Onuf's nucleus

Onuf's nucleus is a distinct group of neurons located in the ventral part (lamina IX) of the anterior horn of the sacral region of the human spinal cord involved in the maintenance of micturition and defecatory continence, as well as muscular contraction during orgasm. It contains motor neurons, and is the origin of the pudendal nerve. The sacral region of the spinal cord is the fourth segment (cervical, thoracic, and lumbar being the first three) of vertebrae in the spinal cord which consists of the vertebrae 26-30. While working in New York City in 1899, Bronislaw Onuf-Onufrowicz discovered this group of unique cells and originally identified it as “Group X.” “Group X” was considered distinct by Onufrowicz because the cells were different in size from the surrounding neurons in the anterolateral group, suggesting that they were independent.

Structure

Onuf's nucleus is a distinct group of neurons located in the ventral part (lamina IX) of the anterior horn of the sacral region of the human spinal cord involved in the maintenance of micturition and defecatory continence, as well as muscular contraction during orgasm. It contains motor neurons, and is the origin of the pudendal nerve. The sacral region of the spinal cord is the fourth segment (cervical, thoracic, and lumbar being the first three) of vertebrae in the spinal cord which consists of the vertebrae 26-30. and measures about 4–6 mm on each side. In other animals it averages approximately 300-500 on both sides.

Somatic

The motor neurons of Onuf's nucleus innervate striated musculature (rhabdosphincter muscle) which is controlled voluntarily.
A study by Bergmann et al. showed that Onuf nucleus cells have the same cytoskeletal abnormalities as alpha motor neurons in motor neuron disease/amyotrophic lateral sclerosis.

Sexual dimorphism

Onuf's nucleus is sexually dimorphic, meaning that there are differences in Onuf's nucleus between males and females of the same species. Sexual dimorphism of Onuf's nucleus has been found in dogs, monkeys, and humans. Males of these species have more of these motoneurons than do their female counterparts. It has also been shown that the sex differences in Onuf's nucleus can be reduced (or in some cases eliminated) by exposing a prenatal female to high levels of androgen.

Clinical significance

Urinary stress incontinence

Stress urinary incontinence (SUI) is a common disease in women caused by pelvic floor muscle weakness. Coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure, and thus increase pressure on the bladder, are common reasons for urine loss.

There are three layers of muscle that are known to control urine flow through the urethra; an inner band of longitudinal smooth muscle, a middle band of circular smooth muscle, and an external band of striated muscle called the rhabdosphincter. The urethra is controlled by the sympathetic, parasympathetic, and somatic divisions of the peripheral nervous system. The sympathetic innervation (nerve supply) comes from the sympathetic preganglionic neurons located in the upper lumbar spinal cord along the hypogastric nerve and terminates in the longitudinal and circular smooth muscle layers in the urethra. The parasympathetic nerve supply comes from the parasympathetic preganglionic neurons in the sacral spinal cord and also terminates in the longitudinal and circular smooth muscle layers. Finally the somatic nerve supply arises from the urethral sphincter motor neurons in the ventral horn of the sacral spinal cord; better known as Onuf's nucleus. The pudendal nerve that extends from Onuf's nucleus, connects directly to the rhabdosphincter muscle to control micturation.

The sympathetic storage reflex or pelvic-to-hypo-gastric reflex is initiated when the bladder swells. Stretch receptors cause postganglionic neurons to release norepinephrine (NE). NE causes the bladder to relax and the urethra to contract, thus preventing urine loss. The somatic storage reflex or the pelvic-to-pudendal or guarding reflex is initiated when one laughs, sneezes, or coughs, which causes increased bladder pressure. Glutamate is the primary excitatory transmitter for the reflex. Glutamate activates NMDA and AMPA receptors which produce action potentials. These action potentials activate the release of acetylcholine causing the rhabdosphincter muscle fibers to contract. When the guarding reflex does not function normally, SUI occurs.

Shy–Drager syndrome

In order to study Onuf's nucleus from the opposite perspective (meaning cases where it was not preserved) studies were done on Shy–Drager syndrome. Shy–Drager syndrome is a rare neurodegenerative disease that attacks the autonomic nervous system. Since the main symptom of Shy–Drager syndrome is incontinence it makes it a good candidate to study its effects on Onuf's nucleus. When the sacral sections of the spinal cord were studied in patients with Shy–Drager syndrome, it was revealed that cell death was confined to the area of Onuf's nucleus. This, once again, verified the role Onuf's nucleus in vesicorectal function.

History

While working in New York City in 1899, Bronislaw Onuf-Onufrowicz discovered this group of unique cells and originally identified it as “Group X.” “Group X” was considered distinct by Onufrowicz because the cells were different in size from the surrounding neurons in the anterolateral group, suggesting that they were independent.

In addition to differences among location of the motoneurons responsible or sphincter function, it is important to mention the differences in sexual dimorphism between species. Although sexual dimorphism of Onuf's nucleus is present in all species, the extent of the sexual dimorphism varies. For example, sexual dimorphism in the number of perineal motoneurons is less obvious in dogs and humans than it is in rats. This is to be expected because female dogs retain perineal muscles whereas female rats do not have perineal muscles. As in humans, prenatal androgen plays an important role in establishing the sex differences in Onuf's nucleus of these species. If a female is exposed to excess androgen during the prenatal period, the sexual dimorphism does not occur in Onuf's nucleus.