Bilateral electrical pudendal nerve stimulation (bPNS) anecdotally reduces pain in humans with pain due to interstitial cystitis (IC) and we have reported that it reduces bladder hypersensitivity in rat models. Concomitant medication use can alter responses to neuromodulation and so prior to the development of a clinical trial, the interaction between opioid medication use and acute bPNS was examined. Bladder hypersensitivity was produced by neonatal bladder inflammation in rats pups coupled with a second inflammatory insult as an adult. Morphine was administered acutely (1 or 2 mg/kg s.c.) or chronically (5 mg/kg s.c. daily for 2 weeks prior to the final experiment). Acute bPNS consisted of bilateral biphasic electrical stimulation (10 Hz, 100 msec biphasic pulses for 10 min) of the mixed motor/sensory component of the pudendal nerves using embedded hook electrodes. Visceromotor responses (VMRs; abdominal muscle contractile responses to urinary bladder distension, UBD) were used a nociceptive endpoints. Morphine produced a dose-dependent inhibition of VMRs to UBD that was naloxone-reversible. bPNS resulted in statistically significant inhibition of VMRs to UBD in hypersensitive rats that had received acute or chronic s.c. morphine injections. Rats which received chronic doses of morphine were tolerant to acute effects of morphine. Morphine preadministration did not appear to alter strength-duration effects of acute bPNS. This study suggests that inhibitory effects of bPNS can be evoked in subjects who are receiving opioid therapy, thus giving guidance to potential clinical trials for treating episodic pain in IC. This research performed as contract work for Medtronics, Inc.

Clinical reports suggest painful bladder disorders (PBD; e.g. interstitial cystitis) may benefit from neuromodulation of the pudendal nerve (PN). However, a systematic evaluation of this has not been carried out. Here we investigated the effect of PN stimulation on visceromotor reflex (VMR) responses to urinary bladder distension (UBD) in rat models of bladder hypersensitivity1-3 due to 1) early-in-life bladder inflammation, 2) acute bladder inflammation, or 3) footshock-induced stress. Electrodes were placed under the PN bilaterally to deliver biphasic pulses (100 μs) at 3x motor threshold. PN stimulation for 10 min significantly attenuated the VMR to UBD (n=10, P<0.05) in rats which had received intravesical zymosan treatments early-in-life at all three frequencies tested (10 Hz, 50 Hz, 100 Hz). Inhibition was also observed using 10 Hz PN stimulation in rats receiving acute intravesical zymosan treatment as adults (n=8, p<0.05). Overall ANOVA revealed no significant effects of PN stimulation in the chronic stress or control groups. The presence of inhibitory effects of PN stimulation within the early-in-life inflammation group and smaller-but-significant effects in the acute bladder inflammation group suggest potential utility of PN stimulation in the treatment of PBD with inflammatory mechanisms. These findings suggest PN stimulation may be less efficacious for PBD when caused by psychological stress mechanisms. Clinical follow will better direct our understanding of this potentially useful therapy. (1. DeBerry J et al. J Pain, 11: 247-255, 2010. 2. DeBerry J et al. J Pain, 8: 914-923, 2007. 3. Robbins MT and Ness TJ. J. Pain 9: 991-998, 2008.) Supported by a grant from Medtronic, Inc.

Purpose: This investigation examined the effect of inflammation produced by intravesical zymosan during the neonatal period on spinal dorsal horn neuronal responses to urinary bladder distension (UBD) as adults. Methods: Female rat pups (P14-P16) were treated with intravesical zymosan or with anesthesia-only. These groups of rats were subdivided forming four groups: half received intravesical zymosan as adults and half received anesthesia-only. One day later, rats were anesthetized, the spinal cord was transected at a cervical level and extracellular single-unit recordings of L6-S1 dorsal horn neurons were obtained. Neurons were classified as Type I-inhibited by heterotopic noxious conditioning stimuli (HNCS) or as Type II - not inhibited by HNCS - and were characterized for Spontaneous Activity and responses to graded UBD (20-60 mm Hg). Results: 227 spinal dorsal horn neurons excited by UBD were characterized. In rats treated as neonates with anesthesia-only. Type II neurons demonstrated increased spontaneous and UBD-evoked activity following adult intravesical zymosan treatment whereas Type I neurons demonstrated decreased spontaneous and UBD-evoked activity relative to controls. In rats treated as neonates with intravesical zymosan, the spontaneous and UBD-evoked activity of both Type I and Type II neurons increased following adult intravesical zymosan treatment relative to controls. Conclusions: Neonatal bladder inflammation alters subsequent effects of acute bladder inflammation on spinal dorsal horn neurons excited by UBD such that overall there is greater sensory neuron activation. This may explain the visceral hypersensitivity noted in this model system and suggest that impaired inhibitory systems may be responsible. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

The present investigation examined the effect of inflammation produced by intravesical zymosan on spinal dorsal horn neuronal responses to urinary bladder distension (UBD). Extracellular single-unit recordings of neurons excited by UBD were obtained in spinalized female Sprague–Dawley rats. Neurons were classified as Type I—inhibited by heterotopic noxious conditioning stimuli (HNCS) or as Type II—not inhibited by a HNCS. In Experiment 1—following neuronal characterization, 1% zymosan was infused into the bladder and after 2h spinal units were recharacterized. Control rats received intravesical saline or subcutaneous zymosan. In Experiment 2—rats were pretreated with intravesical zymosan 24h prior to surgical preparation. Control rats received anesthesia only. 137 spinal dorsal horn neurons excited by UBD were characterized. In comparison with controls, Type II neurons demonstrated increased spontaneous and UBD-evoked activity following intravesical zymosan treatment (both Experiments 1 and 2) whereas Type I neurons demonstrated either no change (Experiment 1) or decreased activity (Experiment 2) following bladder inflammation. No significant changes were noted in neuronal activity in control experiments. Inflammation differentially affects subpopulations of spinal dorsal horn neurons excited by UBD that can be differentiated according to the effect of HNCS. This results in an altered pattern of spinal sensory transmission that may serve as the mechanism for the generation of visceral nociception.

Bladder inflammation resulting from intravesical administration of zymosan significantly enhances the visceromotor reflex (VMR) evoked by urinary bladder distension (UBD). The present study examined whether intrathecal (i.t.) administration of receptor antagonists to either noreprinephrine (NE) or serotonin (5-HT) altered this enhancement effect. I.t. administration of the non-specific 5-HT receptor antagonist methysergide (30 μg), the 5-HT3 receptor antagonist ondansetron, or the 5-HT1A receptor antagonist WAY 100635 eliminated the enhancement effect produced by intravesical zymosan and also tended to reduce electromyographic (EMG) responses to UBD in non-inflamed rats. I.t. administration of either the non-specific NE receptor antagonist phentolamine (30 μg) or the α1 antagonist WB 4101 also eliminated the enhancement effect, whereas i.t. administration of the α2 antagonist yohimbine failed to significantly affect the enhancement effect. The effects of phentolamine and methysergide were not mediated by changes in bladder compliance. This is the first study to demonstrate that bladder hypersensitivity resulting from bladder inflammation is partly mediated by 5-HT and NE facilitatory effects. Based on these and previous findings we conclude that the net nociceptive response to bladder distension under conditions of bladder inflammation represents a complex interaction of facilitatory influences of spinal 5-HT and NE, and inhibitory influences of spinal opioids.

Two experiments investigated mechanisms underlying the decrease in food intake produced by lipid infusions into the jejunum. In Experiment 1, male Sprague–Dawley rats with truncal abdominal vagotomy (TVx), selective hepatic-branch vagotomy (HVx), or sham vagotomy received repeated 7 h infusions of linoleic acid (LA), corn oil (CO), or saline through indwelling jejunal catheters. Cumulative food intake was measured at 1, 3, 6, and 23 h. LA and, to a lesser extent, CO suppressed food intake in excess of the caloric value of the load. This effect was eliminated by TVx, which significantly attenuated the suppression of intake produced by both lipids at 3 and 6 h and also at 23 h when LA was infused. HVx attenuated suppression at 23 h on tests with LA and at 3 and 6 h on CO tests. Experiment 2 showed that jejunal infusion of LA had no effect on multi-unit activity of afferent fibers in the left splanchnic nerve in anesthetized rats. Thus, these results provide further evidence that satiating effects of intestinal lipid infusions are mediated by the vagal fibers, some of which lie within the hepatic branch. However, because significant suppression of food intake remained after TVx, and because of the negative results of Experiment 2, these lipid infusions engage as yet unidentified mechanisms independent of the vagus.

The present experiment examined whether neurons located in the paraventricular nucleus of the hypothalamus (PVN) respond to intestinal infusions of long-chain fatty acids. Single-unit recordings were made of neurons located in and adjacent to the PVN during jejunal administration of linoleic acid. Jejunal administration of linoleic acid increased single-unit activity of neurons located in the PVN but did not affect activity of neurons located in adjacent tissue outside the PVN. The largest increases in neuronal activity were observed in the anterior PVN (0.9-1.3 mm posterior to bregma) compared with the posterior PVN (1.8-2.1 mm posterior to bregma). Jejunal administration of saline failed to affect activity of neurons located either inside or outside the PVN. When the same neurons were subsequently tested for their response to intravenous administration of 2 microg/kg of CCK-8, excitatory responses were more frequently observed than inhibitory responses, but both types of responses were observed regardless of whether neurons were located inside or outside the PVN. In addition, there was no strong correlation between the magnitude of the neuronal response evoked by jejunal administration of linoleic acid compared with intravenous CCK-8. These data suggest that neurons located in the anterior PVN may play a role in the mediation of suppression of food intake produced by intestinal administration of lipids.

We have found that jejunal infusions of long-chain fatty acids, linoleic acid (LA) and oleic acid (OA), and gastric infusions of a fatty acid ethyl ester, ethyl oleate (EO), produce long-lasting suppression of total caloric intake. This effect is not seen in response to jejunal infusions of medium-chain fatty acids or medium- or long-chain triglycerides. Multiunit recordings have shown that intestinal infusions of LA or OA strongly activate celiac vagal afferents. Truncal vagotomy (TVX) and selective celiac-branch vagotomy (CVX) are equally effective in attenuating, but not eliminating, suppression of food intake by LA and EO. These outcomes suggest that intraintestinal fatty acids reduce intake by activation of vagal mechanisms, critically involving afferent fibers within the celiac branches, as well as unidentified nonvagal mechanisms. The role of cholecystokinin (CCK) in mediating the activation of celiac vagal afferents is suggested by studies showing that (1) inhibition of food intake by CCK-8 administration is attenuated after CVX but robust after celiac-spared vagotomy (CSV), (2) multiunit activity of celiac vagal afferents is increased by CCK-8 administration, and (3) activation of celiac fibers by intestinal LA infusion is severely attenuated by the CCK(A) antagonist lorglumide.

We investigated suppression of food intake by intraperitoneal (IP) injections of peptide YY3-36 (PYY3-36) (24, 60, or 150μg/kg) in rats with ablations of the area postrema (APX) and in controls with sham ablations. In controls, PYY3-36-induced suppression was modest and short-lived, averaging 20% at most and persisting less than 6h. The highest dose tested (150μg/kg) was even less effective than were the two lesser doses after 3h. APX did not diminish the potency of these effects of PYY3-36. In fact, the magnitude of suppression produced by the greatest dose of PYY3-36 in APX rats was significantly greater than in controls and PYY3-36-induced suppression was still present at 24h.

Intrathecal administration of prostaglandin E(2) (PGE(2)) produces mechanical hyperalgesia, thermal hyperalgesia, and touch-evoked allodynia in rats. Experiments were conducted to examine the effects of intrathecal administration of relatively selective PGE(2) receptor (EP receptor) agonists to establish which spinal EP receptors mediate these behavioral effects of spinally administered PGE(2). Administration of either sulprostone (EP(3) receptor agonist) or PGE(1) alcohol (EP(4) receptor agonist) produced marked mechanical and thermal hyperalgesia and touch-evoked allodynia. Neither 17-phenyl trinor PGE(2) (EP(1) receptor agonist) nor butaprost (EP(2) receptor agonist) produced any significant changes in behavioral response thresholds to mechanical or thermal stimuli. However, 17-phenyl trinor PGE(2) (EP(1) receptor agonist) did produce marked touch-evoked allodynia. These data suggest that in rats activation of spinal EP(3) and EP(4) receptors by PGE(2) is important for development of both mechanical and thermal hyperalgesia as well as for touch-evoked allodynia. PGE(2)-induced allodynia also appears to involve activation of spinal EP(1) receptors.

The effects of intrathecal (i.t.) administration of prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α) on behavioral and spinal neuronal responses to mechanical and thermal stimuli were examined in rats. i.t. Administration of either PGE2 (1–100nmol) or PGF2α (1–100nmol) produced a robust, dose-dependent mechanical hyperalgesia, but only a weak thermal hyperalgesia and touch-evoked allodynia. Spinal administration of either PGE2 (100pmol–100nmol) or PGF2α (1–100nmol) produced dose-dependent increases in responses of nociceptive specific (NS) neurons to mechanical stimuli, but only modest increases in wide dynamic range (WDR) neurons to mechanical stimuli. Spinal administration of PGE2 produced a bi-directional, dose–response effect on thermally-evoked responses of both WDR and NS neurons when prostaglandin-induced changes in background discharges were controlled for. Thermally evoked responses of WDR and NS neurons were decreased at lesser doses of PGE2, but this trend reversed with greater doses, such that responses of WDR neurons were significantly increased at the greatest dose tested at some test temperatures. PGF2α generally produced non-significant increases in thermally evoked neuronal responses, and this trend occurred primarily in WDR neurons. Both PGE2 and PGF2α produced increases in background discharges of WDR and NS neurons, although this effect was most consistently observed with WDR neurons and PGE2. These behavioral and electrophysiological data suggest that mechanical hyperalgesia induced by spinal administration of PGE2 and PGF2α is mediated mainly by changes in NS neurons. The weak thermal hyperalgesia may reflect changes in WDR neurons.

Recent research has focused on prostaglandins in the central nervous system and their contribution to hyperalgesia and allodynia. This study sought to establish whether neurokinin-1 (NK-1) receptors and glutamate receptors are involved in the hyperalgesic and allodynic effects of spinally administered prostaglandin E2 (PGE2) in rats, and also to determine if the same receptors are involved the hyperalgesia induced by intraplantar administration of zymosan, an inflammatory agent which is known to evoke spinal PGE2 release. Spinal application of antagonists of the NK-1 receptor, the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)/kainate glutamate or metabotropic glutamate receptor significantly attenuated the decrease in mechanical paw withdrawal response thresholds produced by either spinal administration of PGE2 or intraplantar administration of zymosan. The decrease in thermal paw withdrawal response latencies induced by PGE2, but not by zymosan, was significantly attenuated by spinal administration of an N-methyl-d-aspartate (NMDA) receptor antagonist, an AMPA/kainate receptor antagonist, or a metabotropic glutamate receptor antagonist. Allodynia induced by PGE2 was significantly alleviated by antagonists of NMDA or AMPA/kainate receptors. These results suggest that both PGE2-induced and zymosan-induced mechanical hyperalgesia are mediated in part through activation of NK-1, AMPA/kainate and metabotropic glutamate receptors. PGE2-induced, but not zymosan-induced, thermal hyperalgesia is mediated in part by activation of NMDA, AMPA/kainate and metabotropic glutamate receptors. Activation of both NMDA and AMPA/kainate receptors contribute to PGE2-induced allodynia.

Responses of either hepatic or celiac vagal afferents to intraportal hepatic vein administration of 2-mercaptoacetate (MA) were examined in rats maintained on either a high-fat or low-fat diet. Afferent activity in both hepatic and celiac vagal afferents significantly increased after administration of MA, but the magnitude of these increases did not differ as a function of either diet. Responses of hepatic vagal afferents were highly variable across individual rats, whereas those of celiac vagal afferents were remarkably consistent across individual rats. These data suggest that MA-induced enhanced feeding in rats given a fat-enriched diet does not depend on a stronger hepatic and/or celiac vagal afferent response than that of rats given a low-fat diet.

Jejunal infusions of linoleic acid, corn oil, or caprylic acid significantly increased hepatic vagal afferent activity, whereas saline infusions were ineffective. The magnitude of response was greatest with either linoleic acid or corn oil. Hepatic portal infusions of linoleic acid, Liposyn II, or caprylic acid significantly increased hepatic vagal afferent activity, whereas 5% albumin/phosphate buffer vehicle was ineffective. The magnitude of response was greatest with either linoleic acid or Liposyn II. These data show that either jejunal or portal infusions of lipids increase activity of hepatic vagal afferents and could potentially serve as a complementary and/or alternative substrate to celiac vagal afferents in mediating the effects of jejunal infusions of lipids in suppressing food intake.

We investigated the role of the celiac branch of the vagus nerve in suppression of food intake produced by jejunal fatty acids infusions. Following selective celiac vagotomy or sham surgery, adult, male Sprague–Dawley rats received 7 h infusions of linoleic acid or saline through indwelling jejunal catheters on four consecutive days. Although linoleic acid still produced significant suppression of intake in rats with celiac vagotomy, it was less effective in these animals than in controls. The temporal pattern of results suggested that celiac afferent fibers are involved in mediating both pre- and postabsorptive effects of infused fatty acids.

These experiments examined the effects of spinal administration of the N-methyl-D-aspartate (NMDA) receptor antagonist DL-2-amino-5-phosphonovaleric acid (APV), the non-NMDA receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX), or the metabotropic glutamate receptor antagonist DL-2-amino-3-phosphonoproprionic acid (AP3) on responses of spinal dorsal horn neurons evoked by thermal and mechanical stimuli applied to the rat hindpaw in either an inflamed or noninflamed state. Administration of APV, DNQX, or AP3 decreased heat-evoked neuronal discharges of wide dynamic range (WDR) neurons that were previously augmented by zymosan-induced inflammation. APV and DNQX also decreased heat-evoked discharges of WDR neurons that were previously unaffected by saline injection. Administration of either APV or DNQX, but not AP3, decreased heat-evoked neuronal discharges of nociceptive-specific (NS) neurons in both zymosan- and saline-injected rats. These data suggest that NMDA and non-NMDA receptors contribute to spinal processing of thermal stimuli in both the inflamed and noninflamed state, whereas metabotropic glutamate receptors might serve a role that is unique to WDR neurons in the inflamed state. Only DNQX consistently increased mechanical response thresholds and decreased slopes of the mechanical stimulus response functions (SRFs) of NS and WDR neurons, but this effect was observed in both inflamed and noninflamed states. These data suggest that spinal processing of mechanical stimuli is preferentially mediated by glutamate acting at non-NMDA receptors in either the inflamed or noninflamed state.

Three experiments investigated effects of jejunal lipid infusions given on 4 or 21 consecutive days in adult, male Sprague-Dawley rats. In experiment 1, 7-h infusions of linoleic or oleic acid (0.2 ml/h for 7 h; total load = 11.5 kcal) on 4 consecutive days reduced total intake (ad libitum consumption of the liquid diet Boost, Mead Johnson, plus load) by approximately 15% and decreased weight gain compared with 4-day tests with saline administration. In experiment 2, linoleic acid at 0.1 ml/h for 7 h (5.7 kcal) was ineffective, whereas the same load delivered in 3.5 h produced effects similar in magnitude to those in the first experiment. In experiment 3, jejunal infusions of linoleic acid (0.2 ml/h for 7 h) on 21 consecutive days reduced mean total intake by 16%, body weight by 10%, and carcass fat by 48% compared with controls receiving saline. The net decrease in caloric intake may reflect the combined activation of pre- and postabsorptive mechanisms, and it suggests a possible treatment for obesity.

Multiunit celiac and single-unit cervical recordings of vagal afferents were performed before and during infusions of fatty acids, triglycerides, or saline into either the ileum or jejunum of the rat. In multiunit recordings, lipids increased activity of vagal afferents to a greater extent than saline. The greatest increases in vagal afferent activity resulted from infusions of linoleic acid, conjugated linoleic acid, or oleic acid. The triglycerides, corn oil or Intralipid, were less effective than the fatty acids in affecting vagal afferent activity. Ileal pretreatment with the hydrophobic surfactant Pluronic L-81 significantly attenuated the response of celiac vagal afferents to ileal infusion of linoleic acid. Single-unit recordings of cervical vagal afferents supported the multiunit data in showing lipid-induced increased vagal afferent activity in approximately 50% of ileal units sampled and 100% of a limited number of jejunal units sampled. These data demonstrate that free fatty acids can activate ileal and jejunal vagal afferents in the rat, and this effect can be attenuated by pretreatment with a chylomicron inhibitor. These data are consistent with the view that lipid-induced activation of vagal afferents could be a potential substrate for the inhibitory effects of intestinal lipids on gastrointestinal function, food intake, and body weight gain.