation. In addition, uncontrollable stressors have been shown to sensitize

serotonergic neurons in the DR, which respond to future stressors with exaggerated 5-

HT release that may cause behavioral changes such as learned helplessness (Maier &

Watkins, 2005). We observed an increase in steady state activity in the DR so it is likely

that this pathway was activated by repeated ITTO. Additionally, the activities of sensory

brain regions were modified by 10 days of ITTO, similar to repeated obstructions to

breathing during sleep that resulted in impaired detection of R loads in conscious

humans (McNicholas et al., 1984). The results of McNicholas et al. suggest that neural

structures involved in the respiratory sensory processing in OSA patients may have

been altered. In conclusion, characterizing the acute and chronic respiratory load

compensation responses in conscious animals, determining how these responses are

altered after repeated experience, and elucidating the neural structures involved in

generating these responses is essential to our understanding of respiratory obstructive

diseases and rehabilitation.


123



















I I -___I I raI' JrM









; oar o C hebift e P A G P --r


























Figure 6-1. Representation of central nervous system nuclei and pathways involved in
respiratory control.
___ *_I-ws roiis-on

Nude













Figure 6-1. Representation of central nervous system nuclei and pathways involved in
respiratory control.


124









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BIOGRAPHICAL SKETCH

Kathryn Mackenzie Pate was born in Sebastian, Florida in 1985. She grew up with

her parents, Stephen and Constance, and older brothers, Robert, Matthew, and

Michael. She graduated from the University of Florida with a Bachelor of Science in

Zoology in May 2006 and began her Ph.D. career at the University of Florida's College

of Veterinary Medicine in August 2006. Kate spent four years under the guidance of Dr.

Paul Davenport in the Department of Physiological Sciences, and completed her Ph.D.

in August, 2010. Upon receiving her Ph.D., she began her post-doctoral training at

National Jewish Health respiratory hospital in Denver, Colorado to investigate the role of

redox imbalance in disease. Her new mentor is Dr. James Crapo.


144





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1 RESPIRATORY LOAD COMPENSATION RESPONSES IN CONSCIOUS ANIMALS By KATHRYN MACKENZIE PATE A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010

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2 2010 Kathryn Mackenzie Pate

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3 To my loving parents

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4 ACKNOWLEDGMENTS I would first like to thank my mentor, Dr. Paul Davenport, for his g uidance during my Ph.D. career. He took a chance on me, giving me the opportunity to pursue a doctorate in respiratory physiology without my having extensive research experience or know ing with conviction my ultimate goals. He has been infinitely patient o ver the past years supporting m y various interests and going to bat for me when others might not. I would also like to thank those on my s upervisory committee, including Dr. Donald Bolser, Dr. Linda Hayward, Dr. Christine Sapienza, and Dr. David Fuller, whose wisdom has shaped me in innumerable ways and without whom none of this would have been possible. This body of work was enhanced by the assistance of i ndividuals who were generous with their time : Mark Hotchkiss for his aid in the laboratory and with animal surgeries Dr. Roger Reep for the use of his laboratory space and troubleshooting with imaging software, Margaret Stoll for her knowledge of histochemi cal techniques, and Dr. Deborah Scheuer for her background in cardiovascular physiology and expert ise in stress. I have learned that c ollaborations and teamwork do not just make the science behind research stronger, they make the experience richer Dr. Floyd Thompson, Dr. Kevin Anderson, and Dr. Davenport all deserve special recognition for showing me the joys of teaching. My time spent as a teaching assistant in their neuroscience, gross anatomy, and respiration courses were some of my most memorable during my Ph.D. These individuals gave me the priceless gift of knowing that academia is where I belon g. I would also like to thank Dr. Anderson for his friendship over the years and for bringing me into the world of cycling, which has become an integral part of my life. He will be greatly missed.

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5 The highest and lowest points during the past years of my d octoral career have all been shared with my many laboratory members and friends as only they could understand the happiness and pain that accompany this process Dr. Joslyn Ahlgren, Dr. Carie Reynolds, Dr. Karen Porter, Dr. Pei Ying Sarah Chan, Dr. Teresa Pitts Mark Hotchkiss and soon to be doctor Vipa Bernhardt have all made this s uch a worthwhile journey Every success was celebrated with th ese amazing individuals, no matter how insignificant. They have always been available to offer advice and keep me centered during so many times when I felt off balance. My family has also been an integral part of my success. Their love and support have continually been the rock in my life, but especially during the completion of my Ph.D. I thank my parents and brothers for listening when ever I wanted to share my excitement or frustration, even when they may not have wanted to hear it again, and again. I can not express what it means to have had such unconditional support. Additionally, I wan t to express gratitude to my brother, Matthew, who has had the unfortunate luck of living with me during the last, stressful semester of my Ph.D. and who has remained a peaceful force in my life during these difficult times. Finally, I would like to ackno wledge Dr. David Julian, who piqued my interest in physiology as an undergraduate and opened my eyes to the possibility of pursuing a Ph.D. Without his guidance I would not have discovered the path I am on today.

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6 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ .. 4 LIST OF TABLES ................................ ................................ ................................ ............ 9 LIST OF FIGURES ................................ ................................ ................................ ........ 10 ABSTRACT ................................ ................................ ................................ ................... 12 CHAPTER 1 RESPIRATORY LOAD COMPENSATION AND THE NEURAL CONTROL OF BREATHING ................................ ................................ ................................ ........... 16 Respiratory Load Compensation ................................ ................................ ............ 16 An esthetized Responses ................................ ................................ .................. 17 Conscious Responses ................................ ................................ ...................... 20 Respiratory Brainstem Network ................................ ................................ .............. 22 Re spiratory Related Neural Activation Techniques ................................ ................ 24 Respiratory Discriminatory Sensory Processing and Detection .............................. 26 Respiratory Affective Sensory Processing ................................ .............................. 27 Experimental Approach ................................ ................................ ........................... 29 2 RESPIRATORY LOAD COMPENSATION AND NEURAL ACTIVATION IN ANESTHETIZED RATS ................................ ................................ .......................... 30 Introduction ................................ ................................ ................................ ............. 30 Methods ................................ ................................ ................................ .................. 32 Animals ................................ ................................ ................................ ............. 32 Surgical Procedures ................................ ................................ ......................... 32 Protocol ................................ ................................ ................................ ............ 34 Immunohistochemical Analysis ................................ ................................ ........ 35 Data Analysis ................................ ................................ ................................ ... 35 Breathing pattern ................................ ................................ ....................... 35 c Fos ................................ ................................ ................................ .......... 36 Statistics ................................ ................................ ................................ ..... 36 Results ................................ ................................ ................................ .................... 37 Breathin g Pattern ................................ ................................ ............................. 37 Fos like Immunoreactivity ................................ ................................ ................. 37 Discussion ................................ ................................ ................................ .............. 39 Medulla ................................ ................................ ................................ ............. 41 Pons ................................ ................................ ................................ ................. 43 Midbrain ................................ ................................ ................................ ............ 44

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7 3 RESPIRATORY LOAD COMPENSATION AND BEHAVIORAL CONDITIONING IN CONSCIOUS RATS ................................ ................................ ........................... 51 Introduction ................................ ................................ ................................ ............. 51 Methods ................................ ................................ ................................ .................. 55 Animals ................................ ................................ ................................ ............. 55 Surgical Procedures ................................ ................................ ......................... 55 Diaphragm electrodes ................................ ................................ ................ 55 Tracheal cuff ................................ ................................ .............................. 56 Protocol ................................ ................................ ................................ ............ 56 Analysis ................................ ................................ ................................ ............ 58 Results ................................ ................................ ................................ .................... 59 Timing ................................ ................................ ................................ ............... 59 EMG dia Activity ................................ ................................ ................................ .. 59 Di scussion ................................ ................................ ................................ .............. 60 4 STRESS AND ANXIETY RESPONSES TO REPEATED TRACHEAL OCCLUSIONS ................................ ................................ ................................ ........ 71 Introduction ................................ ................................ ................................ ............. 71 Methods ................................ ................................ ................................ .................. 73 Animals ................................ ................................ ................................ ............. 73 Surgical Procedures ................................ ................................ ......................... 73 Protocol ................................ ................................ ................................ ............ 74 Analyses ................................ ................................ ................................ ........... 76 Results ................................ ................................ ................................ .................... 77 Discussion ................................ ................................ ................................ .............. 77 5 NEURAL PLASTICITY IN RESPONSE TO REPEATED TRACHEAL OCCLUSIONS ................................ ................................ ................................ ........ 86 Introduction ................................ ................................ ................................ ............. 86 Methods ................................ ................................ ................................ .................. 90 Animals ................................ ................................ ................................ ............. 90 Surgical Procedures ................................ ................................ ......................... 91 Protocol ................................ ................................ ................................ ............ 92 Training ................................ ................................ ................................ ...... 92 Cytochrome oxidase (CO) ................................ ................................ .......... 93 Analyses ................................ ................................ ................................ ........... 94 Imaging ................................ ................................ ................................ ...... 94 Statistics ................................ ................................ ................................ ..... 94 Results ................................ ................................ ................................ .................... 95 Brains tem ................................ ................................ ................................ ......... 95 Midbrain ................................ ................................ ................................ ............ 95 Higher Brain Centers, Discriminative & Affective ................................ .............. 95 Discussion ................................ ................................ ................................ .............. 95

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8 6 GENERAL DISCUSSION ................................ ................................ ..................... 110 Acute, Anesthetized Respiratory Load Compensation ................................ .......... 110 Conditioned, Conscious Respiratory Load Compensation ................................ .... 112 Stress and Affective Responses to ITTO Conditioning in Conscious Animals ...... 115 Neural Plasticity Responses to I TTO Conditioning in Conscious Animals ............ 118 Conclusion ................................ ................................ ................................ ............ 122 LIST OF REFERENCES ................................ ................................ ............................. 125 BIOGRAPHICAL SKETCH ................................ ................................ .......................... 144

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9 LIST OF TABLES Table page 2 1 c Fos e xpression in brainstem and suprapontine nuclei. ................................ .... 50 5 1 Brainstem CO staining after 10 days of ITTO or handling without occlusions .. 10 9 5 2 Midbrain CO staining after 10 days of ITTO or handling without occlusions ..... 109 5 3 Higher brain centers, discriminative, and affective CO staining after 10 days of ITTO or handling without occlusions ................................ ............................. 109

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10 LIST OF FIGURES Figure page 2 1 EMG dia and P es traces during ITTO in an int act and tracheostomized animal .... 46 2 2 Inspiratory dur ation during ITTO in intact and tracheostomized animals ........... 46 2 3 Expiratory duration during ITTO in intact and tracheostomized anima ls ............ 47 2 4 Total breath duration during ITTO in intact and tracheostomized animals ......... 47 2 5 Peak amplitude of the integrated EMG dia trace during ITTO in intact and tracheostomized animals ................................ ................................ .................... 48 2 6 Peak negative P es during ITTO in intact and tracheostomized animals. ............. 48 2 7 c Fos in the caudal nTS after repeated ITTO i n a tracheostomized and intact animal. ................................ ................................ ................................ ................ 49 3 1 Diaphragm activity during O on the first and last day of ITTO conditioning.. ...... 67 3 2 Timing parameters during C and O breathing during ITTO conditioning ........... 68 3 3 Relative timing param eters during C and O breathing during ITTO conditioning ................................ ................................ ................................ ........ 69 3 4 Integrated EMG dia activity during C and O breathing during ITTO con ditioning .. 70 4 1 Basal plasma Cort r handli ng without occlusions .. ................................ ................................ ................................ ......... 84 4 2 Adrenal weight s after 10 days of ITTO or handling without occlusions ............... 84 4 3 Percent time spent in each section of the EPM before and after 10 days of ITTO or handling without occlusions. ................................ ................................ .. 85 5 1 CO staining in the rostral nTS after 10 days of ITTO or handling without occlusions ................................ ................................ ................................ ......... 107 5 2 CO staining in the caudal vPAG after 10 days of ITTO or handling without occlusions ................................ ................................ ................................ ........ 107 5 3 CO staining in the VPM thalamus after 10 days of ITTO or handling without occlusions ................................ ................................ ................................ ........ 108

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11 5 4 CO staining in the AI and Cg1 after 10 days of ITTO or handling without occlusions ................................ ................................ ................................ ........ 108 6 1 Representation of central nervous syste m nuclei and pathways involved in respiratory control. ................................ ................................ ............................ 124

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12 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy RESPIRATORY LOAD COMPENSATION RESPONSES IN CONSCIOUS ANIMALS By Kathryn Mackenzie Pate August 2010 Chair: Paul W. Davenport Major: Veterinary Medic al Sciences The respiratory load compensation reflex is well characterized in anesthetized animals, but the load compensation response pattern to mechanical respiratory stimuli in conscious animals is variable and appears to be influenced by behavior This is relevant to our understanding of respiratory obstructive diseases, which evoke load compensation responses in individuals on a regular basis These studies were undertaken to determine the behavioral response pattern to repeated, transient tracheal occlusions in conscious rats understand how stress may contribute to the pattern and elucidate neural structures underl ying these responses The first study was designed to test the hypothesis that intrinsic, transient, tracheal occlusions (ITT O) would elicit reflexive respiratory and neural load compensation, without changing blood gases, lung compliance, or tracheal integrity. It was known that resistive loads and airway occlusions applied to either inspiration or expiration separately evoke d compensation responses including changes in breath volume timing and increases in respiratory muscle activation. It was also known that previous models used to study load compensation responses to mechanical respiratory stimuli changed blood gases or lung compliance. ITTO was sustained for 2 3 breaths and elicited

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13 reflexive respiratory load compensation responses including a prolongation of inspiratory duration (Ti), expiratory duration (Te), an increase in diaphragm activity (EMG dia ), and decrease in esoph ageal pressure (P es ), which is an indication of changes in pleural pressure. Additionally, neural activation in response to repeated ITTO determined by c Fos staining, was found in respiratory brainstem and suprapontine brain nuclei suggesting that there is a neural compensation response to tracheal occlusions, including both sensory and motor components. The second study investigated the hypothesis that the respiratory load compensation response pattern in conscious animals is variable and changes as a r esult of conditioning. The variability, also observed in humans, has been attributed to between individual differences in perception. Previous studies applying mechanical loads to breathing acutely in conscious humans and animals showed inconsistent change s in breath timing but somewhat consistent respiratory motor responses to loads. The initial respiratory load compensation response pattern to ITTO in conscious rats consisted of a prolongation of Te and increase in EMG dia amplitude during occlusions. The change in Te did not habituate T he augmentation of EMG dia during occlusions was greater after ITTO conditioning, suggesting a sensitized behavioral response. These results suggest that the volume timing reflex may be suppressed by behavioral mechanisms in conscious animals, which includes breath holding and increases in respiratory muscle activation The third study investigated the hypothesis that 10 days of ITTO causes stress and anxiety responses in conscious animals. We had evidence from human studies conducted by our laboratory that mechanical loads to breathing were stressful stimuli,

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14 and it is known that acute stress responses. We were also aware tha t individuals with respiratory obstructive diseases often have affective disorders such as anxiety and depression. After 10 days of ITTO rats had increased basal corticosterone levels, greater adrenal weights, and elevated anxiety levels, determined by the Elevated Plus Maze, compared to animals not receiving tracheal occlusions. Thus, healthy animals develop stress an d anxiety responses to repeated, severe airway loading. The final study investigated the hypothesis that the behavioral, stress, and anxiety responses to 10 days of ITTO were mediated by plasticity within respiratory brainstem, stress related and suprapontine discriminative and affective neural regions. It was known that areas within the central nervous system were involved in the acute sensor y and motor responses to respiratory loading, but how activity in these regions may be modified as a result of repeated loading was unknown. We conditioned animals to 10 days of ITTO or 10 days of handling and removed brain tissue the following day. The t issue was stained for cytochrom e oxidase (CO), which is used as an indicator of changes in neural activity. Significant increases in activity were found in the rostral nucleus of the solitary tract (nTS), caudal periaqueductal gray (PAG), dorsal raphe (DR) ventroposteromedial thalamus (VPM), and anterior insular cortex (AI), supporting our hypothesis and suggesting that respiratory load conditioning causes state changes in the brain that may lead to modulation of subsequent responses to respiratory loads. The results of these studies collectively i ndicate that ITTO elicit s behavioral related neural load compensation responses in conscious animals, and that the pattern of these responses is altered through ITTO conditioning. Repeated ITTO leads to stress and

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15 anxiety, supporting the link between r espiratory obstructive diseases, stress, and affective disorders.

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16 CHAPTER 1 RESPIRATORY LOAD COM PENSATION AND THE NEURAL CONTR OL OF BREATHING Respiratory Load Compensation Respiration is a complex physiological process that is carried out continually for the lifetime of an animal. T he system is able to respond to voluntary input and a variety of mechanical and met abolic stimuli in a way that allows the animal to continue ventilation through changes in breathing pattern. Early respiratory studies focused on defining normal respiratory patterns and control mechanisms and were primarily conducted in anesthetized a nimals where reflexes and metabolic needs drive the animals that researchers became aware that consciousness play s a major role in modulating breathing V oluntary contro l of breathing is capable of overriding the expected responses to metabolic needs. It has even been determined that adaptive responses to stimuli, if experienced repeatedly, can develop into regular breathing pattern changes through conditioning and learni ng. Unfortunately, this also means that if the respiratory system responds to a repeated stimulus in a maladaptive manner, aberrant ventilatory patterns may arise. In conscious animals, the voluntary and conscious behavioral changes to breathing are driven by respiratory afferents that cause suprapontine activation, which is suppressed in anesthetized animals. Cortical activation leads to respiratory sensations and emotional responses to those sensations, and it is this combination that ultimately controls breathing in conscious humans and animals.

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17 Anesthetized Responses The two components of the respiratory pattern that contribute to ventilat ion are breath frequency and tidal volume. Clark and von Euler (Clark & von Euler, 1972) showed that inspiratory time (Ti) is dependent upon inspiratory volume (Vi) in a nesthetized cats, but that this relationship can change depending upon the type of anesthesia used. They reported a weak volume timing (Vt T) modulation of breathing pattern in conscious humans. With the respiratory depressant pen tobarbitone, the Vt T rela tionship is maintained for eupneic volumes and those well above eupneic values. When using urethane, however, animals maintained a constant Ti for changing values of Vi in the eupneic range, and Ti only beca me volume dependent for large volumes, mimicking the pattern observed in the conscious man. The subsequent expiratory duration (Te) was thought to be dependent upon the preceding Ti. These volume timing relationships were a bolished after vagotomy in anesthetized animals, indicating that respiratory V t T requires intact vag al afferents Zechman and colleagues (Zechman et al. 1976) investigated the role of breath phase in the V t T rela tionship during eupneic volumes Extrinsic mechanical loads to breathing allow for studying respiratory reflex control in response to mechanical stimuli. Resistive (R) a nd elastic (E) loads are flow and volume dependent, respectively (Zechman & Davenport, 1978) Zechman and colleagues (Zechman et al. 1976) hypothesized that the dependence of Te upon Ti and the cons tant Ti seen during eupneic volumes would be altered if a R load was applied separately to either the inspiratory or expiratory breath phase. The response they observed is called the respiratory load compensation reflex. A pplying a R load to one phase of a single breath causes decreased volume, in creased duration and a return to baseline of volume and

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18 timing parameters for subsequent unloaded breaths in animals (Zechman et al. 1976) and human infants (Kosch et al. 1986) These responses were vagal dependent Koehler and Bishop (Koehler & Bishop, 1979) co nfirmed this volume timing relationship during the expiratory phase of breathing. For inspiration and expiration, there is a volume threshold at which the breath phase is terminated that decreases with time. During a complete occlusion, known as an infinit e R load or functional vagotomy, a change in lung volume is prevented, causing the system to rely upon its inherent brainstem timing pattern to end one phase of the breath and begin another. The increase in breath duration associated with occlusion approac hes the values obtained after vagotomy which are prolonged relative to intact animals and unaffected by volume changes (Zechman et al. 1976) It was hypothesized that slowly adapting pulmonary stretch receptor s (PSR) are the vagal afferents mediating the volume dependent reflex control of breath phase duration (Koehler & Bishop, 1979) Results from Davenport et al. (Davenport et al. 1981a; Davenport et al. 1984) supported that PSR s were the vagal afferent involved in mediating the V t T response to respiratory loading. Further inv estigation of PSR mediated responses led to the understanding that PSR input modulates Ti through changes in action potential ( spike ) frequency and Te through changes in spike number (Davenport et al. 1981a; Davenport & Wozniak, 1986) suggesting separate brainstem regulatory mechanisms for Ti and Te. Additionally Davenport and colleagues (Davenport et al. 1981c) showed that PSR s respond to airway muscle tension, and it is the change in tension associated with differing lung volumes that activates PSR s, not the actual lung volume itself (Davenport et al. 1981b) Thus, the respiratory V t T

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19 relationship can also be thought of as a n airway transluminal pressure timing relationship, with the pressure referring to transmural pressure acr oss the airways during breathing. The transluminal pressure is further modulated by the smooth muscle tone of the airways (Davenport et al. 1981b) In addition to volum e timing changes, load compensation is also characterized by increased respiratory motor output measured using electromyography (EMG), primarily in the diaphragm (EMG dia ) during inspirat ory loading (Lopata et al. 1983) and also i n the abdominal muscles during expirat ory loading (Koehler & Bishop, 1979) PSR s are distributed throughout the smooth muscle of airways and respond to airway pressure differently depending upon their lo cation. I ntra thoracic PSR s in the smooth muscle of bronchi and bronchioles transduce information to the central nervous system (CNS) in phase with lung volume, whereas extra thoracic receptors in the smooth muscle of the trachea lis muscle transduce infor mation in phase with airflow (Sant'Ambrogio & Mortola, 1977; Davenport et al. 1981b; Sant'Ambrogio, 1982) U pper airway afferents have been shown to contribute to the load compensation response during inspiratory (Webb et al. 1994) but not expiratory (Webb et al. 1996) resistive loading in anesthetized animals PSRs in the upper airways send their afferent fibers to the brain stem via the cervical vagus, superior laryngeal (SLN), and recurrent laryngeal nerves (RLN) (Sant'Ambrogio et al. 1977; Lee et al. 1 992) depending upon their location These afferents differentially terminate on separate areas of the nucleus of the solitary tract (nTS) (Kalia & Mesulam, 1980b, a; Kalia, 1981b) The nTS is part of the dorsal respiratory group (DRG), a medullary area involved in inspiratory activity. Preventing PSR in put from reaching the brainstem by cutting the vagi abolishes the

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20 modulation of V t T during loading and hyperinflation even in neonatal animals (Webb et al. 1994, 1996) Afferents from PSR s in the trachea have been found to influence cardiovascular activity (Traxel et al. 1976; Barthelemy et al. 1996) and respir atory reflexes (Traxel et al. 19 76; Remmers & Bartlett, 1977; Citterio et al. 1985) Thus, both i ntra and extra thoracic vagal PSR s are necessary for the reflexive load compensation pattern observed in anesthetized animals. Conscious Responses Studies in conscious humans and animals are less numerous. Results from experiments in anesthetized animals provide information about reflexive and neural load compensation, but do not add to our understanding of behavioral load compensation, or voluntary modulation of the reflexive patterns. In a study in conscious neonatal lambs exposed to a single expiratory R load researchers observed decreased airflow and prolonged Te which resulted in elevated end expiratory volume (Watts et al. 1997) Subsequent unloaded breaths showed decreased Vi, increased expiratory volume ( Ve ) and the integrated EMG activity in the larynx and diaphragm remained active as a compensatory mechanism to help restore lung volume to baseline (Watts et al. 1997) In conscious goats presented with two consecutive inspiratory loads, the integrated diaphragm and external abdominal oblique muscle responses were augmented and Ti increased during the first breath (Hutt et al. 1991) These values remained the same for the second loaded breath but returned to baseline during unloaded breaths, unlike the responses seen during expiratory R loading in lambs (Watts et al. 1997) This difference could be due to the fact that the magnitudes of the R loads were different ( 370 cmH 2 O/L /sec in lambs vs. 18 cmH 2 O/L /sec in goats ), animal ages were different (neonates vs. adults), or perhaps that the inspiratory and expiratory phases of breathing

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21 are under separate contr ol mechanisms (Davenport et al. 1981a; Davenport & Wozniak, 1986; Webb et al. 1994, 1996) When multiple consecutive inspirations are loaded in conscious ponies Ti is prolonged while Te and Vt are decreased during the first breath (Forster et al. 1994) During the second through fifth loaded breaths, small changes were seen in volume and timing parameters which stabilized after the fifth breath for the subsequent 2 4 minutes of loading. The time of EMG dia activation mirrored Ti, and mean EMG dia activity was elevated during the first loaded breath to a value that remained augmented for subsequent loaded breaths. During the first recovery breath fo llowing loading, Vt and mean EMG dia activity increased above values during loading but timing parameters did not change. All parameters progressively returned to control values over the course of subsequent unloaded breaths. Surprisingly, the loaded and re covery breath compensation effect persisted even after pulmonary and diaphragmatic deafferentation, indicating that these afferents quantitatively but not qualitatively modulate the load compensation response (Forster et al. 1994) These researchers hypothesized that intercostal afferents and cortical input likely contributed greatly to the observed response. In the conscious man, some studies have shown that R loading decreases volume, prolongs breath duration, and enhances motor output (Axen et al. 1983; Daubenspeck & Bennett, 1983; Hudgel et al. 1987; Nishino & Kochi, 1994; Daubenspeck & Rhodes, 1995) In addition, an augmented recovery response to loading has been documented (Altose et al. 1979) as have great er respiratory responses to loads of larger magnitudes ( Altose et al. 1979; Nishino & Kochi, 1994;

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22 Calabrese et al. 1998) However, there seems to be great variability in response patterns to respiratory loading and occlusion in conscious humans (Axen et al. 1983; Dau benspeck & Bennett, 1983; Davenport et al. 1986; Hudgel et al. 1987; Nishino & Kochi, 1994; Daubenspeck & Rhodes, 1995) Others have documented increases in v olume and decreases in frequency in response to inspiratory R loading (Iber et al. 1982) Interestingly, load compensation responses that differed between individuals remained qualitatively similar within the same individual in response to various load magnitudes (Daubenspeck & Rhodes, 1995) Differing responses may be due to perceptual differe nces between individuals (Dauben speck & Rhodes, 1995) R espiratory afferents other than those in the airways and in the main inspiratory muscle s must play a role in load compensation in conscious humans and animals. The se other afferents most likely transduce respiratory sensations as sociated with loading and airway occlusion The way a conscious human or animal feels (affective component) about its breathing may further lead to modulation of the reflexive pattern of load compensation Respiratory Brainstem Network A n intact brainstem respiratory neural network includes multiple nuclei in the dorsal, ventral, and ventrolateral medulla and dorsolateral pons. These nuclei are essential for normal breathing rhythm and contribute to respiratory reflexes including reflexive load compensatio n mediated by vagal afferents (Ezure, 1990; Bianchi et al. 1995; St John, 1998) Respiratory vagal afferents primarily terminate within the caudal nTS but can also directly influence pontine respiratory centers to evoke motor responses (Kalia & Mesulam, 1980b, a) P ontine respiratory centers include the parabrachial (PBN) and Kolliker Fuse (KF) nuclei both of which have reciprocal

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23 connections with the nTS (Herbert et al. 1990) The lateral PBN (lPBN) receives projections from the nTS and is involved in sympathetic drive (Hayward, 2007) The extensiveness of the respiratory neural network highlight s the importan t ability of the respiratory system to respond and adapt to a variety of different stimuli. Dorsal periaqueductal gray (dPAG) stimulation leads to c Fos expression in lPBN subnuclei (Hayward & Castellanos, 2003) The PAG plays a major role in the descending pain pathway (Cunha et al. 2010) and is a mediator of defensive behaviors such as freezing, escape, and fear potentiated startle (Brandao et al. 1994; Cunha et al. 2010) Electrical stimulat ion of the dPAG elicits a progression of behaviors characteristic of an animal exposed to a threat, and these behaviors are accompanied by increases in mean arterial pressure, heart rate, and respiration (Hilton & Redfe rn, 1986; Brandao et al. 1990) Hayward and colleagues (Hayward et al. 2003) disinhibited the dPAG and elicited changes in ventilation, whi ch they further determined was mediated by the lPBN in part by glutamate receptor activation (Hayward et al. 2004) The observed increase in respiratory frequency was a result of a decrease in both inspiratory and expiratory durations Zhang and colleagues (Zhang et al. 2007) observed t he same increase in respiratory frequency with dPAG stimulation, along with an increase in EMG dia activity and cardiovascular responses. Stimulation of the caudal PAG evoked greater respiratory responses than in the rostral PAG, but there was no difference in cardiovascular responses depending upon region (Zhang et al. 2007) This same group found that chemical activation of the dPAG pote ntiated the load compensation reflex with an increase in breath phase duration and diaphragm activity associated with inspiratory and expiratory occlusions (Zhang et al. 2009)

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24 Vianna and colleagues (Vianna et al. 2001) showed a progression of behaviors from alertness and freezing to escape with increased electrical stimulation of the PAG. The dorsal and ventral regions of the PAG differentially regulate these responses, such that electrical stimulation of the dorsolateral PAG causes unconditioned freezing in rats and the ventral PAG (vPAG) mediates conditi oned responses (Vianna et al. 2001) The amygdala shares a critical link with the PAG in the fear circuitry of the brain and is also involved in both types of aversive responses (Brandao et al. 1994; Davis et al. 1994; LeDoux, 2000; Martinez et al. 2006) The central nucleus of the amygdala (CeA) is the site of many convergent inputs and is an important part of fear pathways (LeDoux et al. 1988; Phillips & LeDoux, 19 92; Davis et al. 1993; Davis et al. 1994; Campeau & Davis, 1995; Martinez et al. 2006) The basolateral and lateral amygdala a ct as the regulators of information received from aversive stimuli reaching the CeA, the motor output subnucleus of the amygdala (Campeau & Davis, 1995; Saha, 2005) Our laboratory has shown (Shahan et al. 2008) that electrical stimulation of the CeA leads to an increase in respiratory rate in anesthetized rats, lik ely through output to the PAG. The locus stimuli (Bremner et al. 1996; Van Bockstaele et al. 2001) receives afferent projections from the CeA, the nTS, and the PAG (Van Bockstaele et al. 2001) It is evident that respiration is intricately linked with a number of different neural regions, many of which are invol ved in defensive, stress, and fear responses. Respiratory Related Neural Activation Techniques There are a number of different methods available for determining neural activation responses to stimuli. The primary non invasive techniques for determining bra in activity in response to respiratory stimuli include functional magnetic resonance

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25 imaging (fMRI) (Gozal et al. 1995; von Leupoldt & Dahme, 2005a) and cortical evoked potentials (CEP) (Davenport et al. 1985; Davenport et al. 1986; Davenport et al. 1993; Davenport & Hutchison, 2002; Davenport et al. 2006) Inspira tory occlusions lead to activation in the somatosensory cortex in normal humans (Davenport et al. 1986) double lung transplant patients (Davenport et al. 2006) and conscious lambs (Davenport & Hutchison, 2002) Intercostal (Davenport et a l. 1993) and phrenic (Davenport et al. 1985) nerve stimulation also leads to increased activity in the sensorimotor cortex. Although these studies have added to our understanding of how the brain processes respiratory stimuli, they do not provide information about acti vity at the individual neuronal level within discrete brain nuclei. Analysis of neural tissue is one way to obtain more specific information about central nervous system activity patterns in response to a stimulus, but it requires removal of brain tissue a fter experimentation and can therefore only be done in animals. One method that achieves this end is c Fos immunohistochemistry. c Fos is a protein expressed in neurons recently activated and is used as a marker to determine areas of the brain that have an excitatory response to specific stimuli (Dragunow & Faull, 1989) ; however, it cannot differentiate between sensory or motor activation and indicates little about neural inhibition. c Fos expression has been noted in the PAG in response to laryng eal afferent stimulation (Ambalavanar et al. 1999) and throughout the brain and spinal cord in response to phrenic nerve stimulation (Malakhova & Davenport, 2001) Another histochemical method is staining neural tissue for cytochrome oxidase, (CO) an enzyme involv ed in oxidative metabolism in the electron transport chain. CO is used to indicate changes in brain steady state

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26 activity levels in response to stimuli (Wong Riley, 197 9; Wong Riley, 1989; Gonzalez Lima & Garrosa, 1991; Hevner et al. 1995) and is therefore best used in studies of prolonged rather than acute duration. CO can reveal adaptation within brain nuclei, and neural adaptation has been documented in response to inspiratory resistive loading in humans (Gozal et al. 1995) Thus, c Fos immunohistochemistry can be used to onse to a respiratory stimulus, and CO staining can elucidate neural modulation resulting from repeated respiratory stimuli. Respiratory Discriminatory Sens ory Processing and Detection During normal respiration a barrage of sensory information is transmitt ed by respiratory afferents about each breath, but rarely do conscious individuals become aware of these se nsations. When presented with a R load to breathing humans and animals become aware of their respiration ( Zechman & Dav enport, 1978; Davenport et al ., 1991) The qualities of breathing are relayed by various respiratory afferents such as the phrenic (Davenport et al ., 1985; Zechman et al ., 1985) and intercostal nerves (D avenport et al ., 1993) which ultimately reach the somatosensory cortex, the neural substrate for discriminative sensations. When respiratory afferents activate this cortical area in humans and animals, the resulting sensations may cause behavioral changes in order to enhance or diminish those sensations depending upon their quality (affective sensations). The activation of the cortex produces CEP which have been elicited in humans and animal s in response to respiratory stimuli (Davenport & Hutchison, 2002) classifying them as respiratory related evoked potentials (RREP). RREP s are similar in all species, suggesting respiratory information is processed similarly in human s and animals.

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27 Afferent information related to respiration may not reach the cortex if it does not exceed a certain threshold (Chou & Davenport, 2007) is temporally too close to a prior signal (Chan & Davenport, 2008) or if attention is manipulated (Chan & Davenport, 2009 ) Additionally, the time required for detecting a load to breathing decreases as the load magnitude increases (Zechman & Davenport, 1978; Zechman et al ., 1985) and is also dependent upon background resp iratory resistance (Zechman et al ., 1985) Detection and magnitude estimation of respiratory loads in the co nscious human do not require vagal feedback (Guz et al ., 1966; Zhao et al ., 2002a, 2003) nor is cortical activation during a respiratory load dependent upon the vagi (Zhao et al ., 2002b) supporting the hypothesis that other respiratory afferents contribute to respiratory sensations and may contribute to the behavioral load compensation response in conscious animals. Similarly, anesthetizing the glossopharyngeal nerve (Guz et al ., 1 966) or the upper airway (Chaudhary & Burki, 1978, 1980; Fitzpatrick et al ., 1995) does not alter load detection thresholds, and upper airway and mouth afferents are not required for cortical activation during inspiratory occlusions (Davenport et al ., 2006) These studies collectively suggest that although lung, upper airway and mouth afferents may contribute to load compensation in animals, they are not vital for evoking RREP s, detecting loads, or estimating the magnitude of loads. Sensory feedback from respiratory muscles must play a role in these processes (Killian et al., 1980; Killian et al ., 1982; Davenport & Hutchison, 2002) and ultimately influence the load compensation response in conscious animals. Respiratory Affective Sensory Processing Breathing through increased airway resistance causes sensations of discomfort while breathing, a subjective experience called dyspnea (O'Donnell et al. 2007)

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28 Dyspnea is a primary symptom in respiratory obstructive diseases like chronic obstructive pulmonary disease (COPD) and asthma (O'Donnell et al. 2007; Bernstein, 2008) Resistive load s are commonly used to experimentally induce and study dyspnea. Dyspnea includes both a discriminative and affective component (von Leupoldt & Dahme, 2005b) The discriminative component is relayed to the somatosenso ry brain network, which is processed in a similar fashion in both humans and animals (Davenport et al. 1985; Davenport et al. 1991; Davenport et al. 1993; Davenport & Hutchison, 2002) The affective component is relayed to parts of the limbic neural network and shares similarities with the affective component of pain, mostly via processing in the insular and anterior cingulate cortices (Aleksandrov et al. 2000; von Leupoldt & Dahme, 2005a; Schon et al. 2008) In dividuals diagnosed with COPD have dyspnea and are often concomitantly diagnosed with affective disorders such as anxiety and depression (Karajgi et al. 1990; Brenes, 2003; Wagena et al. 2005) Patients diagnosed with respiratory obstructive diseases l ead sedentary lifestyles (ZuWallack, 2007; Bourbeau, 2009) and sedentary behavior can be a symptom of depression (Roshanaei Moghaddam et al. 2009) Because dyspnea is such an aversive sensation, individuals modify their behavior in order to adapt or avoid experiencing the sensati on. It is therefore plausible that repeated respiratory obstructi ons c ause intense sensations of discomfort, leading to an experience of negative affect. Over time, this negative affect may result in disorders such as anxiety or depression. Until the link between respiration, sensations, behavior and mental state is determined we will not fully understand the multitude of respiratory disease phenotypes, disease progression or proper treatment methods.

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29 Experimental Approach It has been demonstrated that : Re spiratory load compensation responses are seen in anesthetized and conscious humans and animals. Although the pattern in conscious humans and animals is less consistently defined, increased respiratory muscle recruitment is always apparent. Load compensati on relies upon afferent and efferent projections relayed throughout the central nervous system that have many connections to pathways involved in stress and defensive behaviors. Resistive loading and airway occlusion cause dyspnea, which has discriminative and affective components, and respiratory obstructive diseases are associated with affective disorders such as anxiety and depression. Based on these previous studies, this dissertation investigated the following hypotheses: Hypothesis 1 : Intrinsic, trans ient tracheal occlusions (ITTO) will evoke respiratory and neural load compensation responses in anesthetized rats w ithout changing lung compliance or tracheal integrity. Hypothesis 2 : ITTO in conscious rats will elicit variable respiratory pattern respons es that change after 10 days of ITTO conditioning. Hypothesis 3 : Ten days of ITTO in conscious rats will lead to stress and anxiety responses. Hypothesis 4 : Respiratory brainstem nuclei, areas involved in stress responses, and suprapontine regions involved in discriminative and affective respiratory information processing will show altered activity in response to 10 days of ITTO conditioning. The overall goal of this dissertation is to determine the pattern of the respiratory load compensation response to tracheal occlusions in conscious rats Urethane anesthetized and conscious, vagal intact, adult, male Sprague Dawley rats were used. The behavioral, stress, and neural components of load compensation were investig ated. These results provide a new understand ing of the conscious modulation of respiratory load compensation reflexes.

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30 CHAPTER 2 RESPIRATORY LOAD COM PENSATION AND NEURAL AC T I VATION IN ANESTHETIZED RATS Introduction Respiratory load compensation in anesthetized animals has been characterized as reflexive and vagal dependent (Zechman et al. 1976) specifically mediated by pulmonary stretch receptors (Davenport et al. 1981a; Davenport et al. 1984; Davenport & Wozniak, 1986) Load compensation has been observed in response to mechanical challenges to breathing such as resistive or elastic loads applied to the respiratory circuit (Zechman & Davenport, 1978) The stereotypical response to a resistive load applied to one phase of the breath included a decrease in volume inspired (Vi) or expired (Ve) for the duration of the load and an inc rease in the loaded breath phase duration (Zechma n et al. 1976) T he volume timing (V t T) parameters of the unloaded phase of the breath were unchanged. T he Vt T values obtained from complete respiratory occlusion approach ed those seen after vagotomy including long loaded phase duration (Zechman et al. 1976) Load compensation is a lso characterized by increased respiratory motor output, measured from respiratory muscle electromyography (EMG) primarily in the diaphragm (Lopata et al. 1983) although abdominal muscle responses are also observed (Koehler & Bishop, 1979) Load compensation has brainstem and suprapontine neural components. The primary non invasive techniques for imaging brain activity in response to respiratory stimuli includes functional magne tic resonance imaging (fMRI) (Gozal et al. 1995; von Leupoldt & Dahme, 2005a) and cortical evoked potentials (CEP) (Davenport et al. 1985; Davenport et al. 1993; Davenport & Hutchison, 2002; Davenport et al. 2006) but these methods can be to o general and do not provide information about activity at the

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31 individual neuronal level. Analysis of neural tissue is one way to obtain more specific information about activity patterns in response to a stimulus, but it requires removal of brain tissue af ter experimentation and can therefore only be done in animals. One method that achieves this end is c Fos immunohistochemistry. c Fos is a protein expressed in neurons recently activated and is used as a metabolic marker to determine areas of the brain tha t respond to specific stimuli (Dragunow & Faull, 1989) c Fos expression has been noted in the periaqueductal gray (PAG) in response to laryngeal afferent stimulation (Ambalavanar et al. 1999) and throughout the brain and spinal cord in response to phrenic nerve stimulation (Malakhova & Davenport, 2001) Determining mechanistically how increased resistances during breathing affect the respiratory pattern, motor output and neural response is vital to understanding aspects of respira tory obstructive diseases, which are characterized by elevated airway resistance. These diseases include chronic obstructive pulmonary disease (COPD), asthma, and obstructive sleep apnea (OSA). Researchers have utilized two primary methods for increasing a irway resistance. Bronchoconstrict ion, such as methacholine challenge, is used to elicit intrinsic, non specific, sustained mechanical loading. Bronchoconstrict ion can also reduce lung compliance, induce lung inflammation and change blood gases (Wiester et al. 1990) preventing the specific mechanical effects of loading from being evaluated. Alternatively, R loads can be applied extrinsically at the mouth or via a tracheal stoma, enabling load duration an d intensity to be controlled. However, extrinsic loading does not model the increase in airway resistance associated with intrinsic obstructions occurring in individuals with COPD, asthma, or OSA.

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32 Our laboratory has developed a model of tracheal occlusions in anesthetized rats that produces increases in airway resistance w ithout changing lung compliance These intrinsic, transient tr acheal obstructions (ITTO) elicit load compensation Vt T and diaphragm activity changes T he neural substrates involved in med iating the load compensation response were investigated using immunohistochemistry. It was hypothesized that ITTO in the rat would elicit a load compensation respiratory motor pattern response and neuronal activation, and the neurons activated by the mecha nical load will express c Fos within brainstem and suprapontine brain nuclei. Methods Animals These experiments were performed on male Sprague Dawley rats (360.5 77.4 g). The animals were housed two to a cage in the University of Florida animal care faci lity where they were exposed to a 12 h light/12 h dark cycle. The experimental protocol was reviewed and approved by the Institutional Animal Care and Use Committee of the University of Florida. Surgica l P rocedures All animals were anesthetized with ureth ane (1.3g/kg, ip) and anesthesia was supplemented as needed (20 mg/ml). Anesthetic depth was verified by the absence of a withdrawal reflex to a rear paw pinch. Body temperature was measured with a rectal probe and maintained at 38C using a heating pad. A nimals were spontaneously breathing room air. The right femoral artery was cannulated using a saline filled catheter (Micro Renathane, 0.033 outer diameter, Braintree Scientific, Inc.) connected to a calibrated differential pressure transducer (Konigsberg ). A saline filled tube (PE90) was passed

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33 through the mouth into the esophagus and connected to a second calibrated pressure transducer to measure esophageal pressure (P es ). Both pressure signals were amplified (Stoelting; Wood Dale, IL), digitized at 1kHz [Cambridge Electronics Designs (CED) 1401 computer interface; Cambridge, UK], computer processed (Spike2, Cambridge Electronics Design) and stored for subsequent analysis. Pleural pressure changes were inferred from relative changes in P es Diaphragm EMG (EMG dia ) was recorded with Teflon coated wire electrodes, threaded through 25 gauge needles. The distal end of the wires were bared and bent to form a hook. With the animal in a supine position, the right ribcage was lifted and the needle was inserted in a rostral and dorsal direction through an incision in the skin. The needle was retracted and the hooked tip of the electrode remained in the costal portion of the right side of the diaphragm. Two electrodes were inserted for bipolar EMG dia recording. The external ends were bared and connected to a high impedance probe. The signal was amplified (P511, Grass Instruments) and band pass filtered (0.3 300 Hz). Analog output was digitized and processed as described above. The trachea was exposed by a ventral incision. The trachea was freed from surrounding tissue and an inflatable cuff (Fine Science Tools) was sutured around the trachea, two cartilage rings caudal to the larynx. The actuator tube of the cuff was connected to an air filled syringe. The extent to which the bladder of the cuff was inflated was dependent upon the amount of pressure applied with the syringe. When fully inflated, the trachea was compressed to completely occlude the airway. Removal of the pressure resulted in full recover y of the trachea with no interference to breathing. Tracheal integrity was anatomically confirmed at the end of the experiment.

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34 There were 4 groups of animals. The experimental group (n=11) was prepared and received tracheal occlusions as described above. Control group 1 (n=4) were prepared as described above with a tracheo s tomy 0.5 cm below the tracheal cuff. A five cm endotracheal tube (PE240) was inserted into the tracheo s tomy with the tube length approximately equal to the distance between the oral cavi ty and incision to maintain dead space volume. These animals received tracheal compression but breathing was not obstructed. Control group 2 (n=4) were prepared as described above but did not receive a tracheostomy or tracheal obstructions. Control group 3 (n = 6) consisted of animals that were anesthetized with urethane and left undisturbed for 90 min before being sacrificed and perfused. Protocol All animals were surgically prepared and maintained under anesthesia for 90 minutes. The experimental group a nd control group 1 animals were presented a 10 min experimental occlusion trial. The tracheal cuff was inflated at end expiration to completely obstruct the airway. The occlusion was applied for 2 3 breaths and then removed for 5 10 unobstructed breaths (c onfirmed by P es ). This was repeated for the duration of the 10 min experimental trial. Animals in control groups 2 and 3 were maintained without obstructions during the 10 min period. Following completion of the experimental trial, the animal was maintaine d under anesthesia for 90 minutes. Following this 90 min period the animal was sacrificed with an overdose of anesthetic, transcardially perfused with 0.5 ml heparin into the left ventricle, followed by 200 ml perfusion saline and 200 ml 4% paraformaldehyd e in 0.4 M phosphate buffered saline ( PBS ) The brain was removed and placed in 4% paraformaldehyde for 24 h. The brain was then transferred to a solution of 30% sucrose

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35 in PBS. The fixed tissue was frozen, sectioned with a cryostat (Carl Zeiss, HM101) int o Immunohistochemical A nalysis For each brain, every third section of tissue was used for processing. Slices were incubated for 1 h in a 1:30 solution of goat serum in PBS + Triton X 100 (GS PBS T ). The tissue then sat overnight in a solution of rabbit anti c Fos primary antibody (1:2000, sc 52r; Santa Cruz Biotechnology). The following day the tissue was washed for 1 h in a solution of 1% GS PBS T, and then incubated for 2 h in a solution of goat anti rabbit biotin (1:500, Jackson ImmunoResearch). Following another 1 h wash in 1% GS PBS T, all slices were treated with avidin biotin peroxidase complex (ABC Vectastain Kit; Vector; Burlingame, CA), and washed again (1% GS PBS T for 1 h). To complete the staining process, a chromagen solution (0.05% diaminobenzidine hydrochloride, 2.5% ammonium sulfate, 0.033% hydrogen peroxide in 0.05 M TrisHCl (DAB); Sigma) was applied for roughly 3 min until the tissue changed to a darker brown color, indicative of Fos like immunoreactivity (FLI). The reaction was halted with distilled water, and then all tissue was washed 3 times in PBS. Following staining, slices of tissue were mounted on glass slides and were allowed to air dry for 3 days. All slides were dehydra ted with a series of washes in alcohol and CitraSolv, then coverslipped (Vectamount). Data Analysis Breathing pattern Breathing pattern analysis was performed with Spike 2 software on six experimental animals and four control group 1 animals. Raw EMG dia si gnal recordings were rectified and integrated (50 ms time constant). The amplitude of the integrated EMG dia signal was measured from baseline to peak amplitude (relative units).

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36 Inspiratory time (T i ) was the duration of EMG dia burst; expiratory time (T e ) w as the duration between EMG dia bursts; total breath time (T tot ) was the sum of T i and T e P es was measured from end expiration to peak (Figure 2 1) These parameters were analyzed for the complete unobstructed control breath (C) prior to occlusion the occ luded breaths (O1 O3), and the complete unobstructed recovery breath (R) immediately following occlusion ( Figure 2 1 ). T i T e and T tot were averaged for each rat and for each group. P es and EMG dia amplitude were normalized by dividing O1 O3 and R by the c ontrol breath, C. The normalized P es and EMG dia values were compared for each rat and for each group. c Fos Images of brain sections to be analyzed were viewed using light microscopy (Zeiss Axioskope) and captured with imaging software (AIS). Masks delineating areas to be counted were drawn on the images using Adobe Photoshop according to brain regions (Paxinos & Watson, 1997) and the masked im ages were saved. Neurons expressing c Fos were identified by the round, dark staining of their nuclei ( Figure 2 7 ) Size and shape limits were set to exclude spots that were too lightly stained, or were outside the diameter range of 7 Fos labeled neurons in the area of interest was counted (MetaMorph). For each brain, 3 sections per nucleus were counted bilaterally. If no bilateral differences were seen, counts for that nucleus were averaged. These values were then combined according t o group, and used for between group comparisons ( Table 2 1 ). Statistics All breathing parameters for C, O1, O2, O3, and R were averaged within each rat. These values were used to conduct a two way ANOVA for each parameter with

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37 breath number and group as f actors. Differences were s tatistical ly significan t if p<0.05. A o ne way ANOVA was performed comparing c Fos expression in all 4 groups for each nucleus. If statistical significance was achieved (p<0.05), post hoc analysis was obtained via multiple t tests differences. All data are reported as means SEM. Results Breathing P attern In obstructed animals with an intact trachea T tot was significantly greater during O1 O3 compared to preceding C and subsequent R breaths (p<0.002) ( Figures 2 1 & 2 4 ). Prolongation of T i (p<0.03) ( Figure 2 2 ) and to a greater extent T e (p<0.008) ( Figure 2 3 ) contributed to this Ttot difference. The T tot of R breaths returned to pre obstruction, C breath values. The rectified and integrated EMG dia signal progressively increased in amplitude over the course of the obstruction (p< 0.001), and remained significantly elevated above C values during R breaths (p=0.02) ( Figure 2 5 ). Similarly, inspiratory P es became increasingly negative during the obstruction (p<0.001) and also remained significantly more negative during R breaths compa red to C (p=0.004) ( Figure 2 6 ). During all obstructions in tracheostomized animals no change s in breath timing or EMG dia w ere observed ( Figures 2 1 to 2 5 ). Pre surgical baseline recordings for P es EMG dia and breath timing did not differ from end experi ment recordings. Implantation of the tracheal cuff had no effect on P es EMG dia or breathing pattern when it was sutured in place and deflated. Fos like Immunoreactivity Fos like immunoreactivity (FLI) was found in all nuclei analyzed for all groups (Tabl e 2 1). In the medulla, the nucleus ambiguus (nA) and caudal nucleus of the

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38 solitary tract (cnTS) (Figure 2 7) had significantly greater c Fos expression in the experimental group compared to all other groups (p values < 0.002). There was also a significan t difference betw een groups in the rostral nTS (r nTS) (p=0.04) but post hoc analysis revealed no differences. In the locus coeruleus (LC) the experimental group had the greatest amount of FLI compared to controls. In the various parabrachial subnuclei the external lateral (elPBN) area showed the greatest number of Fos expressing cells. In the elPBN, dorsal lateral (dlPBN), and central lateral (clPBN) subnuclei the experimental group had great er FLI compared to all control groups, and the difference was sign ificant in the dlBPN (p=0.03, comparing Exp and Ctrl 3). The lateral crescent (lcrPBN) subnucleus was the only pontine region analyzed where the tracheostomized animals had the greatest c Fos expression. In the midbrain periaqueductal gray (PAG), the great est amounts of FLI were observed in the caudal ventral regio n (cvPAG). The tracheostomized c ontrol group 1 had the most stained cells in all PAG regions, and the difference in group means was significant in the caudal dorsal (cdPAG) and cvPAG for this grou p compared to control group 3 (p<0.007). The e xperimental group had significantly more c Fos expre ssion in the cvPAG compared to c ontrol group 3 also (p=0.001). No differences between any groups were seen in the rostral dorsal PAG (rdPAG). In addition, the e xperimental group and c ontrol group 1 had significant (p<0.05) rostral caudal differences in the dorsal PAG; the experimental group showed significant dorsal ventral (p<0.05) differences in the PAG.

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39 Discussion Our method of ITTO for 2 3 breaths in anest hetized rats elicit ed respiratory load compensation, including a prolongation of T i and T e increase d EMG dia activity, and more negative inspiratory P es ITTO in anesthetized rats also induce d neural activation in respiratory brainstem nuclei, and nuclei involved in cardiovascular, stress, and fear responses. End expiratory P es did not change with obstruction or recovery in any animals, indicating that ITTO does not change lung compliance ( Figu re 2 1 ). The short duration of occlusions ensured minimal changes in blood gases, supporting our hypothesis that ITTO elicit s a load compensation respiratory motor pattern r esponse and neuronal activation within respiratory related brain nuclei. In the tra cheostomized c ontrol group 1, tracheostomy decreased baseline P es to a value that remained stable during obstructions and recovery. Because T i T e EMG dia and P es were not altered in c ontrol group 1 during ITTO the changes in th ese parameters observed in the e xperimental group result from the load compensation response of the respiratory neural contr ol system to a breathing effort against a closed airway. Tracheal compression alone was not sufficient to evoke altered breath timing and respiratory motor re sponses. The decreased breathing frequency during ITTO was primarily due to an increase in the duration of T e Because T e is normally longer than T i for a given breath, there could be more potential for breath timing modulation during T e than T i Many pre vious studies on the responses to respiratory loading used loads applied to inspiration (Zechman et al. 1976; Chaudhary & Burki, 1978; Davenport et al. 1981a; Lopata et al. 1983; Davenport et al. 1991; Forster et al. 1994; von Leupoldt & Dahme, 2005b) and expiration (Zechman et al. 1 976; Davenport et al. 1981a; Davenport et al.

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40 1984; Davenport & Wozniak, 1986; Webb et al. 1996; Watts et al. 1997) separately, and this study was unique in that airway occlusion was maintained for both phases during several breaths. Zechman and colleagues (Zechman et al. 1976) show ed that expiratory loading result ed in an upward shift in functional residual capacity (FRC). It is the accumulated volume above FRC that contributes to the termination of th e breath, not the Vi or Ve during only that cycle. If the tracheal occlusion were to occur at FRC, as was the aim in this study, both Vi and Ve would be restricted, preventing a net increase in lung volume. A trache al occlusion at end inspiration would prevent full expulsion of inspired air and a return to FRC, so subsequent breaths would occur upon inflated lungs. Lung inflation activates respiratory afferents, the primary group of which project to the brain via th e vagus nerve (Clark & von Euler, 1972; Zechman et al. 1976) An important type of vagal afferent tha t contributes to the volume timing relationship is the pulmonary stretch receptor (PSR). These receptors lie with in the smooth muscle of bronchi and respond to increases in trans pulmonary pressure (P tp ) which is influenced by lung volume (Davenport et al. 1981b) As lung volume increases with inspiration, the discharge rate of PSR s increases until a frequency threshold is reached that terminates inspiration (Davenport et al. 1981a) T e i s also influenced by PSR activity, although the threshold for terminating expiration is dependent upon PSR discharge number rather than freque ncy (Davenport et al. 1981a; Davenport & Wozniak, 1986) During ITTO at FRC in anesthetized rats, the resistance caused by occlusion decreases Vi and Ve, which subsequently decreases t he frequency and number of PSR discharge, lengthening Ti and Te, respectively. If ITTO occurs at end inspiration, Ve decreases as

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41 Te lengthens, but the subsequent inspiration will begin before the lungs can return to FRC. This will result in a shorter Ti a nd Vi than if the occlusion were applied at FRC since accumulated lung volume causes P tp and PSR discharge frequency to remain elevated. Thus, the Vt T threshold that terminates Ti and Te do es not change, but accumulated volume history may modulate their d urations for a specific breath. P es and EMG dia follow a similar pattern of activity during occluded breaths, with P es becoming more negative as EMG dia amplitude increases from O1 to O3. These values remain elevated above control breaths during the recovery breaths, although they are less than during obstructions Forster and colleagues (Forster et al. 1994) found that sustained inspiratory resistive loading in conscious ponies cause d an augmentation of Vt and respiratory motor but not breath timing responses during recovery breaths The augmentation of paramete rs during recovery breaths after ITTO is likely a result of the respiratory system acting to re store ventilation after prolonged perturbation. Loading or occluding one breath at a time does not affect subsequent breaths (Zechman et al. 1976) The exact mechanisms underlying these responses are unknown, but it is clear that consecutive obstructions to breathing necessitate a recovery response t hat exists in both the anesthetized and conscious state. Although t he augment ed recovery response in the conscious ponies has a reflexive component, it cannot be ruled out that it might also be a behavioral response to the sensations associated with the lo ading. Medulla The r nTS and cnTS were activated with acute ITTO, indicated by enhanced FLI in those regions compared to c ontrol groups. The rnTS and cnTS had more stained cells compared to most other nuclei, which was expected considering the greater amoun t of convergent input to these areas. T he load compensation response in anesthetized

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42 animals is reflexive and dependent upon PSR activation (Zechman et al. 1976; Davenport et al. 1981a; Davenport et al. 1984; Webb et al. 1994, 1996) The nTS part of the medullary dorsal respiratory group is the primary target of these vagal afferents (Kalia & Mesulam, 1980a, b; Kalia, 1981a) Although vagal afferents from the lung play a larg e role in controlling the breath Vt T response during load compensation upper airway vagal afferents also contribute to that response during inspiratory (Webb et al. 1994) but not expiratory (Webb et al. 1996) resistive loading U pper airway tracheal stretch receptors lie within the trachealis muscle (Davenport et al. 1981c) and send their afferent fibers to the brainstem via the cervical vagus, superior laryngeal (SLN), and recurrent laryngeal nerves (RLN) (Sant'Ambrogio et al. 1977; Lee et al 1992) The afferents from these receptors also terminate in the nTS (Kalia, 1981b) and were likely activated by the squeeze of the cuff during ITTO. Thus, both pulmonary and tracheal receptors were activated by ITTO, sending convergent input to the nTS where a compensatory motor response could be initiated. The nA, a nucleus within the vent ral respiratory group ( VRG ) also showed significant increases in FLI in e xperimental animals compared to c ontrols. This nucleus is activated by the nTS (Loewy & Burton, 1978) phrenic, vagus, carotid sinus, and SLN stimulation, bronchoconstriction, and inspiratory occlusions (Davenport & Vovk, 2009) T he increase in FLI in medullary respiratory nuclei results from tracheal afferents stimulated by the squeeze of the cuff, pulmonary afferents activated by lung inflation, and efferents mediating changes in respiratory pattern. Thus, respiratory load compen sation has a neural component that includes both sensory and motor activated medullary neurons.

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43 Pons ITTO also evoked significant neural activation in the dlPBN. The dlPBN responds to various respiratory stimuli including inspiratory occlusions (Davenport & Vovk, 2009) and is also an important part of the descending pathway from the PAG involved in cardiovascular (Hayward et al. 2004; Hayward, 2007) and respiratory (Hayward et al. 2004) control. Neurons in the nTS that are activated by vagal afferents send projections to pontine respira tory groups, including to the lPBN (Loewy & Burton, 1978; Ezure et al. 1998) Specifically, the respiratory (ventrolatera l) nTS has reciprocal connections with the dlPBN (Herbert et al. 1990) The FLI seen in the lPBN after ITTO could be a response to afferent projections to that nucleus, but it could also be a result of projections from the lPBN to other neural areas such as the limbic system (Saper & Loewy, 1980) No dif ferences were seen between groups in the LC, despite receiving input from the medullary dorsal and ventral respiratory groups (Herbert et al. 1990) The LC is the main source of norepinephrine in the brain and is greatl y involved in stress responses (Berridge & Waterhouse, 2003) The lack of group differences in the LC appears to be a resul t of substantial neural activation across all group conditions, possibly resulting from global urethane activation or an elevated and sustained stress response from handling the animals before bringing them to the laboratory. Neural activation seen in the PBN is likely primarily the result of integrating ascending medullary and descending PAG projections into both respiratory and cardiovascular responses to ITTO. The PBN is also involved in defensive, fear, and limbic pathways and although animals in this s tudy were anesthetized and non behaving those roles should also be considered.

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44 Midbrain The caudal region of the midbrain PAG was activated by ITTO, with the ventral region more than the dorsal. The PAG is known to be involved in defensive behaviors (Bandler & Carrive, 1988; Brandao et al. 1994; Vianna et al. 2001) pain modulation (Mayer et al. 1971; Behbehani, 1995) respiratory activation (Hayward et al. 2003; Zhang et al. 2005) and modulation of the respiratory load compensation response (Zhang et al. 2009) The results of Zhang et al., (Zhang et al. 2007) showed greater respiratory activation in response to cdPAG compared to rdPAG stimulation. SLN stimulation activates the PAG (Ambalavanar et al. 1999) and the PAG and nTS have reciprocal projections (Loewy & Burton, 1978; Farkas et al. 1998) The dPAG and vPAG have been implicated in panic and anxiety, respectively (Carrive, 1993; Bandler & Shipley, 1994; Brandao et al. 1994; Vianna et al. 2001; Cunha et al. 2010) and the vPAG appears to be involved in conditioned fear responses (Vianna et al. 2001) It is possible that ITTO causes respiratory specific activation in the cdPAG and cvPAG, but that ITTO also stimulates stress or fear pathways that additionally contribute to PAG activation. In addition, o ne cannot rule out the potential contribution of other sensory afferents to respiratory Vt T motor, and neural responses to ITTO. Any lack of significant differences in FLI expression between c ontrol group 1 and the e xperimental group in cer tain nuclei might signify that tracheal compression is a powerful stimulant of afferents that project to those specific areas Although FLI is a useful indicator of neural activity in response to acute stimuli, many control groups are needed to ensure acti vation is not a result of handling, anesthesia, noise, scent, or another factor. Urethane was used to anesthetize animals for this study, and it is known that urethane causes neural activation throughout the brain, so differences between

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45 treatments may hav e been difficult to determine above an already elevated pattern of activation. Furthermore, cells stained positively for the c Fos protein cannot be divided into sensory or motor activation, and it cannot give any indication of inhibition. If proper contro l groups are designed, however, c Fos immunohistochemistry can lay the foundation for understanding which neural substrates should be investigated further. The results of this study suggest that airway resistance can be increased intrinsically without cha nging lung compliance, evoking respiratory load compensation indicated by breath timing, diaphragm activity, and esophageal pressure changes. This model has potential applications in studying respiratory obstructive diseases characterized by increased uppe r airway resistance. Individuals with asthma, OSA, and COPD all experience some degree of airway mechanical changes including increased resistance, that are maintained over the course of many breaths. Using our model of ITTO to investigate the neural mech anisms mediating the load compensation response has important implications for elucidating the neural mechanisms modulated by these diseases.

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46 Figure 2 1. EMG dia and P es traces during tracheal occlusion in an intact (experimental) and tracheostomized (control group 1) animal. Indications of how Ti and Te were measured are displayed in the trace second from the top. There was no change in end expiratory P es during the course of the experiment. Figure 2 2. Inspiratory duration during tracheal occlusions in intact (Exp) and tracheostomized (Ctrl) animals O1 O3 v alues were significantly different from C for the Exp animal ( p=0.03)

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47 Figure 2 3. Expiratory duration during tracheal occlusions in intact (Exp) and tracheostomized (Ctrl) animals O1 O3 values were significantly different from C for the Exp animal ( p=0.008) Figure 2 4. Total breath duration during tracheal occlusions in intact (Exp) and tracheostomized (Ctrl) animal s O1 O3 val ues were significantly different from C for the Exp animal ( p=0.002)

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48 Figure 2 5. Peak amplitude of the integrated EMG dia trace during tracheal occlusions in intact (Exp) and tracheostomized (Ctrl) animals. V alues were significantly different from C for the Exp animal ( p=0.001, O1 O3; p=0.02, R). Figure 2 6. Peak negative esophageal pressure during tracheal occlusions in intact (Exp) and tracheostomized (Ctrl) animals. V alues were significantly different from C fo r the Exp animal ( p=0.001, O1 O3; p=0.004, R).

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49 Figure 2 7. c Fos in the caudal nTS of anesthetized animals after repeated tracheal occlusion s in B) a tracheostomized and C) trachea intact animal The tracheostomized animal did not experience occlusio ns to breathing because the tracheostomy was distal to the cuff. The dashed line in part A shows the area of the brain atlas (Paxinos & Watson, 1997) corresponding to the images in B and C

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50 Table 2 1. c Fos Expression in brainstem and suprapontine nuclei Nucleus Nave Sx Only Trach'd Intact Obs p value cdPAG 40.8 (6.4) 70.3 (22.2) 131 (33.7)* 88.7 (17.6) 0.007 cvPAG 57.6 (17.0) 153 (31.4) 236.7 (46.7)* 176.5 (39.2)* 0.001 rdPAG 59.5 (18.9) 58 (9.8) 69.2 (19.4) 52.8 (39.2) n/a nA 1.0 (0.2) 0.5 (0.2) 1.4 (0.3) 4.9 (0.5)** 0.001 cnTS 61.9 (16.0) 37.6 (10.5) 66.6 (19.7) 169.5 (21.5)** 0.002 rnTS 44 (0) 79.7 (26.5) 53.3 (6.5) 203.3 (44.3) 0.040 LC 42.5 (12.3) 37.8 (13.8) 42.7 (16.2) 44.9 (10.2) n/a clPBN 13.2 (3.0) 26.8 (7.3) 15.1 (6.8) 29.8 (5.1) n/a elPBN 38.0 (4.9) 30.1 (7.0) 20.7 (7.8) 38.1 (3.9) n/a lcrPBN 17.1 (2.7) 17.9 (2.7) 18.1 (3.1) 16.4 (2.4) n/a dlPBN 6.1 (1.3) 6.7 (0.8) 9.1 (1.3) 12.4 (1.4)* 0.007 The number of cells stained positively for c Fos in each region of interest SEM show n in parentheses V alues were significantly d ifferent from the Nave group; ** values are significantly different from all other groups N ave (control group 3), Sx Only (control group Intact Obs (e xperimental group).

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51 CHAPTER 3 RESPIRATORY LOAD COM PENSATION AND BEHAVI ORAL CONDITIONING IN CONSCIOUS RATS Introduction Respiratory load compensation has been observed in response to mechanical challenges to breathing such as resistive or elastic loads applied to the respiratory circuit (Zechman & Davenport, 1978) The response to a resistive (R) load applied to one phase of the breath included a decrease in volume inspired (Vi) or expired (Ve) for the duration of the load and an increase in the loaded breath phase duration (Zechman et al. 1976) The volume timing param eters of the unloaded phase of the breath were unchanged. Respiratory load compensation in anesthetized animals has been characterized as reflexive and vagal dependent (Zechman et al. 1976) specifically mediated by pulmonary stretch receptors (PSR) responding to transmural pressure changes across th e airways (Davenport et al. 1981a; Davenport et al. 1981b; Davenport et al. 1984; Davenport & Wozniak, 1986) Modulation of Ti occurs through changes in PSR spike frequency and Te through changes in spike number (Davenport et al. 1981a; Davenport & Wozniak, 1986) There is also a muscle response during lo ad compensation which includes increased respiratory motor output, measured from respiratory muscle electromyography (EMG), primarily in the diaphragm (Lopata et al. 1983) The volume timing values obtained from complete respirat ory occlusion approached those seen after vagotomy, including long loaded phase duration (Zechman et al. 1976) O cclusion at end expiration, or FRC, causes a prolongation of Ti and increased EMG dia activity (Zechman et al. 1976; Kosch et al. 1986; Zhang & Davenport, 2003; Zhang et al. 2009) and occlusion at end inspiration causes a prolongatio n of Te (Gautier et al. 1981; Zhang et al. 2009)

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52 Studies in conscious humans and animals are less numerous. Results from experiments in anesthetized animals provide information about reflexive and neural load compensation, but do not add to our understanding of beha vioral load compensation, or voluntary modulation of the reflexive patterns. Single bouts of R loads or tracheal occlusions have been applied during expiration in lambs via a facemask (Watts et al. 1997) and inspiration in dogs through a tracheal stoma (Davenport et al. 1991) Expiratory R loading causes a decrease in airflow and prolonged expiratory time (Te) (Watts et al. 1997) Subsequent unloaded breaths showed decreased Vi increased Ve, and the integrated EMG activity in the larynx and diaphragm remained active as a compensatory mechanism to help restore lung volume to baseline (Watts et al. 1997) When inspiratory R loads are added to two consecutive breaths in conscious goats, the integrated diaphrag m and external abdominal oblique muscle responses were augmented and inspiratory time (Ti) increased during both inspirations (Hutt et al. 1991) These values returned to baseline during unloaded breaths, unlike the responses seen during single bouts of expiratory R loading in lambs (Watts et al. 1997) This difference could be due to the fact that the magnitudes of the R loads were different (370 cmH 2 O/ l/sec in lambs vs. 18 cmH 2 O/ l/sec in goats), animal ages were different (neonatal lam b s vs. adult goats), or perhaps that the inspiratory and expiratory phases of breathing are under separate control mechanisms (Davenport et al. 1981a; Davenport & Wozniak, 1986; W ebb et al. 1994, 1996) When multiple consecutive inspirations are loaded, Ti is prolonged while Te and tidal volume (Vt) are decreased during the first breath in conscious ponies (Forster et al. 1994) During the second through fifth loaded breaths, small changes were seen in

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53 volume and timing parameters which stabilized after the fifth breath for the subsequent 2 4 minutes of loading. The time of EMG dia activation mirrored Ti, and mean EMG dia activity was elevated during the first loaded breath to a value that remained augmented for subsequent loaded breaths. During the first recovery breath following loading, Vt and mean EMG dia activity increased above values during loadin g but timing parameters did not change. These responses differed from responses documented in conscious animals in response to single (Watts et al. 1997) or two breath (Hutt et al. 1991) l oading. All parameters progressively returned to control values over the course of subsequent unloaded breaths. Surprisingly, the loaded and recovery breath compensation effect persisted even after pulmonary and diaphragmatic deafferentation, indicating th at these afferents quantitatively but not qualitatively modulate the load compensation response (Forster et al. 1994) The authors of this study hypothesized that int ercostal afferents and cortical input likely contributed greatly to the observed response. In the conscious man, some studies have shown that R loading decreases volume, prolongs breath duration, and enhances motor output (Axen et al. 1983; Daubenspeck & Bennett, 1983; Hudgel et al. 1987; Nishino & Kochi, 1994; Daubenspeck & Rhodes, 1995) In addition, an augmented recovery response to loading has been documented (Altose et al. 1979) similar to some aspects of conscious animal studies (Forster et al. 1994; Watts et al. 1997) Greater respiratory responses to loads of larger magnitudes have also been recognized (Altose et al. 1979; Nishino & Kochi, 1994; Calabrese et al. 1998) However, there seems to be great variability in response patterns to both respiratory loading and occlusion in conscious humans (Axen

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54 et al. 1983; Daubenspeck & Bennett, 1983; Davenport & Wozniak, 1986; Hudgel et al. 1987; Nishino & Kochi, 1994; Daubenspeck & Rhodes, 1995) Others have documented increases in volume and decreases in frequency in response to inspiratory R loading (Iber et al. 1982) Interestingly, load compensation responses that differed between individuals remained qualitatively similar within the same individual in response to various load magnitudes (Daubenspeck & Rhodes, 1995) Differing res ponses may be due to perceptual differences between individuals (Daubenspeck & Rhodes, 1995) Respiratory afferents other than those in the airways and in the main inspiratory muscles must play a role in load compensation in conscious humans and animals. These other afferents most lik ely transduce respiratory sensations associated with loading and airway occlusion. The way a conscious human or animal feels (affective component) about its breathing may further lead to modulation of the reflexive pattern of load compensation. Our laboratory has developed a method to study the load compensation reflex in conscious rats via intrinsic, transient and reversible tracheal occlusions (ITTO). ITTO is performed by inflating a rubber cuff around the trachea with enough pressure to revers ibly close the lumen of the trachea. We designed a 10 day ITTO protocol in conscious rats that would elicit and behaviorally condition the animal to respiratory load compensation. It was hypothesized that ITTO in conscious rats would cause variable respira tory load compensation pattern responses that are altered after 10 days of ITTO conditioning.

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55 Methods Animals These experiments were performed on four male Sprague Dawley rats (387.5 71.3 g). The animals were housed two to a cage in the University of Florida animal care facility where they were exposed to a 12 h light/12 h dark cycle. The experimental protocol was reviewed and approved by the Institutional Animal Care and Use Committee of the University of Florida. Surgical Procedures Animals were init ially anesthetized using isoflurane gas (2 5% in O 2 ) administered in a whole body gas chamber. Anesthetic depth was verified by the absence of a withdrawal reflex from a rear paw pinch. Buprenorphine (0.01 0.05 mg/kg body weight) and carp r ofen (5mg/kg body weight) were administered preoperatively via subcutaneous injection. Incision sites were shaved and sterilized with povidine iodine topical antiseptic solution. Body temperature was maintained at 38C by a heating pad, and anesthesia was maintained by is oflurane gas via a nose cone. Diaphragm e lectrodes The anesthetized animal was placed in a supine position and a 4 cm vertical incision was made in the abdomen. The skin and muscular abdominal wall were pulled laterally in order to expose the diaphragm. Di aphragm EMG (EMG dia ) electrodes were made using stainless steel, Teflon coated wire (AS631, Cooner Wire, Chatsworth, CA, USA), threaded through the tip of a 22 gauge needle. Two of these electrodes were implanted into the exposed right diaphragm, parallel to one another and roughly 4 mm apart. The wires were bared where they contacted the diaphragm and were secured

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56 into place with knots. The insulated, distal ends of the electrode wires were routed through the abdominal incision and directed subcutaneously to the dorsal surface of the animal, between the scapulae, where they were externalized and secured in place with sutures. Tracheal cuff The trachea was exposed by a ventral neck incision. The trachea was freed from surrounding tissue and a saline filled i nflatable cuff (Fine Science Tools) was sutured around the trachea, two cartilage rings caudal to the larynx. The actuator tube of the cuff was plugged with a blunt needle and routed subcutaneously to the dorsal surface of the animal, externalized via an i ncision between the scapulae, rostral to the EMG dia The tissue exposed in the ventral incision was pulled over the cuff and the skin was sutured closed. The skin at the dorsal incision was sutured closed and the tube was secured in place by tying the ends of the suture around a bead on the tube. Rats were then administered warm normal saline (0.01 0.02 ml/g body weight) and isoflurane anesthesia was gradually reduced. The animal was placed in a recovery cage on a heating pad and was returned to the Animal Care Facilities once fully mobile. Postoperative analgesia was provided for two to three days using buprenorphine (0.01 0.05 mg/kg body weight) and carprofen (5mg/kg body weight) given every 24 hours. Animals were allowed a full week of recovery before exp eriments began. Protocol The animals were retrieved from the Animal Care Facility on the morning of Experiment Day 1 and were taken to the laboratory. They were placed in a recording chamber for an acclimatization period of 15 minutes. During th is time the externalized actuator tube of the tracheal cuff from the animal was connected to a saline filled

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57 syringe outside the chamber but no pressure was applied to the syringe. The external ends of the EMG dia were bared and connected to a high impedance prob e. The signal was amplified and band pass filtered (0.3 3.0 kHz) (P511, Grass Instruments). Analog output was sampled ( PowerLab, ADInstruments ), computer processed (LabChart 7 Pro, ADInstruments), and stored for offline analysis. At the end of the 15 min p rotocol the animal was returned to its home cage and the chamber was cleaned with alcohol wipes. Once all animals had completed the acclimatization protocol they were returned to the Animal Care Facility. The animals were retrieved from the Animal Care Fac ility on the morning of Experiment Day 2 and were brought to the testing laboratory. One animal was placed in the recording chamber and the actuator tube was connected to a saline filled syringe. EMG dia were connected to the recording equipment. Diaphragm activity was recorded and stored for later analysis. The a nimal was allowed to rest undisturbed in the chamber for 2.5 minutes, followed by a series of cuff inflations. The syringe and cuff were pressure calibrated so a known amount of fluid movement in th e syringe would result in the amount of pressure required to fully compress and occlude the trachea. Removing the pressure allowed for full recovery of the trachea with no interference to breathing. The cuff of the animal was inflated 3 6 seconds at a time with ~35 trials in a 15 minute period. The trials were applied in a random time pattern. After the last trial, the animal was allowed to rest undisturbed in the recording chamber for 2.5 minutes. At the end of the 20 minutes, the animal was removed from t he chamber and returned to its cage. The recording chamber was cleaned with alcohol wipes between animals. The next animal was placed in t he recording chamber and the 20 minute protocol was repeated.

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58 This was continued for all animals. All animals were ret urned to the Animal Care Facility at the end of Experiment Day 2. This procedure was repeated daily for Experiment Days 3 11. Animals were sacrificed on Experiment Day 12. Analysis Breathing pattern analysis was performed offline (LabChart 7 Pro, ADInstrum ents). Raw EMG dia signal recordings were rectified and integrated (50 ms time constant). The integrated trace was integrated further to obtain total EMG dia activation (intEMG dia ) during the 3 seconds prior to (C) and the first 3 4 seconds of each occlusion (O). This analysis was completed for the first and last day of ITTO conditioning Additionally, the number of EMG dia peaks (efforts) was counted during C and O. The ratio of intEMG dia to effort was obtained and averaged during C and O for each animal and for each day. T he relative contribution of Ti and Te to Ttot during C and O were determined. Ti was defined as the duration of EMG dia activation, Te as the duration of EMG dia quiescence, and Ttot as Ti + Te. Ti, Te, and Ttot were averaged during C and O fo r each animal and for each day. A one way repeated measures analysis of variance ( RM ANOVA) was performed comparing breath (C vs. O) and day (first vs. last), separately for the following parameters: Ti, Te, Tot, Ti/Te, Ti/Ttot, Te/Ttot, intEMG dia /effort. Differences were significant when p<0.05, and post HSD with overall significance of p<0.05. Additionally, a paired t test was performed comparing the ratio of O to C for intEMG dia /effort for the first and last d ay of ITTO with significance at p values < 0.05. All da ta are reported as means SEM.

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59 Results Timing An example of the raw and integrated EMG dia signal (from the same animal) during the initial segment of one tracheal occlusion at FRC on the first ( A ) an d last ( B ) day of the ITTO protocol is shown in Figure 3 1. Ti non significant ly increased during O compared to C on both the first and last day of ITTO ( Figure 3 2A ). Te was significantly prolonged during O compared to C on both the first and last day of ITTO (Figure 3 2B, *p=0.03). Ttot was non significantly longer during O compared to C on the first or last days of ITTO (Figure 3 2C). Normalized breath timing values (O/C) for Ti, Te, Ttot are shown in Figure 3 2D, and no difference in O/C ratios for any timing variable were seen between the first and last day of ITTO (Figure 3 2A to 3 2 D). There was no significant change in relative contribution of Ti (Figure 3 3 A, D) and Te (Figure 3 3 B, D) to Ttot during O or C on either the first or last day of ITTO, a lthough during O there was a trend for greater contribution to Ttot by Te. The Ti/Te ratio did not change between C and O or between the first and last day of ITTO (Figure 3 3C, D). EMG dia A ctivity The intEMG dia activity is illustrated in Figure 3 4 intEMG dia /effort was not greater during either O or C on the last compared to the first day of ITTO (Figure 3 4A, p=0.07 for difference between O on first compared to last day of ITTO). There was no difference in values during O and C on the first day of I TTO, however, intEMG dia /effort was significantly greater during O compared to C on the last day of ITTO (Figure 3 4A, *p=0.03). The difference between relative values of intEMG dia /effort on the first and last day of ITTO was significant ( Figure 3 4B, *p=0. 05 ).

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60 Discussion The results of this study show that repeated tracheal occlusions elicit a load compensation response in conscious rats, and that the pattern of this response can be altered as a result of repeated days of ITTO conditioning. The first day r esponse to ITTO consisted of a prolongation of Te with no significant changes in Ti, Ttot or diaphragmatic activation. After 10 days of conditioning, conscious rats showed lengthened Te and increased diaphragmatic activation during O compared to C breaths, which were not accompanied by increases in Ti. There were no significant changes in timing parameters from the first day of ITTO to the last day; however, there was a significant increase in the O/C ratio of diaphragmatic activity per effort. This suggest s that after 10 days of ITTO conscious animals preferentially change respiratory drive rather than timing in response to the occlusions, and that the typical volume timing reflex seen in anesthetized animals is modulated by behavioral compensation in cons cious rats. Previous studies investigating timing reflexes in response to airway occlusions applied the occlusions to inspiration (Zechman et al. 1976; Kosch et al. 1986; Zhang & Davenport, 2003; Zhang et al. 2009) or expiration (Zhang et al. 2009) separately. The prolongation of Ti seen with occlusions at FRC is a response to functional vagotomy, which does not allow chang es to occur in PSR input and depends upon the internal respiratory rhythm generator to establish timing parameters (Feldman et al. 2003) T he prolongation of Te seen with end inspiratory occlusions results from an elevated number of activated PSR s that delay inspiration from beginning (Gautier et al. 1981) The ITTO protocol used in this study is unique in that airway occlusions were sustained for both inspiration and expiration over the course of several consecutive breaths. We

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61 tried to apply the tracheal occlusions at FRC in order to maintai n a consistent method of application and to avoid PSR mediated first breath responses to each occlusion. We expected that both Ti and Te would be prolonged during O compared to C since the occlusion s were sustained for both breath phases. We noticed a sign ificant prolongation of Te, but only a trend tow ard an increase in Ti during O. The increase in Te during O on both the first and last day of the ITTO protocol could be explained by lung hyperinflation. Applying the occlusion at end inspiration or during e xpiration would lead to sustained lung inflation, causing continuous PSR activation and producing prolonged Te (Gautier et al. 1981; Zhang et al. 2009) Te would likely remain elevated for subsequent breaths as long as the elevated lung volume was maintained. This cou ld explain why there was not a significant increase in Ti during O compared to C on either the first or last day of ITTO. Although we attempted to prevent this response by applying each occlusion at FRC, the rapid respiratory rate and movement of the anima ls hindered precise timing with the occlusions. To control for the occlusion at lung volumes above FRC, we evaluated parameters for occlusions that occurred near end expiration, most likely during the end expiratory pause phase of the breath. Another expla nation for the prolongation of Te during O is behavioral breath holding. Large resistive loads are known to cause multi dimensional sensations including air hunger and breathlessness (Simon et al. 1989; Simon et al. 1990; ATS, 1999) and these sensations are collectively referred to as the symptom dyspnea. Dyspnea is a highly aversive sensation ( von Leupoldt & Dahme, 2005b; von Leupoldt et al. 2008) and is linked with the fear that arises in response to the threat of suffocation (Lang et al. 2010) or asphyxiation (Campbell, 2007) Threat of asphyxiation is produced

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62 when a stimulus leads to hypoxemia, hypercarbia, or increased inspiratory efforts (Campbell, 2007) In t he current study, only mechanical stimuli were used to elicit responses. Furthermore, results from our laboratory (Van Diest et al. 2006) suggest that respiratory loading is more distressing than hypercapnic stimulation of breathing. Taken togethe r, we conclude that the sensations associated with trying to breathe through the tracheal occlusions were highly aversive to conscious rats. The prolongation of Te observed during tracheal occlusions was likely the attempt of the animals to hold their brea th and avoid the sensations rather than breathe against the closed airway. There was an increase in Te on both the first and last day of ITTO training but those values were not different from each other. This suggests that even with conditioning, animals c ontinue d to behaviorally adjust their load compensation breathing pattern to avoid the aversive sensations associated with ITTO. Aversive sensations associated with respiratory stimuli may not habituate, which is beneficial when considering the survival of the animal. Experimentally induced voluntary breath holding responses in humans are variable, mediated by conscious suppression of the central respiratory rhythm and involuntary mechanisms which eventually restore respiration before loss of consciousness (Parkes, 2006) The central respiratory rhythm does not stop, and only its expression is suppressed (Agostoni, 1963) The eventual override of voluntary suppression appears to be related to diaphragmatic afferents (Parkes, 2006) We have observed ( unpublished observations ) that animals may initially respond to ITTO by voluntary breath holding, but if the occlusion is maintained for 10 15 seconds the animals will reach a breaking point where intense, ballistic respiratory efforts begin.

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63 Future studies using 15 second occlusions and comparing the first 3 seconds with the last 3 seconds would allow us to characterize the respiratory load compensation response to sustained ITTO. In th e present study, the short duration ITTO avoided changes in blood gases and minimized chemical activation of respiration. We observed no change in the breath timing pattern between the first and last day of ITTO. The lack of alterations in breath timing i s consistent with respiratory studies in humans (Clark & von Euler, 1972; Axen et al. 1983) The only significant change we noticed was the increa sed duration of Te during O breaths compared to C on both days. The contribution of Ti and Te to Ttot were not different between O and C breaths or between the first and last day of ITTO. The lack of significance was likely due to the small, non significan t increase in Ti during O breaths that abolished any differences in Te/Ttot. The Ti/Ttot ratio, or duty cycle, during C on the first and last day of ITTO in our rats ranged from 0.44 0.48, consistent with other reports in Sprague Dawley rats (Walker et al. 1997) Ti/Ttot non significantly decreased during O due to the prolonged Te. Thus, Te increased in response to ITTO but there were no other pattern changes due to O or resulting from conditioning, and the respiratory timing pattern in our animals remained in the reported normal range. The respiratory load compensation timing response is extremely variable in conscious humans and animals (Axen et al. 1983) Increased respiratory muscle activation appears to be a more consistently reported response in both the conscious and anesthetized human and animal (Axen et al. 1983; Lopata et al. 1983; Hutt et al. 1991; Frazier et al. 1993; Xu et al. 1993a; Xu et al. 1993b; Osborne & Road, 1995; Zhang et al. 2009) The intEMG dia /effort in conscious rats was increased during O

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64 compared to C in this study. This means that either the EMG dia was active for a longer period of time o r the amplitude of the signal was greater. A longer activation period would correspond with an increase in Ti, which was not observed. Thus, the increase in muscle activation per effort results from larger EMG dia amplitude, suggesting that more motor units were recruited during Ti. The preferential response to ITTO is an increase in respiratory motor drive rather than a change in timing. Taken together with our timing data, the response of conscious rats to tracheal occlusions appears to be breath holding a nd stronger inspiratory efforts. The increased intEMG dia /effort during O compared to C was observed on both the first and last day of ITTO, and the ratio of O/C for this measure was significantly increased on the last compared to the first day of ITTO. Thi s suggests a conditioning response characterized by increased diaphragmatic recruitment during O after 10 days of ITTO. Increasing inspiratory muscle activity would generate a greater driving force to move air into the lungs if the airways were open; howev er, a complete tracheal occlusion closes off the airways and prevents airflow. On the first day of ITTO the animal has no experience with the occlusions and the increased EMG dia response during O compared to C may reflect an attempt to re establish airway patency and restore ventilation. After 10 days of ITTO, however, we expected that the animals would cease intense inspiratory efforts as a result of learning. The reverse was ac tually observed: animals not only maintained a ratio of O/C greater than 1 for intEMG dia /effort, the ratio was significantly greater on the last day of ITTO compared to the first day. In another study done by our laboratory (unpublished results) we observe d that this 10 day ITTO protocol leads to diaphragm and intercostal muscle hypertrophy, indicated by

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65 increased cross sectional area in type IIx/b fibers. This suggests a potential increase in muscular strength and force production, which would in turn requ ire the recruitment of fewer motor units to do the same work load. In the present study, the behavioral load compensation reflex response was characterized by an increase in diaphragm muscle recruitment during each inspiratory effort on the last day of ITT O, counter to what we expected with muscle hypertrophy. Both the learning and muscle hypertrophy effects should have resulted in less EMG dia activity per breath after 10 days of ITTO, hence the observed increase implies that this type of respiratory stimul us drives the behavioral load compensation response to make strong inspiratory efforts in an attempt to defend minute ventilation. The increased O/C ratio for intEMG dia /effort o n the last day of ITTO compared to the first day could be explained by a sensi tized behavioral response to the occlusions. We have shown that ITTO produces stress responses in conscious rats ( unpublished results ), and others have reported fear potentiation in response to uncontrollable stressors (Korte et al. 1999) of which ITTO is one. Also, our animals we re trained in the same context each day, and due to the aversive nature of the ITTO stimulus, it is possible that affective conditioning occurred. Fear potentiated behaviors are observed as a result of contextual affective conditioning (Risbrough et al. 2009) The increased O/C int EMG dia /effort response seen on the last day of ITTO compared to the first day may a lso be due to a heightened affective state from contextual conditioning which could result in alterations in breath timing and EMG dia parameters during C as well. However, resting behaviors in the context are known to habituate (Beck & Fibiger, 1995) Furthermore, if the animals did have potentiated breathing responses during C

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66 we would have expected to s ee increased diaphragmatic activation and increased breath frequency as a typical fear response (Van Diest et al. 2009) This would have resulted in greater O/C ratios for timing parameters and an O/C ratio closer to 1 for the EMG dia activity per breath which was not what was observed. It is possible that the increase in inspiratory effort during O after 10 days of ITTO is a fear potentiate d behavior. In conclusion, the results of this study suggest that there is a behavioral respiratory load compensation response to tracheal occlusions in conscious rats that is different from the anesthetized reflexive response reported in animals exposed t o respiratory loads. We observed an increase in Te during O, attributable to breath holding, and an increase in diaphragmatic activity per breath, attributable to a sensitized affective behavioral response. Thus, the volume timing reflex may be suppressed by behavioral mechanisms in conscious animals where a voluntary increase in respiratory drive is the preferential compensation response.

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67 Figure 3 1. EMG dia during the initial segment (4 s) of one tracheal occlusion at FRC on the first (A) and last (B) day of ITTO conditioning. Traces are from the same animal. Arrows indicate when cuff inflation was performed. Inflation was maintained over the rest of each segment shown in A and B.

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68 Figure 3 2. T iming parameters during control (C) and occluded (O) brea thing. C from the 3 s prior to occlusion, and the first 3 4 s of O are shown for Ti (A) Te (B) and Ttot (C) on the first and last day of ITTO conditioning. Differences in Te during C and O were significantly different on the first and last day ( p=0.03). Normalized breath timing data (O/C) for Ti, Te, Ttot are also shown (D).

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69 Figure 3 3. Relative timing parameters during control (C) and occluded (O) breathing. The contribution of Ti to Ttot (A) and Te to Ttot (B) are shown for C from the 3 s p rior to occlusion, and the first 3 4 s of O on the first and last day of ITTO. The ratio of Ti/Te during C and O are also shown (C). These ratios are expressed as normalized values (O/C; part D).

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70 Figure 3 4. Integrated EMG dia activity during control (C ) and occluded (O) breathing. intEMG dia /effort is shown during C from the 3 s prior to occlusion, and the first 3 4 s of O on the f irst and last day of ITTO (A), and t he difference between O and C on the last day of ITTO conditioning was significant ( p=0 .03). Normalized values ( O/C ) for intEMG dia /effort on the first and last day of ITTO conditioning were significant ly different ( B, p=0.05).

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71 CHAPTER 4 ST RESS AND ANXIETY RES PONSES TO REPEATED T RACHEAL OCCLUSIONS Introduction pathways that lead to arousal in preparation for handling the threat posed by the stressor. Arousal may include increases in heart rate, respiratory rate, blood pressure, and hei ghtened startle responses. The stress related neural pathways converge upon the paraventricular nucleus (PVN) of the hypothalamus (Herman et al. 2003; Herman et al. 2008; Flak et al. 2009) The median parvocellular part (PaMP) is the neurosecretory division of the hypothalamus responsible for producing corticotropin releasing hormone (CRH ) (Vale et al. 1981 ) released in response to stress (Herman et al. 2003; Herman et al. 2008; Flak et al. 2009) CRH is release d in the anterior pituitary and promotes the secretion of adrenocorticotropic hormone (ACTH) (Vale et al. 1981; Antoni, 1986) which circulates to the adrenal glands where glucocorticoids like corticosterone (Cort ; cortisol in humans ) are released by the adrenal cortex. This pathway is known as the hypothalamic pituitary adrenocortical (HPA) axis. Cort via its many neurophysiologic actions, plays a role in normal neuroendocrine function and assists an animal i n ada pting to stressor s (Sapolsky et al. 2000) Thus, measuring blood plasma Cort levels is one way to determine the extent of HPA axis activation. Measuring PVN CRH or blood CRH is not linearly correlated with chronic stress because repeated exposure to the stress leads to a blunted CRH response (Harbuz et al. 1992) Additionally, the acute HPA response to the presentation of a stimulus used in a chronic stress paradigm shows habituation (Girotti et al. 2006; Grissom et al. 2007) while b asal HPA activation remains elevated (Fernandes et al. 2002; Armario, 2006; Filipovic et al. 2010)

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72 The physiological response to stressful s timuli varies depending upon a number of factors such as duration, predictability, and controllabilit y of the stimulu s (Levine, 2000; Herman et al. 2003; Arnhold et al. 2007; Grissom et al. 2007) Stress inducing stimuli can be categorized as internal (visceral) physical, external physical, or psychological (Li et al. 1996; Levine, 2000; Herman et al. 2003) and stimuli can fall under more than one category. Respiratory afferents activated by resistive loads to breathing project to subcortical neural areas, discriminative (Davenport et al. 1985; Davenport et al. 1991; Davenport et al. 1993; Davenport & Hutchison, 2002) and affective sensory regions (von Leupoldt & Dahme, 2005b; Schon et al. 2008) that may contribute to both internal physical and psychological stress. Patients with respiratory obstructive diseases such as chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States (Heron & Tejada Vera, 2009) experience psychological stress and often have affective disorders such as anxiety and panic (Brenes, 2003; Wagena et al. 2005) Additionally, individuals diagnosed with affective disorders are more likely to have higher salivary Cort levels upon waking (Vreeburg et al. 2010) It remains unclear, however, what effect repeated, stressful respiratory stimuli may have on HPA activation in healthy conscious animals, and whether the stimuli are sufficient to cause affective responses. Our laboratory has developed a model of unavoidable, intrinsic, transient tracheal occlusions (ITTO ) in conscious rats. A tracheal occlusion is functionally an infinite resistive load to breathing, and our laboratory has shown that intense resistive loads are stressful stimuli (Alexander Miller & Davenport, 2010) Measuring resting plasma Cort allows for the approximation of stress related HPA activation. With r epeated or chronic

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73 stress sustained increased Cort production (Harbuz et al. 1992; Fernandes et al. 2002; Marquez et al. 2004) Comparing Cort levels and a d renal gland weight in animals after 1 0 day s of ITTO condit ioning to values obtained from animals not receiving occlusions allowed us to approximate the extent of stress caused by ITTO. In addition, the Elevated Plus Maze (EPM) has been used as a behavioral test for anxiety in rodents (Pellow et al. 1985) All animals completed an EPM test prior to ITTO and before their last day of ITTO to determi ne changes in state anxiety caused by conditioning It was hypothesized that after 10 days of uncued ITTO, an unavoidable stress, rats would have elevated basal plasma Cort, increased adrenal weights, and increased anxiety like behavior measured via the EP M. Methods Animals These experiments were performed on 25 male Sprague Dawley rats (374.0 55.0 g). The animals were housed two to a cage in the University of Florida Animal Care F acility where they were exposed to a 12 h light/12 h dark cycle. The experimental protocol was reviewed and approved by the Institutional Animal Care and Use Committee of the University of Florida. Surgical Procedures Animals were initially anesthetized us ing isoflurane gas (2 5% in O 2 ) administered in a whole body gas chamber. Anesthetic depth was verified by the absence of a withdrawal reflex from a rear paw pinch. Buprenorphine (0.01 0.05 mg/kg body weight) and carp r ofen (5mg/kg body weight) were adminis tered preoperatively via subcutaneous injection. Incision sites were shaved and sterilized with povidine iodine

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74 topical antiseptic solution. Body temperature was maintained at 38C by a heating pad, and anesthesia was maintained by isoflurane gas via a no se cone. Th e trachea was exposed by a ventral neck incision. The trachea was freed from surrounding tissue and a saline filled inflatable cuff (Fine Science Tools) was sutured around the trachea, two cartilage rings caudal to the larynx. The actuator tube of the cuff was plugged and routed subcutaneously to the dorsal surface of the animal, externalized via an incision between the scapulae. The tissue exposed in the ventral incision was pulled over the cuff and the skin was sutured closed. The skin at the d orsal incision was sutured closed and the tube was secured in place by tying the ends of the suture around a bead on the tube. Rats were then administered warm normal saline (0.01 0.02 ml/g body weight) and isoflurane anesthesia was gradually reduced. The animal was placed in a recovery cage on a heating pad and was returned to the Animal Care Facilities once fully mobile. Postoperative analgesia was provided for two to three days using buprenorphine (0.01 0.05 mg/kg body weight) and carprofen (5mg/kg body weight) given every 24 hours. Animals were allowed a full week of recovery before experiments began. Protocol The animals were retrieved from the Animal Care Facility on the morning of Experiment Day 1 and were taken to the laboratory. Each animal was pla ced on the EPM in a sound proof room. The animal remained on the EPM for 5 minutes where it was allowed to explore the two open arms and two closed arms freely and undisturbed. its movement were analyzed with the EPM software. At the end of the 5 minutes the animal was removed from the EPM and t he EPM was cleaned with alcohol wipes. After

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75 all animals completed the maze trial they were brought to the testing laboratory and placed in one of two recording chambers placed side by side and separated by a visual barrier During this acclimatization period lasting 15 minutes, the externalized actuator tube of the tracheal cuff from each animal was connected to a saline filled syringe out side the chamber but no pressure was applied to the syringe At the end of the 15 min protocol animals were returned to their home cages and the chambers were cleaned with alcohol wipes. Once all animals had completed the acclimatization protocol they were returned to the Animal Care Facility. The animals were retrieved from the Animal Care Facility on the morning of Experiment Day 2 and were brought to the testing laboratory. They were divided into two groups: e xperimental (n=13) and c ontrol (n=12). Tails were marked with colors to identify group and unique animal number. One e xperimental and one c ontrol animal were placed individually in the two recording chambers and the actuator tube was connected to a saline filled syringe. The e xperimental animal was a llowed to rest undisturbed in the chamber for 2.5 minutes, followed by a series of cuff inflations. The syringe and cuff were pressure calibrated so a known amount of fluid movement in the syringe would result in pressure required to fully compress and occ lude the trachea. Removing the pressure allowed for full recovery of the trachea with no interference to breathing. The cuff of the e xperimental animal was inflated 3 6 seconds with at least 15 seconds separating the occlusions for ~35 trials in a 15 minut e period. The ITTO trials were applied in a random time pattern. After the final ITTO trial, the e xperimental animal was allowed to rest undisturbed in the recording chamber for 2.5 minutes. The c ontrol animal remained undisturbed for the duration of the 2 0 minute protocol. At the end of

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76 the 20 minutes, both animals were removed from the chambers and returned to their cages. The recording chambers were cleaned with alcohol wipes between animals. The next c ontrol and e xperimental a nimals were placed in the r ecording chambers and the 20 minute protocol was repeated. This was continued for all animals. All animals were returned to the Animal Care Facility at the end of Experiment Day 2. This procedure was repeated daily for Experiment Days 3 11. Before the prot ocol on Experiment Day 11, all animals completed the EPM test for the second time. The animals were brought to the laboratory on Experiment Day 12 and they were allowed to remain undisturbed for 2 hours. Each animal was removed from its cage in a random or der and placed in a chamber with isoflurane gas (5% in O 2 ). It was rem oved from the chamber in an anesthetized state within 1.5 min, and sacrificed Adrenal glands were removed and weighed. Trunk blood was collected. Clotted blood was centrifuged at 4C f or 15 minutes, and plasma was extracted and stored at 80C Plasma Cort (ng/ml) was measured using a radioimmunoassay (RIA) kit (rat Cort 125I, MP Biomedicals). Analyses Adrenal gland weight was normalized by divid ing adrenal weight by t body weight on the day the adrenals were removed, and the se values were compared between groups using a t test (significance at p<0.05). Blood Cort levels were also compared between groups using a t test (p value <0.05). Percent time spent in the o pen, c losed a nd c enter regions of the EPM during the test were obtained for each animal on the first and ninth day of ITTO conditioning. Percent times were analyzed (Pellow et al. 1985; Rodgers & Dalvi, 1997; Korte & De Boer, 2003) for each maze region using a one way repeated measures analysis of variance (RMANOVA),

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77 comparing group (experimental vs. control) and day ( p r e vs. post ITTO conditioning). Differences were significant when p<0.05, and post hoc comparisons were performed All da ta are reported as means SEM. Results Figure 4 1 shows averages for basal plasma Cort levels in the c ontrol (2.9 1.2 g/dl) and e xperimental (5.2 1.5 g/dl) groups after 10 days of ITTO ( p=0.02). The difference in group averages for adrenal/body weight is shown in Figure 4 2 (control: 0.14 0.009; e xperimental: 0.17 0.00 6 ; p=0.03). The group averages for the percent time spent on the open arms, closed arms, and center of the EPM during the 5 minute protocol are shown for values obtained before (Pre Tx) and after (Post Tx) ITTO conditioning in Figure 4 3 There were no gro up differences for parameters measured Pre Tx or Post Tx, and there were no Pre Post differences for parameters measured in the c ontrol group; however, the percent time spent on the open arms of the maze Post Tx was significantly less than during Pre Tx fo r the e xperimental group (p=0.05). There were no Pre Pos t differences in the e xperimental group for time spent on the closed arms or on the center of the EPM. Discussion Ten days of uncued uncontrollable ITTO elicited elevated Cort levels and increased ad renal weight to body weight ratios in conscious rats. Increased anxiety measured by the decreased time in the open arms of the EPM in the e xperimental group was also observed after 10 days of ITTO. The results of this study suggest that repeated exposure to tracheal occlusions in conscious animals can cause elevated resting stress and anxiety levels in an imals after only 10 days of conditioning. These

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78 results support the link between intense respiratory stimuli, stress, and anxiety reported with COPD. We assessed resting blood Cort in the morning when the levels were lowest (Windle et al. 1998) and obtained adrenal to body weight ratios to corroborate the Cort measures. The combined results support the hypothesis that repeated bouts of ITTO augment basal HPA activation. This is similar to stress responses elicited by a variety of stimuli (Fernandes et al. 2002; Armario, 2006; Filipovic et al. 2010) Our study indicated that ITTO is a respiratory stimulus sufficient to evoke the same kind of stress responses seen with exposure to other stressful stimuli. It is clear that the stress response pattern to ITTO including adrenal hypertrophy and increased basal Cort is similar to that of other unavoidable intense stressors such as restraint and shock (Raone et al. 2007) c hronic variable stress (Herman et al. 1995) and intermittent restraint ( Fernandes et al. 2002) suggesting that repeated respiratory obstructions qualify as stress evoking stimuli These responses are mediated by both physical and psychological neural pathways, further suggesting that consciousness plays an important role in the stress response to respiratory s timuli. Ten days of ITTO in conscious rats led to increased anxiety. It is known that uncontrollable stress causes blood Cort to increase (Levine, 2000) and sustained HPA activation is linked with affective disorders such as anxiety and depression (Roy Byrne et al. 1986; Kling et al. 1991; Stenzel Poore et al. 1994; Maier & Watkins, 2005) Anxiety and depression share similar behavioral characterizations such as disrupted sleep patterns, enhanced fear responses, fatigue, cognitive deficits, and weight loss due to decrease d appetite (Stenzel Poore et al. 1994; Frazer & Morilak, 2005) In humans,

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79 anxiety and depression often have overlapping symptoms according to DSM IV (APA, 1994) Furthermore, depression is accompanied by hypercortisolism in some individuals (Roy Byrne et al. 1986; Vreeburg et al. 2010) and anxiogenic beha vior is enhanced by CRH overproduction (Stenzel Poore et al. 1994) and correlated with elevated plasma Cort levels in animals (Pellow et al. 1985) Although we did not test our animals for depression after 10 days of ITTO it is possible that they develop anxiety and depression behaviors since both are linked with HPA dysregulation and share similar behavioral characteristics. The PVN projects to the dorsal raphe (DR) (Geerling et al. 2010) and the caudal DR is excited by CRH (Lowry et al. 2000; Hammack et al. 2002) Serotonin (5 HT) is released by the DR and is subject to CRH input (Valentino et al. 2009) ; 5 HT plays a role in stress in duced CRH and ACTH secretion (Jorgensen, 2007) 5 HT and its receptors have important implications in the psychological and behavioral responses to uncontrollable stressors (Maier, 1984; Graeff, 1994; Graeff et al. 1996; Maier & Watkins, 2005; Jorgensen, 2007; Valentino et al. 2009) According to Graeff and colleagues (Graeff et al. 1996) stress activates the DR which releases 5 HT into the periaqueductal gray (PAG) and amygdala, causing immediate escape behaviors that ultimately become anxiety behaviors through conditioning or learning. When a stressor is unavoidable, 5 HT released in the hippocampus helps the animal adapt to the stress. If this pathway becomes dysfunctional, perhaps resulting from repeated activa tion with chronic stress, depression behaviors emerge (Graeff et al. 1996) S erotonergic pathways stimulated by stress likely play a role in the ITTO conditioning responses seen in our animals, both with HPA axis and anxiety behaviors.

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80 During the 10 days of ITTO conditioning, we observed the animals decreasing their exploratory behavior and withdrawal fear responses to ITTO and developing immobility throughout the 20 minute ITTO trial These responses are consistent with the animals developing depression behaviors. However we did not test for depression and future studies need to include measures of depression. In another study done by our laboratory we have found alterations in 5 HT receptor gene expression in thalamic neural areas after one exposure to ITTO (Bernha rdt et al. 2008) and after 10 days of ITTO (Bernhardt et al. 2010) It appears that serotonergic signaling is modulated in response to ITTO conditioni ng, likely from activation of stress responses (Maier, 1984; Graeff, 1994; Graeff et al. 1996; Maier & Watkins, 2005; Jorgensen, 2007; Valentino et al. 2009) Changes in serotonergic and stress pathways may suggest that ITTO can modulate behavioral load compensation, control of respiration (Hodges et al. 2009) and respiratory neural plasticity (Feldman et al. 2003; Doi & Ramirez, 2008) The PVN also projects to the b rainstem respiratory network including the nucleus ambiguus (nA) and the nucleus of the solitary tract (nTS) (Geerling et al. 2010) and the nTS has both direct and indirect projections to the PVN (Hermes et al. 2006) This loop may be useful in modulating respiratory motor output during situations of both respiratory and non respirat ory related stress. The afferents activated by ITTO likely have direct projections to the PVN that influence the internal physical stress response, while activated limbic regions may mediate the psychological stress response that includes the HPA axis (Jankord & Herman, 2008) It is significant that conscious animals were used in these experiments because consciousness introduces a behavioral component to the stress response and is

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81 important in the cognitive processing of sensations associated with ITTO Tracheal occlusions are infinite resistive loads, and breathing through resistive loads causes individuals to experience sensations of discomfort, known as dyspnea (von Leupoldt & Dahme, 2005b; O'Donnell et al. 2007; Schon et al. 2008; von Leupoldt et al. 2008) Dyspnea is a common symptom of respiratory obstructive diseases (von Leupoldt & Dahme, 2005a; O'Donnell et al. 2007) and includes both a discriminative and affective component (von Leupoldt & Dahme, 2005b) The discriminative component is relayed to the so matosensory brain network, which is processed in a similar fashion in both humans and animals (Davenport et al. 1985; Davenport et al. 1991; Davenport et al. 1993; Davenport & Hutchison, 2002) The affective component is relayed to parts of the limbic neural network and shares similarities with the affective component of pain via processing in the insular and anterior cingulate cortices (Aleksandrov et al. 2000; von Leupoldt & Dahme, 2005a; Schon et al. 2008) Thus, although dyspnea cannot be assessed in animals as it is in humans, the neural correlates that mediate dyspnea are similar. It is therefore plausible that respiratory obstructions in animals cause intense sensations of discomfort, leading to an e xperience of negative affect. Over time, this negative affect may result in disorders such as anxiety or depression which are both highly prevalent in patients with COPD who also experience dyspnea (Karajgi et al. 1990; Brenes, 2003; Wagena et al. 2005) Dyspnea is a highly aversive sensation and individuals modify their behavior in order to adapt or avoid experiencing the sensation. Patients diagnosed with respiratory obstructive diseases often l ead sedentary lifestyles (ZuWallack, 2007; Bourbeau, 2009) and sedentary behavior can be a symptom of

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82 depression (Roshanaei Moghaddam et al. 2009) Determining if our animals experience symptoms of depression as a result of ITTO is an important future study. We hypothesized that repeated ITTO would change basal stress levels in animals. We measured blood Cort the morning after the last exposure to ITTO. Habituation of the acute HPA response to a homotypic stressor and sensitization to new stressors after a chronic stress paradigm has been reported (Fernandes et al. 2002; Grissom et al. 2007) It is possible that animals in the current study could express a blunted acute Cort and PVN CRH response to ITTO after multiple days of conditioning, but these responses would likely be increased if the animals experienced a novel stress such as shock or restra int stress. These results sugge st increased stress reactivity in individuals who experience airway occlusions or intermittent, unpredictable increases in airway resistance on a regular basis. In general, one trial on the EPM is accepted as an indicator of anxiety levels resulting from treatment differences. Behavior during a second exposure to the EPM is is resistant to anxiolytics during a short but not long test dura tion (File, 1993; File et al. 1993) However, according to Treit and colleagues (Treit et al. 1993) open arm avoidance during the EPM test was not related to a fear of heights. This group also found that animals do not habituate to repeated exposures to the EPM, even after forced exploration of the open arms. In the present study, a two exposure protocol w as valid if used in conjunction with our appropriate controls. Hence, the decreased open arm time after ITTO conditioning in the experimental animals supports our hypothesis that repeated exposure (10 days) to unexpected, unavoidable, uncontrollable ITTO

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83 prod uces state changes in conscious animals characterized by increased anxiety and stress. ITTO performed once a day for 10 days lead to elevated basal HPA activation, anxiety, and potentially depression behavior. Intense, unavoidable respiratory stimuli like tracheal occlusions likely produce intense physical discomfort and severe psychological stress due to the life threatening quality of ITTO which is relevant for individuals who experience respiratory stress on a regular basis, such as those with COPD and asthma. C hronic experience with one type of stress can make an individual more reactive to new types of stress, a dangerous fact when patients with asthma and COPD have other physiological and psychological symptoms that could be worsened by airway obstru ction dependent HPA activation. Determining the links between respiration, sensations, stress and psychological state is extremely important work that needs to be continued.

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84 Figure 4 training (Exp) or handling without tracheal occlusions (Ctrl). The difference in group averages was significant ( p=0.02). Figure 4 2 Adrenal weight normalized to animal body weights after 10 days of ITTO (Exp) or handling without tracheal occlusions (Ctrl). The difference in group averages was significant ( p=0.03 ).

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85 Figure 4 3. Percent time spent in each section of the EPM before (Pre Tx) and after (Post Tx) 10 days of ITTO (Exp) or handling witho ut tracheal occlusions (Ctrl). Time spent on the open arms of the EPM Post Tx was significantly different from time spent on the open arms of the EPM Pre Tx in Exp animals ( p=0.05).

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86 CHAPTER 5 NEURAL PLASTICITY IN RESPONSE TO REPEATED TRACHEAL OCCLUSIONS Introduction The complexity of t he respiratory system enables it to respond to a variety of mechanical, metabolic, and voluntary stimuli allowing for the continuation of ventilation through changes in breathing pattern. Early respiratory studies focused on defining normal respiratory pa tterns and control mechanisms and were primarily conducted in anesthetized animals where reflexes and metabolic needs drive the system. For example, mechanically challenging the respiratory system using resistive loads to breathing causes respiratory load compensation, characterized by a decrease in loaded phase volume and increase in the phase duration, and the unloaded phase of the breath remains unchanged (Zechman et al. 1976) This response is a vagal dependent reflex (Clark & von Euler, 1972; Zechman et al. 1976) Others have described further components of the load compensation refle x in anesthetized animals including abdominal muscle activity (Koehler & Bishop, 1979) pulmonary stretch receptor (PSR) discharge (Davenport et al. 1981a; Davenport et al. 1984; Davenport & Wozniak, 1986) influence of neural activation (Zhang et al. 2009) and the importance of upper airway afferents during loading (Webb et al. 1994, 1996) Consciousness and behavior play a major role in modulating breathing, however, and voluntary control of breathing is capable of overriding the expecte d responses to metabolic needs. Stud ies in conscious animals are less numerous, but they add a vital component to the understanding of respiratory load compensation. Respiratory loads elicit respiratory sensations that are detected in conscious animals presented wi th inspiratory resistive lo ads (Davenport et al. 1991) Respiratory loads also elicit cortical

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87 evoked potentials in conscious lambs (Davenport & Hutchison, 2002) suggesting the load compensation response in conscious states may include suprapontine cognitive behavioral components. The pattern of beha vioral load compensation in conscious animals is variable (Hutt et al. 1991; Forster et al. 1994; Watts et al. 1997) and differs from the pattern seen in anesthetized animals. Also unlike anesthetized animals, conscious animals do not require pulmonary or diaphragm afferents to respond to resistive loading (Forster et al. 1994) and respiratory muscle activity is not suppressed by serotonergic inhibition in conscious animals (Sood et al. 2006) The neural mechanisms responsible for these differences are unclear. Most of what is known about the neural control of breathing has been determined from acute studies in anesthetized animals using immunohistochemical or electrophysiological methods. In anesthetized rats, electrical stimulat ion of the phrenic nerve causes neural activation, indicated by c Fos immunohistochemistry, in the nucleus of the solitary tract ( nTS ) rost ral ventral respiratory group (r VRG), and ventrolateral medullary reticular formation (Malakhova & Davenport, 2001) These nuclei contribute to vagal efferents and are termination sites of vagal afferents, which transduce information to and from the airways and lungs (Kalia & Mesulam, 1980b a; Kalia, 1981b, a) In a related study, c Fos was found in the periaqueductal gray (PAG) in response to superior laryngeal nerve (SLN) stimulation (Ambalavanar et al. 1999) Afferents from tracheal receptors travel in the SLN and recurrent laryngeal nerve (RLN) (Traxel et al. 1976; Sant'Ambrogio et al. 1977; Lee et al. 1992) respond to changes in pressure (Traxel et al. 1976; Sa nt'Ambrogio & Mortola, 1977; Citterio et al. 1985) and stretch (Davenport et al. 1981c) and have cortical projections via various relay nuclei

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88 (O'Brien et al. 1971; Fukuyama et al. 1993) The PAG is a region involved in defensive behaviors (Brandao et al. 1994; Vianna et al. 2001) Electrical stimulation and chemical disinhibition of the dorsal PAG (dPAG) in anesthetized animals activates respiration (Hayward et al. 2003; Zhang et al. 2005 ) and respiratory act ivation is greater with caudal compared to rostral dPAG stimulation (Zhang et al. 2007) Furthermore, chemical activation of the dPAG m odulates the brainstem volume timing reflex in response to inspiratory and expiratory occlusions in anesthetized rats (Zhang et al. 2009) The lateral parabrachial nucleus (lPBN) has been shown to mediate the respiratory responses evoked by the dPAG (Hayward et al. 2004) and is a potential site during voluntary breath holding where suprapontine efferents are integrated, resulting in a cohesive response that exerts inhibitory control over brainstem respiratory nuclei (McKay et al. 2008) Although brainstem and suprapontine nuclei important in mediating acute respiratory responses in anestheti zed animals would be expected to play a role in mediating respiratory responses in conscious animals, their exact role is unknown. It is additionally unknown whether neural activity in these nuclei may increase or decrease in response to repeated respirato ry stimuli. Our laboratory has developed a method to study the load compensation reflex in conscious rats via intrinsic, transient and reversible tracheal occlusions ( IT TO) ITTO is performed by inflating a rubber cuff around the trachea with enough pressu re to reversibly close the lumen of the trachea Tracheal squeeze with ITTO is expected to activate lung, airway, and muscle afferents that project to central neural structures and e to respiratory stimuli can be voluntarily modulated, higher brain centers were expected to

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89 increase activity as a result of repeated ITTO. The somatosensory cortex, an area responsible for processing discriminative components of stimuli, has increased ac tivity in response to phrenic (Davenport et al. 1985; Davenport & Vovk, 2009) and intercostal (Davenport et al. 1993) nerve stimulation, and inspiratory occlusion in conscious lambs (Davenport & Hutchison, 2002) The ventroposterior ( VP ) thalamic complex is also an important area in d iscriminatory processing, regulating activation in the somatosensory cortex (Rausell et al. 1992) Phrenic nerve evoked cortical activation in the cat is relayed through the VP (Yates et al. 1994; Zhang & Davenport, 2003) and the VP responds to somatosensory stimuli depending upon body region (Bushnell et al. 1993) It was expected that the VP would be involved in encoding the discriminatory components of ITTO. The anterior insular cortex (AI) is pa be involved in affective sensory processing (Davenport & Vovk, 2009) The AI activates respiration upon stimulation (Aleksandrov et al. 2000) and becomes active when conscious humans breathe through large resistive loads (von Leupoldt & Dahme, 2005a; von Leupoldt et al. 2008) The symptom of dyspnea, or difficult and uncomfortable breathing, is often associated with respiratory obstructive diseases and is accompanied by activation in the AI (Banzett et al. 2000; Evans et al. 2002; von Leupoldt & Dahme, 2005a; von Leupoldt et al. 2008) and amygdala (Evans et al. 2002; von Leupoldt et al. 2008) The amygdala is also involved in affective sensory processing and is vital in fear conditioning (LeDoux et al. 1988; Beck & Fibiger, 1995; Campeau & Davis, 1995; Da y et al. 2008) str ess responses (Bremner et al. 1996; Chowdhury et al. 2000) and is activated by phrenic nerve stimulation (Malakhova &

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90 Davenport, 2001) The affective or emotional component evoked by ITTO should result from activation in the AI and amygdala. To de termine the neural substrates that may mediate behavioral and reflex load compensation, we stained neural tissue for cytochrome oxidase (C O ), an enzyme involved in oxidative metabolism in the electron transport chain. CO is used to indicate changes in brai n steady state activity levels in response to stimuli (Wong Riley, 1979; Wong Riley, 1989; Gonzalez Lima & Garrosa, 1991; Hevner et al. 1995) and is therefore best used in studies of prolonged rather than acute duration. CO can reveal adaptation within brain nuclei, and neural adaptation has been documented in response to inspiratory resistive loading in humans (Gozal et al. 1995) CO staining would help determine increases or decreases in neural activity in response to repeated ITTO, significantly advancing our understanding of the neural areas mediating behavioral load compensation. We designed a 10 day ITTO protocol in conscious rats that would elicit and behavio rally condition the animal to respiratory load compensation. It wa s hypothesized that 10 days of IT TO would induce state changes in respiratory brainstem nuclei, areas involved in stress response s and suprapontine nuclei involved in discriminative and aff ective respiratory information processing. M ethods Animals These experiments were performed on 10 male Sprague Dawley rats ( 363.2 38.3 g). The animals were housed two to a cage in the University of Florida animal care facility where they were exposed to a 12 h light/12 h dark cycle. The experimental protocol was reviewed and approved by the Institutional Animal Care and Use Committee of the University of Florida.

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91 Surgical Procedures Animals were initially anesthetized using isoflurane gas (2 5% in O 2 ) ad ministered in a whole body gas chamber. Anesthetic depth was verified by the absence of a withdrawal reflex from a rear paw pinch. Buprenorphine (0.01 0.05 mg/kg body weight) and carp r ofen (5mg/kg body weight) were administered preoperatively via subcutane ous injection. Incision sites were shaved and sterilized with povidine iodine topical antiseptic solution. Body temperature was maintained at 38C by a heating pad, and anesthesia was maintained by isoflurane gas via a nose cone. The animal was placed in a supine position and the trachea exposed by a ventral neck incision. The trachea was freed from surrounding tissue and a saline filled inflatable cuff (Fine Science Tools) was sutured around the trachea, two cartilage rings caudal to the larynx The actua tor tube of the cuff was plugged with a blunt needle and routed subcutaneously dorsal ly and externalized through an incision between the scapulae. The tissue exposed in the ventral incision was pulled over the cuff and the skin was sutured closed. The skin at the dorsal incision was sutured closed and the tube was secured in place by tying the ends of the suture around a bead on the tube. Rats were then administered warm normal saline (0.01 0.02 ml/g body weight) and isoflurane anesthesia was gradually redu ced. The animal was placed in a recovery cage on a heating pad and returned to the Animal Care Facilities once fully mobile. Postoperative analgesia was provided for two to three days using buprenorphine (0.01 0.05 mg/kg body weight) and carprofen (5mg/kg body weight) given every 24 hours. Animals were allowed a full week of recovery before experiments began.

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92 Protocol The animals were retrieved from the Animal Care Facility on the morning of Experiment Day 1 and were brought to the testing laboratory and pl aced in one of two recording chambers side by side and separated by a visual barrier for an acclimatization period of 15 minutes. During this time the externalized actuator tube of the tracheal cuff from each animal was connected to a saline filled syringe outside the chamber but no pressure was applied to the syringe. Chambers were cleaned with alcohol wipes between each animal. Animals were then returned to the Animal Care Facility. Training The animals were retrieved from the Animal Care Facility on the morning of Experiment Day 2 and were brought to the laboratory. They were randomly divided into two groups: Experimental (n=5) and Control (n=5). One experimental and one c ontrol animal were placed individually in the two recording chambers and the actuato r tube was connected to a saline filled syringe. The e xperimental animal was allowed to rest undisturbed in the chamber for 2.5 minutes, followed by a series of cuff inflations. The syringe and cuff were pressure calibrated to a known amount of fluid movem ent in the syringe that would result in the pressure required to fully compress and occlude the trachea. Removing the pressure allowed for full recovery of the trachea with no interference to breathing The 10 minute protocol consisted of twenty 10 second inflations. The trials were applied in a random time pattern. After the last trial, the e xperimental animal was allowed to rest undisturbed in the recordin g chamber for 2.5 minutes. The c ontrol animal remained undisturbed for the duration of the 15 minute protocol. At the end of the 15 minutes, both animals were removed from the chambers and returned to their cages. The recording chambers were cleaned with alcohol wipes

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93 between animals. The next control and experimental a nimals were placed in the recording chambers and the 15 minute protocol was repeated. This was continued for all 5 pairs of animals. This protocol was repeated once daily for Experiment Days 2 11. Experiment Day 12 began by retrieving the animals from the Animal Care Facility and bringing th em to the testing laboratory where they were allowed to remain undisturbed for 2 hours. Each animal was removed from its cage in a random order and placed in a chamber with isoflurane gas (5% in O 2 ). It was removed from the chamber in an anesthetized state and b rains were removed, blocked into three pieces via coronal cuts and placed in 4% paraforma ldehyde. Cytochrome oxidase (CO) The blocked brains remained in the paraformaldehyde solution for 3 days, and then were transferred into a 30% sucrose solution for 2 days. Brains were cut with a microtome and the tissue was placed one slice per well in 24 well plates. Each well was filled with phosphate buffer saline, pH 7.4 (PBS), and the tissue remained in the PBS for 5 days. One full series (column) of tissue per animal brain was used for the staining protocol, adapted from (Wong Riley, 1979) Briefly, the CO solution was made [600 ml PBS, 60 g sucrose, 300 mg cytochrome C (Sigma, C2506), 200 mg catalase (Sigma, C9322) and 150 mg diaminobenzidine (Sigma, D5905)] and applied to the tissue. All plates were put on a shaker and covered to prevent light exposure. They r emained on the shaker overnight, were removed 17 hours later and transferred into PBS. The following day, tissue was mounted on glass microscope slides dehydrated with ethanol, cleaned with xylene, and coverslipped with Eukitt.

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94 Analyses Imaging Slides of brain tissue were viewed using light microscopy (Zeiss Axioplan 2), images were captured using a computer software system (ImagePro Plus), converted to 8 bit mono images, and stored. During each capture session the image of a blank slide was also captured using the same settings. A standard optical density calibration (arbitrary units) was created by setting black levels to zero and using the image of the blank slide as the incident light re ference. This corrects for differences in background light levels between capture sessions where different settings may have been applied. The standard calibration was applied to all relevant images before any measurements were made. Three line readings we re taken from within a nucleus defined by stereotaxic coordinates (Paxinos & Watson, 1997) for at least one slide per nucleus per animal (Hevner et al. 1995) This results in at least three readings per nucleus per animal that were averaged. The intensity of staining in each nucleus was determined for each animal. Those values were normalized to the average intensity of staining in an area of white matter (optic tract) for that animal to control for variability between stai ning batches Statistics The normalized values were combined according to group and were used to conduct a t test for each nucleus analyzed. Statistical significance was determined at p values < 0.05. The group means SEM are reported.

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95 Results Brainstem In the brainstem, t he primary respiratory neural areas included the VRG and nTS The level of CO staining measured in the rostral nTS in experimental animals was significantly greater than in controls ( Figure 5 1 ; p=0.01 ) T he re were no significant differences in staining intensities between groups in the cnTS, VRG, AP, l PB N or locus coeruleus (LC) Midbrain Staining intensities in the PAG and the dorsal raphe (DR) ( Table 5 2) were greater in the experimental group compared to control, and differences between group averages were statistically sig nificant for all areas except the rostral d PAG ( p=0.06). The most significant difference between group averages in all nuclei was seen in the caudal v entr al PAG (vPAG) ( Figure 5 2 ; p=0.004 ). Highe r Brain Centers, Discriminative & Affective The amount of CO staining in the experimental group was significantly greater compared to control in the v entropostero medial thalamic nucleus (VPM), and the agranular in sular cortex (AI) ( Figures 5 3 5 4 ; p=0.02 ). There were no significant differences in average CO staining between groups in t he a rc uate (Arc) PaMP, centromedial thalamus ( CM ) ventroposterolateral thalamus ( VPL ) cingulated cortex ( Cg1 ) or central nucleus of the amygdala ( CeA ) Discussion The load compensation response in conscious animals arises as a result of activated reflexive respiratory pathways and the modulation of these pathways by conscious input. Ten days of repeated ITTO in con scious rats caused significant state

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96 changes in the rostral nTS, PAG, DR, VPM and AI. This is the first evidence of neural compensation in response to respiratory load conditioning in conscious animals. Other techniques of conscious respiratory loading inc lude tracheal banding (Greenber g et al. 1995; Rao et al. 1997) restricting airflow to a head c hamber (Farre et al. 2007) and applying loads via a tracheostomy (Davenport et al. 1991; O sborne & Road, 1995; Davenport & Hutchison, 2002) or facemask (Davenport & Hutchis on, 2002) Tracheal banding is a sustained increase in airway resistance that leads to compensation from both mechanical and chemical activation. Restricting airflow via a head chamber, tracheostomy, and facemask are extrinsic airway resistances and are often implemented acutely. The model used by our laboratory is unique in that it allows for intrinsic, transient, tracheal occlusions in conscious animals with a return to normal airway resistance between cuff inflations. Increases in neural metabolic act ivity after 10 days of ITTO were seen in the e xperimental group compared to c ontrol in the rostral nTS but not the brainstem respiratory nuclei such as the VRG or caudal nTS. The caudal nTS is the primary nucleus targeted by cardiorespiratory afferents and is involved in respiratory control (Kubin et al. 2006) whereas the rostral nTS is involved in gustatory sen sory processing In other studies in our laboratory ( unpublished results ), we have shown that ITTO elicits transient changes in blood pressure that temporally correspond with each occlusion This is likely due in part to sympathetic activation and in part to the hemodynamic response to such large negative intrathoracic pressures. During each occlusion afferents activated in the lung, airway, trachea, and blood vessels ascend to the caudal nTS In addition, i t is possible that afferents from chemoreceptors might also

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97 ascend to the nTS if the 10 second tracheal occlusions are long enough to cause a slight degree of hypoxia by the end of the occlusion. Farre and colleagues (Farre et al. 2007) foun d a 10 s obstruction reduced the SpO 2 to 83% in rats, and results from Yasuma et al. (Yasuma et al. 1991) showed increased arousal in dogs at higher SaO 2 levels when resistive loads were also applied. The mechanical stimulation may enhance chemical stimulation, which would be relayed to the nTS by c arotid body afferents traveling in the glossopharyngeal nerve. With ITTO the caudal nTS should re ceive great amounts of intermittent, convergent mechanical and potential chemical input. This input was not sufficient to induce permanent modulatory changes in activity level within the caudal nTS after 10 days of ITTO, however The observation of increased basal activity in the rostral nTS due to ITTO conditioning could be related to the proximity of the cuff to the pharynx and oral cavity in which a re taste receptors sending sensory information to the rostral nTS. Rostral nTS activation could also be related to the fact that cranial nerves relaying gustatory information to the rostral nTS are also involved in mediating visceral sensations, some poten tially related to cuff inflation, and that this overlap resulted in the increase in CO activity seen in these results. (Mitchell & J ohnson, 2003) Neural modulation in the respiratory circuit is known to occur in response to respiratory stimuli (Baker et al. 2001; Mitchell & Johnson, 2003) and also occurs in other brain structures (Huang & Kandel, 1994; Feldman et al. 1999) The nTS is an area well known for its plastic abilities (Chen et al. 2001; Kline, 2008) and it is possible that the rostral nTS alters basal neural activity as an adaptatio n to the intermittent convergent input caused by repeated ITTO

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98 conditioning. This could indicate that the nTS changes its state for conditioned load compensation to subsequent airway obstruction challenges, allowing for adaptation of physiological response s to the severe respiratory challenge posed by repeated ITTO. McKay and colleagues (McKay et al. 2003) suggest that the brainstem respiratory network including the nTS, may be an important site for the voluntary control of breathing in humans. Thus, the nTS may also be an important site for the voluntary modulation of breathing in animals, with the rostral division undergoing plastic changes as a result of ITTO conditioni ng and potentially generating a new response pattern for the animal. Veening and colleagues (Veening et al. 2009) found increased c Fos expression in the AP as a result of an anxiety producing paradigm, and the AP projects to the nTS (Bonham & Hasser, 1993) No group differences were seen in the present study i n the AP as a result of ITTO indicating it did not undergo changes in baseline activity ; however, that does not rule out a potential role for the AP in the acute response to ITTO. The AP projects to the lPBN (Herbert et al 1990) and neurons in the nTS activated by vagal afferents send projections to pontine respiratory groups, including to the lPBN (Herbert et al. 1990; Ezure et al. 1998) The lPBN is involved in PAG activated cardiovascular (Hayward et al. 2004; Hayward, 2007) and respiratory responses (Hayward et al. 2004) and the PAG has projections to other areas like the medulla that also mediate these responses (Cameron et al. 1995; Farkas et al. 1 998) The lack of group differences in CO staining seen in the lPBN suggests that there was no change in steady state activity after 10 days of ITTO, b ut this does not mean the lPBN was not activated during ITTO or that this activation could not lead to steady state

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99 changes in inter connected nuclei. The lPBN is not a brain region where a change in basal activity is often seen, but the lPBN is known to pl ay a role in plasticity in other neural areas (Lopez de Armentia & Sah, 2007) Surprisingly, no change in baseline activity was seen in the LC in response to 10 days of ITTO The LC is involved in the noradrenergic response to stressful stimuli (Bremner et al. 1996; Van Bockstaele et al. 2001) and our laboratory has shown that ITTO is a stress evoking stimulus ( unpublished results ). The LC receives efferent projections from the CeA, nTS, and the PAG (Van Bockstaele et al. 2001) There can be opposing actions on the LC from these nuclei and others in response to different types of stressors (Van Bockstaele et al. 2001) ; excitatory and inhibitory inputs to this area may prevent an alteration in steady state activity. Alternatively, a change in baseline neura l activity in the LC may not be a necessary response to repeated ITTO. A study looking at the fMRI response to inspiratory loading in humans showed that the level of activation in regions corresponding with the LC decreased upon the second presentation of the load (Gozal et al. 1995) Perhaps the LC initially responds to ITTO by increasing activity but does not remain active if the stimulus is not present, having no effect on baseline activity levels. The midbrain PAG was the brai n region with the largest differences in staining between groups. The PAG is involved in defensive behaviors (Bandler & Carrive, 1988; Brandao et al. 1994; Viann a et al. 2001) pain modulation (Mayer et al. 1971; Behbehani, 1995) respiratory activation (Hayward et al. 2003; Zhang et al. 2005) and modulation of the load compensation response (Zhang et al. 2009) Neural activation was observed in the PAG in response to SLN stimulation (Ambalavanar et al. 1999)

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100 which is one group of tracheal afferents likely stimulated by cuff inflation. After 10 days of ITTO we noticed the greatest differences in the caud al compared to the rostral PAG Interestingly, the results o f (Zhang et al. 2007) showed greater respiratory activation in response to caudal vs. rostral dPAG s timulation. The caudal PAG has desc ending input to the nTS and the ventrolateral PAG innervates the VRG and the paraventricular hypothalamus (PVN) (Farkas et al. 1998) T he dPAG showed significantly increased steady state excitation in animals exposed to 10 days of ITTO, while increases in the vPAG approached significance. The response of the PAG may have contributed to the significant chan ges also seen in the rostral nTS. The dPAG and vPAG have been implicated in panic and anxiety, respectively (Carrive, 1993; Bandler & Shipley, 1994; Brandao et al. 1994; Vianna et al. 2001; Cunha et al. 2010) and the vPAG appears to be involved in conditi oned fear responses (Vianna et al. 2001) Repeated ITTO may initially produce panicogenic respon ses that ultimately become anxiogenic as a result of contextual fear during ITTO conditioning in our rats. The raphe n ucleus is a main source of serotonin (5 HT) in the brain. The DR is the subdivision with the greatest serotonergic input to other nuclei, and the amygdala receives most of its 5 HT from the DR (Azmitia & Segal, 1978; Li et al. 1990) After 10 days of ITTO the DR had elevated steady state activity, suggesting a potential role in the adaptive response to repeated severe respiratory stimuli. 5 HT has been implicated in respiratory (Lindsay & Feldman, 1993; Bianchi et al. 1995; Pena & Ramirez, 2002; Hodges et al. 2009) and cardiovascular control (Merahi et al. 1992; Dergacheva et al. 2009) and is also involved in respiratory plasticity (Baker et al. 2001; Fuller et al. 2001; Bocchiaro & Feldman, 2004; Doi & Ramirez, 2008) The DR and serotonin also

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101 play a role in stress responses and mental disorders (Maier, 1984; Maier & Watkins, 2005; Jorgensen, 2007; Mizoguchi et al. 2008) Many individuals with respiratory obstructive diseases have anxiety, and 5 HT is often pharmacologically manipulated to treat anxiety in these patients (Brenes, 2003) Also, learned helplessness caused by uncontrollable stressors can lead to sensitization of serotonergic neurons in the DR, which respond to future stressors with exaggerated 5 HT release that su bsequently leads to behavioral changes (Maier & Watkins, 2005) ITTO is an unexpected, uncontrollable, life threatening stressor, and the increase in steady state DR activity may be an indicator that the serotonergic system is sensitized as a result of our 10 day protocol. This has implications for individuals who experience transient uncontrollable respiratory stress, especially in the form of obstructive events occurring with asthma and chronic obstructive pulmonary disease (COPD). These i ndividuals may be sensitized to exaggerated stress responses to other stimuli as well, creating an unhealthy physiological and psychological state. Serotonergic influence is dependent upon the nucleus and the receptor(s) activated I t is generally conside red that 5 HT1A and 5 HT1B receptor activation is inhibitory (Barnes & Sharp, 1999) and both are present i n the CeA (Saha et al. 2010) The amygdala shares a critical link with the PAG in the fear circuitry of the brain and is also involved in aversive responses (Brandao et al. 1994; Davis et al. 1994; LeDoux, 2000; Martine z et al. 2006) The CeA is the site of many convergent inputs, including nociceptive afferents from the PBN and spinal cord (LeDoux, 2000) The basolateral and lateral am ygdala act as the regulators of information received from aversive stimuli reach ing the CeA, the motor output subnucleus of the amygdala (Campeau & Davis,

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102 1995) Our laboratory has shown (Shahan et al. 2008) that electrical stimulation of the CeA leads to an increase in respiratory rate in anesthetized rats, potentially through output to the PAG. We expected to see down regulation of CeA activity as a result of ITTO conditioning potentially via DR activity, assuming increased DR activation after ITTO would result in greater 5 HT release in the CeA ; however, there was no observable change in CeA activity. The CeA has inhibitory projection s to the PAG and nTS via gamma aminobutyric acid (GABA) (Davis et al. 1994; Saha et al. 2010) Down regulation of CeA GABA ergic innervation could disinhibit the PAG (Saha, 2005; Oka et al. 2008) Thus, if baseline activity in the CeA decrease d activation of the PAG and nTS could increase through disinhibition, potentiating the fear and anxiety component of behaviora l respiratory load compensation observed after repeated airway obstruction experiences such as ITTO. This might allow t he animal to modulate its physiological responses to repeated respiratory mechanical stressors or fearful stimuli via CeA plasticity. The lack of staining differences in the CeA suggests there are other neural areas playing a larger role in the modulation of responses. The PVN is another nucleus known to respond to stressful stimuli. The PaMP is the neurosecretory division of the PVN responsible for producing corticotropin releasing hormone (CRH) (Vale et al. 1981) and it projects to a number of brain regions inclu ding the DR, PAG, PB N nTS, and VRG (Dampney, 1994; Geerling et al. 2010) Because ITTO is a stressful stimulus ( unpublished results ), the PaMP was expected to have increased basal activit y after 10 days of ITTO, however no significant differences between groups were found. A ccording to Arnhold and colleagues (Arnhold et al. 2007) the PaMP response to acute stress may be different from repeated stress. They

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103 found decreased c Fos expression in CRH positive parv ocellular neurons after repeated episodes of restriction induced drinking, a stress evoking stimulus. They suggested that the inhibition could be a result of conditioning. The lack of increased or decreased activity in the PaMP after ITTO conditioning may be due to the duration of the protocol. The 10 days of conditioning may be long enough that an increase in activity is no longer observed, but short enough that a persistent downregulation of activity has not yet occurred. Subcortical neural networks are e ssential for maintaining normal cardiorespiratory function, generating reflexes, and adapting to recurring or prolonged stimuli. Some components of these networks can be voluntarily modulated in conscious animals via cortical input An awake animal has two defined systems involved in sensory processing. The discriminative system encodes stimulus details such as intensity, timing, and location of the stimulus, whereas the affective system integrates the qualitative emotional aspects associated with the stimu lus. The discriminative pathway includes a relay through the thalamus to the somatosensory cortex, and the affective pathway involves structures such as the amygdala, anterior cingulate (Cg1) and AI (von Leupoldt & Dahme, 2005b, a; Schon et al. 2008; von Leupoldt et al. 2008; Davenport & Vovk, 2009) Both these pathways are involved in respiratory sensations (von Leupoldt & Dahme, 2005b, a; Schon et al. 2008; von Leupoldt et al. 2008; Davenport & Vovk, 2009) With ITTO we have found long term increases in activity in the VPM thalamus and AI. The VPM is an area that responds to facial stimuli P rior experiments have found activation in the VPL in response to phrenic nerve stimulation (Yates et al. 1994; Zhang & Dave nport, 2003) It is possible that tracheal afferents activated upon cuff

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104 inflation send projections beyond the brainstem to the VPM via polysnaptic pathways (Ambalavanar et al. 1999) In addition, Cechetto and Saper (Cechett o & Saper, 1987) found that the VPM projects visceral sensory information to the AI some of which includes cardiopulmonary afferent information. The present study shows changes in the activity state of the discriminatory cortical pathway but the affere nts activated by ITTO mediating these changes remain unknown. The affective AI had significantly increased CO staining in the e x perimental animals compared to c ontrols. The AI has an excitatory projection to the PAG (Behbehani et al. 1993) responds to respiration, arterial chemoreceptors, and cardiovascular baroreceptors (Cechetto & Saper, 1987) and is active during voluntary breath holding maneuvers (McKay et al. 2008) Aleksandrov and colleagues (Aleksandrov et al. 2000) found a respiratory related area in the insu lar cortex that produced either excitatory or inhibitory respiratory responses when stimulated, depending upon whether the region was posterior or anterior, respectively. Of note, the AI also plays a vital role in the neural processing of dyspnea, or the s ensation of difficult and uncomfortable breathing (v on Leupoldt & Dahme, 2005a; von Leupoldt et al. 2008; Davenport & Vovk, 2009) Becaus e loaded breathing has been shown to produce dyspnea (Schon et al. 2008) it is likely that the AI is activated by the sensations associated with ITTO and may play a significant role in modulating the behavioral load compensation responses to repeated ITTO. This modulatory function migh t arise from plasticity within the region suggested by the increase in basal activity after 10 days of ITTO.

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105 In order to understand the neural mechanisms involved in load compensation responses to respiratory stimuli in human subjects, non invasive method s such as fMRI and cortical evoked potentials (CEP) are most often used (Gozal et al. 1995; Davenport et al. 2006; Chan & Davenport, 2008; von Leupoldt et al. 2008; Chan & Davenport, 2009) Both methods provide info stimulus. fMRI produces information about both inhibition and activation, and CEP indicates temporal activity patterns primarily in the cortex. Both methods have been used in animals. Although they prod uce large quantities of data, they offer little information about specific neural networks and plasticity. Because of the ability to conduct invasive experiments in animals, researchers can also use histochemistry to determine specific neural changes in re sponse to stimuli after the stimulus has been delivered. A common method is staining neural tissue for c Fos, which only depicts areas of activation, not inhibition. Furthermore, c Fos cannot differentiate between afferent or efferent activation, and many control groups are needed. CO is another histomchemical method, but unlike with c Fos it can show both excitatory and inhibitory state changes in brain activity but does not provide information on acute neural activity. One potential difficulty with using CO lies in the fact that brain nuclei have inherent differences in metabolic rates. Certain areas are always less active than others and will have less intense CO staining. Determining group differences in metabolic activity for these nuclei can be difficu lt when the changes are small. Similar to the observations of Hevner and colleagues (Hevner et al. 1995) the greatest staining was observed in special sensory and motor nuclei such as the dorsal and ventral respiratory groups, while the lowest staining intensities were seen in limbic nuclei like the amygdala, which

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106 is known for less CO reactivity. The between group differences in steady state activity in limbic nuclei resulting from ITTO may actually be more robust than is indicated by CO staining, especially if the change is a net decrease in activity level as was seen in the am ygdala in this study. This study shows state changes in specific brain nuclei elicited by conscious load compensation conditioning to respiratory mechanical stimuli. Significant findings include increases in basal activity of the nTS PAG, DR, VPM, and AI This list includes important respiratory nuclei, nuclei and nuclei mediating discriminative and affective sensory processing. These results suggest a modulation of sensory brain regions, which is especially releva nt to pulmonary diseases characterized by transient, unexpected, inescapable, uncontrolled ai rway obstruction such as asthma, COPD, and obstructive sleep apnea. Patients with these pulmonary diseases have a high incidence of stress and affective disorders Repeated obstructions to breathing during sleep have resulted in impaired detection of R loads in conscious humans (McNicholas et al. 1984) suggesting that neural structures involved in the respiratory sensory processing in t hese patients may have been altered. The present study reports state changes in brain pathways that are consistent with neural plasticity related to affective disorders in pulmonary obstructive diseases. Characterizing the load compensation response in con scious animals, how this response is alt ered after repeated experience and what neural structures mediate these responses is essential to our understanding of respiratory diseases and rehabilitation.

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107 Figure 5 1. CO staining in the rostral nTS after A) 10 days of handling and no tracheal occlusions and B) 10 days of ITTO. Differences in staining averages between groups were significant (p=0.01). Figure 5 2. CO staining in the caudal vPAG after A ) 10 days of handling and no tracheal occlusions, and B ) 10 days of ITTO. Differences in staining averages between groups were significant (p=0.004).

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108 Figure 5 3. CO staining in the VPM thalamus after A ) 10 days of handling and no tracheal occlusions, and B ) 10 days of ITTO. Differences in staining averages between groups were significant (p=0.02). Figure 5 4. CO staining in the AI and Cg1 after A) 10 days of handling and no tracheal occlusions, and B) 10 days of ITTO. Differences in staining averages between groups were significant in the AI only (p=0.02).

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109 Table 5 1 Brainstem CO staining after 10 days of ITTO (Exp) or handling without tracheal occlusions (Ctrl). Nucleus Exp Ctrl p value caudal nTS 2. 66 (.13 ) 2.46 (.10 ) 0.31 rostral nTS 2.87 (.19 ) 2.12 (.14 ) 0.01 c VRG 3.04 (.17 ) 2.86 (.10 ) 0.4 0 r VRG 3.08 (.1 6) 2.43 (.16 ) 0.02 AP 2.76 (.20 ) 2.85 (.30 ) 0.82 l PB N 2.07 (.10 ) 1.93 (.20 ) 0.57 LC 2.25 (.09 ) 1.85 (.17 ) 0.08 Reported values are staining intensities in each nucleus normalized to unstained white matter from the same animal and staining batch. Table 5 2. Midbrain CO staining after 10 days of ITTO (Exp) or handling without tracheal occlusions (Ctrl). Nucleus Obs Ctrl p value caudal d PAG 2. 11 (.10 ) 1.74 (.08 ) 0.01 caudal v PAG 2.25 (.07 ) 1.90 (.04 ) 0.004 rostral d PAG 1.98 (.08 ) 1.70 (.10 ) 0.06 DR 2.11 (.06 ) 1.80 (.11 ) 0.05 Reported values are staining intensities in each nucleus normalized to unstained white matter from the same animal and staining batch. Table 5 3. Higher brain centers, discriminative, and affective CO staining after 10 days of ITTO (Exp) or handling without tracheal occlusions (Ctrl). Nucleus Obs Ctrl p value Arc 2.22 (.14 ) 2.16 (.1 9) 0.79 PaMP 2.09 (.11 ) 2.12 (.27 ) 0.93 CM 1.74 (.08 ) 1.47 (.12 ) 0.09 VPL 2.45 (.13 ) 2.27 (.13 ) 0.37 VPM 2.48 (.08 ) 2.11 (.10 ) 0.02 AI 2.69 (.06 ) 2.43 (.06 ) 0.02 Cg1 2.6 0 (.1 3) 2.32 (.12 ) 0.19 CeA 1.34 (.03) 1.45 (.12 ) 0.39 Reported values are staining intensities in each nucleus normalized to unstained white matter from the same animal and staining batch.

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110 CHAPTER 6 GENERAL DISCUSSION Acute Anesthetized Respiratory L oad C ompensation Our method of intrinsic, transient, tracheal obstructions for 2 3 breaths in anesthetized rats elicit ed respiratory load compensation, including a prolongation of T i and relativ ely longer T e increase d EMG dia activity, and more negative inspiratory P es End expiratory P es did not change with obstruction or recovery in any animals, indicating that ITTO does not change lung compliance. T he changes in breath timing and respiratory m otor responses resulted from the load compensation response of the respiratory neural control system to breathing efforts against a closed airway and t racheal squeeze alone was not sufficient to evoke responses. These responses were mediated by respiratory afferents, including vagal PSR s responding to transpulmonary pressure (P tp ), which is influenced by lung volume (Davenport et al. 1981b) The elevated P es and EMG dia during recovery breaths are consistent with other studies (Forster et al. 1994; Watts et al. 1997) and it appears that whether respiratory motor responses return to baseline during recovery depends upon the s everity and properties or both). Breath timing parameters are often reported to return to baseline during recovery (Hutt et al. 1991; Forster et al. 1994) The augmentation of paramete rs during recovery breaths after ITTO is likely a result of the respiratory system acting to restore ventilation after prolonged perturbation. Respiratory load compensation in the anesthetized animal is mediated by reflexive neural mechanisms and is dependent upon lung, airway and muscle afferent activation, including PSR s (Zechman et al. 1976; Davenport et al. 1981a; Davenport et al. 1984;

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111 Webb et al. 1994, 1996) ITTO in anesthetized rats induce d neural activation in respiratory brainstem nuclei, and nuclei involved in cardiovascul ar, stress, and affective responses, indicating that nucl ei within these pathways may participate in the breath timing and motor load compensation responses to ITTO. Our neural pathway model is represented in Figure 6 1 The nTS is the primary target of lung (Kalia & Mesulam, 1980a, b; Kalia, 1981a) and upper airway afferents (Sant'Ambrogio et al. 1977; Kalia, 1981b; Lee et al. 1992) The nA is activated by the nTS (Loewy & Burton, 1978) phrenic, vagus, carotid sinus, and superior laryngeal nerve stimulation, bronchoconstriction, and inspiratory occlusions (Davenport & Vovk, 2009) and also participates in load compensation responses. The increase d FLI in medullary respiratory nuclei results from tracheal afferents stimulated by the squeeze of the cuff, pulmonary afferents activated by lung inflation, and efferents mediating changes in respiratory pattern. ITTO also evoked significant neural activation in the dlPBN, which has been shown to respond to occlusions (Davenport & Vovk, 2009) and neurons from the nTS (Loewy & Burton, 1978; Ezure et al. 1998) The lPBN plays a role in the descendi ng pathway from the PAG involved in cardiovascular (Hayward et al. 2004; Hayward, 2007) and respiratory (Hayward et al. 2004) control, and the PAG was also activated by ITTO with the greatest response seen in the caudal region. The PAG is an i mportant nucleus involved in defensive behaviors (Bandler & Carrive, 1988; Brandao et al. 1994; Vianna et al. 2001) pain modulation (Mayer et al. 1971; Behbehani, 1995) panic and anxiety, (Carrive, 1993; Bandler & Shipley, 1994; Brandao et al. 1994; Vianna et al. 2001; Cunha et al. 2010) conditioned fear (Vianna et al. 2001) and respiratory responses (Hayward et al. 2003; Zhang et al. 2005, 2007, 2009) The FLI

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112 seen in the lPBN after ITTO could be a response to afferent projections to that nucleus, but it could also be a result of projections from the lPBN to other neural areas such as the limbic system (Saper & Loewy, 1980) T he FLI seen in the PAG after ITTO could be respiratory specific and/or related to stress and fear pa thways. The potential contribution of other sensory afferents to respiratory volume timing, motor, and neural responses to ITTO cannot be ruled out. It is clear that reflexive respiratory load compensation has a neural component that includes both sensory and motor activated neurons involved in respiratory, cardiovascular, stress, and affective pathways ( Figure 6 1 ). Conditioned, Conscious Respiratory Load C ompensation The results of the first study in the anesthetized animal provide evidence that our model of ITTO is effective for eliciting respiratory load compensation and elucidating the neural component of that compensation. Behavioral load compensation is fundamenta l to adaptation to respiratory loads in conscious animals (i.e. escape is a critical compensation behavior in obstructive pulmonary diseases). It is known that changes in respiratory behavior can be elicited through conditioning in conscious humans (Gallego & Perruchet, 1991) and animals (Nsegbe et al. 1997; Nsegbe et al. 1998; Nsegbe et al. 1999; Durand et al. 2003) Stimuli such as hypoxia and hypercapnia can be paired with a discrete cue, like a tone or odor, or be implemented in an consistent context. Conditioned responses were variable, depending upon the stimuli used, species, and age of the animal H owever, the results of those studies indicate that stimuli can change res piratory behavior which, over time, may become a persistent response as a result of learning (conditioning).Thus, we developed a conscious rodent model of ITTO using the same surgical procedures as in the first study in order to characterize the conscious

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113 response to tracheal occlusions and understand how the behavioral control of breathing modulates reflexive responses, especially after conditioning. The results of that study showed that the first day response to ITTO consisted of a prolongation of Te wit h no significant changes in Ti, Ttot or diaphragmatic activation. After 10 days of conditioning, conscious rats lengthened Te and increased diaphragmatic activation during occluded (O) compared to control (C) b reaths, which were not accompanied by increases in Ti. There were no significant changes in total breath timing parameters from the first day of ITTO to the last day; however, there was a significant increase in the O/C ratio of diaphragmatic activity per breath This suggests that after 10 days of ITTO conscious animals preferentially change respiratory drive rather than timing in response to the occlusions, and that the volume timing reflex seen in anesthetized animals is modulated in conscious rats. Th e prolongation of Te during O was hypothesized to be a result of behavioral breath holding rather than lung hyperinflation since we attempted to occlude animals at FRC and only evaluate breaths where that was accomplished. The discomfort caused by trying t o breathe through a large resistive load (Simon et al. 1989; Simon et al. 1990; ATS, 1999) is aversive (von Leupoldt & Dahme, 2005b; v on Leupoldt et al. 2008) and linked with the fear that arises in response to the threat of suffocation (Lang et al. 2010) or asphyxiation (Campbell, 2007) The prolongation of Te observed during tracheal occlusions was likely the attempt of the animals to hold their breath and avoid the sensations rather than breathe through them. There was an increase in Te on both the first and last day of ITTO tr aining, however those values were not different from one another suggesting that even with conditioning the animals will continue to breath hold

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114 and avoid the aversive sensations associated with ITTO. Aversive sensations associated with respiratory stimuli may not habituate, which is beneficial when considering the survival of the animal. We observed no other changes in breath timing between O and C or between the first and last day of ITTO indicating that the primary respiratory load compensation response in conscious animals does not include modulation of breath timing, which is consistent with respiratory studies in humans (Clark & von Euler, 1972; Axen et al. 1983) Increased respiratory muscle activation appears to be a more consistently reported response in both the conscious and anesthetized human and animal (Axen et al. 1983; Lopata et al. 1983; Hutt et al. 1 991; Frazier et al. 1993; Xu et al. 1993a; Xu et al. 1993b; Osborne & Road, 1995; Zhang et al. 2009) The diaphragmatic activation per breath in conscious rats was increased during O compared to C in this study, and the O/C ratio was greater on the last compared to the first day of ITTO. This was a result of increased EMG dia amplitude ( i.e muscle fiber recruitment) during Ti, indicative of stronger inspiratory efforts. These results suggest the enhanced diaphragm motor response was a result of conditioning, attributed to behavioral sensitization. ITTO produces stress responses in conscious rats ( unpublished results ), and others have reported fear potentiation in response to uncontrollable stressors (Korte et al. 1999) Additionally, fear potentiated behaviors are observed as a result of contextual affective conditioning (Risbrough et al. 2009) and the increased O/C diaphragm response seen on the last day of ITTO compared to the first day may also due to a heightened affect ive state from contextual conditioning. These potentiated behaviors were only apparent during stimulus presentation and not during C breathing, consistent with habituation of

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115 resting behaviors during context exposure (Beck & Fibiger, 1995) These results su ggest that there is a respiratory load compensation response to tracheal occlusions in conscious rats that is different from the anesthetized reflexive response and from other patterns reported in conscious humans and animals exposed to respiratory loads. This response includes breath holding and increased inspiratory effort potentially d ue to a sensitized behavioral affective response. Thus, the volume timing reflex may be modulated in conscious animals by behaviorally mediated increased respiratory drive as the preferential load compensatory mechanism. Stress and Affective Responses to I TTO Conditioning in Conscious Animals ITTO causes neural activation of nuclei involved in stress and affective pathways in anesthetized animals and the pattern of the respiratory load compensation response in conscious animals is influenced by behavioral control. To determine whether stress and/or aversive mechanisms play a role in the behavioral modulation of respiratory load compensation we conditioned conscious animals to 10 days of ITTO. Load compensation responses were determined by physiological ass ays for stress and a behavioral measure of anxiety. We found that 10 days of unexpected, unavoidable, uncontrollable ITTO elevated basal Cort l evels, increased adrenal weight and heightened anxiety in conscious rats. These results suggest that repeated ex posure to tracheal occlusions in conscious animals can cause elevated resting stress and anxiety levels in animals after only 10 days of ITTO conditioning. The augmentation of basal HPA activity is similar to responses evoked by other repeated stressors (Fernandes et al. 2002; Armario, 2006; Filipovic et al. 2010) Our study indicated that ITTO is a respiratory stimulus sufficient to evoke the same kind of stress responses seen with exposure to other stressful stimuli such as restraint and

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116 sh ock (Raone et al. 2007) chronic variable stress (Herman et al. 1995) and intermittent restraint (Fernandes et al. 2002) Sustained HPA activation is linked wi th affective disorders such as anxiety and depression (Roy Byrne et al. 1986; Kling et al. 1991; Stenze l Poore et al. 1994; Maier & Watkins, 2005) and 10 days of ITTO increased anxiety in our rats. We did not test for depression in our anim als, but because anxiety and depression have many similarities (APA, 1994; Stenzel Poore et al. 1994; Frazer & Morilak, 2005) especially related to HPA activity (Pellow et al. 1985; Roy Byrne et al. 1986; Stenzel Poore et al. 1994; Vreeburg et al. 2010) it is possible that our anima ls developed depression behaviors. These responses are mediated by both physical and psychological neural pathways, further suggesting that consciousness plays an important role in the response to respiratory load stimuli. It was hypothesized that the stre ss anxiety response observed after 10 days of ITTO is mediated in part by the PVN and CRH release, as well as the DR and 5 HT release. These nuclei and neurotransmitters modulate the activity of one another (Lowry et al. 2000; Hammack et al. 2002; Jorgensen, 2007; Valentino et al. 2009; Geerling et al. 2010) and 5 HT and its receptors have important implications in the psychological and behavioral responses to uncontrollable stressors (Maier, 1984; Graeff, 1994; Graeff et al. 1996; Maier & Watkins, 2005; Jorgensen, 2007; Valentino et al. 2009) including anxiety and depression behaviors arising from PAG and limbic activation (Graeff et al. 1996) We have shown alterations in 5 H T receptor gene expression in thalamic neural areas after one exposure to ITTO (Bernhardt et al. 2008) and after 10 days of ITTO (Bernhardt et al. 2010) Alterations in the serotonergic and stress pathways suggests that tracheal occlusions can cause changes in the neural modulators mediating

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117 behavioral load compensatio n, the control of respiration (Hodges et al. 2009) and respiratory neural plasticity (Feldman et al. 2003; Doi & Ramirez, 2008) Furthermore, t he PVN has reciprocal projections with the b rainstem respiratory network (Herme s et al. 2006; Geerling et al. 2010) which may modulate respiratory motor output during situations of both respiratory and non respiratory rel ated stress. Because these experiments were performed in conscious animals, we were sensations associated with large resistive loads and tracheal occlusions since these sens ations, collectively referred to as dyspnea, are highly aversive (von Leupoldt & Dahme, 2005b; O'Donnell et al. 2007; Schon et al. 2008; von Leupoldt et al. 2008) Dypsnea includes both discriminative and affective component s (von Leupoldt & Dahme, 2005b) that ar e relayed to the s omatosensory (Davenport et al. 1985; Davenport et al. 1991; Davenport et al. 1993; Davenport & Hutchison, 2002) and limbic neural networks (Aleksandrov et al. 2000; von Leupoldt & Dahme, 2005a; Schon et al. 2008) Dyspnea cannot be assessed in animals but the neural correlates that mediate dyspnea are similar, and it is plausible that respiratory obstructions in animals cause similar intense and aversive sensations, leading to an experienc e of negative affect. N egative affect if experienced repeatedly may result in psychological disorders such as anxiety or depression which are both highly prevalent in patients with COPD who also experience dyspnea (Karajgi et al. 1990; Brenes, 2003; Wagena et al. 2005) Indeed, we observed anxiety responses in our anim als after 10 days of ITTO. Furthermore, individuals modify their behavior in order to adapt, avoid or escape from experiencing the sensation of dyspnea. It was hypothesized that the prolongation of Te in response to

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118 the occlusions in the previous study was a behavioral breath holding technique used to avoid the sensations associated with breathing through a respiratory load. Intense, unavoidable respiratory stimuli like tracheal occlusions likely produce intense physical discomfort and stress due to the lif e threatening quality of ITTO, which is highly relevant to individuals who experience these types of respiratory stressors on a regular basis, such as those with COPD and ast hma This is also important because chronic experience with one type of stress can make an individual more reactive to new types of stress, which would be detrimental in patients with asthma and COPD who often have other physiological and psychological sympto ms that could be worsened by airway obstruction dependent HPA activation. Determining the neural mechanisms behind these responses in future studies is extremely important. Neural Plasticity Responses to ITTO Conditioning in Conscious Animals This project investigated the neural structures and mechanisms mediating the behavioral, stress, and anxiety responses observed in animals after 10 days of ITTO. We hypothesized that respiratory brainstem nuclei, areas involved in stress responses, and regions partici pating in discriminative and affective sensory processing would show modulation in response to repeated ITTO. Significant state changes in the medullary dorsal respiratory group, PAG, DR, discriminatory VPM and the affective AI were found, indicated by alt erations in CO staining. This was the first evidence of neural state modulation in response to respiratory load conditioning in conscious animals. In this study we used 10 s tracheal occlusions rather than the 3 6 s used in the other studies to ensure a co nsistent pattern of neural activation. It is possible that chemoreceptor afferents would have incre ased activation if the 10 s occlusions were long enough to cause a slight hypercapnic or hypoxic response. However, Farre and colleagues (Farre

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119 et al. 2007) found that a 5 s econd obstruction reduced the SpO 2 to 85 % in rats and that a 10 second obstruction only reduced the SpO 2 to 83%. These values are both greater than the 67 80% SaO 2 that would result from the oxygen partial pressures of 35 45 mmHg often used in intermittent hypoxia studies (Zabka et al. 2001; Lee & Fuller, 2010) Chemoreceptor afferents project to the nTS, which is also the primary target of cardiorespiratory afferents in the lung, airway, trachea, and blood vessels. The pattern of stimulation in the nTS from co nvergent input during ITTO was sufficient to induce plasticity after 10 days, but the relationship between mechanical and chemical stimulation mediating this plasticity are unknown. The plasticity in the nTS could indicate that the nTS changes its state fo r conditioned load compensation to subsequent airway obstruction challenges, allowing for adaptation of physiological responses to the severe respiratory challeng e posed by repeated ITTO. The results of McKay et al. (McKay et al. 2003) suggest that the brainstem respiratory network including nTS may be an important site for the voluntary control of breathing in humans. Thus, the nTS may also be an important site for the behavioral modulation of breathing in animals, and may undergo pl astic changes as a result of ITTO conditioning, potentially generating a new respiratory load compensation pattern for the animal. Similar to the results of the acute ITTO protocol in anesthetized animals, differences in neural activation between control a nd experimental groups were observed in the midbrain dorsal and ventral PAG. This indicates that the PAG plays an important role in the respiratory load compensation response in conscious animals and mediates the behavioral, stress, and anxiety responses o bserved after ITTO conditioning The PAG participate s in defensive behaviors (Bandler & Carrive, 1988; Brandao et al. 1994;

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120 Vianna et al. 2001) pain modulation (Mayer et al. 1971; Behbehani, 1995) respiratory activation (Hayward et al. 2003; Zhang et al. 2005) modulation of the load compensation response (Zhang et al. 2009) stress pathways (Farkas et al. 1998) and fear responses (Carrive, 1993; Bandler & Shipley, 1994; Brandao et al. 1994; Vianna et al. 2001; Cunha et al. 2010) Interestingly, we also found a significant increase in DR activity after ITTO conditioning. This result supports our hypothesis that the D R and 5 HT are important in mediating the stress and anxiety behaviors we observed and indicates a possible role in the adaptive response to repeated severe respiratory load stimuli. The plasticity within the DR may have implications for plasticity in oth er pathways and responses in which 5 HT has a modulatory function (Maier, 1984; Merahi et al. 1992; Lindsay & Feldman, 1993; Bianchi et al. 1995 ; Baker et al. 2001; Fuller et al. 2001; Pena & Ramirez, 2002; Bocchiaro & Feldman, 2004; Maier & Watkins, 2005; Jorgensen, 2007; Doi & Ramirez, 2008; Mizoguchi et al. 2008; Dergacheva et al. 2009; Hodges et al. 2009) After ITTO conditioning we observed non significant decreases in neural activity within the CeA and PaMP. The CeA is part of the limbic system in the brain and is essential for fear conditioning and aversive res ponses (Brandao et al. 1994; Davis et al. 1994; LeDoux, 2000; Martinez et al. 2006) Our laboratory has shown (Shahan et al. 2008) that electrical stimulation of the CeA leads to an increase in respiratory rate in anesthetized rats, possibly via output to the PAG. CeA activity decreased in response to repeated ITTO that may, in part, be due to the increase in DR activity after ITTO. The CeA has inhibitory projections to the PAG and nTS (Davis et al. 1994; Saha et al. 2010) so a potential down regulation of CeA GABAergic innervation is likely to disinhibit

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121 the PAG (Saha, 2005; Oka et al. 2008) Thus, a decrease in CeA activity could lead to activation of the PAG and nTS through disinhibition. This suggests that the animal modulates its physiolog ical responses to repeated respiratory mechanical stressors via CeA plasticity. A change in basal activity within the CeA may influence the behavioral sensitization of the inspiratory efforts during occlusions observed on the 10 th day of ITTO. The PaMP als o responds to stressful stimuli by producing CRH (Vale et al. 1981) Because we have shown that ITTO evokes stress responses, the PaMP was initially expected to increase activity in response to 1 0 days of ITTO. However, the PaMP showed a non significant decrease in steady state activity. Although circulating CORT is known to be elevated as a result of chronic stress, basal PVN activity is blunted as a result of conditioning (Girotti et al. 2006; Arnhold et al. 2007) The CeA and PaMP downregulation support our hypothesis that these nuclei mediate fear potentiated behavioral sensitization of inspiratory effort, breath holding, stress, and anxiety responses to ITTO. The discriminative pathway includes a relay through the thalamus to the somatosensory cortex, and the affective pathway involves structures such as the amygdala, Cg1 and AI (von Leupoldt & Dahme, 2005b, a; Schon et al. 2008; von Leupoldt et al. 2008; Davenport & Vovk, 2009) T hese pathways are involved in respiratory sensations (von Leupoldt & Dahme, 2005b, a; Schon et al. 2008; von Le upoldt et al. 2008; Davenport & Vovk, 2009) and have shown plasticity in response to 10 days of ITTO. Specifically, significant increases were found in steady state activity in the VPM thalamus and AI It is possible that tracheal afferents stim ulated during occlusion project to the VPM via polysnaptic pathways (Ambalavanar et al. 1999) In

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122 addition, (Cechetto & Saper, 1987) found that the VPM projects visceral sensory information to the insular cortex, some of which includes cardiopulmonary afferent information. The AI has an excitatory projection to the PAG (Behbehani et al. 1993) responds to respiration, arterial chemoreceptors, and cardiovascular baroreceptors (Cechetto & Saper, 1987) and is active during voluntary breath holding maneuvers (McKay et al. 2008) a behavior our animals appeared to use in response to ITTO. The AI is known to play a vital role in the neural processing of dyspnea (von Leupoldt & Dahme, 2005a; von Leupoldt et al. 2008; Davenport & Vovk, 2009) and we have previously established that loaded breathing produces dyspnea (Schon et al. 2008) Thus, affective neural processing likely takes place in the AI during ITTO and results in significant modulation of the behavioral load compensation responses to repeated ITTO. This modulatory function might arise from plasticity within the region, suggested by the increase in steady state activity after ITTO conditioning Conclu sion Collectively, the results of these studies show that tracheal occlusions elicit neural and behavioral load compensation responses in conscious animals, supporting the link between intense respiratory stimuli, stress, and affective disorders. This has important implications for individuals with respiratory obstructive diseases such as COPD, asthma, and obstructive sleep apnea, who experience repeated life threatening, intermittent, unpredictable increases in airway mechanical load. The increase in airwa y load leads to sensory activation and load compensation behaviors. Sensory activation in response to the airway obstructions can result in intense physical discomfort, or dyspnea (von Leupoldt & Dahme, 2005a; O'Donnell et al. 2007) and compensation behaviors often include leading a sedentary lifestyle (ZuWallack, 2007; Bourbeau,

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123 2009) I t is well established that emotions and respiration are tightly linked (Ley, 1999) and individuals with respiratory obstructive diseases are frequently diagnosed with affective disorders such as anxiety and depression. Furthermore, sedentary behavior can be a symptom of depression (Roshanaei Moghaddam et al. 2009) The severe chronic stress experienced by these individuals could potentially make them more reactive to new types of stress (Fernandes et al. 2002) which is particularly problematic since patients with asthma and COPD often have physiological and psychological symptoms that may be worsened by airway obstruction dependent HPA activation. In addition, uncontrollable stressors have been shown to sensitize serotonergic neurons in the DR, which respond to future stressors with exaggerated 5 HT release that may cause behavioral changes such as learned helplessness (Maier & Watkins, 2005) We observed an increase in steady state activ ity in the DR so it is likely that this pathway was activated by repeated ITTO. Additionally, the activities of sensory brain regions were modified by 10 days of ITTO, similar to repeated obstructions to breathing during sleep that resulted in impaired det ection of R loads in conscious humans (McNicholas et al. 1984) The r esults of McNicholas et al. suggest that neural structures involved in the respiratory sensory processing in OSA patients may have been altered. In concl usion, characterizing the acute and chronic respiratory load compensation response s in conscious animals, determining how th ese response s are altered after repeated experience, and elucidating the neural structures involved in generating these responses is essential to our understanding of respiratory obstructive diseases and rehabilitation.

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124 Figure 6 1. Representation of central nervous system nuclei and pathways involved in respiratory control.

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144 BIOGRAPHICAL SKETCH Kathryn Mackenzie Pate was born in Sebastian, Florida in 1985. She grew up with her parents, Stephen and Constance, and older brothers, Robert, Matthew, and Michael. She graduated from the University of Florida with a Bachelor of Science in Zoology in May of Veterinary Medicine in August 2006. Kate spent four years under the guidance of Dr. Paul Davenport in the Department of Physiological Sciences, and completed her Ph.D. in August, 201 0. Upon receiving her Ph.D., she began her post doctoral training at National Jewish Health respiratory hospital in Denver, Colorado to investigate the role of r e dox imbalance in disease. Her new mentor is Dr. James Crapo.