Abstract
Breathing (or respiration) is an unconscious and complex motor behavior which neuronal drive emerges from the brainstem. In simplistic terms, respiratory motor activity comprises two phases, inspiration (uptake of oxygen, O2) and expiration (release of carbon dioxide, CO2). Breathing is not rigid, but instead highly adaptable to external and internal physiological demands of the organism. The neurons that generate, monitor, and adjust breathing patterns locate to two major brainstem structures, the pons and medulla oblongata. Extensive research over the last three decades has begun to identify the developmental origins of most brainstem neurons that control different aspects of breathing. This research has also elucidated the transcriptional control that secures the specification of brainstem respiratory neurons. In this review, we aim to summarize our current knowledge on the transcriptional regulation that operates during the specification of respiratory neurons, and we will highlight the cell lineages that contribute to the central respiratory circuit. Lastly, we will discuss on genetic disturbances altering transcription factor regulation and their impact in hypoventilation disorders in humans.
Introduction
In vertebrates, the developing brainstem generates an enormous diversity of neuron types that control bodily homeostasis and process multiple modalities of sensory information (; ; Venkatraman et al., 2017). These neurons vary not only in their morphological, chemical, and electrophysiological properties, but also in their connectivity patterns that allow them to form elaborate circuits, such as those required to generate, monitor, and adjust breathing to meet various external and internal physiological demands. How this neuronal diversity emerges during development and how it contributes to functional circuits has been intensively investigated by many generations of neuroscientists, as well as by cellular, molecular, and developmental biologists.
The work of these brainstem enthusiasts has already revealed that neuronal diversity in this brain region depends on the temporal and spatial patterning of local neural progenitors (, ; ; ; van der Heijden and Zoghbi, 2020; ). This patterning is first achieved by early diffusible cues that impose an anterior-posterior identity, and subsequently by other morphogens that provide a distinctive dorsal-ventral molecular signature to progenitor cells. This means that distinct progenitor cells can be distinguished primarily based on their differential expression of numerous transcription factors that commit them to generate specific neuron types. Most transcription factors normally expressed in progenitor cells are later silenced in their progeny, which allows for the postmitotic maturation of the differentiated neurons. At the same time, each neuron type can also be characterized by the expression of particular sets of transcription factors that form part of their cell physiology and identity.
In this review, we aim to summarize our current knowledge on the transcriptional programs that allow for the speciation of brainstem respiratory neurons. We will first present a general overview of the anterior-posterior and dorsal-ventral patterning of the developing brainstem as an entry point to understand its neuronal diversity. Next, we will focus on the specification of three large groups of neurons that play key roles in respiration: (i) the pontine groups, (ii) the dorsal medullary respiratory column, and (iii) the ventral medullary respiratory column. These neurons locate to the pons and the medulla oblongata where they perform a variety of functions, such as respiratory rhythm generation, respiratory modulation, and tissue gas monitoring. Lastly, we will discuss some genetic disturbances that affect breathing and respiratory neuron specification.
Anterior to posterior patterning of the developing brainstem
Brainstem development is an evolutionary conserved process that begins with the specification of the mesencephalon (midbrain) and rhombencephalon (hindbrain) by the isthmic organizer. This organizer is located at the midbrain-hindbrain border and produces diffusible morphogens (particularly Wnt1 and Fgf8 ligands) that act directly on the neighboring nervous tissue to impose midbrain and hindbrain cell fates (Zervas et al., 2004; ; ; ; ). Various transcription factors are differentially expressed anterior and posterior to the isthmic organizer, such as the antagonistic homeodomain factors Otx2 (anterior) and Gbx2 (posterior), whose expression defines the rostral and caudal regions of the developing central nervous system (Figure 1A; , ; ; ; ; ; ). Alterations in the expression of Otx2 and Gbx2 are catastrophic for early brainstem development. For instance, the ablation of Otx2 and its closely related family member Otx1 results in the loss of midbrain tissue, which becomes re-specified into more rostral hindbrain-like regions, such as the cerebellum (; Suda et al., 1997; ). Similarly, the misexpression of Gbx2 disrupts the correct positioning of the isthmic organizer and the development of rostral hindbrain (; Wassarman et al., 1997; ; ; Waters and Lewandoski, 2006).
FIGURE 1
The regulation of both Otx2 and Gbx2 largely depends on a complex molecular network that centers on the instructive signals of Fgf8 (Figure 1B;
Soon after the establishment of the isthmic organizer, the hindbrain undergoes a series of morphological changes that transiently divide it into seven or eight smaller segments called rhombomeres, from which the cerebellum, pons and medulla oblongata emerge (
FIGURE 2

Anterior to posterior patterning of the developing brainstem. (A) Schema illustrating the segmentation of the brainstem into rhombomeres (r) and selected transcription factors differentially express within these rhombomeres. For more details on Hox gene expression in the developing hindbrain please see
Dorsal to ventral patterning of the developing brainstem
Once the brainstem acquires its anterior-posterior identity, a second series of diffusible cues further pattern the identity of progenitor cells along its dorsal-ventral axis. During this patterning, the ventralizing Sonic hedgehog (produced by the floor plate), as well as the dorsalizing bone morphogenetic proteins and Wnt ligands (secreted by the roof plate) create concentration gradients that differentially signal onto brainstem progenitor cells (Roelink et al., 1995;
FIGURE 3

Dorsal to ventral patterning of the developing brainstem. Left, schema illustrating concentration gradients formed by the diffusion of bone morphogenic proteins (BMPs)/WNTs and Sonic hedgehog (SHH) morphogens produced by the roof and floor plate, respectively. Right, schema illustrating a transverse section of the developing hindbrain and the patterning of 13 progenitor domains along its dorsal-ventral axis. These progenitors emerge from the differential action of BMP/WNT/SHH concentration gradients. The rhombomeric distribution of each progenitor domain and contribution to brainstem respiratory centers are indicated. Of note, the origin of the intertrigeminal region (ITR), Bötzinger complex (BötC) and caudal ventral respiratory group (cVRG) has not been conclusively determined (see text). nTS, nucleus tractus solitarius; RTN/pF, retrotrapezoid/parafacial nucleus; preBötC, preBötzinger complex; rVRG, rostral ventral respiratory group; Bmm, branchial motor neurons; Vmn, visceral motor neurons; nRaphe, Raphe nuclei. This figure is adapted from our previous publication
TABLE 1
| Early progenitor domains | bHLH transcription factors | Homeodomain transcription factors |
| dA1 | Olig3, Atoh1 | Pax3, Msx1 |
| dA2 | Olig3, Ngn1, Ngn2 | Pax3, Pax7low, Msx1 |
| dA3 | Olig3, Ascl1, Ngn2 | Pax3, Pax6, Pax7, Gsx2 |
| dA4 | Olig3, Ascl1, Ngn2, Ptf1a | |
| dB1 | Ascl1, Ngn2, Ptf1a | Pax3, Pax6, Pax7, Gsx1/2 |
| dB2 | Phox2b | |
| dB3 | Ascl1 | Pax3, Pax6, Pax7, Gsx1/2, Dbx2 |
| dB4 | Ngn1, Ngn2 | Pax3, Pax6, Pax7, Dbx2 |
| V0 | Ngn1, Ngn2 | Dbx1, Dbx2, Pax6, Pax7 |
| V1 | Ngn1, Ngn2 | Dbx2, Pax6, Nkx6.2 |
| V2 | Ngn1, Ngn2 | Dbx2, Pax6, Nkx6.1, Nkx6.2 |
| MNs | Olig2 | Pax6 |
| MNv | Ascl1 | Phox2b (early), Nkx2.2, Nkx2.9 |
Transcription factors expressed in progenitor domains of the developing hindbrain.
Depending on the rhombomere, six to eight progenitor domains can be distinguished in the dorsal (also known as the alar plate) aspect of the developing hindbrain, while four to five progenitor domains can be identified in its ventral (or basal) plate (Figure 3). Outstandingly, there exist great resemblance between the developing hindbrain and the spinal cord, in terms of progenitor domains that locate to their dorsal-ventral axis, which share similar gene expression patterns, illustrating common developmental programs that occur between these two nervous system regions (
TABLE 2
| Early born neuron types | Transcription factors |
| dA1 | Pou4f1, Barh1, Lhx2, Lhx9, Evx1 |
| dA2 | Pou4f1, Lhx1, Lhx5, Foxp2 |
| dA3 | Tlx3, Phox2b, Lmx1b |
| dA4 | Foxd3, Foxp2 |
| dB1 | Lbx1, Pax2, Lhx1, Lhx5 |
| dB2 | Lbx1, Phox2b, Atoh1 |
| dB3 | Lbx1, Tlx3, Lmx1b, Prrxl1, |
| dB4 | Lbx1, Pax2, Lhx1, Lhx5, Wt1, bHLHb5, Dmrt3 |
| V0 | Evx1, Pax2, Lhx1/5 |
| V1 | En1, Pax2, Lhx1/5 |
| V2 | Chx10, Sox14, Sox21 |
| PMNs | Isl1/2 |
| PMNv | Phox2b, Isl1/2 (visceral motor neurons) Gata2, Gata3, Lmx1b and Pet1 (Raphe neurons) |
Transcription factors expressed in neuronal cell types emerging from the developing hindbrain.
Thus, complex networks of signaling cues pattern the developing brainstem along its anterior-posterior and dorsal-ventral axes to form a molecular grid of longitudinally and transversely distinct progenitor domains, each displaying a particular molecular code of transcription factor expression that singles out the specification of particular neuron types. In the following sections we will discuss the current knowledge of the transcriptional codes that safeguard the specification of pontine and medullary neurons that form the central respiratory circuits in the hindbrain, which collectively generate, monitor and modulate breathing (Figure 4).
FIGURE 4

Brainstem respiratory groups. Scheme representing the sagittal view of a mouse brainstem. This scheme illustrates the location of respiratory neurons belonging to the intertrigeminal region (ITR), parabrachial/Kölliker-Fuse complex (PB/KF), nucleus tractus solitarius (nTS), retrotrapezoid/parafacial nucleus (RTN/pF), Bötzinger complex (BötC), preBötzinger complex (preBötC), postInspiratory COmplex (PiCO), rostral and caudal ventral respiratory groups (rVRG and cVRG). The cerebellum, midbrain (mb), as well as the facial (nVII) motor nucleus and the nucleus ambiguus (na) are illustrated for anatomical orientation. This figure is adapted from our previous publication
Development of the anterior respiratory groups
These respiratory groups locate to the pons and include two major structures: (i) the dorso-lateral parabrachial complex and its associated Kölliker-Fuse nucleus (for simplicity here shortened to parabrachial/Kölliker-Fuse complex) that surrounds the cerebellar peduncle, and (ii) the intertrigeminal (also known as the peritrigeminal) region that surrounds the trigeminal motor nucleus. The parabrachial/Kölliker-Fuse complex is key in the transition phase between inspiration and expiration. It is classically considered the major component of the pontine pneumotaxic center that controls the amount of air inspired in each breath by providing an off-switch for inspiration (
Using conditional mutagenesis and lineage-tracing experiments, the group of Huda Y. Zoghbi has studied the development of these pontine groups to great effect. These studies show that both the parabrachial/Kölliker-Fuse complex and intertrigeminal region depend on the bHLH transcription factor Atoh1 (formerly called Math1) for their development, as ablation of Atoh1 results in the absence of these pontine groups in mice (Wang et al., 2005; Rose et al., 2009a,b). Recently, Van der Heijden and Zoghbi traced the rhombomeric origin of the parabrachial/Kölliker-Fuse complex to rhombomere 1, whereas they identified the intertrigeminal region to derive from rhombomere 2 (van der Heijden and Zoghbi, 2018). One should recall that rhombomere 1 development depends on the correct expression of En1, whereas Hoxa2 is the most rostral Hox gene expressed in the developing hindbrain and delimits the border between rhombomeres 1 and 2 (Figures 1, 2). The importance of neurons derived from En1-expressing cells to respiration has not been specifically investigated, but an early report showed that En1 null mutant mice die at birth and present with severe malformations of the cerebellum, midbrain and the parabrachial/Kölliker-Fuse complex (Wurst and Bally-Cuif, 2001).
In the more recent van der Heijden and Zoghbi study, the ablation of Atoh1 from En1-expressing cells, using En1Cre/+;Atoh1LacZ/Flox mice, leads to the absence of a recognizable parabrachial/Kölliker-Fuse complex (van der Heijden and Zoghbi, 2018). Physiologically, the absence of this respiratory group does not affect basal respiratory parameters, although spontaneous apneas and frequent sighing behavior is observed in En1Cre/+;Atoh1LacZ/Flox mice. Notably, the specific elimination of the parabrachial/Kölliker-Fuse complex impairs respiratory chemoreflexes to hypoxia (low oxygen) and hypercarbia (high carbon dioxide). Despite the fact the parabrachial/Kölliker-Fuse complex does not sense changes in blood gases by itself, it is known to form reciprocal connections with the nucleus tractus solitarius, a center known to mediate respiratory chemoreflexes (
During development, Atoh1 is transiently expressed (E10.5-E13.5) in progenitor cells of the dA1 domain that encompasses rhombomere 1 (also known as the rostral or upper rhombic lip) and rhombomeres 2–7/8 (known as the caudal or lower rhombic lip) (Figure 3 and Table 1;
Development of the dorsal medullary respiratory column
This respiratory column contains neurons known to be critical for the regulation of inspiratory activity. Most neurons forming this respiratory column reside within the nucleus tractus solitarius (nTS, bilaterally located in the dorsal medulla oblongata), although a few neurons belonging to this column can be found in the reticular formation adjacent to the nTS. The nTS extends from the caudal level of the facial motor nucleus (at the border between rhombomeres 6/7) to the cervical spinal cord. It represents the primary entry site of peripheral viscerosensory information into the central nervous system (Figure 5A;
FIGURE 5

Development of the nucleus tractus solitarius. (A) Left, schema illustrating the relay of sensory information from the upper and lower airways to the nucleus tractus solitarius (nTS) by cranial (vagal) ganglion neurons. The nucleus ambiguus (na), area postrema (ap), nucleus vagus (nX), and the nucleus hypoglossus (nXII) are displayed as landmarks. Right, transverse section of the brainstem stained with antibodies against Phox2b and counterstained with DAPI. Phox2b expression can be observed in nTS, ap, nX and na neurons. (B) Left, transverse section of the dorsal rhombomere 7 stained with antibodies against Olig3, Phox2b and Foxd3 at E11.5 in mice. The expression of Olig3 encompasses the progenitor domains dA1-dA4. Phox2b and Foxd3 are differentially express in neurons emerging from dA3 and dA4, respectively. Right, schema illustrating the differential expression of transcription factors in dA progenitor cells and neurons of the dorsal rhombomere 7. This figure is adapted from our previous publication
Histological studies traced the origin of excitatory nTS neurons to the dA3 progenitor domain (located between rhombomeres 4 and 7/8; Figure 3). This progenitor domain shares molecular traits with a progenitor domain in the spinal cord called dl3 (
In the developing hindbrain, the precise identity of dA3 progenitor cells is determined by the co-expression of the bHLH transcription factors Olig3, Ascl1 and Ngn2 (Figure 5B;
Development of the ventral medullary respiratory column
Several anatomical and physiological distinct groups of respiratory-related neurons have been identified in the ventral medulla oblongata, which form the ventral medullary respiratory column, these groups include: (a) the retrotrapezoid/parafacial nucleus, (b) the Bötzinger complex, (c) the preBötzinger complex, (d) the PiCo complex (dorsal to the Bötzinger and preBötzinger complexes), (e) the rostral ventral and caudal respiratory groups, as well as (f) the raphe obscurus (Figure 4). Neurons within these groups can either project onto respiratory premotor neurons or themselves act as premotor neurons to regulate the motoric behavior associated with breathing. Interestingly, three of these groups exhibit intrinsic rhythmic activity during prenatal development: (i) the parafacial nucleus, (ii) the preBötzinger complex and (iii) a newly identified PostInspiratory COmplex (PiCo), and are believed to be central for the generation of the respiratory rhythm (Smith et al., 1991;
Development of the retrotrapezoid/parafacial nucleus
The retrotrapezoid and parafacial nuclei are two small groups of excitatory neurons that are located ventro-laterally to the facial motor nucleus. Whether these groups are genuinely distinct remains to be conclusively determined. However, recent evidence seems to suggest that they are indeed physiologically distinct neuronal populations (
FIGURE 6

Development of the retrotrapezoid/parafacial nucleus. (A) Schema representing the location and function of retrotrapezoid/parafacial nucleus (RTN/pF) in mice. Under normal levels of oxygen (normoxia), the activity of the preBötzinger complex (preBötC) controls the firing rate of neurons in the phrenic motor nucleus (Phrenic) by sending signals via premotor neurons located in the rostral ventral respiratory group (rVRG). Phrenic motor neurons control diaphragm activity. Under hypercarbia (high levels of PCO2) RTN/pF neurons increase their firing rate: this adjusts the activity of preBötzinger complex and eventually the firing rate of the phrenic motor neurons, which in turn increases respiration (B) Histological characterization of RTN/pF in newborn mice (P0). RTN/pF neurons co-express Phox2b and Lbx1 but not choline-acetyltransferase (ChAT), which distinguishes them from facial motor neurons (nVII) that express Phox2b and ChAT but not Lbx1. (C) Histological characterization of dB2 neurons across the indicated rhombomeres (r). dB2 neurons co-express Phox2b and Lbx1 at E11.5 in mice. This molecular signature distinguishes them from the dorsal (dA3 neurons) and ventral (pMNv) cells that express Phox2b but not Lbx1. Note that dB2 neurons emerge from r2 to r6, whereas dA3 neurons originate in r4 to r7/8 and pMNv cells can be found from r2-r7/8 (see text). (D) Transverse section of a E12.5 mouse embryo stained with antibodies against Phox2b, Atoh1, and Lbx1. Note that a subset of dB2 neurons (magenta cells) activate the expression of Atoh1 as they reach the facial (nVII) motor nucleus (boxed area). The boxed area is illustrated at the right with different combinations of the fluorescent signals. (E) Schema depicting the development of RTN/pF neurons. Phox2b + dB2 progenitor cells differentiate an initiate the expression of Lbx1 in neurons. A subset of Phox2b + /Lbx1 + (dB2) neurons ventrally migrates and activates the expression of Atoh1 as they reach the facial (nVII) motor nucleus. It is the co-expression of Phox2b + /Lbx1 + /Atoh1 + what defines the molecular signature of RTN/pF neurons. (F) Upper panels, by E14.5 in mice, RTN/pF neurons (arrowheads) settle underneath the facial motor (nVII) nucleus and express additional marker, such as neurokinin 1 receptor (Nk1R). Lower panels, ventral hindbrain view of a E14.5 wholemount brainstem preparation centered on the facial (nVII) motor nucleus showing Ca2 + green-1AM fluorescence changes (ΔF/F) of parifacial nucleus (pF) activity in physiological (7.4) and low (7.2) pH. This figure is adapted from our previous publication
In 2009,
Development of the Bötzinger complex
The major inhibitory component of the ventral respiratory column is the Bötzinger complex that uses GABA and glycine as its primary neurotransmitters (Shao and Feldman, 1997; Schreihofer et al., 1999; Song et al., 2001). Classic studies showed that the electrophysiological and pharmacological activation of Bötzinger neurons strongly inhibits inspiration and that Bötzinger neurons display decrementing postinspiratory or augmenting firing patterns during expiration (
The precise rhombomeric origin and progenitor domain from which the Bötzinger complex develops has not yet been fully investigated. However, circumstantial evidence might indicate that this respiratory group develops from the Lbx1-lineage. Indeed, a lineage tracing study by
Development of the preBötzinger complex
In the early 1990’s, the work of Jeffrey C. Smith and Jack L. Feldman identified the preBötzinger complex as essential for generating the respiratory rhythm in mammals (Figures 7A,B; Smith et al., 1991). Later studies uncover some molecular markers such as the neurokinin 1 receptor and somatostatin to be expressed by preBötzinger neurons (Smith et al., 1991, 2007;
FIGURE 7

Development of the preBötzinger complex. (A) The neurons of the preBötzinger complex locate ventral to the nucleus ambiguus (na) and can be distinguished by the co-expression of somatotatin (SST) and neurokinin 1 receptor (Nk1R) in mice at birth (P0). Please note that preBötzinger neurons co-express SST and Nk1R but not Phox2b, while motor neurons of the nucleus ambiguus co-express Nk1R and Phox2b but not SST. (B) Left, transverse section of a mouse hindbrain at E14.5 showing Ca2 + green-1AM fluorescence changes (ΔF/F) of preBötzinger complex (boxed area) intrinsic activity. Right, traces illustrating bursts of preBötzinger complex activity in physiological pH or after substance p (SP) treatment, which accelerates their firing. (C) Left, transverse section of a E11.5 mouse brainstem at rhombomere 7. The section was stained with antibodies against Dbx1 (green) Olig3 (red) and Bhlhe22 (blue). Note that the V0 progenitor domain can be distinguished by the expression of Dbx1. Right, histological characterization of the V0 progenitor domain and the neurons that emerge from it, using antibodies against Dbx1, Dbx2, Evx1, Pax7, Lhx1/5, Pax2 and Lbx1. Note the Dbx1 + (V0) progenitor domain generates Evx1 + neurons that co-express in addition Lhx1/5 and Pax2 but not Lbx1 (see also Tables 1, 2 and text for more details). The expression of Bhlhe22 allows the distinction of the dB4 and V1/V2 domains that sandwich the V0 progenitor domain. A fraction of Dbx1-derived neurons will differentiate into the preBötzinger complex (see text). Insets in the main photographs illustrate the co-expression of Evx1 + cells with the indicated markers. This figure is adapted from our previous publication
In 2010, two independent groups defined the V0 progenitor domain (in the basal plate) as the source of the preBötzinger complex (
Expression of the transcription factor Pax7 molecularly distinguishes two V0 progenitor subdomains: V0 dorsal (V0D; Pax7 +) and V0 ventral (V0V; Pax7-) (Figure 7C). In
Even though the anterior-posterior origin of the preBötzinger complex has not yet been identified, an early study indicates that it emerges from the most posterior rhombomeres and partly from rhombomere 6 (MafB +). In this context, a study by
Development of the rostral and caudal ventral respiratory groups
The preBötzinger complex controls breathing by activating premotor neurons that in turn regulate multiple brainstem (e.g., hypoglossal or vagal) and spinal cord (phrenic) motor neurons. Caudal to the preBötzinger complex, two sets of respiratory premotor neurons are associated with inspiratory and expiatory motor activity: the rostral (rVRG) and caudal (cVRG) ventral respiratory groups, respectively (Smith et al., 2013). A recent study from the group of Gilles Fortin identified that excitatory rVRG neurons have a history of Dbx1 expression and, as such, to originate from the V0 progenitor domain (Wu et al., 2017). Even though both preBötzinger neurons and rVRG neurons express Slc17a6 (vGlut2) and Pax2, only the former expresses neurokinin 1 receptor and somatostatin (
Development of respiratory serotonergic neurons
The monoamine neurotransmitter serotonin has long been implicated in the control of respiration. Brain serotonin is produced by nine distinct groups of cells (called raphe nuclei), all of which are in the brainstem. Among the distinct raphe nuclei, several lines of research indicate that the midline located raphe obscurus in the medulla oblongata is an important component of the central respiratory chemoreceptor circuit (
The ventral-most progenitor domain (termed as pMN; Figure 3) in the developing hindbrain initially generates motor neurons, and later all brainstem serotonergic neurons. Due to its proximity to the floor plate, the pMN domain is under the direct influence of Sonic Hedgehog signaling (
The bHLH transcription factor Ascl1 is critical for development of peripheral (i.e., enteric nervous system) and central (raphe) serotonergic cells (
Cell lineages contributing to respiratory and non-respiratory neurons
From a developmental point of view, most brainstem respiratory neurons emerge from a few molecularly defined cell-lineages and progenitor domains: (i) an Atoh1-lineage that contributes to the development of the parabrachial/Kölliker-Fuse complex (dA1, in rhombomere 1) and the intertrigeminal region (either dA1 or dB2, in rhombomere 2); (ii) an Olig3/Phox2b/Tlx3-lineage (dA3, in rhombomere 7/8) that generates the dorsal medullary respiratory column (nTS); iii) a Phox2b/Lbx1/Atoh1-lineage (dB2, in rhombomere 3 and/or 5) that generates the retrotrapezoid/parafacial nuclei; (iv) an Lbx1-lineage (presumably dB1, unknown rhombomeric origin) that produces the Bötzinger complex; v) a Dbx1-lineage (V0) that gives rise to the preBötzinger complex (in rhombomeres 6-7/8) and the rVRG (and possibly the cVRG, in rhombomere 7/8) groups of premotor neurons; as well as (vi) an Nkx2.2/Ascl1/Lmx1b-lineage that produces raphe serotonergic neurons (pMNv, across rhombomeres).
One should not forget, however, that each of these progenitor domains produce a much greater diversity of neuron types than just respiratory neurons. A good example of this is the dA1 (Atoh1 +) domain in rhombomere 1 (upper rhombic lip). This domain generates: in addition to the parabrachial/Kölliker-Fuse complex, all excitatory deep cerebellar neurons, all cerebellar granule cell progenitors, as well as all cerebellar and cochlear unipolar brush cells (
It might not be surprising that across rhombomeres, each progenitor domain generates different neuron types. Nonetheless, an interesting trait of these spatially segregated progenitor domains is that their shared expression of transcription factors might instruct their progeny to synaptically connect and form functional circuits. For instance, both Atoh1 + /Olig3 + (dA1) progenitors in rhombomere 7 or the pdI1 progenitors in the spinal cord (equivalent to dA1) produce second relay neurons that project to the cerebellum and synapse onto granule cells and deep cerebellar neurons that derive from rhombomere 1 dA1 (Atoh1 + /Olig3 +) progenitors (
Conclusion
The enormous knowledge gained during the last three decades of brainstem development research now allows us to further dissect the function of respiratory neurons with unprecedented detail. Several experimental and theoretical approaches have recently taken advantage of the developmental trajectories of respiratory neurons to explore the complex character of the respiratory rhythm generator or to elucidate different components of the central chemoreceptor circuit (
Many aspects of how respiratory neuron diversity emerges during development remain to be elucidated. The identification of how the brainstem generates respiratory neurons is critical to understand this complex behavior and essential for the development of new therapeutic approaches for the management of respiratory diseases. In this context, recent studies on the genetic disturbances causing congenital respiratory syndromes are currently steering our views into both the development and function of respiratory neurons. A clear example is the study of congenital central hypoventilation syndrome (CCHS, also known as Ondine’s curse; OMIM 209880). Although rare (1 in 200,000 live births), this disorder is life threatening and characterized by slow, apneic and shallow breathing (hypoventilation) while awake and respiratory arrest during sleep (Weese-Mayer et al., 2008, 2017; Sivan et al., 2019;
For many years, the size and location of the brainstem was a major impediment to comprehend its physiology. With the advent of new technologies such as single-cell transcriptomics, monosynaptic viral tracing as well as opto- and chemo- genetic tools, several of the long-lasting obstacles associated with the identification and modulation of specific breathing behaviors are now amenable for scientific exploration. There is no doubt that the years to come will foster and propel our understanding of this elementary and humble animal behavior in ways that we can only now imagine.
Statements
Author contributions
YX, KC, AA, EL, and LH-M reviewed the literature. LH-M wrote the original draft and edited it with the input from all authors. All authors contributed to the article and approved the submitted final version.
Funding
Work in the Hernandez-Miranda’s laboratory is supported by the Fritz-Thyssen-Stiftung (grant no. 10.20.1.004MN) and Deutsche Forschungsgemeinschaft (grant no. 450241946), both granted to LH-M.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
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Summary
Keywords
transcription factors, brainstem development, progenitor domains, neuronal specification, respiratory neurons
Citation
Xia Y, Cui K, Alonso A, Lowenstein ED and Hernandez-Miranda LR (2022) Transcription factors regulating the specification of brainstem respiratory neurons. Front. Mol. Neurosci. 15:1072475. doi: 10.3389/fnmol.2022.1072475
Received
17 October 2022
Accepted
14 November 2022
Published
29 November 2022
Volume
15 - 2022
Edited by
Estela Maris Muñoz, CONICET Dr. Mario H. Burgos Institute of Histology and Embryology (IHEM), Argentina
Reviewed by
Flavio S. J. De Souza, CONICET Institute of Physiology, Molecular Biology and Neurosciences (IFIBYNE), Argentina; Mitsuhiro Hashimoto, Fukushima Medical University, Japan
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Copyright
© 2022 Xia, Cui, Alonso, Lowenstein and Hernandez-Miranda.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Luis R. Hernandez-Miranda, luis.hernandez-miranda@charite.de
This article was submitted to Neuroplasticity and Development, a section of the journal Frontiers in Molecular Neuroscience
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