Autonomic Nervous System

AMER H. RAHHAL, MD, PhD

Autonomic Nervous System
Overview

➢ It is the branch of the nervous system that

automatically regulates the function of
internal organs and numerous bodily
functions, such as breathing, heartbeat and
digestion.

➢ These processes all occur without conscious

effort.

➢ The ANS is a complex network that helps

maintain Homeostasis,
Autonomic Nervous System
Overview
Autonomic Nervous System
Anatomy

➢Afferent neurons: sensory input to CNS

✓ Carry sensory input from the periphery to the CNS (Reflex regulation).

➢Efferent neurons: carry output signals from CNS

✓ Carry motor signals from the CNS to the peripheral areas of the body
✓ Two main divisions
❖ Sympathetic neurons (SANS)
❖ Parasympathetic neurons (PANS)

➢Enteric neurons: located in the GIT, send sensory input to both

Sympathetic and Parasympathetic and receive motor out from them.
Autonomic Nervous System
Overview
Why Study the Autonomic Nervous System?

Medicinal
Pathophysiology Chemistry

Therapeutics ANS Pharmacology

Disease State
Management
Autonomic Nervous System
Terminology

➢Synapse: junction between 2 neurons that communicates

the message from the presynaptic neuron to the
postsynaptic neuron.

➢Ganglion: a cluster of neuronal cell bodies in the PNS.

➢Preganglionic neuron: cell body lies within the CNS.

✓ its axon, the preganglionic fiber synapses with the 2nd motor
neuron, the ganglionic neuron, in a peripheral autonomic
ganglion.

➢Postganglionic fiber: (axon) of the ganglionic neuron

extends to the visceral organs.
Autonomic Nervous System
Autonomic Pathways

➢Coordination of homeostatic responses.

✓ Autonomic

✓ Endocrine

✓ Behavioral

➢The Hypothalamus, Pons, and Medulla

Initiate Autonomic, Endocrine, and
Behavioral Responses.
Autonomic Nervous System
Autonomic Control Centers in the Brain

➢Hypothalamus
➢ Water balance, temperature, and hunger.

➢Pons
➢ Respiration.

➢Medulla
➢ Respiration.
➢ Cardiac.
➢ Vomiting.
➢ Swallowing.
Autonomic Nervous System
Motor Pathways

➢The ANS has a chain of Two Motor Neurons.

✓ Preganglionic neuron : exists in brain or spinal cord.
❖ Axon is myelinated.
❖ Postganglionic neuron.
❖ Outside the CNS.

✓ Extends to a specific organ

❖ Axon is un-myelinated ➔ slower response.

➢This arrangement is different from the somatic division

(voluntary motor division) which has only one motor
neuron.
Autonomic Nervous System
Motor Pathways

➢ Two Neuron Chain:

✓ Cell body of first neuron is in CNS.
✓ Axon of first neuron: preganglionic fibers synapse with soma of second
neuron.
✓ Second neuron is in ganglia outside the CNS (in PNS).
✓ Axon of second neuron: postganglionic fibers innervates effecter organ.
Autonomic Nervous System
Comparison of the somatic and autonomic nervous systems
Central
nervous
system Peripheral nervous system Effector organs

Acetylcholine
Somatic nervous Skeletal
system muscle

Acetylcholine Norepinephrine Smooth muscle

(e.g., in stomach)

Sympathetic Ganglion
division Acetylcholine Epinephrine and
Autonomic norepinephrine
nervous Blood Glands
system vessel

Acetylcholine
Parasympathetic Cardiac
division muscle
Ganglion

KEY:
Preganglionic Postganglionic Myelination Preganglionic Postganglionic
axons axons axons axons
(sympathetic) (sympathetic) (parasympathetic) (parasympathetic)
Autonomic Nervous System
Differences Between Somatic and Autonomic Nervous Systems

Somatic Nervous System Autonomic Nervous System

One-neuron system; it
Two-neuron system
originates in the CNS, and
Nerves axons extend to the skeletal
consisting of preganglionic
and postganglionic neurons
muscles served

Smooth muscle, cardiac

Effector organ Skeletal muscle
muscle, glands

Sympathetic and
Subdivisions None
parasympathetic

Acetylcholine, epinephrine
Neurotransmitter Acetylcholine (adrenaline), norepinephrine
Autonomic Nervous System
Antagonistic Control of the Autonomic Division

➢Most internal organs are under

antagonistic control.
✓ One autonomic branch is excitatory
and the other branch is inhibitory.

✓ Example:
❖ Effector organ: heart

❖ Parasympathetic response: slows rate

❖ Sympathetic response: increases rate

and force of contraction
Autonomic Nervous System
Autonomic Sympathetic and Parasympathetic Pathways

➢Sympathetic versus parasympathetic

pathways.
✓ Spinal cord exit.

✓ Neurotransmitters.

✓ Receptors.

➢The major parasympathetic tract is

the Vagus nerve.
Autonomic Nervous System
Sympathetic Division

• Generally stimulates the effector organ (except GIT)

• It is activated in emergencies, flight– or– fight reaction.

• The preganglionic fibers of the sympathetic nervous system produce Acetylcholine and are called
cholinergic fibers.

• Most postganglionic fibers produce Norepinephrine and are called adrenergic fibers (exceptions
are the sweat glands and blood vessels in skin).

• Location of ganglia is within a few cm of CNS, along the vertebral column.

• Sympathetic fibers originate from the thoracolumbar region of the spinal cord (T1 – L2).
Autonomic Nervous System
Sympathetic Division

➢ Short preganglionic fibers.

➢ Long postganglionic fibers.

➢ Postganglionic fibers are distributed throughout

the body.

➢ Postganglionic fibers run from the ganglion to

the organs that they supply.

➢ A single preganglionic fiber connects with 50 to

200 postganglionic neurons.
Autonomic Nervous System
Parasympathetic division

➢ Generally inhibits the effector organ (except in digestive tract).

➢ All pre and postganglionic fibers product Ach and are cholinergic.

➢ Location of ganglia (terminal ganglia) is in or near effector organ.

➢ Preganglionic fibers arise from the CNS (Brain stem) and sacral
region of spinal cord (S2 – S4).

➢ Long preganglionic fibers.

➢ Short postganglionic fibers.

➢ Postganglionic fibers are limited to the head, viscera of chest,

abdomen and pelvis.

➢ A single preganglionic fiber connects with 1 or 2 postganglionic

neurons.
Autonomic Nervous System
Neurotransmitters & Receptors
Autonomic Nervous System
Cholinergic Receptors

➢ Nicotinic receptors:

✓ Are all excitatory.

✓ Their response is rapid (milliseconds).

➢ Muscarinic receptors:

✓ Either excitatory or inhibitory , depending on

the target organ.

✓ Decrease heart activity (Hyperpolarization of

cardiac muscle fibers).

✓ Increase motility in Digestive system

(Depolarization of smooth muscle fibers).
Autonomic Nervous System
Nicotinic Receptors

➢ Located in
✓ The ganglia of both the PANS and SANS
✓ Adrenal medulla
✓ Neuromuscular junction (NMJ)
✓ CNS
➢ Ligand-gated ion (Na+) channel (ionotropic receptors).
➢ Composed of 5 subunits: α2, β, γ, δ.
➢ ACh binds to the α subunits.
➢ Channel opening requires binding of two ACh molecules.
➢ Named “Nicotinic” because can be stimulated by the
alkaloid Nicotine.
Autonomic Nervous System
Muscarinic Receptors
➢ Located postsynaptically:
✓ Smooth muscle
✓ Cardiac muscle

✓ Glands of parasympathetic fibers

✓ Effector organs of cholinergic sympathetic fibers (sweat glands).

➢ Muscarinic receptors: GPCR

➢ The five muscarinic receptor subtypes, M1 - M5, are associated with specific anatomical sites.
For example:
✓ M1: ganglia; secretory glands

✓ M2: myocardium, smooth muscle

✓ M3: bladder, smooth muscle, secretory glands

➢ Named muscarinic as it recognize muscarine “alkaloid present in certain poisonous mushrooms”.

➢ They show a weak affinity for Nicotine.

Autonomic Nervous System
Adrenergic Receptors

➢Adrenergic receptors : Alpha and Beta receptors.

➢Norepinephrine or epinephrine binding to alpha

receptors are stimulatory while their binding to
beta receptors are inhibitory.

➢Both and receptors have distinct subtypes

(alpha 1 , 2 , beta 1, 2, 3 ).
Autonomic Nervous System
Adrenergic Receptors

➢Alpha-1 Receptors:
✓ Reflect the "flight or fight".
✓ Cause constriction of blood vessels (control of B.P.).
✓ Inhibit motility in the gut by contracting sphincter muscles and
relaxing non sphincter tissue.
✓ Mobilize energy by breaking down liver glycogen to glucose.

➢ Alpha-2 Receptors:
✓ found in presynaptic membranes and provide feed back control
of neurotransmitter secretion (Inhibit Calcium influx, decrease
neurotransmitter release).
Autonomic Nervous System
Adrenergic Receptors

➢Beta-1 receptors:
• well known for their effects in the heart ( increase rate
and force of contraction).
• induce muscle relaxation in the gut.

➢Beta-2 receptors:
• Induce bronchodilation.
• Induce smooth muscle relaxation in the gut.
• Induce conversion of glycogen to glucose.
• Stimulate secretion of insulin from pancreas.
Autonomic Nervous System
Adrenergic Receptors
Autonomic Nervous System
Autonomic Sympathetic and Parasympathetic Pathways

➢ The Vagi account for 90% of all preganglionic

parasympathetic fibers in the body.

➢ Major portion of parasympathetic cranial

outflow is via Vagus nerve.

➢ Mixed nerve containing both sensory and motor

fibers.

➢ Sensory input from medulla to cardiovascular,

pulmonary, urinary, reproductive, and digestive
system travels in the afferent fibers of the Vagus
nerve.
Autonomic Nervous System
Autonomic Neuron Structure

➢Neuroeffector junction

➢Postganglionic axon
✓ Varicosities

➢Axon
✓ Neurotransmitter synthesis
Autonomic Nervous System
Norepinephrine Release at a Varicosity of a Sympathetic Neuron
 Autonomic Nervous System
Adrenal Medulla

➢ Primary neurohormone.
✓ Epinephrine.

➢ Multiple and distant targets.

Autonomic Nervous System
Autonomic Agonists and Antagonists
Autonomic Nervous System
Efferent Pathways of the Peripheral Nervous System