A cholinergic spinal pathway for the adaptive control of breathing.

The ability to amplify motor neuron (MN) output is essential for generating high-intensity motor actions. This is critical for breathing that must be rapidly adjusted to accommodate changing metabolic demands. While brainstem circuits generate the breathing rhythm, the pathways that directly augment respiratory MN output are not well understood. Here, we map first-order inputs to phrenic motor neurons (PMNs), a key respiratory MN population that initiates diaphragm contraction to drive breathing. We identify a predominant spinal input from a distinct subset of genetically defined V0C cholinergic interneurons. We find that these interneurons receive phasic excitation from brainstem respiratory centers, augment phrenic output through M2 muscarinic receptors, and are highly activated under a hypercapnia challenge. Specifically silencing cholinergic interneuron neurotransmission impairs the breathing response to hypercapnia. Collectively, our findings identify a spinal pathway that amplifies breathing, presenting a potential target for promoting recovery of breathing following spinal cord injury.