Fig. 9: Signaling pathways and the projection circuit of the ACC-ACC.

a Signaling pathways that mediate the excitatory transmission of ACC to the contralateral ACC. Stimulation of ACC-ACC pre-synapses leads to AMPA/KA receptor-mediated postsynaptic excitatory response and an increase in calcium signaling. b Bilateral short-distance positive feedback projection in the internal ACC. Neurons from the superficial (II/III) and deep (V/VI) layers of the ACC have different output projections. Neurons located in layer II/III mainly project to the ipsilateral ACC and the contralateral ACC, while a mass of layer V/VI neurons project to the thalamus. c Bilateral long-distance positive feedback projection from the ACC. Peripheral nociceptive information is transmitted to the thalamus through the dorsal horn of the spinal cord. ACC neurons receive inputs from the thalamus. This study shows that ACC is directly projected to the contralateral ACC. Neurons in the deep layers of the ACC also send their projections directly or indirectly to the dorsal horn of the spinal cord. This positive spinal dorsal horn-thalamus-cortex-contralateral cortex-spinal dorsal horn loop may also provide a circuit for central sensitization. ACC anterior cingulate cortex.