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POINT-COUNTERPOINT
We never denied that the pre-Bötzinger complex is an important component of the pontomedullary respiratory control system. What we denied is that this region contains the exclusive mechanism for the neurogenesis of eupnea. If a noeud vital, why is eupnea only transiently interrupted and/or altered to an ataxic pattern following ablation of neurons in this region (2,6)? Is this alteration, rather than irreversible apnea, now taken as evidence of a noeud vital (1)? It appears inconsistent to consider that this change to an ataxic pattern represents an alteration in the mechanisms of respiratory rhythm generation and yet maintain that all "nongasping" rhythms generated by the isolated medulla must be variants of eupnea (5). As gasping, nongasping medullary rhythms are eliminated, at least sometimes, following a blockade of persistent sodium conductances (4, 5)(9). However, these blockers do not eliminated eupnea of conscious or anaesthetized in vivo or in situ preparations (3, 8). Ramirez and Garcia take exception to our conclusion that pacemakers depending on persistent sodium conductance ("cadmium insensitive") are not essential for the neurogenesis of eupnea by proposing that a blockade of both cadmium-sensitive and cadmium-insensitive pacemakers would be necessary. Yet this hypothesis of dual pacemakers is confounded by the absence of any identification of cadmium-sensitive pacemakers in other than medullary slice preparations. Also, antagonists of cadmium-sensitive pacemakers, such as flufenamic acid, have non-specific blocking actions on synaptic transmission throughout the central nervous system, making interpretation of any changes in eupnea difficult.
As a final word, several investigators (1), including Ramirez and Garcia, evoke plasticity and transformations to deal with the lack of correspondence of their findings from in vitro preparations with those from in situ or in vivo preparations. Perhaps the necessity for so much plasticity and so many transformations to fit aberrant data into the mould of the pre-Bötzinger complex as a noeud vital simply reflects an incorrect mould.
REFERENCES
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