The respiratory rhythm is generated by the interaction of oscillators disparately distributed throughout the pons, medulla, and spinal cord. According to the classic model, the interaction amongst preBötzinger complex (preBötzC) spontaneously bursting preinspiratory units and Bötzinger complex (BötzC) expiratory cells generates the principal respiratory rhythm, thence relayed caudally to the pattern generating elements and premotoneurons of the rostral and caudal divisions of the ventral respiratory group and bulbospinal units of the dorsal respiratory group. Rhythm and pattern generating elements in the ventrolateral medulla receive powerful phasic and tonic modulatory inputs from diencephalic structures, midbrain, Kölliker-Fuse, and parabrachial nuclei, retrotrapezoid nucleus, parafacial respiratory group, ventrolateral metencephalon, nucleus tractus solitarius, and brainstem reticular formation, collectively shaping the normal eupneic discharge. Empirical and computational studies have generated models of respiratory rhythmogenesis and pattern formation variously predicated upon pacemaker, network, or hybrid pacemaker network mechanisms to explain oscillatory behavior and regularity. Network mechanisms critically require the integrity and functionality of inhibitory synaptic neurotransmission. The operation and contribution of inhibitory elements in respiratory rhythm generation and pattern formation are well demonstrated empirically and incorporated in computational network and hybrid models of breathing. Fast inhibitory synaptic neurotransmission utilizes GABAAergic and glycinergic mediated activation of receptor linked chloride conductances, generating an inwardly directed flux of chloride ions mediating membrane voltage hyperpolarization and is required to generate eupneic respiratory patterns in vivo and situ. Persistence of rhythmicity in the presence of synaptic antagonism of GABAA and glycine receptor mediated fast inhibitory neurotransmission indicates pacemaker generating mechanisms sufficiently capable of independently generating this behavior in vitro and transected intact preparations maintaining the preBötzC as the most rostrally preserved structure. The role of GABAB receptor mediated neuromodulation in respiratory rhythm generation and pattern formation is comparatively significantly less investigated. GABABergic activation of postsynaptic and presynaptic membrane receptors variably upregulates potassium conductances and downregulates calcium conductances. Respiratory rhythm and pattern are powerfully modulated in vivo, in situ, and in vitro by superfusion or localized microinjections of GABABergic agonists and antagonists, though are typically not abolished by these experimental interventions. Directionality and magnitude of these effects exhibit maturational changes. The relative depolarization of chloride reversal potentials during the early neonatal period, with gradual shifts towards normal hyperpolarizing values during development, suggests GABABergic signaling may mediate the inhibitory neurotransmission necessary to generate triphasic eupnea. We review and discuss the role of spontaneously bursting oscillators and network mechanisms predicating upon fast inhibitory synaptic neurotransmission in contributing to respiratory rhythmogenesis and pattern formation.
