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Tonko JB, Lambiase PD. The proarrhythmogenic role of autonomics and emerging neuromodulation approaches to prevent sudden death in cardiac ion channelopathies. Cardiovasc Res 2024; 120:114-131. [PMID: 38195920 PMCID: PMC10936753 DOI: 10.1093/cvr/cvae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 01/11/2024] Open
Abstract
Ventricular arrhythmias in cardiac channelopathies are linked to autonomic triggers, which are sub-optimally targeted in current management strategies. Improved molecular understanding of cardiac channelopathies and cellular autonomic signalling could refine autonomic therapies to target the specific signalling pathways relevant to the specific aetiologies as well as the central nervous system centres involved in the cardiac autonomic regulation. This review summarizes key anatomical and physiological aspects of the cardiac autonomic nervous system and its impact on ventricular arrhythmias in primary inherited arrhythmia syndromes. Proarrhythmogenic autonomic effects and potential therapeutic targets in defined conditions including the Brugada syndrome, early repolarization syndrome, long QT syndrome, and catecholaminergic polymorphic ventricular tachycardia will be examined. Pharmacological and interventional neuromodulation options for these cardiac channelopathies are discussed. Promising new targets for cardiac neuromodulation include inhibitory and excitatory G-protein coupled receptors, neuropeptides, chemorepellents/attractants as well as the vagal and sympathetic nuclei in the central nervous system. Novel therapeutic strategies utilizing invasive and non-invasive deep brain/brain stem stimulation as well as the rapidly growing field of chemo-, opto-, or sonogenetics allowing cell-specific targeting to reduce ventricular arrhythmias are presented.
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Affiliation(s)
- Johanna B Tonko
- Institute of Cardiovascular Science, University College London, 5 University Street, London WC1E 6JF, London, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, 5 University Street, London WC1E 6JF, London, UK
- Department for Cardiology, Bart’s Heart Centre, West Smithfield EC1A 7BE, London, UK
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Lee K, Lee JM, Phan TT, Lee CJ, Park JM, Park J. Ultrasonocoverslip: In-vitro platform for high-throughput assay of cell type-specific neuromodulation with ultra-low-intensity ultrasound stimulation. Brain Stimul 2023; 16:1533-1548. [PMID: 37909109 DOI: 10.1016/j.brs.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 11/02/2023] Open
Abstract
Brain stimulation with ultra-low-intensity ultrasound has rarely been investigated due to the lack of a reliable device to measure small neuronal signal changes made by the ultra-low intensity range. We propose Ultrasonocoverslip, an ultrasound-transducer-integrated-glass-coverslip that determines the minimum intensity for brain cell activation. Brain cells can be cultured directly on Ultrasonocoverslip to simultaneously deliver uniform ultrasonic pressure to hundreds of cells with real-time monitoring of cellular responses using fluorescence microscopy and single-cell electrophysiology. The sensitivity for detecting small responses to ultra-low-intensity ultrasound can be improved by averaging simultaneously obtained responses. Acoustic absorbers can be placed under Ultrasonocoverslip, and stimuli distortions are substantially reduced to precisely deliver user-intended acoustic stimulations. With the proposed device, we discover the lowest acoustic threshold to induce reliable neuronal excitation releasing glutamate. Furthermore, mechanistic studies on the device show that the ultra-low-intensity ultrasound stimulation induces cell type-specific neuromodulation by activating astrocyte-mediated neuronal excitation without direct neuronal involvement. The performance of ultra-low-intensity stimulation is validated by in vivo experiments demonstrating improved safety and specificity in motor modulation of tail movement compared to that with supra-watt-intensity.
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Affiliation(s)
- Keunhyung Lee
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jung Moo Lee
- Center for Cognition and Sociality, Institute for Basic Science, Daejeon, Republic of Korea
| | - Tien Thuy Phan
- IBS School, University of Science and Technology (UST), Daejeon, Republic of Korea
| | - C Justin Lee
- Center for Cognition and Sociality, Institute for Basic Science, Daejeon, Republic of Korea
| | - Joo Min Park
- Center for Cognition and Sociality, Institute for Basic Science, Daejeon, Republic of Korea; IBS School, University of Science and Technology (UST), Daejeon, Republic of Korea.
| | - Jinhyoung Park
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea; Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea.
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Liu T, Choi MH, Zhu J, Zhu T, Yang J, Li N, Chen Z, Xian Q, Hou X, He D, Guo J, Fei C, Sun L, Qiu Z. Sonogenetics: Recent advances and future directions. Brain Stimul 2022; 15:1308-1317. [PMID: 36130679 DOI: 10.1016/j.brs.2022.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/15/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Sonogenetics refers to the use of genetically encoded, ultrasound-responsive mediators for noninvasive and selective control of neural activity. It is a promising tool for studying neural circuits. However, due to its infancy, basic studies and developments are still underway, including gauging key in vivo performance metrics such as spatiotemporal resolution, selectivity, specificity, and safety. In this paper, we summarize recent findings on sonogenetics to highlight technical hurdles that have been cleared, challenges that remain, and future directions for optimization.
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Affiliation(s)
- Tianyi Liu
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China
| | - Mi Hyun Choi
- Department of Bioengineering, Stanford University, CA, USA
| | - Jiejun Zhu
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China
| | - Tingting Zhu
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China
| | - Jin Yang
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China
| | - Na Li
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China; School of Microelectronics, Xidian University, Xi'an, China
| | - Zihao Chen
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China; School of Microelectronics, Xidian University, Xi'an, China
| | - Quanxiang Xian
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Xuandi Hou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Dongmin He
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China
| | - Jinghui Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China; Department of Physiology, Faculty of Medicine, Jinan University, Guangzhou, China
| | - Chunlong Fei
- School of Microelectronics, Xidian University, Xi'an, China
| | - Lei Sun
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
| | - Zhihai Qiu
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, 519031, China.
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