The study by Richter et al. () found significant electrophysiological communication between gastric pacemaker activity and the alpha rhythm within certain regions of the cerebral cortex including the right anterior insula. In other words, they found a role for interstitial cells of Cajal in interoception, the sensory system responsible for detecting internal regulation responses. The communication between ICC and the insular cortex occurred through phase amplitude coupling, the phase of the lower frequency gastric pacemaker modulated the amplitude of alpha waves in the anterior insula. Although phase amplitude coupling has almost exclusively been shown to occur within the brain, this study discovered that it also facilitates gut—brain communication. Interestingly, phase amplitude coupling was also observed within the gut; the amplitude of the higher frequency dominant intestinal pacemaker [the “slow wave” generated by interstitial cells of Cajal associated with the myenteric plexus (ICC-MP; Huizinga et al., ; Thomsen et al., )] was seen to be modulated by the phase of a lower frequency induced rhythmic depolarization likely originating in the network of ICC associated with the deep muscular plexus (ICC-DMP) (Huizinga et al., ). This interaction changed propulsive activity into the classical segmentation pattern of the intestine associated with absorption of nutrients. The study from Richter et al. () is highly significant since it demonstrates the ongoing monitoring of gastric pacemaker activity by the right anterior insula. In the stomach, the three-cycles/min pacemaker activity responsible for the orchestration of its dominant peristaltic activity, is generated by a network of ICC-MP and ICC-IM (the intramuscular ICC) (Edwards and Hirst, ). The communication between gastric ICC and the brain involves the intramuscular array (IMA)-ICC-complexes which incorporate ICC-IM, nerve endings of the vagal afferents and varicosities of motor neurons (Powley et al., , ), ideally suited for bi-directional communication with the brain (Figure 1). The vagal afferents connect to the insular cortex via the nucleus tractus solitarius (Shipley, ) and the insular cortex innervates the dorsal motor nucleus, which, in turn, provides innervation to enteric nerves of the stomach (Berthoud et al., ). The insular cortex was activated during gastric balloon distention and deactivated during ingestion of a meal, indicating a detailed monitoring of stomach conditions (Geeraerts et al., ). Vagal afferents are all connected to ICC (Powley et al., ) indicating that the vagus will not monitor individual ICC but the features of the interconnected network of ICC (Huizinga et al., ; Pawelka and Huizinga, ; Wei et al., ). How detailed information from this network is conveyed to the brain should be a topic for future research. This information will contain signals from several slow waves propagating over the stomach at the same time. This information will contain changes in ICC network properties that occur in response to a meal (Chen and McCallum, ) (Berthoud, ), which may relate to satiety (Andrews and Sanger, ). There is the potential that detailed information regarding meal quality and/or quantity, or even types of nutrients ingested could be signaled via alterations in ICC signaling. Detailed information is now emerging how ICC network properties change in patients with gastroparesis (O'Grady et al., ; O'Grady and Abell, ) and diabetes (He et al., ). Dyspepsia may relate to abnormal vago-vagal reflexes, including efferent innervation and abnormal signaling from the stomach to the insula or abnormal processing of such signals (Page and Blackshaw, ; Lee et al., ). Abnormalities in initiation and conduction were observed in patients with gastroparesis in the presence of a normal 3 cpm frequency (O'Grady et al., ) suggesting that in certain conditions, the recorded ICC pacemaker frequency may be normal but that it is the injury to the ICC network that is related to gastroparesis, which may relate to delayed gastric emptying and/or the initiation of nausea and vomiting through vagal afferents. Gastric dysmotilities are also related to depression indicating the myriad of ways that different regions of the brain can influence each other (Ruhland et al., ). Gastric slow wave activity changes markedly in response to neurotransmitters and hormones (El-Sharkawy and Szurszewski, ; El-Sharkawy et al., ), hence it is likely that the insular cortex monitors such changes. Vagal stretch and tension receptors are always incorporated in mechanistic explanations as to how the stomach signals to the brain (Young et al., ; Kentish et al., ). The study of Richter et al. () suggests that the ICC-IMA complexes are a sensorimotor unit and that sensations might be primarily integrated by and expressed by ICC activity and as such monitored by the insular cortex, where, in conjunction with other regions of the brain, conscious and subconscious decisions are made how to react to these stimuli. Monitoring of slow wave activity, even at rest (Richter et al., ), ensures an exquisitely sensitive system that is instantly available to inform the brain of any activity, change in activity or abnormal conditions. Further investigations into the role of ICC will be essential to unravel this gut brain communication pathway, including the sensitivity of ICC to inflammation, the remarkable ability of ICC to recover from severe injury and loss (Wang et al., ; Bettolli et al., ) and the molecular basis of ICC network regeneration (Hayashi et al., ).
Figure 1
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References
1
AndrewsP. L.SangerG. J. (2002). Abdominal vagal afferent neurones: an important target for the treatment of gastrointestinal dysfunction. Curr. Opin. Pharmacol.2, 650–656. 10.1016/S1471-4892(02)00227-8
2
BerthoudH. R. (2008). The vagus nerve, food intake and obesity. Regul. Pept.149, 15–25. 10.1016/j.regpep.2007.08.024
3
BerthoudH. R.JedrzejewskaA.PowleyT. L. (1990). Simultaneous labeling of vagal innervation of the gut and afferent projections from the visceral forebrain with dil injected into the dorsal vagal complex in the rat. J. Comp. Neurol.301, 65–79. 10.1002/cne.903010107
4
BettolliM.De CarliC.Cornejo-PalmaD.Jolin-DahelK.WangX. Y.HuizingaJ.et al. (2012). Interstitial cell of Cajal loss correlates with the degree of inflammation in the human appendix and reverses after inflammation. J. Pediatr. Surg.47, 1891–1899. 10.1016/j.jpedsurg.2012.05.006
5
ChenJ.McCallumR. W. (1992). Gastric slow wave abnormalities in patients with gastroparesis. Am. J. Gastroenterol.87, 477–482.
6
EdwardsF. R.HirstG. D. (2006). An electrical analysis of slow wave propagation in the guinea-pig gastric antrum. J. Physiol.571, 179–189. 10.1113/jphysiol.2005.100743
7
El-SharkawyT. Y.SzurszewskiJ. H. (1978). Modulation of canine antral circular smooth muscle by acetylcholine, noradrenaline and pentagastrin. J. Physiol.279, 309–320. 10.1113/jphysiol.1978.sp012346
8
El-SharkawyT. Y.MorganK. G.SzurszewskiJ. H. (1978). Intracellular electrical activity of canine and human gastric smooth muscle. J. Physiol.279, 291–307. 10.1113/jphysiol.1978.sp012345
9
GeeraertsB.Van OudenhoveL.DupontP.VanderghinsteD.BormansG.Van LaereK.et al. (2011). Different regional brain activity during physiological gastric distension compared to balloon distension: a H2 15O-PET study. Neurogastroenterol. Motil.23, 533–e203. 10.1111/j.1365-2982.2010.01642.x
10
HayashiY.AsuzuD. T.GibbonsS. J.AarsvoldK. H.BardsleyM. R.LomberkG. A.et al. (2013). Membrane-to-nucleus signaling links insulin-like growth factor-1- and stem cell factor-activated pathways. PLoS ONE8:e76822. 10.1371/journal.pone.0076822
11
HeC. L.SofferE. E.FerrisC. D.WalshR. M.SzurszewskiJ. H.FarrugiaG. (2001). Loss of interstitial cells of cajal and inhibitory innervation in insulin-dependent diabetes. Gastroenterology121, 427–434. 10.1053/gast.2001.26264
12
HuizingaJ. D.ChenJ. H.ZhuY. F.PawelkaA.McGinnR. J.BardakjianB. L.et al. (2014). The origin of segmentation motor activity in the intestine. Nat. Commun.5:3326. 10.1038/ncomms4326
13
HuizingaJ. D.ParsonsS. P.ChenJ. H.PawelkaA. J.PistilliM.LiC.et al. (2015). Motor patterns of the small intestine explained by phase-amplitude coupling of two pacemaker activities; the critical importance of propagation velocity. Am. J. Physiol. Cell Physiol.309, C403–C414. 10.1152/ajpcell.00414.2014
14
HuizingaJ. D.ThunebergL.KluppelM.MalyszJ.MikkelsenH. B.BernsteinA. (1995). W/kit gene required for interstitial cells of Cajal and for intestinal pacemaker activity. Nature373, 347–349. 10.1038/373347a0
15
KentishS. J.O'DonnellT. A.IsaacsN. J.YoungR. L.LiH.HarringtonA. M.et al. (2013). Gastric vagal afferent modulation by leptin is influenced by food intake status. J. Physiol.591, 1921–1934. 10.1113/jphysiol.2012.247577
16
LeeI. S.WangH.ChaeY.PreisslH.EnckP. (2016). Functional neuroimaging studies in functional dyspepsia patients: a systematic review. Neurogastroenterol. Motil.28, 793–805. 10.1111/nmo.12793
17
O'GradyG.AbellT. L. (2015). Gastric arrhythmias in gastroparesis: low- and high-resolution mapping of gastric electrical activity. Gastroenterol. Clin. North Am.44, 169–184. 10.1016/j.gtc.2014.11.013
18
O'GradyG.AngeliT. R.DuP.LahrC.LammersW. J.WindsorJ. A.et al. (2012). Abnormal initiation and conduction of slow-wave activity in gastroparesis, defined by high-resolution electrical mapping. Gastroenterology143, 589.e1–598.e1. 10.1053/j.gastro.2012.05.036
19
PageA. J.BlackshawL. A. (2009). Roles of gastro-oesophageal afferents in the mechanisms and symptoms of reflux disease. Handb. Exp. Pharmacol.194, 227–257. 10.1007/978-3-540-79090-7_7
20
PawelkaA. J.HuizingaJ. D. (2015). Induction of rhythmic transient depolarizations associated with waxing and waning of slow wave activity in intestinal smooth muscle. Am. J. Physiol. Gastrointest. Liver Physiol.308, G427–G433. 10.1152/ajpgi.00409.2014
21
PowleyT. L.HudsonC. N.McAdamsJ. L.BaronowskyE. A.PhillipsR. J. (2016). Vagal intramuscular arrays: the specialized mechanoreceptor arbors that innervate the smooth muscle layers of the stomach examined in the rat. J. Comp. Neurol.524, 713–737. 10.1002/cne.23892
22
PowleyT. L.WangX. Y.FoxE. A.PhillipsR. J.LiuL. W.HuizingaJ. D. (2008). Ultrastructural evidence for communication between intramuscular vagal mechanoreceptors and interstitial cells of Cajal in the rat fundus. Neurogastroenterol. Motil.20, 69–79. 10.1111/j.1365-2982.2007.00990.x
23
RichterC. G.Babo-RebeloM.SchwartzD.Tallon-BaudryC. (2017). Phase-amplitude coupling at the organism level: the amplitude of spontaneous alpha rhythm fluctuations varies with the phase of the infra-slow gastric basal rhythm. Neuroimage146, 951–958. 10.1016/j.neuroimage.2016.08.043
24
RuhlandC.KoschkeM.GreinerW.PeupelmannJ.PietschU.HockeM.et al. (2008). Gastric dysmotility in patients with major depression. J. Affect. Disord.110, 185–190. 10.1016/j.jad.2007.12.236
25
ShipleyM. T. (1982). Insular cortex projection to the nucleus of the solitary tract and brainstem visceromotor regions in the mouse. Brain Res. Bull.8, 139–148. 10.1016/0361-9230(82)90040-5
26
ThomsenL.RobinsonT. L.LeeJ. C.FarrawayL. A.HughesM. J.AndrewsD. W.et al. (1998). Interstitial cells of Cajal generate a rhythmic pacemaker current. Nat. Med.4, 848–851. 10.1038/nm0798-848
27
WangX. Y.BerezinI.MikkelsenH. B.DerT.BercikP.CollinsS. M.et al. (2002). Pathology of interstitial cells of Cajal in relation to inflammation revealed by ultrastructure but not immunohistochemistry. Am. J. Pathol.160, 1529–1540. 10.1016/S0002-9440(10)62579-5
28
WeiR.ParsonsS. P.HuizingaJ. D. (2016). Network properties of ICC affect intestinal pacemaker activities and motor patterns, according to a mathematical model of weakly coupled oscillators. Exp. Physiol.10.1113/EP086077
29
YoungR. L.CooperN. J.BlackshawL. A. (2008). Chemical coding and central projections of gastric vagal afferent neurons. Neurogastroenterol. Motil.20, 708–718. 10.1111/j.1365-2982.2007.01071.x
Summary
Keywords
interoception, interstitial cells of Cajal, vagal afferents, pacemaking, brain gut axis, motility, gastric motility
Citation
Huizinga JD (2017) Commentary: Phase-amplitude coupling at the organism level: The amplitude of spontaneous alpha rhythm fluctuations varies with the phase of the infra-slow gastric basal rhythm. Front. Neurosci. 11:102. doi: 10.3389/fnins.2017.00102
Received
14 January 2017
Accepted
17 February 2017
Published
02 March 2017
Volume
11 - 2017
Edited by
Nick Spencer, Flinders University, Australia
Reviewed by
Kirsteen Browning, Pennsylvania State University, USA
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© 2017 Huizinga.
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*Correspondence: Jan D. Huizinga huizinga@mcmaster.ca
This article was submitted to Autonomic Neuroscience, a section of the journal Frontiers in Neuroscience
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