Reviewer #1 (Public review):
Summary:
The study by Xu and colleagues provides a useful study of brainstem circuits involved in evoked respiratory reflexes that they define to be cough or cough-like in nature. The study is conducted in mice which has the benefit of allowing for the use of modern transgenic tools, although many of the experiments end up using viral vector-based approaches that could be deployed in any species. The disadvantage of the mouse model is understanding the true identity of the respiratory event that is defined as cough. This limitation requires careful interrogation in order to understand the biology of the circuit under investigation. In this respect, the authors provide an incomplete description of a putative cough pathway linking the caudal spinal trigeminal nucleus with the ventral respiratory group. Neurons assigned as CaMKII+ with putative inputs from the paratrigeminal nucleus are central to this circuit, although the evidence for each of these claims is relatively weak or non-existent. Overall, the study employs interesting methods but limitations in methods and details of methods reduce interpretation of the study outcomes.
Strengths:
The use of modern methods to investigate brainstem circuits involved in an essential respiratory reflex.
Weaknesses:
(1) The most significant issue that needs careful consideration is the exact respiratory response, which is called a cough. The authors show a trace from their plethysmography recordings and superimpose the 3 phases of cough (inspiration, compression, expiration) with confidence, yet the parameters used to delineate these phases are unclear. Of more concern, an identical respiratory trace was reported recently as a sneeze in Jiang et al Cell 2024 (PMID 39243765). Comparing Figure 1 in the Xu study with Figure 5 in the Jiang study, it is impossible to see any difference in the respiratory trace that would allow the assignment of one as cough and the other as sneeze. The audio signals also look remarkably similar and the purported cough signal in the Jiang study is quite different. Gannot et al Nat Neurosci 2024 (PMID 38977887) seems to agree with Xu in the identity of a cough signal, but Li et al Cell 2021 (PMID 34133943) again labels these as sneezes. One of the older studies that tried to classify respiratory signals in mice (Chen et al PlosONE 2013) labeled the Jiang cough trace as a deep inspiration, while sneeze looks different again. To add further confusion, Zhang et al AJP 2017 (PMID 28228416 ) provide yet another respiratory plethysmography trace that they define as a cough, and label responses discussed above as expiration reflexes. This begs the question - who, if anyone, is correct? Interpreting the circuits underlying these peculiar mouse responses depends on accuracy in defining the response in the first instance.
(2) The involvement of the causal nSp5 in cough is an unexpected finding. Some understanding of if and how vagal afferent inputs reach this location would help strengthen the manuscript. The authors claim in the discussion that the nucleus of the solitary tract is not the source of inputs, but rather they may arise from the paratrigeminal nucleus (although no data is presented to support this claim). This could fit with the known jugular vagal afferent pathway, which is embryologically distinct and terminates in trigeminal regions, rather than the NTS. But if this is correct, what does this finding then say about the purported involvement of NTS neurons in cough in mice, for example, the recent study by Gannot et al Nat Neurosci where Tac1-expressing NTS neurons were integral for what they call cough in mice? Xu and colleagues are encouraged to resolve their input circuitry so that we can better understand the pathway under investigation and how it relates to the NTS pathway. Related to this, and the issues differentiating cough-like responses from sneeze, the authors will need to consider how to differentiate their cough-like circuitry from the sneeze pathway from the caudal nSp5 to the cVRG as reported by Li et al Cell 2021. It seems highly possible that the two groups are studying the same circuitry, yet the interpretation is confounded by an inability to agree on the identity of the evoked response.
(3) Injection volumes and titres for AAV transductions are not stated anywhere. The methods (line 484) indicate that different volumes were used for different purposes, but nowhere is this information stated properly. Looking at representative images suggests that volumes were very large, with most of the brainstem often transduced. As single slices are only ever shown it becomes a concern as to how extensive transductions truly are. The authors need to provide complete maps of viral transduction so that readers can understand exactly what regions could contribute to responses, thereby confounding interpretation.
(4) The authors do not provide any data to explore the impacts of manipulations on basal breathing. This is important as impacts on the respiratory patterning will likely have profound effects on evoked responses that are not related to the specific pathway under investigation. For example, in Figure 2b. breathing looks to be severely compromised in the TKO animals and disrupted in the M4 DREADD animals. Figure 3 also shows the effects of optical stimulation on breathing patterns, which appear like apnea with several breakthrough augmented breaths (some labeled as cough?), although hard to see properly in the traces provided. Figure 5, one would expect VRG inhibition to have impacts on breathing, and the traces supplied appear to suggest this is the case. Please include data showing breathing effects and consider how these may confound your study interpretation.