Neurotransmitters in the CNS control of breathing.

This review summarises our current understanding of the neurotransmitters involved in the generation, transmission and modulation of respiratory rhythm. The principal neurotransmitters involved in generating and transmitting respiratory rhythm include glutamate, GABA, and glycine. Glutamate acts primarily at non-NMDA receptors within the networks to generate respiratory rhythm in neonatal in vitro preparations, but it may also engage NMDA receptors in mature intact animals. Glutamate may likewise act as presynaptic AP-4 metabotropic receptors to fine tune its own release in the transmission of respiratory rhythm to the phrenic motoneurones. The role of other metabotropic receptors in rhythmogenesis is not known. GABA (primarily by acting at GABAA receptors), as well as glycine, transmit phasic waves of inhibition within the primary respiratory network. Neuroactive agents synthesized outside the primary network may shape the final expression of the basic rhythm. The most studied inputs originate in the pons and from the slowly adapting pulmonary stretch receptors (SAR). Both of these inputs contribute to the transition from inspiration to expiration. Pontine mechanisms rely on excitatory amino acid activation of NMDA receptors, while SAR pathways utilize non-NMDA receptors. Serotonin has also been implicated in regulating respiratory rhythm, possibly via serotonergic projections originating in the raphe nuclei. The amine has diverse effects on respiratory neuronal activity; the most consistent effect appears to be an augmentation of phrenic motoneuronal at the level of the spinal cord. Substance P regulates respiratory activity by acting in the CNS and on peripheral sensory receptors. Centrally, substance P largely augments respiration, by increasing respiratory rhythm in neonatal in vitro preparations and also by increasing tidal volume in the intact animal. Substance P is also released by carotid chemoreceptor afferents during hypoxia. Opioids are well known to decrease respiration; the central mechanism involves the suppression of baseline inspiratory neuronal activity and possibly the blunting of glutamate-evoked increases in inspiration drive.