Talk Title: Visceral Awakenings
The brain and bladder coordinate to implement fundamental adaptive physiological and social functions; dysfunctions in this integration result in comorbid viscero-behavioral pathology. Urodynamic status must be conveyed to the cortex and be coordinated with arousal and attentional processes so that voiding occurs under appropriate social and environmental conditions. This complex task requires reciprocal communication between the brain and bladder. Anatomical and electrophysiological evidence will be presented supporting the concept that the pontine nuclei, Barrington’s nucleus and the norepinephrine-containing locus coeruleus are part of a circuit that coordinates the descending limb of the micturition reflex with a central limb that initiates arousal and shifts the focus of attention. This fundamental viscero-behavioral coordination is adaptive. However, in engaging this same circuitry, pathology that originates in the bladder can be represented centrally and contribute to viscero-behavioral comorbidity that is characteristic of certain urological disorders in humans. An important neuromodulator within the descending limb of the micturition reflex is the stress-related peptide, corticotropin-releasing factor (CRF). I will introduce the concept that the physiological role of CRF to regulate micturition also functions as a defensive response to social challenges that when repeatedly engaged induces an allostatic load resulting in bladder pathology. The potential translation of these findings in rodents to human disease will also be discussed.