Arousal-promoting effect of the parabrachial nucleus and the underlying mechanisms: Recent advances

The parabrachial nucleus (PBN) is responsible for integrating both internal and external sensory information and controlling/regulating a wide range of physiological processes, such as feeding, thermogenesis, nociceptive and pruritic sensations, and respiration. Recently, the PBN has been found to be involved in mediating wakefulness maintenance, sleep-wake transition, exogenous neuromodulation of awakening, and arousal-promoting process triggered by drastic changes in the internal environments, such as hypercapnia, hypoxia, and hypertension. Multiple neural pathways and subpopulations of neurons are responsible for arousal-promoting effects of the PBN. The medial PBN seems to be more important for the maintenance of physiological arousal, while the lateral PBN are more crucial in mediating interoception-driven arousal. Glutamatergic projection from the PBN to the basal forebrain (BF) and GABAergic projection from the BF to the cerebral cortex GABAergic neurons are the most pivotal neural pathways for awareness-promotion. Here, we review the relevant literature in this field in recent years and emphasize the potential prospects of PBN stimulation in translational medicine for the rehabilitation of disorders of consciousness.