FISIOLOGI RESEPTOR

dr. Rebecca Rumesty Lamtiar, M.Biomed

Departemen Fisiologi
Fakultas Kedokteran
Universitas HKBP Nommensen
2016
• Konsep suatu reseptor diantaranya
adalah:
– Menerima sinyal
– Mentransduksikan sinyal
– Berhubungan dengan suatu mekanisme
efektor
 Definisi
• Reseptor adalah:
– Suatu molekul protein yang berinteraksi
dengan sinyal ekstraseluler dan
mengubahnya sehingga memberikan efek
intraseluler
– Bagian dari ujung saraf sensoris yang
mengubah suatu stimulus spesifik menjadi
suatu impuls pada saraf.
 Definisi
• Reseptor
– Sering disebut sebagai transduser selektif
– Mengubah energi stimulus menjadi bentuk
lain yaitu suatu sinyal elektrik yang secara
spesifik menyebabkan perubahan potensial
membran
– Bersifat selektif terhadap stimulus
 Receptors
• Detect stimulus (detectable change) from
different modalities (energy forms) • e.g.
light, heat, sound, pressure, chemical
changes •
• Adequate stimulus = the stimulus to which
the receptor is most sensitive •
• Convert forms of energy into electrical
signals (action potentials) • Process is
called transduction •
Sensation
Perception
 Types of receptors
• Photoreceptors
– Responsive to visible wavelengths of light
• Mechanoreceptors
– Sensitive to mechanical energy
• Thermoreceptors
– Sensitive to heat and cold
 Types of receptors

• Osmoreceptors
– Detect changes in concentration of solutes in body fluids and
resultant changes in osmotic activity •
• Chemoreceptors •
– Sensitive to specific chemicals • Include receptors for smell and
taste and receptors that detect O2 and CO2 concentrations in
blood and chemical content of digestive tract •
• Nociceptors •
– Pain receptors that are sensitive to tissue damage or distortion of
tissue
 Potensial Generator
• Separate receptor  Stimulus causes release of
chemical messenger
• Specialized afferent nerve ending Stimulus alters
receptor’s permeability which leads to graded receptor
potential
• Usually causes nonselective opening of all small ion
channels : receptor (generator) potentials.
• The magnitude of the receptor potential represents the
intensity of the stimulus.
• A receptor potential of sufficient magnitude can produce
an action potential.
• This action potential is propagated along an afferent fiber
to the CNS.
• Resceptors may adapt slowly or rapidly to
sustained stimulation
• Types of receptors according to their speed of
adaptation:
– Phasic receptors:
• Rapidly adapting receptors
• Tactile receptors in skin (the reason you don’t
“feel” your clothes or watch)
– Tonic receptors:
• Do not adapt at all or adapt slowly.
• Muscle stretch receptors, joint proprioceptors (to
continuously receive information regarding posture
and balance)
 Pain
• Primarily a protective mechanism meant to bring
a conscious awareness that tissue damage is
occurring or is about to occur
• Storage of painful experiences in memory helps
us avoid potentially harmful events in future
• Sensation of pain is accompanied by motivated
behavioral responses and emotional reactions
• Subjective perception can be influenced by other
past or present experiences (Are you afraid of
your dentist?)
 Nociceptors
• Nociceptors do not adapt to sustained or
repetitive stimulation
• Three categories:
– Mechanical nociceptors •
• Respond to mechanical damage such as cutting, crushing, or
pinching •
– Thermal nociceptors
• Respond to temperature extremes
– Polymodal nociceptors
• Respond equally to all kinds of damaging stimuli
 prostaglandin
• Released after tissue injury
• As Lowers nociceptors threshold for
activation
• Greatly enhances receptor response to
noxious stimuli
• Aspirin-like drugs inhibit their synthesis
analgesic effect
Characteristics of Pain
 Neurotransmitter
• Two best known pain neurotransmitters:
– Substance P
• Activates ascending pathways that transmit
nociceptive signals to higher levels for further
processing
– Glutamate
• Major excitatory neurotransmitter
• Causes hypersensitivity in the area
– Protection mechanism for healing and against further
damage
 Patofisiologi Nyeri
Heat > 45oC
Tissue damage Stimulus mekanis
Tissue ischemia Stimulus kimiawi
Muscle spasm Stimulus termis
Dan lain-lain Bradikinin,
histamin,
serotonin,
K+, Asam,
enzim
Depolarisa proteolitik,
si Ach.
Nosiseptor
Contoh :
 Berbagai patofisiologi nyeri akibat kerusakan
jaringan :
• kerusakan jaringan pelepasan mediator (histamin,
leukotrien, bradikinin & serotonin → merangsang /
depolarisasi nosiseptor kimia/polimodal  sensasi nyeri
• perdarahanproses pembekuan darah → platelet
melepaskan bradikinin & serotonin → depolarisasi
nosiseptor polimodal/kimia  sensasi nyeri
• histamin → permeabilitas vaskuler ↑ → edema → tekanan
jaringan ↑→ depolarisasi nosiseptor mekanikal  sensasi
nyeri
• sel nekrotik melepas K+ → ↑ konsentrasi K+ & H+ ekstrasel →
depolarisasi nosiseptor kimia  sensasi nyeri.
 Reseptor & Jalur sensasi
• Reseptor : free nerve endings
• Jenis reseptor berdasarkan modalitas:
1. Nosiseptor mekanis
2. Nosiseptor termal
3. Nosiseptor polimodal (irritating chemicals)

• Jenis serat saraf :

1. Myelinated Aδ (2-5 μm)
2. Unmyelinated C (0.4-1.2 μm)
 Pathway
• Reseptor  nervus afferent
 bersinaps di dorsal horn.
• Second-order neuron
melintasi komisura anterior
 melalui anterolateral
pathway  ascending ke
otak melalui 2 jalur :
neospinothalamic tract (fast
pain) atau
paleospinothalamic tract
(slow/dull pain).
• The neospinothalamic tract
menuju thalamus (sensasi
dan persepsi nyeri) , dan
third-order neuron
diteruskan ke kortex
(interpretasi kualitas,
lokasi).

• The paleospinothalamic
tract : menuju brain stem
(pons and medulla) 
thalamus dan hipotalamus.
 Pathway dan Respon
Stimulus Nociceptor Afferent pain fiber

Release Nt

Substance P Glutamat

Reseptor di
Reseptor AMPA NMDA
dorsal horn
cell
Ca2+ influx
2nd order
2nd
neuron
mess.system
Higher center
dorsal horn :
hyperexcitability
Thalamus &supersensitivity
Formasio retikularis (local area)
(persepsi
nyeri) Hipotalamus; sistem
limbik
Respon emosional &
Korteks somatosensori
perilaku terhadap
(mengetahui lokasi nyeri)
nyeri
The Gate-Control Theory of Pain
The Gate-Control Theory of Pain
The Gate-Control Theory of Pain
 Nyeri Viseral
• Gangguan pada organ viseral dapat
menimbulkan nyeri.
• Nyeri disampaikan melalui jalur nyeri
viseral dan jalur nyeri parietal.
• Jalur viseral membawa sinyal nyeri dari
organ (melalui persarafan otonom).
• Jalur parietal membawa sinyal dari
peritonium parietal, pleura, dan
perikardium (melalui persarafan spinal).
Pain fiber innervation of the viscera
Penyebab nyeri viseral :
Mechanical
and chemical
• Iskemi stimulations
• Stimulus kimiawi
• Spasme organ berongga
• Overdistensi organ berongga
• Jaringan sangat sensitif (kapsul hepar,
bronkus, pleura parietal, saluran empedu)
 Referred Pain
Ketika terjadi
stimulasi pada
reseptor nyeri
viseral, sebagian
sinyal dihantarkan
melalui neuron yang
berfungsi sebagai
penghantar nyeri
kulit.
Sehingga nyeri
dirasakan seolah
dari permukaan
tubuh. Figure 10-13b
Referred Pain Sites
 Pain Suppression (“Analgesia”) System
in the Brain and Spinal Cord
 Beberapa transmitter berperan di
dalam sistem analgesia; misalnya
enkephalin , endorfin, dan
serotonin.
 Neuron yang berasal dari
periventricular nuclei dan area
periaqueductal gray  bersinap
ke nukleus raphe magnus 
melepaskan enkephalin .
 Selanjutnya; serat saraf dari
nukleus raphe magnus mengirim
sinyal ke  dorsal horns di spinal
cord mengeluarkan serotonin
• Serotonin menyebabkan
interneuron lokal
mensekresikan enkephalin .

• Enkephalin 
menyebabkan inhibisi
presynaptic dan
postsynaptic terhadap serat
nyeri type C and type Aδ
ketika bersinap di dorsal
horns.
 analgesic system
• Brain has built in analgesic system •
• Suppresses transmission in pain pathways as
they enter spinal cord  Suppress release of
Substance P •
• Depends on presence of opiate receptors •
– Endogenous opiates (morphine like substances) –
endorphins, enkephalins, dynorphin •
• Factors which modulate pain •
– Exercise (“runner’s high”) •
– Stress (survival mechanism) •
– Acupuncture