51
|
Zhu C, Hanna P, Rajendran PS, Shivkumar K. Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: A Clinical Scenario-Based Review. JACC Clin Electrophysiol 2019; 5:881-96. [PMID: 31439288 DOI: 10.1016/j.jacep.2019.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022]
Abstract
Autonomic dysregulation in cardiovascular disease plays a major role in the pathogenesis of arrhythmias. Cardiac neural control relies on complex feedback loops consisting of efferent and afferent limbs, which carry sympathetic and parasympathetic signals from the brain to the heart and sensory signals from the heart to the brain. Cardiac disease leads to neural remodeling and sympathovagal imbalances with arrhythmogenic effects. Preclinical studies of modulation at central and peripheral levels of the cardiac autonomic nervous system have yielded promising results, leading to early stage clinical studies of these techniques in atrial fibrillation and refractory ventricular arrhythmias, particularly in patients with inherited primary arrhythmia syndromes and structural heart disease. However, significant knowledge gaps in basic cardiac neurophysiology limit the success of these neuromodulatory therapies. This review discusses the recent advances in neuromodulation for cardiac arrhythmia management, with a clinical scenario-based approach aimed at bringing neurocardiology closer to the realm of the clinical electrophysiologist.
Collapse
|
52
|
Rasul FT, Bal J, Pereira EA, Tisdall M, Themistocleous M, Haliasos N. Current Surgical Options for Patients with Epilepsy. Curr Pharm Des 2019; 23:6508-6523. [PMID: 29086680 DOI: 10.2174/1381612823666171031101839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/22/2022]
Abstract
Surgery for epilepsy dates back to 1886 and has undergone significant developments. Today it is considered a key treatment modality in patients who are resistant to pharmacological intervention. It improves seizure control, cognition and quality of life. New technologies, advances in surgical technique and progress in scientific research underlie the expansion of surgery in epilepsy treatment. Effectiveness of surgical treatment depends on several factors including the type of epilepsy, the underlying pathology and the localisation of the epileptogenic zone. Timely referral to an experienced epilepsy surgery centre is important to allow the greatest chance of seizure control and to minimise associated morbidity and mortality. Following referral, patients undergo thorough presurgical investigation to evaluate their suitability for surgery. The commonest form of epilepsy treated by surgery is mesial temporal lobe sclerosis and there is Class I evidence for the medium-term efficacy of temporal lobe resection from two randomised control trials. Various other forms of epilepsy are now considered for resective and neuromodulatory surgical intervention due to favourable results. In this article, the authors review the current status of surgical treatment for epilepsy including the presurgical evaluation of patients, surgical techniques and the future directions in epilepsy surgery.
Collapse
Affiliation(s)
- Fahid T Rasul
- Essex Neurosciences Centre, Barking, Havering and Redbridge University NHS Trust, United Kingdom
| | - Jarnail Bal
- Essex Neurosciences Centre, Barking, Havering and Redbridge University NHS Trust, United Kingdom
| | - Erlick A Pereira
- Academic Neurosurgery Unit, St. George's, University of London, United Kingdom
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital for Children, United Kingdom
| | | | - Nikolaos Haliasos
- Essex Neurosciences Centre, Barking, Havering and Redbridge University NHS Trust, United Kingdom
| |
Collapse
|
53
|
Borland MS, Vrana WA, Moreno NA, Fogarty EA, Buell EP, Vanneste S, Kilgard MP, Engineer CT. Pairing vagus nerve stimulation with tones drives plasticity across the auditory pathway. J Neurophysiol 2019; 122:659-671. [PMID: 31215351 DOI: 10.1152/jn.00832.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous studies have demonstrated that pairing vagus nerve stimulation (VNS) with sounds can enhance the primary auditory cortex (A1) response to the paired sound. The neural response to sounds following VNS-sound pairing in other subcortical and cortical auditory fields has not been documented. We predicted that VNS-tone pairing would increase neural responses to the paired tone frequency across the auditory pathway. In this study, we paired VNS with the presentation of a 9-kHz tone 300 times a day for 20 days. We recorded neural responses to tones from 2,950 sites in the inferior colliculus (IC), A1, anterior auditory field (AAF), and posterior auditory field (PAF) 24 h after the last pairing session in anesthetized rats. We found that VNS-tone pairing increased the percentage of IC, A1, AAF, and PAF that responds to the paired tone frequency. Across all tested auditory fields, the response strength to tones was strengthened in VNS-tone paired rats compared with control rats. VNS-tone pairing reduced spontaneous activity, frequency selectivity, and response threshold across the auditory pathway. This is the first study to document both cortical and subcortical plasticity following VNS-sound pairing. Our findings suggest that VNS paired with sound presentation is an effective method to enhance auditory processing.NEW & NOTEWORTHY Previous studies have reported primary auditory cortex plasticity following vagus nerve stimulation (VNS) paired with a sound. This study extends previous findings by documenting that fields across the auditory pathway are altered by VNS-tone pairing. VNS-tone pairing increases the percentage of each field that responds to the paired tone frequency. This is the first study to document both cortical and subcortical plasticity following VNS-sound pairing.
Collapse
Affiliation(s)
- Michael S Borland
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Will A Vrana
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Nicole A Moreno
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Elizabeth A Fogarty
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Elizabeth P Buell
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Sven Vanneste
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Crystal T Engineer
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| |
Collapse
|
54
|
Brázdil M, Doležalová I, Koritáková E, Chládek J, Roman R, Pail M, Jurák P, Shaw DJ, Chrastina J. EEG Reactivity Predicts Individual Efficacy of Vagal Nerve Stimulation in Intractable Epileptics. Front Neurol 2019; 10:392. [PMID: 31118916 PMCID: PMC6507513 DOI: 10.3389/fneur.2019.00392] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Chronic vagal nerve stimulation (VNS) is a well-established non-pharmacological treatment option for drug-resistant epilepsy. This study sought to develop a statistical model for prediction of VNS efficacy. We hypothesized that reactivity of the electroencephalogram (EEG) to external stimuli measured during routine preoperative evaluation differs between VNS responders and non-responders. Materials and Methods: Power spectral analyses were computed retrospectively on pre-operative EEG recordings from 60 epileptic patients with VNS. Thirty five responders and 25 non-responders were compared on the relative power values in four standard frequency bands and eight conditions of clinical assessment-eyes opening/closing, photic stimulation, and hyperventilation. Using logistic regression, groups of electrodes within anatomical areas identified as maximally discriminative by n leave-one-out iterations were used to classify patients. The reliability of the predictive model was verified with an independent data-set from 22 additional patients. Results: Power spectral analyses revealed significant differences in EEG reactivity between responders and non-responders; specifically, the dynamics of alpha and gamma activity strongly reflected VNS efficacy. Using individual EEG reactivity to develop and validate a predictive model, we discriminated between responders and non-responders with 86% accuracy, 83% sensitivity, and 90% specificity. Conclusion: We present a new statistical model with which EEG reactivity to external stimuli during routine presurgical evaluation can be seen as a promising avenue for the identification of patients with favorable VNS outcome. This novel method for the prediction of VNS efficacy might represent a breakthrough in the management of drug-resistant epilepsy, with wide-reaching medical and economic implications.
Collapse
Affiliation(s)
- Milan Brázdil
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia.,Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Irena Doležalová
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| | - Eva Koritáková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Chládek
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia.,Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia
| | - Robert Roman
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Martin Pail
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| | - Pavel Jurák
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czechia
| | - Daniel J Shaw
- Behavioral and Social Neuroscience Research Group, CEITEC-Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Jan Chrastina
- Departments of Neurology and Neurosurgery, Medical Faculty of Masaryk University, Brno Epilepsy Center, St. Anne's University Hospital, Brno, Czechia
| |
Collapse
|
55
|
Buell EP, Borland MS, Loerwald KW, Chandler C, Hays SA, Engineer CT, Kilgard MP. Vagus Nerve Stimulation Rate and Duration Determine whether Sensory Pairing Produces Neural Plasticity. Neuroscience 2019; 406:290-299. [PMID: 30904665 DOI: 10.1016/j.neuroscience.2019.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 01/28/2023]
Abstract
Repeatedly pairing a brief train of vagus nerve stimulation (VNS) with an auditory stimulus drives reorganization of primary auditory cortex (A1), and the magnitude of this VNS-dependent plasticity is dependent on the stimulation parameters, including intensity and pulse rate. However, there is currently little data to guide the selection of VNS train durations, an easily adjusted parameter that could influence the effect of VNS-based therapies. Here, we tested the effect of varying the duration of the VNS train on the extent of VNS-dependent cortical plasticity. Rats were exposed to a 9 kHz tone 300 times per day for 20 days. Coincident with tone presentation, groups received trains of 4, 16, or 64 pulses of VNS delivered at 30 Hz, corresponding to train durations of 0.125 s, 0.5 s, and 2.0 s, respectively. High-density microelectrode mapping of A1 revealed that 0.5 s duration VNS trains significantly increased the number of neurons in A1 that responded to tones near the paired tone frequency. Trains lasting 0.125 or 2.0 s failed to alter A1 responses, indicating that both shorter and longer stimulation durations are less effective at enhancing plasticity. A second set of experiments evaluating the effect of delivering 4 or 64 pulses in a fixed 0.5 s VNS train duration paired with tone presentation reveal that both slower and faster stimulation rates are less effective at enhancing plasticity. We incorporated these results with previous findings describing the effect of stimulation parameters on VNS-dependent plasticity and activation of neuromodulatory networks to generate a model of synaptic activation by VNS.
Collapse
Affiliation(s)
- Elizabeth P Buell
- Texas Biomedical Device Center, Richardson, TX 75080, USA; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA.
| | - Michael S Borland
- Texas Biomedical Device Center, Richardson, TX 75080, USA; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA
| | - Kristofer W Loerwald
- Texas Biomedical Device Center, Richardson, TX 75080, USA; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA
| | - Collin Chandler
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA
| | - Seth A Hays
- Texas Biomedical Device Center, Richardson, TX 75080, USA; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, BSB 11; Richardson, TX 75080, USA
| | - Crystal T Engineer
- Texas Biomedical Device Center, Richardson, TX 75080, USA; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA
| | - Michael P Kilgard
- Texas Biomedical Device Center, Richardson, TX 75080, USA; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, USA
| |
Collapse
|
56
|
Meroni E, Stakenborg N, Viola MF, Boeckxstaens GE. Intestinal macrophages and their interaction with the enteric nervous system in health and inflammatory bowel disease. Acta Physiol (Oxf) 2019; 225:e13163. [PMID: 29998613 PMCID: PMC6519157 DOI: 10.1111/apha.13163] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022]
Abstract
Over the past decades, there has been an increasing understanding of cellular and molecular mechanisms that mediate modulation of the immune system by the autonomic nervous system. The discovery that vagal nerve stimulation (VNS) attenuates endotoxin-induced experimental sepsis paved the way for further studies investigating neuro-immune interaction. In particular, great attention is now given to intestinal macrophages: several studies report the existence of both intrinsic and extrinsic neural mechanisms by which intestinal immune homoeostasis can be regulated in different layers of the intestine, mainly by affecting macrophage activation through neurotransmitter release. Given the important role of inflammation in numerous disease processes, such as inflammatory bowel disease (IBD), cholinergic anti-inflammatory mechanisms are under intense investigation both from a basic and clinical science perspective in immune-mediated diseases such as IBD. This review discusses recent insights on the cross-talk between enteric neurons and the immune system, especially focusing on macrophages, and provides an overview of basic and translational aspects of the cholinergic anti-inflammatory response as therapeutic alternative to reinstall immune homoeostasis in intestinal chronic inflammation.
Collapse
Affiliation(s)
- Elisa Meroni
- Department of Chronic Diseases, Metabolism and AgeingTranslational Research Center for Gastrointestinal Disorders (TARGID)KU Leuven—University of LeuvenLeuvenBelgium
| | - Nathalie Stakenborg
- Department of Chronic Diseases, Metabolism and AgeingTranslational Research Center for Gastrointestinal Disorders (TARGID)KU Leuven—University of LeuvenLeuvenBelgium
| | - Maria Francesca Viola
- Department of Chronic Diseases, Metabolism and AgeingTranslational Research Center for Gastrointestinal Disorders (TARGID)KU Leuven—University of LeuvenLeuvenBelgium
| | - Guy E. Boeckxstaens
- Department of Chronic Diseases, Metabolism and AgeingTranslational Research Center for Gastrointestinal Disorders (TARGID)KU Leuven—University of LeuvenLeuvenBelgium
| |
Collapse
|
57
|
Jiang MN, Zhou YY, Hua DH, Yang JY, Hu ML, Xing YQ. Vagal Nerve Stimulation Attenuates Ischemia-Reperfusion Induced Retina Dysfunction in Acute Ocular Hypertension. Front Neurosci 2019; 13:87. [PMID: 30804746 PMCID: PMC6378858 DOI: 10.3389/fnins.2019.00087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose: The present study aimed to investigate whether cervical vagal nerve stimulation (VNS) could prevent retinal ganglion cell (RGC) loss and retinal dysfunction after ischemia/reperfusion (I/R) injury. Methods: First, rats were randomly divided into sham group (n = 4) and VNS group (n = 12). Activation of the nodose ganglia (NOG), nucleus of the solitary tract (NTS), superior salivatory nucleus (SSN), and pterygopalatine ganglion (PPG) neural circuit were evaluated by c-fos expression at 0 h after sham VNS and at 0 h (n = 4), 6 h (n = 4), 72 h (n = 4) after VNS. Secondly, rats were randomly assigned to I/R group (pressure-induced retinal ischemia for 1 h and reperfusion for 1 h in the right eye, n = 16) and I/R+VNS group (right cervical VNS for 2 h during the I/R period, n = 16). The left eye of each rat served as a control. Electroretinogram (ERG), RGC numbers, tumor necrosis factor-α (TNF-α) and vasoactive intestinal polypeptide (VIP) levels in retina were determined. Additionally, the level of VIP in PPG was evaluated. Results: In the first part of the study, compared with the sham group, the VNS group exhibited significantly increased expression of c-fos in NOG, NTS, SSN, and PPG tissues at 0, 6, and 72 h. In the second part of the study, compared with left eyes, retinal function in right eyes (as assessed by the a-wave, b-wave and the oscillatory potential amplitudes of ERG and RGC data) was significantly decreased by I/R. The decreased retinal function was attenuated by VNS. In addition, I/R induced an increase in inflammation, which was reflected by elevated TNF-α expression in the retina. VNS significantly attenuated the increase in I/R-induced inflammation. Moreover, VIP expression in the retina and PPG, which may contribute to the inhibition of the inflammatory response, was significantly increased after VNS. Conclusion: VNS could protect against retinal I/R injury by downregulating TNF-α. Upregulation of VIP expression due to activation of the NOG-NTS-SSN-PPG neural circuit may underlie to the protective effects of VNS.
Collapse
Affiliation(s)
- Meng-Nan Jiang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu-Yang Zhou
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Di-Hao Hua
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jia-Yi Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Man-Li Hu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yi-Qiao Xing
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
58
|
Abstract
Accumulating evidence suggests that non-invasive and invasive brain stimulation may reduce food craving and calorie consumption rendering these techniques potential treatment options for obesity. Non-invasive transcranial direct current stimulation (tDCS) or repetitive transcranial magnet stimulation (rTMS) are used to modulate activity in superficially located executive control regions, such as the dorsolateral prefrontal cortex (DLPFC). Modulation of the DLPFC’s activity may alter executive functioning and food reward processing in interconnected dopamine-rich regions such as the striatum or orbitofrontal cortex. Modulation of reward processing can also be achieved by invasive deep brain stimulation (DBS) targeting the nucleus accumbens. Another target for DBS is the lateral hypothalamic area potentially leading to improved energy expenditure. To date, available evidence is, however, restricted to few exceptional cases of morbid obesity. The vagal nerve plays a crucial role in signaling the homeostatic demand to the brain. Invasive or non-invasive vagal nerve stimulation (VNS) is thus assumed to reduce appetite, rendering VNS another possible treatment option for obesity. Based on currently available evidence, the U.S. Food and Drug Administration recently approved VNS for the treatment of obesity. This review summarizes scientific evidence regarding these techniques’ efficacy in modulating food craving and calorie intake. It is time for large controlled clinical trials that are necessary to translate currently available research discoveries into patient care.
Collapse
Affiliation(s)
- Burkhard Pleger
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,IFB AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany.,BMBF nutriCARD, Center of Veterinary Public Health, University of Leipzig, Leipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital Leipzig, Leipzig, Germany.,Collaborative Research Centre 874 "Integration and Representation of Sensory Processes", Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
59
|
Yoshida K, Saku K, Kamada K, Abe K, Tanaka-Ishikawa M, Tohyama T, Nishikawa T, Kishi T, Sunagawa K, Tsutsui H. Electrical Vagal Nerve Stimulation Ameliorates Pulmonary Vascular Remodeling and Improves Survival in Rats With Severe Pulmonary Arterial Hypertension. ACTA ACUST UNITED AC 2018; 3:657-671. [PMID: 30456337 PMCID: PMC6234524 DOI: 10.1016/j.jacbts.2018.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
Abstract
Autonomic imbalance has been documented in patients with PAH. Electrical VNS is known to restore autonomic balance and improve heart failure. This study aimed to elucidate the therapeutic effects of VNS on severe PAH in a rat model. VNS significantly restored autonomic balance, decreased mean pulmonary arterial pressure, attenuated pulmonary vascular remodeling, and preserved right ventricular function. In addition, VNS markedly improved the survival of rats with PAH. Our findings may contribute greatly to the development of device therapy for PAH and widen the clinical applicability of VNS.
This study aimed to elucidate the therapeutic effects of electrical vagal nerve stimulation (VNS) on severe pulmonary arterial hypertension in a rat model. In a pathophysiological study, VNS significantly restored autonomic balance, decreased mean pulmonary arterial pressure, attenuated pulmonary vascular remodeling, and preserved right ventricular function. In a survival study, VNS significantly improved the survival rate in both the prevention (VNS from 0 to 5 weeks after a SU5416 injection) and treatment (VNS from 5 to 10 weeks) protocols. Thus, VNS may serve as a novel therapeutic strategy for pulmonary arterial hypertension.
Collapse
Key Words
- BNP, brain natriuretic peptide
- HF, high-frequency
- HRV, heart rate variability
- IL, interleukin
- MCP, monocyte chemotactic protein
- NE, norepinephrine
- NO, nitric oxide
- PA, pulmonary artery
- PAH, pulmonary arterial hypertension
- PAP, pulmonary arterial pressure
- PVR, pulmonary vascular resistance
- RV, right ventricular
- RVEDP, right ventricular end-diastolic pressure
- SS, sham-stimulated
- VNS, vagal nerve stimulation
- autonomic imbalance
- eNOS, endothelial nitric oxide synthase
- mRNA, messenger ribonucleic acid
- pulmonary arterial hypertension
- pulmonary vascular remodeling
- vagal nerve stimulation
Collapse
Affiliation(s)
- Keimei Yoshida
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Keita Saku
- Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
- Address for correspondence: Dr. Keita Saku, Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kazuhiro Kamada
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mariko Tanaka-Ishikawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Nishikawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Kishi
- Department of Advanced Risk Stratification for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| |
Collapse
|
60
|
Affiliation(s)
| | - Daniel M. Greif
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine and the Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
61
|
Loerwald KW, Buell EP, Borland MS, Rennaker RL, Hays SA, Kilgard MP. Varying Stimulation Parameters to Improve Cortical Plasticity Generated by VNS-tone Pairing. Neuroscience 2018; 388:239-247. [PMID: 30063940 DOI: 10.1016/j.neuroscience.2018.07.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
Abstract
Pairing vagus nerve stimulation (VNS) with movements or sounds can direct robust plasticity in motor or auditory cortex, respectively. The degree of map plasticity is influenced by the intensity and pulse width of VNS, number of VNS-event pairings, and the interval between each pairing. It is likely that these parameters interact, influencing optimal implementation of VNS pairing protocols. We varied VNS intensity, number of stimulations, and inter-stimulation interval (ISI) to test for interactions among these parameters. Rats were implanted with a vagus nerve stimulating cuff and randomly assigned to one of three treatment groups to receive 20 days of VNS paired with a 9-kHz tone: (1) Fast VNS: 50 daily pairings of 400-µA VNS with a 30-s ISI; (2) Dispersed VNS: 50 daily pairings of 400-µA VNS with a 180-s ISI; and (3) Standard VNS: 300 daily pairings of 800-µA VNS with a 30-s ISI. Following 20 days of VNS-tone pairing, multi-unit recordings were conducted in primary auditory cortex (A1) and receptive field properties were analyzed. Increasing ISI (Dispersed VNS) did not lead to an enhancement of cortical plasticity. Reducing the current intensity and number of stimulations (Fast VNS) resulted in robust cortical plasticity, using 6 times fewer VNS pairings than the Standard protocol. These findings reveal an interaction between current intensity, stimulation number, and ISI and identify a novel VNS paradigm that is substantially more efficient than the previous standard paradigm.
Collapse
Affiliation(s)
| | - Elizabeth P Buell
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, United States
| | - Michael S Borland
- The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, United States
| | - Robert L Rennaker
- Texas Biomedical Device Center, Richardson, TX 75080, United States; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, BSB 11, Richardson, TX 75080, United States
| | - Seth A Hays
- Texas Biomedical Device Center, Richardson, TX 75080, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, BSB 11, Richardson, TX 75080, United States.
| | - Michael P Kilgard
- Texas Biomedical Device Center, Richardson, TX 75080, United States; The University of Texas at Dallas, School of Behavioral Brain Sciences, 800 West Campbell Road, GR 41, Richardson, TX 75080-3021, United States
| |
Collapse
|
62
|
Tsioufis C, Iliakis P, Kasiakogias A, Konstantinidis D, Lovic D, Petras D, Doumas M, Tsiamis E, Papademetriou V, Tousoulis D. Non-pharmacological Modulation of the Autonomic Nervous System for Heart Failure Treatment: Where do We Stand? Curr Vasc Pharmacol 2018; 16:30-43. [PMID: 28462724 DOI: 10.2174/1570161115666170428124756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION An imbalance in the Autonomic Nervous System (ANS) is a central pathophysiologic mechanism in Heart Failure (HF) and has been a principal target of treatment in these patients. Traditional pharmacologic agents do not provide specific modulation of discrete arms of the ANS, while side effects may lead to poor tolerance. Technological advances have provided a series of invasive methods that may provide a focused effect on the ANS in selected patient groups. Renal denervation, initially targeted for patients with resistant hypertension, has given positive preliminary results in terms of heart structure and function. Baroreceptor stimulation also has ongoing research with respect to its efficacy and longer term effects in HF patients. Vagal nerve stimulation and spinal cord stimulation have limited data but represent novel treatments that target the hard to reach parasympathetic system. CONCLUSION The present review overviews the pathophysiologic basis, current preclinical and clinical data and future expectations of these promising treatments.
Collapse
Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece
| | - Panayiotis Iliakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece
| | - Alexandros Kasiakogias
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece
| | - Dimitrios Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece
| | - Dragan Lovic
- Clinic for Internal Disease InterMedica, Hypertension Centre, Nis. Serbia
| | | | - Michalis Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki. Greece
| | - Eleftherios Tsiamis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece
| | - Vasilios Papademetriou
- Veteran Affairs Medical Center and Georgetown University, Washington, D.C. United States
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece
| |
Collapse
|
63
|
Maharjan A, Wang E, Peng M, Cakmak YO. Improvement of Olfactory Function With High Frequency Non-invasive Auricular Electrostimulation in Healthy Humans. Front Neurosci 2018; 12:225. [PMID: 29740266 PMCID: PMC5928377 DOI: 10.3389/fnins.2018.00225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
In past literature on animal models, invasive vagal nerve stimulation using high frequencies has shown to be effective at modulating the activity of the olfactory bulb (OB). Recent advances in invasive vagal nerve stimulation in humans, despite previous findings in animal models, used low frequency stimulation and found no effect on the olfactory functioning. The present article aimed to test potential effects of non-invasive, high and low frequency vagal nerve stimulation in humans, with supplementary exploration of the orbitofrontal cortex using near-infrared spectroscopy (NIRS). Healthy, male adult participants (n = 18) performed two olfactory tests [odor threshold test (OTT) and supra-threshold test (STT)] before and after receiving high-, low frequency vagal nerve stimulation and placebo (no stimulation). Participant's olfactory functioning was monitored using NIRS, and assessed with two behavioral olfactory tests. NIRS data of separate stimulation parameters were statistically analyzed using repeated-measures ANOVA across different stages. Data from olfactory tests were analyzed using paired parametric and non-parametric statistical tests. Only high frequency, non-invasive vagal nerve stimulation was able to positively modulate the performance of the healthy participants in the STT (p = 0.021, Wilcoxon sign-ranked test), with significant differences in NIRS (p = 0.014, post-hoc with Bonferroni correction) recordings of the right hemispheric, orbitofrontal cortex. The results from the current article implore further exploration of the neurocircuitry involved under vagal nerve stimulation and the effects of non-invasive, high frequency, vagal nerve stimulation toward olfactory dysfunction which showcase in Parkinson's and Alzheimer's Diseases. Despite the sufficient effect size (moderate effect, correlation coefficient (r): 0.39 for the STT) of the current study, future research should replicate the current findings with a larger cohort.
Collapse
Affiliation(s)
- Ashim Maharjan
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Eunice Wang
- Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Mei Peng
- Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Yusuf O Cakmak
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,Brain Health Research Centre, Dunedin, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
| |
Collapse
|
64
|
Buchholz B, Kelly J, Muñoz M, Bernatené EA, Méndez Diodati N, González Maglio DH, Dominici FP, Gelpi RJ. Vagal stimulation mimics preconditioning and postconditioning of ischemic myocardium in mice by activating different protection mechanisms. Am J Physiol Heart Circ Physiol 2018; 314:H1289-H1297. [PMID: 29631370 DOI: 10.1152/ajpheart.00286.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vagal stimulation (VS) during myocardial ischemia and reperfusion has beneficial effects. However, it is not known whether short-term VS applied before ischemia or at the onset of reperfusion protects the ischemic myocardium. This study was designed to determine whether short-term VS applied before ischemia or at the onset of reperfusion reduces myocardial infarct size (IS), mimicking classic preconditioning and postconditioning. A second objective was to study the participation of muscarinic and nicotinic receptors in the protection of both preischemic and reperfusion stimulation. FVB mice were subjected to 30 min of regional myocardial ischemia followed by 2 h of reperfusion without VS, with 10-min preischemic VS (pVS), or with VS during the first 10 min of reperfusion (rVS). pVS reduced IS, and this effect was abolished by atropine and wortmannin. rVS also reduced IS in a similar manner, and this effect was abolished by the α7-nicotinic acetylcholine receptor blocker methyllycaconitine. pVS increased Akt and glycogen synthase kinase (GSK)-3β phosphorylation. No changes in Akt and GSK-3β phosphorylation were observed in rVS. Stimulation-mediated IS protection was abolished with the JAK2 blocker AG490. rVS did not modify IL-6 and IL-10 levels in the plasma or myocardium. Splenic denervation and splenectomy did not abolish the protective effect of rVS. In conclusion, pVS and rVS reduced IS by different mechanisms: pVS activated the Akt/GSK-3β muscarinic pathway, whereas rVS activated α7-nicotinic acetylcholine receptors and JAK2, independently of the cholinergic anti-inflammatory pathway. NEW & NOTEWORTHY Our data suggest, for the first time, that vagal stimulation applied briefly either before ischemia or at the beginning of reperfusion mimics classic preconditioning and postconditioning and reduces myocardial infarction, activating different mechanisms. We also infer an important role of α7-nicotinic receptors for myocardial protection independent of the cholinergic anti-inflammatory pathway.
Collapse
Affiliation(s)
- Bruno Buchholz
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Patología, Instituto de Fisiopatología Cardiovascular , Buenos Aires , Argentina.,Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Bioquímica y Medicina Molecular, Facultad de Medicina , Buenos Aires , Argentina
| | - Jazmín Kelly
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Patología, Instituto de Fisiopatología Cardiovascular , Buenos Aires , Argentina.,Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Bioquímica y Medicina Molecular, Facultad de Medicina , Buenos Aires , Argentina
| | - Marina Muñoz
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Química Biológica, Instituto de Química y Fisicoquímica Biológicas , Buenos Aires , Argentina
| | - Eduardo A Bernatené
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Patología, Instituto de Fisiopatología Cardiovascular , Buenos Aires , Argentina.,Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Bioquímica y Medicina Molecular, Facultad de Medicina , Buenos Aires , Argentina
| | - Nahuel Méndez Diodati
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Patología, Instituto de Fisiopatología Cardiovascular , Buenos Aires , Argentina.,Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Bioquímica y Medicina Molecular, Facultad de Medicina , Buenos Aires , Argentina
| | - Daniel H González Maglio
- Cátedra de Inmunología, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires , Buenos Aires , Argentina.,Instituto de Estudios de la Inmunidad Humoral, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires , Argentina
| | - Fernando P Dominici
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Química Biológica, Instituto de Química y Fisicoquímica Biológicas , Buenos Aires , Argentina
| | - Ricardo J Gelpi
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Patología, Instituto de Fisiopatología Cardiovascular , Buenos Aires , Argentina.,Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Bioquímica y Medicina Molecular, Facultad de Medicina , Buenos Aires , Argentina
| |
Collapse
|
65
|
Ganzer PD, Darrow MJ, Meyers EC, Solorzano BR, Ruiz AD, Robertson NM, Adcock KS, James JT, Jeong HS, Becker AM, Goldberg MP, Pruitt DT, Hays SA, Kilgard MP, Rennaker RL. Closed-loop neuromodulation restores network connectivity and motor control after spinal cord injury. eLife 2018. [PMID: 29533186 PMCID: PMC5849415 DOI: 10.7554/elife.32058] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recovery from serious neurological injury requires substantial rewiring of neural circuits. Precisely-timed electrical stimulation could be used to restore corrective feedback mechanisms and promote adaptive plasticity after neurological insult, such as spinal cord injury (SCI) or stroke. This study provides the first evidence that closed-loop vagus nerve stimulation (CLV) based on the synaptic eligibility trace leads to dramatic recovery from the most common forms of SCI. The addition of CLV to rehabilitation promoted substantially more recovery of forelimb function compared to rehabilitation alone following chronic unilateral or bilateral cervical SCI in a rat model. Triggering stimulation on the most successful movements is critical to maximize recovery. CLV enhances recovery by strengthening synaptic connectivity from remaining motor networks to the grasping muscles in the forelimb. The benefits of CLV persist long after the end of stimulation because connectivity in critical neural circuits has been restored. The spine houses a network of neurons that relays electric signals from the brain cells to the muscles. When the spine is injured, some of these neurons may be damaged and their connections to the muscles broken. As a result, the muscles they command become weak, and movement is impaired. It is possible to strengthen the remaining neural connections with physical rehabilitation, but the results are limited. Vagus nerve stimulation, VNS for short, is a new technique that could help people recuperate better after their spine is injured. The vagus nerve controls the heart, lungs and guts, and it reports the state of the body to the brain. When this nerve is electrically stimulated, it releases chemicals that can strengthen the neural connections between brain, spine and muscles, and even create new ones. This rewiring process is essential to repair or bypass the broken neural connections caused by a spine injury. However, it is still not clear how best to use VNS to optimize recovery. Here, Ganzer et al. study how VNS helps rats whose forelimbs are weakened after a spine injury. Three groups of rats go through physical rehabilitation, using their affected front paws to pull a handle and feed themselves. Two of these groups also receive VNS: their vagus nerve is stimulated either after the best trials (strongest pulls) or worst trials (weakest pulls). Compared to the rehab-only and the worst trials-VNS animals, the rats that receive VNS on the best trials while using their affected paw have many more neuronal connections between their brain and the muscles in this limb. These muscles also become much stronger. VNS during the movement improves recovery whether the rodents have one or two front limbs injured, and the benefits are long lasting. As the rats pull the handle, the neurons involved in the movement get activated: they then carry a molecular ‘signature’ that lasts for a short time. When VNS is applied during that window, it appears to help these neurons form new connections with each other, as well as strengthen existing ones. These improved connections mean the brain can communicate better with the muscles: movement is enhanced, which results in greater functional recovery compared to rehabilitation alone. VNS is already trialed in stroke patients, who have weakened muscles because their brain neurons are damaged. The work by Ganzer et al. provides crucial information on how VNS could ultimately improve the recovery and quality of life of people with spine injuries.
Collapse
Affiliation(s)
- Patrick D Ganzer
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States.,Texas Biomedical Device Center, Richardson, United States
| | - Michael J Darrow
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States
| | - Eric C Meyers
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States.,Texas Biomedical Device Center, Richardson, United States
| | | | - Andrea D Ruiz
- Texas Biomedical Device Center, Richardson, United States
| | | | - Katherine S Adcock
- School of Behavioral Brain Sciences, The University of Texas at Dallas, Richardson, United States
| | - Justin T James
- Texas Biomedical Device Center, Richardson, United States
| | - Han S Jeong
- Texas Biomedical Device Center, Richardson, United States
| | - April M Becker
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, United States
| | - Mark P Goldberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, United States
| | - David T Pruitt
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States.,Texas Biomedical Device Center, Richardson, United States
| | - Seth A Hays
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States.,Texas Biomedical Device Center, Richardson, United States.,School of Behavioral Brain Sciences, The University of Texas at Dallas, Richardson, United States
| | - Michael P Kilgard
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States.,Texas Biomedical Device Center, Richardson, United States.,School of Behavioral Brain Sciences, The University of Texas at Dallas, Richardson, United States
| | - Robert L Rennaker
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, United States.,Texas Biomedical Device Center, Richardson, United States.,School of Behavioral Brain Sciences, The University of Texas at Dallas, Richardson, United States
| |
Collapse
|
66
|
Abstract
Inflammatory bowel disease negatively affects the quality of life of millions of patients around the world. Although the precise etiology of the disease remains elusive, aberrant immune system activation is an underlying cause. As such, therapies that selectively inhibit immune cell activation without broad immunosuppression are desired. Inhibition of immune cell activation preventing pro-inflammatory cytokine production through neural stimulation has emerged as one such treatment. These therapeutics are based on the discovery of the cholinergic anti-inflammatory pathway, a reflex arc that induces efferent vagal nerve signaling to reduce immune cell activation and consequently mortality during septic shock. Despite the success of preclinical and clinical trials, the neural circuitry and mechanisms of action of these immune-regulatory circuits are controversial. At the heart of this controversy is the protective effect of vagal nerve stimulation despite an apparent lack of neuroanatomical connections between the vagus and target organs. Additional studies have further emphasized the importance of sympathetic innervation of these organs, and that alternative neural circuits could be involved in neural regulation of the immune system. Such controversies also extend to the regulation of intestinal inflammation, with the importance of efferent vagus nerve signals in question. Experiments that better characterize these pathways have now been performed by Willemze et al. in this issue of Neurogastroenterology & Motility. These continued efforts will be critical to the development of better neurostimulator based therapeutics for inflammatory bowel disease.
Collapse
Affiliation(s)
- Kaitlin Murray
- Department. of Anatomy, Physiology, and Cell Biology, UC Davis School of Veterinary Medicine, UC Davis, Davis, California, United States of America
| | - Colin Reardon
- Department. of Anatomy, Physiology, and Cell Biology, UC Davis School of Veterinary Medicine, UC Davis, Davis, California, United States of America,Corresponding author: Colin Reardon PhD, Assistant Professor, University of California, Davis, VM: Anatomy, Physiology, & Cell Biology, 1089 Veterinary Medicine Drive, VM3B, Room 2007, Davis, CA 95616, Ph: 530-752-7496,
| |
Collapse
|
67
|
Bayer AD, Blum AS, Asaad WF, Roth J, Toms SA, Deck GM. Fighting Fire with Fire: Surgical Options for Patients with Drug-Resistant Epilepsy. R I Med J (2013) 2018; 101:37-40. [PMID: 29490324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
While antiepileptic drugs (AEDs) provide adequate seizure control for most patients with epilepsy, ~30% continue to have seizures despite treatment with two or more AEDs.1 In addition to direct harm from seizures, poor epilepsy control correlates with higher mortality, morbidity, 2, 3 and cost to the healthcare system.4 In the subset of patients with persistent seizures despite medical management, surgical intervention and neuromodulation may be more effective. Primary care physicians and general neurologists should be aware of non-AED treatment options that are standard of care for drug- resistant epilepsy (DRE).
Collapse
Affiliation(s)
- Alina D Bayer
- Neurology resident at Rhode Island Hospital, Providence, RI
| | - Andrew S Blum
- Professor and Vice Chair of Neurology at the Warren Alpert Medical School of Brown University; Medical Director of the Brown - Rhode Island Hospital Comprehensive Epilepsy Program
| | - Wael F Asaad
- Assistant Professor of Neurosurgery at the Warren Alpert Medical School of Brown University; Director of the Functional Neurosurgery and Epilepsy Program at Rhode Island Hospital
| | - Julie Roth
- Assistant Professor of Neurology at the Warren Alpert Medical School of Brown University; Attending neurologist, specializing in epilepsy, as part of the Comprehensive Epilepsy Program at Rhode Island Hospital
| | - Steven A Toms
- Professor of Neurosurgery and Radiation Oncology at the Warren Alpert Medical School of Brown University; Vice Chair of the Department of Neurosurgery; Director of the Brain Tumor and Stereotactic Radiosurgery Program at Rhode Island Hospital
| | - Gina M Deck
- Assistant Professor of Neurology at the Warren Alpert Medical School of Brown University; Attending neurologist, specializing in epilepsy, as part of the Comprehensive Epilepsy Program at Rhode Island Hospital
| |
Collapse
|
68
|
Kiss A, Tratsiakovich Y, Mahdi A, Yang J, Gonon AT, Podesser BK, Pernow J. Vagal nerve stimulation reduces infarct size via a mechanism involving the alpha-7 nicotinic acetylcholine receptor and downregulation of cardiac and vascular arginase. Acta Physiol (Oxf) 2017; 221:174-181. [PMID: 28238218 DOI: 10.1111/apha.12861] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/17/2016] [Accepted: 02/21/2017] [Indexed: 02/05/2023]
Abstract
AIMS Vagal nerve stimulation (VNS) protects from myocardial and vascular injury following myocardial ischaemia and reperfusion (IR) via a mechanism involving activation of alpha-7 nicotinic acetylcholine receptor (α7 nAChR) and reduced inflammation. Arginase is involved in development of myocardial IR injury driven by inflammatory mediators. The aim of the study was to clarify whether VNS downregulates myocardial and vascular arginase via a mechanism involving activation of α7 nAChR following myocardial IR. METHODS Anaesthetized rats were randomized to (i) sham-operated, (ii) control IR (30-min ischaemia and 2-h reperfusion, (iii) VNS throughout IR, (iv) the arginase inhibitor nor-NOHA+IR, (v) nor-NOHA+VNS+IR, (vi) selective α7 nAChR blockade by methyllycaconitine (MLA) followed by VNS throughout IR and (vii) MLA+IR. RESULTS Infarct size was reduced by VNS compared to control IR (41 ± 3% vs. 67 ± 2% of the myocardium at risk, P < 0.001). Myocardial IR increased myocardial and aortic arginase activity 1.7- and 3.1-fold respectively (P < 0.05). VNS attenuated the increase in arginase activity compared to control IR both in the myocardium and aorta (P < 0.05). MLA partially abolished the cardioprotective effect of VNS and completely abrogated the effect of VNS on arginase activity. Arginase inhibition combined with VNS did not further reduce infarct size. CONCLUSION Vagal nerve stimulation reduced infarct size and reversed the upregulation of arginase induced by IR both in the myocardium and aorta via a mechanism depending on α7 nAChR activation. The data suggest that the cardioprotective effect of VNS is mediated via reduction in arginase activity.
Collapse
Affiliation(s)
- A. Kiss
- Department of Medicine; Unit of Cardiology; Karolinska Institutet; Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center for Biomedical Research; Medical University of Vienna; Vienna Austria
| | - Y. Tratsiakovich
- Department of Medicine; Unit of Cardiology; Karolinska Institutet; Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
| | - A. Mahdi
- Department of Medicine; Unit of Cardiology; Karolinska Institutet; Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
| | - J. Yang
- Department of Medicine; Unit of Cardiology; Karolinska Institutet; Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
| | - A. T. Gonon
- Department of Medicine; Unit of Cardiology; Karolinska Institutet; Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
| | - B. K. Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research at the Center for Biomedical Research; Medical University of Vienna; Vienna Austria
| | - J. Pernow
- Department of Medicine; Unit of Cardiology; Karolinska Institutet; Heart and Vascular Theme; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
69
|
Guarino D, Nannipieri M, Iervasi G, Taddei S, Bruno RM. The Role of the Autonomic Nervous System in the Pathophysiology of Obesity. Front Physiol 2017; 8:665. [PMID: 28966594 PMCID: PMC5606212 DOI: 10.3389/fphys.2017.00665] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/22/2017] [Indexed: 12/18/2022] Open
Abstract
Obesity is reaching epidemic proportions globally and represents a major cause of comorbidities, mostly related to cardiovascular disease. The autonomic nervous system (ANS) dysfunction has a two-way relationship with obesity. Indeed, alterations of the ANS might be involved in the pathogenesis of obesity, acting on different pathways. On the other hand, the excess weight induces ANS dysfunction, which may be involved in the haemodynamic and metabolic alterations that increase the cardiovascular risk of obese individuals, i.e., hypertension, insulin resistance and dyslipidemia. This article will review current evidence about the role of the ANS in short-term and long-term regulation of energy homeostasis. Furthermore, an increased sympathetic activity has been demonstrated in obese patients, particularly in the muscle vasculature and in the kidneys, possibily contributing to increased cardiovascular risk. Selective leptin resistance, obstructive sleep apnea syndrome, hyperinsulinemia and low ghrelin levels are possible mechanisms underlying sympathetic activation in obesity. Weight loss is able to reverse metabolic and autonomic alterations associated with obesity. Given the crucial role of autonomic dysfunction in the pathophysiology of obesity and its cardiovascular complications, vagal nerve modulation and sympathetic inhibition may serve as therapeutic targets in this condition.
Collapse
Affiliation(s)
- Daniela Guarino
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy.,Institute of Clinical Physiology of CNRPisa, Italy.,Scuola Superiore Sant'AnnaPisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| |
Collapse
|
70
|
Jin H, Guo J, Liu J, Lyu B, Foreman RD, Yin J, Shi Z, Chen JDZ. Anti-inflammatory effects and mechanisms of vagal nerve stimulation combined with electroacupuncture in a rodent model of TNBS-induced colitis. Am J Physiol Gastrointest Liver Physiol 2017; 313:G192-G202. [PMID: 28546285 DOI: 10.1152/ajpgi.00254.2016] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to determine the effects and mechanisms of vagal nerve stimulation (VNS) and additive effects of electroacupuncture (EA) on colonic inflammation in a rodent model of IBD. Chronic inflammation in rats was induced by intrarectal TNBS (2,4,6-trinitrobenzenesulfonic acid). The rats were then treated with sham ES (electrical stimulation), VNS, or VNS + EA for 3 wk. Inflammatory responses were assessed by disease activity index (DAI), macroscopic scores and histological scores of colonic tissues, plasma levels of TNFα, IL-1β, and IL-6, and myeloperoxidase (MPO) activity of colonic tissues. The autonomic function was assessed by the spectral analysis of heart rate variability (HRV) derived from the electrocardiogram. It was found that 1) the area under curve (AUC) of DAI was substantially decreased with VNS + EA and VNS, with VNS + EA being more effective than VNS (P < 0.001); 2) the macroscopic score was 6.43 ± 0.61 in the sham ES group and reduced to 1.86 ± 0.26 with VNS (P < 0.001) and 1.29 ± 0.18 with VNS + EA (P < 0.001); 3) the histological score was 4.05 ± 0.58 in the sham ES group and reduced to 1.93 ± 0.37 with VNS (P < 0.001) and 1.36 ± 0.20 with VNS + EA (P < 0.001); 4) the plasma levels of TNFα, IL-1β, IL-6, and MPO were all significantly decreased with VNS and VNS + EA compared with the sham ES group; and 5) autonomically, both VNS + EA and VNS substantially increased vagal activity and decreased sympathetic activity compared with sham EA (P < 0.001, P < 0.001, respectively). In conclusion, chronic VNS improves inflammation in TNBS-treated rats by inhibiting proinflammatory cytokines via the autonomic mechanism. Addition of noninvasive EA to VNS may enhance the anti-inflammatory effect of VNS.NEW & NOTEWORTHY This is the first study to address and compare the effects of vagal nerve stimulation (VNS), electrical acupuncture (EA) and VNS + EA on TNBS (2,4,6-trinitrobenzenesulfonic acid)-induced colitis in rats. The proposed chronic VNS + EA, VNS, and EA were shown to decrease DAI and ameliorate macroscopic and microscopic damages in rats with TNBS-induced colitis via the autonomic pathway. The addition of EA to VNS provided a significant effect on the behavioral assessment of inflammation (DAI, CMDI, and histological score) but not on cytokines or mechanistic measurements, suggesting an overall systemic effect of EA.View this article's corresponding video summary at https://youtu.be/-rEz6HMkErM.
Collapse
Affiliation(s)
- Haifeng Jin
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma.,The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jie Guo
- The First Hospital of Wuhan, Wuhan, China.,Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| | - Jiemin Liu
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma.,University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Guizhou Provincial People's Hospital, Guizhou, Guiyang, China
| | - Bin Lyu
- The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Robert D Foreman
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jieyun Yin
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma.,Ningbo Pace Medical Research Center, Beilun, Ningbo, China; and
| | - Zhaohong Shi
- The First Hospital of Wuhan, Wuhan, China.,Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| | - Jiande D Z Chen
- Veterans Research and Education Foundation, Veterans Affairs Medical Center, Oklahoma City, Oklahoma; .,Ningbo Pace Medical Research Center, Beilun, Ningbo, China; and.,Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| |
Collapse
|
71
|
Abstract
A 17-year-old female, of consanguineous parents, presented with a history of seizures and cognitive decline since the age of 12 years. She had absence, focal dyscognitive, generalized myoclonic, and generalized tonic-clonic seizures, all of which were drug resistant. The diagnosis of Lafora body disease was made based on a compatible clinical, EEG, seizure semiology picture and a disease-causing homozygous mutation in the EPM2A gene. A vagus nerve stimulator (VNS) was inserted and well tolerated with a steady decrease and then stabilization in seizure frequency during the six months following insertion (months 1-6). At follow-up, at 12 months after VNS insertion, there was a persistent improvement. Seizure frequency during months 7-12, compared to pre-VNS, was documented as follows: the absence seizures observed by the family had decreased from four episodes per month to 0 per month, the focal dyscognitive seizures from 300 episodes per month to 90 per month, the generalized myoclonic seizures from 90 clusters per month to eight per month, and the generalized tonic-clonic seizures from 30 episodes per month to 1.5 per month on average. To our knowledge, this is the second case reported in the literature showing efficacy of VNS in the management of seizures in Lafora body disease.
Collapse
|
72
|
Brock C, Brock B, Aziz Q, Møller HJ, Pfeiffer Jensen M, Drewes AM, Farmer AD. Transcutaneous cervical vagal nerve stimulation modulates cardiac vagal tone and tumor necrosis factor-alpha. Neurogastroenterol Motil 2017; 29. [PMID: 27957782 DOI: 10.1111/nmo.12999] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/27/2016] [Indexed: 12/13/2022]
Abstract
The vagus nerve is a central component of cholinergic anti-inflammatory pathways. We sought to evaluate the effect of bilateral transcutaneous cervical vagal nerve stimulation (t-VNS) on validated parameters of autonomic tone and cytokines in 20 healthy subjects. 24 hours after t-VNS, there was an increase in cardiac vagal tone and a reduction in tumor necrosis factor-α in comparison to baseline. No change was seen in blood pressure, cardiac sympathetic index or other cytokines. These preliminary data suggest that t-VNS exerts an autonomic and a subtle antitumor necrosis factor-α effect, which warrants further evaluation in larger controlled studies.
Collapse
Affiliation(s)
- C Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - B Brock
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Q Aziz
- Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - H J Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - M Pfeiffer Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - A M Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - A D Farmer
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, UK
| |
Collapse
|
73
|
Hong J, Desai A, Thadani VM, Roberts DW. Efficacy and safety of corpus callosotomy after vagal nerve stimulation in patients with drug-resistant epilepsy. J Neurosurg 2017; 128:277-286. [PMID: 28298036 DOI: 10.3171/2016.10.jns161841] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Vagal nerve stimulation (VNS) and corpus callosotomy (CC) have both been shown to be of benefit in the treatment of medically refractory epilepsy. Recent case series have reviewed the efficacy of VNS in patients who have undergone CC, with encouraging results. There are few data, however, on the use of CC following VNS therapy. METHODS The records of all patients at the authors' center who underwent CC following VNS between 1998 and 2015 were reviewed. Patient baseline characteristics, operative details, and postoperative outcomes were analyzed. RESULTS Ten patients met inclusion criteria. The median follow-up was 72 months, with a minimum follow-up of 12 months (range 12-109 months). The mean time between VNS and CC was 53.7 months. The most common reason for CC was progression of seizures after VNS. Seven patients had anterior CC, and 3 patients returned to the operating room for a completion of the procedure. All patients had a decrease in the rate of falls and drop seizures; 7 patients experienced elimination of drop seizures. Nine patients had an Engel Class III outcome, and 1 patient had a Class IV outcome. There were 3 immediate postoperative complications and 1 delayed complication. One patient developed pneumonia, 1 developed transient mutism, and 1 had persistent weakness in the nondominant foot. One patient presented with a wound infection. CONCLUSIONS The authors demonstrate that CC can help reduce seizures in patients with medically refractory epilepsy following VNS, particularly with respect to drop attacks.
Collapse
Affiliation(s)
| | - Atman Desai
- 2Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California
| | - Vijay M Thadani
- 3Department of Neurology, Dartmouth-Hitchcock Medical Center,Lebanon, New Hampshire; and
| | - David W Roberts
- 1Section of Neurosurgery, Department of Surgery.,3Department of Neurology, Dartmouth-Hitchcock Medical Center,Lebanon, New Hampshire; and
| |
Collapse
|
74
|
Alexander GM, Huang YZ, Soderblom EJ, He XP, Moseley MA, McNamara JO. Vagal nerve stimulation modifies neuronal activity and the proteome of excitatory synapses of amygdala/piriform cortex. J Neurochem 2017; 140:629-644. [PMID: 27973753 DOI: 10.1111/jnc.13931] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/13/2016] [Accepted: 12/09/2016] [Indexed: 12/19/2022]
Abstract
Vagal Nerve Stimulation (VNS) Therapy® is a United States Food and Drug Administration approved neurotherapeutic for medically refractory partial epilepsy and treatment-resistant depression. The molecular mechanisms underlying its beneficial effects are unclear. We hypothesized that one mechanism involves neuronal activity-dependent modifications of central nervous system excitatory synapses. To begin to test this hypothesis, we asked whether VNS modifies the activity of neurons in amygdala and hippocampus. Neuronal recordings from adult, freely moving rats revealed that activity in both amygdala and hippocampus was modified by VNS immediately after its application, and changes were detected following 1 week of stimulation. To investigate whether VNS modifies the proteome of excitatory synapses, we established a label-free, quantitative liquid chromatography-tandem mass spectrometry workflow that enables global analysis of the constituents of the postsynaptic density (PSD) proteome. PSD proteins were biochemically purified from amygdala/piriform cortex of VNS- or dummy-treated rats following 1-week stimulation, and individual PSD protein levels were quantified by liquid chromatography-tandem mass spectrometry analysis. We identified 1899 unique peptides corresponding to 425 proteins in PSD fractions, of which expression levels of 22 proteins were differentially regulated by VNS with changes greater than 150%. Changes in a subset of these proteins, including significantly increased expression of neurexin-1α, cadherin 13 and voltage-dependent calcium channel α2δ1, the primary target of the antiepileptic drug gabapentin, and decreased expression of voltage-dependent calcium channel γ3, were confirmed by western blot analysis of PSD samples. These results demonstrate that VNS modulates excitatory synapses through regulating a subset of the PSD proteome. Our study reveals molecular targets of VNS and point to possible mechanisms underlying its beneficial effects, including activity-dependent formation of excitatory synapses.
Collapse
Affiliation(s)
- Georgia M Alexander
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yang Zhong Huang
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Erik J Soderblom
- Duke Proteomics Core Facility, Duke University Medical Center, Durham, North Carolina, USA
| | - Xiao-Ping He
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - M Arthur Moseley
- Duke Proteomics Core Facility, Duke University Medical Center, Durham, North Carolina, USA
| | - James O McNamara
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
75
|
Xue RQ, Sun L, Yu XJ, Li DL, Zang WJ. Vagal nerve stimulation improves mitochondrial dynamics via an M 3 receptor/CaMKKβ/AMPK pathway in isoproterenol-induced myocardial ischaemia. J Cell Mol Med 2017; 21:58-71. [PMID: 27491814 PMCID: PMC5192749 DOI: 10.1111/jcmm.12938] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022] Open
Abstract
Mitochondrial dynamics-fission and fusion-are associated with ischaemic heart disease (IHD). This study explored the protective effect of vagal nerve stimulation (VNS) against isoproterenol (ISO)-induced myocardial ischaemia in a rat model and tested whether VNS plays a role in preventing disorders of mitochondrial dynamics and function. Isoproterenol not only caused cardiac injury but also increased the expression of mitochondrial fission proteins [dynamin-related peptide1 (Drp1) and mitochondrial fission protein1 (Fis-1)) and decreased the expression of fusion proteins (optic atrophy-1 (OPA1) and mitofusins1/2 (Mfn1/2)], thereby disrupting mitochondrial dynamics and leading to increase in mitochondrial fragments. Interestingly, VNS restored mitochondrial dynamics through regulation of Drp1, Fis-1, OPA1 and Mfn1/2; enhanced ATP content and mitochondrial membrane potential; reduced mitochondrial permeability transition pore (MPTP) opening; and improved mitochondrial ultrastructure and size. Furthermore, VNS reduced the size of the myocardial infarction and ameliorated cardiomyocyte apoptosis and cardiac dysfunction induced by ISO. Moreover, VNS activated AMP-activated protein kinase (AMPK), which was accompanied by phosphorylation of Ca2+ /calmodulin-dependent protein kinase kinase β (CaMKKβ) during myocardial ischaemia. Treatment with subtype-3 of muscarinic acetylcholine receptor (M3 R) antagonist 4-diphenylacetoxy-N-methylpiperidine methiodide or AMPK inhibitor Compound C abolished the protective effects of VNS on mitochondrial dynamics and function, suggesting that M3 R/CaMKKβ/AMPK signalling are involved in mediating beneficial effects of VNS. This study demonstrates that VNS modulates mitochondrial dynamics and improves mitochondrial function, possibly through the M3 R/CaMKKβ/AMPK pathway, to attenuate ISO-induced cardiac damage in rats. Targeting mitochondrial dynamics may provide a novel therapeutic strategy in IHD.
Collapse
Affiliation(s)
- Run-Qing Xue
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lei Sun
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiao-Jiang Yu
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Dong-Ling Li
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wei-Jin Zang
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| |
Collapse
|
76
|
Dhingra RR, Dutschmann M, Galán RF, Dick TE. Kölliker-Fuse nuclei regulate respiratory rhythm variability via a gain-control mechanism. Am J Physiol Regul Integr Comp Physiol 2016; 312:R172-R188. [PMID: 27974314 DOI: 10.1152/ajpregu.00238.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/14/2016] [Accepted: 12/11/2016] [Indexed: 11/22/2022]
Abstract
Respiration varies from breath to breath. On the millisecond timescale of spiking, neuronal circuits exhibit variability due to the stochastic properties of ion channels and synapses. Does this fast, microscopic source of variability contribute to the slower, macroscopic variability of the respiratory period? To address this question, we modeled a stochastic oscillator with forcing; then, we tested its predictions experimentally for the respiratory rhythm generated by the in situ perfused preparation during vagal nerve stimulation (VNS). Our simulations identified a relationship among the gain of the input, entrainment strength, and rhythm variability. Specifically, at high gain, the periodic input entrained the oscillator and reduced variability, whereas at low gain, the noise interacted with the input, causing events known as "phase slips", which increased variability on a slow timescale. Experimentally, the in situ preparation behaved like the low-gain model: VNS entrained respiration but exhibited phase slips that increased rhythm variability. Next, we used bilateral muscimol microinjections in discrete respiratory compartments to identify areas involved in VNS gain control. Suppression of activity in the nucleus tractus solitarii occluded both entrainment and amplification of rhythm variability by VNS, confirming that these effects were due to the activation of the Hering-Breuer reflex. Suppressing activity of the Kölliker-Fuse nuclei (KFn) enhanced entrainment and reduced rhythm variability during VNS, consistent with the predictions of the high-gain model. Together, the model and experiments suggest that the KFn regulates respiratory rhythm variability via a gain control mechanism.
Collapse
Affiliation(s)
- Rishi R Dhingra
- Department of Neurosciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mathias Dutschmann
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; and
| | - Roberto F Galán
- Department of Electrical Engineering and Computer Science, School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Thomas E Dick
- Department of Neurosciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; .,Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
77
|
Rossi S, Santarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. Philos Trans A Math Phys Eng Sci 2016; 374:rsta.2015.0187. [PMID: 27044999 DOI: 10.1098/rsta.2015.0187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 05/03/2023]
Abstract
Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres). Vagal nerve stimulation (VNS) has shown clinical benefits in patients with pharmacoresistant epilepsy and depression. Non-invasive brain stimulation neuromodulatory techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are also being increasingly investigated for their therapeutic potential in several neurological and psychiatric disorders. In this review, we first address the most common neural targets of each of the mentioned brain stimulation techniques, and the known mechanisms of their neuromodulatory action on stimulated brain networks. Then, we discuss how DBS, VNS, rTMS and tDCS could impact on the function of brainstem centres controlling vital functions, critically reviewing their acute and long-term effects on brain sympathetic outflow controlling heart function and blood pressure. Finally, as there is clear experimental evidence in animals that brain stimulation can affect autonomic and heart functions, we will try to give a critical perspective on how it may enhance our understanding of the cortical/subcortical mechanisms of autonomic cardiovascular regulation, and also if it might find a place among therapeutic opportunities in patients with otherwise intractable autonomic dysfunctions.
Collapse
Affiliation(s)
- Simone Rossi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Emiliano Santarnecchi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Gaetano Valenza
- Department of Information Engineering, and Research Center E. Piaggio, University of Pisa, 56122 Pisa, Italy Neuroscience Statistics Research Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Monica Ulivelli
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| |
Collapse
|
78
|
Shah AP, Carreno FR, Wu H, Chung YA, Frazer A. Role of TrkB in the anxiolytic-like and antidepressant-like effects of vagal nerve stimulation: Comparison with desipramine. Neuroscience 2016; 322:273-86. [PMID: 26899129 DOI: 10.1016/j.neuroscience.2016.02.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/23/2016] [Accepted: 02/09/2016] [Indexed: 12/27/2022]
Abstract
A current hypothesis regarding the mechanism of antidepressant (AD) action suggests the involvement of brain-derived neurotrophic factor (BDNF). Consistent with this hypothesis, the receptor for BDNF (and neurotrophin 4/5 (NT-4/5)), Tropomyosin-related kinase B (TrkB), is activated in rodents by treatment with classical AD drugs. Vagal nerve stimulation (VNS), a therapy for treatment resistant depression (TRD), also activates TrkB in rodents. However, the role of this receptor in the therapeutic effects of VNS is unclear. In the current study, the involvement of TrkB in the effects of VNS was investigated in rats using its inhibitor, K252a. Anxiolytic-like and AD-like effects were analyzed using the novelty suppressed feeding test (NSFT) and forced swim test (FST), respectively. K252a blocked the anxiolytic-like effect of chronic VNS treatment and the AD-like effect of acute VNS treatment. By contrast, blocking TrkB did not prevent either the anxiolytic-like or AD-like effect of chronic treatment with desipramine (DMI), a selective noradrenergic reuptake inhibitor; it did, however, block the acute effect of DMI in the FST. To examine whether the activation of TrkB caused by either VNS or DMI is ligand-dependent, use was made of TrkB-Fc, a molecular scavenger for ligands of TrkB. Intraventricular administration of TrkB-Fc blocked the acute activation of TrkB induced by either treatment, indicating that treatment-induced activation of this receptor is ligand-dependent. The behavioral results highlight differences in the involvement of TrkB in the chronic effects of an AD drug and a stimulation therapy as well as its role in acute versus chronic effects of DMI.
Collapse
Affiliation(s)
- A P Shah
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, TX, USA.
| | - F R Carreno
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, TX, USA
| | - H Wu
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, TX, USA
| | - Y A Chung
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, TX, USA
| | - A Frazer
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, TX, USA; South Texas Veterans Health Care System (STVHCS), Audie L. Murphy Division, San Antonio, TX, USA
| |
Collapse
|
79
|
O'Callaghan EL, Chauhan AS, Zhao L, Lataro RM, Salgado HC, Nogaret A, Paton JFR. Utility of a Novel Biofeedback Device for Within-Breath Modulation of Heart Rate in Rats: A Quantitative Comparison of Vagus Nerve vs. Right Atrial Pacing. Front Physiol 2016; 7:27. [PMID: 26869940 PMCID: PMC4740386 DOI: 10.3389/fphys.2016.00027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/18/2016] [Indexed: 12/04/2022] Open
Abstract
In an emerging bioelectronics era, there is a clinical need for physiological devices incorporating biofeedback that permits natural and demand-dependent control in real time. Here, we describe a novel device termed a central pattern generator (CPG) that uses cutting edge analog circuitry producing temporally controlled, electrical stimulus outputs based on the real time integration of physiological feedback. Motivated by the fact that respiratory sinus arrhythmia (RSA), which is the cyclical changes in heart rate every breath, is an essential component of heart rate variability (HRV) (an indicator of cardiac health), we have explored the versatility and efficiency of the CPG for producing respiratory modulation of heart rate in anesthetized, spontaneously breathing rats. Diaphragmatic electromyographic activity was used as the input to the device and its output connected to either the right cervical vagus nerve or the right atrium for pacing heart rate. We found that the CPG could induce respiratory related heart rate modulation that closely mimicked RSA. Whether connected to the vagus nerve or right atrium, the versatility of the device was demonstrated by permitting: (i) heart rate modulation in any phase of the respiratory cycle, (ii) control of the magnitude of heart rate modulation, and (iii) instant adaptation to changes in respiratory frequency. Vagal nerve pacing was only possible following transection of the nerve limiting its effective use chronically. Pacing via the right atrium permitted better flexibility and control of heart rate above its intrinsic level. This investigation now lays the foundation for future studies using this biofeedback technology permitting closer analysis of both the function and dysfunction of RSA.
Collapse
Affiliation(s)
- Erin L O'Callaghan
- School of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | | | - Le Zhao
- Department of Physics, University of Bath Bath, UK
| | - Renata M Lataro
- School of Physiology, Pharmacology and Neuroscience, University of BristolBristol, UK; Department of Physiology, School of Medicine of Ribeirão Preto, University of São PauloSão Paulo, Brazil
| | - Helio C Salgado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo São Paulo, Brazil
| | | | - Julian F R Paton
- School of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| |
Collapse
|
80
|
LI HAIXIA, YIN JIEYUN, ZHANG ZHAOHUI, WINSTON JOHNH, SHI XUANZHENG, CHEN JIANDED. Auricular vagal nerve stimulation ameliorates burn-induced gastric dysmotility via sympathetic-COX-2 pathways in rats. Neurogastroenterol Motil 2016; 28:36-42. [PMID: 26486522 PMCID: PMC4688125 DOI: 10.1111/nmo.12693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/29/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe burn injury has been demonstrated to delay gastric emptying. The aim of this study was to investigate effects and cellular mechanisms of auricular electroacupuncture (AEA) at the acupoints innervated by the auricular branch of vagus nerve on burn-induced gastric dysmotility in rats. METHODS Propranolol (β-adrenoceptor antagonist) was injected intraperitoneally after the rats underwent burn injury. All experiments were performed 6 h following burn/sham burn injury. AEA was performed at bilateral auricular acupoints for 45 min. Electrocardiogram was recorded for 30 min. Plasma hormones were measured; cyclooxygenase (COX)-2 expressions in gastric tissue were measured using western blotting and real-time RT-PCR. KEY RESULTS (i) Burn injury delayed gastric emptying (p = 0.006) and AEA increased gastric emptying by 49% (p = 0.045). (ii) Burn injury evoked a significant elevation in plasma noradrenaline, which was suppressed by AEA. (iii) Burn injury significantly increased protein and mRNA expressions of COX-2 in gastric fundus and antrum. AEA suppressed burn-induced increase in protein expressions, but not mRNA expressions of COX-2. CONCLUSIONS & INFERENCES Burn injury delays gastric emptying by up-regulating COX-2 attributed to sympathetic overactivity. AEA improves burn-induced delay in gastric emptying, possibly mediated via the sympathetic-COX-2 pathway.
Collapse
Affiliation(s)
- HAIXIA LI
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch at Galveston, Texas,Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JIEYUN YIN
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch at Galveston, Texas,Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21224
| | - ZHAOHUI ZHANG
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch at Galveston, Texas
| | - JOHN H. WINSTON
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch at Galveston, Texas
| | - XUAN-ZHENG SHI
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch at Galveston, Texas
| | - JIANDE D.Z. CHEN
- Department of Internal Medicine, Division of Gastroenterology, University of Texas Medical Branch at Galveston, Texas,Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21224
| |
Collapse
|
81
|
Grioni D, Landi A, Gasperini S, Trezza A, Fiori L, Rigoldi M, Parini R, Sganzerla EP. Vagal Nerve Stimulation in the Treatment of Drug-Resistant Epileptic Encephalopathies in Inborn Errors of Metabolism: Report of 2 Cases. Child Neurol Open 2015; 2:2329048X15612432. [PMID: 28503597 PMCID: PMC5417020 DOI: 10.1177/2329048x15612432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/21/2015] [Accepted: 09/09/2015] [Indexed: 11/15/2022] Open
Abstract
Patients affected by inborn errors of metabolism can develop catastrophic epilepsies ineligible for resective surgery. Few reports concerning vagal nerve stimulation in patients with epileptic encephalopathy in the context of metabolic diseases have been published in the literature. Drug-resistant epilepsies in metabolic disease could be a specific target for vagal nerve stimulation, although the efficacy of this technique in these patients still needs to be proved. The authors report our experience in treating refractory epilepsy with vagal nerve stimulation in 2 patients affected by inborn errors of metabolism. The first patient is a 23-year-old patient affected by glutaric aciduria type II, the other one is a 16-month-old child with nonketotic hyperglycinemia. Vagal nerve stimulation reduced seizures up to 50% in the first case and up to 90% in the second one.
Collapse
Affiliation(s)
- Daniele Grioni
- Child Neuropsychiatric Clinic, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Andrea Landi
- Neurosurgery Clinic, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Serena Gasperini
- Rare Metabolic Disease Unit, Pediatric Department, MBBM Foundation, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Andrea Trezza
- Neurosurgery Clinic, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Leonardo Fiori
- Neurosurgery Clinic, S. Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Miriam Rigoldi
- Rare Metabolic Disease Unit, Pediatric Department, MBBM Foundation, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | - Rossella Parini
- Rare Metabolic Disease Unit, Pediatric Department, MBBM Foundation, San Gerardo Hospital, University of Milan Bicocca, Monza, Italy
| | | |
Collapse
|
82
|
Pruitt DT, Schmid AN, Kim LJ, Abe CM, Trieu JL, Choua C, Hays SA, Kilgard MP, Rennaker RL. Vagus Nerve Stimulation Delivered with Motor Training Enhances Recovery of Function after Traumatic Brain Injury. J Neurotrauma 2015; 33:871-9. [PMID: 26058501 DOI: 10.1089/neu.2015.3972] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Traumatic Brain Injury (TBI) is one of the largest health problems in the United States, and affects nearly 2 million people every year. The effects of TBI, including weakness and loss of coordination, can be debilitating and last years after the initial injury. Recovery of motor function is often incomplete. We have developed a method using electrical stimulation of the vagus nerve paired with forelimb use by which we have demonstrated enhanced recovery from ischemic and hemorrhagic stroke. Here we have tested the hypothesis that vagus nerve stimulation (VNS) paired with physical rehabilitation could enhance functional recovery after TBI. We trained rats to pull on a handle to receive a food reward. Following training, they received a controlled-cortical impact (CCI) in the forelimb area of motor cortex opposite the trained forelimb, and were then randomized into two treatment groups. One group of animals received VNS paired with rehabilitative therapy, whereas another group received rehabilitative therapy without VNS. Following CCI, volitional forelimb strength and task success rate in all animals were significantly reduced. VNS paired with rehabilitative therapy over a period of 5 weeks significantly increased recovery of both forelimb strength and success rate on the isometric pull task compared with rehabilitative training without VNS. No significant improvement was observed in the Rehab group. Our findings indicate that VNS paired with rehabilitative therapy enhances functional motor recovery after TBI.
Collapse
Affiliation(s)
- David T Pruitt
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Ariel N Schmid
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Lily J Kim
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Caroline M Abe
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Jenny L Trieu
- 2 Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Connie Choua
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Seth A Hays
- 2 Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Michael P Kilgard
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| | - Robert L Rennaker
- 1 The, School of Behavioral Brain Sciences, The University of Texas at Dallas , Richardson, Texas.,2 Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas , Richardson, Texas.,3 Texas Biomedical Device Center, The University of Texas at Dallas , Richardson, Texas
| |
Collapse
|
83
|
Deer TR, Mekhail N, Petersen E, Krames E, Staats P, Pope J, Saweris Y, Lad SP, Diwan S, Falowski S, Feler C, Slavin K, Narouze S, Merabet L, Buvanendran A, Fregni F, Wellington J, Levy RM. The appropriate use of neurostimulation: stimulation of the intracranial and extracranial space and head for chronic pain. Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2015; 17:551-70; discussion 570. [PMID: 25112890 DOI: 10.1111/ner.12215] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 04/17/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. METHODS The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors. RESULTS The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational. CONCLUSIONS The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.
Collapse
|
84
|
Sun J, Lu Y, Wugeti N, Aikemu A. The influence of cardiac autonomic nerve plexus on the electrophysiological properties in canines with atrial fibrillation. Int J Clin Exp Med 2015; 8:4968-4978. [PMID: 26131069 PMCID: PMC4483871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND This study sought to examine the effect of the cardiac autonomic nerve plexus, which originates from the vagus nerve trunk, on atrial vulnerability. METHODS Dogs in group I (n = 6) underwent ganglionated plexi (GP) sequential ablation following six hours of left atrial appendage rapid atrial pacing (RAP). The monophasic action potential duration at 90% of repolarization (APD90), effective refractory period (ERP), and the atrial fibrillation inducing rate of bilateral atria and pulmonary veins were recorded at baseline, l h, 3 h and 6 h after pacing, as well as after sequential ablation (RAGP + RIGP ablation, LSGP + RIGP ablation). Dogs in group II (n = 6) received vagus nerve stimulation following six hours of left atrial appendage RAP. APD90, ERP and atrial fibrillation inducing rate of bilateral atria and pulmonary veins were recorded at baseline, 1 h, 3 h and 6 h after pacing, as well as after GP sequential ablation (RAGP + RIGP ablation, LSGP + RIGP ablation). RESULTS In group I, APD90 and ERP progressively shortened and atrial fibrillation inducing rate increased in various sites l h, 3 h and 6 h after RAP (P < 0.05). APD90 and ERP shortened significantly and atrial fibrillation inducing rate was significantly higher in the left atrial appendage and bilateral pulmonary veins than in other sites (P < 0.05). Following GP sequential ablation, APD90, ERP and atrial fibrillation inducing rate were not significantly different from baseline levels (P > 0.05). In group II, APD90 and ERP progressively shortened in various sites over pacing time period, and the atrial fibrillation inducing rate increased l h, 3 h and 6 h after RAP + VNS (P < 0.05). APD90 and ERP shortened significantly and atrial fibrillation inducing rate was significantly higher in the left atrial appendage and right superior/inferior pulmonary veins when compared with other sites (P < 0.05). After GP sequential ablation, APD90, ERP and atrial fibrillation inducing rate were not significantly different from baseline levels (P > 0.05). Compared with group I, APD90 and ERP shortened significantly, while atrial fibrillation inducibility increased significantly at baseline and l h, 3 h, and 6 h after pacing in group II (P < 0.05). After ablation of the four major cardiac GPs, no significant differences were observed in the two groups with respect to APD90, ERP and atrial fibrillation inducing rate (P > 0.05). CONCLUSION GP activation, as a result of vagal nerve stimulation, alters MAP90, ERP and atrial fibrillation inducing rate of the atrium and pulmonary veins and promotes the occurrence of RAF in the early stage of atrial fibrillation, resulting in increased atrial vulnerability and triggering the occurrence and maintenance of atrial fibrillation.
Collapse
Affiliation(s)
- Juan Sun
- Heart Center, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Yanmei Lu
- Heart Center, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Najina Wugeti
- Heart Center, The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054, Xinjiang, China
| | - Ainiwaer Aikemu
- Department of Drug Analysis, Faculty of Pharmacy, Xinjiang Medical UniversityUrumqi 830011, Xinjiang, China
| |
Collapse
|
85
|
DeMazumder D, Kass DA, O'Rourke B, Tomaselli GF. Cardiac resynchronization therapy restores sympathovagal balance in the failing heart by differential remodeling of cholinergic signaling. Circ Res 2015; 116:1691-9. [PMID: 25733594 DOI: 10.1161/circresaha.116.305268] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 03/02/2015] [Indexed: 12/29/2022]
Abstract
RATIONALE Cardiac resynchronization therapy (CRT) is the only heart failure (HF) therapy documented to improve left ventricular function and reduce mortality. The underlying mechanisms are incompletely understood. Although β-adrenergic signaling has been studied extensively, the effect of CRT on cholinergic signaling is unexplored. OBJECTIVE We hypothesized that remodeling of cholinergic signaling plays an important role in the aberrant calcium signaling and depressed contractile and β-adrenergic responsiveness in dyssynchronous HF that are restored by CRT. METHODS AND RESULTS Canine tachypaced dyssynchronous HF and CRT models were generated to interrogate responses specific to dyssynchronous versus resynchronized ventricular contraction during hemodynamic decompensation. Echocardiographic, electrocardiographic, and invasive hemodynamic data were collected from normal controls, dyssynchronous HF and CRT models. Left ventricular tissue was used for biochemical analyses and functional measurements (calcium transient, sarcomere shortening) from isolated myocytes (n=42-104 myocytes per model; 6-9 hearts per model). Human left ventricular myocardium was obtained for biochemical analyses from explanted failing (n=18) and nonfailing (n=7) hearts. The M2 subtype of muscarinic acetylcholine receptors was upregulated in human and canine HF compared with nonfailing controls. CRT attenuated the increased M2 subtype of muscarinic acetylcholine receptor expression and Gαi coupling and enhanced M3 subtype of muscarinic acetylcholine receptor expression in association with enhanced calcium cycling, sarcomere shortening, and β-adrenergic responsiveness. Despite model-dependent remodeling, cholinergic stimulation completely abolished isoproterenol-induced triggered activity in both dyssynchronous HF and CRT myocytes. CONCLUSIONS Remodeling of cholinergic signaling is a critical pathological component of human and canine HF. Differential remodeling of cholinergic signaling represents a novel mechanism for enhancing sympathovagal balance with CRT and may identify new targets for treatment of systolic HF.
Collapse
Affiliation(s)
- Deeptankar DeMazumder
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David A Kass
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian O'Rourke
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gordon F Tomaselli
- From the Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
86
|
Derakhshan N. Vagal Nerve Stimulation for the Treatment of Autism. Ment Illn 2015; 7:5788. [PMID: 26266025 PMCID: PMC4508631 DOI: 10.4081/mi.2015.5788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/10/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nima Derakhshan
- Department of Neurosurgery, Neuroscience Research Center, Shiraz University of Medical Sciences , Iran
| |
Collapse
|
87
|
Perez SM, Carreno FR, Frazer A, Lodge DJ. Vagal nerve stimulation reverses aberrant dopamine system function in the methylazoxymethanol acetate rodent model of schizophrenia. J Neurosci 2014; 34:9261-7. [PMID: 25009259 DOI: 10.1523/JNEUROSCI.0588-14.2014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Vagal nerve stimulation (VNS) is an alternative therapy for epilepsy and treatment refractory depression. Here we examine VNS as a potential therapy for the treatment of schizophrenia in the methylozoxymethanol acetate (MAM) rodent model of the disease. We have previously demonstrated that hyperactivity within ventral regions of the hippocampus (vHipp) drives the dopamine system dysregulation in this model. Moreover, by targeting the vHipp directly, we can reverse aberrant dopamine system function and associated behaviors in the MAM model. Although the central effects of VNS have not been completely delineated, positron emission topographic measurements of cerebral blood flow in humans have consistently reported that VNS stimulation induces bilateral decreases in hippocampal activity. Based on our previous observations, we performed in vivo extracellular electrophysiological recordings in MAM- and saline-treated rats to evaluate the effect of chronic (2 week) VNS treatment on the activity of putative vHipp pyramidal neurons, as well as downstream dopamine neuron activity in the ventral tegmental area. Here we demonstrate that chronic VNS was able to reverse both vHipp hyperactivity and aberrant mesolimbic dopamine neuron function in the MAM model of schizophrenia. Additionally, VNS reversed a behavioral correlate of the positive symptoms of schizophrenia. Because current therapies for schizophrenia are far from adequate, with a large number of patients discontinuing treatment due to low efficacy or intolerable side effects, it is important to explore alternative nonpharmacological treatments. These data provide the first preclinical evidence that VNS may be a possible alternative therapeutic approach for the treatment of schizophrenia.
Collapse
|
88
|
Saku K, Kishi T, Sakamoto K, Hosokawa K, Sakamoto T, Murayama Y, Kakino T, Ikeda M, Ide T, Sunagawa K. Afferent vagal nerve stimulation resets baroreflex neural arc and inhibits sympathetic nerve activity. Physiol Rep 2014; 2:2/9/e12136. [PMID: 25194023 PMCID: PMC4270242 DOI: 10.14814/phy2.12136] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
It has been established that vagal nerve stimulation (VNS) benefits patients and/or animals with heart failure. However, the impact of VNS on sympathetic nerve activity (SNA) remains unknown. In this study, we investigated how vagal afferent stimulation (AVNS) impacts baroreflex control of SNA. In 12 anesthetized Sprague–Dawley rats, we controlled the pressure in isolated bilateral carotid sinuses (CSP), and measured splanchnic SNA and arterial pressure (AP). Under a constant CSP, increasing the voltage of AVNS dose dependently decreased SNA and AP. The averaged maximal inhibition of SNA was ‐28.0 ± 10.3%. To evaluate the dynamic impacts of AVNS on SNA, we performed random AVNS using binary white noise sequences, and identified the transfer function from AVNS to SNA and that from SNA to AP. We also identified transfer functions of the native baroreflex from CSP to SNA (neural arc) and from SNA to AP (peripheral arc). The transfer function from AVNS to SNA strikingly resembled the baroreflex neural arc and the transfer functions of SNA to AP were indistinguishable whether we perturbed ANVS or CSP, indicating that they likely share common central and peripheral neural mechanisms. To examine the impact of AVNS on baroreflex, we changed CSP stepwise and measured SNA and AP responses with or without AVNS. AVNS resets the sigmoidal neural arc downward, but did not affect the linear peripheral arc. In conclusion, AVNS resets the baroreflex neural arc and induces sympathoinhibition in the same manner as the control of SNA and AP by the native baroreflex. Afferent vagal nerve stimulation resets the baroreflex neural arc and inhibits sympathetic nerve activity.
Collapse
Affiliation(s)
- Keita Saku
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takuya Kishi
- Department of Advanced Therapeutics for Cardiovascular Diseases, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takafumi Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yoshinori Murayama
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takamori Kakino
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Masataka Ikeda
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kenji Sunagawa
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| |
Collapse
|
89
|
Hays SA, Khodaparast N, Hulsey DR, Ruiz A, Sloan AM, Rennaker RL, Kilgard MP. Vagus nerve stimulation during rehabilitative training improves functional recovery after intracerebral hemorrhage. Stroke 2014; 45:3097-100. [PMID: 25147331 DOI: 10.1161/strokeaha.114.006654] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Vagus nerve stimulation (VNS) delivered during rehabilitative training enhances neuroplasticity and improves recovery in models of cortical ischemic stroke. However, VNS therapy has not been applied in a model of subcortical intracerebral hemorrhage (ICH). We hypothesized that VNS paired with rehabilitative training after ICH would enhance recovery of forelimb motor function beyond rehabilitative training alone. METHODS Rats were trained to perform an automated, quantitative measure of forelimb function. Once proficient, rats received an intrastriatal injection of bacterial collagenase to induce ICH. Rats then underwent VNS paired with rehabilitative training (VNS+Rehab; n=14) or rehabilitative training without VNS (Rehab; n=12). Rehabilitative training began ≥9 days after ICH and continued for 6 weeks. RESULTS VNS paired with rehabilitative training significantly improved recovery of forelimb function when compared with rehabilitative training without VNS. The VNS+Rehab group displayed a 77% recovery of function, whereas the Rehab group only exhibited 29% recovery. Recovery was sustained after cessation of stimulation. Both groups performed similar amounts of trials during rehabilitative, and lesion size was not different between groups. CONCLUSIONS VNS paired with rehabilitative training confers significantly improved forelimb recovery after ICH compared to rehabilitative training without VNS.
Collapse
Affiliation(s)
- Seth A Hays
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson.
| | - Navid Khodaparast
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Daniel R Hulsey
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Andrea Ruiz
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Andrew M Sloan
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Robert L Rennaker
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| | - Michael P Kilgard
- From the Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering (S.A.H., A.M.S., R.L.R.), Texas Biomedical Device Center (S.A.H., N.K., D.R.H., A.R., R.L.R., M.P.K.), and School of Behavioral Brain Sciences (D.R.H., R.L.R., M.P.K.), The University of Texas at Dallas, Richardson
| |
Collapse
|
90
|
Yamakawa K, So EL, Rajendran PS, Hoang JD, Makkar N, Mahajan A, Shivkumar K, Vaseghi M. Electrophysiological effects of right and left vagal nerve stimulation on the ventricular myocardium. Am J Physiol Heart Circ Physiol 2014; 307:H722-31. [PMID: 25015962 DOI: 10.1152/ajpheart.00279.2014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vagal nerve stimulation (VNS) has been proposed as a cardioprotective intervention. However, regional ventricular electrophysiological effects of VNS are not well characterized. The purpose of this study was to evaluate effects of right and left VNS on electrophysiological properties of the ventricles and hemodynamic parameters. In Yorkshire pigs, a 56-electrode sock was used for epicardial (n = 12) activation recovery interval (ARI) recordings and a 64-electrode catheter for endocardial (n = 9) ARI recordings at baseline and during VNS. Hemodynamic recordings were obtained using a conductance catheter. Right and left VNS decreased heart rate (84 ± 5 to 71 ± 5 beats/min and 84 ± 4 to 73 ± 5 beats/min), left ventricular pressure (89 ± 9 to 77 ± 9 mmHg and 91 ± 9 to 83 ± 9 mmHg), and dP/dtmax (1,660 ± 154 to 1,490 ± 160 mmHg/s and 1,595 ± 155 to 1,416 ± 134 mmHg/s) and prolonged ARI (327 ± 18 to 350 ± 23 ms and 327 ± 16 to 347 ± 21 ms, P < 0.05 vs. baseline for all parameters and P = not significant for right VNS vs. left VNS). No anterior-posterior-lateral regional differences in the prolongation of ARI during right or left VNS were found. However, endocardial ARI prolonged more than epicardial ARI, and apical ARI prolonged more than basal ARI during both right and left VNS. Changes in dP/dtmax showed the strongest correlation with ventricular ARI effects (R(2) = 0.81, P < 0.0001) than either heart rate (R(2) = 0.58, P < 0.01) or left ventricular pressure (R(2) = 0.52, P < 0.05). Therefore, right and left VNS have similar effects on ventricular ARI, in contrast to sympathetic stimulation, which shows regional differences. The decrease in inotropy correlates best with ventricular electrophysiological effects.
Collapse
Affiliation(s)
- Kentaro Yamakawa
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Eileen L So
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California
| | - Pradeep S Rajendran
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California; UCLA Neurocardiology Program, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | - Jonathan D Hoang
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nupur Makkar
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California
| | - Aman Mahajan
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California; UCLA Neurocardiology Program, David Geffen School of Medicine at UCLA, Los Angeles, California; and Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California; UCLA Neurocardiology Program, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | - Marmar Vaseghi
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California; UCLA Neurocardiology Program, David Geffen School of Medicine at UCLA, Los Angeles, California; and
| |
Collapse
|
91
|
Kawada T, Akiyama T, Shimizu S, Kamiya A, Uemura K, Turner MJ, Shirai M, Sugimachi M. Sympathetic afferent stimulation inhibits central vagal activation induced by intravenous medetomidine in rats. Acta Physiol (Oxf) 2013; 209:55-61. [PMID: 23710753 DOI: 10.1111/apha.12123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/08/2013] [Accepted: 05/21/2013] [Indexed: 11/29/2022]
Abstract
AIM To examine whether sympathetic afferent stimulation (SAS) inhibits central vagal activation induced by α2 -adrenergic stimulation. METHODS In anaesthetized Wistar-Kyoto rats, a cardiac microdialysis technique was applied to the left ventricle, and the effect of α2 -adrenergic stimulation by medetomidine on myocardial interstitial acetylcholine (ACh) levels was examined in the absence (n = 6) or the presence (n = 6) of SAS delivered from the left stellate ganglion. The effect of electrical vagal efferent stimulation on myocardial interstitial ACh release was also examined in the absence or the presence of SAS (n = 6). RESULTS Intravenous medetomidine (0.1 mg kg(-1) ) significantly increased myocardial interstitial ACh levels in the absence of SAS (from 1.95 ± 0.79 to 3.36 ± 1.61 nM, P < 0.05), but not in the presence of SAS (from 1.67 ± 0.67 to 2.01 ± 0.78 nM). In contrast, electrical vagal nerve stimulation increased myocardial interstitial ACh level to the same degree regardless of SAS (from 1.66 ± 0.16 to 3.93 ± 0.72 nM without SAS vs. 4.05 ± 0.89 nM with SAS). CONCLUSION Sympathetic afferent stimulation inhibited medetomidine-induced ACh release, but not electrical stimulation-induced ACh release, suggesting that SAS inhibited medetomidine-induced vagal activation via central mechanisms. While central vagal activation by α2 -adrenergic agonists could be an alternative to electrical vagal activation, blocking sympathetic afferent input may be important to increase the efficacy of α2 -adrenergic agonists in enhancing vagal nerve activity.
Collapse
Affiliation(s)
- T. Kawada
- Department of Cardiovascular Dynamics; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - T. Akiyama
- Department of Cardiac Physiology; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - S. Shimizu
- Department of Cardiovascular Dynamics; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - A. Kamiya
- Department of Cardiovascular Dynamics; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - K. Uemura
- Department of Cardiovascular Dynamics; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - M. J. Turner
- Department of Cardiovascular Dynamics; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - M. Shirai
- Department of Cardiac Physiology; National Cerebral and Cardiovascular Center; Osaka; Japan
| | - M. Sugimachi
- Department of Cardiovascular Dynamics; National Cerebral and Cardiovascular Center; Osaka; Japan
| |
Collapse
|
92
|
Hwang GS, Park JS, Yang HM, Lim HS, Choi BJ, Choi SY, Yoon MH, Shin JH, Tahk SJ. Noncoronary ST elevation and polymorphic ventricular tachycardia during left-sided accessory pathway ablation. J Cardiovasc Electrophysiol 2013; 24:1240-5. [PMID: 23889813 DOI: 10.1111/jce.12217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/09/2013] [Accepted: 06/11/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An early repolarization (ER) pattern on electrocardiogram (ECG) sometimes has the risk of polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF). An abnormal ER pattern can develop in various experimental or clinical situations. We experienced 4 cases of abnormal ER pattern with or without PVT during the radiofrequency (RF) ablation of the left accessory pathway. METHODS AND RESULTS An electrophysiologic study and RF ablation were performed in 4 patients. Four patients had atrioventricular reentrant tachycardia. During RF ablation of the left accessory pathway, severe chest pain developed and was followed by abnormal J-point elevation. During the ongoing chest pain and J-point elevation, coronary angiograms showed normal findings. The chest pain and J-point elevation were followed by PVT or VF that was unresponsive to defibrillation. The PVT was spontaneously terminated and repeated. After 0.5 mg atropin was given, chest pain and ECG change disappeared. CONCLUSION The mechanisms of ER syndrome during RF ablation might be increased vagal tone due to chest pain or direct vagal stimulation.
Collapse
Affiliation(s)
- Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
93
|
Wu CW, Dionigi G, Chen HC, Chen HY, Lee KW, Lu IC, Chang PY, Hsiao PJ, Ho KY, Chiang FY. Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery. Head Neck 2012; 35:1443-7. [PMID: 22987562 DOI: 10.1002/hed.23154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Vagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection. METHODS Two hundred twenty patients with 376 nerves at risk were enrolled in this study. VNS without nerve exposure during IONM was applied by simply pressing a ball-tip stimulator on the space between the carotid artery and jugular vein. RESULTS VNS without nerve exposure was feasible in all cases and did not result in any morbidity. All VNS signals were successfully obtained within 30 minutes of the start of the operation and all showed a clear and reliable laryngeal electromyography (EMG) response that was similar to that from the conventional method in which nerve exposure for VNS is applied. CONCLUSIONS VNS without dissecting the carotid sheath is feasible and reliable, rendering it a simple, safe, and surgeon-friendly procedure during IONM.
Collapse
Affiliation(s)
- Che-Wei Wu
- Faculty of Medicine and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital and Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
94
|
Abstract
Epilepsy is a common chronic neurologic disorder affecting approximately 1% of the world population. More than one-third of all epilepsy patients have incompletely controlled seizures or debilitating medication side effects in spite of optimal medical management. Medically refractory epilepsy is associated with excess injury and mortality, psychosocial dysfunction, and significant cognitive impairment. Effective treatment options for these patients can be limited. The cellular mechanisms underlying seizure activity are incompletely understood, though we here describe multiple lines of evidence supporting the likely contribution of astroglia to epilepsy, with focus on individual astrocytes and their network functions. Of the emerging therapeutic modalities for epilepsy, one of the most intriguing is the field of neuromodulation. Neuromodulatory treatment, which consists of administering electrical pulses to neural tissue to modulate its activity leading to a beneficial effect, may be an option for these patients. Current modalities consist of vagal nerve stimulation, open and closed-loop stimulation, and transcranial magnetic stimulation. Due to their unique properties, we here present astrocytes as likely important targets for the developing field of neuromodulation in the treatment of epilepsy.
Collapse
Affiliation(s)
- Mark R Witcher
- Department of Neurosurgery, Wake Forest University Winston-Salem, NC, USA
| | | |
Collapse
|