Joel C. Geerling

Central regulation of sodium appetite

Sodium appetite, the behavioural drive to ingest salt, is stimulated by prolonged physiological sodium deficiency in many animal species. The same neural mechanisms that are responsible for sodium appetite in laboratory animals may influence human behaviour as well, with particular relevance to the dietary salt intake of patients with diseases such as heart failure, renal failure, liver failure and salt‐sensitive hypertension. Since the original experimental work of Curt Richter in the 1930s, much has been learned about the regulation of salt‐ingestive behaviour. Here, we review data from physiology, pharmacology, neuroanatomy and neurobehavioural investigations into the stimulatory and inhibitory signals that regulate sodium appetite. A rudimentary framework is proposed for the brain circuits that integrate peripheral information representing the need for sodium with neural signals for the gustatory detection of salt in order to drive a motivated ingestive response. Based on this model, areas of remaining uncertainty are highlighted where future information would allow a more detailed understanding of the neural circuitry responsible for sodium appetite.

Paraventricular hypothalamic nucleus: axonal projections to the brainstem

The paraventricular hypothalamic nucleus (PVH) contains many neurons that innervate the brainstem, but information regarding their target sites remains incomplete. Here we labeled neurons in the rat PVH with an anterograde axonal tracer, Phaseolus vulgaris leucoagglutinin (PHAL), and studied their descending projections in reference to specific neuronal subpopulations throughout the brainstem. While many of their target sites were identified previously, numerous new observations were made. Major findings include: 1) In the midbrain, the PVH projects lightly to the ventral tegmental area, Edinger‐Westphal nucleus, ventrolateral periaqueductal gray matter, reticular formation, pedunculopontine tegmental nucleus, and dorsal raphe nucleus. 2) In the dorsal pons, the PVH projects heavily to the pre‐locus coeruleus, yet very little to the catecholamine neurons in the locus coeruleus, and selectively targets the viscerosensory subregions of the parabrachial nucleus. 3) In the ventral medulla, the superior salivatory nucleus, retrotrapezoid nucleus, compact and external formations of the nucleus ambiguus, A1 and caudal C1 catecholamine neurons, and caudal pressor area receive dense axonal projections, generally exceeding the PVH projection to the rostral C1 region. 4) The medial nucleus of the solitary tract (including A2 noradrenergic and aldosterone‐sensitive neurons) receives the most extensive projections of the PVH, substantially more than the dorsal vagal nucleus or area postrema. Our findings suggest that the PVH may modulate a range of homeostatic functions, including cerebral and ocular blood flow, corneal and nasal hydration, ingestive behavior, sodium intake, and glucose metabolism, as well as cardiovascular, gastrointestinal, and respiratory activities. J. Comp. Neurol. 518:1460–1499, 2010.

Aldosterone target neurons in the nucleus tractus solitarius drive sodium appetite.

Sodium appetite can be enhanced by the adrenal steroid aldosterone via an unknown brain mechanism. A novel group of neurons in the nucleus tractus solitarius expresses the enzyme 11-β-hydroxysteroid dehydrogenase type 2, which makes them selectively responsive to aldosterone. Their activation parallels sodium appetite in different paradigms of salt loss even in the absence of aldosterone. These unique aldosterone target neurons may represent a previously unrecognized central convergence point at which hormonal and neural signals can be integrated to drive sodium appetite.

Aldosterone in the brain

Pharmacological and physiological phenomena suggest that cells somewhere inside the central nervous system are responsive to aldosterone. Here, we present the fundamental physiological limitations for aldosterone action in the brain, including its limited blood-brain barrier penetration and its substantial competition from glucocorticoids. Recently, a small group of neurons with unusual sensitivity to circulating aldosterone were identified in the nucleus of the solitary tract. We review the discovery and characterization of these neurons, which express the enzyme 11beta-hydroxysteroid dehydrogenase type 2, and consider alternative proposals regarding sites and mechanisms for mineralocorticoid action within the brain.

Aldosterone-sensitive neurons in the rat central nervous system

The purpose of this study was to identify brain sites that may be sensitive to the adrenal steroid aldosterone. After a survey of the entire brain for mineralocorticoid receptor (MR) immunoreactivity, we discovered unique clusters of dense nuclear and perinuclear MR in a restricted distribution within the nucleus of the solitary tract (NTS). These same cells were found to contain the glucocorticoid‐inactivating enzyme 11‐β‐hydroxysteroid dehydrogenase type 2 (HSD2), a signature of aldosterone‐sensitive tissues. Immunoreactivity for various other NTS marker molecules failed to colocalize with HSD2 in these putative aldosterone target neurons, so they may represent a unique neuronal phenotype. Finally, the entire rat CNS was examined for evidence of HSD2 protein expression. Outside the NTS, HSD2‐immunoreactive neurons were found in only two other sites: the ventrolateral division of the ventromedial hypothalamic nucleus and a few scattered neurons in the medial vestibular nucleus, just rostral to the NTS. HSD2 immunoreactivity was also found in the ependymal cells that form the subcommissural organ. In summary, few brain sites contain neurons that may be aldosterone sensitive, and only one of these sites, the NTS, contains neurons that express HSD2 and contain dense nuclear MR. The HSD2 neurons in the NTS may represent an important target for aldosterone action in the brain. J. Comp. Neurol. 494:515–527, 2006.

Inputs to the ventrolateral bed nucleus of the stria terminalis

The ventrolateral bed nucleus of the stria terminalis (BSTvl) receives direct input from two specific subpopulations of neurons in the nucleus tractus solitarius (NTS). It is heavily innervated by aldosterone‐sensitive NTS neurons, which are selectively activated by sodium depletion, and by the A2 noradrenergic neurons, which are activated by visceral and immune‐ and stress‐related stimuli. Here, we used a retrograde neuronal tracer to identify other brain sites that innervate the BSTvl. Five general brain regions contained retrogradely labeled neurons: cerebral cortex (infralimbic and insular regions), rostral forebrain structures (subfornical organ, organum vasculosum of the lamina terminalis, taenia tecta, nucleus accumbens, lateral septum, endopiriform nucleus, dorsal BST, substantia innominata, and, most prominently the amygdala—primarily its basomedial and central subnuclei), thalamus (central medial, intermediodorsal, reuniens, and, most prominently the paraventricular thalamic nucleus), hypothalamus (medial preoptic area, perifornical, arcuate, dorsomedial, parasubthalamic, and posterior hypothalamic nuclei), and brainstem (periaqueductal gray matter, dorsal and central superior raphe nuclei, parabrachial nucleus, pre‐locus coeruleus region, NTS, and A1 noradrenergic neurons in the caudal ventrolateral medulla). In the arcuate hypothalamic nucleus, some retrogradely labeled neurons contained either agouti‐related peptide or cocaine/amphetamine‐regulated transcript. Of the numerous retrogradely labeled neurons in the perifornical hypothalamic area, few contained melanin‐concentrating hormone or orexin. In the brainstem, many retrogradely labeled neurons were either serotoninergic or catecholaminergic. In summary, the BSTvl receives inputs from a variety of brain sites implicated in hunger, salt and water intake, stress, arousal, and reward. J. Comp. Neurol. 511:628–657, 2008.

Orexin neurons project to diverse sympathetic outflow systems

The viral transneuronal labeling method was used to demonstrate that orexin-containing neurons of the lateral hypothalamic area (LHA) are linked via multisynaptic connections to different sympathetic outflow systems. Two different types of transneuronal tracing experiments were performed: single- and double-virus studies. In the first series of experiments, Bartha pseudorabies virus (PRV), a retrograde transneuronal tracer, was injected into single sympathetic targets, viz., stellate ganglion, adrenal gland, celiac ganglion, and kidney. Six to 7 days post-injection, orexin (hypocretin) neurons were transneuronally labeled. In a second set of experiments, the double-virus tracing method was used to determine whether single orexin LHA neurons are linked to two different sympathetic outflow systems. Two isogenic forms of Bartha PRV were used that differed by a single gene. beta-Galactosidase Bartha PRV was injected into the stellate ganglion and green fluorescent protein Bartha PRV into the adrenal gland of the same rat. The reverse placement of viral injections was made in another set of rats. In both paradigms, some orexin LHA neurons were transneuronally labeled with both viruses, indicating that they are capable of modulating multiple sympathetic outflow systems. These findings raise the possibility that orexin LHA neurons regulate general sympathetic functions, such as those that occur during arousal or the fight-or-flight response.

Aldosterone‐sensitive neurons in the nucleus of the solitary tract: Efferent projections

The nucleus of the solitary tract (NTS) contains a subpopulation of neurons that express the enzyme 11‐β‐hydroxysteroid dehydrogenase type 2 (HSD2), which makes them uniquely sensitive to aldosterone. These neurons may drive sodium appetite, which is enhanced by aldosterone. Anterograde and retrograde neural tracing techniques were used to reveal the efferent projections of the HSD2 neurons in the rat. First, the anterograde tracer Phaseolus vulgaris leucoagglutinin was used to label axonal projections from the medial NTS. Then, NTS‐innervated brain regions were injected with a retrograde tracer, cholera toxin beta subunit, to determine which sites are innervated by the HSD2 neurons. The HSD2 neurons project mainly to the ventrolateral bed nucleus of the stria terminalis (BSTvl), the pre‐locus coeruleus (pre‐LC), and the inner division of the external lateral parabrachial nucleus (PBel). They also send minor axonal projections to the midbrain ventral tegmental area, lateral and paraventricular hypothalamic nuclei, central nucleus of the amygdala, and periaqueductal gray matter. The HSD2 neurons do not innervate the ventrolateral medulla, a key brainstem autonomic site. Additionally, our tracing experiments confirmed that the BSTvl receives direct axonal projections from the neighboring A2 noradrenergic neurons in the NTS, and from the same pontine sites that receive major inputs from the HSD2 neurons (PBel and pre‐LC). The efferent projections of the HSD2 neurons may provide new insights into the brain circuitry responsible for sodium appetite. J. Comp. Neurol. 497:223–250, 2006.

Aldosterone-sensitive neurons in the nucleus of the solitary tract: bidirectional connections with the central nucleus of the amygdala.

The HSD2 (11‐β‐hydroxysteroid dehydrogenase type 2‐expressing) neurons in the nucleus of the solitary tract (NTS) of the rat are aldosterone‐sensitive and have been implicated in sodium appetite. The central nucleus of the amygdala (CeA) has been shown to modulate salt intake in response to aldosterone, so we investigated the connections between these two sites. A prior retrograde tracing study revealed only a minor projection from the HSD2 neurons directly to the CeA, but these experiments suggested that a more substantial projection may be relayed through the parabrachial nucleus. Small injections of cholera toxin beta subunit (CTb) into the external lateral parabrachial subnucleus (PBel) produced both retrograde cell body labeling in the HSD2 neurons and anterograde axonal labeling in the lateral subdivision of the CeA. Also, injections of either CTb or Phaseolus vulgaris leucoagglutinin into the medial subdivision of the CeA labeled a descending projection from the amygdala to the medial NTS. Axons from the medial CeA formed numerous varicosities and terminals enveloping the HSD2 neurons. Complementary CTb injections, centered in the HSD2 subregion of the NTS, retrogradely labeled neurons in the medial CeA. These bidirectional projections could form a functional circuit between the HSD2 neurons and the CeA. The HSD2 neurons may represent one of the functional inputs to the lateral CeA, and their activity may be modulated by a return projection from the medial CeA. This circuit could provide a neuroanatomical basis for the modulation of salt intake by the CeA. J. Comp. Neurol. 497:646–657, 2006.

Can Dietary Sodium Intake Be Modified by Public Policy

Sodium chloride holds a unique position in the annals of human existence and science (1). For thousands of years, salts high value has made it the foundation of a society, a currency of trade, and cause for wars. Over the past century, sodium chloride has been the subject of intense scientific research to understand its role in human physiology and its impact on health. The latter has focused primarily on salts role in BP regulation, an issue fraught with controversy, as documented a decade ago (2) and still evident in the scientific literature (3,4). Since the first Surgeon Generals Report Healthy People: Promotion and Disease Prevention published in 1979 (5), public health guidelines have recommended that adults consume less salt. This culminated in 2003 with the Institute of Medicine (IOM) Electrolyte DRI Committee targeting 2300 mg/d as the safe upper level of sodium in the diet (6). The 2005 Dietary Guidelines recommended this same level for healthy adults and 1500 mg/d for individuals at risk of hypertension (7). As increasingly more restrictive guidelines have been introduced over the past 30 yr, scientific research has continued to provide new insights regarding the effectiveness and safety of lowering sodium intake. Some, but certainly not all, of the newer data have supported the sodium guidelines (8,9), although the feasibility of their implementation remains in question. It has been assumed that if adults better understood how to reduce sodium in their diets and if more low-sodium foods were available, more individuals would be able to achieve these levels. Public health experts throughout the world have devised strategies targeting greater compliance with the lower sodium recommendations. In the United States (US), a special IOM committee has recently been charged to formulate such strategies (10). Great Britain initiated an intense …