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Mertens A, Raedt R, Gadeyne S, Carrette E, Boon P, Vonck K. Recent advances in devices for vagus nerve stimulation. Expert Rev Med Devices 2018; 15:527-539. [DOI: 10.1080/17434440.2018.1507732] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ann Mertens
- Department of Neurology, Ghent University Hospital, Gent, Belgium
| | - Robrecht Raedt
- Department of Neurology, Ghent University Hospital, Gent, Belgium
| | - Stefanie Gadeyne
- Department of Neurology, Ghent University Hospital, Gent, Belgium
| | - Evelien Carrette
- Department of Neurology, Ghent University Hospital, Gent, Belgium
| | - Paul Boon
- Department of Neurology, Ghent University Hospital, Gent, Belgium
| | - Kristl Vonck
- Department of Neurology, Ghent University Hospital, Gent, Belgium
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102
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Lee SW, Anderson A, Guzman PA, Nakano A, Tolkacheva EG, Wickman K. Atrial GIRK Channels Mediate the Effects of Vagus Nerve Stimulation on Heart Rate Dynamics and Arrhythmogenesis. Front Physiol 2018; 9:943. [PMID: 30072916 PMCID: PMC6060443 DOI: 10.3389/fphys.2018.00943] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/27/2018] [Indexed: 01/09/2023] Open
Abstract
Diminished parasympathetic influence is central to the pathogenesis of cardiovascular diseases, including heart failure and hypertension. Stimulation of the vagus nerve has shown promise in treating cardiovascular disease, prompting renewed interest in understanding the signaling pathway(s) that mediate the vagal influence on cardiac physiology. Here, we evaluated the contribution of G protein-gated inwardly rectifying K+ (GIRK/Kir3) channels to the effect of vagus nerve stimulation (VNS) on heart rate (HR), HR variability (HRV), and arrhythmogenesis in anesthetized mice. As parasympathetic fibers innervate both atria and ventricle, and GIRK channels contribute to the cholinergic impact on atrial and ventricular myocytes, we collected in vivo electrocardiogram recordings from mice lacking either atrial or ventricular GIRK channels, during VNS. VNS decreased HR and increased HRV in control mice, in a muscarinic receptor-dependent manner. This effect was preserved in mice lacking ventricular GIRK channels, but was nearly completely absent in mice lacking GIRK channels in the atria. In addition, atrial-specific ablation of GIRK channels conferred resistance to arrhythmic episodes induced by VNS. These data indicate that atrial GIRK channels are the primary mediators of the impact of VNS on HR, HRV, and arrhythmogenesis in the anesthetized mouse.
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Affiliation(s)
- Steven W. Lee
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Allison Anderson
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, United States
| | - Pilar A. Guzman
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, United States
| | - Atsushi Nakano
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elena G. Tolkacheva
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Kevin Wickman
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, United States
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103
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Delfiner MS, Nofi C, Li Y, Gerdes AM, Zhang Y. Failing Hearts Are More Vulnerable to Sympathetic, but Not Vagal Stimulation-Induced, Atrial Fibrillation-Ameliorated with Dantrolene Treatment. J Card Fail 2018; 24:460-469. [PMID: 29885493 DOI: 10.1016/j.cardfail.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Both vagal (VS) and sympathetic (SS) stimulations can increase atrial fibrillation (AF) inducibility, with VS being known as more arrhythmogenic in normal hearts. Heart failure (HF) results in autonomic dysfunction (characterized by sympathetic activation and vagal withdrawal) and is associated with an increased AF incidence. This study investigated whether failing hearts, compared with normal control hearts, respond differently to autonomic stimulation-induced AF arrhythmogenesis and the effect of dantrolene on SS-enhanced AF in HF. METHODS AND RESULTS A rat myocardial infarction (MI) HF model was used. In experiment 1, AF inducibility was compared in 9 MI-HF rats versus 10 sham-control animals at baseline, during VS, and during SS with isoproterenol infusion. In experiment 2, dantrolene treatment (n = 8) was compared with placebo-control (n = 9) on SS-induced AF inducibility in HF. Compared with the sham-control, baseline AF inducibility was higher in the MI-HF group. AF inducibility was augmented in both groups by autonomic stimulation. However, under VS the increased magnitude was less in the MI-HF group (49% ± 11% vs 80% ± 10%; P = .029), but under SS was significantly more (53% ± 8% vs 6% ± 7%; P < .001), compared with sham-control. Dantrolene significantly attenuated SS-enhanced AF in HF (69% ± 6% vs 29% ± 9%; P = .006). CONCLUSIONS Failing hearts are less sensitive to VS, but more vulnerable to SS-induced AF compared with normal-control hearts. Dantrolene can significantly attenuate SS-enhanced AF in HF, indicating that cardiac ryanodine receptor dysfunction may play a critical role in SS-enhanced AF in HF, and stabilizing leaky ryanodine receptor with the use of dantrolene may be a new treatment option in this condition.
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Affiliation(s)
- Matthew S Delfiner
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Colleen Nofi
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - A Martin Gerdes
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York.
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104
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Abstract
In this review, we provide an overview of the US Food and Drug Administration (FDA)-approved clinical uses of vagus nerve stimulation (VNS) as well as information about the ongoing studies and preclinical research to expand the use of VNS to additional applications. VNS is currently FDA approved for therapeutic use in patients aged >12 years with drug-resistant epilepsy and depression. Recent studies of VNS in in vivo systems have shown that it has anti-inflammatory properties which has led to more preclinical research aimed at expanding VNS treatment across a wider range of inflammatory disorders. Although the signaling pathway and mechanism by which VNS affects inflammation remain unknown, VNS has shown promising results in treating chronic inflammatory disorders such as sepsis, lung injury, rheumatoid arthritis (RA), and diabetes. It is also being used to control pain in fibromyalgia and migraines. This new preclinical research shows that VNS bears the promise of being applied to a wider range of therapeutic applications.
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Affiliation(s)
- Rhaya L Johnson
- Lawrence D Longo MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Christopher G Wilson
- Lawrence D Longo MD Center for Perinatal Biology, Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA.,Department of Pediatrics, Loma Linda University, Loma Linda, CA, USA
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105
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Qing KY, Wasilczuk KM, Ward MP, Phillips EH, Vlachos PP, Goergen CJ, Irazoqui PP. B fibers are the best predictors of cardiac activity during Vagus nerve stimulation: Qing, vagal B fiber activation and cardiac effects. Bioelectron Med 2018; 4:5. [PMID: 32232081 PMCID: PMC7098216 DOI: 10.1186/s42234-018-0005-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/14/2018] [Indexed: 12/23/2022] Open
Abstract
Background Vagus nerve stimulation (VNS) is a promising therapy for many neurologic and psychiatric conditions. However, determining stimulus parameters for individual patients is a major challenge. The traditional method of titrating stimulus intensity based on patient perception produces highly variable responses. This study explores using the vagal response to measure stimulation dose and predict physiological effect. Clinicians are investigating the use of VNS for heart failure management, and this work aims to correlate cardiac measures with vagal fiber activity. Results By recording vagal activity during VNS in rats and using regression analysis, we found that cardiac activity across all animals was best correlated to the activation of a specific vagal fiber group. With conduction velocities ranging from 5 to 10 m/s, these fibers are classified as B fibers (using the Erlanger-Gasser system) and correspond to vagal parasympathetic efferents. Conclusions B fiber activation can serve as a standardized, objective measure of stimulus dose across all subjects. Tracking fiber activation provides a more systematic way to study the effects of VNS and in the future, may lead to a more consistent method of therapy delivery.
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Affiliation(s)
- Kurt Y Qing
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA.,2Indiana University School of Medicine, Indianapolis, IN USA
| | | | - Matthew P Ward
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| | - Evan H Phillips
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| | - Pavlos P Vlachos
- 3Mechanical Engineering, Purdue University, West Lafayette, IN USA
| | - Craig J Goergen
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
| | - Pedro P Irazoqui
- 1Biomedical Engineering, Purdue University, West Lafayette, IN USA
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106
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Kulkarni K, Xie X, Fernandez de Velasco EM, Anderson A, Martemyanov KA, Wickman K, Tolkacheva EG. The influences of the M2R-GIRK4-RGS6 dependent parasympathetic pathway on electrophysiological properties of the mouse heart. PLoS One 2018; 13:e0193798. [PMID: 29668674 PMCID: PMC5905881 DOI: 10.1371/journal.pone.0193798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
A large body of work has established the prominent roles of the atrial M2R-IKACh signaling pathway, and the negative regulatory protein RGS6, in modulating critical aspects of parasympathetic influence on cardiac function, including pace-making, heart rate (HR) variability (HRV), and atrial arrhythmogenesis. Despite increasing evidence of its innervation of the ventricles, and the expression of M2R, IKACh channel subunits, and RGS6 in ventricle, the effects of parasympathetic modulation on ventricular electrophysiology are less clear. The main objective of our study was to investigate the contribution of M2R-IKACh signaling pathway elements in murine ventricular electrophysiology, using in-vivo ECG measurements, isolated whole-heart optical mapping and constitutive knockout mice lacking IKACh (Girk4–/–) or RGS6 (Rgs6-/-). Consistent with previous findings, mice lacking GIRK4 exhibited diminished HR and HRV responses to the cholinergic agonist carbachol (CCh), and resistance to CCh-induced arrhythmic episodes. In line with its role as a negative regulator of atrial M2R-IKACh signaling, loss of RGS6 correlated with a mild resting bradycardia, enhanced HR and HRV responses to CCh, and increased propensity for arrhythmic episodes. Interestingly, ventricles from mice lacking GIRK4 or RGS6 both exhibited increased action potential duration (APD) at baseline, and APD was prolonged by CCh across all genotypes. Similarly, CCh significantly increased the slope of APD restitution in all genotypes. There was no impact of genotype or CCh on either conduction velocity or heterogeneity. Our data suggests that altered parasympathetic signaling through the M2R-IKACh pathway can affect ventricular electrophysiological properties distinct from its influence on atrial physiology.
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Affiliation(s)
- Kanchan Kulkarni
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Xueyi Xie
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Allison Anderson
- Department of Pharmacology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kirill A. Martemyanov
- Department of Neuroscience, The Scripps Research Institute, Jupiter, Florida, United States of America
| | - Kevin Wickman
- Department of Pharmacology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Elena G. Tolkacheva
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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107
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de Jong MR, Hoogerwaard AF, Adiyaman A, Smit JJJ, Heeg JE, van Hasselt BAAM, Misier ARR, Elvan A. Renal nerve stimulation identifies aorticorenal innervation and prevents inadvertent ablation of vagal nerves during renal denervation. Blood Press 2018; 27:271-279. [DOI: 10.1080/08037051.2018.1463817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mark R. de Jong
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | | | - Ahmet Adiyaman
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jaap Jan J. Smit
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - Jan-Evert Heeg
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | | | | | - Arif Elvan
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
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108
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Antiarrhythmic effects of vagal nerve stimulation after cardiac sympathetic denervation in the setting of chronic myocardial infarction. Heart Rhythm 2018. [PMID: 29530832 DOI: 10.1016/j.hrthm.2018.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neuraxial modulation with cardiac sympathetic denervation (CSD) can potentially reduce burden of ventricular tachyarrhythmia (VT). However, despite catheter ablation and CSD, VT can recur in patients with cardiomyopathy and the role of vagal nerve stimulation (VNS) in this setting is unclear. OBJECTIVE The purpose of this study was to evaluate the electrophysiological effects of VNS after CSD in normal and infarcted hearts. METHODS In 10 normal and 6 infarcted pigs, electrophysiological and hemodynamic parameters were evaluated before and during intermittent VNS pre-CSD (bilateral stellectomy and T2-T4 thoracic ganglia removal) as well as post-CSD. The effect of VNS during isoproterenol was also assessed pre- and post-CSD. Multielectrode ventricular activation recovery interval (ARI) recordings, a surrogate of action potential duration, were obtained. VT inducibility was tested during isoproterenol infusion after CSD with and without VNS. RESULTS VNS increased the global ARI by 4% ± 4% pre-CSD and by 5% ± 6% post-CSD, with enhanced effects observed during isoproterenol infusion (10% ± 8% pre-CSD and 12% ± 9% post-CSD) in normal animals. In infarcted animals pre-CSD, VNS increased ARI by 6% ± 7% before and by 13% ± 8% during isoproterenol infusion. Post-CSD, VNS increased ARI by 6% ± 5% before and by 11% ± 7% during isoproterenol infusion. VT was inducible in all infarcted animals post-CSD during isoproterenol infusion; this inducibility was reduced by 67% with VNS (P = .01). In all animals, the hemodynamic effects of VNS remained after CSD. CONCLUSION After CSD, the beneficial electrophysiological effects of VNS remain. Furthermore, VNS can reduce VT inducibility beyond CSD in the setting of circulating catecholamines, suggesting a role for additional parasympathetic modulation in the treatment of ventricular arrhythmias.
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109
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Mukhametshina A, Petrov A, Fedorenko S, Petrov K, Nizameev I, Mustafina A, Sinyashin O. Luminescent nanoparticles for rapid monitoring of endogenous acetylcholine release in mice atria. LUMINESCENCE 2018; 33:588-593. [PMID: 29377578 DOI: 10.1002/bio.3450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/20/2017] [Accepted: 12/11/2017] [Indexed: 01/06/2023]
Abstract
The present work introduces for the first time a nanoparticulate approach for ex vivo monitoring of acetylcholinesterase-catalyzed hydrolysis of endogenous acetylcholine released from nerve varicosities in mice atria. Amino-modified 20-nm size silica nanoparticles (SNs) doped by luminescent Tb(III) complexes were applied as the nanosensors. Their sensing capacity results from the decreased intensity of Tb(III)-centred luminescence due to the quenching effect of acetic acid derived from acetylcholinesterase-catalyzed hydrolysis of acetylcholine. Sensitivity of the SNs in monitoring acetylcholine hydrolysis was confirmed by in vitro experiments. Isolated atria were exposed to the nanosensors for 10 min to stain cell membranes. Acetylcholine hydrolysis was monitored optically in the atria samples by measuring quenching of Tb(III)-centred luminescence by acetic acid derived from endogenous acetylcholine due to its acetylcholinesterase-catalyzed hydrolysis. The reliability of the sensing was demonstrated by the quenching effect of exogenous acetylcholine added to the bath solution. Additionally, no luminescence quenching occurred when the atria were pre-treated with the acetylcholinesterase inhibitor paraoxon.
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Affiliation(s)
- Alsu Mukhametshina
- A. E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center, Russian Academy of Sciences, Kazan, Russian Federation
| | - Alexey Petrov
- Department of Normal Physiology, Kazan State Medial University, Kazan, Russian Federation.,Laboratory of Biophysics of Synaptic Processes, Kazan Institute of Biochemistry and Biophysics, Russian Academy of Sciences, Kazan, Russian Federation
| | - Svetlana Fedorenko
- A. E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center, Russian Academy of Sciences, Kazan, Russian Federation
| | - Konstantin Petrov
- A. E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center, Russian Academy of Sciences, Kazan, Russian Federation
| | - Irek Nizameev
- A. E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center, Russian Academy of Sciences, Kazan, Russian Federation
| | - Asiya Mustafina
- A. E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center, Russian Academy of Sciences, Kazan, Russian Federation
| | - Oleg Sinyashin
- A. E. Arbuzov Institute of Organic and Physical Chemistry, Kazan Scientific Center, Russian Academy of Sciences, Kazan, Russian Federation
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Abstract
Heart failure (HF) is associated with significant morbidity and mortality. The disease is characterised by autonomic imbalance with increased sympathetic activity and withdrawal of parasympathetic activity. Despite the use of medical therapies that target, in part, the neurohormonal axis, rates of HF progression, morbidity and mortality remain high. Emerging therapies centred on neuromodulation of autonomic control of the heart provide an alternative device-based approach to restoring sympathovagal balance. Preclinical studies have proven favourable, while clinical trials have had mixed results. This article highlights the importance of understanding structural/functional organisation of the cardiac nervous system as mechanistic-based neuromodulation therapies evolve.
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Affiliation(s)
- Peter Hanna
- David Geffen School of Medicine, University of California Los Angeles (UCLA) Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- David Geffen School of Medicine, University of California Los Angeles (UCLA) Los Angeles, CA, USA
| | - Jeffrey L Ardell
- David Geffen School of Medicine, University of California Los Angeles (UCLA) Los Angeles, CA, USA
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111
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Neuromodulation Therapies for Cardiac Disease. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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112
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113
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Luo D, Hu H, Qin Z, Liu S, Yu X, Ma R, He W, Xie J, Lu Z, He B, Jiang H. Stimulation of ganglionated plexus attenuates cardiac neural remodeling and heart failure progression in a canine model of acute heart failure post-myocardial infarction. Auton Neurosci 2017; 208:73-79. [DOI: 10.1016/j.autneu.2017.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 12/16/2022]
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114
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Pastarapatee N, Kijtawornrat A, Buranakarl C. Imbalance of autonomic nervous systems involved in ventricular arrhythmia after splenectomy in dogs. J Vet Med Sci 2017; 79:2002-2010. [PMID: 29070771 PMCID: PMC5745180 DOI: 10.1292/jvms.17-0482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The role of cardiac autonomic modulation on ventricular arrhythmia, known as ventricular premature complexes (VPC), after splenectomy was investigated. Twelve dogs undergoing splenectomy were divided into 2 groups: low VPC (<1,000/day, n=6) and high VPC groups (≥1,000/day, n=6). Electrocardiograph recording was performed prior to (D0), during the first three days (D1-3) and on day 9 (D9) after surgery. Arrhythmic indices, Tpeak-Tend, corrected QT interval and short-term variability of QT interval as well as heart rate variability (HRV) were evaluated. Plasma concentrations of norepinephrine (NE) and epinephrine (E) were measured. In the high VPC group, the occurrences of VPC were significantly increased (P<0.05) after surgery, and reached the levels higher than those in the low VPC group. For the arrhythmic indices, only Tp-Te in the high VPC group increased significantly (P<0.05) after surgery. For HRV analysis, enhancement of both time and frequency domains were found postoperatively in both groups. On D2, however, the high VPC group showed significantly lower total power and high frequency with higher low to high frequency ratio (P<0.05) than the low VPC group. Plasma NE concentration significantly increased in the high VPC group after surgery. Dogs in the high VPC group had shorter survival time than those in the low VPC group. In conclusion, dogs with imbalance cardiac autonomic modulation accompanied with high circulating NE concentration after splenectomy are prone to ventricular arrhythmia, which leads to short survival time.
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Affiliation(s)
- Nuttika Pastarapatee
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Rd., Pathumwan, Bangkok 10330, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Rd., Pathumwan, Bangkok 10330, Thailand
| | - Chollada Buranakarl
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Henri Dunant Rd., Pathumwan, Bangkok 10330, Thailand
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115
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Musteata M, Mocanu D, Stanciu GD, Armasu M, Solcan G. Interictal cardiac autonomic nervous system disturbances in dogs with idiopathic epilepsy. Vet J 2017; 228:41-45. [PMID: 29153107 DOI: 10.1016/j.tvjl.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
Autonomic nervous system (ANS) activity in the interictal period (InIp) in dogs with presumed idiopathic epilepsy (pIE) was assessed using heart rate variability (HRV) analysis. The HRVs obtained from 28 pIE dogs with interictal epileptic discharges (InIEd; 11 with treatment and 17 without treatment) detected on electroencephalography (EEG) were compared with those obtained from 13 healthy dogs. On electrocardiographic (ECG) study, the P wave dispersion (PWD; P<0.001), P max (P=0.004) and corrected QT interval (QTc; P=0.025) were significantly increased in the pIE group. On the basis of HRV analysis, the pIE dogs had an increased activity of the parasympathetic component of the ANS, including the percentage of R-R interval (pNN50%) that differs more than 50ms (P=0.011) and high frequency band (HF; P=0.041). Administration of phenobarbitone had no influence on the ANS pattern when pIE subgroups were compared (P>0.05). In InIp, dogs elicited specific conductibility delays of the electrical impulses (increased PWD and QTc interval); these delays are considered to be risk factors for developing severe arrhythmias, such as atrial fibrillation and ventricular tachycardia. When compared with human beings, a different ANS pattern characterised by increased parasympathetic activity was observed, which may influence the therapeutic approach of IE in dogs.
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Affiliation(s)
- M Musteata
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - D Mocanu
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - G D Stanciu
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - M Armasu
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania
| | - G Solcan
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine 'Ion Ionescu de la Brad' Iaşi, 8 Mihail Sadoveanu Alley, Iaşi RO-700489, Romania.
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116
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van Bilsen M, Patel HC, Bauersachs J, Böhm M, Borggrefe M, Brutsaert D, Coats AJS, de Boer RA, de Keulenaer GW, Filippatos GS, Floras J, Grassi G, Jankowska EA, Kornet L, Lunde IG, Maack C, Mahfoud F, Pollesello P, Ponikowski P, Ruschitzka F, Sabbah HN, Schultz HD, Seferovic P, Slart RHJA, Taggart P, Tocchetti CG, Van Laake LW, Zannad F, Heymans S, Lyon AR. The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 19:1361-1378. [PMID: 28949064 DOI: 10.1002/ejhf.921] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/23/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022] Open
Abstract
Despite improvements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burdens on patients and health care systems worldwide. Alterations in autonomic nervous system (ANS) activity contribute to cardiac disease progression, and the recent development of invasive techniques and electrical stimulation devices has opened new avenues for specific targeting of the sympathetic and parasympathetic branches of the ANS. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop which brought together clinicians, trialists and basic scientists to discuss the ANS as a therapeutic target in HF. The questions addressed were: (i) What are the abnormalities of ANS in HF patients? (ii) What methods are available to measure autonomic dysfunction? (iii) What therapeutic interventions are available to target the ANS in patients with HF, and what are their specific strengths and weaknesses? (iv) What have we learned from previous ANS trials? (v) How should we proceed in the future?
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Affiliation(s)
- Marc van Bilsen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Hospital, Maastricht, the Netherlands
| | - Hitesh C Patel
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | - Michael Böhm
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | - Martin Borggrefe
- First Department of Medicine, Cardiology Division, University Medical Centre Mannheim, Mannheim, Germany.,German Centre for Cardiovascular Research, Mannheim, Germany
| | - Dirk Brutsaert
- Department of Cardiology, Antwerp University, Antwerp, Belgium
| | - Andrew J S Coats
- Department of Medicine, Monash University, Melbourne, Vic, Australia.,Department of Medicine, University of Warwick, Coventry, UK
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Gerasimos S Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - John Floras
- University Health Network and Sinai Health System Division of Cardiology, Peter Munk Cardiac Centre, Toronto General and Lunenfeld-Tanenbaum Research Institutes, University of Toronto, Toronto, ON, Canada
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Milan, Italy
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Lilian Kornet
- Medtronic, Inc., Bakken Research Centre, Maastricht, the Netherlands
| | - Ida G Lunde
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Christoph Maack
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | - Felix Mahfoud
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Harold D Schultz
- Department of Cellular and Integrative Physiology, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Petar Seferovic
- Department of Cardiology, Belgrade University Medical Centre, Belgrade, Serbia
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Peter Taggart
- Department of Cardiovascular Science, University College London, Barts Heart Centre, London, UK
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Linda W Van Laake
- Department of Cardiology, Heart and Lungs Division, and Regenerative Medicine Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Faiez Zannad
- INSERM, Centre for Clinical Investigation 9501, Unit 961, University Hospital Centre, Nancy, France.,Department of Cardiology, Nancy University, University of the Lorraine, Nancy, France
| | - Stephane Heymans
- Netherlands Heart Institute, Utrecht, the Netherlands.,Department of Cardiovascular Sciences, Leuven University, Leuven, Belgium
| | - Alexander R Lyon
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Carlson GM, Libbus I, Amurthur B, KenKnight BH, Verrier RL. Novel method to assess intrinsic heart rate recovery in ambulatory ECG recordings tracks cardioprotective effects of chronic autonomic regulation therapy in patients enrolled in the ANTHEM-HF study. Ann Noninvasive Electrocardiol 2017; 22:e12436. [PMID: 28213914 PMCID: PMC6931843 DOI: 10.1111/anec.12436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Postexercise heart rate recovery (HRR) is a powerful and independent predictor of mortality. Autonomic regulation therapy (ART) with chronic vagus nerve stimulation (VNS) has been shown to improve ventricular function in patients with chronic heart failure. However, the effect of ART on HRR in patients with heart failure remains unknown. METHODS A new measure involving quantification of intrinsic HRR was developed for 24-hr ambulatory ECG (AECG) recordings based on spontaneous heart rate changes observed during daily activity in patients with symptomatic heart failure and reduced ejection fraction. Intrinsic HRR values were compared in 21 patients enrolled in the ANTHEM-HF study (NCT01823887) before and after 12 months of chronic ART (10 Hz, 250 μs pulse width, 18% duty cycle, maximum tolerable current amplitude after 10 weeks of titration) and to values from normal subjects (PhysioNet database, n = 54). RESULTS With chronic ART, average intrinsic HRR was improved as indicated by a shortening of the rate-recovery time constant by 8.9% (from 12.3 ± 0.1 at baseline to 11.2 ± 0.1 s, p < .0001) among patients receiving high-intensity stimuli (≥2 mA). In addition, mean heart rate decreased by 8.5 bpm (from 75.9 ± 2.6 to 67.4 ± 2.9 bpm, p = .005) and left ventricular ejection fraction (LVEF) increased by 4.7% (from 32.6 ± 2.0% to 37.3 ± 1.9%, p < .005). CONCLUSION Using a new technique adapted for 24-hr AECG recordings, intrinsic HRR was found to be impaired in patients with symptomatic HF compared to normal subjects. Chronic ART significantly improved intrinsic HRR, indicating an improvement in autonomic function.
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118
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Lachowska K, Gruchała M, Narkiewicz K, Hering D. Sympathetic Activation in Chronic Heart Failure: Potential Benefits of Interventional Therapies. Curr Hypertens Rep 2017; 18:51. [PMID: 27193773 DOI: 10.1007/s11906-016-0660-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heart failure (HF) is a major and growing public health problem. This condition is associated with poor prognosis, a high rate of mortality, frequent hospitalization and increasing costs to health care systems. Pharmacological approaches aimed at reducing morbidity and mortality in HF have primarily focused on inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which have been associated with disease development, progression and adverse cardiovascular (CV) outcomes. The increasing number of hospitalizations for HF decompensation suggests the failure of available treatment options, indicating the necessity for alternative therapeutic approaches. Alongside pharmacological and cardiac resynchronization therapies in selected patients with arrhythmia, recent advancements in the management of HF have been directed at inhibiting relevant neurogenic pathways underlying disease development and progression. Initial evidence regarding the safety and effectiveness of interventional procedures suggests that HF patients may benefit from novel adjunctive therapies. Here we review the critical role of sympathetic activation in HF and the rationale for therapeutic interventions including device-based and interventional approaches aimed at restoring autonomic neural balance in this condition.
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Affiliation(s)
- Kamila Lachowska
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Hering
- Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000, MDBP: M570, Australia.
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119
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Kingma JG, Simard D, Rouleau JR. Influence of cardiac nerve status on cardiovascular regulation and cardioprotection. World J Cardiol 2017; 9:508-520. [PMID: 28706586 PMCID: PMC5491468 DOI: 10.4330/wjc.v9.i6.508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/22/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
Abstract
Neural elements of the intrinsic cardiac nervous system transduce sensory inputs from the heart, blood vessels and other organs to ensure adequate cardiac function on a beat-to-beat basis. This inter-organ crosstalk is critical for normal function of the heart and other organs; derangements within the nervous system hierarchy contribute to pathogenesis of organ dysfunction. The role of intact cardiac nerves in development of, as well as protection against, ischemic injury is of current interest since it may involve recruitment of intrinsic cardiac ganglia. For instance, ischemic conditioning, a novel protection strategy against organ injury, and in particular remote conditioning, is likely mediated by activation of neural pathways or by endogenous cytoprotective blood-borne substances that stimulate different signalling pathways. This discovery reinforces the concept that inter-organ communication, and maintenance thereof, is key. As such, greater understanding of mechanisms and elucidation of treatment strategies is imperative to improve clinical outcomes particularly in patients with comorbidities. For instance, autonomic imbalance between sympathetic and parasympathetic nervous system regulation can initiate cardiovascular autonomic neuropathy that compromises cardiac stability and function. Neuromodulation therapies that directly target the intrinsic cardiac nervous system or other elements of the nervous system hierarchy are currently being investigated for treatment of different maladies in animal and human studies.
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120
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Mavropoulos SA, Khan NS, Levy ACJ, Faliks BT, Sison CP, Pavlov VA, Zhang Y, Ojamaa K. Nicotinic acetylcholine receptor-mediated protection of the rat heart exposed to ischemia reperfusion. Mol Med 2017; 23:120-133. [PMID: 28598489 DOI: 10.2119/molmed.2017.00091] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 12/11/2022] Open
Abstract
Reperfusion injury following acute myocardial infarction is associated with significant morbidity. Activation of neuronal or non-neuronal cholinergic pathways in the heart has been shown to reduce ischemic injury and this effect has been attributed primarily to muscarinic acetylcholine receptors. In contrast, the role of nicotinic receptors, specifically alpha-7 subtype (α7nAChR) in the myocardium remains unknown which offers an opportunity to potentially repurpose several agonists/modulators that are currently under development for neurologic indications. Treatment of ex vivo and in vivo rat models of cardiac ischemia/reperfusion (I/R) with a selective α7nAChR agonist (GTS21) showed significant increases in left ventricular developing pressure, and rates of pressure development without effects on heart rate. These positive functional effects were blocked by co-administration with methyllycaconatine (MLA), a selective antagonist of α7nAChRs. In vivo, delivery of GTS21 at the initiation of reperfusion, reduced infarct size by 42% (p<0.01) and decreased tissue reactive oxygen species (ROS) by 62% (p<0.01). Flow cytometry of MitoTracker Red stained mitochondria showed that mitochondrial membrane potential was normalized in mitochondria isolated from GTS21 treated compared to untreated I/R hearts. Intracellular ATP concentration in cultured cardiomyocytes exposed to hypoxia/reoxygenation was reduced (p<0.001), but significantly increased to normoxic levels with GTS21 treatment, and this was abrogated by MLA pretreatment. Activation of stress-activated kinases, JNK and p38MAPK, were significantly reduced by GTS21 in I/R. We conclude that targeting myocardial 17nAChRs in I/R may provide therapeutic benefit by improving cardiac contractile function through a mechanism that preserves mitochondrial membrane potential, maintains intracellular ATP and reduces ROS generation, thus limiting infarct size.
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Affiliation(s)
- Spyros A Mavropoulos
- Center for Heart and Lung Research, Northwell Health, Manhasset, NY.,Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Nayaab S Khan
- Center for Heart and Lung Research, Northwell Health, Manhasset, NY
| | - Asaph C J Levy
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Bradley T Faliks
- Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY
| | - Cristina P Sison
- Biostatistics Unit, The Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
| | - Valentin A Pavlov
- Biostatistics Unit, The Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY.,Laboratory for Biomedical Sciences, The Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
| | - Youhua Zhang
- Dept. of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Kaie Ojamaa
- Center for Heart and Lung Research, Northwell Health, Manhasset, NY.,Hofstra Northwell School of Medicine at Hofstra University, Hempstead, NY.,Dept. of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
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121
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Corsi-Zuelli FMDG, Brognara F, Quirino GFDS, Hiroki CH, Fais RS, Del-Ben CM, Ulloa L, Salgado HC, Kanashiro A, Loureiro CM. Neuroimmune Interactions in Schizophrenia: Focus on Vagus Nerve Stimulation and Activation of the Alpha-7 Nicotinic Acetylcholine Receptor. Front Immunol 2017; 8:618. [PMID: 28620379 PMCID: PMC5449450 DOI: 10.3389/fimmu.2017.00618] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/10/2017] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is one of the most debilitating mental disorders and is aggravated by the lack of efficacious treatment. Although its etiology is unclear, epidemiological studies indicate that infection and inflammation during development induces behavioral, morphological, neurochemical, and cognitive impairments, increasing the risk of developing schizophrenia. The inflammatory hypothesis of schizophrenia is also supported by clinical studies demonstrating systemic inflammation and microglia activation in schizophrenic patients. Although elucidating the mechanism that induces this inflammatory profile remains a challenge, mounting evidence suggests that neuroimmune interactions may provide therapeutic advantages to control inflammation and hence schizophrenia. Recent studies have indicated that vagus nerve stimulation controls both peripheral and central inflammation via alpha-7 nicotinic acetylcholine receptor (α7nAChR). Other findings have indicated that vagal stimulation and α7nAChR-agonists can provide therapeutic advantages for neuropsychiatric disorders, such as depression and epilepsy. This review analyzes the latest results regarding: (I) the immune-to-brain pathogenesis of schizophrenia; (II) the regulation of inflammation by the autonomic nervous system in psychiatric disorders; and (III) the role of the vagus nerve and α7nAChR in schizophrenia.
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Affiliation(s)
| | - Fernanda Brognara
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Carlos Hiroji Hiroki
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rafael Sobrano Fais
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Luis Ulloa
- Department of Surgery, Center of Immunology and Inflammation, Rutgers University-New Jersey Medical School, Newark, NJ, United States
| | - Helio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Alexandre Kanashiro
- Department of Physiological Sciences, Federal University of São Carlos, São Carlos, Brazil
| | - Camila Marcelino Loureiro
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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122
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Ichiki T, Huntley BK, Harty GJ, Sangaralingham SJ, Burnett JC. Early activation of deleterious molecular pathways in the kidney in experimental heart failure with atrial remodeling. Physiol Rep 2017; 5:5/9/e13283. [PMID: 28507167 PMCID: PMC5430128 DOI: 10.14814/phy2.13283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 12/20/2022] Open
Abstract
Heart failure (HF) is a major health problem with worsening outcomes when renal impairment is present. Therapeutics for early phase HF may be effective for cardiorenal protection, however the detailed characteristics of the kidney in early‐stage HF (ES‐HF), and therefore treatment for potential renal protection, are poorly defined. We sought to determine the gene and protein expression profiles of specific maladaptive pathways of ES‐HF in the kidney and heart. Experimental canine ES‐HF, characterized by de‐novo HF with atrial remodeling but not ventricular fibrosis, was induced by right ventricular pacing for 10 days. Kidney cortex (KC), medulla (KM), left ventricle (LV), and left atrial (LA) tissues from ES‐HF versus normal canines (n = 4 of each) were analyzed using RT‐PCR microarrays and protein assays to assess genes and proteins related to inflammation, renal injury, apoptosis, and fibrosis. ES‐HF was characterized by increased circulating natriuretic peptides and components of the renin‐angiotensin‐aldosterone system and decreased sodium and water excretion with mild renal injury and up‐regulation of CNP and renin genes in the kidney. Compared to normals, widespread genes, especially genes of the inflammatory pathways, were up‐regulated in KC similar to increases seen in LA. Protein expressions related to inflammatory cytokines were also augmented in the KC. Gene and protein changes were less prominent in the LV and KM. The ES‐HF displayed mild renal injury with widespread gene changes and increased inflammatory cytokines. These changes may provide important clues into the pathophysiology of ES‐HF and for therapeutic molecular targets in the kidney of ES‐HF.
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Affiliation(s)
- Tomoko Ichiki
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Brenda K Huntley
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gail J Harty
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - S Jeson Sangaralingham
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John C Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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123
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Zhan DY, Du CK, Akiyama T, Morimoto S, Shimizu S, Kawada T, Shirai M, Pearson JT. Cardiac vagal control in a knock-in mouse model of dilated cardiomyopathy with a troponin mutation. Auton Neurosci 2017; 205:33-40. [PMID: 28344023 DOI: 10.1016/j.autneu.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 02/02/2017] [Accepted: 03/10/2017] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate cardiac vagal nerve activity and identify the abnormality of cardiac vagal control in heart failure caused by dilated cardiomyopathy (DCM) using a knock-in mouse model with a ΔK210 mutation in the cardiac troponin T gene. The effects of electrical stimulation of the cervical vagal nerve at 5 and 10Hz (peripheral vagal control) and α2-adrennoceptor stimulation by intravenous medetomidine at 0.1mg/kg (central vagal control) were examined in wild-type (WT) mice and DCM mice. Microdialysis technique was applied to the left ventricular myocardium of anesthetized mice and myocardial interstitial acetylcholine (ACh) levels were measured by HPLC as an index of ACh release from cardiac vagal nerve endings. Electrical vagal nerve stimulation increased cardiac interval and myocardial interstitial ACh level in both WT and DCM mice, and these responses did not differ between WT and DCM mice. In contrast, intravenous medetomidine increased cardiac interval and myocardial interstitial ACh level in both WT and DCM mice, but the responses of cardiac interval and myocardial interstitial ACh level were significantly suppressed in DCM mice compared to WT mice. Medetomidine did not affect the myocardial interstitial ACh response induced by vagal nerve stimulation in WT mice. In this mouse model of DCM, peripheral vagal control including ACh release from vagal nerve endings and the postsynaptic response of pacemaker cells was preserved, but central vagal control through α2-adrenoceptors was impaired.
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Affiliation(s)
- Dong-Yun Zhan
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.
| | - Cheng-Kun Du
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Tsuyoshi Akiyama
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Sachio Morimoto
- Department of Clinical Pharmacology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Mikiyasu Shirai
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - James T Pearson
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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124
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Effect of Loss of Heart Rate Variability on T-Wave Heterogeneity and QT Variability in Heart Failure Patients: Implications in Ventricular Arrhythmogenesis. Cardiovasc Eng Technol 2017; 8:219-228. [DOI: 10.1007/s13239-017-0299-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 02/25/2017] [Indexed: 11/25/2022]
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125
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Effects of short and prolonged transcutaneous vagus nerve stimulation on heart rate variability in healthy subjects. Auton Neurosci 2017; 203:88-96. [DOI: 10.1016/j.autneu.2016.11.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/19/2016] [Accepted: 11/25/2016] [Indexed: 01/14/2023]
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126
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He B, Lu Z, He W, Huang B, Jiang H. Autonomic Modulation by Electrical Stimulation of the Parasympathetic Nervous System: An Emerging Intervention for Cardiovascular Diseases. Cardiovasc Ther 2017; 34:167-71. [PMID: 26914959 DOI: 10.1111/1755-5922.12179] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The cardiac autonomic nervous system has been known to play an important role in the development and progression of cardiovascular diseases. Autonomic modulation by electrical stimulation of the parasympathetic nervous system, which increases the parasympathetic activity and suppresses the sympathetic activity, is emerging as a therapeutic strategy for the treatment of cardiovascular diseases. Here, we review the recent literature on autonomic modulation by electrical stimulation of the parasympathetic nervous system, including vagus nerve stimulation, transcutaneous auricular vagal stimulation, spinal cord stimulation, and ganglionated plexi stimulation, in the treatment of heart failure, atrial fibrillation, and ventricular arrhythmias.
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Affiliation(s)
- Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Wenbo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bing Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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127
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Li-Sha G, Xing-Xing C, Lian-Pin W, De-Pu Z, Xiao-Wei L, Jia-Feng L, Yue-Chun L. Right Cervical Vagotomy Aggravates Viral Myocarditis in Mice Via the Cholinergic Anti-inflammatory Pathway. Front Pharmacol 2017; 8:25. [PMID: 28197102 PMCID: PMC5281590 DOI: 10.3389/fphar.2017.00025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 01/16/2017] [Indexed: 12/21/2022] Open
Abstract
The autonomic nervous system dysfunction with increased sympathetic activity and withdrawal of vagal activity may play an important role in the pathogenesis of viral myocarditis. The vagus nerve can modulate the immune response and control inflammation through a ‘cholinergic anti-inflammatory pathway’ dependent on the α7-nicotinic acetylcholine receptor (α7nAChR). Although the role of β-adrenergic stimulation on viral myocarditis has been investigated in our pervious studies, the direct effect of vagal tone in this setting has not been yet studied. Therefore, in the present study, we investigated the effects of cervical vagotomy in a murine model of viral myocarditis. In a coxsackievirus B3 murine myocarditis model (Balb/c), effects of right cervical vagotomy and nAChR agonist nicotine on echocardiography, myocardial histopathology, viral RNA, and proinflammatory cytokine levels were studied. We found that right cervical vagotomy inhibited the cholinergic anti-inflammatory pathway, aggravated myocardial lesions, up-regulated the expression of TNF-α, IL-1β, and IL-6, and worsened the impaired left ventricular function in murine viral myocarditis, and these changes were reversed by co-treatment with nicotine by activating the cholinergic anti-inflammatory pathway. These results indicate that vagal nerve plays an important role in mediating the anti-inflammatory effect in viral myocarditis, and that cholinergic stimulation with nicotine also plays its peripheral anti-inflammatory role relying on α7nAChR, without requirement for the integrity of vagal nerve in the model. The findings suggest that vagus nerve stimulation mediated inhibition of the inflammatory processes likely provide important benefits in myocarditis treatment.
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Affiliation(s)
- Ge Li-Sha
- Department of Pediatrics, Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Chen Xing-Xing
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China; Department of Cardiology, First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, China
| | - Wu Lian-Pin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Zhou De-Pu
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Li Xiao-Wei
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Lin Jia-Feng
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
| | - Li Yue-Chun
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University Wenzhou, China
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128
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Ichige MHA, Pereira MG, Brum PC, Michelini LC. Experimental Evidences Supporting the Benefits of Exercise Training in Heart Failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 999:181-206. [PMID: 29022264 DOI: 10.1007/978-981-10-4307-9_11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Heart Failure (HF), a common end point for many cardiovascular diseases, is a syndrome with a very poor prognosis. Although clinical trials in HF have achieved important outcomes in reducing mortality, little is known about functional mechanisms conditioning health improvement in HF patients. In parallel with clinical studies, basic science has been providing important discoveries to understand the mechanisms underlying the pathophysiology of HF, as well as to identify potential targets for the treatment of this syndrome. In spite of being the end-point of cardiovascular derangements caused by different etiologies, autonomic dysfunction, sympathetic hyperactivity, oxidative stress, inflammation and hormonal activation are common factors involved in the progression of this syndrome. Together these causal factors create a closed link between three important organs: brain, heart and the skeletal muscle. In the past few years, we and other groups have studied the beneficial effects of aerobic exercise training as a safe therapy to avoid the progression of HF. As summarized in this chapter, exercise training, a non-pharmacological tool without side effects, corrects most of the HF-induced neurohormonal and local dysfunctions within the brain, heart and skeletal muscles. These adaptive responses reverse oxidative stress, reduce inflammation, ameliorate neurohormonal control and improve both cardiovascular and skeletal muscle function, thus increasing the quality of life and reducing patients' morbimortality.
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Affiliation(s)
- Marcelo H A Ichige
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo G Pereira
- Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil
| | - Patrícia C Brum
- Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil. .,National Institute for Science & Technology - INCT (In)activity & Exercise, CNPq - Niterói (RJ), Rio de Janeiro, Brazil.
| | - Lisete C Michelini
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil.,National Institute for Science & Technology - INCT (In)activity & Exercise, CNPq - Niterói (RJ), Rio de Janeiro, Brazil
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Feriani DJ, Souza GI, Carrozzi NM, Mostarda C, Dourado PM, Consolim-Colombo FM, De Angelis K, Moreno H, Irigoyen MC, Rodrigues B. Impact of exercise training associated to pyridostigmine treatment on autonomic function and inflammatory profile after myocardial infarction in rats. Int J Cardiol 2017; 227:757-765. [DOI: 10.1016/j.ijcard.2016.10.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
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Horn MA, Bode EF, Borland SJ, Kirkwood GJ, Briston SJ, Richards MA, Dibb KM, Trafford AW. Temporal Development of Autonomic Dysfunction in Heart Failure: Effects of Age in an Ovine Rapid-pacing Model. J Gerontol A Biol Sci Med Sci 2016; 71:1544-1552. [PMID: 26707382 PMCID: PMC5106849 DOI: 10.1093/gerona/glv217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/09/2015] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is predominantly a disease of older adults and characterized by extensive sympatho-vagal imbalance leading to impaired reflex control of heart rate (HR). However, whether aging influences the development or extent of the autonomic imbalance in HF remains unclear. To address this, we used an ovine model of aging with tachypacing-induced HF to determine whether aging affects the chronotropic and inotropic responses to autonomic stimulation and reduction in heart rate variability (HRV) in HF. We find that aging is associated with increased cardiac dimensions and reduced contractility before the onset of tachypacing, and these differences persist in HF. Additionally, the chronotropic response to β-adrenergic stimulation was markedly attenuated in HF, and this occurred more rapidly in aged animals. By measuring HR during sequential autonomic blockade, our data are consistent with a reduced parasympathetic control of resting HR in aging, with young HF animals having an attenuated sympathetic influence on HR. Time-domain analyses of HR show a reduction in HRV in both young and aged failing animals, although HRV is lowest in aged HF. In conclusion, aging is associated with altered autonomic control and β-adrenergic responsiveness of HR, and these are exacerbated with the development of HF.
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Affiliation(s)
- Margaux A Horn
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre
| | - Elizabeth F Bode
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre
| | | | - Graeme J Kirkwood
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre
| | - Sarah J Briston
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre
| | - Mark A Richards
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre
| | - Katharine M Dibb
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre
| | - Andrew W Trafford
- Unit of Cardiac Physiology, Manchester Academic Health Sciences Centre.
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131
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Gronda E, Vanoli E. Autonomic Modulation With Baroreflex Activation Therapy in Heart Failure. Curr Heart Fail Rep 2016; 13:273-280. [DOI: 10.1007/s11897-016-0307-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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132
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Roberts A, Sithole A, Sedghi M, Walker CA, Quinn TM. Minimal adverse effects profile following implantation of periauricular percutaneous electrical nerve field stimulators: a retrospective cohort study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:389-393. [PMID: 27843360 PMCID: PMC5098779 DOI: 10.2147/mder.s107426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The periauricular percutaneous implantation of the Neuro-Stim System™ family of devices EAD, MFS, and BRIDGE is a procedure involving the use of a non-opiate, neuromodulation analgesic for relieving acute and chronic pain. It has been approved as a minimal-risk procedure by multiple governmental and institutional facilities. This retrospective report of findings will help quantify the incidence of clinically observed bleeding, localized dermatitis, and infections at the implantation sites of the electrode/needle arrays, dermatitis at the site of the generator, and patient syncope. A total of 1,207 devices, each producing up to 16 percutaneous punctures, for a total of 19,312 punctures were monitored for adverse effects, based on retrospective chart audits conducted at six clinical facilities over a 1-year period.
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Affiliation(s)
- Arthur Roberts
- Indiana Craniofacial Center; Department of Oral Pathology, Medicine and Radiology, Indiana University School of Dentistry, Indianapolis, IN, USA; Department of Anesthesia, Critical Care, and Pain Management, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Alec Sithole
- Department of Computer Science, Mathematics and Physics, Missouri Western State University, St Joseph, MO
| | - Marcos Sedghi
- Conservative Care Specialists Medical Group, Los Angeles, CA
| | - Charles A Walker
- Walker Pain Management Center, Jackson, TN; Bethel University, Paris, TN
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Ichige MHA, Santos CR, Jordão CP, Ceroni A, Negrão CE, Michelini LC. Exercise training preserves vagal preganglionic neurones and restores parasympathetic tonus in heart failure. J Physiol 2016; 594:6241-6254. [PMID: 27444212 PMCID: PMC5088253 DOI: 10.1113/jp272730] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/08/2016] [Indexed: 01/01/2023] Open
Abstract
KEY POINTS Heart Failure (HF) is accompanied by reduced ventricular function, activation of compensatory neurohormonal mechanisms and marked autonomic dysfunction characterized by exaggerated sympathoexcitation and reduced parasympathetic activity. With 6 weeks of exercise training, HF-related loss of choline acetyltransferase (ChAT)-positive vagal preganglionic neurones is avoided, restoring the parasympathetic tonus to the heart, and the immunoreactivity of dopamine β-hydroxylase-positive premotor neurones that drive sympathetic outflow to the heart is reduced. Training-induced correction of autonomic dysfunction occurs even with the persistence of abnormal ventricular function. Strong positive correlation between improved parasympathetic tonus to the heart and increased ChAT immunoreactivity in vagal preganglionic neurones after training indicates this is a crucial mechanism to restore autonomic function in heart failure. ABSTRACT Exercise training is an efficient tool to attenuate sympathoexcitation, a hallmark of heart failure (HF). Although sympathetic modulation in HF is widely studied, information regarding parasympathetic control is lacking. We examined the combined effects of sympathetic and vagal tonus to the heart in sedentary (Sed) and exercise trained (ET) HF rats and the contribution of respective premotor and preganglionic neurones. Wistar rats submitted to coronary artery ligation or sham surgery were assigned to training or sedentary protocols for 6 weeks. After haemodynamic, autonomic tonus (atropine and atenolol i.v.) and ventricular function determinations, brains were collected for immunoreactivity assays (choline acetyltransferase, ChATir; dopamine β-hydroxylase, DBHir) and neuronal counting in the dorsal motor nucleus of vagus (DMV), nucleus ambiguus (NA) and rostroventrolateral medulla (RVLM). HF-Sed vs. SHAM-Sed exhibited decreased exercise capacity, reduced ejection fraction, increased left ventricle end diastolic pressure, smaller positive and negative dP/dt, decreased intrinsic heart rate (IHR), lower parasympathetic and higher sympathetic tonus, reduced preganglionic vagal neurones and ChATir in the DMV/NA, and increased RVLM DBHir. Training increased treadmill performance, normalized autonomic tonus and IHR, restored the number of DMV and NA neurones and corrected ChATir without affecting ventricular function. There were strong positive correlations between parasympathetic tonus and ChATir in NA and DMV. RVLM DBHir was also normalized by training, but there was no change in neurone number and no correlation with sympathetic tonus. Training-induced preservation of preganglionic vagal neurones is crucial to normalize parasympathetic activity and restore autonomic balance to the heart even in the persistence of cardiac dysfunction.
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Affiliation(s)
- Marcelo H A Ichige
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Carla R Santos
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Camila P Jordão
- Heart Institute, University of Sao Paulo, Medical School, Sao Paulo, SP, Brazil
| | - Alexandre Ceroni
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos E Negrão
- Heart Institute, University of Sao Paulo, Medical School, Sao Paulo, SP, Brazil
- School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Lisete C Michelini
- Department of Physiology and Biophysics, Biomedical Sciences Institute, University of Sao Paulo, Sao Paulo, SP, Brazil.
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134
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Arimura T, Saku K, Kakino T, Nishikawa T, Tohyama T, Sakamoto T, Sakamoto K, Kishi T, Ide T, Sunagawa K. Intravenous electrical vagal nerve stimulation prior to coronary reperfusion in a canine ischemia-reperfusion model markedly reduces infarct size and prevents subsequent heart failure. Int J Cardiol 2016; 227:704-710. [PMID: 27816306 DOI: 10.1016/j.ijcard.2016.10.074] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reducing myocardial damage is a prerequisite to prevent chronic heart failure after acute myocardial infarction (AMI). Although vagal nerve stimulation (VNS) has been repeatedly demonstrated to have potent anti-infarct effect, technical difficulties have precluded its clinical application. We developed a novel therapeutic strategy of intravenous VNS (iVNS) and examined whether iVNS administered prior to coronary reperfusion in a canine AMI model reduces infarct size and prevents heart failure. METHODS AND RESULTS In 35 mongrel dogs, we induced ischemia by ligating the left anterior descending coronary artery and then reperfused 3h later (I/R). We transvenously placed a catheter electrode in the superior vena cava and adjusted the stimulation intensity to a level that induced bradycardia but maintained stable hemodynamics (continuous, 5.1±2.1V, 10Hz). We administered iVNS from onset (iVNS-0, n=7) or 90min after onset (iVNS-90, n=7) of ischemia until one hour after reperfusion. Four weeks after ischemia-reperfusion, iVNS markedly reduced infarct size (iVNS-0: 2.4±2.1%, p<0.05 and iVNS-90: 4.5±4.5%, p<0.05) compared with I/R control (I/R: 13.3±2.5%), and improved cardiac performance and hemodynamics. Atrial pacing (n=7) to abolish iVNS-induced bradycardia significantly attenuated the beneficial effects of iVNS. CONCLUSIONS Short-term iVNS delivered prior to coronary reperfusion markedly reduced infarct size and preserved cardiac function one month after AMI. The bradycardic effect plays an important role in the beneficial effect of iVNS. How other mechanisms contribute to the reduction of infarct size remains to be studied.
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Affiliation(s)
- Takahiro Arimura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Keita Saku
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takamori Kakino
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takuya Nishikawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takafumi Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takuya Kishi
- Collaborative Research Institute of Innovative Therapeutics for Cardiovascular Diseases, Center for Disruptive Cardiovascular Medicine, Kyushu University, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, 1-1-3 Maidashi Higashi-ku, Fukuoka 812-8582, Japan.
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Delfiner MS, Siano J, Li Y, Dedkov EI, Zhang Y. Reduced epicardial vagal nerve density and impaired vagal control in a rat myocardial infarction-heart failure model. Cardiovasc Pathol 2016; 26:21-29. [PMID: 27852001 DOI: 10.1016/j.carpath.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Autonomic remodeling, characterized by sympathetic activation and vagal withdrawal, contributes to heart failure (HF) progression. However, the exact mechanism(s) responsible for vagal withdrawal in HF remain(s) unclear, and whether HF causes epicardial autonomic nerve remodeling is unknown. METHODS AND RESULTS Myocardial infarction (MI) was produced in 14 Sprague-Dawley rats, and 10 sham surgery rats served as the control. MI-HF was confirmed 2 months after the surgery by echocardiography and hemodynamic measurement. Cervical vagal nerve stimulation was delivered to examine the heart rate slowing effect. Whole heart acetylcholinesterase histochemistry was used to examine the epicardial autonomic nerve remodeling at dorsal ventricles (remote from the infarcted area). Compared with the control animals, the same vagal nerve stimulation had less heart rate slowing effect in MI-HF group. Both epicardial nerve bundle length-density (2.56±0.60 μm/mm2 versus 1.68±0.46 μm/mm2, P=.001) and branching point-density (1.24±0.25 points/mm2 versus 0.66±0.18 points/mm2, P<.001) were lower in MI-HF rats. The chemically stained epicardial nerve bundles contain both sympathetic (tyrosine hydroxylase positive) and vagal (choline acetyltransferase positive) fibers. However, within the stained nerve bundle, the chemical color corresponds mainly with the vagal fibers. CONCLUSIONS Whole heart acetylcholinesterase histochemistry revealed a decreased ventricular epicardial vagal nerve density in MI-HF rats, which may contribute to impaired cardiac vagal control in HF.
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Affiliation(s)
- Matthew S Delfiner
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - John Siano
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Eduard I Dedkov
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
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136
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Phillips Campbell RB, Duffourc MM, Schoborg RV, Xu Y, Liu X, KenKnight BH, Beaumont E. Aberrant fecal flora observed in guinea pigs with pressure overload is mitigated in animals receiving vagus nerve stimulation therapy. Am J Physiol Gastrointest Liver Physiol 2016; 311:G754-G762. [PMID: 27562060 DOI: 10.1152/ajpgi.00218.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/17/2016] [Indexed: 01/31/2023]
Abstract
Altered gut microbial diversity has been associated with several chronic disease states, including heart failure. Stimulation of the vagus nerve, which innervates the heart and abdominal organs, is proving to be an effective therapeutic in heart failure. We hypothesized that cervical vagus nerve stimulation (VNS) could alter fecal flora and prevent aberrations observed in fecal samples from heart failure animals. To determine whether microbial abundances were altered by pressure overload (PO), leading to heart failure and VNS therapy, a VNS pulse generator was implanted with a stimulus lead on either the left or right vagus nerve before creation of PO by aortic constriction. Animals received intermittent, open-loop stimulation or sham treatment, and their heart function was monitored by echocardiography. Left ventricular end-systolic and diastolic volumes, as well as cardiac output, were impaired in PO animals compared with baseline. VNS mitigated these effects. Metagenetic analysis was then performed using 16S rRNA sequencing to identify bacterial genera present in fecal samples. The abundance of 10 genera was significantly altered by PO, 8 of which were mitigated in animals receiving either left- or right-sided VNS. Metatranscriptomics analyses indicate that the abundance of genera that express genes associated with ATP-binding cassette transport and amino sugar/nitrogen metabolism was significantly changed following PO. These gut flora changes were not observed in PO animals subjected to VNS. These data suggest that VNS prevents aberrant gut flora following PO, which could contribute to its beneficial effects in heart failure patients.
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Affiliation(s)
| | - Michelle M Duffourc
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee
| | - Robert V Schoborg
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee
| | - Yanji Xu
- Shaun & Lilly International, Collierville, Tennessee; and
| | - Xinyi Liu
- Shaun & Lilly International, Collierville, Tennessee; and
| | | | - Eric Beaumont
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee;
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137
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Ho HT, Belevych AE, Liu B, Bonilla IM, Radwański PB, Kubasov IV, Valdivia HH, Schober K, Carnes CA, Györke S. Muscarinic Stimulation Facilitates Sarcoplasmic Reticulum Ca Release by Modulating Ryanodine Receptor 2 Phosphorylation Through Protein Kinase G and Ca/Calmodulin-Dependent Protein Kinase II. Hypertension 2016; 68:1171-1178. [PMID: 27647848 DOI: 10.1161/hypertensionaha.116.07666] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/21/2016] [Indexed: 01/01/2023]
Abstract
Although the effects and the underlying mechanism of sympathetic stimulation on cardiac Ca handling are relatively well established both in health and disease, the modes of action and mechanisms of parasympathetic modulation are poorly defined. Here, we demonstrate that parasympathetic stimulation initiates a novel mode of excitation-contraction coupling that enhances the efficiency of cardiac sarcoplasmic reticulum Ca store utilization. This efficient mode of excitation-contraction coupling involves reciprocal changes in the phosphorylation of ryanodine receptor 2 at Ser-2808 and Ser-2814. Specifically, Ser-2808 phosphorylation was mediated by muscarinic receptor subtype 2 and activation of PKG (protein kinase G), whereas dephosphorylation of Ser-2814 involved activation of muscarinic receptor subtype 3 and decreased reactive oxygen species-dependent activation of CaMKII (Ca/calmodulin-dependent protein kinase II). The overall effect of these changes in phosphorylation of ryanodine receptor 2 is an increase in systolic Ca release at the low sarcoplasmic reticulum Ca content and a paradoxical reduction in aberrant Ca leak. Accordingly, cholinergic stimulation of cardiomyocytes isolated from failing hearts improved Ca cycling efficiency by restoring altered ryanodine receptor 2 phosphorylation balance.
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Affiliation(s)
- Hsiang-Ting Ho
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Andriy E Belevych
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Bin Liu
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Ingrid M Bonilla
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Przemysław B Radwański
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Igor V Kubasov
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Héctor H Valdivia
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Karsten Schober
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Cynthia A Carnes
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.)
| | - Sándor Györke
- From the Department of Physiology and Cell Biology (H.-T.H., A.E.B., B.L., P.B.R., S.G.), College of Pharmacy (I.M.B., P.B.R., C.A.C.), and College of Veterinary Medicine (K.S.), The Ohio State University, Columbus; Davis Heart and Lung Research Institute, Columbus, OH (H.-T.H., A.E.B., B.L., I.M.B., P.B.R., C.A.C., S.G.); Department of Medicine, Duke University, Durham, NC (H.-T.H.); Laboratory of Neuromuscular Physiology, I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Petersburg, Russia (I.V.K.); and Center for Arrhythmia Research, Cardiovascular Division of the Department of Internal Medicine, University of Michigan, Ann Arbor (H.H.V.).
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Kwan H, Garzoni L, Liu HL, Cao M, Desrochers A, Fecteau G, Burns P, Frasch MG. Vagus Nerve Stimulation for Treatment of Inflammation: Systematic Review of Animal Models and Clinical Studies. Bioelectron Med 2016. [DOI: 10.15424/bioelectronmed.2016.00005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yoo PB, Liu H, Hincapie JG, Ruble SB, Hamann JJ, Grill WM. Modulation of heart rate by temporally patterned vagus nerve stimulation in the anesthetized dog. Physiol Rep 2016; 4:4/2/e12689. [PMID: 26811057 PMCID: PMC4760392 DOI: 10.14814/phy2.12689] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite current knowledge of the myriad physiological effects of vagus nerve stimulation (VNS) in various mammalian species (including humans), the impact of varying stimulation parameters on nerve recruitment and physiological responses is not well understood. We investigated nerve recruitment, cardiovascular responses, and skeletal muscle responses to different temporal patterns of VNS across 39 combinations of stimulation amplitude, frequency, and number of pulses per burst. Anesthetized dogs were implanted with stimulating and recording cuff electrodes around the cervical vagus nerve, whereas laryngeal electromyogram (EMG) and heart rate were recorded. In seven of eight dogs, VNS‐evoked bradycardia (defined as ≥10% decrease in heart rate) was achieved by applying stimuli at amplitudes equal to or greater than the threshold for activating slow B‐fibers. Temporally patterned VNS (minimum 5 pulses per burst) was sufficient to elicit bradycardia while reducing the concomitant activation of laryngeal muscles by more than 50%. Temporal patterns of VNS can be used to modulate heart rate while minimizing laryngeal motor fiber activation, and this is a novel approach to reduce the side effects produced by VNS.
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Affiliation(s)
- Paul B Yoo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | - Haoran Liu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Juan G Hincapie
- Cardiac Rhythm Management, Boston Scientific Corporation, St Paul, Minnesota
| | - Stephen B Ruble
- Cardiac Rhythm Management, Boston Scientific Corporation, St Paul, Minnesota
| | - Jason J Hamann
- Cardiac Rhythm Management, Boston Scientific Corporation, St Paul, Minnesota
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina Department of Neurobiology, Duke University, Durham, North Carolina Department of Surgery, Duke University, Durham, North Carolina
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140
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de Jong MR, Adiyaman A, Gal P, Smit JJJ, Delnoy PPH, Heeg JE, van Hasselt BA, Lau EO, Persu A, Staessen JA, Ramdat Misier AR, Steinberg JS, Elvan A. Renal Nerve Stimulation–Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation. Hypertension 2016; 68:707-14. [DOI: 10.1161/hypertensionaha.116.07492] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/19/2016] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)–induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (
P
<0.001). Average systolic ABPM was 153±11 mm Hg before RDN and decreased to 137±10 mm Hg at 3- to 6-month follow-up (
P
=0.003). Changes in RNS-induced BP increase before versus immediately after RDN and changes in ABPM before versus 3 to 6 months after RDN were correlated, both for systolic BP (
R
=0.77,
P
=0.001) and diastolic BP (
R
=0.79,
P
=0.001). RNS-induced maximum BP increase before RDN had a correlation of
R
=0.61 (
P
=0.020) for systolic and
R
=0.71 (
P
=0.004) for diastolic ABPM changes. RNS-induced BP changes before versus after RDN were correlated with changes in 24-hour ABPM 3 to 6 months after RDN. RNS should be tested as an acute end point to assess the efficacy of RDN and predict BP response to RDN.
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Affiliation(s)
- Mark R. de Jong
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Ahmet Adiyaman
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Pim Gal
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jaap Jan J. Smit
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Peter Paul H.M. Delnoy
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan-Evert Heeg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Boudewijn A.A.M. van Hasselt
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Elizabeth O.Y. Lau
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Alexandre Persu
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jan A. Staessen
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Anand R. Ramdat Misier
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Jonathan S. Steinberg
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
| | - Arif Elvan
- From the Departments of Cardiology, Internal Medicine, and Radiology, Isala Hospital, Zwolle, The Netherlands (M.R.d.J., A.A., P.G., J.J.J.S., P.P.H.M.D., J.-E.H., B.A.A.M.v.H., A.R.R.M., A.E.); Center for Innovation and Strategic Collaboration, St Jude Medical, Inc, Irvine, CA (E.O.Y.L.); Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université
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Kalla M, Herring N, Paterson DJ. Cardiac sympatho-vagal balance and ventricular arrhythmia. Auton Neurosci 2016; 199:29-37. [PMID: 27590099 PMCID: PMC5334443 DOI: 10.1016/j.autneu.2016.08.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 12/11/2022]
Abstract
A hallmark of cardiovascular disease is cardiac autonomic dysregulation. The phenotype of impaired parasympathetic responsiveness and sympathetic hyperactivity in experimental animal models is also well documented in large scale human studies in the setting of heart failure and myocardial infarction, and is predictive of morbidity and mortality. Despite advances in emergency revascularisation strategies for myocardial infarction, device therapy for heart failure and secondary prevention pharmacotherapies, mortality from malignant ventricular arrhythmia remains high. Patients at highest risk or those with haemodynamically significant ventricular arrhythmia can be treated with catheter ablation and implantable cardioverter defibrillators, but the morbidity and reduction in quality of life due to the burden of ventricular arrhythmia and shock therapy persists. Therefore, future therapies must aim to target the underlying pathophysiology that contributes to the generation of ventricular arrhythmia. This review explores recent advances in mechanistic research in both limbs of the autonomic nervous system and potential avenues for translation into clinical therapy. In addition, we also discuss the relationship of these findings in the context of the reported efficacy of current neuromodulatory strategies in the management of ventricular arrhythmia. We review advances in mechanistic research in the cardiac autonomic nervous system. This is discussed in relation to neuromodulatory therapy for ventricular arrhythmia. Neuromodulation therapies can influence both neurotransmitters and co-transmitters. This may therefore improve on conventional medical treatment.
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Affiliation(s)
| | - Neil Herring
- Corresponding author at: Burdon Sanderson Cardiac Science Centre, Dept. of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, OX13PT, UK.Burdon Sanderson Cardiac Science CentreDept. of Physiology, Anatomy and GeneticsUniversity of OxfordParks RoadOX13PTUK
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142
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Ng GA. Neuro-cardiac interaction in malignant ventricular arrhythmia and sudden cardiac death. Auton Neurosci 2016; 199:66-79. [DOI: 10.1016/j.autneu.2016.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 12/30/2022]
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143
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Molecular Mechanisms Linking Autonomic Dysfunction and Impaired Cardiac Contractility in Critical Illness. Crit Care Med 2016; 44:e614-24. [PMID: 26950003 PMCID: PMC4950969 DOI: 10.1097/ccm.0000000000001606] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Molecular mechanisms linking autonomic dysfunction with poorer clinical outcomes in critical illness remain unclear. We hypothesized that baroreflex dysfunction alone is sufficient to cause cardiac impairment through neurohormonal activation of (nicotinamide adenine dinucleotide phosphate oxidase dependent) oxidative stress resulting in increased expression of G-protein-coupled receptor kinase 2, a key negative regulator of cardiac function. DESIGN Laboratory/clinical investigations. SETTING University laboratory/medical centers. SUBJECTS Adult rats; wild-type/nicotinamide adenine dinucleotide phosphate oxidase subunit-2-deficient mice; elective surgical patients. INTERVENTIONS Cardiac performance was assessed by transthoracic echocardiography following experimental baroreflex dysfunction (sino-aortic denervation) in rats and mice. Immunoblots assessed G-protein-coupled receptor recycling proteins expression in rodent cardiomyocytes and patient mononuclear leukocytes. In surgical patients, heart rate recovery after cardiopulmonary exercise testing, time/frequency measures of parasympathetic variables were related to the presence/absence of baroreflex dysfunction (defined by spontaneous baroreflex sensitivity of <6 ms mm Hg). The associations of baroreflex dysfunction with intraoperative cardiac function and outcomes were assessed. MEASUREMENTS AND MAIN RESULTS Experimental baroreflex dysfunction in rats and mice resulted in impaired cardiac contractility and upregulation of G-protein-coupled receptor kinase 2 expression. In mice, genetic deficiency of gp91 nicotinamide adenine dinucleotide phosphate oxidase subunit-2 prevented upregulation of G-protein-coupled receptor kinase 2 expression in conditions of baroreflex dysfunction and preserved cardiac function. Baroreflex dysfunction was present in 81 of 249 patients (32.5%) and was characterized by lower parasympathetic tone and increased G-protein-coupled receptor kinase 2 expression in mononuclear leukocytes. Baroreflex dysfunction in patients was also associated with impaired intraoperative cardiac contractility. Critical illness and mortality were more frequent in surgical patients with baroreflex dysfunction (relative risk, 1.66 [95% CI, 1.16-2.39]; p = 0.006). CONCLUSIONS Reduced baroreflex sensitivity is associated with nicotinamide adenine dinucleotide phosphate oxidase subunit-2-mediated upregulation of G-protein-coupled receptor kinase 2 expression in cardiomyocytes and impaired cardiac contractility. Autonomic dysfunction predisposes patients to the development of critical illness and increases mortality.
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144
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Optimal Titration Is Important to Maximize the Beneficial Effects of Vagal Nerve Stimulation in Chronic Heart Failure. J Card Fail 2016; 22:631-8. [DOI: 10.1016/j.cardfail.2016.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/22/2016] [Accepted: 04/28/2016] [Indexed: 11/22/2022]
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145
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Shivkumar K, Ajijola OA, Anand I, Armour JA, Chen PS, Esler M, De Ferrari GM, Fishbein MC, Goldberger JJ, Harper RM, Joyner MJ, Khalsa SS, Kumar R, Lane R, Mahajan A, Po S, Schwartz PJ, Somers VK, Valderrabano M, Vaseghi M, Zipes DP. Clinical neurocardiology defining the value of neuroscience-based cardiovascular therapeutics. J Physiol 2016; 594:3911-54. [PMID: 27114333 PMCID: PMC4945719 DOI: 10.1113/jp271870] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022] Open
Abstract
The autonomic nervous system regulates all aspects of normal cardiac function, and is recognized to play a critical role in the pathophysiology of many cardiovascular diseases. As such, the value of neuroscience-based cardiovascular therapeutics is increasingly evident. This White Paper reviews the current state of understanding of human cardiac neuroanatomy, neurophysiology, pathophysiology in specific disease conditions, autonomic testing, risk stratification, and neuromodulatory strategies to mitigate the progression of cardiovascular diseases.
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Affiliation(s)
- Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Inder Anand
- Department of Cardiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Andrew Armour
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey J Goldberger
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ronald M Harper
- Department of Neurobiology and the Brain Research Institute, University of California, Los Angeles, CA, USA
| | - Michael J Joyner
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | | | - Rajesh Kumar
- Departments of Anesthesiology and Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Richard Lane
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Aman Mahajan
- Department of Anesthesia, UCLA, Los Angeles, CA, USA
| | - Sunny Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- University of Tulsa Oxley College of Health Sciences, Tulsa, OK, USA
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Instituto Auxologico Italiano, c/o Centro Diagnostico e di Ricerrca San Carlo, Milan, Italy
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Miguel Valderrabano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, Houston Methodist Hospital, Houston, TX, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA
| | - Douglas P Zipes
- Indiana University School of Medicine, Indianapolis, IN, USA
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146
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Jandackova VK, Britton A, Malik M, Steptoe A. Heart rate variability and depressive symptoms: a cross-lagged analysis over a 10-year period in the Whitehall II study. Psychol Med 2016; 46:2121-31. [PMID: 27181276 DOI: 10.1017/s003329171600060x] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with depression tend to have lower heart rate variability (HRV), but the temporal sequence is poorly understood. In a sample of the general population, we prospectively examined whether HRV measures predict subsequent depressive symptoms or whether depressive symptoms predict subsequent levels of HRV. METHOD Data from the fifth (1997-1999) and ninth (2007-2009) phases of the UK Whitehall II longitudinal population-based cohort study were analysed with an average follow-up of 10.5 years. The sample size for the prospective analysis depended on the analysis and ranged from 2334 (644 women) to 2276 (602 women). HRV measures during 5 min of supine rest were obtained. Depressive symptoms were evaluated by four cognitive symptoms of depression from the General Health Questionnaire. RESULTS At follow-up assessment, depressive symptoms were inversely associated with HRV measures independently of antidepressant medication use in men but not in women. Prospectively, lower baseline heart rate and higher HRV measures were associated with a lower likelihood of incident depressive symptoms at follow-up in men without depressive symptoms at baseline. Similar but statistically insignificant associations were found in women. Adjustments for known confounders including sociodemographic and lifestyle factors, cardiometabolic conditions or medication did not change the predictive effect of HRV on incident depressive symptoms at follow-up. Depressive symptoms at baseline were not associated with heart rate or HRV at follow-up in either sex. CONCLUSIONS These findings are consistent with an aetiological role of the autonomic nervous system in depression onset.
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Affiliation(s)
- V K Jandackova
- Department of Epidemiology and Public Health,University of Ostrava,Ostrava,Czech Republic
| | - A Britton
- Research Department of Epidemiology and Public Health,University College London,London,UK
| | - M Malik
- National Heart and Lung Institute, Imperial College,London,UK
| | - A Steptoe
- Research Department of Epidemiology and Public Health,University College London,London,UK
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147
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Gold MR, Van Veldhuisen DJ, Hauptman PJ, Borggrefe M, Kubo SH, Lieberman RA, Milasinovic G, Berman BJ, Djordjevic S, Neelagaru S, Schwartz PJ, Starling RC, Mann DL. Vagus Nerve Stimulation for the Treatment of Heart Failure. J Am Coll Cardiol 2016; 68:149-58. [DOI: 10.1016/j.jacc.2016.03.525] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 11/28/2022]
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148
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Guiraud D, Andreu D, Bonnet S, Carrault G, Couderc P, Hagège A, Henry C, Hernandez A, Karam N, Le Rolle V, Mabo P, Maciejasz P, Malbert CH, Marijon E, Maubert S, Picq C, Rossel O, Bonnet JL. Vagus nerve stimulation: state of the art of stimulation and recording strategies to address autonomic function neuromodulation. J Neural Eng 2016; 13:041002. [PMID: 27351347 DOI: 10.1088/1741-2560/13/4/041002] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Neural signals along the vagus nerve (VN) drive many somatic and autonomic functions. The clinical interest of VN stimulation (VNS) is thus potentially huge and has already been demonstrated in epilepsy. However, side effects are often elicited, in addition to the targeted neuromodulation. APPROACH This review examines the state of the art of VNS applied to two emerging modulations of autonomic function: heart failure and obesity, especially morbid obesity. MAIN RESULTS We report that VNS may benefit from improved stimulation delivery using very advanced technologies. However, most of the results from fundamental animal studies still need to be demonstrated in humans.
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Affiliation(s)
- David Guiraud
- Inria, DEMAR, Montpellier, France. University of Montpellier, DEMAR, Montpellier, France
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149
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Murray AR, Atkinson L, Mahadi MK, Deuchars SA, Deuchars J. The strange case of the ear and the heart: The auricular vagus nerve and its influence on cardiac control. Auton Neurosci 2016; 199:48-53. [PMID: 27388046 DOI: 10.1016/j.autneu.2016.06.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/20/2016] [Indexed: 02/07/2023]
Abstract
The human ear seems an unlikely candidate for therapies aimed at improving cardiac function, but the ear and the heart share a common connection: the vagus nerve. In recent years there has been increasing interest in the auricular branch of the vagus nerve (ABVN), a unique cutaneous subdivision of the vagus distributed to the external ear. Non-invasive electrical stimulation of this nerve through the skin may offer a simple, cost-effective alternative to the established method of vagus nerve stimulation (VNS), which requires a surgical procedure and has generated mixed results in a number of clinical trials for heart failure. This review discusses the available evidence in support of modulating cardiac activity using this strange auricular nerve.
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Affiliation(s)
- Aaron R Murray
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Lucy Atkinson
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Mohd K Mahadi
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom; Faculty of Pharmacy, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Susan A Deuchars
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Jim Deuchars
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom.
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150
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Ardell JL, Andresen MC, Armour JA, Billman GE, Chen PS, Foreman RD, Herring N, O'Leary DS, Sabbah HN, Schultz HD, Sunagawa K, Zucker IH. Translational neurocardiology: preclinical models and cardioneural integrative aspects. J Physiol 2016; 594:3877-909. [PMID: 27098459 DOI: 10.1113/jp271869] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/14/2016] [Indexed: 12/15/2022] Open
Abstract
Neuronal elements distributed throughout the cardiac nervous system, from the level of the insular cortex to the intrinsic cardiac nervous system, are in constant communication with one another to ensure that cardiac output matches the dynamic process of regional blood flow demand. Neural elements in their various 'levels' become differentially recruited in the transduction of sensory inputs arising from the heart, major vessels, other visceral organs and somatic structures to optimize neuronal coordination of regional cardiac function. This White Paper will review the relevant aspects of the structural and functional organization for autonomic control of the heart in normal conditions, how these systems remodel/adapt during cardiac disease, and finally how such knowledge can be leveraged in the evolving realm of autonomic regulation therapy for cardiac therapeutics.
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Affiliation(s)
- J L Ardell
- University of California - Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, CA, USA.,UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA, USA
| | - M C Andresen
- Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, OR, USA
| | - J A Armour
- University of California - Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, CA, USA.,UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA, USA
| | - G E Billman
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH, USA
| | - P-S Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R D Foreman
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - N Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - D S O'Leary
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - H N Sabbah
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - H D Schultz
- Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - K Sunagawa
- Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - I H Zucker
- Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
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