Recurrent apnea with intermittent hypoxia is a major clinical problem in preterm infants. Recent studies, although limited, showed that adults who were born preterm exhibit increased incidence of sleep-disordered breathing and hypertension, suggesting that apnea of prematurity predisposes to autonomic dysfunction in adulthood. Here, we demonstrate that adult rats that were exposed to intermittent hypoxia as neonates exhibit exaggerated responses to hypoxia by the carotid body and adrenal chromaffin cells, which regulate cardio-respiratory function, resulting in irregular breathing with apneas and hypertension. The enhanced hypoxic sensitivity was associated with elevated oxidative stress, decreased expression of genes encoding antioxidant enzymes, and increased expression of pro-oxidant enzymes. Decreased expression of the Sod2 gene, which encodes the antioxidant enzyme superoxide dismutase 2, was associated with DNA hypermethylation of a single CpG dinucleotide close to the transcription start site. Treating neonatal rats with decitabine, an inhibitor of DNA methylation, during intermittent hypoxia exposure prevented oxidative stress, enhanced hypoxic sensitivity, and autonomic dysfunction. These findings implicate a hitherto uncharacterized role for DNA methylation in mediating neonatal programming of hypoxic sensitivity and the ensuing autonomic dysfunction in adulthood.blood pressure | developmental programming | norepinephrine I n preterm infants, respiratory disorders with recurrent apnea and the associated intermittent hypoxemia (IH) are major clinical problems (1). Infants with recurrent apnea exhibit an enhanced hypoxic ventilatory response (2), an effect that was attributed to a heightened chemo-reflex arising from the carotid body, which is a sensory organ that detects changes in arterial blood O 2 levels (3). Carotid body sensitivity to hypoxia is reset after birth and this effect is modulated by chronic hypoxia (4-6). Neonatal rats exposed to IH showed exaggerated carotid body and ventilatory responses to hypoxia (7,8). Catecholamine secretion from the adrenal medulla is another important homeostatic mechanism that preserves cardiovascular function under hypoxia (9, 10). In neonates, hypoxia facilitates catecholamine secretion by directly affecting the excitability of adrenal chromaffin cells (11), a response that is markedly augmented in neonatal rats subjected to IH (12,13). Exaggerated hypoxic sensing of carotid body and adrenal chromaffin cells in neonates by IH is attributed to increased oxidative stress (12,14). IH also augments hypoxic responses of the carotid body and adrenal medulla in adult rats (15, 16), which is completely reversed following reoxygenation (15). In striking contrast, in neonates the augmented hypoxic sensitivity that is induced by IH persists into adulthood (8,12,14). The molecular mechanisms underlying the long-lasting effects of neonatal IH on hypoxic sensing and its physiological consequences in adult life are not known.It is being increasingly recognized that environm...

Key pointsr Rats exposed to chronic intermittent hypoxia (CIH) exhibited imbalanced expression of hypoxia-inducible factor (HIF)-α isoforms and oxidative stress in brainstem regions associated with the carotid body (CB) chemoreflex, and in the adrenal medulla, an end organ of the sympathetic nervous system. r Selective ablation of the CB abolished the effects of CIH on HIF-α isoform expression and oxidative stress.r In the adrenal medulla, chemoreflex-mediated sympathetic activation regulates HIF-α isoform expression via muscarinic acetylcholine receptor-mediated Ca 2+ influx and the resultant activation of the mammalian target of rapamycin pathway and calpain proteases.r Thus, CB neural activity regulates HIF-α isoform expressions and redox state in the central and peripheral nervous system associated with the chemoreflex pathway under the setting of CIH.Abstract Previous studies reported that chronic intermittent hypoxia (CIH) results in an imbalanced expression of hypoxia-inducible factor-α (HIF-α) isoforms and oxidative stress in rodents, which may be due either to the direct effect of CIH or indirectly via hitherto uncharacterized mechanism(s). As neural activity is a potent regulator of gene transcription, we hypothesized that carotid body (CB) neural activity contributes to CIH-induced HIF-α isoform expression and oxidative stress in the chemoreflex pathway. Experiments were performed on adult rats exposed to CIH for 10 days. Rats exposed to CIH exhibited: increased HIF-1α and decreased HIF-2α expression; increased NADPH oxidase 2 and decreased superoxide dismutase 2 expression; and oxidative stress in the nucleus tractus solitarius and rostral ventrolateral medulla as well as in the adrenal medulla (AM), a major end organ of the sympathetic nervous system. Selective ablation of the CB abolished these effects. In the AM, sympathetic activation by the CB chemoreflex mediates CIH-induced HIF-α isoform imbalance via muscarinic acetylcholine receptor-mediated Ca 2+ influx, and the resultant activation of mammalian target of rapamycin pathway and calpain proteases. Rats exposed to CIH presented with hypertension, elevated sympathetic activity and increased circulating catecholamines. Selective ablation of either the CB (afferent pathway) or sympathetic innervation to the AM (efferent pathway) abolished these effects. These observations uncover CB neural activity-dependent regulation of HIF-α isoforms Abbreviations Ac-LLM-CHO, N-acetyl-leucine-leucine-methionine-aldehyde; AChR, acetylcholine receptor; AIH, acute intermittent hypoxia; AM, adrenal medulla; ASA, adrenal sympathetic ablation; BAPTA, 1,2-bis(o-aminophenoxy)ethane-N,N,N ,N -tetraacetic acid; BP, blood pressure; CA, catecholamines; CB, carotid body; CBA, carotid body ablation; CIH, chronic intermittent hypoxia; HIF-α, hypoxia-inducible factor alpha; HR, heart rate; mAChR, muscarinic ACh receptor; MDA, malondialdehyde; mTOR, mammalian target of rapamycin; nAChR, nicotinic ACh receptor; Nox2, NADPH oxidase 2; nTS, nucleus tractus solitarious; PC12, phe...

Reflexes initiated by the carotid body, the principal O2-sensing organ, are critical for maintaining cardio-respiratory homeostasis during hypoxia. O2 sensing by the carotid body requires carbon monoxide (CO) generation by heme oxygenase-2 (HO-2) and hydrogen sulfide (H2S) synthesis by cystathionine-γ-lyase (CSE). We report that O2 stimulated the generation of CO, but not that of H2S, and required two cysteine residues in the heme regulatory motif (Cys265 and Cys282) of HO-2. CO stimulated protein kinase G (PKG)–dependent phosphorylation of Ser377 of CSE, inhibiting the production of H2S. Hypoxia decreased the inhibition of CSE by reducing CO generation resulting in increased H2S, which stimulated carotid body neural activity. In carotid bodies from mice lacking HO-2, compensatory increased abundance of nNOS (neuronal nitric oxide synthase) mediated O2 sensing through PKG-dependent regulation of H2S by nitric oxide. These results provide a mechanism for how three gases work in concert in the carotid body to regulate breathing.