Compound muscle action potential recording quantitatively assesses functional diaphragm innervation by phrenic motor neurons. Whole-mount diaphragm immunohistochemistry assesses morphological innervation at individual neuromuscular junctions. The goal of this protocol is to demonstrate how these two powerful methodologies can be used in various rodent models of spinal cord disease.
This protocol specifically focuses on tools for assessing phrenic motor neuron (PhMN) innervation of the diaphragm at both the electrophysiological and morphological levels. Compound muscle action potential (CMAP) recording following phrenic nerve stimulation can be used to quantitatively assess functional diaphragm innervation by PhMNs of the cervical spinal cord in vivo in anesthetized rats and mice. Because CMAPs represent simultaneous recording of all myofibers of the whole hemi-diaphragm, it is useful to also examine the phenotypes of individual motor axons and myofibers at the diaphragm NMJ in order to track disease- and therapy-relevant morphological changes such as partial and complete denervation, regenerative sprouting and reinnervation. This can be accomplished via whole-mount immunohistochemistry (IHC) of the diaphragm, followed by detailed morphological assessment of individual NMJs throughout the muscle. Combining CMAPs and NMJ analysis provides a powerful approach for quantitatively studying diaphragmatic innervation in rodent models of CNS and PNS disease.
Amyotrophic Lateral Sclerosis (ALS) is a debilitating motor neuron disease associated with the loss of both upper and lower motor neurons and consequent muscle paralysis. Upon diagnosis, patient survival is on average only 2-5 years1. Phrenic motor neuron (PhMN) loss is a critical component of the pathogenesis of ALS. Patients ultimately die due to loss of PhMN innervation of the diaphragm, the primary muscle of inspiration2,3. Traumatic spinal cord injury (SCI) is also a serious problem with associated breathing difficulties. Approximately 12,000 new cases of SCI occur each year4 due to traumatic damage to the spinal cord. Despite disease heterogeneity with respect to location, type and severity, the majority of SCI cases involve trauma to the cervical spinal cord, which often results in debilitating and persistent respiratory compromise. In addition to ALS and SCI, other central nervous system (CNS) diseases can be associated with diaphragmatic respiratory dysfunction5,6.
The phrenic nerve is an efferent motor nerve that innervates the ipsilateral hemi-diaphragm and that originates from PhMN cell bodies located in the C3-C5 levels of the ipsilateral cervical spinal cord. PhMN output is controlled by descending bulbospinal input from the brainstem in an area known as the rostral ventral respiratory group (rVRG)7. The rVRG-PhMN-diaphragm circuit is central to the control of inspiratory breathing, as well as other non-ventilatory diaphragm behaviors. Various traumatic injuries and neurodegenerative disorders that affect this circuitry can lead to a profound decline in respiratory function and patient quality of life. Descending input to PhMNs from the rVRG, PhMN survival, phrenic nerve integrity and proper innervation at the diaphragm neuromuscular junction (NMJ) are all necessary for normal diaphragm function. It is therefore important to employ techniques that can quantitatively evaluate this circuit in vivo in rodent models of ALS, SCI and other CNS diseases.
With this protocol, the goal is to describe experimental tools for assessing PhMN innervation of the diaphragm at both the electrophysiological and morphological levels. Compound muscle action potentials (CMAPs) are recorded by stimulating all efferent motor neuron axons of a given motor nerve and then analyzing the elicited depolarization response of the target myofibers. This technique can be used in vivo in anesthetized rats and mice to quantify functional innervation of the hemi-diaphragm by PhMNs8. Due to the fact that CMAPs represent simultaneous recording of all (or at least many/most) myofibers of the whole hemi-diaphragm, it is useful to also examine the phenotypes of individual motor axons and myofibers at the diaphragm NMJ in order to track disease- and therapy-relevant morphological changes such as partial and complete denervation, regenerative sprouting and reinnervation. This can be accomplished via whole-mount immunohistochemistry (IHC) of the diaphragm, followed by detailed morphological assessment of individual NMJs throughout the muscle9. Combining CMAPs and NMJ analysis provides a powerful approach for quantitatively studying diaphragmatic innervation in rodent models of CNS and PNS disease.
As respiratory function is compromised in both traumatic SCI and ALS, developing therapies that target breathing and specifically diaphragm innervation are clinically relevant5,6. In order to comprehensively study respiratory function, a combined approach method should be used. CMAPs measure the degree of functional innervation of the diaphragm by way of external phrenic nerve stimulation, but not endogenous bulbospinal respiratory drive8. In addition, these recordings do not allow for examination o…
The authors have nothing to disclose.
This work was supported by the NINDS (grant #1R01NS079702 to A.C.L.) and the SURP Program at Thomas Jefferson University (M.M.).
Paraformaldehyde | Fisher | T353-500 | Make 10% solution first in de-ionized distilled water; make 4% with 1X PBS, adjust pH to 7.4 |
1X Phosphate Buffered Saline, pH 7.4 | Invitrogen | 10010049 | |
2% Bovine serum albumin (2% BSA) | Sigma-Aldrich | A3059-100g | Dissolve 2g BSA into 100mL of 1X PBS |
0.2% Triton X100 in 2% BSA/PBS (Blocking Buffer) | Sigma-Aldrich | T9284-100mL | Dissolve 0.2ml/100mL 2% BSA/PBS |
0.1M Glycine | Sigma-Aldrich | G-7126 | Add 0.185g to 25mL of 2% BSA/PBS |
α-bungarotoxin | Invitrogen | T1175 | Concentration 1:400 |
SMI-312 | Sternberger Monoclonals | SMI312 | Concentration 1:1,000 |
SV2 | Developmental Studies Hybridoma Bank | SV2-Supernatant | Concentration 1:10 |
FITC goat anti-mouse IgG1 | Roche | 3117731001 | Concentration 1:100 |
Silicone rubber | Sylgard, Dow Corning | Part # 184 | Follow instructions that come with kit: can use multiple sized culture dish (30mm, 60mm, 100mm) depending on needs |
Vectashield fluorescent mounting medium | Vector laboratories | H-1000 | This is not a hard-set medium. You will need to secure the cover slip with clear nail polish. |
Small Spring Scissors | Fine Science Tools | 15002-08 | |
Dissection forceps | Fine Science Tools | 11295-51 | |
Software for CMAP recordings | Scope 3.5.6; ADI | ||
Disk surface electrodes | Natus neurology | 019-409000 | |
Subdermal needle electrodes | Natus neurology | 019-453100 | |
Conductive gel | Aquasonic | 122-73720 | |
Stimulator/recording system for CMAP recordings | ADI Powerlab 8SP stimulator | ||
Amplifier for CMAP recordings | BioAMP |