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The Enteric Nervous System: New Developments and Emerging Concepts

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The Enteric Nervous System: New Developments and Emerging Concepts Review Article The enteric nervous system: New developments and emerging concepts Rosa Serio, Maria Garzia Zizzo, Mariangela Mastropaolo Abstract The enteric nervous system (ENS) is an integrative The ENS controls gut motility and secretion via neuronal network, organized in two ganglionated plexuses, local reflexes that are triggered by local distension of myenteric and submucosal, composed of neurons and the intestinal wall, distortion of the mucosa, and enteric glial cells, controlling the activity of the smooth chemical contents in the lumen. This neuronal muscle of the gut, mucosal secretion and blood flow. The regulation of GI functions is due to the liberation of ENS contains as many neurons as the spinal cord, and the specific neuromediators synthesized by functionally functional and chemical diversity of enteric neurons defined enteric neurons. In addition, ENS is involved closely resembles that of the central nervous system. This in the control of immune and inflammatory processes highly integrated neural system is also referred to as the throughout the gut. Thus, it is not surprising that any ‘brain-in-the-gut’, because of its capability to function in damage to ENS circuitries and in the neurotransmitters the absence of nerve inputs from the central nervous systems results in a wide array of gut disorders, system. including motor impairments, which are characterized by high morbidity. In the future, challenges are to Keywords properly understand the molecular and cellular Enteric nervous system; neurotransmission; Parkinson’s changes that underlie enteric neuropathies, to utilize disease knowledge of the normal neurochemistry, pharmacology and physiology of the ENS to devise strategies to treat disorders of motility and to develop effective therapeutic compounds. Introduction The enteric nervous system (ENS) may be defined as the system of neurons and their supporting cells (glia) that is found within the walls of the gastrointestinal Rosa Serio MSc, PhD * Dipartimento di Scienze e Tecnologie Molecolari e tract, including the pancreas and gall bladder. An Biomolecolari (STEMBIO), Viale delle Scienze, “enteric neuron” is any neuron whose cell body is I-90128 Palermo, Università di Palermo, Italia within the ENS. The enteric nervous system regulates Email: [email protected] gastrointestinal functions including motility, secretions, blood flow, and the immune system. It is unique in its Maria Grazia Zizzo MSc, PhD ability to function independently of the central nervous Dipartimento di Scienze e Tecnologie Molecolari e system (CNS) in the control of the functions of the Biomolecolari (STEMBIO), Viale delle Scienze, digestive tract. For this reason, the ENS is considered I-90128 Palermo, Università di Palermo, Italia to be a “second brain in the gut”.1 However, the CNS Email: [email protected] is able to modulate, but not entirely control, the GI Mariangela Mastropaolo, BSc, MSc function by sending instructions via the two Dipartimento di Scienze e Tecnologie Molecolari e components of the extrinsic autonomic nervous Biomolecolari (STEMBIO), Viale delle Scienze, system: the sympathetic and parasympathetic nervous I-90128 Palermo, Università di Palermo, Italia system. * corresponding author The CNS and the ENS share a common origin and have functional and chemical similarities: i) the ENS in fact derives from neural crest cells that migrate to the cranial portion of the gut and subsequently move Malta Medical Journal Volume 23 Issue 03 2011 Review Article caudally to reach the entire GI tract; ii) the ENS contains a ionic mechanisms necessary to regenerate electrical number of neurons similar to those found in the spinal cord slow waves. The search for the origin of rhythmicity in (approximately 80–100 million neurons); iii) ENS express intestinal contraction has identified pacemaker regions all neurotransmitters so far known in CNS (more than 30 of the slow waves located at the myenteric and neurotransmitters). These include classical submucosal borders of circular muscles and contains a neurotransmitters such as acetylcholine (Ach), network of cells known as the interstitial cells of noradrenaline, serotonin, GABA and glutamate, but a great Cajal.2 These interstitial cells of Cajal are distinctive number of other neurotransmitter and hormones also populations of muscle-like cells. They make contact participate in the regulation of functions in the GI tract: with each other and with muscle cells and nerve vasoactive intestinal polypeptide (VIP), nitric oxide, terminals and function as pacemakers in galanin, motilin, adenosine triphosphate, tachykinins, ecc.; gastrointestinal muscles by initiating rhythmic iv) the ENS is an integrative neural network including electrical activity. Excitatory agonists, such as ACh, afferent neurons, interneurons, and efferent neurons; v) the stimulate intestinal phasic motor activity by increasing enteric glial cells are remarkably like astrocytes in the amplitude of slow wave activity and thereby structure and biochemistry and a diffusion barrier around enhancing spike potential activity, resulting in a the capillaries surrounding ganglia, similar to the cerebral contractile wave passing down the gut. Inhibitory blood-brain barrier. transmitters, such as VIP or NO, causes reduction of the amplitudes of slow waves and the membrane The ENS is organized in two ganglionated plexuses, potential at the peak of the slow wave is too far below myenteric and submucosal, composed of neurons and threshold for an action potential to occur and the enteric glial cells. The myenteric plexus (or Auerbach’s smooth muscle relaxes. Besides acetylcholine, plexus) lies between the external longitudinal and internal vasoactive intestinal peptide and nitric oxide, other circular muscle layers. The submucosal plexus (or chemical agents may act as modulator of Meissner’s plexus) lies between the circular muscle layer gastrointestinal function acting at different levels, and the mucosa. Neurons of the myenteric plexus control smooth muscle cells, ICCs, nerve terminals, the activity of the smooth muscle of the gut, whereas those interneural synapses. So, the gastrointestinal smooth in the submucosal plexus regulate mucosal secretion and muscle contractility is regulated not by one or another blood flow. The ENS controls gut motility and secretion of the transmitters, but by at least two and often more, via local reflexes that are triggered by local distension of pharmacologically coupled and working in close the intestinal wall, distortion of the mucosa, and chemical coordination. These complex functional interactions contents in the lumen. These reflexes involve parallel have some variations depending on the species, organ circuits of synaptically interconnected ENS neurons, system and region of the gut. which include primary intrinsic afferent neural cells, ascending and descending interneurons, excitatory and In addition, there is evidence that the ENS is inhibitory motorneurons, vasomotorneurons and involved in the control of immune and inflammatory secretomotorneurons. For example, in the myenteric processes throughout the gut. Immuno-neural plexus, activation of ascending interneurons and excitatory integration progresses sequentially, beginning with motoneurons results in the release of excitatory immune detection followed by signal transfer to neuromediators (acetylcholine, substance P) onto smooth enteric neural microcircuits, followed by neural muscle fibers causing circumferential contraction of the interpretation and then selection of a specific neural circular muscle layer upstream of the bolus. Activation of program of coordinated mucosal secretion and motor descending interneurons and inhibitory motoneurons propulsion that effectively clears the antigenic threat results in the release of inhibitory neuromediators (VIP - from the intestinal lumen. vasoactive intestinal polypeptide, nitric oxide) causing relaxation of circular muscle downstream of the bolus. Thus, it is not surprising that any damage to ENS circuitries results in a wide array of gut disorders, The basic electrical rhythms in the gut are fairly including motor impairments, which are characterized constant and characterized by slow waves, by high morbidity, with a markedly compromised rhythmical oscillations of the smooth muscle patient’s quality of life and occasional fatal outcomes. membrane potential, which are responsible for the Besides a few exceptions, the mechanisms through contractions of the muscles. These threshold events which neural diseases cause gastrointestinal represent true smooth muscle action potentials. Spikes are dysfunction, including motor abnormalities, remain not essential for excitation–contraction coupling in GI poorly understood. smooth muscle, but their occurrence is associated with more forceful contractions. Smooth muscle cells lack the Malta Medical Journal Volume 23 Issue 03 2011 Review Article Among the plethora of neural systems which control decreased in the myenteric plexus of PD patients. GI motility I wish to focus on the dopaminergic system However, the function of enteric dopaminergic since it seems to be a major candidate for the impairment neurons in the regulation of GI motility is still far from of GI function frequently encountered by patients affected clear and the mechanism of dopamine action and by Parkinson’s disease (PD).3 location of dopamine receptors are controversial. Moreover, conclusions regarding the role of dopamine Parkinson’s disease is the second most common
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